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S. HRG. 112–948 

AIR QUALITY AND CHILDREN’S HEALTH 

JOINT HEARING 

BEFORE THE

SUBCOMMITTEE ON CLEAN AIR 

AND NUCLEAR SAFETY 

AND THE

SUBCOMMITTEE ON CHILDREN’S HEALTH AND 

ENVIRONMENTAL RESPONSIBILITY 

OF THE

COMMITTEE ON 

ENVIRONMENT AND PUBLIC WORKS 

UNITED STATES SENATE 

ONE HUNDRED TWELFTH CONGRESS 

FIRST SESSION 

JUNE 8, 2011 

Printed for the use of the Senate Committee on Environment and Public Works 

( 

Available via the World Wide Web: http://www.fdsys.gpo.gov 

(II) 

COMMITTEE ON ENVIRONMENT AND PUBLIC WORKS 

ONE HUNDRED TWELFTH CONGRESS 

FIRST SESSION 

BARBARA BOXER, California, Chairman 

MAX BAUCUS, Montana 

THOMAS R. CARPER, Delaware 

FRANK R. LAUTENBERG, New Jersey 

BENJAMIN L. CARDIN, Maryland 

BERNARD SANDERS, Vermont 

SHELDON WHITEHOUSE, Rhode Island 

TOM UDALL, New Mexico 

JEFF MERKLEY, Oregon 

KIRSTEN GILLIBRAND, New York 

JAMES M. INHOFE, Oklahoma 

DAVID VITTER, Louisiana 

JOHN BARRASSO, Wyoming 

JEFF SESSIONS, Alabama 

MIKE CRAPO, Idaho 

LAMAR ALEXANDER, Tennessee 

MIKE JOHANNS, Nebraska 

JOHN BOOZMAN, Arkansas 

BETTINA POIRIER, Majority Staff Director and Chief Counsel 

RUTH VAN MARK, Minority Staff Director 

SUBCOMMITTEE ON CLEAN AIR AND NUCLEAR SAFETY

THOMAS R. CARPER, Delaware, Chairman 

MAX BAUCUS, Montana 

FRANK R. LAUTENBERG, New Jersey 

BENJAMIN L. CARDIN, Maryland 

BERNARD SANDERS, Vermont 

JEFF MERKLEY, Oregon 

BARBARA BOXER, California, (ex officio) 

JOHN BARRASSO, Wyoming 

DAVID VITTER, Louisiana 

JEFF SESSIONS, Alabama 

LAMAR ALEXANDER, Tennessee 

MIKE JOHANNS, Nebraska 

JAMES M. INHOFE, Oklahoma, (ex officio) 

SUBCOMMITTEE ON CHILDREN’S HEALTH AND ENVIRONMENTAL RESPONSIBILITY

TOM UDALL, New Mexico, Chairman 

SHELDON WHITEHOUSE, Rhode Island 

KIRSTEN GILLIBRAND, New York 

BARBARA BOXER, California, (ex officio) 

LAMAR ALEXANDER, Tennessee 

DAVID VITTER, Louisiana 

JAMES M. INHOFE, Oklahoma, (ex officio) 

(III) 

C O N T E N T S 

Page 

JUNE 8, 2011 

OPENING STATEMENTS 

Carper, Hon. Thomas R., U.S. Senator from the State of Delaware ................... 1 

Barrasso, Hon. John, U.S. Senator from the State of Wyoming .......................... 4 

Udall, Hon. Tom, U.S. Senator from the State of New Mexico ............................ 5 

Inhofe, Hon. James M., U.S. Senator from the State of Oklahoma .................... 6 

Whitehouse, Hon. Sheldon, U.S. Senator from the State of Rhode Island ......... 9 

WITNESSES 

Upson, Dona J., M.D., M.A., Pulmonary/Critical Care Physician ....................... 11 

Prepared statement .......................................................................................... 13 

Responses to additional questions from: 

Senator Boxer ................................................................................................... 28 

Senator Carper ................................................................................................. 30 

Senator Vitter ................................................................................................... 33 

Ginda, James E., M.A., RRT, AE-C, CHES, Supervisor of Respiratory Care, 

Kent Hospital ....................................................................................................... 36 

Prepared statement .......................................................................................... 38 

Response to an additional question from Senator Carper ............................ 61 

Responses to additional questions from Senator Vitter ................................ 63 

Goodman, Julie E., Ph.D., Dabt, Principal, Gradient ........................................... 70 

Prepared statement .......................................................................................... 72 

Thorning, Margo, Ph.D., Senior Vice President, American Council for Capital 

Formation ............................................................................................................. 76 

Prepared statement .......................................................................................... 78 

Resnik, Patty, RTT-NPS, MBA, FACHE, CPHQ, CPUR, Corporate Director, 

Performance Improvement/Utilization Management, Christiana Care 

Health System ...................................................................................................... 87 

Prepared statement .......................................................................................... 89 

(1) 

AIR QUALITY AND CHILDREN’S HEALTH 

WEDNESDAY, JUNE 8, 2011 

U.S. SENATE, COMMITTEE ON ENVIRONMENT AND PUBLIC WORKS, SUBCOMMITTEE ON CLEAN AIR AND NUCLEAR SAFETY, SUBCOMMITTEE ON CHILDREN’S HEALTH AND ENVIRONMENTAL

RESPONSIBILITY, Washington, DC. 

The committees met, pursuant to notice, at 10 a.m. in room 406, 

Dirksen Senate Office Building, Hon. Thomas Carper (chairman) 

presiding. 

Present: Senators Carper, Inhofe, Lautenberg, Cardin, 

Whitehouse, Udall, Vitter, Barrasso. 

OPENING STATEMENT OF HON. THOMAS R. CARPER, 

U.S. SENATOR FROM THE STATE OF DELAWARE 

Senator CARPER. Good morning, one and all. The hearing will 

come to order. 

We want to welcome all of our witnesses. Thank you for joining 

us today, for your preparation and your willingness to respond to 

our questions. 

We don’t get to do this every day, I am delighted to be here with 

our friend, Senator Tom Udall. We are going to have this joint 

hearing today to review the impacts of air pollution on children’s 

health in the United States of America. 

Senators will have roughly 5 minutes for their opening statements. I will then recognize our panel of witnesses and we will ask 

each of you to use about 5 minutes for your opening statements, 

too. Your entire statement will be made part of the record. So if 

you could summarize and try to keep within that time constraint, 

that would be good. And after the panel’s statements, we will have 

maybe two rounds of questions. 

We are reminded today, as the temperatures approach 100 degrees here in our Nation’s capital that summer is here. That means 

kids, I don’t know today, are kids outside swimming? If there is a 

swimming pool around they will be there. But playing baseball and 

eating barbecue on the patio, maybe inside in the air conditioning. 

But in many parts of our Country, summer also means smog and 

exposure to deadly air pollution. 

The summer smog season, also known as the ozone season, is a 

powerful reminder of how important it is to have clean air to 

breathe. Smog-causing air pollution from dirty power plants, from 

automobiles and other sources, is linked to serious health probVerDate Aug 31 2005 12:16 Jan 09, 2017 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 S:\_EPW\DOCS\21143.TXT VERN
2 

lems, like asthma, like strokes, like heart attacks, and even early 

deaths. 

Smog is especially dangerous, as we know, for our children. Parents who have watched their kids with asthma suffer on high ozone 

days know this better than anyone. And some of them are here 

today. 

Unfortunately, smog is not all we have to be concerned about 

when it comes to our children’s health. Millions of our kids ride a 

bus to school, play on a playground or live in a community that exposes them to high levels of ozone, to particle pollution or air 

toxics, all of which can severely impact children’s health. In fact, 

nearly all air pollution is more dangerous to our children than to 

their parents for three primary reasons. One, the immune systems 

of children are still developing. And two, they breathe in more air 

in proportion to their body size than do their parents. And three, 

they are more likely to be outside for longer periods of time during 

the summer, exposing them to more air pollution. 

As a parent myself of two boys, now grown, I have spent a lot 

of time worrying about our own children’s health. As a U.S. Senator, I also worry about every child’s health. That is why I have 

worked hard with my colleagues, Democrat and Republican alike, 

to make sure that all of our children have clean air to breathe, that 

is free of all types of air pollution. 

And we have made remarkable progress in cleaning up our air, 

especially in some parts of our Country. But if truth be told, we 

still have a long way to go in many other parts of America. More 

than 7 million American children have asthma, including nearly 

28,000 in Delaware. Childhood asthma rates are still rising. 

In fact, in Delaware alone, each of our three counties received a 

failing grade from the American Lung Association for the number 

of high pollution days they have experienced. For me, that is just 

more than disappointing, it is almost heart-breaking. I am not too 

old to remember one of the great things about being a kid, especially in summer, was getting to run and play outside. In fact, I 

still love to run distances with my oldest son, 22 years old. And 

even though he runs me into the ground, few things are better 

than that. 

But kids with asthma get left behind on poor air quality days. 

Frequently they have to give up fun as well as healthy exercise. 

They often have to restrict their most basic daily activities. Moreover, those kids may have to miss school. Their parents may have 

to miss work. And all the while, health care costs in America, already the highest in the world, continue to rise. 

Those costs add up to trillions of dollars lost every year in this 

Country. That is not millions; that is not billions; that is trillions 

with a T. The Environmental Protection Agency is now considering 

what I think are sensible rules to reduce smog-causing pollution as 

well as particle pollution, mercury pollution and other harmful air 

toxics. For example, reduce air toxic regulation for utilities would 

limit emissions of known toxics that affect the development of a 

child’s brain or nervous system or affect the way a child’s body develops. These rules can give us all cleaner air while reducing those 

pollutants that will help prevent a wide variety of health, serious 

health threats to our children. 

3 

And in the end, we stand to achieve better health care results 

for less money. That si right, better health care results for less 

money. It is my hope that today’s witnesses will provide us with 

new information and insights on what our Federal Government is 

doing well and maybe what we are not doing so well, so we can enhance the quality of our Nation’s air and protect the health and 

welfare of their systems, especially our Nation’s children. 

Five minutes, on the money. Senator Udall, match that. Thank 

you. Oh, sorry, Jim, I got carried away, John, I got carried away. 

You are on. 

[The prepared statement of Senator Carper follows:] 

STATEMENT OF HON. THOMAS R. CARPER, U.S. SENATOR

FROM THE STATE OF DELAWARE

Summer is here, and that means kids outside swimming, playing baseball, and 

eating bar-b-que on the patio. But in many parts of our country, summer also means 

smog and exposure to deadly air pollution.The summer smog season—also known 

as the ozone season—is a powerful reminder of how important it is to have clean 

air to breathe. 

Smog-causing air pollution from dirty power plants, automobiles, and other 

sources is linked to serious health problems like asthma, strokes, heart attacks— 

and even early deaths. Smog is especially dangerous for our children. Parents who 

have watched their kids with asthma suffer on high ozone days know this better 

than anyone. 

Unfortunately, smog is not all we have to be concerned about when it comes to 

our children’s health. Millions of our kids ride a bus to school, play on a playground 

or live in a community that exposes them to high levels of ozone, particle pollution 

or air toxics—all of which can severely impact children’s health. 

In fact, nearly all air pollution is more dangerous to our children than to their 

parents for three primary reasons: 

1. Their immune systems are still developing; 

2. They breathe in more air in proportion to their body size than do their parents; 

and, 

3. They are more likely to be outside for longer periods of time during the summer, exposing them to more air pollution. 

As a parent, I’ve spent a lot of time worrying about my own children’s health. As 

a U.S. Senator, I worry about every child’s health. That’s why I’ve worked so hard 

with my colleagues—Democrat and Republicans alike—to make sure that all our 

children have clean air to breathe, air that’s free of all types of air pollution. We 

have made remarkable progress in cleaning up our air, especially in some parts of 

our country, but—if truth be told—we still have a long way to go in many parts 

of America. 

More than 7 million American children have asthma—including nearly 28,000 in 

Delaware—and childhood asthma rates are still rising. In fact, in Delaware alone, 

each of our three counties received a failing grade from the American Lung Association for the number of high pollution days they have experienced. That’s more than 

disappointing to me. It’s almost heartbreaking. I’m not too old to remember that one 

of the great things about being a kid is getting to run and play outside. In fact, I 

still love to run distances with my oldest son who’s now 22 years old. Few things 

in life are better. 

But kids with asthma get left behind on poor air quality days. Frequently, they 

have to give up fun as well as healthy exercise. They often have to restrict their 

most basic daily activities. Moreover, those kids may have to miss school. Their parents may have to miss work. And, all the while, health care costs in America—already the highest in the world—continue to rise. Those costs add up, too, to trillions 

of dollars lost every year in this country. That’s not millions. It’s not billions. It’s 

‘‘trillions’’ with a ‘‘t.’’ 

The Environmental Protection Agency is now considering sensible rules to reduce 

smog-causing pollution, as well as particle pollution, mercury pollution and other 

harmful air toxics. For example, recent air toxic regulations for utilities would limit 

emissions of known toxics that affect the development of a child’s brain or nervous 

system or affect the way a child’s body develops. 

These rules can give us all cleaner air, while reducing these pollutants will help 

prevent a wide variety of serious health threats to our children. And, in the end, 

4 

we stand to achieve better health care results for less money. That’s right. Better 

results for less money. It is my hope that today’s witnesses will provide us with new 

information and insights on what our Federal Government is doing well—and not 

doing well—so we can enhance the quality our nation’s air and protect the health 

and welfare of our citizens, especially our nation’s children. 

Thank you. 

OPENING STATEMENT OF HON. JOHN BARRASSO, 

U.S. SENATOR FROM THE STATE OF WYOMING 

Senator BARRASSO. Thank you very much, Mr. Chairman. 

We truly have a number of concerns and problems that we need 

to address in this Country. The most important problem facing 

America today, in my opinion, is actually high unemployment and 

a weak economy. Clean air is always important, and at times it has 

been paramount. The EPA of preceding generations fought the obvious pollution that was visible in our cities. It was a crisis, and 

thanks to the hard work of the EPA, that challenge was answered. 

America’s air now is cleaner than ever before. According to the 

EPA, over the last 30 years, carbon monoxide is down 61 percent, 

lead is down 97 percent, nitrogen oxide is down 48 percent, sulfur 

dioxide down 65 percent, particulate matter number 10 is down 83 

percent. Today, the crisis is the economy and jobs. Unemployment 

is 9.1 percent. That means over 9 percent of Americans who want 

to work can’t find an employer. Millions of Americans are unemployed, looking for work to provide for their families. Many families 

with children are sliding into poverty, as their bills pile up. 

So I believe that our job in the Senate is to make sure things 

don’t get worse and make sure that we create an economic environment where things actually can get better. 

Yet today’s EPA is unleashing a cascade of intersecting regulations that continues to drop a hammer on an already faltering 

economy. For example, the EPA’s proposed ozone standard alone, 

according to the EPA’s own numbers, will cost up to $90 billion per 

year in compliance costs by the year 2020. I didn’t believe it, I rechecked the statistics twice that came out of the EPA. Ninety billion dollars a year in compliance costs by the year 2020. 

Most of the counties in our Nation will be in violation of the law 

if these strictest standards being proposed are adopted by the EPA. 

Economic activity in these counties across the Country that are in 

violation will grind to a halt. These areas will be closed to many 

new types of businesses or expansion of existing businesses that 

are manufacturing-intensive. This will occur because potential employers will not want to do business in these communities where 

the EPA is the gatekeeper in moving forward with any economic 

activity. The result will be jobs leaving the heartland of our Country to go to India or to China. These are the very types of jobs that 

we need so desperately. 

Children’s health is always important. The future of children depends on their parents’ ability to put food on the table, keep the 

lights on, support their education and their medical costs. In order 

to accomplish this, two key things are important. I believe children 

are best served when their parents have good paying jobs with benefits. I believe also that families benefit when they have affordable 

energy. Energy costs are taking up a larger share of household inVerDate Aug 31 2005 12:16 Jan 09, 2017 Jkt 000000 PO 00000 Frm 00008 Fmt 6633 Sfmt 6633 S:\_EPW\DOCS\21143.TXT VERN
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come, and it is often those most in need who are bearing the burden. 

According to the U.S. Department of Energy, on average Americans spend 5 percent of their income on paying energy bills. However, for lower income households, the costs average 18 to 20 percent and can be higher than that. High energy costs will result 

from the regulatory freight train of EPA regulations coming down 

the track. The net result will be the closing of some of America’s 

affordable power plants and replacing them with more expensive 

power. Other plants will make costly upgrades and pass those costs 

on to families. This has already begun to occur. 

Most recently, Louisville Gas and Electric in Kentucky has filed 

for a 19 percent rate increase by 2016 to pay for the upgrades that 

the EPA regulations will require. Those high costs will be passed 

right to the families with children who can afford it the least. 

According to the National Center for Health Statistics, American 

children in poverty are 3.6 times more likely than non-poor children to have poor health and five times more likely to die from an 

infectious disease. When we talk about children’s health, we need 

to talk about their families’ economic situation and economic wellbeing. The health of those children and their future depends upon 

the families’ economic well-being. 

I think we need to focus on making America’s air as clean as we 

can as fast as we can. And let us do it in a way that doesn’t hurt 

American families during this economic situation. I thank you, Mr. 

Chairman, and look forward to the testimony. 

Senator CARPER. Thank you, Senator Barrasso. 

Senator Udall, welcome. Thanks for letting us do this with you 

today. 

OPENING STATEMENT OF HON. TOM UDALL, 

U.S. SENATOR FROM THE STATE OF NEW MEXICO 

Senator UDALL. This is a real pleasure doing this jointly with 

you. 

Senator CARPER. I call it a cheap thrill. 

[Laughter.] 

Senator UDALL. Cheap thrill, right. 

First, let me thank all of our witnesses and welcome everyone to 

the first meeting of the Subcommittee on Children’s Health this 

year. I am pleased to be joining Chairman Carper for his joint subcommittee hearing on the important issue of air quality and children’s health. 

I would like to give a special welcome to Dr. Dona Upson, who 

has taken time off from her important job treating patients to travel all the way here from Albuquerque, New Mexico. It is good to 

have you here, and I know that you are a busy pulmonologist, so 

I know you have given up some important things to be here. 

As her testimony indicates, she is testifying on behalf of the 

American Lung Association and the American Thoracic Association. 

It is always sound advice to listen to your doctor. While her testimony here today is not connected with her official duties, I want 

to make sure to thank her for her service treating veterans at the 

New Mexico Veterans Medical Center. 

6 

I think it is important to note that she also has valuable experience in air quality policy as a member of the Albuquerque 

Bernalillo Air Quality Board. 

We have asked our panel to testify here today about the current 

State of medical and scientific evidence regarding air pollution and 

children’s health. The last major revision to the Clean Air Act was 

in 1990. And the various standards from the Act have been gradually implemented since then. Some standards required by that Act, 

such as air toxics standards, are only now being proposed over 20 

years later. Other standards, like ground level ozone, are coming 

up for an update to reflect the best scientific information. 

In the Four Corners region in the west, EPA is moving forward 

with a regional haze air quality standard for large power plants. 

We are following those efforts carefully. Following the Supreme 

Court’s 2007 decision, EPA is also charged with setting standards 

on global warming pollution for large emitters. Earlier this year, 

the House passed a budget, which would have blocked or delayed 

several of these air pollution standards. And the Senate voted 

against that proposal. 

During the last few months, my office has received hundreds and 

hundreds of emails and calls in support of the Clean Air Act. Several emails were from constituents and parents of children with 

asthma, with deep concern about the impact of those proposals on 

their lungs. Media reports indicate that further legislation is being 

drafted in both the House and the Senate. These bills would block 

or delay not only the global warming pollution standards, but also 

other standards as well. 

This hearing will provide an opportunity for members and the 

public to hear from public health professionals about the impacts 

of air pollution on children’s health. And with that, Chairman Carper, I look forward to the testimony of the witnesses. Thank you. 

Senator CARPER. Thanks. I am happy to be here to be your wing 

many today. 

Senator Inhofe, please. 

OPENING STATEMENT OF HON. JAMES M. INHOFE, 

U.S. SENATOR FROM THE STATE OF OKLAHOMA 

Senator INHOFE. Thank you, Mr. Chairman. It is nice to have you 

back, Dr. Thorning. We have imposed upon you quite a bit. And we 

hope, Dr. Upson, that the fires don’t reach New Mexico. It is a real 

tragedy, what is going on there. 

I think we all agree that we are concerned with children’s health. 

I should have brought my own chart. These are my 20 kids and 

grandkids, so that is my concern. So I have that concern. 

I think one of the concerns that we have up here, and I agree 

with what Senator Barrasso said, we have these hearings, and they 

seem to be hearings focusing on the issues that this Administration 

has. And I think when you look at what the Administration has 

been doing, all this over-regulation and the cost of which I am sure 

we will get to in the testimony of Dr. Thorning, it comes to the conclusion that this Administration, by their own admission, wants to 

increase the price of energy that is out there today. 

Steven Chu said, somehow we have got to figure out how to boost 

the price of gasoline to the levels of those in Europe. He is the EnVerDate Aug 31 2005 12:16 Jan 09, 2017 Jkt 000000 PO 00000 Frm 00010 Fmt 6633 Sfmt 6633 S:\_EPW\DOCS\21143.TXT VERN
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ergy Secretary for this President. I think the idea is so unbelievable to normal people, when you get out of Washington, DC, and 

get back home and talk to them, it is mind-boggling. The advocates 

of the agenda hope that strict regulations can be used to choke off 

traditional energy sources. We see this, we see this every day. Over 

the past 2 years, the EPA has moved forward with an unprecedented number of rules that will have enormous consequences on 

families and businesses and the Nation’s fiscal well-being. 

It wasn’t long about, about 8 months ago, that the CRA, that is 

congressional Review Act, came out with a study. No one questioned it, everyone agrees it is accurate, and that is that America, 

the United States of America, has the greatest reserves in oil, coal 

and gas of any country in the world. Our problem is we are the 

only country that won’t develop our own resources. That is the concern that we have and I have for the future generations. I think 

we will get around to this, because people are now realizing that 

over-regulation does come with a cost. 

I listened carefully as Senator Barrasso talked about some of the 

costs. I would like to share those and have them as a part of this 

record. Incidentally, I am going to ask that my entire statement, 

along with the four pages of subsequent material, be made a part 

of the record. 

Senator CARPER. Without objection, so ordered. 

Senator INHOFE. The greenhouse gas regulations, we are looking 

at a cost, a potential cost to the American people annually of between $300 billion and $400 billion dollars. This is something that 

came from the Wharton Econometric Survey, MIT and others. The 

ozone, it is true, what Senator Barrasso said about the $90 billion 

in compliance. But in addition to that, it is $676 billion in loss of 

GDP by 2020. 

The Boiler MACT is another one that would be a hardship on all 

manufacturing. I am sure we will hear from Dr. Thorning about 

that. Utility MACT, $184 billion in compliance costs between 2011 

and 2030. The Cement MACT—now, these have all been fortunately postponed for a short period of time. I hope that is an indication that the Administration realizes that we have economic 

problems enough without imposing more economic problems on our 

Country. 

So with that, I am going to go ahead—oh, one last thing. In the 

oil and gas end of it, I thought it was interesting when President 

Obama gave his energy speech and I gave a response on one of the 

television stations, and he had said, we have this abundance of 

clean, inexpensive natural gas, right here in our Country. Then at 

the end of his speech, he said, we have to watch these procedures, 

such as hydraulic fracturing. Well, everybody knows that in these 

tight formations that they have right now, there is no way of getting out any of that without using hydraulic fracturing. Since I am 

from Oklahoma, we did the first hydraulic fracturing job in Oklahoma in 1948. There has never been one documented case of 

groundwater contamination as a result of that. 

So it just seems to me that those things that sound good to the 

public always have a little caveat. We are going to be watching 

very closely from this Committee. I am hoping that the Committee 

meeting next week, where we are going to have Administration ofVerDate Aug 31 2005 12:16 Jan 09, 2017 Jkt 000000 PO 00000 Frm 00011 Fmt 6633 Sfmt 6633 S:\_EPW\DOCS\21143.TXT VERN
8 

ficials, will be able to get into a lot of these things as to what is 

motivating them to pass these regulations and try to impose these 

regulations, keeping in mind, whether it is the Clean Water Restoration Act, whether it is cap and trade, these are things that they 

are trying to do through the Administration, since they can’t get 

it done through legislation. 

Certainly I would say to my good friend, Senator Udall, that 

when he talked about the fact that we have all these things with 

cap and trade and greenhouse gases and global warming and all 

that, we have had several votes. I think the wisdom of the Senate 

is that not more than 30 members of a 100-member Senate will 

vote to impose that type of cap and trade and those restrictions 

that would damage our economy. 

Thank you, Mr. Chairman. 

[The prepared statement of Senator Inhofe follows:] 

STATEMENT OF HON. JAMES M. INHOFE, U.S. SENATOR

FROM THE STATE OF OKLAHOMA

Today’s subcommittee hearing is the third in a series of hearings designed to prop 

up the Obama EPA’s aggressive regulatory regime. This hearing nominally focuses 

on air quality and children’s health. But there is no question that we all support 

clean air and that we all care for the well-being of children. 

Taken at face value, one might assume the Obama EPA has only the public good 

in mind. But the truth about Obama’s regulatory agenda is inescapable: it’s designed make the energy we use more expensive. 

But don’t take my word for it. The Energy Secretary Stephen Chu said in 2008, 

‘‘[s]omehow we have to figure out how to boost the price of gasoline to the levels 

in Europe’’ and don’t forget that the President himself stated that under his capand-trade plan ‘‘electricity prices would necessarily skyrocket.’’ 

Advocates for this agenda hope that strict regulations can be used to choke off 

traditional, American energy so that prices will increase to the point that ‘‘green’’ 

energy is the only alternative. But these green subsidies are undermining the economy and hurting working families. 

Over the past 2 years, EPA has moved forward with an unprecedented number 

of rules that will have enormous consequences for families, businesses, and the nation’s fiscal well-being. Known as the ‘‘EPA train wreck,’’ this regulatory agenda is 

driving energy costs up, and hitting those who can least afford it—the working poor, 

the elderly, and veterans—the hardest. 

Take for example, EPA’s new greenhouse gas (GHG) cap and trade regulations. 

EPA admits they will have no impact on global temperatures, yet they will come 

at an estimated cost of $300 to $400 billion annually. The Agency’s voluntary reconsideration of the national ambient air quality standards for ground-level ozone—a 

decision based on outdated data that could lead to significant economic constraints 

on the country—is another Agency action of dubious merit. EPA projects the cost 

of this rule could rise to $90 billion. Meanwhile, the agency is planning to tighten 

the standards again in just 2 years. 

The EPA is also aggressively moving forward with standards to reduce hazardous 

air emissions from industrial boilers, cement manufacturers and from electric power 

generators. Now, reducing hazardous emissions is a goal that we all support. But 

alarmingly, the benefits the EPA associates with the rules come almost entirely 

from reducing particulate matter (PM)—not the hazardous emissions. So here we 

have the Agency justifying new mandates that will cost thousands of jobs on PM 

benefits—even though we already have a specific program designed to address PM 

directly, the national ambient air quality standard for PM. 

Recently, I called for this Committee to fulfill its oversight responsibilities and 

hold hearings on EPA’s ‘‘train wreck’’ regulations. Yet, we are having a hearing next 

week whose title, ominously, resembles that of today’s. Chairwoman Boxer, in the 

coming weeks I look forward to working with you on additional oversight hearings 

where we can begin to take a detailed look at the Obama EPA’s aggressive regulatory agenda. 

Senator CARPER. Thank you, Senator Inhofe. 

Senator WHITEHOUSE. 

9 

OPENING STATEMENT OF HON. SHELDON WHITEHOUSE, 

U.S. SENATOR FROM THE STATE OF RHODE ISLAND 

Senator WHITEHOUSE. Thank you, Chairman. Thank you to you 

and Senator Udall for holding this important hearing. I am delighted that Jim Ginda is here from Rhode Island to share his expertise. I think it is important that we have a hearing like this 

where the perspective of children can be heard. 

EPA is updating air quality standards and setting first-ever Federal air toxic air pollution limits from power plants. That is a good 

thing, because these are long overdue. They have been mired in 

litigation and deliberately undermined by the last Administration. 

But they are supported by the science, they are supported by public 

health. And they are real costs of further delay. 

Our Rhode Island Department of Health reports that 11 percent 

of children in Rhode Island have asthma. Nearly 14 percent of our 

teens have asthma. You get into certain local areas and populations, those numbers climb even further. But just as they are, 

that translates into 25,000 children in our State of 1 million. That 

is more than the entire population of towns in Rhode Island like 

Central Falls, Lincoln, and Westerly. And these children, frankly, 

are not heard. And the costs to them are not heard. 

The polluting industries are always heard loud and clear in this 

town. There has already been a lot of talk about compliance costs 

here in this hearing. But there are real health savings that come 

from these compliance costs, and they usually outweigh the compliance costs by huge factors. And asthma does mean costs. It means 

costs in human terms, as anybody who has seen a child struggling 

for breath knows. But it also has real economic costs. 

The recent report in Rhode Island showed that in 2006 and 2007, the total hospital charges attributable just to asthma were $35 million. That is just the hard hospital charges, not the kids out of 

school, not the parents who had to stay home who couldn’t work 

that day because they had to take care of it. There are costs on the 

health savings side if we don’t take these appropriate steps. 

Two doctors on Brown University’s faculty have found a significant association between pediatric emergency department visits for 

respiratory related conditions on the one hand and exposure to fine 

particulate matter on the other. We in Rhode Island are downwind 

of an array of power plants, many of which have no pollution controls whatsoever, many of which have resorted to high smokestacks 

to pump their pollution up into the sky, protecting their own communities, but leaving Rhode Island vulnerable to being basically 

bombarded. 

It is not unusual to drive to work and have the drive time radio 

in Rhode Island, Mr. Chairman, say that today is a bad air day. 

And infants should be kept indoors, elderly should be kept indoors, 

people with respiratory conditions should be kept indoors. And you 

look around, it looks like a beautiful day. But it is ozone that has 

precipitated down as a result of power plants, primarily in the Midwest, without pollution controls, that have elected to dump it on 

our State rather than clean it up in their State. 

A pediatric pulmonologist at Hasbro Children’s Hospital in Providence, Rhode Island, recently told my office that kids’ health issues 

are too often overlooked because, he said, ‘‘Kids have no money, 

10 

and they don’t vote.’’ Well, the big polluters have plenty of money 

and plenty of lobbyists, and they get their voices heard. We hear 

a ton, as I said, about compliance costs on the polluting industry. 

But we need to also hear about the health savings, both in lives 

and in quality of life and in hard economic dollars as well, which 

lift our economy by multiple times the compliance cost when we 

take care of ourselves, of our children, of our lungs. 

So thank you very much for holding this hearing. 

Senator CARPER. Senator Whitehouse, we are delighted to be 

here with you, very much. 

I am going to introduce four of the five panelists, and I am going 

to call on Senator Whitehouse to introduce our witness from Rhode 

Island. 

Today, joining us on the panel is Dr. Dona Upson. My grandmother’s name is Doma, D-O-M-A, so when I saw your name, I 

said, oh, must be Dona. Fortunately, Senator Udall reined me in. 

So Dr. Dona Upson, we are happy you are here. A board member, 

I am told, at the American Lung Association of New Mexico. 

Thanks for your good work. 

Next, Senator Whitehouse, your turn. 

Senator WHITEHOUSE. Do I get to do my introduction right now? 

Senator CARPER. You are on. 

Senator WHITEHOUSE. Very good. Well, we want to welcome Jim 

Ginda here. He is a registered respiratory therapist, a certified 

asthma educator, a certified health education specialist with over 

33 years in health care. He is the respiratory care supervisor at 

Kent Hospital in Warwick, Rhode Island, and a clinical instructor 

for the Community College of Rhode Island. He received his associate and applied science degree from the Community College of 

Rhode Island, bachelor of science degree from Western Michigan 

University and his MA from the University of Alabama, with National Honor Society induction as a graduate student. 

In Rhode Island, he is past president of the Rhode Island Society 

for Respiratory Care, a past member and chair of the State Board 

of Respiratory Care, and he was a member of the Health Care Advisory Board for TMP Worldwide. He has participated in the Medical Aerosol Focus Group in Canada, he lectured in 11 different 

States. He has written for national publications, provided expert 

opinion in nine medical legal cases in four other States. He is a 

member of the Rhode Island Public Policy Committee for the American Lung Association and the Rhode Island Asthma Control Coalition. 

He has provided testimony on these issues for committees of the 

Rhode Island General Assembly and the Providence City Council. 

He is a recipient of the Hospital Association of Rhode Island Award 

for Excellence in Hospital Care, and the Rhode Island Society for 

Respiratory Care Lifetime Achievement Award. We are very proud 

to have him here in Washington sharing his perspective. 

Senator CARPER. Thanks for that introduction. 

Next we have Dr. Julie Goodman. I understand Dr. Goodman is 

a Principal at Gradient Environmental Consulting. Good morning 

and welcome. 

11 

Next, Dr. Margo Thorning, no stranger here. It is nice to see you. 

She serves as a Senior Vice President at the American Council for 

Capital Formation. 

And finally, we have a familiar face, at least to those of us in 

Delaware, Patty Resnik, from my home State, the Corporate Director for Performance Improvement in Utilization Management at 

the Christiana Care Health System, a place we are very proud of. 

Again, we would ask each of you to try to limit your comments 

to about 5 minutes. If you go much over that, I will have to rein 

you in. But your entire statement will be made part of the record, 

so please proceed. Again, thank you all for coming. 

Dr. Upson. 

STATEMENT OF DONA J. UPSON, M.D., M.A., 

PULMONARY/CRITICAL CARE PHYSICIAN 

Dr. UPSON. Good morning. Thank you, Chairman Carper, Chairman Udall and Senators, for this opportunity to speak with you 

today. My name, as you mentioned, is Dr. Dona Upson. I am a pulmonary and critical care physician form Albuquerque, New Mexico. 

I am speaking today on behalf of the American Lung Association 

and the American Thoracic Society. I would like to speak to you as 

a doctor and a mother about children and their lungs. 

I am here to tell you that children my look like miniature adults, 

but they are not. For many reasons, they deserve special attention 

and protection, including the clean-up of major pollution sources in 

the Nation. 

Air pollution is especially dangerous to children, because their 

lungs are growing and because they are so active. Just like their 

arms and legs, the largest portion of children’s lungs grow long 

after they are born. As Senator Carper mentioned, children are 

outside for longer periods and are more active, especially in the 

summer when ozone levels are highest. They inhale more polluted 

outdoor air than do adults. 

The American Academy of Pediatrics has issued a special statement on the dangers of outdoor air pollution on children’s health. 

The conclude that there is a compelling need to move forward on 

efforts to ensure clean air for all. I absolutely agree. I am attaching 

a copy of their statement. 

Children’s lungs are vulnerable to air pollution, especially from 

ozone and particulate matter. Multiple studies, both in the United 

States and around the world, have provided strong, consistent evidence that air pollution impairs children’s ability to breathe. 

Chamber studies have convincingly shown that exposure to air pollution reduces pulmonary function and promotes airway inflammation. Epidemiologic studies have linked air pollution to a host of adverse health consequences, including cardiac deaths, respiratory 

deaths, heart attacks, asthma exacerbations and low birth weight. 

There is also real world evidence that reducing air pollution can 

help protect children. One of the best known examples is from Atlanta, during the 1996 Olympics, when a reduction in ozone was 

linked to a 42 percent decrease in asthma treatment and hospitalization in the Georgia Medicaid claims files. 

In New Mexico alone, where I practice, 47,000 kids have asthma. 

Similar to the adults I treat, having asthma puts children at even 

12 

greater risk of harm. One example of this from my own experience 

came several years ago when I was the medical director of a 2- 

week asthma camp for children in New Mexico. We had to cancel 

the camp due to the high level of pollution from wildfires from Arizona, similar to what we are seeing this past week. 

What is most impressive about the scientific literature on air pollution is how comprehensive it is, with literally hundreds of studies 

documenting that air pollution is bad for human health. To date, 

most of these have looked at the health effects of individual components of air pollution, such as ozone. However, in real life, we 

breath a whole mix of pollutants together. It is quite likely that 

when the mix of pollutants is more thoroughly investigated, even 

greater impacts on health will be seen. 

Some would lead you to believe that cleaning up ozone, mercury, 

lead, arsenic, dioxin, acid gases, as well as carbon pollution, is unnecessary or just too expensive. Yet it is not hard to fathom how 

breathing toxins can lead to serious health complications. But we 

don’t have to make a choice between protecting our environment 

and our communities and our economy. Let me give you a New 

Mexico example. 

Coal and oil-fired power plants are some of the biggest sources 

of air pollution in the United States. The Four Corners power plant 

is the Nation’s largest source of nitrogen oxides, a pollutant that 

is one of the precursors for both fine particulate matter and ozone. 

Pollution from the plant blows directly into the Navajo Nation and 

into our national parks. 

In February, the EPA and the plant’s owner, Arizona Public 

Service, announced an agreement to cut emissions of that harmful 

pollutant by 87 percent, all while retaining the jobs of the workers, 

most of whom are Native American. When these changes are made, 

the cleanup measures will reduce air pollution, protect health, save 

lives and improve the view of the spectacular New Mexico landscape. 

EPA is proposing to take similar steps for power plants across 

the Nation, steps that will improve health and save tens of thousands of lives, reducing harm from the air we all breathe. The 

Clean Air Transport Rule will protect downwind States in the eastern United States from nitrogen oxides that blow across State 

lines. 

This fall, 21 years after this United States required the cleanup 

of toxic mercury, arsenic, formaldehyde, dioxins and 80 other pollutants, the EPA will be issuing final rules to set limits on the 

amount of these pollutants that coal and oil-fired power plants can 

emit. The Clean Air Act has a proven track record of keeping people healthy. In 2010, the law prevented 160,000 premature deaths 

and 1.7 million asthma attacks. 

In conclusion, the danger from exposure to air pollution is real. 

The science documenting the adverse health effects of air pollution 

is conclusive. There is an urgent need to clean up the air we 

breathe. For all these reasons, the American Lung Association and 

the American Thoracic Society strongly support the Clean Air Act 

as one of the Nation’s best tools to protect our children. 

Thank you. 

[The prepared statement of Dr. Upson follows:] 

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Senator CARPER. You were precisely at 5 minutes. 

[Laughter.] 

Senator CARPER. Dr. Ginda, do you feel up to it? 

STATEMENT OF JAMES E. GINDA, MA., RRT, AE-C, CHES, 

SUPERVISOR OF RESPIRATORY CARE, KENT HOSPITAL 

Mr. GINDA. I will give it my best. 

Senator CARPER. Give it a shot. Welcome. You have 5 minutes. 

Mr. GINDA. Good morning. My name is James Ginda. I am honored to have this opportunity to be here today to testify before you 

on this important topic. It is an opportunity for me to advocate for 

those who do not have a voice, but who are affected by air quality 

issues. 

The topic of air pollution and children’s health is one that means 

a great deal to me. I am a registered respiratory therapist, a certified asthma educator and a certified health education specialist 

and have been in the field for 33 years. I have seen first-hand the 

impact of lung disease on the lives of patients I have cared for in 

hospital settings and in home care. 

While educating children through the years about lifestyle 

choices, such as cigarette somking, I have come to realized the effects of environment on the lung health, and felt the need to try 

to make a difference on a more macro level, upstream and health 

promotion. 

Environment is something that is too often beyond their individual control, whether it be secondhand smoke, housing conditions, or outdoor air quality, which I will focus on today. Beyond 

counseling them to remain indoors on the worst air quality days, 

they are susceptible to environmental triggers when outdoor air 

pollution makes its way indoors, particularly for those in urban 

communities where air conditioning is not an option and their vulnerability is compounded by other co-morbid conditions and socioeconomic factors. 

Airborne toxins are problematic because of the gaseous components, acid aerosols, byproducts of photochemical reactions, such as 

ground level ozone, and the effects of inhaled particulate matter deposited within the lungs. Particulate matter is composed of black 

carbon soot, metals, volatile organic compounds and crustal materials from mobile and stationery sources, such as diesel engines 

and power plants. 

The lungs act as a highly efficient filter and trap inhaled particles within their structures. Black carbon fine particulates get 

past upper airway lung defenses, even in healthy individuals, and 

carry toxins deep into the lungs, including carcinogens. The black 

carbon in particulate matter has been show to be a formidable opponent for alveolar macrophages, which are important for infection 

protection and a last line of lung defense. Chronic inflammation 

which is uncontrolled can lead to airway remodeling and a fixed degree of airflow obstruction, as we see in chronic lung disease. 

Both the fine particle and gaseous components of air pollution 

are triggers in asthma and can affect children even at low levels, 

below the National Ambient Air Quality Standards. Weather 

events, such as air temperature inversions, can trap pollutants and 

compound this problem. Gaseous components, such as sulfur and 

37 

nitrogen oxides, and acid aerosols, are irritating to airways and can 

induce an inflammatory response in the lungs and construction of 

bronchial smooth muscle, which narrows the airways and makes 

breathing difficult. 

Asthma is the most common chronic disease of childhood, and is 

responsible for a large amount of health care expenditures and lost 

school days. The burden extends to families who lose work days 

caring for sick children and to the health care system with increased acute care visits, emergency department visits and hospitalizations. Crisis-centered medical care and asthma education 

are not enough to preserve or improve the health of asthmatic children when environmental triggers are out of the control of the most 

vulnerable. Indeed, the Healthy People goals for improving the 

health of our Nation recognize this in their comprehensive respiratory disease and Environmental objectives. 

In 2010, after 3 years of careful study and consideration, the 

Rhode Island General Assembly passed a comprehensive clean construction bill as part of the Diesel Emissions Reduction Act, known 

as An Act Concerning Government Responsibility to Protect Public 

Health from Diesel Pollution, it is a shining example of a cooperative effort between concerned legislators, State agencies, environmental groups, industry representatives and health advocates. 

Local action has also been taken by city councils to reduce diesel 

emissions in the form of enforcement of anti-idling ordinances and 

pollution control devices on their city fleets. This cooperation momentum to address controllable sources of pollution must continue 

nationwide to improve the health of our communities. Air pollution 

is not confined with local or State borders. And children upwind 

can be affected by pollution from distant sources. So we also rely 

heavily on the United States Environmental Protection Agency and 

Federal Clean Air Act to protect our children. 

Children, and particularly children with asthma, are considered 

more vulnerable to air pollution with their higher respiratory rates, 

lung ventilation and outdoor activity and play. Prevention has to 

be a focus in health care and reducing the health burden of these 

toxins is within our grasp. On my own behalf as well as on behalf 

of the patients and families for whom I advocate today, who I have 

had the honor and privilege of caring for through the years, I applaud you for holding this hearing and urge your support of regulations and legislation aimed at continuing to reduce this preventable 

health threat. 

Children are the future of our Nation, healthy children in safe 

and healthy communities. The yellow cautions for children playing 

can serve as a reminder of all childhood health threats. Creating 

a healthier environment by controlling air toxins from mobile and 

stationary sources will benefit not only those most at risk, but indeed, all of us who depend on breathing clean air for optimal 

health. 

Thank you. 

[The prepared statement of Mr. Ginda follows:] 

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Senator CARPER. Thank you, Mr. Ginda. Exactly five. Exactly 5 

minutes. This is eerie. 

Now, before Senator Udall showed up and joined this hearing, we 

would go seven, eight, nine, 10 minutes. I don’t know what it is, 

but this is pretty impressive. Not even calling the shots here. We 

have had two consecutive witnesses who have come in at exactly 

5 minutes. 

We will see how you do, here. 

STATEMENT OF JULIE E. GOODMAN, PH.D., 

DABT, PRINCIPAL, GRADIENT 

Ms. GOODMAN. I will be under. 

Senator CARPER. OK, well, talk slowly, then. 

Ms. GOODMAN. Good morning, and thank you for the opportunity 

to testify regarding air quality and children’s health. I am Julie 

Goodman, Ph.D., a diplomate of the American Board of Toxicology. 

I am a Principal at Gradient, a firm specializing in human health 

risk assessment in Cambridge, Massachusetts. I also teach a graduate level epidemiology course at the Harvard School of Public 

Health. 

I am presenting testimony this morning on my own behalf as an 

independent scientist. I am not representing myself under any Federal contract or grant. 

Clean air and children’s health are very important to me, both 

as a scientist and as a mother. We all want clean air and appropriate standards if they result in health benefits. But unless there 

is evidence that standards would improve health or reduce the disease burden associated with air pollution, resources should be used 

toward other measures that would more clearly benefit society. 

Several issues with EPA’s risk assessment methodologies were 

noted this year by a committee assembled by the National Research Council, or NRC, of the National Academy of Sciences. This 

committee reviewed EPA’s draft assessment of formaldehyde, and 

noted a number of things that had also been identified in previous 

EPA assessments conducted over the last decade. 

Some of the concerns raised include a lack of information regarding study selection criteria, inconsistent methods for evaluating the 

strengths and weaknesses of studies and the lack of a clear framework for evaluating the weight of evidence for establishing what 

causes adverse health effects. These are also major limitations with 

EPA’s evaluations of the National Ambient Air Quality Standards, 

or NAAQS, including the ongoing reconsideration of the ozone 

standard, which is scheduled to be finalized in July. 

A key point of my testimony today is that because of these limitations identified by the NRC committee, the methods used by EPA 

to assess the risks of air pollution are likely to over-estimate the 

benefits of more stringent air quality standards. This potentially 

diverts limited national resources to implementing air quality 

standards that do not improve public health. 

In the evaluation of air pollution studies, including the ongoing 

ozone science assessment, EPA does not evaluate the strengths and 

weaknesses of individual studies consistently. In several instances, 

EPA criticized one study for using a certain methodology while another study using the same methodology did not receive the same 

71 

critique. This resulted in the latter study receiving more weight in 

the overall analysis, when both studies should have been considered equally. 

This is consistent with what the NRC committee said about the 

formaldehyde assessment, and that some studies receive a fuller 

treatment, including a more extensive assessment of bias and its 

consequences for estimating effect measures and others receive less 

attention. 

This is a particularly salient issue when studies come to different 

conclusions. EPA has a tendency to over-emphasize study results 

that suggest a pollutant may be associated with a health effect and 

de-emphasize or fail to consider at all study results indicating no 

association. This leads to a biased assessment of the data. If similar studies show that a certain level of pollution is harmful in some 

cases but not harmful in others, one must question both results 

and not just the latter. 

Study outcomes depend on many factors besides pollution, so the 

results of a single study or part of a study are not sufficient to determine what is occurring in the general population. Rather, real 

effects should be seen in patterns within and across all relevant epidemiology studies and consistent with the results of other types of 

studies, such as toxicity, mechanistic and exposure studies. This 

does not necessarily mean that all studies should be in complete 

agreement, but rather, if a pollutant is truly causing a health effect, it will be evident when all of the data are considered as a 

whole. EPA does not take this approach in assessing studies. 

Overall, and consistent with the NRC formaldehyde committee 

findings, a presentation of the study selection criteria and a clearly 

articulated framework for weighing the evidence are critical fro any 

determination of whether an air pollutant is causing a health effect. The NRC formaldehyde committee recommended that all key 

studies need to be thoroughly evaluated with standardized approaches that are clearly formulated based on the type of research. 

The committee also stated that strengthened, more integrative 

and more transparent discussions of weight of evidence are needed. 

The discussions would benefit from more rigorous and systematic 

coverage of the various determinants of weight of evidence such as 

consistency. These scientific guidelines should be followed by EPA 

when evaluating air pollution studies as well. Today, they are not. 

Finally, I would like to emphasize that I am not suggesting that 

air pollutants do not cause harm at high concentrations. Studies 

have shown consistently that they do. The issue is whether effects 

occur at air pollution levels observed today. Correcting the weaknesses cited by the NRC committee by using a transparent weight 

of evidence methodology could significantly improve our understanding of the risks posed by air pollution. This would ensure that 

we do not use limited national resources to implement air quality 

standards that do not benefit the health of children or the population at large. 

Thank you. 

[The prepared statement of Dr. Goodman follows:] 

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Senator CARPER. Thank you, Dr. Goodman. 

Dr. Thorning, please proceed. 

STATEMENT OF MARGO THORNING, PH.D., SENIOR VICE 

PRESIDENT, AMERICAN COUNCIL FOR CAPITAL FORMATION 

Ms. THORNING. Thank you, Chairmen Carper and Udall, and 

members of the Committee. It is a great pleasure to be here with 

you. 

My name is Margo Thorning. I am the Chief Economist for the 

American Council for Capital Formation. We represent a wide 

range of American industry, including manufacturing, financial 

services, as well as individual investors and small firms as well. 

In my testimony today I would like to make four points. First, 

the benefits that EPA alleges stem from the Clean Air Act amendments of 1990. The $2 trillion figure of economic benefits in the 

year 2020 has no basis in economic reality. That $2 trillion number 

is based on a survey of individuals asking them what would they 

be willing to pay for a somewhat reduced risk of mortality. It is 

also based on surveys of wage differentials between risky occupations like commercial fishermen and office workers. 

So that number, the $2 trillion number, has nothing to do with 

consumption spending, investment spending, government spending. 

It doesn’t create a single job or cause anybody to spend any money. 

So that number, the $2 trillion number, is not an appropriate one 

to use to analyze the benefits of the Clean Air Act. 

Second point, EPA did its own macroeconomic modeling to look 

at the costs of the Clean Air Act amendments. I would like to show 

chart one from my testimony. This is EPA’s own data showing that, 

and the blue case is the cost only case, showing that GDP steadily 

declines because of the Clean Air amendments. It is down by $79 

billion in 2010, by $93 billion compared to the baseline forecast in 

2015, and by $110 billion in 2020. 

EPA also modeled a case where they assumed that the Clean Air 

Act increased workers’ health, so that we had more workers working and that all the extra people actually found a job. In that case, 

and that is the red bars in the chart, we still see losses in GDP 

in 2010 and 2015. We only see a tiny $5 billion increase in GDP 

in 2020. Compare that $5 billion increase in GDP to the $2 trillion 

figure that EPA puts on their website as an indication of the economic benefits of the Clean Air Act. 

Also, EPA modeled the impact of the Clean Air Act on industrial 

output. That is figure two in my testimony. It shows significant 

losses in 2020 of industrial output, particularly in the other minerals category, which is bricks and gypsum and building materials. 

Particularly losses in aluminum, electricity. Other hard hit industries are petroleum, transportation services. So when EPA does 

standard macroeconomic modeling, it shows very significant impacts, negative impacts on GDP. 

Third point I want to stress is the link between economic growth 

and reduced mortality. For example, a study by Professor Brenner 

at Johns Hopkins University found over a 100-year look at the U.S. 

from 1900 to 2000 a strong correlation between higher per capita 

income and decreased mortality. That is figure three in my testimony. In addition, a study by Sarah Berghard and her colleagues, 

77 

she is at the University of Michigan, showed that higher unemployment levels have a significant negative impact on health. 

The fourth point is that investment spending in the U.S. is severely depressed. Compared to the fourth quarter of 2007 when the 

recession began, we are still down $313 billion, first quarter 2011, 

we are down $313 billion in investment spending compared to prerecession levels. That is figure four in my testimony. The historical data show that each $1 billion increase in investment spending contributes 15,000 new jobs. And conversely, each 

$1 billion decrease is responsible for a loss of 15,000 jobs. So focusing on the conditions that will let American business feel comfortable to invest, to make productive new investments and hire 

workers is going to be a key factor for our economic recovery. 

So finally, I would say that policymakers need to be very careful 

as they look at existing and new regulations to be sure the benefits 

that are reputed to go with those are accurately done, that they 

really represent real economic benefits, and be very careful as they 

look at the cost. Because every existing and new regulation, the 

cost should certainly be less than the benefits. 

Finally, I suggest that the best thing we can do for children’s 

health is to be sure their parents can find a productive, good-paying job. Thank you. 

[The prepared statement of Ms. Thorning follows:] 

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Senator CARPER. Thanks very much. 

Ms. Resnik, you are recognized. Please proceed. 

STATEMENT OF PATTY RESNIK, RRT-NPS, MBA, FACHE, CPHQ, 

CPUR, CORPORATE DIRECTOR, PERFORMANCE IMPROVEMENT/UTILIZATION MANAGEMENT, CHRISTIANA CARE 

HEALTH SYSTEM 

Ms. RESNIK. Thank you. I would like to thank Chairman Carper 

and Chairman Udall and Committee members here for the opportunity to speak today and for your work here. 

I am Patty Resnik, I am the Corporate Director of Performance 

Improvement and Utilization Management at Christiana Care 

Health System in Delaware. We are the largest health system in 

Delaware. And today I am representing not only the tens of thousands who suffer from chronic lung disease in Delaware, but also 

the over 890,000 people of our State who desire to breathe clean 

air and so protect their good health. 

I am a registered respiratory therapist with a sub-specialty certification in neonatal pediatric respiratory care and my professional 

background also includes education, training and certification in 

health care quality and utilization management. There are over 

150,000 practicing respiratory therapists in the United States. 

Therapists work under the direction of physicians and they evaluate, treat and care for patients with cardiopulmonary disease, such 

as asthma. 

Asthma is a chronic disease of the respiratory system. Asthma 

causes swelling and narrowing of the airways, making it difficult 

for a person to breathe. An asthma attack occurs when a person 

encounters or is exposed to a trigger. Triggers are different for each 

individual, but air pollution is a trigger for many people, especially 

children. Because children’s airways are smaller than adults, an 

asthma attack can be more severe for a child. 

When you consider some of the asthma statistics, asthma affects 

8.5 percent of the children in the United States. It is the most common chronic disease in children. It accounts for missed school days, 

children with asthma miss approximately 2.48 more school days, 

accounting for the most common cause of absenteeism. 

Economic costs are estimated to range between $12.7 billion and 

$19.7 billion with approximately $2 billion to $2.3 billion directly 

attributed to children’s asthma direct medical costs and the indirect costs of lost productivity from parental work lost time. In Delaware specifically, in 2008, asthma was one of the top three diagnosis for hospitalization for ages 1 to 17. 

At our health system, Fiscal Year 2009, a little over 1,900 emergency room visits for asthma, age 18 and younger, making up 22 

percent of these visits. At that same time period, about 398 hospital admissions with an average length of stay of 3.7 days. And 

what that means is that a child in the hospital for 3.7 days is missing approximately 4 days of school, and typically a parent will stay 

with their child while they are hospitalized, so that parent, if working, misses 4 days of work. 

In Fiscal Year 2010, we saw 11 percent increase in admissions 

to 441 with an average length of stay of 3.78, and a 5 percent increase in our ED visits as well in that time period. We have taken 

88 

emergency response to asthma to the highest level, including the 

availability of having anesthesia in the emergency room to treat 

people who are resistant to standard care. 

In the American Lung Association State of the Air report, every 

county in Delaware received failing grades for ozone, including 

Newcastle County, the most populated county, as part of the Philadelphia metro area, is among the to 25 most polluted cities for 

ozone. 

As a full-time working mom with two children, I am concerned 

about the quality of air. I had the opportunity to serve two terms 

as our PTA president of my son’s elementary school. Early in the 

first part of my first term, late spring, hot ozone days, the air conditioning malfunctioned. I was inundated with emails and phone 

calls from parents concerned over the impact of air quality on their 

children, parents of asthmatics concerned about availability of their 

child getting from their classroom to the school nurse to get their 

medications, concerns from parents about early dismissals and having to make alternate child care arrangements, so that someone 

could be home to meet their children, myself included. This does 

not account for the lost educational time these children experience 

due to the repeated early dismissals. 

Fortunately, our PTA was able to collaboratively work with our 

local Government and our local school board to fix that situation, 

taking over a year to do so. 

The Clean Air Act is a vital public health law. It sets healthbased air quality standards. The EPA and States around our Country have worked to implement this vital law that reduces air pollution, and it is working. 

I entrust this Committee to protect all those at risk from air pollution, those who are most vulnerable, such as our children, to our 

health enthusiasts. Thank you very much. 

[The prepared statement of Ms. Resnik follows:] 

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96 

Senator CARPER. Thank you so much. And thanks for the good 

work that you and your colleagues at Christiana Care do for us 

every day. 

One of the guiding principles in my life is actually provided by, 

of all people, Albert Einstein. Albert Einstein once said, ‘‘In adversity lies opportunity.’’ We have plenty of adversity with respect to 

our health care challenges in this Country. We spend way more 

money than any other nation. We spend like 18 percent, something 

like 16, 18 percent of GDP for health care. Places like Japan, they 

spend half that. They cover everybody, they get better results. They 

can’t be that smart, we can’t be that dumb. 

But in that adversity lies opportunity. And the opportunity is, 

how do we reduce our costs and get better health care results for 

less money. 

I think part of the solution is actually with respect to air quality. 

One of the issues that Senator Inhofe, Senator Voinovich and others on this Committee have worked on before is diesel emission reduction. For every $1 that we spend for diesel emission reduction, 

with literally implementing and installing technology developed 

and made in America, we basically get a benefit, economic and 

health benefit of about $13. That is what I call taking adversity 

and turning it into opportunity. 

And it is not uncommon, you look in my State and you look in 

other places where people live where there is a lot of highway traffic, a lot of diesel truck traffic, especially, and to look at the incidence of health impairment, particularly for kids, along those arteries. It is pretty clear that something bad is going on, and we have 

an obligation, and I think an opportunity, to do something about 

it. 

With that sort of set as a precursor, let me just ask a couple of 

questions. First, I want to ask Ms. Resnik and Mr. Ginda, can you 

take maybe a minute or two and talk about what a pediatric respiratory therapist does? What kind of treatments would a child received under your care? Just be fairly brief, if you would. 

Mr. GINDA. Yes, thank you, Senator. Children come into the hospital for various reasons. A lot of the care that is provided is as 

an outpatient now compared to the past, where the would previously be admitted. But infections of the lung, reactive airway disease of the upper airways, such as asthma, primarily. There is a 

population with cystic fibrosis, a genetic disorder that would be 

treated by respiratory therapists. 

But evaluating the patient in the emergency room that would be 

a child would involve listening to their lungs and listening to their 

parent describe the symptoms the child has been having, working 

with the physician to develop a treatment plan that includes medication administration to try and relieve the acute episode they are 

going through. And then teaching related to measuring their pulmonary function, so that we can actually record the airflow abnormalities and let them track it over time, teach them in a friendly 

way, like we use a stop light, a red light, a yellow light and a green 

light, when their peak flow is in the right range and as it starts 

to decline. 

So if they are having a bad air day, like Rhode Island was declared today a bad air day, southern Connecticut, southern MassaVerDate Aug 31 2005 12:16 Jan 09, 2017 Jkt 000000 PO 00000 Frm 00100 Fmt 6633 Sfmt 6633 S:\_EPW\DOCS\21143.TXT VERN
97 

chusetts, extending out to Nantucket and Martha’s Vineyard, all 

the way out in the water there. So on a day like today, if they were 

having difficulty breathing, they could measure their peak flow. It 

is just like taking their temperature if they felt sick, and get a feel 

for whether that was abnormal. 

Senator CARPER. All right, thanks. 

Ms. Resnik, can you just respond briefly? 

Ms. RESNIK. And in addition to that, the therapist would be 

working with the family and the child to ensure that the family 

and child understand what caused the trigger for their asthma attack, what caused them to come to the hospital, do they have an 

asthma action plan so that they can self-manage their disease at 

home and not have to come to the hospital, do they have access to 

medications, can the family afford those medications, and help develop that plan for transitioning the child back to their home. 

Senator CARPER. Can you give us a sense of what kinds of costs 

are incurred by virtue of these treatments? Just give us an idea. 

Mr. GINDA. Yes, Senator. In Rhode Island, 2007 data, the average hospitalization stay in Rhode Island for a child with asthma 

was 2 days when they were hospitalized. A child under age 5 had 

the highest hospitalization rate. The average charge for that hospitalization was $7,840. 

Senator CARPER. How much? 

Mr. GINDA. It was $7,840. Now, in 2007 in Rhode Island there 

were 1,856 emergency department visits by children with a primary diagnosis of asthma. The average charge for each one of those 

emergency Department visits was $1,823 per visit. Again, children 

under age 5 accounted for 46 percent of all the ED visits. And the 

average charge was $2,013. 

In Rhode Island, we see the highest visits by the socio-economically disadvantaged, particularly the Providence County area of 

Rhode Island. The effect of asthma on blacks is four times that of 

on Hispanic whites, and the effect on Hispanics is two times that 

of whites. So they are tremendously different. 

Senator CARPER. Wow. That is a lot of money. 

Ms. Resnik, did you want to add? 

Ms. RESNIK. I did provide in my testimony the statistics for Delaware for Christiana Care. I would be happy to followup in writing 

with you on the costs of that care. 

Senator CARPER. All right. 

I am going to stop right there and yield to Senator Barrasso. We 

will have a second round of questions. Thank you for your responses. Senator Barrasso? 

Senator BARRASSO. Thank you very much, Mr. Chairman. 

Dr. Thorning, if I could, I was looking through your testimony 

and there is a table two, a figure two of your testimony entitled 

percentage change in industry output in 2020, and a cost only case. 

It shows the sectors of the economy that would be most hit by this 

new Clean Air Act regulations, it is going to be electricity, mining, 

minerals, aluminum and coal. Then it goes on to show other sectors, like agriculture, lumber, transportation, equipment, iron, 

steel, plastics, rubber, petroleum also going to be hard hit. 

98 

In your opinion, how vital are these sectors in the economy in 

terms of manufacturing and developing the American products for 

future and creating jobs in this Country? 

Ms. THORNING. I think they are extremely critical to our economic recovery and to our competitiveness internationally. For example, the other minerals category that is most hard hit includes 

a range of products used in building, road construction, homebuilding. So to the extent those industries are impacted by these 

regulations, it is going to be harder to see the kind of restart we 

need in our economy. 

Certainly the energy sector is critical. I don’t know if you noticed 

Richard Fisher of the Dallas Feds discussion yesterday on 

Squawkbox, high energy prices are one of the key problems right 

now in terms of economic recovery. And electricity prices, too, we 

need to focus on cost-effective policies that will help us have cleaner energy and not negatively impact, not raise energy prices for our 

households and producers. 

Senator BARRASSO. That gets to the issue of child mortality, because you cited Professor Brenner of Johns Hopkins University, 

who stated that economic growth leads to lowering of morality 

rates. 

Ms. THORNING. Yes. 

Senator BARRASSO. So does that include lowering the mortality 

rates for children as well? 

Ms. THORNING. Of course, yes. 

Senator BARRASSO. Thank you. 

A couple other things. Dr. Goodman, you stated that the EPA 

has a tendency to over-emphasize study results that suggest a pollutant may be associated with a health effect, and then they deemphasize or fail to consider at all different study results when 

they don’t see an association. Do you think the EPA’s practice in 

this regard is scientific or is it something different? 

Ms. GOODMAN. I’m sorry, I don’t understand. 

Senator BARRASSO. You said that the EPA has a tendency to 

over-emphasize study results that they like, and under-emphasize 

study results that they don’t like. 

Ms. GOODMAN. Right. 

Senator BARRASSO. Is that actually being fair and honest with 

the American people? 

Ms. GOODMAN. No, I don’t think it is an appropriate way to analyze scientific data. The appropriate way to analyze data is to look 

at it all and give everything, every study equal consideration and 

strengthen limitations equally among all studies. 

Senator BARRASSO. Based on the scientific evidence, as opposed 

to the ones you like, picking and choosing the ones you like and 

the ones you don’t like? 

Ms. GOODMAN. Correct, based on the scientific evidence. 

Senator BARRASSO. But if EPA is making policies this way, they 

could then make decisions that needlessly cost jobs under the guise 

of trying to say they are protecting the public health or environment? 

Ms. GOODMAN. That is possible, yes. 

Senator BARRASSO. OK. 

99 

Dr. Upson, I understand that the EPA has paid, has paid the 

American Lung Association, and you are here representing the 

American Lung Association, as a member of the board, that the 

EPA has paid the American Lung Association more than $20 million, perhaps double the payments that the EPA made to the American Lung Association in the 1990’s, and that the American Lung 

Association also received another $3.7 million from the American 

Recovery and Reinvestment Act of 2009, the so-called stimulus 

package, is that correct? 

Dr. UPSON. I don’t know, sir. 

Senator BARRASSO. Well, it is an article in the Washington 

Times, Mr. Chairman. I would like to have that Washington Times 

article from March 31st included in the record. 

Senator CARPER. Without objection. 

[The referenced material was not submitted at time of print.] 

Senator BARRASSO. So the letter says that you, the American 

Lung Association has been paid millions and millions of money 

from the taxpayers, from the Environmental Protection Agency, as 

well as this so-called Stimulus Act. It goes on to say that your organization puts ads, does polls and lobbies Congress specifically for 

more EPA regulation. Your organization has sued to expand the 

EPA’s authority. And your organization regularly issues reports 

that lament supposedly poor air quality in the United States and 

touts the purported benefits of EPA’s actions that they have paid 

you to do and to say. 

So just to make clear for the people who are here, does the American Lung Association, of which you serve on the board, does the 

American Lung Association and/or its affiliates use taxpayer funds 

to lobby Congress for more EPA regulations? 

Dr. UPSON. I am on the local board of New Mexico. I know that 

in New Mexico, we do not receive any money from EPA. 

Senator BARRASSO. Do you think it is appropriate for the American Lung Association to take money from the Government to lobby 

the Government, to sue as well? Is that one of the goals of the 

American Lung Association? Is that kind of why you went into 

this? 

Dr. UPSON. The goal of the American Lung Association is to improve lung health for Americans. 

Senator BARRASSO. So it sounds good to you, these other things? 

They sound fair? 

Dr. UPSON. The funds that are provided by EPA, as I understand, are for specific programs. And we have somebody from the 

American Lung Association who could answer that better than I 

could, or I could get back to you in writing on the separation of 

those funds. I know there are of course strict regulations on how 

fund are used, so that there is no conflict of interest. 

I think that the EPA and the American Lung Association share 

the goal of improving lung health and, especially, I don’t know 

about the EPA, but for the Lung Association, certainly especially 

for children who are the most vulnerable to the effects of air pollution. 

Senator BARRASSO. Thank you, Mr. Chairman. 

Senator CARPER. If you just make sure you respond for the 

record, that would be great. Thank you. 

100 

Senator Udall. 

Senator UDALL. Thank you, Senator Carper. I think Dr. Upson 

is on the local lung board in New Mexico, and obviously the national association will respond and have an opportunity to put 

things into the record here. 

Dr. Upson, your testimony is pretty clear that abundant and 

clear peer-reviewed research demonstrates that air pollution harms 

health. I am quoting there from your testimony. There are a number of helpful examples in your testimony. Could you expand upon 

this point for the benefit of those watching who may not be able 

to read all the testimony? 

Dr. UPSON. Thank you, Senator Udall. There is an institute 

called the Health Effects Institute, which is a non-profit organization which is funded half by worldwide motor vehicle industry and 

half by the EPA. And it reported recently, last year, on a very thorough review of the literature on traffic-related air pollution. They 

used rigorous guidelines into which studies they could accept or not 

accept. 

They found, many of the studies were not sufficient, they were 

suggestive, but more research needed to be done. However, the evidence was sufficient to support a causal relationship between exposure to traffic-related air pollution and exacerbation of asthma. 

And that has been found in literally hundreds of studies. There is 

a suggestion that air pollution may in fact cause asthma, but we 

don’t have enough strength to say that yet. But we do clearly know 

that asthma exacerbations are related to air pollution. 

There was a study done in Southern California which showed 

that the risk of children developing asthma was three times that 

for those living in the six high ozone communities compared to the 

six lower ozone communities. 

Senator UDALL. Dr. Upson, today with temperatures in Washington in the mid-’90’s and a code orange air quality alert, we obviously have high air pollution concentrations that may be come 

unhealthy for sensitive groups like people with asthma. I have received from many of my constituents in Albuquerque, saying, and 

I want to quote a couple of these, ‘‘My son is one of the 47,000 New 

Mexico children with asthma. He especially needs pollution-free 

clean air.’’ Another Albuquerque resident, ‘‘Please continue making 

every effort to protect environmental legislation, sincerely, someone 

with asthma.’’ Another from the northwest part of our State, ‘‘My 

husband is an asthmatic, and support for the current law really affect us. Thank you for your work.’’ 

Then finally, one says, and they wanted to post this to you, ‘‘Dear 

Senator Udall, I have lived with the real life effects of air pollution. 

As a mother, it is difficult to witness your child struggle with asthma and feel like there is nothing that you can do, because there 

are millions of children around the Country like my child in need 

of cleaner air. I ask, is pollution from industrial sources like power 

plants, do they place my children at risk of asthma attacks?’’ 

What is your response to these kinds of questions from mothers 

across America? 

Dr. UPSON. So the question is the contribution of pollution to 

asthma attacks? 

Senator UDALL. Yes. 

101 

Dr. UPSON. I think the evidence for that is unequivocal. And I 

don’t think anybody disputes that air pollution causes asthma attacks. I had asthma, I still have asthma, and as a child growing 

up outside of Buffalo, New York, when the steel plants were in full 

gear, there were nights when I was maybe eight or 9 years old, and 

I would lie in bed struggling just to get every breath, and I was 

afraid to go to sleep, because I thought that I would die if I wasn’t 

using every ounce of energy I had to breathe. 

So I know what those mothers are talking about. I see it in children of friends, and certainly of course in adults with COPD, I see 

the same things. 

Senator UDALL. One of the witnesses, Dr. Goodman, used the 

statement, I am not suggesting that air pollutants do not cause 

harm at high concentrations. Studies have shown they consistently 

do. But the point here is that in our communities right now, like 

this high alert here, and like what is happening in New Mexico 

with the wildfire pollution that is coming over from Arizona, the 

levels that we are talking about today make a real impact on lungs 

and have a definite impact on more vulnerable populations, isn’t 

that correct? 

Dr. UPSON. That is correct, sir. 

Senator UDALL. Thank you. 

Senator CARPER. Thank you, Senator. 

Senator WHITEHOUSE. Senator WHITEHOUSE. Dr. Goodman, the sentence that was just 

quoted as yours, so let me ask you directly, do air pollutants cause 

harm at air pollution levels observed today? 

Ms. GOODMAN. There is no consistent evidence that at the levels 

below the current standards that air pollution is causing health effects. 

Senator WHITEHOUSE. There is no consistent evidence that air 

pollution is causing health effects today. 

Ms. GOODMAN. At exposure levels below the current standard. 

Senator WHITEHOUSE. At exposure levels—but you don’t say, that 

is not what your testimony says. You have said the issue is whether effects occur at air pollution levels observed today. Could you answer that question? Do air pollutants cause harm at air pollution 

levels observed today? 

Ms. GOODMAN. What I am saying is studies that look at levels 

observed today, which are generally below the standards, do not observe health effects associated with pollution consistently, or clearly. 

Senator WHITEHOUSE. So there are not air pollution effects from 

air pollution levels observed today? That is your testimony? 

Ms. GOODMAN. I am saying the evidence to date doesn’t clearly 

show that, yes, that is what I am saying. 

Senator WHITEHOUSE. Are you or your firm paid by the American 

Petroleum Institute? 

Ms. GOODMAN. Gradient has many private and public sector clients, and API is one of them. 

Senator WHITEHOUSE. So you are? The answer is yes? 

Ms. GOODMAN. Yes. 

Senator WHITEHOUSE. Dr. Thorning, I am not sure I got the end 

of your testimony exactly right, and I tried to find the language you 

102 

used in your written testimony. I didn’t see it. But it sounded like 

your recommendation for parents of a child suffering from asthma 

is that the parents get a job. What would you tell the parents of 

the 25,000 Rhode Island kids who have asthma who have jobs already about what we could be doing to help their kids not have to 

face these bad air days that keep them indoors, not have to have 

the emergency room visits that Dr. Ginda has referred to at Kent 

County Hospital? 

Ms. THORNING. Senator, the thought I am trying to get across is 

that we need to focus on trying to restart the American economy 

and get job growth going. As the chart that Senator Barrasso 

showed, poverty has the most significant impact on children’s 

health. 

Senator WHITEHOUSE. But what about a child who is not in poverty? Children get asthma who aren’t in poverty, children get asthma whose parents work. What do you do for them? They are in the 

hospital, too. They are part of that 25,000. 

Ms. THORNING. I think we need to take care, as we look at these 

existing regulations and future regulations, to be sure that the benefits equal the costs. It is pretty clear that the benefits EPA has 

alleged that stem from this Clean Air Act amendments are substantially overstated. We need to balance everything and—— 

Senator WHITEHOUSE. How do you value the cost of a mom who 

has to spend 2 days in the hospital as Dr. Ginda suggested is the 

average length of stay for somebody admitted for asthma? Where 

is that priced in your calculus? 

Ms. THORNING. I just refer to the economic calculations that EPA 

produced with their macroeconomic sims that shows that overall 

benefits, even when you factor in stronger health benefits in their 

case, which is the red bars in my chart, you show negative impacts 

on GDP. Every decrease in GDP means fewer jobs, lower—— 

Senator WHITEHOUSE. I get the large point. But how does the 

mom who is spending 2 days in the hospital worrying about her infant, where does the cost of that factor into your calculation? That 

is what I don’t see. 

Ms. THORNING. That is certainly a cost to the individual family. 

I am a macroeconomist thinking about what is best for the overall 

economy. And right now, our key problem is slows job growth and 

a very weak economic recovery. As Senator Barrasso’s chart shows, 

poverty is the most significant negative impact on children’s overall 

health. And to the extent we place regulatory burdens on industry 

that make it difficult for them to invest and hire, we are not going 

to see recovery. And that is going to have negative impact on children’s health. 

Dr. UPSON. Senator Whitehouse, may I add something to that? 

Senator Whitehouse. Of course. 

Dr. UPSON. There is evidence, we know that children in poverty 

have higher rates of asthma. And there is evidence that the reason 

for that is that those children are living in areas of higher air pollution, they live closer to busy roads, they live closer to industrial 

plumes. And it is not the poverty itself, except that poverty is what 

keeps them living in areas of high air pollution. 

103 

Senator WHITEHOUSE. Ms. Resnik, is there any doubt in your 

mind that there is a correlation between to air pollution and asthma? 

Ms. RESNIK. My experience as a respiratory therapist is that 

there are many different triggers of asthma. And air pollution certainly is one of those triggers. 

Senator WHITEHOUSE. At levels observed today? 

Ms. RESNIK. I am not familiar with that particular—— 

Senator WHITEHOUSE. Well, at the levels that you actually see 

out in the world today, that is causing these asthma reactions? 

Ms. RESNIK. Yes, would be a trigger for asthma. 

Senator WHITEHOUSE. Thank you. 

Senator CARPER. Thanks, Senator Whitehouse. 

A question if I could for Dr. Upson and for Ms. Resnik. Senator 

Alexander is not here today, Senator Alexander from Tennessee. I 

have introduced legislation, a couple of Congresses, actually, but in 

the last Congress we introduced legislation that would reduce air 

toxics, reduce sulfur dioxide and nitrogen oxide emissions to levels 

that are very similar to what the EPA has proposed. Cost estimates 

of our legislation for the average household I believe were less than 

$2 a month. Cost estimate of EPA regulations are expected to be 

very similar. 

Let me just ask both of you, if I could, as mothers and health care professionals, would you be willing to spend $2 a month to 

keep your kids from suffering from asthma attacks or neurological 

damage from mercury exposure? Would $2 a month outweigh those 

costs? What do you think? 

Dr. UPSON. I think it would. Of course, I am in a privileged category and I would be willing to spend more than my share of that. 

In fact, I have. I have put solar panels on my house, which will actually save me money in the long run. I have insulated my house, 

I ride a bicycle to work. And I am doing what I can to reduce air 

pollution, and I would certainly spend $2 a month more. 

Senator CARPER. Thank you. Ms. Resnik? 

Ms. RESNIK. As both a mom and a health care professional, I would absolutely be willing to pay $2 a month for clean air and to 

protect my children’s health. 

Senator CARPER. Dr. Goodman, as a toxicologist, could you explain for us if you would what happens to a fetus or a child when 

exposed to high levels of mercury, please? 

Ms. GOODMAN. I am not prepared to talk about mercury today. 

Senator CARPER. OK. Would you do that for us on the record? 

Would you followup for the record? That would be much appreciated. 

Ms. GOODMAN. I would be happy to. 

Senator CARPER. Anybody else want to take a shot at that? I 

don’t know if anybody else is prepared to. 

Dr. UPSON. Mercury is a neurotoxin that settles out in the atmosphere, particularly in water systems. The primary source of 

mercury in people in the U.S. today is from eating fish which has 

ingested mercury which has fallen from the sky. It is a neurotoxin 

that particularly affects children because of their developing brains 

and nervous systems. And it has been shown to decrease cognitive 

ability. 

104 

Senator CARPER. All right, thank you. 

This will be a followup for Dr. Goodman and also for Dr. Upson, 

if I could. When EPA looks at health risks and air toxics, my understanding is that the agency does not look at the cumulative effect of exposure to many different toxics, but looks at them on a 

one by one basis. Could a child’s exposure to one toxic, perhaps 

dioxin or formaldehyde, be amplified by exposure to other toxics, 

such as mercury or arsenic, so that a small amount of exposure to 

one toxic may not seem that unhealthy, but when mixed together 

with a number of others could be damaging, maybe even dangerous? Could we be underestimating health risks to our children 

as a result? 

Dr. Goodman, could you respond to that? Then I will ask Dr. 

Upson too. 

Ms. GOODMAN. It is true that there haven’t been many studies 

today where we are looking at these kinds of cumulative exposures. 

But I do think that science is moving in that direction. But I would 

say that when we do a lot of these human studies that we are 

doing observational studies looking at people in the real world, you 

are trying to isolate the effects of one particular chemical. But people are exposed to everything else that they are exposed to in their 

everyday lives. So often that could be accounted for. 

And another thing to add is that in many of these studies, looking at air pollutants, several air pollutants are measured and are 

accounted for in the analysis. 

Senator CARPER. Dr. Upson, please, same question. 

Dr. UPSON. Yes, sir, I think that you are absolutely right, it is 

very likely that the mix of pollutants is going to be found to create 

more damage than any one individual. The ones we look at now are 

surrogates for the whole mix. If we see a lot of those, we might 

infer there are other pollutants. 

There are problems with that because of dispersal and we don’t 

know exactly what those other pollutants are. I think it is an area 

that we need to invest some funding in for research to find out how 

much the danger is and which mix is really the worst and what 

we can do about it. 

Senator CARPER. All right. And then just briefly, Dr. Upson, it 

is my understanding that 2010 was one of the hottest years on 

record. Throughout the northeast region of our Country it is estimated that we had the most 90 degree plus days in the last 25 

years recorded in 2010, while in 2009 we had the fewest number 

of 90 degree days plus for the same time interval. At the same 

time, we also had a rise in ozone days in 2010 compared to 2009. 

I think the northeast region had something like 63 ozone days in 

2010 and about 34 in 2009. 

Do you believe the warm weather might have had something to 

do with the difference in ozone days? Do you expect we might see 

more ozone days to come, as our temperatures continue to rise? 

Dr. UPSON. Yes. Ozone is formed from the action of sunlight and 

heat on nitrogen oxides and reactive hydrocarbons, so that as temperatures rise, there is increased ozone formation. 

Senator CARPER. Just a followup with Ms. Resnik and I will close 

with this. You mentioned that there was an uptick in asthma related to hospital visits in 2010 compared to 2009 at Christiana 

105 

Care. I realize there are many factors that are at play, but is it 

possible that more ozone days could be one of those factors? 

Ms. RESNIK. As you noted, Senator, there are many reasons why 

that we could have seen an increase in those asthma visits. But it 

is possible that ozone, air pollution could have contributed to that. 

Senator CARPER. All right, my time has expired. Senator 

Barrasso? 

Senator BARRASSO. Thank you, Mr. Chair. 

Just following up, Ms. Resnik, on the previous question, it is interesting, because the Centers for Disease Control, they reported in 

their May 2011, just last month in their update on asthma in the 

United States that ‘‘We don’t know why asthma rates are rising.’’ 

Do you agree with that? 

Ms. RESNIK. I am not familiar with that. I would like the opportunity to respond in writing. 

Senator BARRASSO. Have you done any research in the area as 

to why asthma rates are rising and if so, can you tell us why they 

have risen in the United States? Especially why, in my earlier testimony, I talked about how pollution levels have significantly declined in this Country over the last number of decades. 

Ms. RESNIK. I have not specifically done any research in that 

area. That is outside my realm of expertise. 

Senator BARRASSO. Thank you. 

Dr. Upson, tell me if you agree that doctors are not sure how a 

person gets asthma. 

Dr. UPSON. That is correct. We don’t know all the causes. There 

are probably multiple causes of asthma. Certainly genetics plays a 

role. It is, there is more and more evidence that environmental exposures play a role. We don’t know what causes asthma, that is 

correct. We do know that asthma exacerbations or asthma attacks 

are caused by air pollution. 

Senator BARRASSO. I think we are pretty clear on the triggers of 

an asthma attack for somebody who is already asthmatic. The 

question is, why is that someone may become asthmatic. And you 

talked about the genetic issue as one. 

Dr. UPSON. Yes. 

Senator BARRASSO. OK, thank you. Thank you, Mr. Chairman. 

Senator CARPER. Senator Udall—Dr. Udall. 

Senator UDALL. Dr. Barrasso just asked the question, why asthma rates are rising in the U.S. Dr. Upson, do you have an opinion 

on that? 

Dr. UPSON. I don’t know why they are increasing. I think there 

is certainly evidence, suggestive, not confirmatory yet, that air pollution is related to the development of asthma. As I said, we know 

that it triggers asthma, and everyone, I think, has been in agreement there. I think it is an area that is ripe for more research. We 

are trying to find out why, but we don’t have the answer. 

Senator UDALL. Dr. Ginta, do you have an opinion on that? 

Mr. GINTA. Thank you, Senator Udall. Within my written testimony, I have an article that I published last month on diesel and 

chronic respiratory disease, that would be in your packets. I refer 

to that on page 17 of the article, that there is a connection they 

are looking at between some chemical messengers called 

interleukens, particularly interleuken 8, and then another one 

106 

called granulocyte macrophage colony stimulating factor, which are 

just a couple of genetic possibilities that they are looking at. These 

inflammatory mediators are stimulated by air pollution, particularly, and they are making that link. So that is the background 

question that we look at in the clinical setting, this missing piece 

of environment, are we adequately addressing it when we can continue to see clinical cases of asthma increasing and lack of control 

in so many patients where we have really good drugs to control it, 

even when they are accessible. 

Senator UDALL. Thank you. Dr. Goodman, the American Lung 

Association and the American Thoracic Association, the American 

Society of Pediatrics, all groups of medical doctors and researchers, 

are telling us that air pollution in American cities today is harmful 

to public health. Your statement I read earlier continue with the 

point, the issue is whether effects occur at air pollution levels observed today. That seems to disagree with the medical groups’ 

reading of the evidence. 

Are you saying we have no problem with air pollution in American cities today? 

Ms. GOODMAN. What I am saying is there have been many, many 

studies on air pollution and health effects. And if you look at certain studies, you will see that some of them report that certain levels of pollutants are associated with health effects. But then when 

you look at other studies, you will see that that is not the case. And 

the issue is, there are many—— 

Senator UDALL. No, that isn’t the question. Let me get you focused on the question here. The question I asked you is, are you 

saying, are you saying we may have no problem with air pollution 

in American cities today? I am talking about the air pollution in 

American cities today. I am not talking about the selective pulling 

out of information that you are doing from studies. Your statements today seem to suggest that you have no problem with the 

pollution levels in American cities today. 

Ms. GOODMAN. To answer that question, you really have to rely 

on the scientific evidence. And what—— 

Senator UDALL. Then the scientific evidence right now is that the 

standards are exceeded in American cities today. So is there a 

problem with public health on those standards being exceeded? 

Most major American cities, like is occurring here in Washington 

today, the standards are exceeded. Is that a problem for public 

health? 

Ms. GOODMAN. I really don’t feel prepared to answer that today. 

Because really, what I am prepared to talk about is whether there 

are health effects associated with levels in the studies that have 

been published below the current standards. And there aren’t. 

Senator UDALL. Well, the problem that we have today in our 

American cities is that the standards that the EPA has put into 

place are being violated. And we are having asthma attacks and we 

are having all sorts of health consequences as a result of that, as 

these medical doctors are telling us and medical doctors here on 

the panel. That is what I wanted you to comment on, but I guess 

you are not able to comment on that. You would rather comment 

on picking out studies and arguing with small points with them. 

107 

With that, Senator Lautenberg, why don’t you go to your questioning? Excuse me, I didn’t see Senator Vitter. Senator Vitter, you 

are in line here. Please. 

Senator VITTER. Sure, thank you. 

It seems to me we could cut through a lot of this and similar debates if we had confidence in good, sound science that wasn’t politicized. So a big part of my goal in a lot of this work has been to 

demand that we focus on sound science and basing our decisions, 

legislative and administrative decisions, on that sound science. 

I have to tell you right now, I have absolutely no confidence in 

the science coming out of the EPA. As many of you may be aware, 

I pushed a National Academy of Sciences report on one issue the 

EPA was dealing with, formaldehyde, and finally got them to agree 

to doing that. And the report came out about a month ago, and it 

documented very clearly that the report and the recommendations 

EPA had made were not sound, were not based on science, were 

not credible. And this isn’t from some right-wing industry group, 

this is from the National Academy of Sciences. 

I wanted to ask all of you, starting with Dr. Goodman, are you 

aware of that National Academy of Sciences report and that issue? 

What do you think it says about the larger issue of getting sound 

science as a basic for action, including at EPA? 

Ms. GOODMAN. I am aware of that report, and I actually discussed it in my testimony today. As I said, I feel that the points 

brought up in that report were not only relevant for formaldehyde, 

but for many other EPA assessments, including their assessments 

of the air pollutants that are addressed by the Clean Air Act. 

Senator VITTER. What sort of systemic improvements at EPA do 

you think it suggests? 

Ms. GOODMAN. I think it suggests that EPA needs to have a 

framework for evaluating the weight of evidence, looking at consistency within and among studies, looking at the strengths and limitations of studies, and not giving more weight to certain studies 

over others based on their results, but only weighing studies based 

on the methods that are used. 

Senator VITTER. OK. Any others like to comment on that? 

Dr. UPSON. The EPA works with CASAC, the Clean air Scientific 

Advisory Committee, and I had some colleagues who were on that 

panel, and they used rigorous standards to evaluate their studies. 

I don’t know if that has been true in the past, but I think that is 

true now. And I think there are other studies, as the one I mentioned on traffic-related air pollution, that uses very rigorous guidelines and comes to similar conclusions as the EPA. I agree that 

sound science is the basis for all this. 

Senator VITTER. I know the case study I am talking about is not 

Clean Air related, I realize it is a different category. But it does 

go to the broader issue. Are you aware of this National Academy 

formaldehyde study and the critique it included about EPA conclusions? 

Dr. UPSON. I am not familiar with it. 

Senator VITTER. Anyone else like to comment? 

Mr. GINTA. Senator, I am not familiar with that National Academy of Sciences thing, but there are other studies from other countries, international studies, six Italian studies, that really are conVerDate Aug 31 2005 12:16 Jan 09, 2017 Jkt 000000 PO 00000 Frm 00111 Fmt 6633 Sfmt 6633 S:\_EPW\DOCS\21143.TXT VERN
108 

sistent with the conclusions. Mexico City had a really good study 

where they looked at lung radiology and pulmonary function in 

children chronically exposed to air pollution. They analyzed chest 

x-rays of 249 clinically healthy children, 230 from Mexico City, 

which is a heavily polluted area, chronically exposed to levels that 

are greater than our national ambient air standards for PM 2.5. 

They had a control group from the other city nearby that wasn’t 

exposed. 

But what they found was striking. They had moderate to severe 

hyperinflations, which was air trapping, that we see in asthmatics, 

in 1 child from the control city and 151 out of 230, or 65.6 percent 

of the polluted city. They had additional linear markings in the 

lungs consistent with inflammation that was mild to moderate, in 

121 of the 230 children, which is 52.6 percent in the air pollution 

cities. That was in Mexico City. 

Italian studies have looked at six Italian cities. They have come 

up with a similar thing, that air pollution is a trigger for wheezing 

and gastrointestinal disturbances in children zero to 2 years of age. 

So I would just offer that there are EPA-related, to my knowledge, 

but as I evaluate the body of literature out there, they appear to 

be well-designed, in my opinion. Not being an epidemiologist, coming back. 

There is also a meta-analysis that was done in 2010 that looked 

at, it was really an analysis of the studies. Now, certainly there can 

be external validity issues if somebody doesn’t include the right papers, or excluded papers that didn’t say what they wanted them to 

say. But you go by the quality of the researchers, hopefully, that 

picked those studies. 

They selected 36 studies that were out there. And they were conclusive that short-term effects of PM 2 and NO2 in respiratory 

health among children and asthma-like symptoms were consistently related. 

The last thing I would point out would be related to our national 

air quality standards as far as ambient air, because that came up 

before. There is a paper in your packet that I wrote last May, or 

this past May, there were sub-ambient levels of air pollution associated with asthmatic symptoms in children in the study from Boston University. I can tell you, it was O’Connor and Ness from Boston University School of Medicine. They looked at data from 861 

children with persistent asthma in seven urban U.S. communities. 

What they found, they compared asthma symptom reporting, pulmonary function results and barometric pollution data. They found 

that higher levels of NO2 and PM 2.5 were associated with asthma-related missed school days and higher concentrations of NO2 

with asthma symptoms. It was interesting that almost all the pollutant levels in those studies that they looked at in that multi-city 

group were below the National Air Ambient Quality Standards, 

which speaks to the upwind considerations and the fact that air 

pollution isn’t limited to State borders, and it does travel, and 

weather conditions certainly do affect it, temperature inversions, 

where it is trapped low to the ground, where all of a sudden one 

area can suddenly be exposed to a higher concentration than you 

would normally measure over a cumulative period of time with a 

reference site. 

109 

Senator VITTER. Thank you, Mr. Chairman, if I can just warp up, 

my main point is the following. I appreciate those studies and that 

testimony. I am looking at all of your testimony. 

In general, though, the problem is, as members of the Senate, 

Members of Congress, we can’t review the literature exhaustively 

on any given public health issue. We generally should be able to 

depend on the relevant Federal agency to do that, and make a completely unbiased, completely scientific recommendation based on 

that purely objective review of the literature. 

I can tell you just for me, when it comes to EPA, I have absolutely no faith that that is done in a sound science-based way, 

none. The episode I have the most personal involvement in is this 

National Academy of Sciences report, which I pushed for, which 

unfortunately bore that out. 

So I think it is in all of our interest to demand rigorous sound 

science in Federal agencies, no matter who the Administration is, 

to give the public, Members of Congress, others, the confidence we 

need to know that this is science-based and not political agendabased. Thank you. 

Senator UDALL. [Presiding] Senator Lautenberg. 

Senator LAUTENBERG. Thanks, Mr. Chairman. I am sorry, I 

apologize for not having been here sooner, because this is a discussion that I find critical. And we have your statements, and they are 

under review by my staff. 

But I speak as an expert. I have a grandson who has asthma. 

And I know what happens when there is a code orange or that the 

air is polluted. And my daughter, his mother, when he goes to, he 

is athletic, and when he goes to play in a game or a meet or something like that, the first thing my daughter does is find out where 

the nearest clinic is, so that if he starts wheezing, she knows she 

has to get moving. 

My sister, who had asthma, and carried a small, I will call it a 

respirator, that she could plug into the lighter hole in the car, that 

could help her breathe easier. She was at a school board meeting 

one night, to which she was elected in New York, and she felt an 

attack coming on, and started to go for the car and collapsed in the 

parking lot and never recovered. Asthma. 

So we can discuss failures, but we also have to look at the statistics, what does it take? Are more kids getting sick from asthma? 

Are the attacks more frequent? We have more diseases that challenge child existence. I hear this condemnation of EPA, and know 

darned well that EPA funding is always a problem. What happens 

is if you just register disbelief, maybe that helps make the case. 

But the statistics about families and about children and watching 

them get sicker, I have a child, a grandchild who also has diabetes. 

By the way, I have 10 grandchildren, we do have a lot of healthy 

ones in there. But the other two survive remarkably. 

So I want to say that in 1990, both of our parties came together 

to strengthen the Clean Air Act and protect our children from dangerous air toxics, like mercury, acid, gases. Then the big polluters 

put their lawyers and lobbyists to work spending millions of dollars 

to prevent EPA from implementing the law and setting rules to 

clean up the largest sources of deadly emissions. 

110 

That is unacceptable that many rules on air toxics are now more 

than a decade overdue and children are paying the price, while the 

industries keep stalling. Just think about what is spewing into the 

air from power plants and cement plants. First we had mercury, 

which is brain poison for children. There are dioxins which cause 

birth defects, lead, which damages nervous systems, reduces children’s intelligence levels, arsenic, causes cancer. 

After years of delay by the Bush administration, the Obama administration is finally getting the job done, and in a way that 

treats everyone fairly. The EPA wants to hold all companies to the 

standards used at the cleanest plants. But big polluters are up to 

their old tricks and they are claiming that cleaning up their act is 

going to be too costly. 

Ask the parent of a child who is suffering from asthma or other 

diseases associated with chemicals in the atmosphere, asthma, et 

cetera. It is nonsense. These company, competitors, have already 

invested in this technology and they are succeeding. 

So we want to be clear. EPA is doing the right thing when it puts 

limits on the largest sources of mercury and other air toxics. EPA 

estimates that its rules on cement plants will prevent as many as 

2,500 premature deaths and 17,000 asthma outbreaks each year. 

And we don’t want to forget another fact, that children are not simply small adults. That proportionately, children breathe more air 

than adults, because their bodies are growing, it means they are 

exposed to more air toxics and smog than adults are. Since a child’s 

lungs, and you may have discussed this, so forgive me if it is repetitions, it says, a child’s lungs are still developing; substances that 

might harm adults can seriously damage a child’s health. 

So that is why we have a very special responsibility to our children to make sure they always have clean, safe air to breathe. 

Tragically, this isn’t the promise that we are keeping to the next 

generation. Recent data shows two-thirds of all children in the 

United States live in areas where the air is fouled by soot, smog, 

other pollutants that can cause asthma attacks. And nationally 

now, almost one in ten children suffers from asthma. That is according to new research from the Centers for Disease Control. 

New Jersey, one out of 12 of the residents has this lung disease. 

But the rate is far higher in the area called Newark, Newark’s east 

ward, where one in four residents has asthma. And the east ward 

is near the region’s port, airport and has heavy truck traffic, with 

drivers idling for hours in residential neighborhoods. Shockingly, 

improving children’s health doesn’t appear to be sufficient motivation for some of the other side of the aisle. Earlier this year, the 

House Republicans tried to stop EPA from making it harder for 

polluters to foul our air. And we defeated those efforts. But we 

have to continue remaining vigilant if we want to continue protecting the health of America’s children. 

So I have introduced legislation to reform TSCA, you all know 

what TSCA is, the Toxic Substances Control Act, to require all 

chemicals to be tested and proven safe for their intended use before 

they get into product, before they make it into other things. 

What might be the impact if we could do some reforming for 

TSCA? What effects could it have on air quality, Ms. Upson? 

111 

Dr. UPSON. Senator Lautenberg, your question is the impact of 

reducing toxic emissions of the health of the people? 

Senator LAUTENBERG. Right. 

Dr. UPSON. I think there is no question that reducing toxic emissions will improve the health of people, especially people with respiratory conditions, people with asthma, adults with emphysema or 

bronchitis, cystic fibrosis, any number of respiratory conditions are 

worsened when people are exposed to air pollution and other toxins. 

Senator LAUTENBERG. I am, permit this immodesty, but I am a 

cancer sponsor of no smoking in airplanes. And it has made a substantial difference. It is hard to imagine what it would be like to 

get into an airplane today, smoke-filled cabin, who would tolerate 

it. So when we hear so much about the cost of companies to reduce 

their emissions, we don’t hear enough about the benefits of cleaning up pollution sources and the costs that are saved, in addition 

to the anguish and pain that is put upon people who are affected 

by it. How does cleaning up pollution generate tangible economic 

benefits for the public as a whole? Does it matter? 

Dr. UPSON. And your question is, the economic benefit? 

Senator LAUTENBERG. Yes, economic benefits. 

Dr. UPSON. I think the major economic benefit is in decreased 

visits to the emergency Department, decreased hospitalizations, 

fewer days absent from school, fewer days absent from work taking 

care of children who are home from school. And you mentioned 

your clean air from tobacco legislation. I have worked a lot on that 

in New Mexico. And one of the consequences that we saw, a benefit 

that we weren’t anticipating from that legislation, in areas and 

towns and cities that have gone smoke-free, there have been 17 

studies now, all 17 of those studies show a decreased in heart attack or acute myocardial infarction after those laws went into 

place. 

In one town, they reversed that law and the rates of myocardial 

infarction went back up to the baseline level within 2 weeks. 

We weren’t anticipating that benefit. This is my opinion, that we 

would see benefits that we are not even anticipating if we decrease 

air pollution. 

Senator LAUTENBERG. The response that you might get here 

could be bah humbug. 

Thank you very, very much for your testimony. 

Senator UDALL. Senator Lautenberg, thank you for that excellent 

statement. We are now at the close of the hearing, and I want to 

thank all of the witnesses for their statements. You have given us 

some very good information and there has been some very compelling testimony. 

Senators will have 2 weeks to submit questions and material for 

the record. I ask that our witnesses promptly respond to these 

questions. These answers will become part of the hearing record. 

Again, I appreciate the witnesses’ time and attendance. With that, 

the hearing is adjourned. 

[Whereupon, at 11:50 a.m., the committees were adjourned.] 

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