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Now that I administer a program in a State agency and my counterparts across the entire country—hello, Mr. Dickey. It is such a pleasure to see you, sir.
Mr. DICKEY. Hello. How are you doing?
Mr. SIMPSON. I am good. I am good.
I am just frustrated, to tell you the truth. I am tired of turning people away with disabilities saying we can't serve you because we don't have enough money to assist you to get the basic services you need to enter the world of work. I am tired of telling folks with disabilities who know they have a disability, they have a need for rehabilitation services in order to go to work, I am tired of telling them, I am sorry, but your disability is just not severe enough because our Federal laws and Federal regulations say if we don't have enough money, we can only serve those with the most severe disabilities.
Our folks in Arkansas, they don't care whether they are classified as severely disabled or non-severely disabled. If they have a disability, they want some assistance from us in order to enter the world of work. And in order for us to be effective in our program and to deliver the kinds of services that people with disabilities need, it is essential that we receive an increase above the basic cost-of-living increase that we find in the administration's proposal.
So, therefore, Mr. Chairman and members of the committee, I don't really want to take a lot of your time, but I really want to re-emphasize the fact that with the public vocational rehabilitation system having been around for some seven decades and transformed itself, streamlined our systems over the years, we feel that we have really positioned ourselves to work very effectively with people with disabilities, with business and industry, with the increasing number of people who will be coming to us from the welfare-to-work initiatives. We are well positioned to work effectively and put people with disabilities to work if we have the resources to do so.
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I am very pleased with the program we operate in Arkansas and with the State-Federal partnership that we have consisting of individualized, systematic services, leading to employment opportunities. We have even been able to show the welfare-to-work folks how we do it in rehabilitation in terms of a systematic plan that results in a positive employment outcome.
So, Mr. Chairman, again, I urge the committee to seriously consider appropriating $3,000,000,000 for the public vocational rehabilitation program, Title I, in order that we can go on down the road of providing the kinds of services that enable people, like those you saw in this room today, to prepare for and enter the world of work and become productive, independent, taxpaying citizens.
I greatly appreciate the opportunity to appear before this body again and to see our champion and hero in Arkansas, Congressman Jay Dickey.
Mr. DICKEY. Did you hear that, Mr. Chairman?
Mr. PORTER. The Chair yields to Mr. Dickey, the hero. [Laughter.]
Mr. DICKEY. I apologize for being late. I wanted to introduce Bobby, but I think the best introduction was just hearing him talk. I think one of the gifts that Bobby has, Mr. Chairman, is that he is an advocate and that he fights for people who he sees want to improve. And in Arkansas, his office, his place of business, is right across the street from our office, and we know for sure that Bobby is exhorting people, that he is not letting this become just a distribution of money, but it is a distribution of opportunity. Bobby Simpson is one of the heroes, and I want to put my—whatever—little influence I have behind this man's testimony. Bobby, I want to tell you, I want to thank you, and I want to show you my thanks by trying to do what you have asked to get done in this committee.
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I wish I had more influence, particularly with that man right there, you see. If I had more influence with him, I could do more.
Mr. PORTER. Don't every believe that Jay Dickey doesn't have a lot of influence.
Mr. SIMPSON. Yes, sir. I know he is the master of understatement sometimes.
Mr. DICKEY. Thank you, Mr. Chairman.
Mr. PORTER. Mr. Simpson, let me first apologize for not stating correctly that it was Rehabaction Network. My notes say that, but it is run together, and I thought it was a misprint when I first looked at it and I read it as ''rehabilitation.'' It is Rehabaction, and I apologize.
Mr. SIMPSON. No problem.
Mr. PORTER. Secondly, because you are asking for substantially more money than the President's budget has suggested, you get Sermonette No. 1.
Mr. SIMPSON. Yes, sir.
Mr. PORTER. And that sermonette goes something like this: We can only do as well as the resources that we have to work with. And there are two parts to this process. One is here at the appropriations level, where we look at priorities and try to sort them out in a fair and equitable way. And the other is at the Budget Committee where they give us the allocation of funds that we have to work with. So we urge all—and this is not just for you this is for everybody in the room. We urge all of you to not only participate in our hearings and impact our process, but to also participate in the budget process, because what they give us to work with determines largely what we can accomplish.
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Mr. SIMPSON. Absolutely, Mr. Chairman. We will certainly do that. I appreciate your time.
Mr. PORTER. Thank you.
[The prepared statement of Bobby Simpson follows:]
[CLERK'S NOTE.—Information required pursuant to clause 2(g)(4) of Rule XI of the Rules of the House of Representatives was not received from this witness or from an entity represented by this witness.]
"The Official Committee record contains additional material here."
Thursday, February 5, 1998.
WITNESS
JACK LAVERY, LUPUS FOUNDATION OF AMERICA
Mr. PORTER. Jack Lavery, Chairman, Lupus Foundation of America, testifying in behalf of the foundation, and we are pleased to welcome our colleague, one of our favorite people in Congress, Congresswoman Carrie Meek, to introduce him. Carrie, it is nice to see you.
Mrs. MEEK. Thank you very much, Mr. Chairman. It is always good to come before you and the committee today as last year, I am here to introduce a man I think is a very profound person, Mr. Chairman, one who has displayed over the years the sensitivity to this disease which doctors have not been able to find the cause nor the cure, and that is lupus.
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Mr. DICKEY. Excuse me. I am Jay Dickey from Arkansas.
Mrs. MEEK. Hello, Jay. I just saw you this morning.
Mr. DICKEY. I am on this committee, and you have my vote. You understand that?
Mrs. MEEK. Good, good. Thank you.
Mr. Lavery, Mr. Chairman, brings a new dimension to testimony before committees. He has had a background in the business world and the corporate arena, and he has served as volunteer in the movement to help us receive adequate funds for lupus.
I just want to say that to introduce Jack Lavery is to introduce a man who has worked so hard with lupus throughout this country, and he does his full-time job. He is a senior vice president of Merrill Lynch & Company, and he represents the Lupus Foundation.
I won't take a long time, Mr. Chairman, because you know I always ask for money, you always give us a little tad, but we are happy for that. Whatever you give we are happy for it. I want now Mr. Lavery to come up, and you will agree with me that he is a very, very outstanding person.
Thank you.
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Mr. PORTER. Thank you, Congresswoman.
Mr. Lavery?
Mr. LAVERY. Thank you very much, Congresswoman Meek, for that nice introduction.
Good morning, Mr. Chairman, members of the committee. In introducing myself, I am Jack Lavery, and my principal role in life is as senior vice president of Merrill Lynch & Company. But I am here today in my volunteer capacity as chairman of the board of the Lupus Foundation of America, therefore representing the between 1.4 and 2 million Americans that our own marketing research study done by the Lupus Foundation of America believes to be the actual incidence of lupus in this country. One of those 1.4 to 2 million Americans is my own daughter.
The Lupus Foundation of America is a national advocacy organization. It is pursuing finding the cause and the cure of lupus. It is also involved in providing patient services and a great deal of educational information with regard to lupus.
Lupus, in a nutshell, is an autoimmune disease. The body, in effect, turns on itself, attacking many organs in the body, and quite randomly.
The challenge is, because the cause and the cure aren't known, the side effects of dealing with this disease, the side effects of the current treatments, can be every bit as devastating as the disease itself. The principal medication to deal with the symptoms relate to steroids, but protracted use of steroids causes osteonecrosis, or bone death. And when lupus is active in the kidney, the principal medication that current research makes available is cytoxan, a highly toxic chemotherapy drug, the side effects of which are high risks of sterility, bladder cancer, and lymphoma later in life.
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Lupus is a woman's disease, by and large. It doesn't mean a lot of men haven't been affected by it. Terrell Davis, the star of the Super Bowl, his father passed away from lupus recently. Julius Irving, the star basketball player, lost a brother to lupus. So it is not uniquely women, but 90 percent of the people who have lupus are women.
The relative incidence of lupus is much greater among minority women. Specifically, Hispanic Americans, Asian Americans, and African Americans are more likely to have lupus than are Caucasian females.
I want to thank this committee, particularly you, Mr. Chairman, and all the committee for your leadership in ensuring the continuation of immune system research at the National Institutes of Health and NIAMS, the National Institute of Arthritis, Musculoskeletal and Skin Diseases.
I urge your support, very important support, to fund NIAMS at the $315,900,000 level recommended by the Ad Hoc Group for Medical Research Funding and supported by the NIAMS Coalition.
NIAMS has already started moving on creating scores, SCORs, Specialized Centers of Research, with regard to lupus, and NIAMS is also supporting the creation of a lupus registry of patient information throughout the country.
In November of 1997, we had a flagship conference here in Washington, D.C., supported by the National Institutes of Health. This conference was also cosponsored by the Lupus Foundation of America and by the SLE Foundation, standing for systemic lupus erythematosus, the technical name of the disease, the largest single chapter of the Lupus Foundation of America. And that research forum was a landmark scientific event because it brought together private and public sector folks, research people. Collaboration, we believe, is the key to finding the cause and the cure of lupus.
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That research forum in November of 1997 will result shortly in output in the form of a definitive white paper, the blueprint for the cure, because, Mr. Chairman, I must say, that lupus is the prototypical autoimmune disease. If we are able to unlock the keys to find the cause and the cure of lupus, the beneficial consequence will not uniquely be to lupus patients alone, but also to folks with myasthenia gravis, Crohn's disease, multiple sclerosis, grave's disease, or any other autoimmune disease that I have neglected to mention.
My own daughter got it at age 13. It wasn't correctly diagnosed until she was 19. Typically, it is incorrectly diagnosed as juvenile rheumatoid arthritis in the early stages. She has had the osteonecrosis consequences. She has had core decompressions, drilling of her left hip, right hip, left knee, right knee, and left elbow, to try to create renewed blood vessel growth. It failed in the hips. She has since had bilateral hip replacement. She is only one example.
But I am inspired by her courageous fight. She has an optic neuritis, a lupus flare in the central nervous system that caused her permanent blindness in one of her eyes. But she is still going forward, teaching high school English. She is battling this disease, but we need a great deal of help with regard to research. It is absolutely critically important. We have started the ball rolling with this tremendous scientific conference that the NIH, SLE, and LFA all combined upon in November here in this city, and, again, I want to thank the committee for its time and attention this morning.
[The prepared statement of Jack Lavery follows:]
"The Official Committee record contains additional material here."
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Mr. PORTER. Mr. Lavery, thank you for not only your testimony this morning, but for your tremendous commitment to seeing this research through to improve the lives of all people afflicted with the autoimmune diseases. We very much appreciate it. We are going to take your words to heart and do the very best we possibly can to put biomedical research and research on lupus in a high priority.
Mr. LAVERY. Thank you very much, Mr. Chairman.
Mr. PORTER. Thank you for coming here to testify.
The House has two votes on. We will be forced to take a brief recess until we can cast those votes and then resume our schedule. The subcommittee stands in recess.
[Recess.]
—————
Thursday, February 5, 1998.
WITNESS
JOHN D. AQUILINO, JR., PRIVATE CITIZEN
Mr. PORTER. The subcommittee will come to order.
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Our next witness is John D. Aquilino, a private citizen, testifying in his own behalf.
Mr. Aquilino.
Mr. AQUILINO. On behalf of my son, Johnny, his brother Tommy, and my family and myself, I would like to thank the chairman for allowing me to testify today before you.
My son, who is having a constant struggle with phonics, couldn't be here today. I didn't want to take him away from school. I didn't want him to miss any more.
I am here primarily to dispel the myth that heart disease is a condition confined to people my age and older. It is not. Heart disease is America's number one killer of all of our people. It is the cause of America's most common birth defects. I am here also to plead for increased funding for the National Heart, Lung, and Blood Institute and, in specific, its heart program.
Congenital heart defects are the major cause of birth defect-related infant deaths. They strike 32,000 newborns each year, and they kill more than 2,300 babies before their first birthday. Nearly one million children, like my son, bear the consequences of those defects.
My son is almost 8. He plays tee-ball for St. Jerome's School in Hyattsville, Maryland. He is the oldest surviving patient at Washington, D.C., Children's Hospital, and perhaps the east coast, with hypoplastic left heart syndrome, which basically means his left heart's major pumping chamber, the ventricle, is missing.
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At age 2 days, Johnny spent 6 frantic hours in Children's Hospital's emergency room before his condition was diagnosed. His heart and lungs stopped twice, and twice they brought him back. One week later, he underwent the first of three open-heart surgeries he received before he was 4. To the degree he can, Johnny has also given of himself for biomedical research. He participated in a program to develop treatment—I am sorry, but all my life, when I talk about it, I have the same reaction—for RSV, a condition that debilitates young heart and lung patients.
A few years before Johnny's birth, one of my dearest friends, B.J. Pino of Home, Pennsylvania, lost his first son to hypoplastic left heart. Barely 3 years before Johnny's birth, little or nothing could be done for infants with this condition. Thanks to the research funded in great part by this subcommittee, and the efforts of a great number of men and women, my son is alive and able to suffer the rigors of second grade.
I am here because Federal funding for the Heart, Lung, and Blood Institute decreased by 5.5 percent in constant dollars from 1986 to 1996. I concur with the American Heart Association's recommended funding of the institute at $1,825,000,000. I also join the American Heart Association and Research!America in asking that NIH funding be doubled in 5 years.
The main reason I am here is the fact that I love my son. Animal-based biomedical research gave me my son. Over the next 5 or so years, if you and the Congress allow it, the ethical use of organ cloning research, if you allow it to continue, he may have a new heart made from his own DNA.
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When my son's condition was diagnosed, he lay connected to a tangle of tubes and monitors, looking as sad as any human can be. The doctors asked if we wanted him to live. That was the single hardest question anyone could ask a new parent. It was not hard to answer. From the bottom of my heart then and from the bottom of my heart now, I answer yes. Yes, I want my son to live.
Yes, I want the children of fathers and mothers from Hyattsville to Harare, Zimbabwe, and all points in between to live.
From my heart and from the love I have for my son, I want to thank you for your help in allowing men and women of science to be able to do the research that gives the gift of life to children like my son. I only ask that you please make this America's first priority.
[The following statement of John Aquilino Jr., follows]
"The Official Committee record contains additional material here."
Mr. PORTER. Mr. Aquilino, we are doing everything we can to make it the first priority. I think it is the first priority. I think if people in the Congress could have the chance to listen to people like you, they would understand much more how much these problems touch American families, and they would push it to a higher priority. So your advocacy here is very important. I wish the whole subcommittee were here to hear you.
Obviously we need the resources in the jurisdiction of the subcommittee to make the kinds of increases that we want to make. And I am going to say this to this panel, too. This is not just to you, but to all who are concerned about this. I think it is going to be very difficult this year, because the budget isn't yet in balance, to get the kinds of increases that will start us on a 5-year path to doubling the budget for NIH. Yet, I think the prospects in a very good economy are that we can start on it next year when the budget is in balance, if we have the kind of support from the American people that I think we need to have. In other words, we need to have this process impacted, not just our subcommittee, where we do put it at a high priority, but the whole Congress and particularly the budget process, which gives us the money that we have to work with.
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So I think it depends on how much we can get into the minds of the American people that this is something that we can do if we want to do it, and that we ought to do it. In other words, every Member of Congress has to have it in their mind that their constituents want them to do this. If we got them there, the job would be done.
So I say often that we don't make policy here in Washington, we merely ratify what the policies of the American people are. And to the extent that they can communicate those ideas to Congress, Congress is going to respond. So your advocacy is terribly important on this, yours and so many others, and to the extent that you can impact as broad a population as possible, that is what is going to make the difference, as it always does.
Thank you for being here to testify. We are going to do the best for your son, John, and all other kids that are suffering the same way and do everything we can to provide the resources to NIH that they need to address these kinds of problems.
Mr. Aquilino. Thank you, and I will do what I can from my point.
Mr. PORTER. I know. You are doing it.
Mr. AQUILINO. Thank you.
Thursday, February 5, 1998.
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WITNESS
DONALD S. COFFEY, PH.D., NATIONAL COALITION FOR CANCER RESEARCH
Mr. PORTER. Donald S. Coffey, Ph.D., member, Board of Directors, the National Coalition for Cancer Research.
Dr. Coffey?
Dr. COFFEY. Chairman Porter, I am going to discard my speech—it is in the record—and just tell you that you are a champion of trying to make health funds available, and we salute you. And we recognize the problems you face in today seeing the people that suffer. You see this every year, and this is my first time. But I see it from the cancer standpoint, and it is the same thing we see here.
What I would like to share with you is I represent the National Cancer Coalition for Research, and this is 22 organizations. It is not-for-profit, and it represents about 55,000 physicians, nurses, and many thousand patients, 40,000 children, 82 cancer centers and hospitals, and so it is a large coalition for cancer research. I am president of the American Association of Cancer Research, which is a separate group of researchers. But I am here today with the president, Carolyn Alders, sitting here, the president of this organization.
Let me just start by first telling you that what we are trying to do is reach out to the House and Senate Budget and Appropriations Committees, because we recognize only the pot of money they give you to work with. So we are working hard at that level, and we are encouraged by what we see.
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But from my heart, let me tell you what I really see. I was a young engineer with Westinghouse on October 27, 1957, and we had nothing going in space, and I saw the Russians fire up that satellite. And the money poured in, and I just could not tell you. We went from worrying about whether we were going to hit Russian residential areas when we landed on the moon to having a car up there in no time flat. Of course, as you know, our space efforts are about six times what cancer research is, and we know that the funds have to be somehow from the American people through Congress redistributed here.
Now, we are not against space. We are not against military. We are not against any other diseases. So what we are pushing for is a doubling of the NIH funds overall. We don't want to be in a war against all the people suffering in the United States, and we push the budget as seen there.
The great moment in my life occurred when I stood at the Children's Hospital in Baltimore and watched five dump trucks haul 75 iron lungs to the trash dump that will never be used for polio, after having seen some of my classmates in iron lungs in Bristol, Tennessee, when I was a kid. I know research can do this, and we have cured six cancers. People say, When are you going to cure cancer? We have cured testicular cancer, which was devastating. We get a lot of lymphomas and leukemias in children, and there has been tremendous increases. So we can do this.
The big ones that are tougher—lung, prostate, colon—these are the ones we are having trouble with. I cannot tell you what is out there. We have made more progress in cancer research than has been made in the computer. We have got to bring that now to where it impacts on the patient, the same way we did on those others. And it can happen.
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Now, what disturbs me is that every time we put in ten grants of these young people putting in grants and things, seven of those do not get funded; only three get funded. And you are aware of that. Actually, it is 23 percent. So we have never had a war on cancer. The entire act that we do as far as supporting this wouldn't buy two big Stealth bombers. They cost more than the whole cancer act. So we recognize it is time for America to declare war.
Now, President Nixon—it was a bold step forward—declared this war, but it didn't follow that the money followed that. So we went from funding it at 42 percent when he declared the war down to 18 percent over the next few—now we are up to 23.
We think that young people who have a lot of debts for their education, they look up and they only have a 23 percent chance of being funded, and they have wives and children. They are falling out by the droves. And with the medical care changes and managed care, it is devastating.
So what we would like to do is three things to call upon, please, sir, is to support the resolution, both in the Senate, and you have certainly been on that. That is like asking me to support eating with my obesity. You are a man who has really supported this. But I am asking you and your committee to support that resolution.
The second thing is the tobacco allotment. I cannot tell you the devastation that this has done to the American people, and you know that. But when you see it up close, it is beyond belief. The number of people dying in this country every day, every day from cancer, would fill five Boeing 747s crashing with everybody on board. Now, if the people knew that, that five Boeing—everybody has to die, but you don't want to die from cancer. Five of these go down. Two of these Boeing 747s are brought down because of smoking. We just cannot have this sort of thing going on. And now none of the money is going to go for research.
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We are asking for Congress and these allotments to figure out how to put some of this into cancer research and some of it into NIH research, and to have it go through the regular peer reviews where it will have high quality.
So we salute you, sir, and your committee, and we are working as hard as we can, and we hope that the big changes we see in the spirit towards medicine will carry over for all these people in this room.
Thank you, sir.
[The prepared statement of Donald Coffey follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Dr. Coffey, you have raised a lot of very important issues. You get Sermonettes 2 and 3 on these, I am afraid.
The first one is that if you look at NIH throughout its history, 50 years of history, the average rate of increase over that period of time in real terms—in other words, above inflation—is about 3 percent. So the Congress has made a continuous—and administrations have made a continuous commitment to increasing the funding for biomedical research, and even in the last 3 years in very tough budgetary times, it has been put ahead of almost everything else, and we are actually having an increase that is in excess of 3 percent, even in this time frame.
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The difficulty isn't that we are not giving it more money. The difficulty is that there is more good science to be funded. And, therefore, as you say, there are fewer chances to get it funded. There simply is so much there.
What that tells me is exactly what it tells you, that we have got to dramatically increase the funding because we are falling behind even though we have been supporting it very strongly. And that is why we need to double the research.
Sermonette No. 3 says, however, I worry—and this is a strategic, political question. I worry that if we don't increase funding for all research funded by Government that we will set one type of research against another. And I don't want that to happen.
Mr. COFFEY. Absolutely not.
Mr. PORTER. While I think that biomedical research, because it is a direct effect on the lives of human beings, is the highest priority, I believe that we also ought to make a commitment to increasing funding of basic research in all areas.
Mr. COFFEY. We agree with that.
Mr. PORTER. And that they should come together, because if they won't, they will fight one another, and that will make it much more difficult.
Your point about clinical research and what is happening to our academic medical centers in this new environment of health care delivery is a very good point and something we must worry about. This subcommittee can't do a lot about that, but it can do something. But I think it is a tremendously important point. This is where our resources, our intellectual resources lay, and they are under siege because of the changes to managed care that have been the hallmark of our delivery system over a long period of time.
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The tobacco tax, I sure agree with you, those are funds that, by anyone's logic, ought to go to research. We ought to raise the tax simply to get young people off of being hooked so that they won't be in the clutches of the industry. That lies ahead, and that may end up being a part of the research portfolio. No one quite knows at this point.
My own prediction is that nothing will happen on the tobacco settlement, but there is some talk—you have to consider this in the context—that a tobacco tax will be raised in order to use the funds to bring greater tax equity in other taxation programs, like the marriage penalty that is in our income tax system, and greater relief for families. If that is done, it will be revenue neutral and won't have any effect on the budget, but it will also make it much more difficult in the future to raise tobacco taxes for research purposes, because we will have pushed the tax up so high that you begin to get to the point of diminishing returns.
All the points you make are very salient points, things that we have to worry about. I thank you for coming to testify.
Mr. COFFEY. Just let me share one last thing, if I might, with your permission.
Mr. PORTER. Surely.
Mr. COFFEY. One of the things that has horrified us as scientists is discovering in the last 2 years that the lungs of former smokers are badly damaging to their DNA, that is, it is permanent and not correcting itself. And over half of cigarette smoking cancers are occurring in former smokers. We didn't realize that this is not coming back to normal like everybody thought. And they have to pay for this. Somebody has to——
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Mr. PORTER. Now you are getting personal, as a former smoker——
Mr. COFFEY. Yes, I smoked, too.
Mr. PORTER. How long——
Mr. COFFEY. Even 20 years out you have a 1.5- to four-fold increase, and it is not correcting these damages, and we have to understand——
Mr. PORTER. How about 30 years out? [Laughter.]
Mr. COFFEY. You are better off. Thank you, sir.
Mr. PORTER. Thank you. I appreciate it very much.
Thursday, February 5, 1998.
WITNESS
RALPH G. YOUNT, PH.D., FEDERATION OF AMERICAN SOCIETIES OF EXPERIMENTAL BIOLOGY
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Mr. PORTER. Dr. Ralph Yount, President, Federation of American Societies for Experimental Biology, testifying in behalf of the federation.
Dr. Yount?
Dr. YOUNT. Thank you, Mr. Chairman.
I am Ralph Yount, professor of biochemistry at Washington State University, and I am a basic scientist who works on the mechanism of muscle contraction. This year I am serving as president of the Federation of American Societies for Experimental Biology, which is commonly known as FASEB. This is the largest organization of life scientists in the United States and has over 52,000 members and does the basic research that we hope is going to underpin the diseases that we have been hearing about today, the cures for the diseases we hear about today.
Like our previous two speakers, I am here to encourage the doubling of the NIH budget for fiscal year 1999, realizing the difficulties you face in doing this—I am sorry, a 15 percent increase in the NIH budget in the next fiscal year, with the idea that we can double it in 5 years.
I think we are also very pleased with the budget request for NIH submitted by the President this week and his strong statement in favor of biomedical research that he gave in his State of the Union address, and we are hopeful that Congress can go even further, but we also recognize this is the first time since the war on cancer Dr. Coffey talked about that a President has aggressively supported funding for the NIH, I think due in large part to your leadership and this subcommittee.
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It appears that finally the President and the Appropriations Committees—both the House and the Senate, and both the Republicans and the Democrats—now agree for a large increase for NIH. We think this goal is fully justified and achievable, and we stand ready to work with you on achieving it.
I think the other thing is that NIH has fostered the development of biomedical research which is the envy of the world, and the scientific investigations they have supported have given rise to the biotechnology industry, fueled the activities of the pharmaceutical industry. They have altered the daily course of health care of every American. And they are even changing the nature of agriculture. So the list of discoveries is remarkable, and I just wanted to give you two examples of these.
One is that NIH-supported research led to the development of so-called DNA chips, which are defined fragments of DNA on computer chips, which promise to revolutionize the detection of gene-based diseases such as breast cancer.
A second example is that NIH researchers developed a crucial enzyme called telomerase, which plays a critical role in cancer and normal growth and likely in the fundamental process of human aging.
The tragedy of these examples is that many more breakthroughs are possible, and they remain elusive due to insufficient resources. As Dr. Coffey alluded to, this year NIH will fund about three of ten proposals approved by study sections, but when you look at young investigators, it is substantially less. It is slightly more than one in ten. I can tell you as a researcher, these are discouraging, and particularly for young faculty members starting out in research. These unfunded applications and the unfunded researchers we think are the best argument for increased support for NIH.
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We also have a view on how these new monies can be best utilized, and while we don't have—these are not etched in stone, we would like to use these as a starting point for your committee and for NIH to consider. They are in seven areas.
First, fund increased numbers of investigator-initiated research grants selected through the competitive review by scientific peers;
Second, adequately fund research projects by increasing the average size of grants;
Third, raise stipends for pre-doctoral and post-doctoral trainees to a living wage;
Four, modernize the research infrastructure, including facilities, instruments, and clinical research support mechanisms, the things that Dr. Coffey was talking about;
Five, support a wide variety of new scientific partnerships, including more extensive direct support by NIH for relevant studies in chemistry, physics, mathematics, and computational science—the idea that you were just discussing in terms of supporting other areas of science;
Six, develop and support mechanisms for more rapidly translating research findings from the laboratory to the patient;
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Finally, increase the average length of grants to create a more stable research environment.
These are our suggestions to you as you begin this difficult task of deciding how best to invest the increased resources for biomedical research that we all hope can be found. We have made other policy recommendations in the formal report which we hope you will review carefully.
In conclusion, as we have heard this morning, I believe this point in time is the best opportunity in a generation to expand our Nation's efforts to improve America's health using the tools of science. We recognize the challenge this represents, and we pledge to use all our resources to convince Congress to give this subcommittee the budget allocation it will need in order to make our mutual goal a reality.
Thank you very much.
[The prepared statement of Ralph Yount follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Dr. Yount, if I can comment just a second on the President's budget, I also was encouraged by what he had to say about increasing research funding. His proposal, however, is to increase it 50 percent over 5 years, which is not, I think, enough to close the gap on the number of good science proposals being funded, in other words, increasing the percentage. I think that is going to fall way short of the mark.
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However, this is the first President who has made that commitment. The President's budgets in the past 3 or 4 years have been way short of what Congress has provided, and so I think all of us have been encouraged that it was mentioned as a high priority.
The difficulty with the President's budget is that spending, particularly the discretionary spending, depends upon a revenue stream that is very unlikely to occur any time soon, and maybe not at all. And the proposed increases have about $100,000,000,000 of new revenue over 5 years behind them. And I don't think that we can count on those revenues being part of this budget as the House takes up and the Senate takes up the President's proposals. And that means that the spending in—I am not talking just about biomedical research. I am talking about everything under the jurisdiction of this subcommittee that is going to make getting the kind of allocation we need much more difficult if we are going to reach the goals that have been mentioned by so many witnesses.
And you said very early you are going to impact the budget process as well, and that is exactly what I think we need to do.
Mr. YOUNT. Right. Well, we stand ready to work with you on this, and we realize the difficulties in finding the funds for this kind of increase.
Mr. PORTER. Thank you, Dr. Yount. We very much appreciate your testimony.
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Thursday, February 5, 1998.
WITNESS
JERRY LAWRENCE, FEDERAL MANAGERS ASSOCIATION
Mr. PORTER. Jerry Lawrence, President, Federal Managers Association, Social Security Administration Conference, reporting the Federal Managers Association.
Mr. Lawrence.
Mr. LAWRENCE. Thank you, Mr. Chairman. My name is Jerry Lawrence, and I am President of the Federal Managers Association, Social Security Council. We represent more than 1,000 Social Security managers who work in our program service centers, our office of central operations, and our office of hearings and appeals.
And, at the risk of getting sermonette number four, I will avoid that. I have never testified before Congress and we are not asking for more funding than is in the President's budget. We do have some rather passionate feelings about how the funding is going to be spent by the Social Security Administration and we do think that the Administration can do more in terms of taking a more modernized approach in terms of the way it delivers service to the American public.
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Collectively, I guess our average age is about more than 50 and we have, on an average, more than 25 years of service, within the Social Security Administration. We feel that the Social Security Administration is on a precipice of moving forward with new technology and with a lot of advancements but we think that the agency has to come to grips with the way it delivers service to the American public.
Essentially, the way we are operating is the way we operated when I first started working for the Social Security Administration. We have not taken advantage of the technology and we have not really moved forward.
There have been a number of reasons why we have not done that. Some are very valid, others can properly be attributed to internal politics within the agency, and we think it is time with this Fiscal Year budget to take a serious look at the way we are doing business and the way we present service to the American people.
Over the last five years, our 800-number has grown by 500 percent. Just as an example, in our Kansas City Social Security Office, that office took about 500,000 telephone calls in 1992. By 1997, they had more than 2.5 million telephone calls. Clearly, the American public wants to do business with us using the telephone and we want to be able to serve the American public that very same way.
We have the capacity right now to take one telephone call from a number of people and resolve most of their issues within that one telephone call. But because of internal SSA policies and a reluctance to move into the new technology, in many instances what we are doing is we are making appointments for somebody to call those people back, either several weeks or several months hence.
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From our perspective, as experienced mangers working for the agency, we really do not think that that is the best way to serve the American people. We also have some very strong feelings about the quality of our work product and recently a number of periodicals, Money Magazine, has highlighted some of the issues that we are being confronted with right now in terms of our service delivery.
We think that the agency feels the pressure of trying to stay on top of their work loads. In our program service centers right now we have approximately 2 million claims from the American public that we have not processed yet.
In our office of central operations, we have more than 1 million claims. Our office of hearings and appeals also has 1 million claims pending. Many of those claims, approximately 10 percent, are more than three months old and there is a number of them that are more than a year old.
We believe that the agency, feeling the pressure of trying to push out those work loads, has an expedient not addressed the issues of the quality of the product as much as we would like to see the agency do. We understand the pressures that are on the agency to serve the public the best way that we can and we know that sometimes it is important to, well, it is always important to process cases timely but it is also just as important to process them correctly.
We think that the new technology offers us a lot of challenges and, we think, a lot of opportunities. But we also think that we must be mindful of the impact of fraud and systems abuse that the new technology could possibly expose us to.
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Moving out technology to our field offices without properly determining whether there is a potential for fraud and for systems abuse will only cause us more problems and will have an impact on our Trust Funds.
We think the agency needs to come to grips with the way we do business in the 1990s. The agency has traditionally structured their service delivery operation by having approximately 1,300 field offices around the country and 38 tele-service centers. We refer to them, within Social Security, as the mom-and-pop stores of America.
Frankly, we believe that the Walmarts and the Home Depots that are opening up all over the country are probably the most efficient way to operate. We think the agency must come to grips with that. In the New York City area, for example, where I'm from, we have approximately 55 Social Security field offices serving the American public. When we look at other public agencies that provide service to the American public, the number of offices are significantly fewer.
We think that the Social Security Administration pays a very high price for having these offices. We think that the American public for the most part would prefer to do business with us by calling us, by interacting with us using either telephones or the Internet.
We do think that we should have a presence in each community but we do have a particular concern about the extent of that presence and we think it is costing the American taxpayers a significant amount of money.
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We, as managers in the Social Security Administration, also have some particular concerns about the number of managers and some of the efforts that have come out of the National Performance Review in terms of reducing the number of managers to employees. In our program service centers, by 1999, we are going to have one manager for every 38 employees on the line. That will not give us much of an opportunity to do much in the way of performance management in terms of working with employees and trying to motivate employees to achieve the best that they possibly can.
We think that a lot of the reasons why we are doing this is being driven by some arbitrary goals by the National Performance Review. We think that there is some room for improvement in terms of some of our excess layers. And we do believe in efficient government and we believe in lean government. But we think that we should take a realistic view of how we serve the American public in terms of structuring our organizations and we do not believe that we should be totally driven by artificial numbers or specific goals that we have to achieve.
We are extremely cognizant of some of the stories that we have heard coming out of the Internal Revenue Service these days. And we have particular concerns as managers within the Social Security Administration about some of the pressures that are being brought to bear on some of our managers to achieve artificial or arbitrary goals and numerical standards.
We believe in——
Mr. PORTER. I am sorry to interrupt, but we have to stick within our 5-minute time limit. So, if you could finish your thought up we would be happy to oblige you.
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Mr. LAWRENCE. Okay. We do thank the committee for the opportunity to speak before it. This is the first time we have spoken. We have a full document which we have submitted and we would ask the committee to consider our concerns.
Thank you.
[The prepared statement of Jerry Lawrence follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Thank you very much for your testimony, Mr. Lawrence.
[CLERK'S NOTE.—Information required pursuant to clause 2(g)(4) of Rule XI of the Rules of the House of Representatives was not received from this witness or from an entity represented by this witness.]
Thursday, February 5, 1998.
WITNESS
WILLIAM W. MILLAR, AMERICAN PUBLIC TRANSIT ASSOCIATION
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Mr. PORTER. William W. Millar, President, American Public Transit Association, testifying in behalf of the Association.
Mr. Millar.
Mr. MILLAR. Thank you, Mr. Chairman.
Good morning, Mr. Chairman, I am William W. Millar, and I am the President of the American Public Transit Association.
I have submitted a statement for the record, so with your permission, that will go in the record and I will not take your time to read it. I am here really today for two reasons.
First, this is the first time that the American Public Transit Association has ever testified before this committee so we wanted to introduce our association to you and the members of the committee. And, second, we have some suggestions for making the very limited funds that you have referred to repeatedly through the morning go a little bit further than they are able to do now by taking use of the services that our members have to offer.
Before I describe that, I also need to say to you that many of our members that are in the Chicago area, when they heard that I was coming to testify before you this morning asked that I convey their good wishes to you and particularly thank you for the strong support that you have given the starting of Metro's new commuter rail service up through the North Central area, the Northern suburbs. It apparently has been a great success. So, we do thank you very much in your other role for strong support for public transit.
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The American Public Transit Association is the largest trade organization that represents both the providers of public transit, such as the Chicago Transit Authority, the Pace suburban bus system, those types of operations, but also the private sector companies that supply the industry, for example, Gen Fare in Elkrow Village, Illinois, is a member of ours. So, we have both public sector and private sector members.
About 90 percent of all the people who use public transit in America every day utilize services that are provided by our members, just to give you a little bit of background.
Now, Mr. Chairman, we believe that public transit has much to offer. We believe that we can assist the very, very fine agencies that utilize the funds that your committee makes available to them to serve the American public. We believe we can make these limited funds go a lot further if we all work together.
I want to share with you today four specific ideas of how that might happen and offer to continue to work with you and the members of the committee and others to pursue this.
First, over the years, we have learned that coordination of transportation services is very important and that if the coordination is done right, we believe that it can really help the money go much further.
We are very appreciative that this committee, I believe, in the 1997 appropriations bill directed that some joint coordination guidelines be developed between the Department of Transportation and the Department of Health and Human Services. However, so far as we know, there has been no significant progress made on those guidelines since they were directed to develop them and we think they could be extremely valuable.
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Despite not having the guidelines, there are numerous examples from around the country of where coordination has worked and worked well and, unfortunately, some examples where it has not gone so well. Let me give you two examples.
In Dade County, Florida, the Department of Social Services there has teamed up with the Metro Dade Transit Organization in Dade County to buy bus passes for Medicare recipients, medical assistance recipients. And in doing this and by using the services that are already on the street of the public transit agency, I understand they have been able to save over $16,000,000 that was formerly going into medical assistance transportation.
On the other hand, not that far away in a nearby State, in Georgia, there the director of medical assistance without proper coordination, without discussing it with the local transit agencies or social service agencies merely issued an edict that cut the funding for medical assistance transportation in half. That may have looked very good in his budget but, unfortunately, it meant that many people were left without service and the Metropolitan Atlanta Rapid Transit Authority suddenly was faced with a $6,700,000 rise in its budget and no funding to make up that shortfall.
Again, we think many of these problems could have been solved by proper coordination, by proper sitting down and talking and working things out. We think tens of millions of dollars still could have been saved in Georgia with a lot less heartache.
Another area that I want to turn to now is the whole issue of welfare-to-work. Certainly that has been one of the major discussions in this Congress and the previous Congress and Secretary Rodney Slater of the U.S. Department of Transportation has often said, public transit is the ''to'' in welfare-to-work. Well, we agree with him. We believe we can do that. We believe that again by coordinating with the agencies that have to find the jobs and get people to those jobs, transit can be a big help.
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We were pleased recently that the Department of Labor issued some regulations on the distribution of funds for this effort and they did make transportation an eligible expense but they do not allow public transit agencies to apply for those funds. So, we would encourage the committee to allow that to happen.
Third, we believe that there are opportunities through having as flexible as possible interpretations in HHS regulations to take advantage of the ADA, Americans With Disabilities Act, paratransit systems that our members are already implementing. And, so, we would encourage the committee to encourage the flexible interpretation of those regulations.
I guess my time must be up. Let me get my fourth point in if I can and then I will leave you. That is that we understand that studies have shown that HHS has over $2,000,000,000 of its appropriations go to transportation purposes. Just on the other side of this wall there is a committee on transportation appropriation that deals with a lot of planning issues to make sure that transportation money is properly spent.
And yet, the HHS money is not involved in that planning process, the social agencies that distribute that $2,000,000,000 do not sit at the table with the transportation planning agencies to see that there is proper coordination and proper connection. So, our final point would be that we would ask that you encourage both the Department of Health and Human Services, as well as the Department of Transportation to bring those social service agencies to the table to have them participate in the regional planning processes so that together we can work out the best possible coordinated services for the public.
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We thank you very much for the opportunity to be with you, sir.
[The prepared statement of William Millar follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Mr. Millar, I think you have made a lot of very valid points. And we are delighted that the Public Transit Association can be here for its first time but let us make it continuous in the future. Because I think you are exactly right, there are a lot of savings that can be achieved through better coordination. I will follow-up with the HHS and the Department of Transportation to see why that has not proceeded more quickly. And, obviously, we want to do exactly what you said, we want to save as many resources as we possibly can and you are, obviously, willing to help us do that, so, we are anxious to work with you.
Thank you so much for testifying.
Mr. MILLAR. Thank you very much.
Thursday, February 5, 1998.
WITNESS
DAVID R. BICKERS, M.D., THE SOCIETY FOR INVESTIGATIVE DERMATOLOGY
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Mr. PORTER. David R. Bickers, M.D., Secretary-Treasurer, Society for Investigative Dermatology, testifying in behalf of the Society.
Dr. BICKERS. Mr. Chairman, thank you very much.
I am David Bickers. I am a dermatologist. I represent the Society for Investigative Dermatology. We have some 2,000 members nationwide, scientists, researchers and university hospitals, industry across the United States.
We are engaged in research to discover ways to improve the quality of life of the American people who suffer from diseases of the skin which number in excess of 60 million individuals.
We do support the Ad Hoc Group for Medical Research Funding calling for a 15 percent increase in Fiscal Year 1999, as a first step toward doubling the NIH budget over the next 5 years.
Mr. Chairman, I have also brought with me today a booklet that has been made available, I think, to members of the committee that from which most of my testimony will be derived and additional copies are available if anyone is interested.
Basically diseases of the skin produce devastation not only because of the damage they do to the tissue, itself, but also to the individual's self image. For example, young people with severe acne who have resultant scarring may have, and studies have shown, difficulty finding employment as compared to individuals not so affected.
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Similarly, people who have early premature loss of hair, like you and me, are sometimes looked upon as prematurely old. And be that as it may, what I would like to focus on for a minute or so are some recent advances that highlight the potential that exists and also to express gratitude to the Congress for the support that led to these discoveries.
For example, there has recently been discovery of isolation of genes that are responsible for skin cancer, the most common form of human cancer. With these insights I think it is reasonable to predict that we will have better strategies for preventing skin cancer in the not too distant future.
A second very exciting and very recent discovery just published last week in Science that, in fact, the discovery of a member of my own Department in Columbia, relates to the first human mutation for hair loss. And this is actually an interesting story of research and international good will. The investigator, Dr. Angela, Christiano, herself about two years ago, suddenly noticed that she was losing large clumps of hair from her scalp. She went into the medical literature to ascertain what was known about the condition, in this case, Alopecia areata, and was appalled to find how little science there was to explain the disorder.
She, at the same time, found reference to a family or several families in Pakistan who had several generations in whom individuals were born with hair but subsequently lost all of their body hair. She contacted a doctor in Islamabad and that led then to a trek into the wilderness of Pakistan in which samples were obtained from these family members. Brought them to New York and then Dr. Christiano then set about to find this gene.
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I am happy to say that in the paper published in Science last Friday based on the studies done in this family she was able to show for the first time a human gene mutation for hair loss.
While on one level one could say, well, this is a cosmetic problem. But, point of fact, this discovery could lead to profoundly important insights into regulation of hair growth, and since many skin cells originate in hair, it could also lead to discoveries that could help us with technologies to, for example, find better ways to provide skin replacement for patients with burns, et cetera.
The other point about this research is interestingly we hear criticism and concerns about the experiments in animals, the final link in the chain finding this gene for hair loss came about because of a mouse model in which the hair falls out and that gene had been discovered and it helped the doctor to find this gene on chromosome 8.
Finally, let me say that we have, our society has worked in close collaboration with the Coalition of Patient Advocates for Skin Diseases Research and these individuals have been a powerful voice for those who suffer from the ravages of skin disease and together we have put together this document that highlights not only the achievements but the opportunities that are before us.
Finally, I would like to thank you, Mr. Chairman, for your strong and sustained advocacy for bio-medical research. I think we are on the brink of discoveries that could profoundly improve the health of the American people and our society is committed to waging that war with your generous support.
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Thank you very much.
[The prepared statement of David Bickers, M.D., follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Perfect timing, Dr. Bickers.
Let me thank you for your testimony. I appreciate that you said my hair loss was premature, I doubt that; I think it is probably mature rather than premature.
We had someone in yesterday to testify from the Alopecia Areata Foundation I think it was, and obviously the discovery of this gene is extremely exciting and the subjects that you raised for us, I think, are important ones. We are going to do the best that we can to provide the resources that are needed.
Thank you very much and thank you for your testimony this afternoon.
Dr. BICKERS. Thank you very much.
Mr. PORTER. Thank you, Dr. Bickers.
Thursday, February 5, 1998.
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WITNESS
ANTHONY COLE, HAYMARKET HOUSE
Mr. PORTER. I am going to have to leave to make a speech off of Capitol Hill and I am going to ask Mr. Wicker of Mississippi to take the chair in just a moment.
But first I want to introduce our next witness, Anthony Cole, the Vice President of Haymarket House, testifying in behalf of Haymarket House, and Mr. Cole, it is great to see you again. I have been down to Haymarket House in Chicago to see the really very effective operation that they run in behalf of people at-risk in a number of different ways. And I am sorry that I cannot stay to hear your testimony. Mr. Wicker is going to take the chair, but Mr. Cole it is really wonderful to see you here and we thank you for coming to testify.
Mr. COLE. Thank you very much, Chairman Porter. And our founder sends his best regards.
Good afternoon.
I want to thank Mr. Wicker and the other members of the committee for providing Haymarket Center with the opportunity to present testimony to your subcommittee again this year.
My name is Anthony Cole and I am Vice President of Haymarket. We are a comprehensive substance abuse treatment center on the near West side of Chicago. Over the past 23 years, we have developed several unique programs to address the needs of high-risk females and non-violent drug offenders.
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I present this testimony this year to provide a status report on Haymarket's ongoing efforts to be innovative and effective in our programming. We, at Haymarket believe that the treatment community needs to be encouraged to fully develop and refine what is called a continuum of care. This continuum is the integration of drug abuse prevention, drug abuse treatment, health services, including HIV–AIDS, day care, parent training, vocational education, job placement and screening for domestic violence and gambling addiction.
We also believe that the treatment community needs to equip ourselves with a better understanding of which treatments are most effective for which subgroup of users. We need to recognize that program models developed to treat a white, male population are not directly transferrable to other groups like pregnant and postpartum women. These clients bring with them a whole other set of clients—their children.
Haymarket believes that the Federal Government's limited prevention and treatment resources need to be targeted toward high-risk and hard to place populations such as women and their children, especially when one considers that the greatest cost savings associated with treating this population.
In addition to the savings connected to treating the mother, there are significant savings to be realized by delivering drug-free infants. The expense of intensive hospital care for each drug-exposed newborn ranges from $20,000 to $40,000. The average total cost of care from birth to age 18 for each drug-exposed child is $750,000 according to the General Accounting Office.
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I also recognize that this subcommittee receives no credit or benefit from savings to the Medicaid program resulting from an increased appropriation for treatment. This is unfortunate. Just look at the numbers. At least one in every five Medicaid dollars spent on hospital care is as a result of substance abuse, at a cost of $8,000,000,000 a year.
Haymarket remains concerned that as this trend of shifting public health care to managed care continues, little attention is being paid to how to effectively transfer managed care practices to publicly funded residential treatment settings without negatively impacting treatment outcomes.
We are asking that this committee, that we all know that the research shows that the longer length of residential stays are highly correlated with successful treatment outcomes. Haymarket believes that there is a direct correlation between the comprehensive nature of treatment and reductions in the recidivism rates.
Accordingly, we have incorporated a preventive health services clinic into our treatment programs. Through the establishment of an on-site clinic in partnership with a highly qualified community health center in Chicago, we have been able to address a variety of medical and health problems which impede our clients' treatment progress.
We urge the committee to encourage the CDC and HRSA to continue to work with community-based organizations to control the spread of infectious disease, the reduction of chronic diseases and the reduction of risk factors through preventive and primary health care.
Finally, Haymarket is looking to expand vocational education and job placement services we offer our clients. Once we have completed treatment and have begun to address their other medical and health-related problems the one impediment is a lack of employment opportunities. Haymarket is looking to collaborate with the Job Corps center which is scheduled to open in Chicago this year in developing an outpatient demonstration project. We ask that the committee encourage the Department of Labor to consider working with community-based organizations in this and other innovative ways.
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Clearly, if welfare-to-work efforts are going to succeed, demand for substance abuse treatment will increase and exceed the capacity of the current system. For example, the Illinois Department of Health and Human Services estimates that 40 percent of our TANF population has a substance abuse problem and is in need of treatment. Thus, for welfare-to-work to succeed, it must include substance abuse treatment funding increases.
In closing, Haymarket requests that you help the treatment community create a continuum of care for individuals with drug abuse problems so those individuals can address their problems more quickly and completely.
Thank you very much.
[The prepared statement of Anthony Cole follows:]
"The Official Committee record contains additional material here."
Mr. WICKER. Thank you, Mr. Cole, we appreciate your testimony.
Thursday, February 5, 1998.
WITNESS
KAREN JOHNSON, FSH SOCIETY, INC.
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Mr. WICKER. Our next witness is Karen Johnson, Board Member of the FSH Society, speaking to us today. We are delighted to have you with us today.
Ms. JOHNSON. Thank you, Mr. Wicker. Thank you for letting me submit this testimony to you today. As stated, my name is Karen Johnson and I am from Bowie, Maryland, and I am testifying as a Member of the Board of Directors of the Facioscapulohumeral Society, the facilitator for the Mid-Atlantic FSH support group and as an individual who has this disorder.
FSH disorder, otherwise known as Facioscapulohumeral, muscular dystrophy or FSHD, is an inherited neuromuscular disorder affecting one in 20,000 people. FSHD causes a progressive and severe loss of skeletal muscle throughout the whole body. As an American with FSHD and generations of my family afflicted with FSHD, I would like to tell Congress just how hard it is for a family to deal with this disease.
FSHD has diminished me physically. There is no cure or treatment. I live with physical and emotional pain and the frustration of losing independence daily. Both of my brothers have FSHD. I watch them endure it for a lifetime.
My only child has FSHD. I wish that he not see his mother progressively weaken knowing that he is watching what is certain to be his fate. Surely he knows at his age that without a cure he, too, will progressively weaken and be burdened with a diseased body.
It is physically impossible for me to hug my son. I cannot tell him any more that it will be all right. I watch helplessly as his carefree personality changes into that of a depressed young man burdened with the realization that he has inherited his disease from me. I worry about the day that he brings home his forever love with the fear that she will not be strong enough in seeing what he will become.
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I worry for the happiness in future of my grandchildren because FSHD is inherited. My husband will soon be my care-giver for I cannot walk. I cannot roll over or get out of bed. I cannot close my eyes to sleep and feeding myself is getting more difficult.
I need assistance with bathing, toileting and dressing. And all the while my son sees my pain, my anguish, and my increasing disability and I see his fear. How can a mother reassure their child if she, too, is unsure?
Largely, thanks to the efforts of Mr. Porter, the National Institutes of Health Researching Fund continues to grow. This past year has seen an unprecedented level of communication between the research community, the FSH Society, NIH and Congress. We are indebted to the members of this subcommittee and Representative Edward J. Markey from Massachusetts for his support. And for the report language submitted to you last year co-signed by Representatives McHugh, Frank, Meehan, Schumer, and Wexler.
While we wait for a formal response to last year's report language from Congress to the Director of NIH, we need Congress to give NIH resources now for FSHD research.
Understanding that the process takes time, we are positive we will see major initiatives in this area. Today, I am asking Congress to communicate to the NIH its awareness of our current crisis on research with FSHD.
Mr. Chairman, there is perhaps $200,000 of funding on FSHD from NIH and this is clearly insufficient. Congress must act on the one item that we cannot do for ourselves, that is to fund research on FSHD. We need a commitment to the FSHD research in areas outlined by the international community of scientists working on FSHD.
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We ask the subcommittee to assign a dollar amount to FSHD research. We request that an amount of not less than $2,000,000 and not more than $4,000,000 be earmarked for FSHD research.
The men, women and children who live with this devastating disease are taxpayers and contributors to the American way of life. With an 88 percent employment rate we personally bear our burden of health care costs and training expenses to maintain financial and personal independence.
We implore that the United States Government allocate our hard-earned tax dollars commensurate with our numbers and valuable contributions to the American way of life and society. Time is of the essence now. Lives are in the balance. The FSHD community demands bold, persistent and innovative initiatives.
We ask you to, please, act today for our children, my child, and the generations to come. I have brought along a statement from the FSH Society to be included in the record. And I really appreciate you looking that over.
Again, I want to thank you.
[The prepared statement of Karen Johnson follows:]
"The Official Committee record contains additional material here."
Mr. WICKER. Thank you, Ms. Johnson, for your very effective testimony. I am sure that if Chairman Porter were still here he would express to you that he intends to do his best as chairman of this subcommittee to work with the scientists and physicians at NIH to see that these scarce public resources that we have are used most effectively.
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And I certainly hope that we can bring some relief to you.
Ms. JOHNSON. Thank you.
Mr. WICKER. Thank you very, very much.
—————
Thursday, February 5, 1998.
WITNESS
KAREN HENDRICKS, COALITION FOR HEALTH CARE FUNDING
Mr. WICKER. Our next witness is Karen M. Hendricks, President, Coalition For Health Funding and Assistant Director, Department of Government Liaison, American Academy of Pediatrics.
Ms. Hendricks, we are delighted to have you with us.
Ms. HENDRICKS. Thank you, Mr. Wicker.
The Coalition for Health Care Funding is very pleased to have an opportunity to present our statement recommending Fiscal Year 1999 funding levels for the agencies and the programs of the Public Health Service. We sincerely appreciate the strong and continued support that this subcommittee has given to help discretionary programs.
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This year we celebrate the Bicentennial of the U.S. Public Health Service. For 200 years, the Public Health Service has been protecting the health of the American public beginning with the establishment of the Marine Hospital Service to care for sick and disabled Navy men in 1798.
While we have seen major advances in medical care over the past 200 years, the greatest impact on people's lives and well-being has been in the arena of public health. Since the turn of the 20th Century life expectancy of Americans has increased from 45 to 75 years. A recent report estimates that five of those added years are due to the medical care system but 25 years are due to the public health interventions.
Dr. William Foege, a former Director of the Centers for Disease Control and now with the Carter Center in Atlanta, noted in a recent PBS Television documentary recounting the progress of medicine, ''One of the most remarkable things of this century of science has not been what happens in the emergency room or in an intensive care unit or in the laboratory, it is the information now available to the average person about how to live longer and stay healthier.''
Disseminating this information to all Americans is largely the work of public health agencies like the CDC and HRSA. The Coalition appreciates that many members of this subcommittee will want to provide a significant increase in the funding for NIH in the coming Fiscal Year. The Coalition agrees.
However, as we both know, other sources of funding beyond the amount available under the current tightly capped discretionary accounts will need to be found to support the NIH and all other Public Health Service agencies. The Coalition has in the past and remains committed to working with the budget committees and others to increase funding for NIH in a manner that does not rob Peter to pay Paul.
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Biomedical and behavioral research provides the foundation that underlines a continuum of public health activities that include health services and outcomes research, targeted health care delivery to special populations, health professions education and training, disease and injury prevention and control, and health promotions activities.
Without these essential public health partners our increasing investment in biomedical research will fail to achieve the goal of a healthier and more productive nation. Recently the Coalition was approached for examples of how our investment in NIH-sponsored research eventually translates into healthier lives for our citizens through the actions of other agencies of the Public Health Service. Let me give you just one or two examples.
We have relied on NIH-sponsored research to identify the mysterious and tragic causes of SIDS, deaths in young infants but have looked to the Maternal and Child Health Block Grant program to deliver and implement the back to sleep campaign that has reduced SIDS by approximately 38 percent.
In the area of chronic disease, our investment in NIH research has identified a limited number of unhealthy lifestyle behaviors, many adopted early in life, which contribute to billions of dollars in direct and indirect costs due to heart disease, cancers, diabetes, and intentional and unintentional injuries. Investing in nationwide disease prevention and health promotion activities to reduce this largely preventable national burden would more than pay its way.
As we stand on the brink of the next millennium, our continued investment in a very strong Public Health Service will help us address these ongoing challenges and help us deal effectively with the newest challenges.
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The challenges of the next millennium include keeping our food and water supply safe, discovering effective methods for addressing new and emerging and multi-drug resistant infectious diseases, and identifying and protecting the work place, our homes and communities from chemicals that are harmful to health while we continue the effort to provide quality, cost-effective health care to all Americans.
For Fiscal Year 1999, the Coalition is recommending $29,000,000 be provided to address the nation's needs in the areas of biomedical, behavioral, and health services research; disease prevention and health promotion; health services for vulnerable and medically under-served populations; health professions education and training; substance abuse and mental health services; and food, drug and medical device regulation. The members of the Coalition for Health Funding look forward to working with this subcommittee and meeting the difficult public health challenges that are still ahead.
Thank you.
[The prepared statement of Karen Hendricks follows:]
"The Official Committee record contains additional material here."
Mr. WICKER. And we look forward to working with you.
It is perfectly all right in this building to yield back some time. Remind us of that and you will get it back next year.
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Thursday, February 5, 1998.
WITNESS
MICHAEL Q. FORD, NATIONAL NUTRITIONAL FOODS ASSOCIATION
Mr. WICKER. Our next witness, Mr. Michael Q. Ford, Executive Director, National Nutritional Foods Association.
Mr. Ford, we are delighted to have you with us.
Mr. FORD. Thank you, Mr. Wicker.
It is an honor to be here and I want to thank the staff, too, for their flexibility in changing around the schedule so that I could be here today. The National Nutritional Foods Association represents about 2,500 health food stores and about 800 manufacturers, distributors and suppliers of health foods, dietary supplements and natural ingredients, cosmetics, and we want to talk to you today about increased research on the benefits of dietary supplements, particularly nutrient vitamins and herbs and other botanicals.
In yesterday's, sometimes it works out very well, in yesterday's Washington Post this article appeared on page A–3. The headline says, ''Vitamins Sharply Reduced Risk of Heart Attack Study Finds.''
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This was a very large study, 14 years, 80 thousand nurses, Harvard School of Public Health, published in the Journal of the American Medical Association. And what it says is two simple B vitamins, Folic Acid and B–6, taken in amounts regularly larger than what is recommended by the FDA as the recommended daily allowance, can reduce the risk of heart attack by 50 percent. I mean this to us is just a wonderful revelation and I think for all Americans it is a wonderful revelation.
We have more than 100 million citizens of this country taking dietary supplements, herbs and vitamins, every day and the Congress has mandated more research and more service in this area, particularly with the passage of the Dietary Supplement Health and Education Act of 1994.
Two scholarly documents have recently been published that support more research in this area. One is by the Food and Nutrition Board of the National Academy of Sciences which is the body responsible for creation of the RDAs. They now, for the first time, since the RDAs were created in 1941, are talking about optimal health and using nutrients to fight chronic disease other than the classical nutrient-deficiency diseases, like beriberi and scurvy. And the chairman of the Food and Nutrition Board calls this particular report a great leap forward and we agree with him.
Also the President's Commission on Dietary Supplement Labels, which was created by the Dietary Supplement Act, has come out very strongly in support of increased research in this area saying the public interest would be served by such research.
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We are looking for a continuum of research in this area that goes like this. There is at the NIH the Office of Dietary Supplements, again created by the Dietary Supplement Act, which is to coordinate and stimulate research on dietary supplements, other nutrients and the botanicals. This office is currently funded at about $1,000,000 with 1.5 FTEs. We support the President's Commission in calling for the full authorized funding of this office at $5,000,000, so that they continue to stimulate the kinds of research that will give us the results as reported in the Washington Post.
Secondly, the Office of Complementary and Alternative Medicine, created in 1992 by Congress as the Office of Alternative Medicine, is currently funded at about $20,000,000 which is very good, but it does not come close to mirroring the popularity and importance of alternative providers. The New England Journal of Medicine has said that in an average year 425 million visits are made to alternative providers as compared to 338 million visits to contemporary, to traditional doctors and primary care givers.
We would like to see the funding for research in this area mirror the national demand for these kinds of services which often use nutrients and botanicals and herbs.
Also, we do support Congressman D'Fazio's H.R. 1055, which would elevate the Office of Complementary and Alternative Medicine to a center status so that it could make its own agenda, have its own peer review panels and let its own grants and contracts.
Once we have the kind of research that is necessary from NIH, we would like to see the subcommittee consider directing the agency for health care prevention and research to look at the feasibility of cost effectiveness studies of some of the products that are bringing such relief to people with chronic illnesses and doing a great job of preventing. For example, Saw Palmetto is a botanical which is shown to be much more effective with no side effects with respect to treating benign prostate enlargement. We think that there would be cost effectiveness and the AHCPR would find this because people will take their medicines when there are not the kind of side effects that come so often with prescription drugs.
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We would hope with the cost effectiveness shown the committee would eventually consider some sort of demonstration project through Medicare and Medicaid and the Health Care Financing Administration.
Thank you for your time and I would ask that in addition to our formal statement, we have submitted a copy of this article from the Washington Post about the Harvard study and I would like that to be made a part of the record.
[The prepared statement of Michael Ford follows:]
"The Official Committee record contains additional material here."
Mr. WICKER. Thank you. That will be received.
[The article from the Washington Post follows:]
"The Official Committee record contains additional material here."
Thursday, February 5, 1998.
WITNESS
JUDITH S. STERN, Sc.D., AMERICAN OBESITY ASSOCIATION
Mr. WICKER. We will now hear Judith Stern, Dr. Judith Stern, Vice President, American Obesity Association.
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And at the end of Dr. Stern's testimony I may have to make a mad dash on the floor to vote.
Dr. Hadley, who is our final witness will testify at 2 o'clock and at the conclusion of Dr. Stern's testimony we will stand in recess until 2 o'clock.
Dr. STERN. Thanks, Mr. Wicker.
I am reporting the American Obesity Association and it was founded in 1995 to serve as an advocate for millions of persons in this country suffering from obesity. I am also a professor of nutrition and internal medicine at the University of California, Davis, and I have served as Presidents of the American Society for Clinical Nutrition and the North American Association for the Study of Obesity and I am a member of the Institute of Medicine, National Academy of Sciences.
Today, I have come to talk with you very briefly about the growing epidemic of obesity in America where obesity affects a minimum of 58 million adults and 5 million children. And if this were tuberculosis nobody would doubt that it was an epidemic. Former Surgeon General Dr. C. Everett Koop has taken up this banner and he has pointed out that obesity is prematurely killing 300,000 Americans each year, and Dr. Koop knows that I am here this morning and supports my testimony.
Obesity is second only to smoking as the leading cause of preventable death but obesity does not appear on the 300,000 death certificates. People are dying of diseases casually linked to obesity like heart disease and hypertension and stroke and Type 2 diabetes and certain cancers and these are the diseases that appear on death certificates.
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Putting this in perspective this is the equivalent of four Oklahoma City bombings a day for a year. It is a lot.
Why do people die of obesity? There is no longer any doubt that obesity interferes with a number of physiological functions and metabolic processes. Cardiovascular, respiratory, they are all negatively impacted.
The utilization of nutrients, especially glucose, is abnormal and the result is hypertension, and dyslipidemia, and atherosclerosis and eventually heart disease and diabetes.
Obesity increases the risk for all of these diseases. Once they are established weight gain makes it worse, and a little bit of weight loss improves it but what I am really here for today is to really object to the fact that the NIH is devoting far too few resources to obesity research especially in relationship to the number of premature deaths and the costs of obesity are staggering.
The best figures we have are from 1986 and more than $67,000,000,000 a year and including $22,200,000,000 for the cost of obesity related to heart disease; $11,300,000,000 per year spent to treat and manage Type 2 diabetes, nearly all of whom are obese; $2,400,000,000 for gallbladder disease associated with obesity; $1,500,000,000 for the treatment of high blood pressure and it goes on.
Now, Mr. Wicker, the NIH only spends $92,000,000 a year for obesity research. You work it out. That is a $1.46 per obese person. Compare that $1.46 to $20 per diabetic person, $40 on each patient with heart disease; $338 for cancer; and $2,101 for each patient with HIV–AIDS.
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So, I think the Department of Health and Human Services needs a complete reevaluation of its response to this obesity crisis and NIH must have a budget that appropriately reflects the prevalence, health consequences, and costs of obesity. Funding is vitally needed for basic and clinical research in obesity, prevention and intervention research. So, in conclusion, on behalf of the 63 million obese Americans, who are living and dying prematurely with this disease, we urge this committee to make a five-fold increase in the money that NIH spends on obesity research. It would only raise it from the current $92,000,000 to $460,000,000 in Fiscal Year 1999.
Mr. Wicker, I really thank you for your time and attention and I would like to urge you to recall that one of three out of your constituents is struggling with this disease. It is an awful.
[The prepared statement of Judith Stern follows:]
"The Official Committee record contains additional material here."
Mr. WICKER. Dr. Stern, if a person can get through childhood and adolescence without having obesity, are their chances of becoming obese as an adult reduced dramatically?
Dr. STERN. Somewhat, but 53 million of the 58 million obese adults became obese as adults. There are only about 5 million obese children and I think it is, Mr. Wicker, genetics is important, that sort of loads the gun, but environment pulls the trigger. There is a problem with inactivity and food intake but there is that underlying genetics. And we can make great progress, we need the money.
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Mr. WICKER. I hope we can be of service.
Thank you very much for your testimony and this subcommittee stands in recess until 2 p.m.
Dr. STERN. Thank you.
Thursday, April 30, 1998.
TESTIMONY OF MEMBERS OF CONGRESS
WITNESS
HON. FRANK PALLONE, JR., A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY
Mr. PORTER. The subcommittee will come to order. We continue our hearing on the appropriations for fiscal year 1999, and we will hear this morning and this afternoon from Members of Congress, and we are pleased to welcome our colleague, Frank Pallone of New Jersey. We will allocate 5 minutes to each of our witnesses.
Frank, please proceed.
Mr. PALLONE. Thank you, Mr. Chairman and members of the committee. Hopefully I won't use the 5 minutes. I will submit my statement for the record and just highlight four areas of concern.
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One is impact aid. I have a number of towns in my district that received impact aid because of the soldiers or sailors that are stationed there, and I am just requesting that the subcommittee provide the level of funding that has been recommended by the Impact Aid Coalition, which I understand is 887 million for the fiscal year, as opposed to I guess 609 million that the President has requested. I know that your subcommittee usually does better than what the President requests on that, and I would just hope that you do that once again.
The second issue is what we call RUNet 2000, which will be based at Rutgers University, which is the State university in my district. RUNet 2000 is basically a comprehensive, integrated, voice video data and communications network.
Rutgers, although the major campus is in my district, it also has campuses in Newark and Camden, New Jersey. And basically this is a way of sort of linking not only the three campuses at Rutgers, but also with other institutions of higher education. It is essentially a creative approach to share research expertise and instructional talents with people far beyond the university.
Very quickly, this is a 5-year plan. To put this together, it will cost $100 million. We are looking for 10 percent of the funding or $10 million from the Federal Government, strictly for capital costs, not for actual operations of this network. It is something innovative; I would like the subcommittee to look at it and consider it.
The third thing I wanted to mention is the Job Corps. I know you have been very supportive of the Job Corps program and I just wanted to say that it works very well in my district. I get a lot of information from the Edison Center, which has been very successful in terms of the opportunities for the individuals that have been involved.
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Just to give you an idea, 75 percent of the students in this program went on to join the work force, the Armed Forces, or to continue their education. It has just been a very successful program in terms of people's futures, as well as the hands-on activity they are involved with, and I would just ask that you continue to support the program by providing $1.3 billion for the next fiscal year.
The last thing I wanted to mention is harmful algal blooms. They call them HABs, another acronym. This has plagued humans for a long time. But the biggest problem now—you remember in Chesapeake where we had the Pfisteria blooms and in the Gulf of Mexico we had the red tide. In both cases, there have been a lot of chronic illnesses that have resulted from exposure to these harmful algal blooms, and they are known to be responsible for about five different types of seafood poisoning.
What I am asking for is more money to do research on the consequences of these harmful algal blooms. The National Institute of Environmental Health Sciences—I am sorry, the National Institute of Environmental Health Sciences is, of course, part of the NIH and they are the institute that has the mandated permission to address these harmful algal bloom issues. Basically there is not a lot of research on it right now, because these environmental problems from the algal blooms are increasing. I am asking that you put a $10 million increase into this institute, specifically to address the effects of these harmful algal blooms on humans.
There are a lot more studies that need to be noted and, of course, you have seen in the papers these have received a lot of attention lately, and I am concerned it is a growing problem that needs more attention at the National Institute.
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That is all I wanted to address and I appreciate all your efforts in the past, certainly.
[The prepared statement of Congressman Frank Pallone, Jr., follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Frank, thank you for your testimony. Obviously we have agreed with you on Impact Aid and Job Corps being high priorities. Depending on our allocation, we will hope to agree with you again and certainly look into the RUNet 2000 and—it is HAB; right?
Mr. PALLONE. Right.
Mr. PORTER. With which I was not familiar.
Mr. PALLONE. I was not going to use the acronym because it is not familiar to me either.
Mr. PORTER. We will do our best to respond in both those cases.
Mr. PALLONE. Thank you.
Mr. PORTER. Thank you, Frank.
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—————
Thursday, April 30, 1998.
WITNESS
HON. BILL GOODLING, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF PENNSYLVANIA
Mr. PORTER. Next we are pleased to welcome the Chairman of the authorizing committee, Education and the Workforce, Congressman Bill Goodling of Pennsylvania.
Bill, it is good to see you.
Mr. GOODLING. Thank you, Mr. Chairman. I will take my 5 minutes.
Mr. PORTER. Very good.
Mr. GOODLING. First, I want to thank you for having the opportunity to testify. I would like to first focus on IDEA and first, by thanking you and your committee for your efforts in the last couple of years. The more than 1.4 billion funding increases you have given since we have been in the Majority certainly is very, very helpful not only to the children, but also to the local school districts. As you know, when it was passed in 1975, we said we would send 40 percent of the excess costs, since we sent 100 percent of the mandates; and thank goodness, at least in the last 2 years, we are now up to 9 percent, a long way from 40 percent, but we are getting there.
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If we have another 1.1 billion in IDEA part B, we trigger in a new formula and that will get us away, hopefully, from identification of students. The new formula also will be able to help local school districts because it will be the first time they will be able to reduce their spending. Not the States. They have to continue with the local district, and so they will be able to do all those wonderful things the President talked about in the State of the Union that are none of our business in the first place. But they can do pupil-teacher ratios, improve school buildings, and new buildings and so on, if we send them what we promised we would send them when we sent the mandate.
A good example is the city of York, which is a small city. They spent about 16 percent of their entire budget on our mandate from the Federal level. We sent them about 7.5 percent of the money. If we sent the extra money that we promised, there would probably be another million dollars, and they could do all sorts of things to improve teacher training, they could do all sorts of things to reduce pupil-teacher ratio, all the things the President talked about.
Mr. PORTER. Did you say that if we add $1.1 billion——
Mr. GOODLING. No; if we ever got to the 40 percent.
Mr. PORTER. Oh, if we got to the 40 percent.
Mr. GOODLING. The 1.1 billion will at least help them to reduce their spending on special ed so they can do some other things for all the rest of the students that they have. So it would be very helpful if we can continue what you started 2 years ago toward that promise.
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The second issue I would like to talk about is I hope we have put testing to bed until the authorizing committee authorizes. We had a big vote again in the House. The Senate also voted, I believe, 52 to 47 to follow our lead. So I would hope now it would be a joint effort on the House and the Senate side to make sure we don't move ahead without authorization on any field testing and any pilot testing, anything.
Mr. PORTER. You are saying we will need a provision in the bill this year to continue what we started, what you started last year.
Mr. GOODLING. We will——
Mr. PORTER. On testing.
Mr. GOODLING. Right. You will need to make it very clear that you are abiding by the will of the House and the will of the Senate in relationship to funding for testing.
Let me then go on to something very near and dear to me, which is Even Start. We finally found a family literacy program that works, after all these years, and I have given you copies of the evaluation; a very outstanding evaluation. Now instead of saying what they said about Head Start so many years when we didn't have quality in the program—they would always say there is no Head Start by the time they get to third grade. This evaluation indicates from all the teachers and administrators that what they have gained in Even Start is a continuation beyond third grade, that they really hold onto what they gain, and we make the parents better parents and improve their literacy so they can be the child's first and most important teacher.
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So instead of the $9 million cut—which I assume was sending a message to me—in the President's budget, I would recommend a $9 million increase, because we finally found something that works. It is amazing because last year he asked for an increase, because he told the Secretary that he really liked the program in Ireland where they had the parents over here working with them and the preschool children over here and they bring them together. And, of course, I said, Mr. Secretary, they stole that from us, you know. We have been doing it for 10 years and it has been very effective.
The next area I would like to mention is Chapter 2; it is now Title VI. I see he zeros that out. But, again, it is that block grant that really gives the local school district an opportunity to improve their teaching, and so I would hope that we would not pay attention to his budget.
I would also like to point out migrant education. When you talk about disadvantaged, these are the most disadvantaged of all, nobody looking out for them. They haven't gotten any increase in the last 2 years. Of course, they have a tremendous increase in numbers, but no increase as far as money is concerned. So I would hope that we can take a look at that.
Since I don't have time to get into the work force issues, I would merely say that I would refer you to my written testimony for fuller explanation.
I just simply want to emphasize the Department of Labor funds should focus on helping employers, employees, and unions voluntarily comply with and better understand workplace laws. That is the drive we have on, we have gotten them away from this business of the more fines they get, the better they can run their department, so those are the areas that I want to highlight.
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[The prepared statement of Congressman William F. Goodling follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Bill, thank you. I think that we can, depending on our allocation, we can be responsive in each of these areas, and we certainly agree with you on IDEA and how it frees up funds at the local level to do things that otherwise couldn't be done. And certainly testing, Even Start, Title VI, all these are things that we very much agree with you on.
Mr. GOODLING. Just one other statement. At 11 o'clock last night, I reminded them on the floor they are their making each other feel good with some of these programs that they are now accepting in our higher ed bill. I would just encourage you not to pay any attention to those whatsoever, because I reminded them that if you would appropriate, then they are going to come from some other place and it just might be one of their favorite programs where they had to take money in order to ignore these amendments for a couple of them that were accepted because they don't merit your recognition. Thank you.
Mr. PORTER. All right. Thank you.
Thursday, April 30, 1998.
WITNESS
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HON. BUCK McKEON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA
Mr. PORTER. Next we are pleased to welcome our colleague from California, a member of the authorizing committee, representative Buck McKeon. Buck, good to see you.
Did he say something he shouldn't have said?
Mr. MCKEON. No; we were just kidding about that.
Mr. Chairman, thank you for the opportunity to speak before your subcommittee this morning. I am pleased to testify this morning with my colleagues on the Committee on Education and the Workforce on the fiscal year 1999 funding priorities for postsecondary education and adult training programs.
As you are aware, the Higher Education Amendments of 1998 are currently being considered on the House floor. This bill was adopted by the full committee with strong bipartisan support, passed out of committee 38 to 3.
It brings us closer to my goal of ensuring that every American who wants a quality education at an affordable price will be able to get it.
I would like to take the opportunity today to briefly explain the changes we have made in this important piece of legislation.
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The committee is proud of the accomplishments made to date in making college affordable for all students since the Republicans gained control of the Congress. For example, Pell grants and college work study are funded at all-time highs, while provisions in the Taxpayer Relief Act created education IRAs and other tax credits to help low- and middle-income students obtain a postsecondary education.
The Higher Education Amendments will build on these achievements by continuing the important programs that serve students well and by reforming burdensome requirements to best meet the needs of students, families and colleges across the country.
The Higher Education Amendments of 1998 will simplify the student aid system. Our legislation will eliminate 45 unfunded programs, including the State postsecondary review entities, and terminate 11 studies and commissions. It will bring our student financial aid delivery system into the next century by creating a performance-based organization within the Department of Education, focused on providing quality service to students and parents.
For the first time, the day-to-day management of our student aid programs will be in the hands of someone with real-world experience in financial services. This individual will be given the hiring and contracting flexibility necessary to get results and will be paid based on performance.
For the first time, the Department's student financial aid systems will be run like a business. This performance-based organization will manage the Department's computer systems and ensure that the Department of Education does not waste money due to poor contract management or duplication. I don't know why we have to do this. In law, it seems to me like that would have been something they would have already done but they didn't, so this will improve that system.
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The bill also requires the Secretary to work with the higher education community to adopt common and open electronic data standards for important parts of the delivery system. By adopting these common standards, we can greatly simplify the student aid system by eliminating paper forms and unnecessary steps in the process. The student will fill out one piece of paper that will work for all their financial needs, instead of having to respond to many different forms.
Many other improvements we made in the bill, I do not have time to discuss in detail this morning. My written testimony provides more specific information and I would ask that it be entered into the record.
Mr. Chairman, I hope the Pell grants once again will be given top priority for funding increases in your bill. Last year's increase of $300, for a maximum of 3,000, was the single best step taken to help low-income students have an opportunity to obtain a higher education. Continuing the trend started by a Republican Congress to provide increases to the Pell maximum is a clear indication of the Republican commitment to this important program that helps needy students obtain a postsecondary education.
As in the past, I also hope the College Work Study and the TRIO will continue to be a funding priority of your committee. I really would like to stress the Work Study. I think the more we can do in that area, I think that is the best program out of all of these.
Finally, I will briefly mention the Employment Training and Literacy Enhancement Act of 1997. As you know, the House passed this bill last May and it is currently pending in the Senate. We understand the Senate will consider it shortly. This bill is an important step in addressing the Nation's long-term work force preparation needs by helping States and local communities to make sense out of our current confusing array of employment training and literacy programs.
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The bill accomplishes long overdue reform, consolidating over 60 Federal programs through the establishment of three block grants to States and localities for the provision of job training services. This legislation is written to empower individuals, and not the Federal Government, to make decisions about their own lives and their individual employment and training needs. It will go far to help States and local communities to reform employment, training, and literacy programs and address the individual skill needs of their citizens, and it will go far to empower individuals to break the cycle of dependency that has plagued our country for far too long.
I trust that you will be able to conference this bill quickly and that the President will sign this legislation into law soon. I hope that your fiscal year 1999 appropriations bill will continue to provide sufficient funding for the important programs it reauthorizes.
Thank you, Mr. Chairman, for the opportunity to testify before you today. I would be happy to answer any questions that you may have.
[The prepared statement of Congressman Howard P. ''Buck'' McKeon follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Well, that was perfect timing. Buck, I think we are tracking one another on each of the concerns that you have addressed in your testimony and, again, we are going to do the best we can. The allocation, obviously, is our limiting factor, but we will do the best we can within the resources we have. Thank you for coming.
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Mr. MCKEON. And all kidding aside, I seconded what the Chairman said as he was leaving.
Mr. PORTER. Thanks, Bud.
I am informed by staff our colleague Frank Riggs has a child that is ill and he can't be here for oral testimony. We will accept his written testimony for the record at this point.
[The prepared statement of Congressman Frank D. Riggs follows:]
"The Official Committee record contains additional material here."
Thursday, April, 1998.
WITNESS
HON. JAMES P. McGOVERN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MASSACHUSETTS
Mr. PORTER. Next is Representative James P. McGovern of Massachusetts, and we are happy to see him.
Your timing was impeccable.
Mr. MCGOVERN. I hope so.
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I want to thank you, Mr. Chairman, for all the great work you do on behalf of medical research, which is very important to my area and also your great work on behalf of children's health, which is something I care very much about. I am going to abbreviate the testimony I submitted because I know you are backed up here.
I am here today seeking support for two vitally needed health care initiatives in western Massachusetts, which is in my district, and I am also here to urge that this committee provide a $100 million increase for the Consolidated Health Centers program overall.
First, I request $3 million for the health facilities construction program from the Health Resources and Services Administration for the recently merged University of Massachusetts Medical Center and Memorial Health Care in Worcester, now the largest provider of health care delivery in central Massachusetts.
These funds would help support an $11 million renovation of UMASS-Memorial City Campus which operates and maintains programs dedicated to meeting the needs for ambulatory medical services, mental health services, and associated social services for Worcester's disadvantaged residents, and I am confident that the subcommittee's efforts to assist with this worthy project would have tremendous returns.
I also want to applaud you and the subcommittee for having increased the Consolidated Health Centers program by $68 million in fiscal year 1998. It is my opinion every dollar our government invests in this program brings a return of incredible savings, health care savings, and it is for this reason I strongly urge the subcommittee to increase this program additionally for fiscal year 1999.
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My second request represents an ideal example of how the consolidated health centers program would be successfully utilized, and I urge the subcommittee to provide a $1 million health facilities construction grant to the Great Brook Valley Community Health Center to help them expand and meet the needs of the growing number of patients they serve, more than double in the past. This facility serves the poorest population in the city of Worcester. I mean, close to 50 percent or more of the people they serve do not have insurance, and it is an incredible institution in the city of Worcester.
I know that there are budgetary constraints and I know everybody comes before you and asks for things, but these projects that I have just mentioned I would hope would get your consideration, and whatever you can do, I would appreciate it.
[The prepared statement of Congressman James McGovern follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Jim, thank you. I have to say I am very pleased to be able to work with you on a bipartisan basis on children's health and I know of your very strong concern about the consolidated health centers and we will do our best.
Mr. MCGOVERN. I appreciate it very much. Thank you very much, Mr. Chairman.
Mr. PORTER. Thank you.
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Thursday, April 30, 1998.
WITNESS
HON. STEVEN R. ROTHMAN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY, COMMUNITY HEALTH CENTERS
Mr. PORTER. Next we are pleased to welcome Congressman Steve Rothman from New Jersey, who came before our committee and provided us—I guess it was last year, Steve—with very, very poignant testimony on autism, and we appreciate your counsel in this area.
Why don't you proceed with your statement?
Mr. ROTHMAN. Thank you, Mr. Chairman. I too am grateful for your commitment to children's diseases and finding the cures for them, and I am profoundly grateful and appreciative of your bipartisan spirit and your kindness that you show to Members of both parties who come before you and this committee, so I am very grateful, Mr. Chairman.
Last year my brother and I came before you. My twin brother gave testimony about one of his three sons, the one who is autistic. His name is Jack. I have, since Jack's birth 7 years ago, met dozen and dozens of families in my district alone who are living with a child with autism. It is an excruciating, heartbreaking situation. You have a child who looks normal. If you saw this child on the street, you would say this is just a normal kid. The child is in his or her own world. There is all different levels of functioning. Five percent of them actually can be trained and educated, 5 percent. Yet we never know until the child is older, perhaps in his or her teens, whether they will be one of the 5 percent, so you are taking every single penny you can possibly get your hands on to invest in training and tutoring on a daily basis, lest you miss something, lest you miss a time in that child's life when that bit of tutoring or education could have flicked the switch. So it is a constant state of unknown that goes on, and you are constantly wondering am I doing enough, have I found the right research, because 4 or 5 percent, they do realize this progress.
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Four hundred thousand people in the United States are afflicted with autism. One in 500 children born today will be on the autistic spectrum. Though 5 percent will make strides with early intervention, the remaining 95 percent will never marry, never have a meaningful job, never live on their own, more than half will never learn to speak.
Until a few years ago, there was no hope for people with autism. For 30 years, psychiatrists thought it was an emotional problem or a problem of bad parenting. As a result of this tragic mistake, parents did not organize, medical research was not funded, scientists were not encouraged to enter the field, and a generation of autistic children was lost. While autism affects more people than multiple sclerosis, cystic fibrosis, or childhood cancer, autism still only receives less than 5 percent of the Federal research funding for these other decisions.
Recently, with your help, Mr. Chairman, and the help of your committee, the plight of autism and the need to vigorously pursue research in this area was recognized on a level never before achieved. Last year, the NIH announced it is undertaking a 5-year research effort focusing on neurobiology and genetics of autism, again with your prompting and your efforts.
Last summer, NIH held a conference aimed at improving autism research efforts. While we applaud these efforts as important first steps, we must recognize them as what they are: first steps. We need more research into the genetic, biochemical, physiological and psychological aspects of autism so that we can provide the more complete view of the disorder. Through this research we can identify genes and factors that cause autism, which can lead to earlier diagnoses and treatments or even prenatal gene therapy. In an age when important discoveries are being made in other diseases every day, we cannot allow autism, which affects so many Americans, to be left behind.
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Mr. Chairman, there is still a major deficiency in the current spending on autism, despite last year's profound and terrific efforts on your behalf. I hope that this committee will again support strong report language encouraging the NIH to redouble its efforts in the fight against autism. I would encourage this committee to consider establishing Centers of Excellence for Autism Programs modeled after the very successful NIH centers programs for Alzheimers. These centers would provide an infrastructure that would allow clinical and basic research to take place in one site. In addition, training and demonstration of advanced diagnostic prevention and treatment for autism could be done at the centers. Data could then be shared between sites, and collaborative research projects could be organized across multiple sites.
If there is one thing everyone involved with autism is in agreement upon, it is that with continued medical research there will be treatment, there may even be a cure for autism. It is only a question of time, energy, money, and will. I know that there are so many diseases that are worthy of your attention, Mr. Chairman, and that of your committee. I know that every disease of a child is a source of unbelievable pain for the parent. This human suffering is not a competitive sport or one to be ranked one against the other. But in autism, we have been so far behind for so long, and there is so much progress that was kept in abeyance because of our own ignorance of our own society. Now that we are opening our eyes, with the scientists' help for the first time, and we see how far behind we are, perhaps it is still appropriate to raise the level of attention and funding for autism which, as you know, will not only result in breakthroughs for autism but other neurological and brain disorders.
Mr. Chairman, again I want to thank you for allowing me to come before you and your committee, and I want to thank you again for your very sincere and widely acknowledged concern for childhood diseases and for your sincere and widely acknowledged reputation for bipartisanship.
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[The prepared statement of Congressman Steven R. Rothman follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Let me thank the gentleman for those very kind comments. Let me say it wasn't my leadership, but your own, that got us moving in the right direction on autism, and we learned a lot by listening to you last year and this year as well. And I think that is what made the difference. We are only responding to the things that we hear.
I have to say, as I listened to your testimony both years, it strikes me that there are the same kind of similarities between Alzheimers and autism. They both are such heart-rending diseases not only for the individual afflicted, but for the family. And you referred to the mirroring of the centers' approach for Alzheimers in your testimony concerning autism, so we are listening very carefully to what you say.
I would appreciate your giving us some suggested language on this for the report, and we will work with you and do everything we can do advance the cause. Thank you for your tremendous advocacy, Steve.
Mr. ROTHMAN. Thank you, sir.
Thursday, April 30, 1998.
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WITNESSES
HON. LEE H. HAMILTON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF INDIANA
HON. JOHN N. HOSTETTLER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF INDIANA, ACCOMPANIED BY JOHN MARVEL, CHAIRMAN OF THE BOARD OF THE INDIANA SOCIETY OF RADIATION ONCOLOGY
DR. ALLAN THORNTON, RADIATION ONCOLOGIST AT HARVARD MEDICAL SCHOOL
DR. WILLIAM SMALL, RADIATION ONCOLOGIST AT NORTHWESTERN UNIVERSITY HOSPITAL
Mr. PORTER. Next we are pleased to welcome our colleague from Indiana, Congressman Lee Hamilton, one of our favorite people in this institution. I am sorry; is Mr. Hostettler appearing with you? Are you all together?
Mr. HAMILTON. Well we are all together on the project, I know that.
Mr. PORTER. I am sorry. My staff informs me I should welcome John as well. With Congressman Hostettler is John Marvel, Chairman of the Board of the Indiana Society of Radiation Oncology; Dr. Allan Thornton, Radiation Oncologist at the Harvard Medical School; and Dr. William Small, Radiation Oncologist at Northwestern University Hospital. So we are having a full panel here.
Mr. HAMILTON. Mr. Chairman, thank you very much. I ask that my statement be made a part of the record and I will be very brief.
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We are requesting $10 million to fund the Midwest Proton Radiation Institute at Indiana University in Bloomington. We are joined here by the gentlemen you have just introduced, who are the experts in this area, and who will discuss the project in more detail. I am delighted to work with my colleague, Congressman Hostettler, to advance this project.
I don't pretend to be any kind of expert here, Mr. Chairman, but proton therapy, as I understand it, focuses a beam of accelerated protons on certain cancer growths and can effectively radiate tumors in a way that conventional radiation cannot.
The proton beam focuses cleanly on the tumor, causing little damage to surrounding tissues and organs.
There are proton therapy facilities in Massachusetts and California. We don't have any in the Midwest. I think these gentlemen will be able to indicate the success of these facilities on the two coasts.
The Midwest Proton Radiation Institute in Bloomington involves a unique collaboration of physicians and scientists from throughout the Midwest providing access to proton therapy treatment of various cancers. It will serve over 60 million people in the Midwest, including my State of Indiana and your State of Illinois.
The advantage of this is that the Indiana University already has the proton accelerator on site. The cost of upgrading it, I think, is $20 million. We are asking for $10 million from the Congress. An additional $10 million will be made available from non-Federal sources.
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If you had to have a new facility, it is my understanding the estimate would be about $65 million dollars for that facility.
This is an enormously important project for us and, more importantly, for Illinois or for Indiana, just for millions and millions of people I think who would benefit over a period of years, of course.
So it is a project of personal interest to me, it is of great importance, and I want to urge you to do what you can, with all of the competing pressures upon you, to help us out.
Mr. Chairman, I am involved in another hearing, so I will excuse myself, with your permission, and perhaps Congressman Hostettler would like to join in as well.
[The prepared statement of Congressmen Lee H. Hamilton, John N. Hostettler, John Marvel, M.D., Allan Thornton and William Small, Jr., follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Thank you, Lee.
John.
Mr. HOSTETTLER. Thank you, Mr. Chairman and members of the committee, and I thank my colleague, Congressman Hamilton, for being here as well and lending his bipartisan support to this very important project.
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Mr. Hamilton capsulized very well what we are going to hear about with regard to the expertise and experience of this fine panel that includes Dr. John Marvel, chairman of the board of the Indiana Society of Radiation Oncology; Dr. Allan Thornton, who is a radiation oncologist at Harvard Medical School; and Dr. William Small, who is a radiation oncologist at Northwestern University Hospital.
Mr. Chairman, if it please the committee, I lend the rest of the time of Mr. Hamilton and myself to the testimony of the following witnesses.
Dr. MARVEL. Mr. Chairman, It is a privilege to be here. Thank you.
Mr. PORTER. Are you Dr. Marvel, since you don't have name plates?
Dr. MARVEL. I am Dr. Marvel.
It is a great opportunity to give testimony for a facility that will provide care for millions of citizens in Indiana, Wisconsin, Kentucky, of course your State, and surrounding midwestern States.
You already have my written testimony. I will try to be brief.
We formed a consortium of physicians and scientists throughout the Midwest to put together the Midwest Proton Radiation Institute, MPRI. The purpose is to bring to the Midwest access to proton therapy, which is currently only available on each of the coasts, in California and Massachusetts.
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When compared to conventional X-rays, if I could present myself as a target, ordinary X-rays enter and deposit most of the dose and then fall off with depth. Protons, conversely, enter at a lower dose, build up to a maximum right where you want them to stop, and fall off so there is no exit dose. You focus your dose at the tumor and you minimize collateral damage.
Proton beam therapy is a preferred treatment choice at selected treatment sites, including base and skull tumors, ocular tumors, paraspinal tumors, some head and neck cancers and some brain tumors. It is useful for many pediatric cancers. There are promising results published for prostate cancer and macular degeneration. There is active interest in treating lung patients with it. If widely available, it would undoubtedly be the treatment of choice at many additional sites.
We learned long ago as physicians and radiation oncologists, we are limited in the doses we can safely deliver to cure patients. We are forced to accept some acute and chronic side effects in the hopes of better local control. Many patients live with acute effects during therapy. A lot of them have chronic side effects, such as dry mouth, outer bowel habits, loss of sexual function, limited respiratory reserve. A few patients suffer the ultimate complication, death. My wife's first husband, treated for Hodgkin's Disease, developed bowel complications, a fistula peritonitis, and death.
A good friend, John Kiger, was cured of testicular cancer, but a decade later developed a radiation-induced cancer in field, and he died. Proton therapy minimizes the dose to healthy tissue and minimizes this risk.
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As a physician in Indiana, my patients have no regional access to this form of cancer treatment; therefore, with the others on this panel, I am asking you to provide $10 million to be matched by non-Federal funds for the conversion of the cyclotron facility at Indiana University into a proton therapy facility so that citizens in the Midwest have the same access to this form of cancer treatment as do individuals in South Africa, Japan, Europe and the east and west coasts of our great Nation. I also have written testimony from Dr. John Cameron, the director of the Indiana University Cyclotron, that I would like to submit concerning the concept of funding and organization. Thank you.
[The information follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Thank you.
Dr. THORNTON. I am Dr. Allan Thornton, a candidate for medical directorship of the Midwest Proton Radiation Institute, and I appreciate the time you have given to convey our support for the Midwest Proton Radiation Institute.
The MPRI is a consortium of physicians and oncologists really from the entire Midwest, extending from Wisconsin down through Kentucky and into Pennsylvania, who have banded together to support the conversion of a cyclotron machine on the Indiana University campus in Bloomington into a truly state-of-the-art facility to provide proton therapy.
The most prohibitive elements in the establishment of a proton beam facility is the cost of the accelerator itself, and in the case of the MPRI, Indiana University is offering that accelerator to the consortium for use in the proton therapy treatments. This dramatically reduces the cost from an estimated $65 million to about $20 million. As the State of Indiana has been targeted for half of this need, our request is for an appropriation of an additional $10 million from the NCI to allow the conversion of the cyclotron facility to begin.
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As you will recall, the facility I am familiar with, the Massachusetts General Proton Therapy Facility, was initiated through the efforts of this very subcommittee in 1989. Language was included in the fiscal year 1990 Labor-HHS-Education appropriations bill which targeted the National Cancer Institute, which lauded the potential for proton beam therapy as a treatment option for certain tumors and vascular diseases. Funding was included in each of the subsequent appropriation bills to construct and equip the proton facility at Mass General Hospital, and I am pleased to announce the facility will open in September of this year.
As a bit of insight into the need for this facility, we currently at Mass General have a 5-month delay in the treatment of our patients waiting for beam time, which will be reduced with the new facility's opening in September. However, patients from the Midwest are not served by this facility, and I know this well through my own patient referral basis.
During my tenure at the University of Michigan and at Mass General Hospital, my colleagues have increased the 4-year control rates of paranasal sinus tumors and base-of-skull tumors by 30 percent with the use of proton beam therapy, and this has been peer reviewed in journals. My colleagues have performed dosimetric studies, comparative studies, on patients with pediatric malignancies and gynecologic malignancies, indicating approximately a 50-percent reduction in the normal tissue irradiation that is achieved with the use of proton therapy over conventional therapy, which should reduce significantly the risk of second malignancies many years later. This is only possible with particle beam proton therapy.
While we appreciate the many competing priorities your subcommittee faces, we request the inclusion of the $10 million in the fiscal year 1999 Labor-HHS-Education appropriations measure to aid in the conversion of the accelerator on the Bloomington campus into a facility dedicated to the treatment of cancers and other afflictions with the use of proton beam therapy. Thank you.
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Mr. PORTER. Thank you very much, Dr. Thornton.
Dr. SMALL. Thank you for the opportunity to testify and support the Midwest Proton Radiation Institute. I am William Small, Jr., M.D. I am an attending physician at Northwestern University Medical School and assistant professor at Northwestern University in Chicago.
My support for the MPRI centers on the fact of the establishment of this facility in close proximity to Northwestern would allow my patients access to this proven form of cancer therapy. From a practical point, it is very difficult to get a patient to go to Boston, even if we note the critical importance for their treatment, as the travel and lodging costs are sometimes quite prohibitive to patients.
As Dr. Thornton indicated, MPRI is made up of a consortium of physicians and oncologists from throughout the Midwestern States. Because of this consortium approach, patients receiving treatment can remain under the supervision of their physicians in St. Louis, Chicago, Detroit, Louisville and other midwestern cities.
This unique model creates a joint center, operated by several institutions, and offers an enormous and continuing increase in knowledge and expertise.
I am also supportive because the facility will generate useful clinical research. Partnership agreements between the MPRI facility and other institutions in the region will allow for comparison studies between proton radiation therapy and a much a wider range of treatment options, and I know Northwestern would be very happy to participate.
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The accelerator to be used in this facility was originally developed through the National Science Foundation over many years and has concluded the studies for which it was designed. However, in addition to the existing equipment, the large body of top scientists from around the world who can enhance research programs at the MPRI remain on staff. Using these medical accelerated research experts, the MPRI will be able to conduct studies to create a more powerful and adaptable facility than is currently available in the U.S.
This consortium approach also encourages a wider sharing of resources among the institutions located within the region. These factors, combined, will accelerate the development of this technology in a manner that increases the rate of technology transfer and affordability reduction, while at the same time expanding access to this treatment.
The fact the facility could be up and running with just a $10 million Federal investment far short of the $60 million-plus needed to develop a new functional facility, is a definite advantage. I hope you will be able to provide the $10 million through the NCI to make the facility a reality for those who are geographically isolated from the existing U.S. proton beam facilities. Thank you very much.
Mr. PORTER. Thank you, Dr. Small.
Can I ask John several questions? First of all, is the cyclotron accelerator, once it has been converted, is it then to be exclusively used for this purpose, or will it continue to have other research applications? In other words, will it be devoted solely to proton therapy, So from then on it would be used just for that purpose?
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Secondly, let me ask: Is this therapy covered by Medicare and Medicaid payment and insurance; in other words, is it established therapy that is included within those reimbursable structures?
Dr. MARVEL. It has been paid for on each coast by Medicare. We talked with the carrier in Indiana and the plan is to basically bill at the same rates we would be billed for conventional therapy and it is our understanding it will be covered.
Mr. PORTER. I talked yesterday with some physicians and scientists about boron therapy for malignant brain tumors. Is there any relationship between this type of therapy and that type of therapy?
Dr. THORNTON. Perhaps I better answer that. Not particularly. The theory with boron neutron capture therapy is the neutrons are trapped by chemicals that are taken up by tumor cells within the brain, the theory being that neutrons will preferentially be distributed within the brain in that area. Protons, ounce per ounce, are no better or worse than conventional therapy. It is their accuracy of delivery and dose delivery that is crucial and it is proven in protons, in over 35 years of work at Mass General Hospital, whereas boron neutron capture therapy is still very much in the developmental phases and we do hope it will be successful, but it is far from having been demonstrated as a success.
Mr. PORTER. Is there any possibility, and I understand the need to verify its application, but is there any possibility that that application to malignant brain tumors could be expanded in the future to other types of cancerous tumors or cells; in other words, is this therapy—I didn't ask them, so I will ask you—a possibility of a much broader application?
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Dr. THORNTON. You are asking about boron. They are looking at that currently in the melanoma trial, looking for skin cancer; there are compounds that are preferentially uptaken in the skin, and they are looking at that in an initial phase with melanoma.
Mr. PORTER. If that therapy were to develop along those lines, would it be a possibility to replace proton radiation therapy, or do they do entirely different things?
Dr. THORNTON. They are really entirely different. The difficulty is most of the tumors that we treat with proton therapy are next to critical structures. When I treat patients with head and neck tumors, paranasal sinus tumors, I am treating 1 to 2 millimeters away from the visual system. We have very little likelihood of developing an agent, a drug, that will be so preferentially absorbed in one tissue and not in another, but one and two millimeters apart. I think the likelihood of BNCT, which is what we call it, effectively doing the same job is unlikely.
BNCT will be used, if it is successful at all, in relatively global tumors, over a large area, that are very resistant to conventional radiation therapy. Proton therapy is effective for tumors that are responsive to regular radiation, but for whom you cannot give a high enough dose of regular radiation because you are next to critical structures. A 10-percent increase makes the difference between cure and failure in these patients, and that is the patient population we are really speaking of with proton therapy.
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Mr. PORTER. See, John, I get a medical education if I listen carefully.
Mrs. Northup.
Mrs. NORTHUP. Mr. Chairman, I would like to speak on behalf of this and submit the testimony of Dr. Joes from the University of Louisville. He happened to have treated my daughter at the Brown Cancer Center. He was the radiation oncologist, and unfortunately she had conventional treatment and will always suffer the lung, the heart, the back-of-the-neck damage that comes with that kind of treatment. I would like to speak on behalf of this and pass this testimony on to submit.
Mr. PORTER. Thank you, Mrs. Northup.
One final question. I wasn't sure that I understood correctly. Does NCI already have money—have they already put money into this project?
Mr. HOSTETTLER. My understanding is no.
Mr. PORTER. But they have put money in the past in your project.
Dr. THORNTON. In the Mass General project.
Mr. PORTER. So there is a precedent for this type of investment through NCI?
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Mr. HOSTETTLER. In fact, there has been significant investment recently in a machine from Belgium, is my understanding, to be placed at Mass General, and that was new machinery, new hardware going in place. This project, much of the hardware is already in place, and a significantly smaller investment by NCI will be necessary to make this a reality for the Midwest.
Mr. PORTER. John, thank you very much. Let me thank each of the physicians that have appeared here today, and as I say, I have learned a great deal and we will do our best to be responsive.
Thursday, April 30, 1998.
WITNESS
HON. JAMES E. CLYBURN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF SOUTH CAROLINA
Mr. PORTER. Next is Congressman James E. Clyburn of South Carolina, who will testify on several projects of interest.
Mr. CLYBURN. Thank you, Mr. Chairman. Mr. Chairman, I appreciate the opportunity to appear before you today on behalf of a project which is of vital importance not only to the Sixth District of South Carolina but the entire State.
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I am here to ask you to consider an appropriation of $358,000 for a research initiative for child and family studies at University of South Carolina's College of Social Work.
The center is the State's premiere research and training unit in family dynamics. The research initiative the center seeks to develop will increase knowledge of intrafamily violence, lead to more effective treatment and prevention of violence, and increase faculty capacity for further research.
This research will focus on the following three types of intrafamily violence: child abuse, spouse abuse, and elder abuse. The objective of the research will be to study violence in the family over the lifespan, with an ultimate goal of developing appropriate treatment methodologies to address these forms of intrafamily violence; thereby, this treatment will allow us to respond to this societal ill in a more cost-effective manner.
Mr. Chairman, in my written request to you, I submitted more detailed information on this proposal, which I instructed the university to prepare and I would refer your staff to that package. If you need additional information beyond that, I would be happy to provide it to the subcommittee.
Mr. Chairman, I would be personally grateful for any consideration you may extend to this worthwhile and dynamic initiative.
[The prepared statement of Congressman James E. Clyburn follows:]
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"The Official Committee record contains additional material here."
Mr. PORTER. Well, thank you. That is the project that you are interested in testifying on behalf of today?
Mr. CLYBURN. Yes.
Mr. PORTER. We have several here. This is the one you are focusing on?
Mr. CLYBURN. Yes, sir.
Mr. PORTER. Thank you, Congressman Clyburn. We will do our best, as I say, to respond; and this is obviously a very important area.
Mr. CLYBURN. Thank you very much, Mr. Chairman.
Mr. PORTER. Thank you.
Thursday, April 30, 1998.
WITNESS
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HON. BILLY TAUZIN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF LOUISIANA
Mr. PORTER. Next we are pleased to welcome our colleague from Louisiana, Congressman Billy Tauzin, Chairman of the Telecommunications Subcommittee of Commerce. And Billy, it is good to see you.
Mr. TAUZIN. Mr. Chairman, I noticed the chairs here have ashtrays on the back of them. I thought that was rather strange.
Mr. PORTER. That is strange. I didn't know that.
Mr. TAUZIN. In the Commerce Committee, we are struggling with the tobacco issues ourselves.
I wanted to thank you for allowing me to come today. I am accompanied today by my office manager and her husband who have particular interest in my comments to you today, because their son has recently been diagnosed with Friedreich's ataxia. Recently, as you know, Dr. Varmus appeared before this Congress and testified and used Friedreich's ataxia to make his points about NIH funding. He used Friedreich's ataxia as his focal point because, in fact, this is a genetic disorder that is going to leave this young boy incapacitated. By the time he hits his twenties, he will be in a wheelchair, all his muscle functions are eroding, and it is genetic. It is a genetic disease that affects Cajuns at 2 1/2 times the national rate, and it is because of this particular feature of the people I represent, for whom I come, the Cajun population of Louisiana, that I appeal to you today.
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We are really in a unique position with the unique Cajun population, which is still very closely organized and associated in South Louisiana. The oil and gas industry allowed them to sort of live together for many, many family generations and not to have to move to seek employment or locate somewhere else, and the particular community is one that is ideal for genetic studies.
There are a number of diseases in the Cajun population—cancer, diabetes, heart disease, as well as Usher syndrome and Friedreich's ataxia. Many diseases affect our population at 2 1/2 times the national rate, and these genetic connections are what Dr. Varmus talked about.
In that regard, I would like to bring to your attention again this unique scientific opportunity in terms of examining genetic diseases in the context of studying through the history of these families inside Louisiana the connection between these diseases and genetics and the gene pool.
In that regard, I am here, along with five members of the Louisiana delegation, to petition you for money for the LSU Medical Center in New Orleans, $6 million in 1999, and then $3 million per year for the following 3 years, for the establishment of the Acadiana Medical Center to indeed assist NIH and the whole medical community in the identification of the genetic connection to the diseases.
LSU Medical Center is committed to the goals of the center. They are going to provide the space and a million and a half a year in support of it. It is again an extraordinary opportunity to find answers to these genetic problems, not only answers as to how they arise, but how to deal with them; and perhaps even, before this young man is totally incapacitated, perhaps some cure.
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Recently in Washington, you recall, members of the general disorder community, families who are suffering Friedreich's disorders and others, were here in Washington, and we saw firsthand what an awful impact it has on so many families in our country.
This center in New Orleans is indeed exactly what Dr. Varmus talked about when he came and testified, when he talked about the need to broadly identify the impact of genetic disorders in our society, and it could lead to important work across America in the discovery, the diagnoses, the treatment, and eventually the cure of many of these diseases.
I also wanted to put in a good word for the community health centers and funding, Mr. Chairman. I am strongly in support of your efforts to increase funding for the Consolidated Health Centers Program by $100 million each year, bringing the total to $926 million.
I represent rural America along the bayous in Louisiana. There are places I represent, sir, that you can't get to from here; you have to go somewhere else before you can get there. Most of my communities are along bayous that sort of stretch out like fingers of a hand, and you can't get from here to there without going back up the bayou and going down the bayou. It is very difficult to reach many of these Cajun populations on the edges of bayous and swamps and marshes in south Louisiana, and the community health centers provide incredibly important medical assistance to those families. Health care prevention—disease prevention, rather, and those sorts of things are coming to the bayou communities because of community health centers.
Use of emergency rooms are way down. Federal funds to the centers in fact, in several of the centers, is decreasing each year because of the success of the center movement. And I would just encourage you, to the extent you can, to assist in encouraging the establishment and success of the centers across rural America. In the bayous, they are literally essential to good health care practices for our citizens.
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[The prepared statement of Congressman Billy Tauzin follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. When you were talking about the bayous, I was thinking how vast this country is and how different it is, and each of us have to understand that the needs of our constituents may be different than the needs of each other, and be prepared to respond to that.
Can I ask one question about the Friedreich's ataxia, and that is has the gene been identified yet? It has been.
Mr. TAUZIN. About 2 years ago.
Mr. PORTER. And is there followup work being done to see what can be done to change that so that the disease can be avoided?
Mr. TAUZIN. In fact, Dr. Varmus testified that in some very—I mean, work that was not even connected to this, they discovered valuable information. The protein has been identified that is lacking in the genes. They were doing some other research. It was with yeast. They were doing yeast research, and Dr. Varmus—this was the whole center of his testimony before Congress when he came. What they found in the yeast research was yielding incredibly valuable information with reference to the protein that was identified, that was connected to what is missing in the cells because of the defect in the genes. And so they are beginning to make the links.
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I guess what I am trying to tell you is when you have a population like that, that is closely associated, 2 1/2 times the national average in all these diseases, you have a unique laboratory to find out what the links are all about and how to cure them.
Mr. PORTER. It is also fascinating, the serendipitous nature of research and how people look for one thing and find something they weren't looking for at all.
Mr. TAUZIN. So there is hope. I mean, here is a young family. Rachel has served me in Louisiana, has come to Washington to serve our office here, and she is my oldest in seniority employee going way, way back, and she is much younger than her years with me would tell. But the bottom line is she married here in Washington, only to find out this fellow she married had Cajun genes, and one of their children is diagnosed with this genetic disorder. And we learned through her about it. We learned how Cajuns all over my district were suffering at abnormally high rates in this disorder and other disorders.
So this young family's experience, as they watch their son lose his bodily functions—he can no longer ride a bike and has great difficulty riding—they are watching him deteriorate. It is something our office is—all of us are experiencing together with them, and it has brought to us in a very personal way how urgent the need for this research to advance is.
It is possible, Mr. Chairman, if we do this right, if we find these connections, it is possible we can reverse this and have this young man lead a normal life instead of seeing him continually wither away. I can't tell you in a personal way any more than that, we are all experiencing the suffering of this child and the suffering of this family and, through them, the suffering of so many other Cajun families and Americans. And here is a potential way of reaching a solution for them and I don't want to pass it up.
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Mr. PORTER. We will do our best to respond to you. I feel very strongly that, as resources become available, we really want to increase funding for biomedical research. There are so many areas like this one where we are on the edge of making the discovery that really will make a difference in terms of the effect on others, and we will do our best to respond.
Mr. TAUZIN. You have been very kind. Thank you, sir.
Mr. PORTER. Thank you.
Thursday, April 30, 1998.
WITNESS
HON. RICK LAZIO, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW YORK, THE NATIONAL SERVICE CORPS, AIDS DRUGS ASSISTANCE PROGRAM, RYAN WHITE CARE ACT, AND HIV/AIDS RESEARCH
Mr. PORTER. Next we are pleased to welcome Congressman Rick Lazio of New York to testify on the National Service Corps, AIDS Drug Assistance Program, Ryan White Care Act, and HIV/AIDS research.
Your timing was impeccable. We were just about to go to the next witness.
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Mr. LAZIO. Thank you, Mr. Chairman.
I appreciate very much the opportunity to testify before the committee, and I want to begin by complimenting you for the fine work you have done in some difficult circumstances over the last few years as you manage what I think is one of the more important portfolios in the appropriations 602(b)'s.
As you mentioned, Mr. Chairman, I am here to just ask for your continued assistance. You have been a strong supporter of virtually all these programs as we move toward the cycle, and I know we don't know exactly what we are going to be dealing with until we have the budget adopted, but there are certain programs that I think have been remarkably successful and deserve the committee's full support.
Let me list, first of all, in no particular order, frankly, but let me acknowledge that the National Senior Service Corps, which is responsible as the umbrella organization for many different programs, particularly the foster grandparent program, which has been leveraging volunteerism—and if you have had the opportunities I have, to go into a classroom to see a foster grandma or grandpa connect with these kids, they provide assistance and allow the teachers to focus on some special needs that they have in the classroom. It gives incredible meaning to the seniors. I have had more seniors come to me and say, ''It gives me a reason to get up in the morning, I feel loved and important.'' It provides incredible, I think, leverage to our educational opportunities, over 119 million hours of service to our communities, and it is estimated about 1.5 billion dollars is saved through the use of this volunteerism. It is also expected new funding will generate 14,000 new volunteers, with about 3.5 million hours of work.
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Let me also ask if you would continue to provide your support and your leadership, which you have in the past, for cancer research to the National Cancer Institute, certainly our premier global institutions in terms of research. I know without your leadership, we would not be in a position where we are today, where we are on the verge of numerous breakthroughs.
I want to just touch on a few that I know that you have been incredibly supportive of: the human genome project and the gene therapies that really hold extraordinary promise in terms of our ability to find what has been described as a repair manual for the human condition.
On Long Island, we have an extraordinarily high instance in mortality rate of breast cancer, so we are very focused on this issue. This is a national problem, it transcends breast cancer to ovarian cancer, prostate cancer, lung cancer, which continues to be the number one killer, and the progress being made through NCI deserves our continued support.
The next program, which I would ask for the committee's support would be through the ADAP program, the AIDS Drug Assistance Program. One of the frustrations, as we move toward these cocktails of medication, these integrated therapies that are showing extraordinary promise for people who are living with the HIV and AIDS, is that the cost of the program often is a very significant barrier to treatments. So some people know it is there, that they can benefit from it, it can save or prolong their life, and yet they can't quite afford to do that.
Many States have stepped forward, New York is one of those that I think has been cooperative on this, and I would ask the committee to continue to support this program. Through this program, we establish a network of providers for treatment, and especially important are the new protease inhibitor drugs which are widely credited with reducing the AIDS mortality rate.
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Last year we had about a $21 million shortfall. Last year about 26 States implemented emergency measures due to financial shortfalls. Ten States are closed to new enrollment and two States remain without protease inhibitor coverage. So there is some very extreme need in the case of some of these areas, some of these States.
The next program that I ask the Chairman's support and the committee's support on is an FDA hotline. Last year, as part of the FDA reform bill, I was able to have a bill that I had filed, an amendment adopted, which would create a one-stop information hotline over at NIH to provide the public with the latest information about scientific research efforts designed to combat all life-threatening illnesses. It would provide a human contact for people who are interested in clinical trials, not just publicly financed, but privately financed clinical trials, to give them information how they could participate, what is going on, and what hope is out there. I will be forwarding to the subcommittee a strategic plan with specific funding requests in the coming days to try and help with that.
And, finally—I am trying to move through this quickly and trying to be sensitive to your time—Job Corps, which has in the past enjoyed the Chairman's support and the committee's support, has enabled more than 69,000 economically disadvantaged young people to receive education, vocational training, social skills training, and job placement assistance. About 80 percent of its graduates are placed. It is, I think, a very fine alternative to what might otherwise be the alternative in the streets.
I would say just briefly, in visiting Job Corps centers—and I don't have the advantage of having one yet in my district, but I will say that one in the south Bronx is really doing some fantastic work—I have spoken to some of the young people there who never knew how to open a checking account, do a job interview, interact with a boss, resolve conflicts with colleagues, the things many young people take for granted but because of their upbringing and the communities in which they are raised, they don't have that.
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One young woman said, ''The only time I go home anymore is to go to a funeral for one of my friends,'' and that is not the environment we want for our young people to be part of a global work force.
So I ask for your continued support for these programs. I think they are extraordinarily important. I know you have shown leadership on these in the past, I salute you for that and I ask for your sustained support of these programs.
[The prepared statement of Congressman Rick Lazio follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Rick, thank you very much for your testimony, and we will do the best we can within our allocation. I talked to John Kasich yesterday about a budget resolution, and he tells me it is still a long way off. So while we are going to complete our hearings next week, we may have to wait quite a while before we can mark up.
Mr. LAZIO. You can count on my support, Mr. Chairman, to ensure your allocation is properly protected.
Mr. PORTER. Thanks, Rick.
—————
Thursday, April 30, 1998.
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WITNESS
HON. ROBERT A. WEYGAND, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF RHODE ISLAND
Mr. PORTER. Let me tell members that we are proceeding in order of the time slots assigned to members, and if a member does not arrive or is not available when they are called, then they have to go to the end of the list. So we will proceed as we have been on our list.
Congressman Robert Weygand of Rhode Island, who has been very patient here.
Mr. WEYGAND. Thank you very much, Mr. Chairman. I want to thank you for the opportunity to testify again before you. I have submitted testimony in greater detail for the staff and committee's review. I would just like to highlight a couple points, because I know your time is of the essence and I know a couple of my colleagues here would really like to testify as well.
I would like to first start off talking about an issue, not just in the State of Rhode Island but all throughout the country. Telemarketing fraud, you have heard and I know the committee members have heard, costs consumers tremendous amounts of money every year. Approximately $40 to $50 billion every year, the FBI indicates, is a result of telemarketing fraud and scams throughout the country. Over 50 percent of those people that are scammed are over the age of 55, which means approximately $15 to $20 billion every year.
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There are stories, horrendous stories, that I could tell you about from Texas to California to Rhode Island; but just a couple. Just last year, a man in Florida was put in jail for a scam that robbed elderly citizens in eight States throughout the South of over $1 million, elderly citizens. A 74-year-old woman in Texas recently lost $74,000 to phony telemarketers; as well as in Rhode Island a little while ago, a prisoner, while in prison serving time, scammed elderly residents in six other States of $95,000.
We have some very good laws with regard to, once we catch the people, putting them in jail. The problem we have is trying to alert elders in terms of an education and awareness program on how to prevent telemarketing fraud. We have been working with the Office on Aging within HHS to create a bill, 3134, which I think we have around 50 or so cosponsors on it right now. What this would do would be providing $10 million—and that is why I am asking you for this support, Mr. Chairman—in the bill, $10 million to the Department for purposes of conducting extensive outreach programs to senior citizens across the country, to educate them about the dangers and also some of the techniques and tricks that they can use to prevent scamming.
And when it is costing us, our taxpayers, billions of dollars, to invest $10 million throughout the country is really a very, very small amount, although it is substantial with a very, very tight budget, but it will bode well for this Congress to show to the public that we really want to prevent these. Catching them afterwards is fine, but when elders give out all of their money—and many times it is their life savings on some of these scams—hoping they are going to be able to have a very good final few years of their life, and they lose it all, we need to educate them about telemarketing scams. We hope you will support the provision that will provide for another $10 million within the Office of the Administration on Aging.
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Another area, very important, I was very happy to hear my friend and colleague from Long Island talk about is Job Corps. Forty-six of the States have Job Corps centers. We are requesting that you fully fund the administration's request on Job Corps.
Rhode Island is one of only four States that does not have a Job Corps center. We are now under application to the Department of Labor for one. But for all the reasons Rick Lazio mentioned, it is an important program to get our youth into; first of all, knowing how to go to work in the morning; secondly, giving them the kind of skills they need to be able to become a productive part of society. Job Corps centers really do that in many different ways. By fully funding the administration's request, we as well as three other States will be able to have Job Corps centers that will truly help many intercity youth in ways many of the programs that are out there could not.
The last program I would like to leave you with is home delivery meals. My wife and my children and I have worked many years with Meals on Wheels and many of the other meals programs. Most of these are staffed by volunteers, RSVP programs, and a host of others. We find that there are waiting lists on nearly 41 percent of all of our meal sites throughout the country, waiting lists for seniors who really do need nutrition programs.
This is really important for a lot of reasons. First of all, having reasonable nutrition programs is good for the seniors, but many of these programs are the first warning signs of what may be going wrong in a home or with some of our seniors. They help us prevent people going into a nursing home by alerting to some of the health care centers and other people what is going wrong with our seniors, and so therefore, they help them with home care and less expensive means than putting them into nursing homes.
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The second thing many of the meal sites do is provide an emotional and cultural and social support for seniors that in many cases they don't have. They do not have sometimes the family support, and they rely upon the sites not only for nutrition, but for social interaction and emotional support. It is a wonderful, wonderful program that yields us many dividends in terms of other things we as taxpayers don't have to pay for by having these problems.
So I ask you on that program, Mr. Chairman, to fully fund that as well, and sincerely appreciate your time for allowing me to testify here today.
Mr. PORTER. These are all important priorities. You said there is authorizing legislation introduced on telemarketing fraud?
Mr. WEYGAND. Yes, it is called the PASS Act, Protection Against Senior Scams. But we have not moved very far on the authorization, Mr. Chairman; that is why it would be so important to have it within this piece of legislation. And quite frankly, I am not so sure it will move alone by itself.
Mr. PORTER. We can't put authorizing language in without the authorizers telling us we should.
Mr. WEYGAND. But the authorizing bill may exist within the Administration on Aging. They may be able to do it if they have the additional money without authorization language; that is what our hope is. If there is money in there to allow them to do it, they think we could be able to—if we don't get the authorizing language, and we hope we will, they believe we may be able to do it even with the additional money. We have been working closely with the Administration on Aging on it.
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Mr. PORTER. Why don't you have the administration send us a letter telling us under what authority they could act if that is the case? That would help us.
Mr. WEYGAND. I will be happy to do that, Mr. Chairman. Thank you very much.
Mr. PORTER. Thank you very much.
[The prepared statement of Congressman Bob Weygand follows:]
"The Official Committee record contains additional material here."
Thursday, April 30, 1998.
WITNESS
HON. J.D. HAYWORTH, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF ARIZONA
Mr. PORTER. Next our colleague from Arizona, Congressman J.D. Hayworth. You have been very, very patient.
Mr. HAYWORTH. Mr. Chairman, I thank you very much, and I would also like to point out the patients of some of my very important constituents who join us today; not to violate any protocol, but I think we should recognize some exceptional young people who are here under the Close Up program from both the Loop and Rough Rock community schools of the Navaho nations. Would you stand up to be recognized today? I love to show off my constituents who are here.
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Mr. PORTER. We are delighted to have them and we welcome each one of them.
Mr. HAYWORTH. Thank you, students, and thank you, Mr. Chairman. I hope it wasn't too great a violation of protocol, but they are very important, and I think for purposes of my testimony today, they put a very human face on a very real need.
I am pleased to have this opportunity to testify today, Mr. Chairman, on two very important programs to the people of the Sixth District of Arizona: impact aid and community health centers.
Mr. Chairman, on behalf of all the members of the Impact Aid Coalition, I want to thank you for your continued support for the Impact Aid Program and for helping us secure $808 million for fiscal year 1998.
As you know, the coalition recently sent you a letter in support of $887 million in funding for the Impact Aid Program for fiscal year 1999, and I hope you will help us secure that amount. Later today, members of the coalition will testify on the importance of the Impact Aid Program, and instead of rehashing their testimony, I would like to focus my remarks, as I did last year, on section 8007, the school construction portion of Impact Aid.
Mr. Chairman, as you know, my district is unique because it has the largest Native American population in the 48 contiguous States. The Navaho nation, from which my special guests come today, stretches across four States and is roughly the size of West Virginia, and is one of the largest and most economically challenged of the sovereign Indian nations, with staggering unemployment rates which can run as high as 50 percent, depending on the season. Education is the only way for the students here with us today and so many others on the reservation to escape a life of poverty.
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The other 7 tribes, I represent, in my sprawling district face similar hardships and depend on impact aid to help educate their youth.
Mr. Chairman, part of our treaty obligations to the Indian tribes includes educating these children. Without impact aid, the Federal Government cannot live up to its treaty obligations. I support the coalition's goal of securing at least $887 million for this important program. While that money will help educate impacted children in my district, I think we all can establish the fact that they need to learn in a safe and healthy environment.
Many school buildings on the Navaho nation and on other Indian reservations are cracking, leaking, and, simply stated, falling apart. They are in decrepit conditions, and frankly, most of these buildings should be condemned. Nevertheless, students must be educated even if their schools are sadly in substandard conditions.
I recently examined five school districts—Chinle, Red Mesa, Sacaton, Pinon, and Window—to determine what their school construction needs are. And, Mr. Chairman, I am glad you are sitting down. The total need was an incredible $179 million. And, Mr. Chairman, sadly, some of the problems include the use of so-called temporary buildings for the last 30 years. It is simply unacceptable.
The coalition is asking for an increase from $7 million to 16 million in section 8007 funds. This increase will help alleviate some concerns, but the reality is this program hasn't received increases in the past, and sadly, it will hardly make a dent in the sad state of federally impacted schools in my district and across the United States.
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Now, ladies and gentlemen, for the record, I note the average school in the U.S. costs nearly $6 million to build. With the coalition's request for 16 million, we would only be able to build the equivalent of three schools each year. There is certainly a need for more than three schools a year in my district alone. Section 8007 must be increased substantially if we are to effectively educate our children on Federal lands in a safe and healthy environment.
I respectfully request this subcommittee fund Section 8008 and Section 8007 of Impact Aid at a minimum of $25 million for fiscal year 1999. With this increase, we could start to repair, renovate, and build new schools that are badly needed in my district and across the country.
On another issue, Chairman Porter, I am pleased to testify before you in support of an increase of 100 million for a model program that is the epitome of what a government program should be: the Consolidated Health Centers Program. I come before you today on behalf of the citizens of the Sixth District to thank this committee for past investments made in the program.
Over the last 2 years, you have provided health centers with $68 million in funding increases. As a result of your wise generosity, three new health centers were fully funded and constructed in my district. Thanks to the consistent investments made by this committee, Arizona has 11 health centers serving 150,000 people. And for my medically indigent constituents, this means no longer having to drive significant distances to receive affordable medical attention that quite often has literally made the difference between life and death.
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In addition, each community health center serves as a prime example of how a Federal program should work in three important ways: cost-effectiveness, local control, and quality.
First of all, when it comes to cost-effectiveness, health centers primarily serve minority and low-income populations; but for less than 76 cents per patient per day, health centers provide preventive service to uninsured and underinsured, even in the face of language and cultural barriers.
Second, local control. The Federal Government has provided seed money to empower communities to establish their own local boards to govern these health centers, thus linking the community to patients and local citizens who in turn have a real voice in the works of the center.
And, third and certainly not least in this, quality. Mr. Chairman, studies show that Medicaid beneficiaries who are regular patients of health centers have fewer chronic diseases, use the emergency room less, have fewer costly complications of diseases and ailments, and have fewer hospital admissions than those Medicaid patients who are not regular users of health centers. However, without significant increases in grant funding, the utilization of community health centers has the potential of overwhelming the ability of health centers to provide quality care.
As Dr. Marilyn Gaston, director of the Bureau of Primary Care, pointed out to this committee, 5 percent of health centers are bankrupt and between 5 and 10 percent more soon will be, due to fiscal constraints. Health resources and services administrator, Dr. Claude Earl Fox, indicated that it is his professional judgment that health centers need a $200 million increase in fiscal year 1999 to meet the demands.
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Mr. Chairman, simply stated, you face a daunting challenge, and that is perhaps the understatement of this legislative session. But on behalf of my constituents, I would like to once again thank you for allowing me this opportunity and honor to highlight the importance of providing this program with an increase of $100 million for fiscal year 1999, for you responding to the challenges of Impact Aid, and again for you so graciously and warmly welcoming my constituents to today's testimony.
[The prepared statement of Congressman J.D. Hayworth follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. J.D., thank you very much for your testimony. I have been slowing us down by commenting on everybody's testimony. I will have to keep quiet for a while and just listen. Thank you. We will do our very best.
Mr. HAYWORTH. Thank you, Mr. Chairman.
Thursday, April 30, 1998.
WITNESS
HON. ELIZABETH FURSE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF OREGON
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Mr. PORTER. Congresswoman Elizabeth Furse of Oregon to testify on the subject of education.
Elizabeth, nice to see you.
Ms. FURSE. Nice to see you, Mr. Chairman. Thank you. I am going to try to rush through this. I know we have a vote.
Every year, I have come before your committee to support education and ask for your support, so there are a number of programs I am just going to touch on that I am very, very supportive of. Federal funding for Head Start. We just recently received notice that the State of Oregon was going to give additional funding for Head Start because of the Federal help that they had received, so that matchup is so important.
School construction initiatives, of course, I am very, very supportive of. We have seen some problems with a real danger in our schools. I would request that the committee fund civic education. There is a Senate level of $7 million, and this would be very helpful for programs such as We the People. That is a program that really teaches kids civic values and it has been one we have had in Oregon a lot of experience with.
TRIO, Mr. Chairman. I always come and talk about TRIO. In Oregon, our successes are very, very impressive. We had over 3,800 students engaged in TRIO. TRIO not only exposes kids to college, it gives them some special skills and some help where they need a little extra help.
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The President's request is $583 million and if that is possible, Mr. Chairman, we would love to see that. Just unfortunate about Upward Bound is that so many kids qualify and so few can actually use it. In one program alone, 500 children qualified; there were only 55 slots, so it would have been great for them.
Job Corps. I am very supportive of Job Corps. We have a Job Corps center in Astoria, Oregon, and over 80 percent of their graduates receive jobs, go to the military, or advance in education.
We have a number of financial aid issues which obviously are so important for students going to college. A Pell grant—I would like to urge the committee to increase the Pell grant to 3,100, although I would love to see it go to the authorized level of 4,500. That would be great.
State-issued incentive grants. We use those in Oregon tremendously. We have a lot of students who are involved in that. Portland State University is requesting $750,000 in special purpose funding.
Obviously we use a lot of these urban community service grants. They have made a great improvement in the lives of young people and I hope that the $10 million will be included.
Now, Mr. Chairman, I would like to focus on one program. As you know, I support you tremendously in trying to increase medical research funding, especially in diabetes, but in order to complete the picture for medical health improvement, we need to invest in infrastructure. The health facilities program of the HRSA Administration is the avenue for your committee.
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We have a program in Oregon, the Oregon Health Sciences Program, that has managed to pull together about $30 million in donated services, in donated land. It is going to be a wonderful program. It is a women's health program and it will be the full continuum, both research and care; a Federal investment of just $3 million. A one-time investment will help us complete this whole picture. Thirty million will come from our community. And it is an ideal model of HRSA funds. It is a private-public partnership, and I would like to have your attention to that.
Those are just a few of the issues, Mr. Chairman. I don't want to take more of your time. I will submit a full statement, but again I want to thank you for all you have done in the past for the First Congressional District of Oregon. We are deeply grateful.
[The prepared statement of Congresswoman Elizabeth Furse follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Thank you, Congresswoman Furse. Elizabeth, you covered a lot of ground there. They are all important priorities, very definitely.
We do have a vote on. We have Congressman Cliff Stearns next; then Congressman Davis; then Congresswoman Slaughter; then Congresswoman Thurman.
—————
Thursday, April 30, 1998.
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WITNESS
HON. CLIFF STEARNS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF FLORIDA
Mr. PORTER. Cliff, good to see you. Please proceed.
Mr. STEARNS. Thank you, Chairman Porter. I am pleased to be here and want to thank you for allowing us.
I come here, quite simply, to ask for increased funding for the NIH budget. I think when we look politically across the spectrum, you say either you are a fiscal conservative or you believe in more Federal spending, but I think the longer you are here in Congress, you start to realize that depending upon the issue in your congressional district is perhaps more important than anything because you are trying to represent those people.
I just am here to say that I think we need an additional 7 percent a year increase for the NIH. When you look at the overall NIH budget compared to foreign aid, they are almost comparable in size, and I think the NIH budget should be a lot higher, and I can't understand why we continue to fund NIH at, I think, a very tepid pace. I am suggesting, as well as our Senator from Florida, Connie Mack, to increase NIH funding. I hope, having said all that, you will realize the enormous implications that the NIH funding would have for Americans, particularly for senior citizens, Florida, who are coming into the Medicare program, and in the area of the genomics, which is one of the most exciting and promising developments in molecular medicine. Once a map of the human genes is made available within the next few years, we will be able to make comparisons with our own genetic, unique genetic blueprint.
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Mr. Chairman, this will herald in a new era of computer collaboration with molecular medicine to develop a DNA chip, transferring the functions of the human genome to a computer chip to be run for comparison for diagnostic and treatment purposes against our own genetic map. The NIH is funding the genome center.
I have a bill dealing with genetic privacy. I am chairman of the Genetic Privacy and Health Records Task Force of the Commerce Committee, and I can't tell you, after having been to NIH, how important it is for you to consider increasing funding for the NIH, and I think perhaps my brevity will make the point. Thank you, Mr. Chairman.
Mr. PORTER. Cliff, I can't agree with you more. I think you are exactly on point, and we are going to do the best we can to do exactly what you and Senator Mack want us to do.
[The prepared statement of Congressman Cliff Stearns follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Off the record for a moment.
[Discussion off the record.]
Mr. PORTER. The subcommittee will stand in recess.
[Recess.]
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—————
Thursday, April 30, 1998
WITNESS
HON. DANNY K. DAVIS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF ILLINOIS
Mr. PORTER. The subcommittee will come to order.
We continue our hearings with Members of Congress and are pleased to welcome our colleague from Chicago, Representative Danny Davis, to testify on federally qualified health centers.
Mr. DAVIS. Thank you very much, Mr. Chairman.
Let me thank you for the opportunity to be here this morning. I certainly want to thank you and the committee for the support that you have given to the programs that I am going to touch on over the years.
I am here this morning to ask that we increase the funding for our community health centers by at least $100 million, and I do so not only on the basis of the research and statistics, but also on the basis of my personal experiences with community health centers, with which I have been associated for more than 30 years now. As a matter of fact, I had the good fortune to work in one, become the member of a board, and ultimately to become president of the National Association of Community Health Centers. So, I have traveled around the country and I have seen them extensively, and I have seen what they bring to especially underserved communities and what they bring to poor, rural, migrant, urban, inner-city communities all over the country. They have proven themselves to be the very best that we have seen in terms of the ability to deliver quality health care to large numbers of poor people. All of the indicators suggest that, all of the statistics suggest it, and what we need in order to keep them viable and keep them moving is, in fact, an increase.
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I was pleased to hear the testimony of my colleague from Arizona, who just testified a few minutes ago about the need for the centers in areas that he represents. So we would hope that we could get at least 100 million additional dollars that would ultimately save at least $1.2 billion, according to all of the estimates that we have, because now we are going to catch people at the early stages of their illnesses, we are going to do prevention, we are going to keep them out of the hospital, and we are also going to revitalize and redevelop these communities, because community health centers are economic tools that are used in many instances to help redevelop communities that otherwise would lie stagnant. So we appreciate the opportunity to convey and share this information and this position.
I would also urge that we increase funding for the TRIO programs, for the Pell Grant programs, and for medical research. I was pleased to be at an affair not very long ago for the opening of a new research center at the Rush Presbyterian St. Luke's Hospital. When they talked about support they had received, they mentioned you most prominently and indicated that I somehow or another was being thrown into that same category, although being a new Member of Congress. So, I am very pleased to join with you in supporting these very worthwhile ventures, and I appreciate the opportunity to testify this morning.
Mr. PORTER. Danny, thank you.
[The prepared statement of Congressman Danny K. Davis follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. I was at a community health center in the city, and I think it probably was in your district on Erie, just west of the Loop, and they were doing wonderful things. They were doing outreach through volunteers and bringing people in who wouldn't otherwise be served, and the level of quality care that they were providing was just wonderful. So I am very impressed with what community health centers are doing, and we want to obviously continue to give them the kind of support you are suggesting.
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Mr. DAVIS. Thank you very much. That was the Erie Family Center, and they are indeed doing well. Thank you.
—————
Thursday, April 30, 1998.
WITNESS
HON. LOUISE McINTOSH SLAUGHTER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW YORK
Mr. PORTER. Next is Congresswoman Louise Slaughter of New York.
Ms. SLAUGHTER. Thank you.
Mr. PORTER. Who returned just in time.
Ms. SLAUGHTER. In the nick of time. I have disappointed several of my colleagues with my timing, Mr. Chairman.
I appreciate this opportunity to testify before you again. Before I say anything, I want to say to you how grateful I am to you for your work as an outspoken advocate for the most vulnerable in this society, and the work you have done for homeless, the elderly and low-income families is very important. You have also been a very good friend for those of us who are trying to bring new attention to neglected issues like women's health, and I thank you for that.
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I am going to be very brief because I know how busy you are, but there are a number of things I wanted to bring to your attention.
As the head of the Task Force on Women's Health in the House, I wanted to talk about the Office of Women's Health at the NIH. It was established in 1990 to coordinate, facilitate and improve the quality of women's health research, and it certainly has, but I am concerned that since its inception, it really has not received a meaningful budget increase, and particularly as the prominence of women's health has increased and women are taking more active interest in their own health.
The administration is requesting 19.2 million for this office for 1998, which is an increase of only 4 percent over the previous fiscal year, and I would like to urge the subcommittee to provide a budget increase proportional to that increase given to NIH as a whole. We are way behind.
Federal research into the effects of the drug diethystilbestrol are still yielding important insights into the action of environmental estrogens on the human body. As you know, that awful drug was given to millions of pregnant American women between the years of 1938 and 1971 to prevent miscarriage, but it didn't; it cause cancers in their children. So we would really appreciate for you to continue that funding.
Eating disorders are a growing problem in our Nation, particularly among young women, and I appreciated the committee's inclusion in last year's conference report the language encouraging the National Institute of Mental Health and the National Institute of Child Health and Human Development to coordinate the eating disorders research.
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I am also grateful that last year's report instructed the Secretary of Health and Human Services to pursue eating disorders education efforts. When we have children as young as 7 and 8 years old going on diets, we have a critical problem. It is a serious health problem. So I am sure that once again you will show your concern.
Colorectal cancer, Mr. Chairman, is another neglected health issue. Ninety-seven percent of the persons diagnosed can be cured. The difficulty is getting people to be screened. We need to make sure that women understand it is not just a man's disease, but it strikes men and women at equal rates, and it is the number three cancer killer of the Nation's women. It has to have renewed attention, so we are working very hard to raise the education program from 2.5 to 5 million. We think we will save a lot of lives with that.
Menopause is another issue we are just beginning to look at. Aging women still don't feel able to discuss it, even with their own doctors. Women need to have full factual information about normal changes that can be expected with menopause and the treatment that is available to provide relief for some symptoms. So we would appreciate some attention on that research as well.
I have some information about the National Technical Institute for the Deaf, but you have been kind enough to hear me on that before, and I know you like them as much as I do.
One of the things I do need to talk about is your support for the homeless children's bill, and, Mr. Chairman, although that is kind of an orphan bill, your support of that has meant the world to me as author of that bill in 1986, as part of the McKinney Act. We are asking for 30 million this year, which is still not very much, but the little money we have given, we have reduced the number of homeless children now to 14 percent. We need to reduce it to zero.
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We found the homeless education program is working. It is improving regular school attendance, and grades, and scores in high school graduation and GED completion rates, and we hope this may be a phenomenon of the past and that now that the employment is good, the economy is good, we are going to see fewer and fewer families that are homeless.
I want to show you how this program worked. His name was James. He was a 10th-grader staying with a family friend while his mother and sister stayed in a shelter. It was all women, so James couldn't stay there. He had to stay with a friend, and he didn't go to school at all, and he was ill. When he was finally able to go to school, he was tired and coughing, his clothes were soiled and ripped, and he didn't have any books or pens or anything to write with.
The vice principal called in the person in charge of homeless education, Mr. Sayles, and in accordance with the bill that has been written, Mr. Sayles helped him get an appointment with a physician at a neighborhood health clinic. They let him pick out clothing, alarm clocks, school supplies and hygiene products that they had put aside for children, and he is now a more productive student as a result of support received from the adults around him. And that is just one of the many ways this program provides education, but it makes sure children are looked after and have the opportunity to get educated.
I think it is an important component of welfare reform, because we think children who are obviously unhealthy, uneducated and untrained are probably going to grow up to be tomorrow's welfare recipients, and if we can do anything to stop that—and, frankly, every American child should be allowed to get a good education in the United States. We can't leave any part of that population out, and homeless children have been neglected.
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In regard to the 21st Century Community Learning programs, they are very important, have done wonderful things already, but there are going to be $40 million in it this year, and there are over 2,000 applications already, and out of that, only 13 percent will be funded this year, so we really need to increase that. I urge you to consider increasing the funding to 200 million for year 1999, because we need to expand the after-school programs which promote safe and nurturing activities for young people during the nonschool hours.
We all know the crime rate in this country goes up every day between the hours of 3 and 7 p.m. when children are out on their own. If we can offer them positive alternatives, and give them some tutoring, and make sure they have homework and are ready for next day's school, and give them something besides a television set for company, we will be doing a great thing for the future generations. Art projects are there that help them develop their minds.
So that is the request I have for you today, Mr. Chairman, and thank you again for your unfailing kindness.
[The prepared statement of Congressman Louise M. Slaughter follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Louise, that is a pretty good list. I have to tell you, and you know this, when we first talked, this is probably 3 years ago now, about homeless children's education, frankly, I was very skeptical about needing another program and thought they could be served within existing programs. And you convinced me very, very quickly that this is probably a prime example of how, since they don't have any homes, they don't have any school districts, and they fall right between the cracks, and you have been exactly right in that, and we appreciate your tremendous leadership in that area.
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Ms. SLAUGHTER. I thank you for that.
Mr. PORTER. As well as so many others.
Ms. SLAUGHTER. I appreciate that. But it is true, too many school districts, if you don't live in that school district, you can't go there. So a lot more children need our help, and I know you will be there to help us, and thank you.
Mr. PORTER. We are going to do our best.
Ms. SLAUGHTER. Thank you very much.
Mr. PORTER. Thank you, Louise.
Thursday, April 30, 1998.
WITNESSES
HON. KAREN L. THURMAN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF FLORIDA
DR. STEPHEN SOMLO, ALBERT EINSTEIN COLLEGE OF MEDICINE
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Mr. PORTER. Representative Karen Thurman of Florida testifying on polycystic kidney disease.
Ms. THURMAN. Mr. Chairman, thank you.
I just want to note that that exchange just a few minutes ago was so good to hear. So many times we do come up here with preconceived ideas, and I think that is a shame, and if we keep our minds open, it is amazing what we can do. So what Louise had to say about you says a lot about who you are, and it says a lot, and I just wanted you to kind of know that.
Mr. Chairman, we have talked a little bit about this issue before on polycystic kidney disease. It certainly is one that I deal with on an everyday basis with my husband. He now has had a transplant, so we have been one of the fortunate groups. We also have two children, though, and because it is genetic, and this is kind of a late disease to find out what is going to happen, but there is the potential either one of my children might have it, or they might not have it at all.
The other issue from a standpoint of just policy is looking at the amount of people that have PKD, it is about 600,000 people. It can attack as many as 12.5 million worldwide, and it costs the American taxpayers about $1.5 billion annually.
I really want to emphasize this because I was a little bit disturbed after I found this out—this committee really did do some good work in this area, and they specifically asked NIH and NIDDK to redouble their efforts in this area, and that, in fact, did not happen. I know that you don't and I agree that we shouldn't be earmarking, because none of us want to see, quote, the disease of the month, but on the other side, you did make it clear we should have some redoubling. That has not happened, and I hope we can let the folks know there is some real reason why that was done that way.
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But I think also in this process sometimes that we don't always see the end results of things, or, you know, you always hear about what people want and not necessarily what has happened since you have helped them along the way, so today I have Dr. Stephen Somlo, actually from Albert Einstein College of Medicine, is accompanying me, and he is going to give you kind a little update as to where we are and why the redoubling of these efforts are so important.
[The prepared statement of Congresswoman Karen Thurman follows:]
"The Official Committee record contains additional material here."
Dr. SOMLO. Chairman Porter, my name is Steve Somlo, and I am a physician scientist conducting research in polycystic kidney disease at the Albert Einstein College of Medicine in the Bronx. It is my honor to come before you to report on the progress that I and my colleagues in the PKD research community have made in recent years.
It is my goal to convince you of the promise of this field and of the merits of redoubling efforts to ensure continued growth of funding for PKD research. The recommendation is mentioned that your committee made as recently as last year.
Whether it is the high blood pressure or the acute ataxia, severe debilitating pain, that results from the rupture or bleeding of cysts, PKD patients have a decades-long losing battle with consequences of their genetic makeup. PKD is the third leading cause of renal failure in the U.S., and our available therapies of dialysis and transplantation have their own spectrum of complications.
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As a physician, my goal is to prevent disease progression, not just to treat its ravages along the way, yet as a physician treating PKD patients, all I really can do is the latter.
Ten years ago, I resolved not to be only a nephrologist in PKD patients, but also an investigator working to discover treatments to change the course of polycystic disease. To my great satisfaction, this past decade has seen tremendous scientific progress in PKD research. I have had the good fortune of being part of this progress supported by three NIH research awards, one of which I obtained through the last round of RFA for PKD.
The application of the advances of the human genome project to the problem of PKD had been the focus of my studies. Genome chromosome 16 that accounts for 85 percent of PKD families was discovered in 1993, and its gene product, the proteins, heretofore unknown proteins, are currently under intense investigation.
In 1996, my laboratory succeeded in identifying a second gene for PKD accounting for the disease in the remaining 15 percent of families. It also uncoats an unknown protein. Working with investigators at John Hopkins, we were able to show that the two proteins, the first and second genes for polycystic kidney disease, interacted directly; that is to say, they talk to each other through direct physical contact inside cells. This discovery has profound implications for an understanding of PKD.
Most recently, my group has inactivated the mouse copy of the PKD gene and in the process has successfully reproduced the human polycystic disease state in the mouse. This achievement will enable us to study PKD in ways that we cannot do in humans. The mouse model has already taught us PKD occurs by a mechanism that had previously only thought to be operational in cancer syndromes, the so-called two-hit hypothesis.
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PKD patients inherit one bad copy of the gene from their affected parent and one good copy from their other parent. With the passage of time, the good copy also gets inactivated in some cells in the body, and this is the second hit. These individual cells with the two bad copies of the PKD gene are the ones that multiply and go on to form cysts.
The fundamental change in our understanding of cyst formation has caused us to rethink approaches to therapeutic strategies. Slowing the occurrence of these second inactivating mutations in the next 5 to 10 years could change the course of PKD in affected patients.
The PKD mouse model also provides a system in which we can develop and test novel directed therapeutic strategies without exposing patients to any risk. Therapy, whether it is small molecules, that is to say drugs, or gene replacement that shows promise in treating the disease in the mouse can subsequently be pursued for safety and efficacy in human subjects, and to my mind, this is the definition of translational research from the bench to the bedside. In my opinion, the polycystic research community is poised to make that trip within the next decade.
Perhaps our most willing partners in all this research have been the PKD patients themselves. They supported us both financially and through organ donations, and they did it for themselves and for their children.
So, Mr. Chairman, when we are moving so fast and getting so close, I hope that we can convince NIH and NIDDK to share in this enthusiasm and increase funding for polycystic kidney disease research.
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That concludes my statement.
Mr. PORTER. Doctor, I don't have your name before me. Can you tell me it again?
Dr. SOMLO. Steve Somlo, S-O-M-L-O.
Mr. PORTER. Well, thank you, Dr. Somlo. We appreciate your testimony.
Karen, I wasn't aware until you told me that they have not proceeded. I have asked staff to find out so we will know, and we will follow up on that and do what we can to straighten that out.
Thank you very much for your testimony.
Thursday, April, 1998.
WITNESS
HON. DON YOUNG, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF ALASKA
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Mr. PORTER. Don, you have been very, very patient and long-suffering in waiting for us to get to your point in the testimony. Why don't you proceed.
Mr. YOUNG. Thank you, Mr. Chairman. I would like to submit the testimony of Doug Bereuter on the same subject.
Mr. PORTER. It will be received.
[The prepared statement of Congressman Doug Bereuter follows:]
"The Official Committee record contains additional material here."
Mr. YOUNG. I ask unanimous consent to submit for the record my written statement.
Mr. PORTER. Without objection.
Mr. YOUNG. Number one, Mr. Chairman, since you have been Chairman, and when you were Ranking Member, we have asked for support from this committee on the Allen Ellender Fellowship Program, and the Close Up Foundation administrates the program. This program is probably the most—I think the most rewarding program for young people across this Nation. In Alaska, we have had 9,000 students since 1979 attend this program here in Washington, D.C. Today, I have 55 Close Up students today from all over from the State of Alaska that get a better understanding of what you and I are doing, what the committee members are doing, and how the system works. And I think that is crucially important now during this period of what I call cynicism about politics. I have had a lot of follow-up conversation with students through the correspondence and personal discussions about their attitude towards our government and towards the workings of Congress, and I have never had one that came away negative.
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So there is a request for a $3 million from you to continue this program, this scholarship program, or fellowship program, and I would suggest it is probably the best money invested. Every time I come to testify before you, I listen to all the other people testifying, and they all have worthwhile projects and worthwhile suggestions in asking you for the request of money. But I am speaking now of the future of those people who will lead this Nation, and the more we can get away from cynicism, the better off we are.
The Close Up program really does the job it was set out to do, and that is expose young people to the better parts of our government, the United States Congress, of course the administrative end of it, and the executive branch and the judicial branch.
So I can only say that without the money that I am requesting, a lot of the students across this Nation would not be able to attend. It is not a freebie, it is matched money. There is a lot of effort put forth by each student. Some of our students in some of my other areas have to go out and raise their dollars. They do a good job, but without this money, a lot of the students would not be able to come down to Washington, D.C. to see us operate.
With that, Mr. Chairman, I just want to thank you for your efforts, and I guess I can afford to be patient when it is a worthwhile project.
[The prepared statement of Congressman Don Young follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. I think Close Up does a super job, and I think all of us put young people who come to Washington at a very high priority and want to give them a good feel about what we do, and I think Close Up really helps us do that. I know that the money that they receive from our grant is only a small proportion of the money they raise and provide for young people, and I want to do my best to provide and share support for their very important mission.
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So we thank you very much for testifying and for your patients and for your advocacy for Close Up.
Mr. YOUNG. Thank you, Mr. Chairman.
Mr. PORTER. Thank you.
Thursday, April 30, 1998.
WITNESS
HON. JOHN F. TIERNEY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MASSACHUSETTS
Mr. PORTER. Congressman John Tierney of Massachusetts testifying about a building at Salem State College; is that correct?
Mr. TIERNEY. How are you, Mr. Chairman?
Mr. PORTER. Fine, thank you. How are you?
Mr. TIERNEY. Fine. I thank you for giving me this opportunity to speak before your committee and you in particular. You and I have had some involvement in the past with regard to the comprehensive schools, and I applaud you for working to make sure that that project went through.
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The public schools, I think, are critical to the backbone of this country and to our moving forth as individuals in society, but also economically. It is in that regard that I come before the committee today, because just as we are supportive of our public schools, the elementary and the secondary level, I think there is a place for us to be somewhat helpful and supportive at the college level. Salem State College is indicative of that.
I come before the committee today asking for $4.8 million for so-called smart building work to be done at Salem State College in Salem, Massachusetts. This Federal money would be used to help toward the construction and equipment cost of that project.
In the reauthorization of the Higher Education Act, H.R. 6, I am pleased to say that we were able to get language in establishing a mechanism for Title III schools for the participation of the Federal Government in such projects.
Smart buildings, if I can just define them, make provision for computer technology to be incorporated in the planned construction of a building, and that computer technology might be for multiple ports, laptops in every classroom, allow access to computer network and Internet. The classrooms' computers have wiring for hardware and software necessary to use the technology in every aspect of instruction; connects the faculty office with the college's computer network and Internet; implements computerization of the campus security, janitorial services, heating, ventilation and air conditioning; and makes available student services through kiosks in the corridors, giving them information on financial aid, class registration and tuition payments; and essentially brings us into the next century and lets us be competitive with those private institutions that are able to get enormous endowments to put these types of facilities together so we can have students that go to public colleges that qualify into Title III to have the same type of facilities going forward.
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In this particular project, the State has stepped forward and given substantial funds for the purchase of the site, which Salem State College is expanding. They have given an enormous amount. There has been a private effort to raise money for this. Salem State will be moving its business courses and section over to the performing arts area and is going to have an incubator business segment of the college campus that allows businesses to come in and start up, use the students as interns, and get new businesses going, use the technology, and have the students benefit in that way.
I think not only will the college benefit, obviously, and the students that attend, but the business community and the North Shore around Salem will be able to get people out for the work force developed and ready to go to work and to enhance the number of small businesses that have been generating so much for the economy around there. And that is really what this is about, trying to get an opportunity for students to come out ready to go to work at well-paying jobs and businesses in the area to benefit from having those students trained.
There has been a greatness of cooperative efforts. Salem State College has been around since 1854. It started as a normal school, and we have been trying to define that term since then. It is now a fully accredited 4-year college; has been for some time. It is an institution that has an enrollment of 9,200 full-and part-time students. It is well-known nationally for some of its courses in geography, in nursing, in education and in business, as well as other areas of social work and the sciences and liberal arts.
I would ask this committee give serious consideration to participating in that with the $4.8 million. I think it will be a worthwhile project, and I think it will be an indication of what we can do to share a role in making sure that people have the kind of education we talk about down here a lot to move forward and be productive.
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[The prepared statement of Congressman John F. Tierney follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. John, this is going to be authorized in the Higher Education Act that we are dealing with right now.
Mr. TIERNEY. That is correct. The language is in there, and it looks like it will be authorized, and it is a good opportunity.
Mr. PORTER. I can't speak for the East, but in the Midwest, normal schools were schools to train teachers.
Mr. TIERNEY. That's exactly what it was in Salem, and we have expanded out considerably since then. It still maintains a good national reputation, particularly in early childhood education.
Mr. PORTER. This is a fascinating concept as you described it. You know, sometimes you think you are born too late.
Mr. TIERNEY. I went there and I graduated from there, so it is particularly interesting for me to see the school expand in this way and have those kinds of opportunities for students. I went there for the reason a lot of Title III schools exist: It was the only choice that we had. It was the place I could afford and the opportunity that we could do. I really think it would be a shame for us to miss this opportunity to let those students have the kind of educational facility that others who go to tremendously well-endowed schools get on a regular basis.
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Mr. PORTER. Thank you for your testimony. We will again do our very best.
—————
Thursday, April 30, 1998.
WITNESS
HON. SUE W. KELLY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW YORK
Mr. PORTER. Congresswoman Sue Kelly of New York, testifying on the Impact Aid Program, particularly on section 8002.
Mrs. KELLY. Thank you, Mr. Chairman.
Mr. PORTER. Sue.
Mrs. KELLY. I thank you for providing me with the opportunity to testify this morning. While there are a number of important programs under your jurisdiction that I would gladly speak to, I want to focus my remarks on two specific issues that concern my district. The first one is Impact Aid; the second one is Lyme disease research.
First, I would like to thank you, Chairman Porter, for the sensitivity you have shown to the importance of funding the Impact Aid Program. Without this program, specifically the section 8002 program, the Highland Falls-Fort Montgomery School District in Orange County, New York, could not keep its doors open.
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The school district is literally surrounded by Federal and State lands and the Hudson River, leaving no room for expansion. About 93 percent of the lands within the school district are nontaxable, making it increasingly difficult for the school system to raise the revenues necessary to provide our children with the quality education they deserve.
Three years ago, the school system was struggling, laying off teachers, closing buildings, neglecting maintenance and curriculum development. The district had protracted contract issues with its teachers, had a staff with a very low morale, was experiencing strained relationships with its neighborhoods and partners. The children were using outdated textbooks, and test scores were really suffering.
What a difference a couple of years makes. Thanks to the good work of this subcommittee in the past 2 years, I come before you today to tell you about a true success story, a story of renewed community spirit and children learning in a better, cleaner, safer and healthier environment. Because of the committee, this subcommittee and this Congress, the commitment you have made to us over the past 2 years to fund the Impact Aid Program, I can today tell you all about the new textbooks and the new teachers development program that the school has that I have been able to implement. I can tell you about the new social worker they were able to hire that has affected the greater drug intervention programs that they have; the two new advanced placement classes; the eight new elective classes. This summer is the first summer they are going to be able to offer summer school for remediation.
In addition to the academic improvements, the school system has been able to address some long-neglected physical plant improvements as well. New tiling has been installed, and 20-year-old carpeting has been replaced, which, according to our school nurse, has significantly reduced the number of asthmatic incidences.
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The list of improvements goes on and on, but please don't take my word for it. I want to quote briefly a summary of the Educational Vistas Incorporated, who conducted independent evaluations of the Highland Falls-Fort Montgomery Central School District curriculum. They do this every 2 years, and this is what they said: ''The Highland Falls Fort Montgomery School District is a decidedly different district than the one visited 2 years ago. Today, while still facing a number of challenges, it has a 'renewed' teaching staff, many of whom are actively engaged in self-reflection, professional growth and school improvements. It emphasizes collaboration and partnership at the building level and at the district level.''
Still quoting: ''A caution, there is no 'miracle' performed here. The district has only begun a journey long delayed and long neglected, but it has begun strongly. The district should now commit to moving to the next level.''
These results were largely due to the renewed commitment that Congress made to the Impact Aid Program. Through the Impact Aid funds provided the school district, we have placed these schools and especially the children who attend them on the right track. It will take additional funds and time to get them where they should be, but look at what a difference 2 years of funding have made in my school district.
I join with all of my colleagues in the Impact Aid Coalition in requesting $887 million for the Impact Aid Program in fiscal year 1999, which represents a very modest increase in funding over 1998. I also would urge this subcommittee to ensure this increase is spread fairly to ensure that all impacted communities, including land-impacted communities, receive the funding that they need and deserve.
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Finally, Mr. Chairman, I would like to touch upon the importance of funding for Lyme disease research. I speak not only as a Member of Congress, but as one who has suffered from Lyme disease. This disease has reached record levels in 1996, with 16,000 diagnosed cases, and probably approximately 100,000 unreported cases, because it is very difficult for the doctors to diagnose these cases.
I strongly urge the committee to support increases in the CDC and NIH funding. I also ask that the committee encourage both agencies to renew their commitment to the study of emerging diseases, such as Lyme disease. In Congress we talk about reducing the cost of health care in this country. What we need to realize is that the most effective way to do so is to invest in medical research and prevention and education.
Mr. Chairman, those affected with Lyme disease feel abandoned. As a resident of one of the most Lyme-affected areas, I have a responsibility to see this disease gets the attention it deserves so we can stop the suffering and find a cure. Please help us.
Thank you very much, Mr. Chairman.
[The prepared statement of Congresswoman Sue W. Kelly follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Sue, that was an excellent statement. Let me say that it wasn't the leadership of this subcommittee, it was your leadership and your advocacy for funding for Impact Aid, and particularly 8002, that has made a difference in that school district, and we want to obviously put the resources there to help you make that school district even better, and we will do our best to do that.
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Mrs. KELLY. Thank you very much.
Mr. PORTER. Thank you, Sue.
Thursday, April 30, 1998.
WITNESS
HON. HAROLD E. FORD, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF TENNESSEE
Mr. PORTER. Next, Representative Harold E. Ford of Tennessee testifying regarding the Job Corps.
Harold, nice to see you.
Mr. FORD. Good to see you, Mr. Chairman.
I won't take up much of your time because I know, as a new Member, that you bring the experience and the knowledge and the commitment in more amount of time than I have been actually been on this Earth, being 27.
You are one of the main reasons, if not the principal reason, that we have a Job Corps Center in the 9th District, with the help of my father over the past few years, and I thank you for your leadership there and thank you also for your leadership on the floor as it relates to all education issues.
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I would only just really reemphasize or reiterate some of the points that I am certain you are fully aware of. Job Corps Centers throughout this Nation have really served as a force for economic and educational development for a group of young people, many of them who look like me, young African American males who have been really written off largely by a large segment of society and have been labeled as incorrigibles. But this program, as you well know, sir, has worked and has been able to reach out to many who have been locked out of the mainstream and in some cases have felt hopeless that their chances of integrating or finding some long-term participation has really been nil.
Seventy-eight percent of Job Corps participants are high school dropouts; 66 percent have never held a full-time job; 73 percent are between 16 and 19 years of age. Although Job Corps has resources to assist fewer than 2 percent of eligible youth, of that 2 percent, 80 percent leave the program to join our work force or to further their education.
I had the privilege of visiting my Job Corps Center some several weeks back during one of our most recent recesses and had an opportunity to visit with teachers who indicated it was the most pleasant teaching environment, and they have never seen students more eager to learn and to absorb than what they have experienced. These are teachers with vast teaching experiences and educators with vast teaching experiences, all attesting to the fact that Job Corps Centers work.
My Center—I shouldn't say my Center, the Center that you helped create, Mr. Chairman, is one of only three Centers in this Nation that trains young people in the computer service-computer repair industry for those jobs. The President later today will announce a 4.2 percent increase in GDP growth and credit this expansion with the robust demand for computer goods.
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You know better than anyone, Mr. Chairman. I just hope that this committee is able to fund the request the administration has asked for, the increase of $61.4 million.
Lastly, one of the reasons, I think, that they have asked for the increase, as you well know, Mr. Chairman, is the need to meet some of the child care and Head Start challenges as many of the young people move toward trying to better themselves and trying to cost us less on the front end than they will on the back end.
With that I say thank you and hope that you are able to, as you have been able to in the past, gain this committee's support and this Congress's support.
[The prepared statement of Congressman Harold Ford, Jr., follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Harold, thank you for your advocacy and your father's advocacy and others who strongly support Job Corps. We think the same thing about this program as you do, that this really works for kids that are most at risk in our society.
The thing that all of us have to do, because there is so much negative news on our television screens every night, is to get the media to look at things that work and are really inspiring and help young people find their way when otherwise they wouldn't. I think the American people, if they knew more about Job Corps, the support would be even stronger. But we put it at a very high priority, and we will continue to do so.
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Mr. FORD. These young people at the Center, Mr. Chairman, if you don't mind, are deeply, deeply appreciative of the Federal efforts. They understand where the commitment comes from, the business community back home, particularly our computer service industry. We are the home to Federal Express Corporation, which creates the lion's share of the jobs in our local economy, and they have also helped to really create and spawn a new sort of job creation effort there in the Memphis area. With the continued support of this Center and some of the other efforts under way, hopefully the region will continue to grow and live down the fact that regrettably Dr. King was assassinated in my district some 30 years ago and many of the challenges that we face.
I thank you again, Mr. Chairman, and look forward to working with you on this issue.
Mr. PORTER. Thank you, Congressman Ford.
That completes our morning's session. We will stand in recess until 2:00 p.m.
On the record, and let me retract the recess, I wanted to say on the record that Representative Pete Stark of California talked to me informally on the last vote about the matters that he wanted to testify in respect to particularly HCFA, and the funding of ombudsman services for seniors when the choices in Medicare are offered, and we will receive his testimony in the record and appreciate his advocacy.
[The prepared statement of Congressman Pete Stark follows:]
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"The Official Committee record contains additional material here."
Mr. PORTER. Now we stand in recess until 2:00.
Thursday, April 30, 1998.
WITNESS
HON. GEORGE NETHERCUTT, JR., A REPRESENTATIVE IN CONGRESS FROM THE STATE OF WASHINGTON
Mr. PORTER. We continue our hearings on the fiscal year 1999 appropriations and hearing testimony of Members of Congress.
I am pleased to welcome George Nethercutt of Washington to testify on NIH and NIDDK.
Mr. NETHERCUTT. Thank you, Mr. Chairman and Mr. Stokes. I am delighted to be here and testify today and to express my support for biomedical research and translation funding at the National Institutes of Health and the Centers for Disease Control and Prevention.
I do have a prepared statement which I would ask to be entered into the record, and I will try to summarize it as best I can.
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As the Chairman knows and Mr. Stokes knows, the incidence of serious diseases enters most of our lives at one time or another. It affects us no matter our political affiliation and race or gender.
I have had some personal tragedy in my life, relatives who have contracted serious disease. My dad died of lung cancer 20 years ago, and I have a daughter who is diabetic, and it touches all of us. That is why I have been so committed, Mr. Chairman, to seeing the greatest resources in our Nation for health care research.
The National Institutes of Health function effectively and have a mission of curing disease. The NIH research, the CDC activities are essential to finding cures and advancing better treatments for these serious diseases.
I was pleased to see last year that the final appropriations legislation increased NIDDK funding above that to NIH overall, even though it was smaller than we wish it could be, but we also got some assistance through the Balanced Budget Act for diabetes research and especially Native American diabetes research which I think will be very helpful.
Last night, I was in attendance at part of the hearing and operation of the diabetes working group, which convened here again yesterday at NIH, and was encouraged by what I saw in the time that I was there. They met from early in the morning until late at night.
This subcommittee approved legislation that directed their formation and directed that working group to look at the cures, the best evidence of cures for diseases like diabetes—specifically diabetes, and also collected great scientific minds from around the country to do just that.
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I can report to you both that the committee working group was enthusiastic, tremendous brain power, great ideas not restricted by convention necessarily but really were free thinking and being imaginative how we can chart a course to cure diabetes.
Diabetes funding has been on a trend downward. I believe it is on a trend upward now because of the seriousness, and it affects so many institutes, I think eight or nine at least, and it also affects 16 million people in our country and countless others who die or are afflicted by the consequences of diabetes.
About 2 weeks ago, Mr. Chairman, I went out to NIH and had a very good meeting with Dr. Varmus; and I sat with the representatives of the institutes, in many cases directors of the various institutes at NIH and talked to them about their mission, some of the progress they are undertaking and achieving and talking with them about my support and the support in Congress for doubling the research funds over the next 5 years. I think it is a wonderful goal, and we ought to do it.
There is an issue that this subcommittee has faced before and would look at again, and that is the issue of who has ultimate responsibility for how the funding goes. While I understand the arguments against making it a political judgment, it is the Members of Congress who have to make the judgment and answer to the citizens about how much money we spend on various diseases, and so I think Congress has a very important role to play in that decision.
We don't want to micromanage these various agencies, but there is a role that we need to play to make clear to the NIH and other research entities that there are priorities in the country that need to be addressed, and so my statement speaks in more detail about that, but I want to summarize that we have a responsibility as Members of Congress to make sure that the money is spent wisely.
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I am serving as co-chair of the caucus. We have 158 Members who have signed on, and we are delighted that it is such a force, and I think we need to really mobilize not only diabetes-interested Members of Congress but people with Multiple Sclerosis and Alzheimers and all of the other diseases out there to get on board this idea that we need to assist this great research effort at NIH.
Because I speak here today in support of diabetes, I can certainly verify the statistical information that is out there about how the disease directly causes 180,000 deaths a year and permanently 75,000 people are disabled because of diabetes. It costs us about $37.1 billion from disability, diabetes does, and it is a leading cause of many problems in our health condition in the country.
So I will just close by saying, Mr. Chairman, Lou Holtz met with me and perhaps with the two of you earlier this year. His son has diabetes and he said, ''If enough people care, you can solve anything.''
This is true. We have a lot of people who care in the Congress, and I know the two of you do and this subcommittee does, and I would just urge that additional funding be dedicated to diabetes and we move toward increased funding for NIH overall, and I thank you both for your attention today.
Mr. PORTER. George, thank you for your very good statement.
[The prepared statement of Congressman George Nethercutt, Jr., follows:]
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"The Official Committee record contains additional material here."
Mr. PORTER. I know that you know that we will do everything that we can to respond to it positively and that we share your concern that we need to strongly encourage NIH to put more resources into diseases that effect people more broadly. As you and I have discussed, we are doing that.
We think that the allocations previously were justified under circumstances that existed previously, but we think that circumstances have now changed and that there is no question that we need more money for research into diabetes and cancer and heart disease and others, that perhaps because of the AIDS epidemic and the lack of knowledge at the beginning and for some time as to how it would effect broad populations prevented us from doing that.
Now, I think, we need to move back to where we would have been and to try to make up some of that lost ground, and we can do that best by substantially increasing the money that we put into NIH and then encouraging that money be put into research and diseases like the ones that we have been discussing.
Mr. Stokes.
Mr. STOKES. Thank you, Mr. Chairman.
I would just like to take a moment and commend Mr. Nethercutt for his testimony here today. He has appeared before us on other occasions, and you have always been an ardent advocate on behalf of the diseases. I quite agree with you that diabetes is one of the most devastating diseases that one can incur.
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You mentioned the fact that most families have some type of experience with it, and I have a brother who passed 2 years ago. Although he incurred cancer later, he also had diabetes, and so I am familiar with the devastation this particular disease brings upon those it afflicts.
I appreciate so much your testimony today.
Mr. NETHERCUTT. Thank you.
Mr. PORTER. You have been a real leader, and your leadership on the task force has been appreciated, and we want to work closely with you to see if we can't all do a better job of directing and providing resources to NIH.
Mr. NETHERCUTT. Thank you very much.
Mr. PORTER. We have no other Members here. We are about to have a vote, and we will stand in recess until after the vote.
[Recess.]
—————
Thursday, April 30, 1998.
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WITNESS
HON. TIM ROEMER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF INDIANA
Mr. PORTER. The subcommittee hearing will come to order, and we will continue the testimony from Members of Congress, and in the order specified, we are pleased to welcome Congressman Tim Roemer to testify regarding the Close-Up Foundation.
Mr. ROEMER. Thank you, Mr. Chairman.
I would, first of all, ask unanimous consent to revise and extend and have my entire statement be entered into the record.
Mr. PORTER. Without objection.
Mr. ROEMER. Thank you, Mr. Chairman.
First of all, I would like to thank you and your staff and the other members of the committee for all the hard work you do and the hard decisions that you face on this committee. You have very, very many tough choices and important programs to try to fund, and you listen to the different testimony by Members of Congress all day, and we appreciate your understanding and your sensitivity and your difficult decision-making process.
Thank you again for your invaluable work you and the subcommittee members such as Mr. Stokes make on a daily basis.
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I want to start off by recommending, Mr. Chairman and Mr. Stokes, the full level of funding for the Close Up program. My statement has been entered into the record so I want to say, and hopefully in an eloquent way, how important this program is for those underserved and at-risk young students to get them involved in understanding government and eventually participating in civil responsibility.
We find out more and more every single year about the capability of young people. We find out that now two and three years old might be the best time for them to learn a foreign language.
We understand in science in order to get young children interested in becoming a scientist, you have to capture them at the third and fourth grade level. In order to play T-ball, we are now starting them, and I am a coach, at five years old.
In order to get them involved in music, the governor of Georgia is handing out tapes of Mozart to parents to play music for young people to increase their linear thinking.
We are finding out how important it is to get this early learning going, yet in education for civic responsibility and political participation which the Close-Up Foundation encourages, we are not doing as much as we might be able to.
This program is one of the few in the country that achieves the objective of getting people involved by bringing them to Washington, D.C., targeting underserved populations and at-risk populations, exposing them to Capitol Hill, showing them the good things that happen up here and then seeing them get involved later on in their lives.
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UCLA sponsored a study earlier this year that shows that only 26 percent of the freshman class thought that government was relevant to their lives, the lowest figures I believe since the study has been done.
Now that shows that we are not starting early enough and getting our young people involved in the political process, and this is a non-bipartisan way that leverages private dollars that concentrates on the most at-risk population and one that I think has done some great service for our community and country in the past, and I would strongly encourage you to consider full funding of the program, and I thank you for your time.
Mr. PORTER. Tim, thank you very much for your testimony.
[The prepared statement of Congressman Tim Roemer follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Don Young was in this morning to iterate the words that you said about Close-Up, and obviously there is very strong bipartisan support for a program that really touches all of us, and we hope we influence the young people that come to visit us as well.
Thank you for your testimony this afternoon.
Mr. ROEMER. Thank you.
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Mr. PORTER. Mr. Stokes.
Mr. STOKES. I just wanted to commend Tim for his testimony here on behalf of Close-Up. I happen to think it is one of the finest programs that I have had the chance to participate in. Oftentimes now, I have a young person who is a professional, lawyer, doctor, some other professional, and they come up and say, the first time I met you was when I came to Washington with the Close-Up Foundation, and they still recall the Close-Up program which put them in touch with Washington the first time, and it is an excellent program.
Mr. ROEMER. We will miss you, Mr. Stokes, when you go back to private life in Ohio, and I am sure that the Close-Up people will, too.
Thank you, Mr. Chairman.
—————
Thursday, April 30, 1998.
WITNESS
HON. DARLENE HOOLEY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF OREGON
Mr. PORTER. Just to inform the Members who are here to testify, we are going to go through the list as the time slots are set, and any Member who is not here at the time will then drop down in the order and have to testify later.
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Next will be Congresswoman Darlene Hooley. She is testifying on certain projects.
Ms. HOOLEY. Mr. Chairman, thank you very much for letting me have the opportunity to testify today.
I am here to respectfully request inclusion of several projects that are administered by the Departments of Health, Education and Human Services.
The first is a program called Distance Education Alliance. What it will do is link all of Oregon's higher education institutions into that partnership that will establish a degree program using existing distance technologies. Oregon is a rather rural state—and it will allow access to education for an advanced degree for individuals so they can have the ability to have access to education.
What this program is about, this Alliance, is they want to develop about 200 courses for delivery in this distant education mode. I am seeking $3 million to implement the program. This would be under the President's Learning Anywhere Any Time Program, and the purpose would be to support the faculty training, the course development and technology expenses to make those degree programs possible.
I am also seeking support for a program at Western State University, a Spanish Language Training Institute. The purpose is to offer intensive language courses to civil service and judicial personnel.
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This university is located in the middle of an area that has a lot of Hispanics and Latinos. This program would help communities in the Willamette Valley overcome significant language barriers by ensuring that our civil service and judicial personnel have the communication skills to provide those services. I am requesting $350,000 to help establish the institute, and hopefully this could be part of the Professional Development Program under the Bilingual and Immigrant Education Program.
The next thing I am looking at, is an initiative to help forge partnerships between institutions and smoothing the seams for students between educational levels.
So those students going into community colleges or colleges and those going from community colleges to higher education, it is a way to improve their transition so it is seamless. The program works to provide strong support services, develop cross-institutional faculty and student services to help ease those transitions of students between educational levels.
We have institutions already working on this, and I am requesting $750,000 for a pilot program to enable the expansion of the partnership. Again, we would be happy, once we go through this pilot project, to make sure that we spread that information throughout the United States.
Another program that we are asking funding for is the Environmental Health Science Education Program at Oregon State University. It focuses on increasing the public's ability to understand and make informed decisions on environmental factors contributing to health and diseases. I am requesting $300,000 for this program.
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Finally, I am joining the entire Oregon congressional delegation to request money for a one-time grant of $3 million to help build a Women's Health Center in Portland, Oregon.
This facility is for the entire State. It would be a distribution point for patient education materials, serve as a conduit for public education. It would be an asset to our community to improve women's health, and I urge this committee to support its construction. There are lots of partners, and we are hoping that the Federal Government can also be a partner.
Thank you for the opportunity to testify, and you have my full written testimony.
Mr. PORTER. Thank you, Congresswoman Hooley. We will consider your requests.
Ms. HOOLEY. Thank you.
[The prepared statement of Congresswoman Darlene Hooley follows:]
"The Official Committee record contains additional material here."
Thursday, April 30, 1998.
WITNESS
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HON. JAMES L. OBERSTAR, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MINNESOTA
Mr. PORTER. I am not going to comment on the testimony because it slows things down, and we are so far behind because of the votes. I will just call on each Member and listen.
Representative Jim Oberstar, testifying on breast cancer, energy assistance, library services, rural health programs and adoption opportunities. Jim, nice to see you.
Mr. OBERSTAR. Thank you very much. You just about gave my testimony right there.
You have been very kind and thoughtful for so many years on the subcommittee as I come here in memory of my late wife Jo to talk about the need for breast cancer research funds and this committee has responded to the challenge.
When Jo first self-diagnosed by accident her breast cancer, there was only about $35 million for research funding in NIH for that little-known, little-understood area of public health. In the 8 years that she coped with breast cancer treatment, surgery, radiation, chemotherapy and hormone treatments, 300,000 women died of the disease, and it finally claimed her life.
We have three daughters, and as each one turned 21, knowing that there was the history of breast cancer in her family, her mother had it, she died of it, each of those girls has gone to have a base-line mammogram. Mammograms weren't even available when Jo was diagnosed.
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That old adage, you can't throw money at problems, if you don't have money, you can't address the problems, and the level of $500 million of funding for breast cancer is a reasonable level to request. This is not throwing money at problems. This is engaging the best minds of America to approach the issue from its multi-dimensional aspects, to look at it, each researcher, from a different aspect.
I have spent days at NIH at different times going through their laboratory and their programs, the research protocols, and at other research centers across the country doing the same, and I know that it is going to be a continuing, long struggle. We are getting closer.
As Dr. Steve Rosenberg, chief of surgery at the National Cancer Institute said, we have begun to make a wedge in the bleak stone face of cancer. Our task now is to widen that crack, and this is funding to do it.
The Women's Health Initiative that is looking at a broad range of women's health concerns, funding at the $200 million level I think would be the largest research initiative on women anywhere in the world.
The early detection program for Centers for Disease Control, I appeal to the committee to give it the funding that it requires.
Energy assistance, we had a mild winter, but we in the Northern tier States, Mr. Stokes included, know that every year the glacier makes a comeback, starting in November in my part of the country. While the level of funding is in the range of a billion dollars, 10 years ago we had $2 billion funding for LIHEAP.
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The needs of elderly and low-income families have not diminished or gone away again. They haven't benefited from this great economic recovery we have had, and I know families who have been saved by the funding.
I also appeal for continuing your—at least for this year, the disproportionate share payments for Minnesota hospitals which were affected by a reporting error in the 1997 balanced budget agreement. You addressed that issue last year. The State needs this one additional year of transition to address the problem, and I think the reporting error issue will then be resolved.
The Community Health Centers Section 330 Program Grants, I just cite because I was there recently on the northern tip of Lake Superior, Minnesota, Grand Marais, a small community of 1,250 people, it is 76 miles to the nearest health facility along a two-lane road, 110 miles to the next hospital.
Without the Community Health Centers grant program, those people would be without health care, and communities die when they don't have it. It has made all the difference in the world to this little community who is totally dependent on the health facilities at that one place.
And, finally, do continue the Impact Aid program. It is vitally important to the small towns in my district, like the county in which Grand Marais is located, it is 96 percent public ownership, most of it Federal. Without the Impact Aid, they can't provide the services that the communities need. They don't have the tax dollars. Four percent of the land is private ownership. Without the aid that you provide through this program, they don't have libraries. They don't have all of the other public facilities.
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I know that my time has expired, and I appreciate your consideration.
Mr. PORTER. Jim, thank you very much for your testimony.
[The prepared statement of James Oberstar follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. The one that you mentioned that is a problem is the disproportionate share because last year we realized that this was a problem, but we felt that we could only address it on a one-year basis and that the authorizers have to correct the problem.
Mr. OBERSTAR. That is fair enough.
Mr. PORTER. We will keep an open mind on it, but that one may be a problem.
Mr. OBERSTAR. I understand, and I can appreciate that.
Thursday, April 30, 1998.
WITNESS
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HON. ELIJAH CUMMINGS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MARYLAND
Mr. PORTER. Congressman Cummings of Maryland to testify on Healthy Start.
Mr. CUMMINGS. Thank you, Mr. Chairman.
I have only one issue, a very important issue, Mr. Chairman, and I have introduced H.R. 3724, the Healthy Start initiative continuation, which would establish a permanent authorization for this program.
In my district, Baltimore, Healthy Start has been extremely effective. So often when I visit elementary schools and I see little children who unfortunately were damaged in the womb, they are starting 30 feet behind the starting line of life. It really does concern me greatly.
In our district, Healthy Start has succeeded in reducing Baltimore's infant mortality rate. The pre-Healthy Start baseline infant mortality rate of 20.1 infant deaths per 1,000 live births in a Healthy Start project area was reduced to 13 by the end of 1995, a 35 percent reduction.
Healthy Start also assisted Baltimore City in preventing instances of very low birth weight babies. According to the Johns Hopkins University School of Hygiene and Public Health, Healthy Start has lowered the incidence of low birth weight babies by nearly 67 percent.
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I believe that all of us in this Congress and most Americans believe that—they don't mind being taxed, but they want to make sure that we spend their dollars wisely and that we are efficient and cost-effective. When you think about the cost of a low birth weight baby, trying to bring that baby up compared with the money that we are spending compared with Healthy Start, there is no comparison. That doesn't even go into saving the pain and the anguish that these children go through.
In the City of Baltimore, about 35 percent of the women enrolled in Healthy Start have problems with drugs and alcohol. The evaluation data suggested Healthy Start is just as effective in women who abuse controlled substances as compared to women who do not.
On September 27, 1997, the Secretary of Health, Donna Shalala, when announcing the new Healthy Start grants totaling nearly $50 million to 40 new communities with high infant mortality rates, stated and I quote, ''The five-year Healthy Start Initiative has demonstrated what works. The best way to make sure that babies are healthier is for all pregnant women to get early prenatal care, adequate housing, and support from family and friends.''
Mr. Chairman, I also want to applaud you and Mr. Stokes and other members of the committee for having a concern about this very important initiative. I understand that we have a commitment to the American taxpayer to effectively use those tax revenues that they entrust to us. The Healthy Start program has proved to be a success. It saves lives and makes for a healthy beginning into parenthood for both low income women and infants, and so I ask that you take into consideration this legislation, because, again, I think that it has been effective. It is one of the many things that we can point to from a bipartisan standpoint that this Congress has done to really make a major difference in the lives of children and parents.
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Thank you.
Mr. PORTER. Congressman Cummings, thank you for your good testimony.
[The prepared statement of Congressman Elijah Cummings follows:]
"The Official Committee record contains additional material here."
Mr. STOKES. This testimony, Mr. Chairman, is so important because, through this particular program, we have been able to see a reduction in the infant mortality rate, particularly in the Northern communities and all of the inner cities in which the program was originally established. This is one program which has been effective in terms of making a difference, and we appreciate your testimony.
Mr. PORTER. Thank you very much.
Thursday, April 30, 1998.
WITNESS
HON. CARLOS A. ROMERO-BARCELÓ, A REPRESENTATIVE IN CONGRESS FROM THE COMMONWEALTH OF PUERTO RICO
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Mr. PORTER. Carlos Romero-Barceló of Puerto Rico, testifying on the Frank Tejeda Scholarship Program.
Mr. ROMERO-BARCELÓ. Thank you, Mr. Chairman and Mr. Stokes. I appreciate the opportunity to testify before you today.
I am appearing to discuss the Frank Tejeda Scholarship Program. I am requesting that the committee provide $5 million for fiscal year 1999 for this important program.
This March, the House Committee on Education and the Workforce voted to establish the Frank Tejeda Scholarship Program in the Higher Education Act. The Frank Tejeda Scholarship Program honors the memory of our former colleague, Frank Tejeda, who died last year while serving the 28th District of Texas. As a national leader and role model to the Nation's students, it is fitting that this program carry his name.
Under the Frank Tejeda Scholarship Program, scholarships of $5,000 per academic year for up to 4 years would be awarded to students who are proficient in Spanish and English and who want to be teachers in our Nation's public schools. The award recipients must agree to teach in public schools that have a need for teachers and other professionals and others who are proficient in Spanish. This is directed to providing the schools the opportunity to have teachers who understand the language of those students who are being taught English. Sometimes they are teaching to a student who doesn't know English. A teacher who doesn't know Spanish would have a difficult time teaching Spanish students.
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Also, a teacher proficient in Spanish would provide the ability for those students who have difficulty communicating in English with a counselor in school so we don't have children leaving school at an early age.
Congressman Frank Tejeda was a person of tremendous courage and conviction. Like too many Hispanic youth today, he dropped out of school, but he persevered. At the age of 17, he volunteered for the Marine Corps and served a tour of duty in Vietnam. For his courage in battle, he received the Bronze Star. While in the military, he received the highest grades ever in the Marine Corps Officer Candidate School.
When he returned to the U.S., he returned to San Antonio and graduated from St. Mary's University with a bachelor of arts degree. Congressman Tejeda then went on to receive a law degree from the University of California at Berkeley, a master's degree from Harvard and an LLM from Yale.
The Frank Tejeda Scholarship Program embodies the academic excellence that Frank Tejeda pursued throughout his life and his commitment to helping others achieve their personal and professional goals.
Under the Frank Tejeda Scholarship Program, funds would be awarded to students who are low-income or eligible for a Pell Grant; U.S. citizens; enrolled or accepted for admission, full or part-time, at a graduate or undergraduate level at an institution of higher education that has an accredited teacher preparation program; and can demonstrate English and Spanish proficiency. The Tejeda scholars would be students who have demonstrated outstanding academic achievement.
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From the sums appropriated for this program, the Secretary of Education would allocate to each State an amount equal to $5,000 multiplied by the number of scholarships determined by the Secretary to be available to such State, which shall bear the same ratio to the number of scholarships made available to all States as the State's population ages 5 through 17 bears to the population ages 5 through 17 in all States, except that not less than 10 scholarships shall be made available to any State.
For Hispanic Americans, it is imperative that bold steps be taken now to bridge the educational and economic gaps that separate Hispanics from the rest of the Nation. Undoubtedly, staying in school is a key to helping to improve the quality of life for Hispanic Americans. There is an urgent need to educate and train persons at the college level who are willing to go into urban and rural settings that are in need of teachers who are proficient in both Spanish and English. For all these reasons, the Frank Tejeda Scholarship Program is supported by the Congressional Hispanic Caucus.
Hispanics now are the fastest-growing population in the Nation and by early in the 21st century will be the largest minority population in the United States. The number of Hispanic school age children is growing rapidly as well. In 1980, more than 4 million Hispanic children between the ages of 5 and 17 were enrolled in the Nation's public schools. By the year 2005, this population is expected to double.
How this population of students fares in the Nation's schools will have great national implications in the 21st century and beyond. The Hispanic student dropout rate, the highest of any group in the Nation, is a matter of great national concern. The availability of well-qualified teachers who can serve the needs of this student population can make a tremendous and positive impact on the lives of these children and play a significant role in keeping them in school.
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Thank you, Mr. Chairman.
Mr. PORTER. Thank you, Mr. Romero-Barceló.
Is this program authorized by the Higher Education Act we are considering right now?
Mr. ROMERO-BARCELÓ. Yes. It is on the floor right now.
Mr. PORTER. Thank you very much for your good testimony.
Mr. ROMERO-BARCELÓ. Thank you very much.
[The prepared statement of Congressman Carlos Romero-Barcelo follows:]
"The Official Committee record contains additional material here."
Thursday, April 30, 1998.
WITNESS
HON. BERNARD SANDERS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF VERMONT
Mr. PORTER. Arriving just in time, Congressman Bernie Sanders of Vermont, testifying regarding the Social Security Administration; and it looks like you brought a significant entourage that you should introduce.
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Mr. SANDERS. These are young people from the State of Vermont. We have about five separate schools here today, and I would like to introduce the young people to Chairman Porter and Mr. Stokes and Congresswoman Pelosi from California.
Mr. PORTER. We welcome each one of you.
Mr. SANDERS. Thank you very much, Mr. Chairman.
Mr. Chairman, let me put my discussion into context, and the context regarding senior citizens is that, in my view, in the last few years the United States Congress has largely not been friendly to senior citizens if you look at the $115 million cut in Medicare that was passed last year; and the implications are now being seen in Vermont, cuts in home health care, and in veterans' care and we are seeing that in VA hospitals around the country; if we look at the consistent attacks, and I think your committee has been strong in resisting that, but attacks to cut back on LIHEAP, for example; if we look at what is going on in senior citizen housing and the fact that we are not building senior citizen housing despite the enormous backlog and waiting lists; if you look at an issue that has not been getting the attention that it deserves in that the Bureau of Labor Statistics is reconfiguring, if you like, what inflation is, and their work has resulted in a 0.7 percent reconfiguration lowering for Social Security.
Add all of those things together, I think we have not been treating seniors well, 50 percent of whom have incomes of less than $15,000 a year.
Now, having said that, it seems to me that no matter what our political point of view, we should appreciate that the Conduit Meal Program is a fantastic program. Not only is it the humane and right thing to do, but it is cost-effective.
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Conduit Meal Program deals with two issues. Number one, seniors come together for meals. Now, in Vermont, we have centers to provide meals one day a week, sometimes five days a week. What is important is not only that seniors get nutrition, good meals, but social workers see them and directors. They can say, you are not feeling well, Mr. Jones; go to the doctor.
So the Conduit Meal Program is very important. It allows seniors to socialize, and I think we can make the argument that it is cost-effective. We gain more than we lose.
Obviously, I don't have to tell you very much about the importance of the Meals-on-Wheels program. What kind of country are we if we are not taking care of low-income senior citizens who do not get enough food, who do not see people and live in isolation?
I would argue that, given the cuts that have taken place to various senior citizen programs, that, no matter what our political persuasions may be, I think it is appropriate to say that in America we are going to substantially increase funding for the Conduit Meal Program. I think it is a very good investment. If we understand that we are talking about a program which, combined, probably is 5 percent of one B–2 bomber, I think it is a good investment; and I would hope that you would stand up for America right now and say, look, we are not going to ignore the seniors any more. That is issue number one.
The second point that I would like, and with your permission, Mr. Chairman, I will give you my written remarks for the record, deals with the administration of Social Security, and we are not talking about the Social Security but the administration of.
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My reaction is that, last year, there was in the Balanced Budget Agreement, my recollection is that there was—what would amount to a 23 percent cut in the administration for Social Security.
My concern there is we will agree or not agree with what is going to happen with Social Security, but I get a real concern when folks in my office and perhaps in your office, a constituent calls and they have a problem with Social Security. Your caseworker gets on the phone, and it is going to take quite a while to get a response, and that is from a congressional office. What happens when Mrs. Jones herself says, I have a question about Social Security?
I think the evidence is pretty clear that, right now, we are not doing a good enough job in terms of having the personnel out there to respond quickly. That is not a secret. It is not just Vermont that has that problem. Why then are we cutting back substantially on the administration of Social Security?
I hope very much that this is not just a back doorway to make people feel less kindly toward Social Security. I would hope that is not the case. But it seems to me if anybody has a concern about Social Security, they should be able to get a prompt and accurate response from a qualified Social Security employee.
So those are my two concerns, Mr. Chairman; and I thank you very much for hearing me out.
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[The prepared statement of Congressman Bernie Sanders follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Congressman Sanders, I think you will find that we have not cut back on the administration of Social Security. We consider it just as high a priority as you do. In fact, we have been providing Social Security with substantial increases for the computers that they need to do their job better.
So, in any case, we do hear what you are saying very clearly; and we agree with you that it is a very high priority that people get served very promptly and efficiently by the Social Security.
Mr. SANDERS. My understanding is that, according to an analysis by minority staff, and I don't know if Ms. Pelosi and Mr. Stokes want to comment about this, but the freeze, the 2002 freeze reflected in last year's budget for discretionary funds for Social Security would result in a cut baseline of 23 percent.
Mr. PORTER. The staff tells me that it was in the budget agreement, but we didn't follow the budget agreement.
Mr. SANDERS. I am glad to hear that. So, in fact, it is a cut that did not take place?
Mr. PORTER. That is correct.
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Mr. SANDERS. That is a wise decision.
Mr. PORTER. It is a high priority.
Mr. SANDERS. In terms of the Conduit Meal Program, I think it is a cost effective and important program.
Mr. PORTER. Thank you, Congressman Sanders, for testifying today. We definitely will take your testimony into account and will be marking up as soon as we get a budget resolution which may be sometime soon and may not be. Thank you very much.
Mr. SANDERS. Thank you very much, Mr. Chairman.
This is 38 percent of our entire State's population.
—————
Thursday, April 30, 1998.
WITNESSES
HON. GLENN POSHARD, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF ILLINOIS
HON. JIM NUSSLE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF IOWA
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Mr. PORTER. I want to ask the Members who have been waiting very, very patiently, one of our Members has informed us that she has a very serious time problem, and she has the demonstration that she wants to show on the monitors that have been set up here and that they have to complete that and be finished by 4:00.
Therefore, with your permission, I would like to take Juanita Millender-McDonald—she is not here in the room?
I am sorry, I just assumed that she was in the room. Okay, she is not in the room. Let me take that all back.
Congressman Glenn Poshard of Illinois and Congressman Jim Nussle on the Rural Health Care Coalition. Thank you for your patience.
Mr. NUSSLE. Thank you, Mr. Chairman, for allowing us to come here and testify on the Rural Health Care Coalition.
I want to thank my friend Glenn Poshard who has been my co-chairman in this endeavor. I know that he is looking for another endeavor these days, but I want to tell you that he has been a true friend to rural health care issues during his tenure here in Congress, and, regardless of outcomes, we will be very sorry to lose his leadership on that coalition.
I know that you know that, Mr. Chairman, coming from the same State, but I just wanted to say that, Glenn, it has been a real pleasure working with you.
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Mr. Chairman, we have 140 members of the Rural Health Care Coalition, and we want to thank you for your leadership and the committee's leadership. In the past year, you have been very supportive of our issues and have demonstrated that in the priorities that you have placed in the appropriations bill.
By the way, most of our requests are continuing requests; and certainly they come with additional dollars. We believe that they could be heightened, but I am sure that is true with a number of different programs and entities that come to you around the table. But we did want to highlight that for you and give that to you in written form, which we have done.
Just to put it in context, and I thought it was kind of interesting, I read a news story not too long ago about a suburb in New Jersey—and this is not to be disparaging towards New Jersey; this could happen anywhere—but there is a major controversy going on involving an ambulance that took 11 minutes to arrive at the scene of an accident, of a call, and it was a major controversy that it took so long, 11 minutes, and what I found interesting about that controversy is that is health care delivery in urban and suburban areas.
In rural areas, as you know, Mr. Chairman, 11 minutes would be a Godsend. If you have a tractor roll over on top of you during planting season or you have a heart attack in your home in Ryan, Iowa, and you have to get up to Manchester, Iowa, that would be an 11-minute trip one way for the ambulance, let alone the return trip to get you to the emergency room, and that is why rural health care is so important.
We need different answers and solutions, and that is why the programs that we advocate are for flexibility and for new ideas and for grants to test new theories and new deliveries.
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One that is in the budget that I want to highlight, because the rest are continuing requests, is called the Medicare Rural Hospital Flexibility Program, which was part of the Balanced Budget Act of 1997, and it is intended to recognize that there are hospitals in rural areas that are not going to look like or be like hospitals in suburban or urban areas. They are just not going to possibly be able to provide the same kind of services and yet the emergency basis of those clinics, of those hospitals need to be there for the clients and for the citizens that they serve.
So, basically, what we are trying to do is improve the access to this essential health care service through critical access hospitals and rural health care networks; and this program through Medicare would allow us to do just that.
With that, let me just yield my time, whatever is left, to my friend, and you know this issue very well. I thank you for your support and your patience, and I will let Glenn finish off.
[The prepared statement of Congressman Jim Nussle follows:]
"The Official Committee record contains additional material here."
Mr. POSHARD. I appreciate that, Jim; and, Mr. Chairman, let me thank you and other members of the committee for being very sensitive to the Rural Health Care Caucus over the years. We are very appreciative of it.
Just to mention a few things here. The National Health Service Corps. As you know, it is very difficult for us to recruit doctors into the underserved areas of this Nation. The ability for us to help doctors get through medical schools and then relocate in these medically underserved areas is very, very critical; and we want to continue as much funding as we possibly can in that area.
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The new designation that we came up last year in the budget which you supported, the Rural Critical Care Hospital, we all know that it is not possible for a rural hospital that has 40 beds and maintaining an inpatient service, it is not possible for them to exist much longer; and the new critical care status allows reimbursement primarily for emergency room care and outpatient, which is what is going to be essential for keeping our hospitals in the small rural communities at least open to the capacity that we can continue to provide adequate services for them. That is real important.
I want to just mention one other thing in the time that we have remaining. This is not part of the Rural Health Care Caucus program, but I serve a large coal mining district, and my father's generation just saw thousands of young people go down into the mines and come up when they were 35 years old with black lung disease and be dead before they were 40–45 years old. The black lung clinics that you folks fund in the coal-producing States around the Nation are so important.
Black lung is a respiratory disease that coal miners get which is worse than anything that you can possibly imagine; and if you ever visited these clinics and saw these people barely having the capability to stay alive, you would know how important they are. So if we can maintain that $5 million funding for those clinics, it is a huge, huge issue in some poor regions of the State that are all rural. It is not in Caucus bills, but it is real important to me and the coal mining areas of the country, and I want to implore you not to cut any of those funds if you can keep from doing it at all.
[The prepared statement of Congressmen Glenn Poshard and Jim Nussle follows:]
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"The Official Committee record contains additional material here."
Mr. PORTER. Let me thank both of you for your testimony, and again we will do the best that we possibly can in each of those areas.
Let me say, Glenn, you have been, as Jim said, a tremendous advocate for rural health programs; and I am going to get a chance to say this many more times, but we are going to miss you around here.
Mr. POSHARD. Thank you. I appreciate that.
Mr. NUSSLE. Thank you, Mr. Chairman.
—————
Thursday, April 30, 1998.
WITNESS
HON. JUANITA MILLENDER-McDONALD, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA
Mr. PORTER. Now Representative Millender-McDonald is here. We are going to put you on ahead of time alone, and you have a video that you want to show us.
Ms. MILLENDER-MCDONALD. That is right.
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Mr. PORTER. Please proceed any way you want.
Ms. MILLENDER-MCDONALD. Mr. Chairman, thank you very much, and to the ranking member and all the committee members, I want to thank you for this opportunity to join me today to discuss how telemedicine can improve the accessibility and quality of health care provided to numerous Americans.
Telemedicine improves health care to patients by shortening the time between diagnosis and treatment, lowers cost for treatment by detecting conditions before they become serious or lead to emergency room visits, and expands opportunity for continuing education for health care providers. It can be used in home health care to monitor medications, blood pressure, and for more serious conditions such as diabetes, which causes blindness, kidney failure and amputations among far too many African-Americans today.
Telemedicine can also be used to educate and care for the underserved communities in the areas of pediatrics, prenatal care, cardiology, depression and dermatology.
In addition to the immediate health benefits and long-term financial savings that are natural outcomes of this medical care, telemedicine creates jobs. The telemedicine sites can provide jobs for those who are moving from welfare to work through technical training and the use of telemedicine equipment. In fact, a telemedicine site that is run by Drew University in my district has done just that.
I have Dr. Charles Flowers, who is the founder of the first-ever urban telemedicine site in the country, who is joined by two women who have made the very successful transition from welfare to meaningful, self-sustaining and rewarding employment. This was launched in 1996.
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The Drew University and the Community Development Commission County of Los Angeles' telemedicine site is focused on providing preventive eye care and treating serious eye conditions. It is located in a public housing unit and has already served hundreds of patients, the majority of whom made their first visit for an ophthalmologic examination at this site. Dr. Flowers and his colleagues at Drew University have diagnosed hypertension retinopathy, cataracts and preventable blindness caused by HIV, which continues to be the number one killer of African-American women aged 25 to 44.
I would like to have Dr. Flowers demonstrate how this urban telemedicine project works.
Dr. Flowers.
[Telemedicine demonstration.]
Ms. MILLENDER-MCDONALD. As you can see, the telemedicine site, as with many others throughout the country, provides the medical attention that is not only equivalent to, but oftentimes better than a regular physician's visit. By taking a picture of the eye, Dr. Flowers or any other doctor has a visual image of the eye that is saved on a regular personal computer that can be used in the future for follow-up treatment or additional diagnosis. This is a clear benefit over doctors relying on their memory and their notes.
This urban telemedicine site helped numerous people in and near my district, while this project has provided a critical service, as Dr. Flowers noted. Telemedicine, and urban telemedicine in particular, improves the rate of early diagnosis, enhances disease surveillance and closes the gap between the poor, underserved and predominantly minority communities that are continually denied access to health care or are provided with less-than-adequate health care.
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I want to thank you, Mr. Chairman, and the ranking member. I know that you are committed to improving this Nation's health care in the most cost-effective way. I hope after today's telemedicine demonstration you are as compelled as I am to ensure that we provide the necessary funding for both rural and urban telemedicine for those most in need.
Thank you very much.
[The prepared statement of Congresswoman Juanita Millender-McDonald follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. I can tell you right now, Congresswoman Millender-McDonald, that we are just as impressed as you are with the technology, and its application fits right in—we just had the Rural Health Care Coalition, Jim Nussle and Glenn Poshard, and it fits right in with what their needs are as well.
Ms. MILLENDER-MCDONALD. Thank you. We have worked very well with the rural community, and so thank you very much for this opportunity to come before you.
Mr. PORTER. Thank you.
Mr. Stokes.
Mr. STOKES. I just want to associate myself with your remarks and concur. I want to compliment you on your statement and how impressive the presentation is and how much it ties into our work.
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Ms. MILLENDER-MCDONALD. Thank you.
Mr. PORTER. Thank you, Mr. Stokes.
—————
Thursday, April 30, 1998.
WITNESSES
HON. RANDY ''DUKE'' CUNNINGHAM, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA
HON. CHET EDWARDS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS
Mr. PORTER. The Impact Aid Coalition, represented by Congressman Duke Cunningham and Chet Edwards.
Mr. EDWARDS. Duke had to leave because of another meeting, Mr. Chairman.
Mr. Chairman, I will be very brief because I know that time is limited.
Two things I would like to say in addition to submitting Mr. Cunningham's and my testimony.
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First, I wish any cynic about Federal programs would have sat here as I did through the last number of witnesses talking about black lung clinics, Healthy Start programs and medical and breast cancer research at NIH. I have great respect for the work of this committee, although I do not envy you in having to weigh these incredibly difficult priorities.
Quite frankly, I was one of those voting against the highway bill because I was afraid that, ultimately, it would take money away from the incredibly important programs that you are supporting.
The second thing I want to say to you, Mr. Stokes, is thank you for your leadership on the Impact Aid program. Mr. Chairman, you have especially gone the extra mile to speak for those who otherwise wouldn't have a voice, and of all of the deserving groups in America I can think of few more deserving than the children of military families.
I am going to catch the first plane home so I can be with my children, because I hate being away from them for 3 days and 2 nights, but yet, in just a few weeks, I am going to have to see 2,000 to 3,000 parents off in Fort Hood in my district who will be serving their country at the President's request in Bosnia for the next 6 months, and I can't imagine leaving my 9-month-old baby now and coming back when he is nearly a year and a half.
I don't think that we can put a dollar value on the kind of sacrifice those military children make; and, as both of you know, because of cuts in the defense budget, military families are spending more time away from their families today than they did a year ago or 2 years or 3 years ago.
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The final point I would say is, considering the number of Native American children served by this program and the fact that one-third of our military families are minorities, the Impact Aid program is not only good for helping military children, Native American children and minority children and improving the ability to bring the best and brightest in our military, this program is truly one of the largest minority education programs in America—regardless of race or background. I can think of few groups more deserving than those who make the sacrifices of our military children.
For those reasons, I would urge you for full support of the requested budget this year. Most importantly, I want to say thank you. The program would not be where it is today had it not been for your help and the work of this committee.
[The prepared statement of Congressmen Randy ''Duke'' Cunningham and Chet Edwards follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Chet, I very much appreciate your testimony and also your tremendous advocacy on behalf of Impact Aid which has been constant throughout all of the time that we have been in Congress.
I wish that the President had done a little bit better job for us because it makes—even though we will tell you we don't listen very much to the President's numbers, it makes it more difficult for us to get to the kind of position where we want to be in the absence of strong support from the White House.
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Mr. EDWARDS. I would like to find, with your help, Mr. Chairman, the person down in the bowels of the OMB office that each year zeros out Part B Impact Aid. It has happened for years now, but I understand your comment.
Mr. PORTER. We will do the best that we absolutely can on this.
Mr. EDWARDS. Thank you. You always have.
Thursday, April 30, 1998.
WITNESS
HON. NANCY JOHNSON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CONNECTICUT
Mr. PORTER. There is a second bell already rung. We are going to have to stand in recess.
Mrs. JOHNSON. Can I just make my presentation? I am going to have trouble coming back.
Mr. PORTER. Sure. Congresswoman Nancy Johnson.
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Mrs. JOHNSON. I think I can do this in 2 minutes. Thank you very much.
Other members of the Caucus will testify when you reconvene, at least I suppose that they will, but I want to go through, quickly, a few things. I will just enumerate them and leave my longer testimony.
I have testified before you many times in support of Title X funding being. I feel as strongly about Title X funding as I ever have. There are more and more low income women depending on these clinics for their primary health care. Likewise with the Community Health Center program. That is just critical to the well-being of our inner city families.
The Office of Women's Health has done an enormous amount to reach out and develop national centers of excellence, women's health information centers, improve the quality of mammograms, and is about to launch a national osteoporosis education campaign, a totally preventable disease with sufficient education.
I want to mention two other things.
NIH funding. I know how you are committed to NIH funding. I have a little bill that needs attention, and we hope to get it through the Congress this year. Because, as we increase NIH funding, we must also provide better support for clinical research because the managed care competition has pressed down on the resources of our medical centers to support clinical research, and the system of clinical research has atrophied. It is critical to translating to basic research into pharmaceuticals and other things that will improve the quality of our health.
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Also, for NIH research, please, we have to have some money for contraceptive research.
NIH has to be reminded that that is one of the legitimate areas of research. Because they have dedicated so little attention to it, the private sector dollars have atrophied and, to this day, sterilization is the most common form of contraceptive, 42 percent. It is really an outrage.
Lastly, education; I would urge you to focus on special ed. Increase the money for special ed. Then towns can hire more teachers and fix their buildings and do what they need to do. But if we could somehow find the money to get special ed up to 40 percent, then communities like mine, a small city of 70,000, could have a lot of choices, including private property tax cuts.
Very briefly, the President cut the Services Block Grant money, critical as we try to get people off welfare, cut 20 percent. I know how hard it is to add it back, but if you could that and pay attention to the need for better day-care funding. Those two things, the child care and development block grant money, those two things are critical to the success of welfare reform. If we don't have funding for the vouchers for low-income working people, then we can't support people in getting off welfare. No one can pay day-care for three kids on a minimum wage job or starting job.
I know how hard it is to get the social service dollars back; and I suppose, in some ways, the day-care dollars are more important, then voucher dollars, but that group of people is really terribly important if independence is going to succeed. Thank you very much for your attention.
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Mr. PORTER. Thank you, Congresswoman Johnson.
We will stand in recess for these votes.
[The prepared statement of Congresswoman Nancy L. Johnson follows:]
"The Official Committee record contains additional material here."
Thursday, April 30, 1998.
WITNESS
HON. CHARLIE RANGEL, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW YORK
Mr. PORTER. The subcommittee will come to order.
We continue our hearings of Members of Congress, with the Congressional Black Caucus; and Congressman Rangel, for the moment, you are able to——
Well, Congresswoman Millender-McDonald has already testified. She can testify again if she would like.
Ms. MILLENDER-MCDONALD. With reference to HIV and AIDS.
Mr. PORTER. No, this is the Black Caucus. Then we are going to have the Women's Caucus after that.
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Ms. MILLENDER-MCDONALD. However, I am a member of the Congressional Black Caucus.
Mr. PORTER. Well, you can talk on either one. Why don't you testify now on whatever you would like to add to what you testified to before?
Mr. PORTER. Representative Rangel.
Mr. RANGEL. Mr. Chairman, thank you so much for having these hearings and allowing the Congressional Black Caucus to be here and also to, once again, publicly thank Mr. Stokes. In my opinion, Mr. Stokes will always be with us. Mr. Chairman, I would like to thank him for his sensitive leadership and inspiration he has given to our Nation over the years he has served and, most importantly, on this committee.
It is always a problem when someone is testifying and wondering how far they have to go in the facts because they don't know whether the person listening understands how serious the problem is. But when you see that Lou Stokes is around and the life that he has given to these problems in trying to find some solution, it makes our political lives and legislative lives a lot easier.
I am here to advocate that, wherever you can, try to find adequate appropriations for education and drug rehabilitation. I cannot think of a more serious problem that our Nation is facing as we move into the next century than the moral indictment that we have in jail of a million and a half young people.
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I remember when I was briefed before I went to Cuba with the Pope, and I was asked, if you see Mr. Castro, make certain you bring up the question of political prisoners. I said I don't mind bringing up that question, but what happens if they ask us about our one and a half million political prisoners?
Because the truth of the matter is that we are talking about hopelessly unemployed young people that really have given up on their lives, and we find our country moving more to give priorities on the local, State and Federal level to jails than they are to education. It seems to me that we cannot sit down at the table of international competition with this heavy burden on us, losing out on productivity, losing out on revenue and that, at our present costs, just talking about the jail maintenance, of $350 billion a year.
In New York City, we pay $84,000 a year to keep a bum kid in detention, and it is hard for us to get more than $7,000 a year to keep a kid in school. If we can get these youngsters in school to even dream and to believe that they can become part of the general society—these are the kids that are not making the babies, doing the drugs and doing the abuse. They are dreaming, they are moving and they are providing an exciting contribution to America.
But if we give up on these kids in school, and the school budgets are a total disaster, then they find themselves in the street, without role models, without jobs; and, quite frankly, drugs and violence is not a serious problem for them to deal with as many, many kids are going to more funerals than they are to graduations.
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I don't know what it is going to take to jolt this country into believing that this is not just a racial community problem, it is a national problem. It has economic impact.
This committee has the ability to establish priorities through appropriations. We can go to the floor and talk about what is not happening in the District of Columbia, but I had hoped that maybe if they made the District of Columbia a model city, with model public schools, with model job training and model opportunities, as we have the greatest minds in the world here in the Nation's Capital, that maybe the other cities could see the potential that we have.
But if we are going to fight as to who is getting the next prison and ignore the needs of our kids, you can be assured that the prison population will increase and that our competitive edge will decrease, and the differences between those that have and those that don't have is going to widen, and when the kid doesn't give a darn about living, then the rest of us got a heck of a problem to live with.
So, Mr. Chairman, you have proven your sensitivity on these issues. I guess the real question is, what can we do to get the message out there that this is not a parochial interest; indeed, it is a national security interest.
Once again, Mr. Stokes, you have done far more in the time you have been here than I could ever dream about doing; and I guess all of us will have to try to get together and fill the big shoes that you leave here.
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Thank you, Mr. Chairman.
Mr. PORTER. Thank you, Congressman Rangel.
[The prepared statement of Congressman Charles B. Rangel follows:]
"The Official Committee record contains additional material here."
Thursday, April 30, 1998.
WITNESS
HON. MAXINE WATERS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA
Mr. PORTER. Congressman, Millender-McDonald.
Ms. MILLENDER-MCDONALD. I would like to refer to our chairwoman for her remarks.
Mr. PORTER. Congresswoman Maxine Waters of California.
Ms. WATERS. Thank you very much. I appreciate that.
Chairman Porter, I appreciate the opportunity to be before you this afternoon. But, I certainly do appreciate Congressman Stokes, who organizes this panel of the Congressional Black Caucus every year. Not only does he provide leadership as we address our needs here in appropriations, but he provides leadership for all of us in our caucus and, of course, in the Congressional Black Caucus as well as the Democratic Caucus and this entire House. As a matter of fact, each time I have to admit that he is retiring, it makes me sad, because his leadership is going to be sorely missed.
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Let me just say, having the opportunity to come before you today, I would like to follow up on the testimony that you just heard. Each time you have seen me come, I have made a case for funding our efforts to get rid of drugs in our community.
It is no secret to anybody that the Congressional Black Caucus, in the development of its agenda for the 105th Congress, made the eradication of drugs our number one priority; and we have been saying it over and over again, not only in all of the relevant appropriations subcommittees and committees but in all of our public speeches and everything that we do. We have tried to sound the alarm that America must be about the business of dealing with the eradication of drugs.
So with that being our number one priority, with 27.8 million Americans needing treatment, the untreated substance abuse costs America more than $167 billion annually in lost productivity, law enforcement, criminal case processing and health care.
We are here in support of SAMHSA. The President's request is $40.5 million, but particularly important is the request to increase the substance abuse block grant by $200 million. We think this is very critical to meet the current treatment gap.
Federal block grants provide about 44 percent of all national funds for substance abuse and supports treatment for some 3.8 million persons, and it is vital for local and State organizations and agencies trying to help people take back their lives from the ravages of drug addiction and prevent our youth from turning to drugs.
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Let me just move on. We have had a debate on the floor of Congress, I guess it was just a day or so ago, about needle exchange. Well, whether we approach the problems of HIV and AIDS from one direction or the other, there are people who believe that needle exchange will make a difference. There are people who take the opposite point of view. The fact of the matter is, we have got to be serious about this issue. We have got to take our heads out of the sand. There are dramatic increases in HIV/AIDS infection and really is devastating the African American and minority communities.
AIDS is now the number one killer of African Americans between the ages of 25 and 44, and we believe that the Federal funds must go where the problem is.
What we are finding, in addition to all the work we do here to try to get those funds into our communities, something is wrong in the system that is not allowing our local groups to access the dollars in the way that they should.
I called together all of the AIDS groups in my community over a year ago to find out why I was constantly getting calls about the inability to get dollars to deal with the problem. Well, what I discovered was this:
When the money goes down from the Federal Government to the State, each of the States have different systems by which to get the money into the community, and you have got to now be sophisticated and learn how these systems work, and the people who manage the systems have got to be open to allowing new people to come in and not just those who started early in this funding game.
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So the commissions and the task forces that design the RFPs and change the direction, sometimes from treatment, from outreach to treatment, they do this oftentimes without some of the very local groups knowing what direction the funding is going in, and they miss the ability to respond to a request for a proposal, and they are left out there trying to serve populations.
I think, as we look at this funding, we are going to have to be advocates for several things, technical assistance and the kind of outreach and education that will help to teach communities about the systems that impact their districts.
In addition to that, let me make a case for the trauma that we are experiencing in the African American community as it relates to almost every disease that you can mention.
The papers are constantly reminding us or alerting us to the fact that African Americans are dying at high rates for cardiovascular diseases, HIV and AIDS. We are high on the list for diabetics, even though I don't think we are number one. But we are right up there with a lot of amputations taking place, you name it.
In almost every category of disease, African Americans are number one, and we get less treatment. We can't get the transplants, many of the life-saving therapies and new technologies that can save lives. We are the last to get it.
I was reminded of this attending the Health Brain Trust that has been led by Mr. Stokes for so many years, and I sat there, and I became overwhelmed with hearing the information one more time. So the President, as part of his race initiative, has included a proposal for $80 million to set up some demonstration projects, to foster more outreach and access to health care in minority communities. This is desperately needed.
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African Americans are dying from preventible diseases, and the money that the President is requesting would be a portion between the Centers for Disease Control and the National Institutes of Health and other agencies within Health and Human Services.
I wish that I could come before this committee this year or in the next few years and say, Mr. Chairman, it has been done, we are making headway, but today I can't say that. Today I am overwhelmed, somewhat frightened, but determined that we direct the resources toward these problems, that we get on top of the problems; and, of course, your decisions are crucial and critical to our ability to do that.
I appreciate your listening one more time, but I would appreciate even more your support for these and other initiatives that will help with the problem.
Mr. PORTER. Congresswoman Waters, thank you for your statement.
[The prepared statement of Congresswoman Maxine Waters follows:]
"The Official Committee record contains additional material here."
Thursday, April 30, 1998.
WITNESS
HON. JUANITA MILLENDER-McDONALD, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA
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Mr. PORTER. You are the chair of this panel. I would plan to call on people in the order of their arrival, but you might want to vary that. I will follow your lead on that.
Ms. WATERS. Oh, please, in the order of arrival would be fair.
Mr. PORTER. That would be Congresswoman Millender-McDonald.
Ms. MILLENDER-MCDONALD. Thank you so much, Mr. Chairman; and let me please associate myself with the testimony that has taken place here already.
We do know that education is the liberating tool that would bring people out of welfare to work. We recognize that under the rubric of education comes job training, comes counseling, comes after school programs; and we are really encouraging you to encourage all those on this panel, on this committee, to be sensitive to the needs.
We come here every year asking for the same thing, so, obviously, that money is not coming down to where it is really needed. It is needed solely in our communities. We are trying to fight the drugs, HIV and other serious diseases; and we cannot do that without help, without resources, financial and other resources. So I just ask you, you have been very sensitive to the requests that I have made before your committee since I have been here, and I ask that you continue to do that.
We are losing a giant among us. Mr. Stokes has been a national leader. I knew him before I got here, and I tell you, I look up to him all the time, not because he is six whatever but because he has made giant steps in this House, and he has certainly served us well. We want to continue to make sure that his presence is here on this committee when we come before you touting the critical concerns that we have about the ills of our community.
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I did not come with a prepared speech, but when you call the Congressional Black Caucus, of course I am a member of that, and I do thank you very much for this opportunity.
Mr. PORTER. Thank you, Congresswoman Millender-McDonald.
Thursday, April 30, 1998.
WITNESS
HON. JOHN CONYERS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MICHIGAN
Mr. PORTER. Next would be Congressman John Conyers.
Mr. CONYERS. Thank you, Mr. Chairman.
Say it isn't so, Lou. We may have to use extraordinary means to get you to reconsider. This is one of the few times I have disagreed with your judgment in these 20-something years.
But I come here on a local note, just to tout where some of these Health and Human Services appropriations go in the Departments of Labor and Health and Human Services. In Detroit, there are three areas that I just want to mention; and my remarks will be in the record.
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The Focus: HOPE job training center, that serves as an international model, Mr. Chairman. They started off with the late father, Bill Cunningham, started off feeding, and then he went into pharmaceuticals, and then he started doing some kind of job—he was getting a few labor grants for jobs, and then he started pulling in the retiring vice presidents and sometimes CEOs of the auto corporations, and then the training program grew from just apprenticeship to an engineering-certified, degree-granting institution. We have had everybody in there from the President and Colin Powell; many of our colleagues have come in. The late Secretary Brown took this plan over to South Africa to present to President Mandela's government. When the students finished this really grueling program, they walked across the stage into the arms of an employer.
If you have an engineering degree from Focus: HOPE, you have a degree that is more welcome in the ranks of the auto industry than the degree-granting institutions of Wayne University, U of M, and MSU. Because this has been developed by auto management executives, so it is tailored exactly for what they need this kind of skill for.
The other success story in metro Detroit is the Job Corps Center. It has really done great work with kids through 16 to 24. They receive a basic education plus vocational education, plus counseling, plus placement. So it is a really gratifying institution.
The other is the medical grants that have come our way. Henry Ford Hospital has research grants for vision research, so it was no accident that the senior senator of Michigan brought the Chinese dissident, Wang Dan, who was flown straight into Detroit to the Henry Ford Hospital, for the very necessary treatment that he needed.
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On the policy front, we are asking the committee to look into the inability of HHS to allow its community development corporation grantees to retain their assets, which of course allows them to grow. Example, if a development corporation happens to make a profit off of their enterprise, it shouldn't be required to return the money to HHS. I mean, it seems to me that this undercuts the entrepreneurial spirit that we spend a lot of time around here promoting. Development corporations ought to be permitted to retain and reuse the money.
So I am happy to join and affiliate myself with the remarks of our chairperson, of the gentlelady, Ms. Millender-McDonald, from Los Angeles, and all of us who have really, under Mr. Stokes' guidance, have provided some of the fundamental basic policy directions in the delivery of all of these very important services in health and in labor as well.
Thank you for allowing this intervention.
Mr. PORTER. John, thank you very much.
[The prepared statement of Congressman John Conyers, Jr., follows:]
"The Official Committee record contains additional material here."
Thursday, April 30, 1998.
WITNESS
HON. EDDIE BERNICE JOHNSON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS
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Mr. PORTER. Next, Congresswoman Eddie Bernice Johnson of Texas.
Ms. JOHNSON. Thank you very much, Mr. Chairman.
I serve as an officer in the Caucus and the vice chair of the Health Brain Trust of the Caucus; and I want to just say, very quickly, the uniqueness of program needs for the minority community is that the population that is becoming infected by HIV/AIDS now is a population that many of us don't come in direct contact with. It is not like addiction to smoking where professionals will see other professionals and they can talk about it or even the addict that is a professional.
This is a unique population because you have to go into very difficult areas, into specific communities and neighborhoods and areas to attempt to find the people.
Many of the addicts, and this is what is causing most of the infection now with women and children, don't have that information. That was the value of having the needles. Because just as you can't stop smoking without help and you can't stop prescription drug addiction without help, you really cannot stop other drug addiction without help. It becomes an illness. It becomes a way of life. So that is one of the uniquenesses, that any poor population, especially a minority population, has to be individually targeted in order to touch that particular population.
What we are dealing with now is block granting going to the States. We don't have as much expertise in the black community in grant writing. We have not had the experience. We have not been doing it as long. And, as a consequence, our population that is infected is growing very, very rapidly.
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It is being transmitted through sexual contact and needle infection of men to wives and children. We have the largest number of children being born infected with that virus. The incidence among black women now is higher than their population percentage in the population. It is serious.
Somehow we have got to educate our colleagues well enough to understand that some specific areas must be considered when you are attempting to get to a population that cannot be accessed in any other way except one on one, people actually going to the street and finding these people and going into particular isolated neighborhoods, where they tend to be, and without the knowledge of how they can help themselves and often without the knowledge that they even carry the virus.
I thank you so much for your past consideration. I thank you for the time.
Mr. PORTER. Thank you, Congresswoman Johnson, for your good statement.
[The prepared statement of Congresswoman Eddie Bernice Johnson follows:]
"The Official Committee record contains additional material here."
Thursday, April 30, 1998.
WITNESS
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HON. DONALD PAYNE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY
Mr. PORTER. Congressman Don Payne.
Mr. PAYNE. Thank you, Mr. Chairman.
Let me say, first of all, that we really appreciate the support that we have gotten from this subcommittee through the years and appreciate your interest in our issues, and we are simply Stokes soldiers out here trying to carry this on to victory. I don't know what we are going to do without our esteemed leader, but we will have to come up with—maybe it will take 10 of us to step in his shoes, he is such a great man.
Let me also commend the Chairperson of the Congressional Black Caucus for her fine leadership.
Let me just move quickly into a statement that we all know that we are privileged to be living in a time of great prosperity in this country, experiencing unprecedented economic growth and the lowest unemployment rate in decades. Unfortunately, this prosperity has not spread to our inner cities. In fact, the overall unemployment rate for African American teenagers continues to hover around 30 percent. In urban and rural areas of concentrated poverty, joblessness is even more pervasive.
Surveys conducted by the Department of Labor and selected inner city neighborhoods in Chicago, Houston, Los Angeles, found unemployment rates for out-of-school youth of only 39 percent, with only 29 percent employed full time. Now is the time the economy is strong to begin addressing the issues of joblessness and poverty in our Nation's most impoverished areas. If we can't do it now, we will never be able to do it.
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The effects of joblessness and poverty on our society are staggering. I believe that education and employment are the keys to fighting poverty in racial and ethnic inequities in our country.
Therefore, I come before the subcommittee today to support the Department of Labor's $250 million appropriation for the President's Youth Opportunity Areas initiative. This initiative specifically addresses the issues of poverty and joblessness. It targets funds directly to high-poverty urban and rural areas, and its goals are to increase the employment rate of out-of-school youth ages 16 to 24 in high-poverty neighborhoods from the current levels of less than 50 percent to a level of 80 percent—that is in the goals of this bill—equal to what we would find among youth with at least a high school diploma in nonpoverty areas. The Department of Labor estimates that 50,000 youth could be served at this funding level of $250 million.
The Youth Opportunity Areas initiative should have strong appeal to both Democrats and Republicans, because its main emphasis is work, and I think all of us believe fundamentally in the importance of work and work effort. It also has a strong emphasis on the private sector for employment, so, therefore, the core of this initiative is working to place and keep out-of-school youth in private sector jobs.
The Department of Labor has made three initial pilot programs. One is in Boston, one is in New York City, and one is in rural Kentucky.
The Houston site, in particular, is very promising because the program has 14 case managers. Job developers are working with youth. They have placed 220 persons in jobs, 150 other youngsters are working in other areas, 78 are enrolled in job training, and 60 have GED classes, and another 60 are at the point of getting work. This is a specific pilot that we could look at. It is quantitative. We can see that it works.
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So, once again, I just appeal to you that the Youth Opportunity Areas pilot sites could be duplicated and replicated if we can get the $250 million that the President is asking for.
I have some other material, but since there are other members of our committee I would simply, once again, thank the committee for allowing us this opportunity, once again, we appreciate your previous support; and we hope it continues in the future. Thank you very much.
Mr. PORTER. Thank you, Don.
[The prepared statement of Congressman Donald M. Payne follows:]
"The Official Committee record contains additional material here."
Thursday, April 30, 1998.
WITNESS
HON. MAJOR OWENS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW YORK
Mr. PORTER. Next, our colleague from New York, Representative Major Owens.
Mr. OWENS. Mr. Chairman, members of the committee, I want to thank you for this opportunity; and I am going to be brief and not repeat things you know very well.
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I want to talk about the TRIO programs, and you are quite familiar with that. You have been a guardian of this program and nurtured it along through some very difficult periods while other programs were being cut. I am here to talk about the fact that everybody agrees on the Education and the Workforce Committee that this is an exemplary program that works. The Higher Education System Act is now being considered on the floor. We were there until midnight last night, I understand, and will be back next week.
It is important to note that H.R. 60 is basically a good bill. My problem is, I think we missed some golden opportunities to move forward; and, most of all, we should have provided more opportunities for more people to go to college.
When you consider how complicated the world is becoming and the fact that we can point to specific areas where there are large shortages now of trained personnel, especially in the information technology industry where there are now about 300,000 vacancies right now and they expect, in the next 3 or 4 years, you will have as many as a million vacancies—these are unfilled positions. They project there won't be people coming out of college who will fill them if you keep the present number of people in college at the same level.
We need more people going to college. It is true we have a lot going in this country, more than most industrialized nations, but still less than 10 percent of the population goes to college. Certainly we want the segment of the population that has been locked out before, those people whose parents didn't go to college are the ones that TRIO focuses on. TRIO, which now, as you know, is no longer TRIO, it is about six different programs, but the heart of TRIO is still Talent Search and Upward Bound, and it works.
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The authorizing committee did a very unusual thing when we had it before us. We voted unanimously, both parties, to increase the TRIO program from the level of $560 million down to $800 million. The authorization has been raised to $800 million by unanimous consent on the authorizing committee, which held fast and didn't increase anything else, by the way. But it recognized it works.
There was a discussion, some people felt the TRIO programs have proceeded very well, and they wanted to disqualify and defund some of the existing programs so that new areas where people had been disadvantaged and are not as sophisticated and didn't get in on the proposal writing and qualify first, they should be given preferential treatment and funded instead of the old areas.
We are not in favor of that, and that was rejected by the committee. Instead, we unanimously authorized an increased amount of money. And although we didn't have a vote on it, there was a general sentiment that the increased money, the new money, should go to areas, and they should be picked on the basis of the most disadvantaged areas that had been left out before, who had not been funded before, and some kind of system should be developed to guarantee those people get a fair share.
So we would like to see the Appropriations Committee, which has always been very supportive of TRIO, follow through on the unprecedented, bipartisan cooperation of the authorizing committee and sustain the $800 million funding we have asked for.
I would appreciate your efforts in direction.
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Mr. PORTER. Thank you, Major.
[The prepared statement of Congressman Major Owens follows:]
"The Official Committee record contains additional material here."
Thursday, April 30, 1998.
WITNESS
HON. ROBERT SCOTT, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF VIRGINIA
Mr. PORTER. Congressman Robert Scott of Virginia.
Mr. SCOTT. Thank you, Mr. Chairman.
I am pleased to join my good friend, Louis Stokes, in his tireless effort to improve the health of disadvantaged individuals and groups. I am sure you will agree with me when I say that, as a result of his efforts and leadership, there is a much greater awareness in Congress and in the Nation of the health needs of disadvantaged children and adults.
We held a Congressional Black Caucus Brain Trust on Health last Friday; and, unfortunately, it went much longer than we had anticipated because all of the 200 participants there felt individually compelled to go on and on about the accolades for the leadership and hard work of the chairman of that Brain Trust, Congressman Stokes, and how disappointed they were at the news he is not seeking reelection. And because of those accolades—I mean, you tried to stop it, and somebody else would jump up and go on and on about the hard work. So we have a lot of work to do in joining the others in expressing their dismay that Congressman Stokes is not running for reelection.
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Mr. Chairman, while the health status in the general population of the United States has improved, the health indicators for minorities overall and African Americans in particular have not kept pace. We heard at that Congressional Black Caucus health forum a long list of disparities in health status indicators between disadvantaged minority populations and the general population.
There are three specific initiatives before the subcommittee that will help close those gaps: the Healthy Start program, Minority Health Professions Training Initiative, and the Youth Violence Prevention.
The Healthy Start program has been recognized and funded by this subcommittee, started as a program to improve infant mortality rate in high infant mortality communities. It has brought a significant drop in infant mortality and low birth weights.
The second initiative, research has shown that most health care to minorities is provided by minority health professionals. So another way to effectively address the disparities in health status is to increase the number of minority health professionals. The program, under the Disadvantaged Minorities Health Improvement Act of 1997, designed to increase the number of minority health professionals, is an important initiative to achieving that goal.
I would also ask that the subcommittee support funding of the Youth Violence Prevention Initiative, developed by the gentleman from Ohio. Violence has reached almost an epidemic proportion in some of our communities, and far too much of it involves young people on both sides of it. Research has shown that early, comprehensive, family-based interventions for at-risk youth will have a significant impact in reducing violence and other crimes and at a much lower cost than the ineffective, after-the-fact approaches on which we are now spending billions of dollars.
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Mr. Chairman and Mr. Stokes and Ms. DeLauro, I appreciate the opportunity to provide this testimony and hope you see fit to fund the Healthy Start program, the Minority Health Professionals Training and Youth Violence Prevention Initiatives.
Thank you, Mr. Chairman.
Mr. PORTER. Thank you, Bobby.
[The prepared statement of Congressman Robert C. Scott follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Lou might be reconsidering his decision here. I don't know. Lou, would you like to respond?
Mr. STOKES. Thank you, Mr. Chairman.
Mr. Chairman, let me take just a moment. You have been very gracious with your time that you have extended to each of my colleagues; and I don't want to take up too much time, particularly knowing you have got to make a very important call.
But, I do want to take just a moment to say to my colleagues in the Congressional Black Caucus how much it has meant to me that, each year when I have requested you to appear here as a panel, that you have been responsive in coming here and testifying on the programs that you have addressed here this afternoon.
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It has been difficult over the last 20 years to sit here each year, day after day, year after year, listening to the testimony of the secretaries of the various departments, the heads of all the NIH departments, as they, in response to questions posed by me, reiterate the devastating condition of minorities in this country. Whether it be in the area of labor, health, human services or education, we are the bottom rung of the ladder.
I need not say that to you because I know, on the committees where you work, you are carrying out the same type of work that I carry out here, pointing out the disparities in life in America for minorities. So your presence here today is very, very important to me.
Many of the programs you have responded to, I have to give credit to this subcommittee. I don't know of any subcommittee or committee in the Congress that has been more responsive than this committee has been to the kind of concerns that I have expressed and you have expressed here today.
In particular, I want to commend Chairman Porter. He and I have sat on this committee together many, many years, even before he became chairman of this committee, but he has always been responsive and sensitive to these areas of concern which you have addressed here today, and I want the record to show my appreciation for his response to these areas.
While I will not be here to carry on this fight, as I have in the past, it will be extremely important in my absence that you continue to be as vocal and as articulate and as vigilant as you have been in the past to see that this type of concern and sensitivity is brought before this subcommittee.
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I thank you for your appearance.
Mr. PORTER. Lou, it hasn't been the subcommittee or the chairman, it has Lou Stokes and his advocacy, believe me; and you know we are going to miss you and the leadership that you have provided.
Mr. STOKES. Thank you, Mr. Chairman. Thank you.
Mr. PORTER. We will have a chance to dwell on that a little bit more.
Ms. DeLauro.
Ms. DELAURO. Very, very briefly, I would like to say to the Black Caucus what an honor it has been for me to serve on this committee with Lou Stokes. I sit at this end, and he is there, but he is always a mentor.
I listen carefully when he speaks, and don't let anyone be misled, he knows the absolute big picture. He focuses in on the questions about what is going on in the lives of minorities, men, women and children, in this country. Those issues have always been at the forefront of his agenda. He has taught me a lot, and I will deeply miss him. He has been a mentor to me.
And I say to the Black Caucus, whether it is education or the TRIO or the drug issue and so forth, whatever happens in this committee, everything affects everyone's lives personally when it comes before us. You have focused foursquare on making sure that those are the issues that you spend your time and your emphasis on. Thank you for being here, and we will do the very, very best we can for you on this committee.
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Mr. STOKES. Thank you.
Mr. PORTER. Ms. Lowey, do you want to add anything at this point? You certainly may.
Mrs. LOWEY. First of all, I want to apologize for not being here for my good friends' testimony; but I have worked with these outstanding Members of Congress; and I can almost write the testimony, knowing that they care passionately, and I mean passionately, about the issues we are dealing with.
The only problem with this committee is there is a constant trade-off between the great issues we all care about. We care about schools, we care about education, and we care about child care. We would like to make sure that our schools are open until 7:00, all of them, so we can have real, constructive after-school programs and child care within the schools.
So I just want to thank you for your advocacy, thank you for your agenda, thank you for your heart, thank you for your commitment, and I just want to assure you that there are many of us on this committee that are going to continue to advocate for your agenda because we care as well.
We are all so sad that our star is going to be retiring. Lou Stokes has not only been a star in the entire Caucus but he is such an eloquent advocate on this committee, a good friend of ours, and we are going to miss him. We will work very hard to try to achieve just a fraction of what Lou Stokes has achieved in the service to this committee.
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So I want to thank you for appearing before us; and we thank you, Lou Stokes, for being on our committee; and we will try and work hard to carry on your good name. Thank you.
Thank you, Mr. Chairman.
Mr. PORTER. Thank you, Ms. Lowey.
Thank you everybody who has testified.
Mr. Scott.
Mr. SCOTT. I have testimony I would like to have as part of the record that goes in a little more depth than my statement.
Mr. PORTER. Without objection, it will be received.
Mr. PAYNE. Mine also, Mr. Chairman.
Ms. WATERS. Thank you very much.
—————
Thursday, April 30, 1998.
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WITNESS
HON. ELEANOR HOLMES NORTON, A DELEGATE IN CONGRESS FROM THE DISTRICT OF COLUMBIA
Mr. PORTER. Some of you are also staying for the next panel, the Congressional Caucus for Women; and whomever is here, we will next hear from.
Ms. Norton, you are the chair, are you not?
Ms. NORTON. Yes.
Mr. PORTER. Well, we will next hear from the Congressional Caucus for Women; and we are pleased to welcome the Chair, Congresswoman Eleanor Holmes Norton of the District of Columbia.
Ms. NORTON. Thank you very much, Mr. Chairman. I hope you will indulge me so that I can say at least a half a minute about Mr. Stokes. Because of a dinner in my district, I may have to leave before all of my colleagues in the Caucus testify.
That special word, Lou, is simply that if there was a tradition in the House of hanging up and retiring the shirt, yours would have to be gone. We are going to leave your chair there, but, for some of us, it is going to be a chair that will never be filled. The esteem in which you are universally held does not come simply because of your remarkable personality. It comes because of your work and your brain and what you have earned in that esteem. You will be missed across this body.
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Mr. Chairman, the Congressional Caucus for Women's Issues very much appreciates the opportunity once again to testify before you. Today, we carry on a great tradition in the Women's Caucus in which your subcommittee has kindly indulged us. As we come before you once again to continue the fight for important initiatives which are vital to meeting the needs of women, children and families, we stress the unique bipartisan nature of our Women's Caucus and its strength and solidarity and growing numbers that has helped bring about many changes for women, many of them with the help of this very subcommittee.
This necessarily means, of course, that not all issues are Women's Caucus issues. The issues of this subcommittee, however, are quintessentially Women's Caucus issues.
This year, we celebrate a record number of women in the House. We are 55 strong and growing. All three special elections this year were won by women. Our growing numbers have strengthened our issues and strengthened our resolve.
For the first time in 20 years, the Women's Caucus initiated informational hearings of its own in the 105th Congress to put us on the cutting edge of issues for women, children and families. All of our hearings share individual subject matter under your purview. We have had hearings on child care for 0 to 3-year-olds, contraceptive research, coverage and technology, Title IX, Federal procurement for women-owned businesses in a town meeting on economic equity.
Earlier today, we had our latest informational hearing on exciting new developments in drug technology for the prevention of breast cancer. The Tamoxifin breakthrough on breast cancer is the kind of issue we particularly seek for our own informational hearings.
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No subcommittee has proved more critical to our work than this subcommittee. We want to offer our very special appreciation for the way in which you, Mr. Chairman, and this subcommittee have been responsive to the concerns of women and families.
Members will be testifying today about issues of special concern to them personally. Our co-chair, Nancy Johnson, will be testifying about Title X, an issue of great importance to our Caucus.
Through our hearings on contraceptive research, we learned publicly funded family planning prevents 1.2 million unintended pregnancies a year.
There are a few members who have had to leave, and I won't call their names because they will be submitting testimony directly to you, Mr. Chairman.
The former co-chair of the Caucus, Representative Connie Morella of Maryland, will testify about osteoporosis, AIDS and domestic violence. Representative Eddie Bernice Johnson of Texas will testify about HIV and AIDS. Representative Juanita Millender-McDonald of California will testify about telemedicine. Representative Carolyn McCarthy will testify about breast cancer. Representative Sheila Jackson Lee of Texas will cover domestic violence. Representative Lucille Roybal-Allard of California will identify her concerns in her testimony.
Mr. Chairman, I would like to conclude by thanking you and the ranking member for the extensive work you have done through these tough budget years to salvage the priorities of women and families. We appreciate just how difficult this task has been. We urge you to focus on and to emphasize the important priorities we bring to you today and that we think fairly represent the priorities of women in the country.
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Thank you very much, Mr. Chairman.
[The prepared statement of Delegate Eleanor Holmes Norton follows:]
"The Official Committee record contains additional material here."
Mr. PORTER. Congresswoman Norton, you are the chair and if you wish, you can call on members in the order you wish to present them or I will call them in the order in which they arrived.
Ms. NORTON. You may do that, Mr. Chairman. I prefer you do that, except Ms. McCarthy apparently has to get a plane.
Ms. MCCARTHY. I have to get a vote first.
Ms. NORTON. Well, then I think they shouldn't be called out of order.
Mr. PORTER. Congresswoman Millender-McDonald has been with us all afternoon, and this is her third appearance, so she is next.
Ms. MILLENDER-MCDONALD. Does that mean I get a seat up here perhaps?
Mr. PORTER. Pretty soon, right.
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—————
Thursday, April 30, 1998.
WITNESS
HON. JUANITA MILLENDER-McDONALD, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA
Ms. MILLENDER-MCDONALD. I thank you so much, Mr. Chairman and members and all of the women on this great committee, for the opportunity to bring together the women of the House, who I am proud to say are now 55 members strong.
Although I would like to discuss the dire need of school construction, the climbing rate of teen pregnancy, the serious health disparities that exist for minorities and women and numerous other important health and education issues, I will limit my comments to the problem of AIDS.
Just this past weekend, I led the Second Annual AIDSWalk for Minority Women and Children in Los Angeles to address this issue in my community and the State of California. While the number of national AIDS cases declined among most populations in the past couple of years, the number of cases actually increased among women by 2 percent.
African American women are nearly 15 times more likely to have AIDS than that of white women. Women die 33 percent faster than men from AIDS. This is a dangerous national trend that is hitting the 37th district of California particularly hard. In Los Angeles alone, there are an estimated 25,000 AIDS cases.
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Earlier today, I shared with you a remarkable resource for inner cities that is run by Drew University in my district, the first-ever urban telemedicine project in the country. In treating and preventing severe loss of vision and blindness resulting from AIDS, telemedicine is just one of the many ways underserved communities can obtain the medical care they need.
The other resources that are critical in lowering not just the death rate but also the transmission rate among women and children include allowing States to fund needle exchange programs and providing the necessary funds for the Ryan White CARE Act.
Particularly, I am requesting a $105.2 million increase from last year's appropriation for Title I and a $36.7 million increase for last year's appropriation for Title III.
There are 51 metropolitan areas eligible to receive Title I funds that provide emergency assistance care to 74 percent of all reported AIDS cases in the United States. Each year, HRSA estimates 20 percent of Title I clients are new cases.
Title III of the CARE Act serves the hardest to reach communities. Approximately 80 percent of Title III clients have incomes below 300 percent of the poverty level, and 25 percent of Title III HIV patients are women of child-bearing age.
These Title III primary care programs in 43 States provide early diagnosis, treatment and ongoing care for people with AIDS, which extends lives and saves money. Early diagnosis and treatment for almost 100,000 people reduce hospitalization by up to 75 percent.
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I need not go on and on. It is also important that you know of the funding that is critically needed for AIDS and the drug assistance program under Title II; and I thank you, Mr. Chairman, for your sensitivity to this issue.
Mr. PORTER. Thank you again, Congresswoman Millender-McDonald, for your good testimony.
[The prepared statement of Congresswoman Juanita Millender-McDonald follows:]
"The Official Committee record contains additional material here."
Thursday, April 30, 1998.
WITNESS
HON. EDDIE BERNICE JOHNSON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS
Mr. PORTER. Congresswoman Eddie Bernice Johnson of Texas.
Ms. JOHNSON. Thank you very much, Mr. Chairman, for allowing me an opportunity to speak on behalf of the Women's Caucus on the critically important issue of HIV/AIDS and its devastating effects upon American women.
The number of AIDS cases among women is swiftly increasing and growing more rapidly than in men. Women are the fastest-growing population of HIV-infected persons, and the number of AIDS cases among women is doubling every 1 to 2 years.
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The Centers for Disease Control preliminary data indicates HIV/AIDS continues to be the fourth leading cause of death among women 25 to 44 years old. In 1995, African American and Latino women represented 78 percent of all U.S. women diagnosed with AIDS. A recent report on the AIDS epidemic in Dallas County, where I reside, revealed the proportion of African American women living with AIDS is greater than the proportion of African Americans in the general population.
Federal funding for biomedical and behavioral research is crucial in order to combat this disease. Research priorities for HIV/AIDS must include studies that identify patterns of behavior and social conditions among cultural and age-based groups of women that determine their risk of infection. Serious focus must be placed on issues such as power in various relationships, physical and sexual abuse, substance abuse and economic inequities between men and women.
In fiscal year 1998, Congress provided welcomed increases in HIV/AIDS research prevention and care. However, more is needed if we are to combat this ever-evolving epidemic and take full advantage of the medical advances that are beginning to emerge; and I would certainly urge this committee to support funding for the Centers for Disease Control and the National Institutes of Health. The agencies must receive the highest priority in order to address this number.
I am close to this issue because of my profession. I understand the devastating effect it has on the entire population and certainly these people and their families.
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Through the increased funding of the Ryan White Program and prevention activities initiated by NIH and the Centers for Disease Control, I believe it will be accomplished and that we can find a vaccine and that, eventually, we will find a cure.
So, again, I thank you very much for your sensitivity and interest in this.
Mr. PORTER. Thank you, Congresswoman Johnson.
Thursday, April 30, 1998.
WITNESS
HON. CAROLYN McCARTHY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW YORK
Mr. PORTER. We have a vote on, and we have probably 6 or 7 or 8 minutes.
The order that I have is Carolyn McCarthy, then Sheila Jackson Lee and then Connie Morella.
Congresswoman McCarthy.
Mrs. MCCARTHY. I am known to be extremely fast.
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Mr. PORTER. You have been very patient. You have been here a long time.
Mrs. MCCARTHY. I will submit my full testimony.
I am here to represent the women certainly of this country but also the women of Long Island and New York State on breast cancer. Unfortunately, on Long Island, we have an extremely high rate of breast cancer. Many of us feel it has to do with our environment; and we are looking for, obviously, funding, again, within NIH to look into this.
Not only does breast cancer affect women, it affects all the families. I myself am a nurse, and I know a lot, and I examine a lot. Every year I go for my mammogram, I always wonder, am I going to be next? We have one out of nine women on Long Island that come down with this terrible disease. I happen to believe research can come up with why are we getting it.
Only 10 percent of women actually have breast cancer because of their genetic makeup. There are many other reasons. We have to find this out. The money we spend on research and maybe the connection between environmental causes will save this country billions and billions of dollars through, certainly, our lifetime. I just want to put my strong support onto research.
I don't envy any of you in your jobs. I sit here listening. Every single project that we have is important to the people of this country; and, unfortunately, you have to make those choices. It is tough, and God bless you.
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Mr. PORTER. Thank you, Congresswoman McCarthy.
[The prepared statement of Congresswoman Carolyn McCarthy follows:]
"The Official Committee record contains additional material here."
Thursday, April 30, 1998
WITNESS
HON. SHEILA JACKSON-LEE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS
Mr. PORTER. Sheila Jackson-Lee of Texas.
Ms. JACKSON-LEE. Mr. Chairman, thank you very much; and we should offer our great appreciation for this committee's work. It is the heart and conscience of America, seriously, on the kinds of programs—and let me associate myself with the remarks of the Congressional Black Caucus and the Chairwoman of the Women's Caucus and tribute to Lou Stokes. I would want to stand up and retire shirts and say a whole lot of things, but I hope we will have times to come. And the women on this panel, in particular, I do thank you for your leadership.
I would like to talk in a bionic minute to say the domestic violence programs are enormously important; and I would like to submit into the record, if I could, more information on that.
Ms. JACKSON-LEE. Because I have an additional cause I would like to raise to this committee's attention, and it impacts women. It is the Comprehensive Community and Mental Health Services for Children and Their Family's program. This actually deals with mothers and families but children with emotional disorders. Eleven million children who need to be diagnosed in this country are not. This legislation was authorized in 1992, and it has not gotten its full appropriations.
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I want to thank the committee for what it has done, but we are talking about situations where 1 in 20 children will have a severe disorder by the age of 18 and from ages 9 to 17 may have a serious emotional disturbance as well. The children usually wind up in the juvenile justice system. Suicide is the fourth largest cause of death among teenagers.
This program is only in 22 States and helps to go into communities and work with parents and schools and churches to embrace the child who has an emotional disorder.
I encourage your support along with support for the Head Start program and support for funding for NIH in order to have more testing of the cause of the impact of silicon breast implants, and I would greatly appreciate the committee's review of that issue as well.
Mr. PORTER. Thank you, Congresswoman Jackson-Lee.
Thursday, April 30, 1998.
WITNESS
HON. CONNIE MORELLA, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MARYLAND
Mr. PORTER. Congresswoman Morella.
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Mrs. MORELLA. Thank you, Mr. Chairman.
I echo everything that has been said laudatory about Mr. Stokes. I am going to miss him as a constituent, too. He used to give me an idea of what was happening in the community, but he has been a great statesman and a very good friend.
Mr. Chairman, you are certainly one of the top congressional supporters of the National Institutes of Health; and I appreciate it very much. I commend you for ensuring such a generous increase of NIH funding in fiscal year 1998 and I know you will continue to make biomedical research a priority.
We ask you continue your strong support for the Public Health Service Office on Women's Health, the NIH Office of Research on Women's Health and the other offices of women's health within the Public Health Service agencies.
I will pick up on the concept of AIDS, too. It continues to be the fourth leading cause of death that was mentioned among young women, the fastest growing group of people with HIV and AIDS. It is the leading cause of death in young African American women.
I particularly urge your continued support for the development of microbicide to prevent the transmission of HIV and sexually transmitted diseases at a level of $50 million.
Secondly, we urge this subcommittee to provide adequate NIH funding for the Women's Interagency HIV Study, the natural history study of HIV in women.
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We commend the increases for research, prevention and the CARE Act in fiscal year 1998 and hope that that momentum will continue into fiscal year 1999.
I also want to point out a couple other items briefly.
Sexually transmitted diseases. Unbelievably, the rate of STDs in the United States is the highest in the industrial word, and it approximates the rates in the developing world in some populations. STDs cause infertility, cervical cancer, infant mortality. They are also fueling the HIV epidemic.
I have testimony which I will submit to you. I think it is all pretty shocking with regard to STDs and chlamydia in young people.
[The prepared statement of Congresswoman Connie Morella follows:]
"The Official Committee record contains additional material here."
Mrs. MORELLA. From 1988 to 1995, there was a drop of 65 percent in chlamydia positivity in the Pacific Northwest where the program was first implemented, and that is the Infertility Prevention Program administered by the Centers for Disease Control. We are asking it to be funded at $60 million to reduce the severe and costly burden of STD-related infertility.
Also, we fully support the syphilis examination program at $25 million. The highest incidence of syphilis is confined to specific regions, particularly in urban centers in the Southeast.
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Osteoporosis, with continued funding we hope for research and public education.
Breast cancer, as has been mentioned, women continue to face a 1 in 8 chance of developing breast cancer during their lifetimes.
Of course, we are asking that you fund shelters for battered women and children at $120 million and the National Domestic Women's Hotline at $1.2 million in fiscal year 1999.
I very much appreciate, along with my colleagues in the Women's Caucus, the opportunity—every year we look forward to presenting to you many things that this committee already knows, but it is nice to know that we continue to push for it and you continue to follow through.
You have a good subcommittee, and you are great at the helm, thank you.
Mr. PORTER. Thank you, Congresswoman Connie Morella and all those who testified. We will do our very best to respond to your priorities.
Thank you all very much. The subcommittee will recess until 2 next Wednesday.
Mrs. MORELLA. Can we make my full statement a part of the record?
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Mr. PORTER. Yes.
[Additional testimonies were prepared to be submitted for the record:]
"The Official Committee record contains additional material here."