DEPARTMENTS OF LABOR, HEALTH AND HUMAN 

SERVICES, EDUCATION, AND RELATED AGENCIES 

APPROPRIATIONS FOR 2011 

HEARINGS 

BEFORE A 

SUBCOMMITTEE OF THE 

COMMITTEE ON APPROPRIATIONS 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED ELEVENTH CONGRESS 

SECOND SESSION 

SUBCOMMITTEE ON THE DEPARTMENTS OF LABOR, HEALTH AND 

HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES 

DAVID R. OBEY, Wisconsin, Chairman 

NITA M. LOWEY, New York 

ROSA L. DELAURO, Connecticut 

JESSE L. JACKSON, JR., Illinois 

PATRICK J. KENNEDY, Rhode Island 

LUCILLE ROYBAL-ALLARD, California 

BARBARA LEE, California 

MICHAEL HONDA, California 

BETTY MCCOLLUM, Minnesota 

TIM RYAN, Ohio 

JOSE ́ E. SERRANO, New York 

TODD TIAHRT, Kansas 

DENNIS R. REHBERG, Montana 

RODNEY ALEXANDER, Louisiana 

JO BONNER, Alabama 

TOM COLE, Oklahoma 

NOTE: Under Committee Rules, Mr. Obey, as Chairman of the Full Committee, and Mr. Lewis, as Ranking 

Minority Member of the Full Committee, are authorized to sit as Members of all Subcommittees. 

DAVID REICH, NICOLE KUNKO, STEPHEN STEIGLEDER, DONNA SHAHBAZ, 

JOHN BARTRUM, LISA MOLYNEUX, and MIKE FRIEDBERG, 

Subcommittee Staff 

PART 5 

Page 

Department of Labor FY 2011 Budget Overview ............. 1 

Department of Education FY 2011 Budget Overview .... 59 

Department of Health and Human Services FY 2011 

Budget Overview .................................................................. 145 

National Institutes of Health FY 2011 Budget 

Overview ................................................................................ 279 

Printed for the use of the Committee on Appropriations 


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Part 5 


sroberts on DSK3CLS3C1PROD with HEARING
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, 

AND RELATED AGENCIES APPROPRIATIONS FOR 2011 


sroberts on DSK3CLS3C1PROD with HEARING

sroberts on DSK3CLS3C1PROD with HEARING
DEPARTMENTS OF LABOR, HEALTH AND HUMAN 

SERVICES, EDUCATION, AND RELATED AGENCIES 

APPROPRIATIONS FOR 2011 

HEARINGS 

BEFORE A 

SUBCOMMITTEE OF THE 

COMMITTEE ON APPROPRIATIONS 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED ELEVENTH CONGRESS 

SECOND SESSION 

SUBCOMMITTEE ON THE DEPARTMENTS OF LABOR, HEALTH AND 

HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES 

DAVID R. OBEY, Wisconsin, Chairman 

NITA M. LOWEY, New York 

ROSA L. DELAURO, Connecticut 

JESSE L. JACKSON, JR., Illinois 

PATRICK J. KENNEDY, Rhode Island 

LUCILLE ROYBAL-ALLARD, California 

BARBARA LEE, California 

MICHAEL HONDA, California 

BETTY MCCOLLUM, Minnesota 

TIM RYAN, Ohio 

JOSE ́ E. SERRANO, New York 

TODD TIAHRT, Kansas 

DENNIS R. REHBERG, Montana 

RODNEY ALEXANDER, Louisiana 

JO BONNER, Alabama 

TOM COLE, Oklahoma 

NOTE: Under Committee Rules, Mr. Obey, as Chairman of the Full Committee, and Mr. Lewis, as Ranking 

Minority Member of the Full Committee, are authorized to sit as Members of all Subcommittees. 

DAVID REICH, NICOLE KUNKO, STEPHEN STEIGLEDER, DONNA SHAHBAZ, 

JOHN BARTRUM, LISA MOLYNEUX, and MIKE FRIEDBERG, 

Subcommittee Staff 

PART 5 

Page 

Department of Labor FY 2011 Budget Overview ............. 1 

Department of Education FY 2011 Budget Overview .... 59 

Department of Health and Human Services FY 2011 

Budget Overview .................................................................. 145 

National Institutes of Health FY 2011 Budget 

Overview ................................................................................ 279 

Printed for the use of the Committee on Appropriations 

U.S. GOVERNMENT PRINTING OFFICE 

58–233 WASHINGTON : 2010 


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COMMITTEE ON APPROPRIATIONS 

DAVID R. OBEY, Wisconsin, Chairman 

NORMAN D. DICKS, Washington 

ALAN B. MOLLOHAN, West Virginia 

MARCY KAPTUR, Ohio 

PETER J. VISCLOSKY, Indiana 

NITA M. LOWEY, New York 

JOSE ́ E. SERRANO, New York 

ROSA L. DELAURO, Connecticut 

JAMES P. MORAN, Virginia 

JOHN W. OLVER, Massachusetts 

ED PASTOR, Arizona 

DAVID E. PRICE, North Carolina 

CHET EDWARDS, Texas 

PATRICK J. KENNEDY, Rhode Island 

MAURICE D. HINCHEY, New York 

LUCILLE ROYBAL-ALLARD, California 

SAM FARR, California 

JESSE L. JACKSON, JR., Illinois 

CAROLYN C. KILPATRICK, Michigan 

ALLEN BOYD, Florida 

CHAKA FATTAH, Pennsylvania 

STEVEN R. ROTHMAN, New Jersey 

SANFORD D. BISHOP, JR., Georgia 

MARION BERRY, Arkansas 

BARBARA LEE, California 

ADAM SCHIFF, California 

MICHAEL HONDA, California 

BETTY MCCOLLUM, Minnesota 

STEVE ISRAEL, New York 

TIM RYAN, Ohio 

C.A. ‘‘DUTCH’’ RUPPERSBERGER, Maryland 

BEN CHANDLER, Kentucky 

DEBBIE WASSERMAN SCHULTZ, Florida 

CIRO RODRIGUEZ, Texas 

LINCOLN DAVIS, Tennessee 

JOHN T. SALAZAR, Colorado 

PATRICK J. MURPHY, Pennsylvania 

JERRY LEWIS, California 

C. W. BILL YOUNG, Florida 

HAROLD ROGERS, Kentucky 

FRANK R. WOLF, Virginia 

JACK KINGSTON, Georgia 

RODNEY P. FRELINGHUYSEN, New 

Jersey 

TODD TIAHRT, Kansas 

ZACH WAMP, Tennessee 

TOM LATHAM, Iowa 

ROBERT B. ADERHOLT, Alabama 

JO ANN EMERSON, Missouri 

KAY GRANGER, Texas 

MICHAEL K. SIMPSON, Idaho 

JOHN ABNEY CULBERSON, Texas 

MARK STEVEN KIRK, Illinois 

ANDER CRENSHAW, Florida 

DENNIS R. REHBERG, Montana 

JOHN R. CARTER, Texas 

RODNEY ALEXANDER, Louisiana 

KEN CALVERT, California 

JO BONNER, Alabama 

STEVEN C. LATOURETTE, Ohio 

TOM COLE, Oklahoma 

BEVERLY PHETO, Clerk and Staff Director 

(II)


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DEPARTMENTS OF LABOR, HEALTH AND 

HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR 

2011 

WEDNESDAY, MARCH 10, 2010. 

DEPARTMENT OF LABOR, FY2011 BUDGET OVERVIEW 

WITNESS 

HON. HILDA SOLIS, SECRETARY OF LABOR 

INTRODUCTION

Mr. OBEY. Welcome, Madam Secretary. I am sorry we had to 

delay this hearing for an hour because of the special meeting I was 

called to today. So, to try to put us somewhat back on schedule, I 

am going to forego an opening statement and simply welcome you 

here. I know you probably have the toughest job that any Secretary 

of Labor has had since the Great Depression. I wish you luck and 

anything else that you need to get the job done. 

Mr. Tiahrt. 

Mr. TIAHRT. Thank you, Mr. Chairman. 

Secretary Solis, welcome back to the Committee. It is always a 

privilege to receive testimony from a former colleague. 

During these tough times, it is an extremely important Cabinet 

position to hold. Madam Secretary, when I look back over this past 

year, I become quite anxious about where we are today, and even 

more concerned about where we are headed. Unemployment continues to hover around 10 percent, twice the level of structural unemployment. We are seeing record budget deficits and historic levels of debt, many State budgets are also deep in red, and households continue to tighten their belts. They are making very difficult 

decisions, but necessary, decisions on spending cuts, which is what 

they expect their Government to do. 

We have to work our way through this together and do so responsibly, and that does not mean that we spend our way out of 

this recession, as the distinguished Majority Whip said last month. 

I fundamentally disagree with that approach. In order to work towards a vibrant American economy in the 21st century, Congress 

needs to take a comprehensive look at policies and incentives which 

build solid economic foundation. This will not be accomplished by 

Federal funds, but by private capital which spurs innovation and 

leads to job growth. Lasting economic growth comes from the bottom up, and not the top down. 


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Government does not create wealth. I think that is a misnomer 

in Washington today, that Government does create wealth. It does 

not. Government does not create wealth; the private sector does. 

And jobs are a byproduct of creating wealth. Our fellow Americans 

have been the victims of a top-down approach this past year. The 

Recovery Act was supposed to create 3.5 million jobs; yet 3.3 million jobs have been lost since its passage, including over 25,000 

manufacturing jobs in Kansas. Kansas wants to get back to work. 

Kansas employers want to hire them. It is our duty to give them 

the tools and the opportunity to do so, not enacting policies that 

will only lead to a jobless recovery. 

FISCAL RESTRAINT

Yet, these are macro issues, Madam Secretary, and it will take 

so much more than the Department of Labor alone to positively affect them. But it can start here, with this Committee, and it has 

to because it has not started with the Administration. President 

Obama promised a three-year freeze on non-defense, non-security 

domestic spending; yet, his request for programs under the jurisdiction of this Subcommittee have increased by $27,000,000,000. 

We need to do exactly what the President promised, but has so 

far failed to do: apply the scalpel to this budget request and make 

the tough, perhaps politically unpopular, decisions. 

There was an excellent article in the Wall Street Journal today 

about Ireland and how they are going to survive their red ink. The 

title of it is Irish Take Bitter Medicine to Survive the Age of Red 

Ink. 

ETA CARRYOVER

I strongly support many of the programs funded through this 

bill; they are important for sustainable economic growth. But in 

these difficult times they call for fiscal restraint responsibility. 

Case in point—and I know the mere mention of this term, carryover, will cause many to sit upright, but consider the Employment 

and Training Administration. The entity was responsible for providing employment and training assistance programs and the administration of unemployment benefits; $2,500,000,000 of unspent 

funds was carried into fiscal year 2010, $700,000,000 more than 

you had estimated; $2,500,000,000 appropriated in fiscal year 2009 

that was simply not needed. 

We all know the trillion is the new billion, but these are huge, 

huge numbers. Just because the practice is permissible by statute 

does not make it an appropriate use of taxpayer dollars. Again, 

tough but responsible decisions must be made this year, and we 

have to own up to them. 

CREATION OF GREEN JOBS

Lastly, your budget request is premised on the notion of creating 

good jobs, a simple enough concept that we all support. And as 

these good jobs are created, I certainly hope that we do not fall into 

the same nebulous void as green jobs. Not only does the definition 

of a green job seem to be ever-evolving, but even the process by 

which we now calculate green jobs growth is flawed. 


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Take Vice President Biden’s December memo to the President entitled The Transformation of Clean Energy Economy. In it he cites 

that renewable energy investments would create 253,000 jobs and 

would ‘‘support’’—I presume he means save—up to 469,000 more 

jobs. But he footnotes these numbers saying, ‘‘A project that employs one person for two years would count as creating two jobs.’’ 

One person working for two years is two jobs. 

I do not buy this. We could say that one job per month for two 

years would be 104 jobs. I think it is just one job and we need to 

keep our calculations correct and have an accurate representation 

of job growth, because the American people deserve and need to 

know the real facts. 

So, Madam Secretary, I welcome you back once again, and I look 

forward to your testimony today. 

Mr. Chairman, thank you for your time. 

OPENING STATEMENT

Mr. OBEY. Madam Secretary, why do you not proceed? Summarize your statement and proceed to the questions. 

Secretary SOLIS. Thank you, Mr. Chairman, Chairman Obey and 

Ranking Member Tiahrt and members of the Subcommittee. It is 

a pleasure to be here again this year. Thank you for inviting me 

to discuss our fiscal year 2011 budget request, and I ask that my 

prepared testimony be entered into the record, as I will review the 

highlights with you. 

First, it is not possible to discuss next year’s budget without acknowledging the immediate need to put Americans back to work. 

I am proud of the work we have done with the Recovery Act resources, which include providing nearly $50,000,000,000 in UI benefits to unemployed workers and assisting over 190,000 of them to 

maintain their health care coverage under COBRA; creating summer job opportunities for nearly 318,000 low-income youth and over 

18,000 wage-paying community service jobs for low-income seniors; 

and providing training opportunities for demand health care jobs 

and emerging jobs in the new green economy, renewable energy. 

While these efforts are helping, they are clearly not enough, and 

at 9.7 percent, unemployment remains persistently and unacceptably high, and especially for those particular groups most affected. 

African Americans are suffering at 15.8 percent, Latinos at 12.4 

percent. The situation is dire. And in the Native American communities it is even higher. 

I remain hopeful, however, that Congress will reach agreement 

on measures that will allow us to continue to assist Americans 

until the labor market fully recovers. 

Mr. Chairman, you recognized this need when you added funds 

last year for the Senior Community Service Employment Program. 

We moved quickly as a result and many low-income seniors did not 

need to wait for a jobs package to secure employment. But there 

is so much more that needs to be done, and some examples are: 

To further extend the safety net for those displaced and dislocated workers by extension of the UI and COBRA assistance, 

which I believe the House and the Senate are working on; to commit to $1,200,000,000 to ensure that a robust summer jobs program 


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can be implemented to put the high number of unemployed youth 

to work to receive job training and education exposure; To jump-start our employment through a $500,000,000 investment through on-the-job training programs that can help small 

businesses and hopefully be incentivized to hire and add on more 

workers; and 

To add $300,000,000 to further support the oversubscribed Pathways out of Poverty and Energy Training Partnership programs 

that include employers in all of those partnerships. 

Our budget request will sustain those investments through programs that give workers the tools they needed to succeed in this 

new economy. I want to highlight some of the measures that will 

allow us to increase the skills of all segments of our workforce. 

For the first time in over a decade, the budget proposes a significant increase in funding for the Workforce Investment Act programs. However, the additional resources are also closely linked to 

reform. In keeping with the Administration’s WIA reauthorization 

goals, a percentage of the funds appropriated for adults, dislocated 

workers, and youth will be reserved for two new WIA Innovation 

Funds to provide competitive grants to encourage the workforce 

system to test or replicate models that we know work to expand 

and improve services and results for their customers, namely, employment in the private sector. The budget also requests an increase of $45,000,000 for the 

Green Jobs Innovation Fund. And I can tell you from my experience with the Recovery Act competitions that the demand for green 

job training has been enormous, and it has come from the private 

sector. We have simply not been able to keep pace with the record 

number of applications, submissions that came into my office; and 

I believe this unprecedented level of interest calls for further investment, more resources. 

We are committed to linking this training with job creation efforts in green industries and expect our grantees to work with employers and other participants to gain those valuable skills and industry-recognized credentials that will help them move into better 

and higher paying jobs. 

In addition to the Youth Innovation Fund, the budget request includes an increase in other services for youth, such as $17,500,000 

in the YouthBuild program that will allow us to extend this program and serve an estimated 230 competitive grants to local organizations to serve disadvantaged youth. 

We also expect to see benefits from fully integrating the Job 

Corps program with other youth programs and returning it into the 

ETA program. We are also undertaking a rigorous and comprehensive review of the Job Corps operations to identify any needed reforms that we might need to take. 

Good jobs for everyone means that other vulnerable populations 

must not also be left behind. That is why we are doing more to target resources to areas of greatest poverty, and that is why the 

budget request includes increases in the Indian and Native American and Migrant and Seasonal Farm Worker Programs. Two DOL 

agencies, ETA and the Office of Disability Employment and Policy, 

known as ODEP, will also receive $12,000,000 each to continue 

their job disability initiative to increase the capacity at our oneVerDate Mar 15 2010 08:35 Nov 16, 2010 Jkt 058233 PO 00000 Frm 00004 Fmt 6633 Sfmt 6602 E:\HR\OC\A233P2.XXX A233P2

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stop system to provide accessible services to individuals with disability. 

We know returning veterans, including those who are disabled, 

can contribute greatly to the expansion of our economy. They are 

the most under-utilized population. For the Veterans Employment 

and Training Service, the budget requests $262,000,000 and includes increases for homeless veterans grants and transition assistance programs which are vitally important for those individuals 

that are coming back and want to be reintegrated into our society. 

Our Assistant Secretary, Ray Jefferson, will be with you tomorrow to fill in any items or activities that you require more information regarding our Vets program. The ETA Assistant Secretary, 

Jane Oates, will also be here tomorrow to discuss any further plans 

and details you might have regarding partnerships that include the 

nursing shortage and also efforts to help provide assistance to 

States to pay for a paid leave program that we are now initiating. 

I know you understand that it can be too easy to exploit workers 

when jobs are scarce. We need to remain vigilant in protecting the 

rights and safety of all of our workers. In fiscal year 2011 the budget continues that vigilance by hiring additional enforcement personnel and strengthening our regulatory efforts. We build upon the 

resources that you provided last year to return our worker protection programs to the 2001 staffing levels or greater, after years of 

decline. 

To do so, the request includes $1,700,000,000 in discretionary 

funds for 10,957 FTE for our worker protection activities. This 

funding level is $67,000,000, 4 percent, and 177 FTE above last 

year’s level, and the agency-by-agency details are in my prepared 

testimony. 

In discussing worker protection, I want to point out that the request also includes increases to support the development of regulations in areas such as pensions, worker health and safety. These 

resources will help reinvigorate the Department’s regulatory program and are critical to the success of our worker protection agenda. 

The budget also includes an important interagency effort to address the issue of employee misclassification. Workers wrongly 

classified as independent contractors are denied access to critical 

benefits and protections in the workplace to which they are entitled, for example, overtime, health care coverage, worker’s compensation, family and medical leave, and unemployment insurance. 

In addition to denying workers these protections and benefits, 

misclassification results in billions, billions of dollars of losses to 

Government through unpaid taxes. Our budget includes 

$25,000,000 to hire additional enforcement personnel targeted at 

misclassification to fund competitive grants to boost States’ incentives and capacity to address this problem. 

Restoring our economy requires ensuring the world economy is 

also sound and balances. I firmly believe that our responsibility to 

promote acceptable conditions of work abroad is closely linked to 

our worker protection agenda here at home. It is with this goal in 

mind that we are requesting an increase of $22,000,000 in the 

ILAB program to increase the monitoring of labor provisions in 

trade agreements and to support programs that use innovative and 


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successful models to improve the labor rights of workers in our 

trading partner countries. 

Mr. Chairman, it is thanks to your leadership that we have been 

able to pursue these approaches, which is based on highly successful garment industry projects that we have been working on in 

Cambodia. By increasing funding, we will be able to expand our 

reach of worker rights protections in additional countries. So I 

thank you for your previous support. 

Before I conclude, I want to say just a few words about our commitment to ensuring accountability for the resources that you entrust us with. This is why my testimony links investments to performance outcomes and why we have new commitment to program 

evaluation. 

Members of the Subcommittee, I think we all know that too 

many Americans are ready and willing to work. But we know that 

they cannot find a job. There are six applicants for each job that 

is available now. We know the urgency. The budget before you will 

help spur new and better job opportunities while fostering safe 

workplaces that respect workers’ rights. That is what my goal of 

Good Jobs For Everyone is, and I look forward to working with you 

on making this vision a reality. 

I am happy to respond to any questions that the members of the 

Subcommittee might have. 

[The information follows:] 


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Mr. OBEY. Thank you very much. 

Mr. Tiahrt. 

GREEN JOBS

Mr. TIAHRT. Thank you, Mr. Chairman. 

I want to talk just a little bit, ask you some questions about the 

green jobs. In the fiscal year 2011 request for increased funding for 

green jobs training, the request is for $45,000,000 over fiscal year 

2010, for a total of $85,000,000, more than doubling its funding in 

one year. This would be in addition to the $500,000,000 provided 

in the Recovery Act. 

However, your latest Recovery Act execution report states that only $520,000 of the $500,000,000 provided for green jobs has been 

spent. These funds were provided 13 months ago. I am aware the 

obligation rate is higher, but I think it is important to focus on 

what has actually been injected into the economy. 

Money that is merely obligated does not provide the economic 

stimulus intended by the Recovery Act, and it certainly does not 

help the American worker. Furthermore, I am concerned about the 

push to create green jobs, whether they will actually have a 

counter effect. There is a Washington Post article about the smart 

grid, and that is considered to be one of the clean energy sector 

jobs growth. The author, who is the Director of GE Smart Grid Initiative, suggests that because the smart grid is premised on automation, more than 28,000 jobs of meter readers are likely to disappear. 

Now, maybe that is just the normal course of technology; we 

should accept that. But green jobs is kind of a novel concept. In the 

article he says that there are really four categories, based on what 

has happened in Europe, for green jobs when it comes to this smart 

grid: it is research and development, it is manufacturing, installation, and then information technology. 

Now, we are excited about the manufacturing side of it because 

we have to make things in this Country. If we do not make things, 

our economy is going to be stagnant. We cannot exist as a service 

economy only; we have to make things. So the manufacturing side 

of it is very good. In fact, we have a wind generating manufacturing facility owned by Siemens, a German company, in Hutchinson, Kansas, not far from my home. But when you look at the 

actual jobs that are residual or long-term for these green jobs, it 

is a minimal number. So I am concerned that we are overestimating the impact on our economy by green jobs. 

If you take into consideration the study done by King Juan Carlos University in Spain, they decided that for every green job that 

was created, the resources were taken from the private sector and 

actually cost 2.2 jobs in the private sector. So we had a net loss 

of 1.2 jobs, according to their estimate, in Spain for having a single 

green job. So taking resources out of the private sector to create 

these and subsidize these jobs may not be the best plan to get the 

economy rolling again. 

I am going to go back to this $500,000,000. So if you have not 

spent any of the $500,000,000 of the stimulus fund, how can we assess whether or not unemployed individuals have been able to obtain work through the so-called green jobs sector? 


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DECREASE IN JOB LOSSES

Secretary SOLIS. Thank you, Congressman Tiahrt, for your question. You bring up a lot of good questions here, and what I would 

like to begin with is, frankly, if we can all look back where we were 

in January and February of last year. We were losing well over 

700,000 jobs a month at that time. 

This last month, one of the roles that I play in the Department 

of Labor is to have to issue what that job report is. I am happy 

to say that we have seen a very, very dramatic decrease in job loss; 

it went down to 32,000 jobs a month. However, I do want to say 

that we have a high, high number of people who continue to be unemployed and have been out of work for longer than six months. 

GREEN JOBS

The green job programs that we have rolled out—and much of 

that money was actually released through a competitive process 

where we had—in each case, entrepreneurs, partnerships with different providers that were a compilation of community colleges, apprenticeship programs, but, more importantly, we had business involved. These efforts are to help create job training slots, and the 

idea is that the results of those partnerships come about because 

of the design of the grants’ writers from the local area. 

Much of what is coming to us is by way of what the community 

sees as a need. So, for example, in a community that I visited in 

Tennessee, their interest was in looking at solar panels, looking at 

trying to change how work was done in the Sharp Corporation. 

They were doing televisions before; now they are doing solar panels. The owner of that property was telling me that they would like 

to see more help so that they can have a trained workforce to make 

that kind of transition. This is where I believe our partnerships 

will work in a better way to help focus in terms of what regional 

sectors are looking for. 

I know that there has been much debate about how many jobs 

we created, but I know that because of the Recovery Act we have 

seen more than 1.5 to at least 2.5 million jobs that have been created. That also represents people in law enforcement, teachers, 

people who are also working in construction and hopefully now beginning to get involved in those construction projects that are going 

to be rolled out through the infrastructure monies that were made 

available by the Congress. 

Mr. OBEY. The gentleman’s time has expired. 

Mrs. Lowey. 

And let me explain. I am going to try to hold each questioner to 

five minutes, so if members want long answers from the witness, 

they need to ask short questions. 

G–20 SUMMIT

Mrs. LOWEY. Well, I am delighted, Madam Secretary, to have you 

with us, and once again I want to congratulate you on your effective administration. We really are delighted to see you in this position. 

I know that you were very enthusiastic at the last year’s summit 

in Pittsburgh when the G–20 leaders called upon you to host a 


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meeting of employment and labor ministers in early 2010. The economic crisis that our Country is recovering from has been felt 

worldwide. So if you can tell us about this G–20 meeting, how it 

will help us solve the jobs crisis we face, I think it would be very 

helpful. 

Secretary SOLIS. Thank you, Congresswoman Lowey, and it is a 

delight and pleasure to be here with you as well. I know how deeply concerned you are with respect to foreign relations, and have 

watched you in action on the floor and always with the mind-set 

of how can we build our relationships with our trading partners; 

and under that premise the G–20 summit that is going to be held 

here in Washington for the first time, I think, is a very historic moment. To have our Administration actually present this idea in 

Pittsburgh and have, then, the buy-in from the G–20 labor ministers and all those parties to say yes, we want to come together. 

This is a global crisis. The economic crisis of job loss is hitting 

everyone, and more severely than our own Country; and I think 

this is an opportunity for us to be able to position ourselves once 

again to talk about some of the innovative things that we are doing 

and listen clearly to what some of the other countries are doing 

that may work better. 

But, more importantly, making sure that the U.S. can play a significant role in this effort. And I am very, very appreciative that 

we are able to get the support that we did in the last year’s budget 

to help provide the foundation for the ILAB division under the auspices of Sandra Polaski. She is doing a tremendous job to help 

build upon those relationships that we saw that may have been 

very fragile in the last few years. 

And I am very excited about the opportunity, as I travel to other 

meetings representing our Country at the G–8 Summit, talking to 

other labor ministers there. They are very, very much engaged to 

see where our investments are; where that safety net, where those 

monies are going to help provide security for those dislocated workers and what kinds of new programs are being implemented to 

keep people on the job. 

Germany and other countries have very, very different types of 

approaches in how they address keeping workers on the job; they 

help to subsidize that salary and they actually give an incentive to 

businesses to keep those industries in place, unlike what we have 

been doing here. And I say that because they have had a tremendous manufacturing industry going there for many years, but they 

know that that investment cannot be lost easily, so they make sure 

that they try to attempt to keep dollars there. Those are things 

that we can learn from. 

So I am very excited to be able to pull together the labor ministers here, along with the Administration, to hear about some good 

innovative programs, but also bring together business leaders. So 

we are also bringing together the different chamber representatives, the manufacturing representatives, as well as labor, to talk 

about the kinds of ideas and what is needed most now in the world. 

So I take this very seriously and I am very pleased that the Department of Labor can finally play a role here. 


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BUREAU OF INTERNATIONAL LABOR AFFAIRS

Mrs. LOWEY. Thank you. In the couple of minutes I have left, I 

know you have been proud of the work that the International 

Labor Affairs Bureau has done. Well, we have given you, I believe, 

the budget request—I do not know that the Chair has appropriated 

it yet—$22,000,000 and an increase which would be focusing on 

labor conditions in foreign countries, reducing child labor, protecting women’s rights, maintaining our education, HIV/AIDS initiatives. Could you comment on the importance of that increase to 

accomplish these goals? 

Secretary SOLIS. I think these are very, very important investments that we are making. As I said earlier in my statement, we 

have been working with other international partners, including the 

International Labor Organization, the ILO, to look at what best 

practices we can offer to other countries that are perhaps having 

some trouble, with trade enforcement or labor relation protections. 

But, more importantly, how to try to bring up the quality of life 

for some of our trading partners. I think about the example in 

Cambodia, where an effort was made there to look at the garment 

industry and to try to bring all those industries in that part of the 

world together to set a better standard to protect their workers, 

provide better wages for them, and then allow for our markets and 

other international markets through the ILO to also become partners with them. This expands their economic base, which creates 

more jobs, and creates opportunities for the U.S. to import and export those goods from countries like Cambodia. 

We are trying to use that model in other parts of Central America. In particular, we are exploring discussions with El Salvador 

and Nicaragua. 

Mr. OBEY. Mr. Rehberg. 

OSHA ERGONOMICS REGULATION

Mr. REHBERG. Thank you, Mr. Chairman. I was going to ask a 

meaningful question, but our staff left to have his picture taken 

with Herschel Walker, and I had to decide whether to go with him. 

He is out in the hall. 

Welcome. Nice to have you back. 

Secretary SOLIS. Thank you. 

Mr. REHBERG. The majority put language in the bill last year to 

add a column in the 300 log for musculoskeletal injuries, and some 

of us kind of think that that is the first sign towards a movement 

towards doing something that we successfully stopped in 2001, and 

that was the creation of an ergonomics regulation. Does your Administration intend to reestablish an ergonomics regulation in the 

three years that you have left? 

Secretary SOLIS. Congressman, I do want to tell you that there 

is a lot of confusion surrounding this issue, and we have decided 

that we want to put this back in terms of gathering information, 

because we think it is going to be useful. Many businesses are required to report any injury anyway, and all we are saying is that 

we are going back to the 2001 practice. It does not mean that we 

are going to roll out an ergonomics standard—— 


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Mr. REHBERG. So there is no intent at this time for the Administration? 

Secretary SOLIS. At this time that is not—— 

Mr. REHBERG. And you do not anticipate in the future a movement towards—— 

Secretary SOLIS. At this time I can tell you that that is not the 

direction that the Department is going in. It is more of a means 

and mechanism to help provide information to businesses so we can 

prevent injuries. We know worker’s compensation premiums and 

what have you have gone way up. We think this is a way to help 

provide provision information. 

WORKER PROTECTION

Mr. REHBERG. Over the course of 2001 forward, Secretary Chao 

was very aggressive in, one, enforcement; two, working on the 

things she promised to do, and that was create industry-specific 

guidelines; and, three, to continue ergonomic research. Could you 

report what the Department has done in all three of those areas? 

Are you still going to aggressively work on industry-specific regulations like the nursing home industry? 

Secretary SOLIS. I think that we are obviously trying to put the 

OSHA division back where it was in 2001, so one of our efforts is 

to try to make sure that we staff up, that we are not having to do 

things that really bog down the system; and we would like to try 

to streamline the system and get information out to businesses, as 

well as workers, so that we can prevent injuries. I think we will 

be taking a look at different regulations in more detail, and I would 

be happy to provide you and your staff that information. 

But at this time, we are trying to respond to what Congress has 

also made clear to us, that in the past, OSHA and the Wage and 

Hour Division have not been as aggressive in terms of going and 

seeking and investigating some of these problems that have been 

occurring. The GAO is very clear on that; the Congress, this Congress, has been very clear. So we are attempting to address those 

issues that have kind of landed on my lap now as the Secretary of 

Labor. 

[The information follows:] 

There are no specific plans involving ergonomics rulemaking at this time. OSHA 

is carefully assessing its best course for preventing work-related musculoskeletal injuries, which includes a review of the guidelines that have been published and the 

effectiveness of guidelines as a strategy to address work-related musculoskeletal injuries. 

The agency plans to continue to use the general duty clause, when appropriate, 

for enforcement when work-related musculoskeletal injuries occur. OSHA has also 

launched a recordkeeping National Emphasis Program (NEP), which will help ensure that musculoskeletal injuries are being recorded accurately by employers filling 

out the OSHA recordkeeping logs. 

A final rule will be issued in FY 2010 to revise the Occupational Safety and 

Health Administration’s (OSHA) recordkeeping form to restore a separate column 

on musculoskeletal disorders (MSD) that was removed from the form in the last administration. Restoring this column will improve the workplace injury and illness 

data collected by OSHA and the Bureau of Labor Statistics (BLS). Having more 

complete and accurate data will further our understanding of work-related MSDs, 

which is certainly beneficial to any ergonomics research, and also better inform employers about ergonomic hazards in their workplaces. 


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OSHA STAFFING

Mr. REHBERG. Well, that is an interesting comment, putting the 

agency back. What was done to the agency, was the budget cut? 

Are there less employees? 

Secretary SOLIS. I would say to you that the priorities were much 

different. And in terms of, again, trying to address the issues that 

the Congress has put before us, we thought it was well worth our 

efforts to focus in on looking at how we can reduce the injuries in 

the workplace; minimize fatalities and injuries that cost business 

and our economy an even greater amount of money. 

Mr. REHBERG. Okay, I would like to see the research that has 

been done. It was promised that it was being done, and I am not 

sure I have ever seen that. Again, was the budget cut or are there 

less employees in OSHA that there were at the start of 2001? 

Secretary SOLIS. Over the course of the last decade, we did not 

see the same—how could I put it?—equivalent number of staffing 

that should have been kept up to pace. So again, what I am saying 

is that we are trying to go back to 2001 levels. There may have 

been priorities placed on other divisions and did not focus in on enforcement and protection, where the Congress has been stating 

very clearly for the past few years that they wanted to see more 

enforcement occurring. And because there were a lot of complaints 

that were made, that is where our focus has now been directed. 

Mr. REHBERG. So if we go back and compare enforcement pre2001, we will find there was more enforcement on an individual 

basis than there was from 2001 forward? 

Secretary SOLIS. I would say that there was more of a compliance 

approach to enforcement, which did not always result in changes 

in behavior in terms of prevention on the part of businesses and 

industry to make those corrections, to provide training, and to access new tools so that we could reduce the number of injuries in 

the workplace. 

Mr. REHBERG. Thank you, Mr. Chairman. 

Mr. OBEY. The Chair would simply point out that the Chart 

shows that there was a decrease of 252 people in OSHA between 

2001 and 2008, and within Federal enforcement there was a decrease of 146 people, or 8.7 percent. The percentage reduction in 

the entire agency was 10.2 percent. And for safety and health 

standards the reduction was 22 percent. 

Ms. Lee. 

RACIAL DISPARITIES IN UNEMPLOYMENT

Ms. LEE. Thank you very much, Mr. Chairman. 

Good morning again, Madam Secretary. Good to see you. You are 

doing a great job. I want to thank you and your staff for being so 

accessible and for really tackling the tough issues of the economy 

and unemployment. It is very desperate out there, as you know. 

A couple of things. In the committee report in 2009, we had report language that addressed looking at what the issues were as 

it relates to racial disparities in unemployment as it relates to the 

structural issues and why this unemployment gap is so great between the national average and the African American and Latino 

communities. So that is one question I would just like to get an upVerDate Mar 15 2010 08:35 Nov 16, 2010 Jkt 058233 PO 00000 Frm 00029 Fmt 6633 Sfmt 6602 E:\HR\OC\A233P2.XXX A233P2

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date for the record. And I want to thank your Assistant Secretary 

for Policy for working on this and for keeping me informed on this. 

EX-OFFENDER GRANTS

Also, secondly, there was report language, I believe it was $20,000,000 for ex-offender funding that should have been put out 

for competitive grants for communities of color, for dropout, for exoffenders, for making sure that these young people have the requisite skills to become employed; and I do not believe any of that 

has been spent yet. So have you issued guidance on that or what 

is the status of that $20,000,000? And that, I believe, was report 

language in 2009 also. 

Secretary SOLIS. Thank you, Congresswoman Lee. To begin with, 

I am also pleased that we now have my Assistant Secretary for Policy, Mr. Bill Spriggs, who is here behind me. He has been the individual that has been working on the request for that report that 

you issued some time ago. And I apologize that we have been so 

late in getting it fully together, but, upon his arrival, we found that 

we needed more data sets, more information so that we could have 

a more accurate picture of what is really taking place. 

That report had now left my office and has been sent over to 

OMB for review. We hope that in a few weeks or perhaps next 

month we will be able to issue that report to you. So I am pleased. 

And a part of it is, as you know, a staffing issue because we just 

were able to get the appropriate staff onboard. But, believe me, this 

is an issue that I am greatly concerned about as well. 

With respect to the ex-offender program, I want to go to that because I know that is of great concern to many members of this 

Committee as well. 

Ms. LEE. I believe it was the 2009 committee report that issued 

the report language for the $20,000,000 that would be allocated for 

ex-offenders and dropouts. 

Secretary SOLIS. Well, what we have done for the 2011 request 

is, to bring together these programs in a more meaningful way so 

that we can actually attack the issue of employment, because the 

hardest, I think, factor here is while we are trying to reintegrate 

folks back into society, the problem is really the barrier of employment. 

Once they are able to achieve employment and get the services 

they appropriately need, I think then we are on our way to recovery; and that is something that really has not been focused on as 

heavily in the past, it was actually more of a focus for younger offenders, which was more in terms of education, which I do not 

want to take away from, because we are going to keep that component, but when we talk about adult ex-offenders, it is really more 

about providing assistance so that they can help stabilize their immediate families that they return to in many cases, and part of it 

is making sure that we can find them jobs or help to subsidize a 

portion of that. 

So we are combining our efforts here and we are really trying to 

make it more strategic because we know dollars are limited. 

Ms. LEE. But have you issued the guidance for that $20,000,000? 

Secretary SOLIS. I think later this month, my staff tells me, it 

will be issued. 


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Ms. LEE. Later this month. 

Secretary SOLIS. So we will work with you to give you that information, and then if there is any input that you want to—— 

Ms. LEE. Okay. Yes, because that is very important. I mean, we 

have it already and all, it is my understanding, we need is to hear 

from your office in terms of how to get that out, in terms of the 

competitive grants. Okay. 

Secretary SOLIS. Thank you. 

Ms. LEE. Thank you very much. 

Thank you, Mr. Chairman. 

Mr. OBEY. Mr. Alexander. 

RATIO OF JOB SEEKERS TO JOBS

Mr. ALEXANDER. Thank you, Mr. Chairman. 

Madam Secretary, in your opening statement you said something 

about six applicants per job opening. How can we determine that? 

Secretary SOLIS. Congressman, that is the information that 

economists have reported, the ratio of job seekers to jobs is about 

six to one. I just saw a report earlier this morning on the news that 

said it actually went down a bit, to 5.5 to one. I cannot break that 

down for you, I am not an economist, but I can tell you that people 

out there are very much looking for jobs. 

And as I go across the Country visiting some of our programs 

and hear about the kinds of efforts that are being made for people 

to try to get into training programs that can upgrade skills so that 

they can be ready when the full-blown economy is back to speed, 

that is the urgency that I hear, and from employers. Employers 

want to know that that gap, the education gap for training, is slowly closing, because they cannot find, enough trained personnel 

ready for some of these jobs that they would like to hire out for. 

NUMBER OF FEDERAL EMPLOYEES

Mr. ALEXANDER. Can you tell us how many new Federal employees have been hired in the last year? 

Secretary SOLIS. I cannot tell you how many Federal employees, 

but I can tell you that through the Recovery Act monies, through 

the CBO, we know that there were anywhere from 1.5 to over 2 

million jobs that were created; and not all of them were Federal 

Government, a lot of them were also in the State with respect to 

teachers, police officers, and also other various industries. And we 

are trying to do a better job in terms of the Recovery Act money 

and how to actually account for those jobs that are created. 

FOREIGN GOVERNMENT SUBSIDIZED EMPLOYMENT

Mr. ALEXANDER. When you were responding to Mrs. Lowey’s 

question a while ago, you said something about the fact that you 

had been to some other nations and in some countries they actually 

subsidize employees, unlike we do here. Can you tell us what that 

means? 

Secretary SOLIS. Well, just as an example, in Germany I am 

aware that they provide substantial subsidies for workers that are 

in areas or industries that are going through economic crisis, the 

automobile industry as an example. 


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And what they do is they make a concerted effort then to allow 

for that salary to be paid for by the Government. A portion of that 

is paid for, maybe two days as opposed to three days, so they do 

not lose that talented, skilled, crafted person. Those are ideas. And 

it is not just in Germany; there are other parts in Europe where 

that model has been used. 

Mr. ALEXANDER. Thank you. 

Mr. OBEY. Mr. Jackson. 

DOL BUDGET REQUEST

Mr. JACKSON. Thank you, Mr. Chairman. Thank you for the time. 

I want to thank my former Rayburn neighbor, Secretary Solis, 

and welcome her back to our Committee, and thank her for her testimony. 

Madam Secretary, during this tough economic period, and with 

unemployment hovering just around and under 10 percent, you 

have one of the toughest jobs in the Administration: putting people 

back to work. I read with great interest your testimony and I understand that we are under budget constraints as we write these 

appropriations bills. However, I find it incomprehensible that we 

are quibbling over about $14,000,000,000 in your discretionary 

budget. We spend close to $1,000,000,000,000 bailing out banks 

that do not lend to us and got us into our current financial crisis. 

My problem with your discretionary budget, at least from my 

perspective, is that it is not bold enough. I read the part of your 

testimony that provides and seeks to put significant resources back 

into employment and training to prepare workers for the 21st century. However, last week the House voted on a ‘‘jobs bill’’ which 

would provide tax incentives to businesses to hire more workers. I 

voted against that bill because I do not believe that tax incentives 

are the best way to create jobs. 

ADDRESSING CHRONICALLY UNEMPLOYED

In my district—and I have been here for 15 years—I am deeply 

concerned about the chronically unemployed. In my district, there 

are three people for every one job, while in the northwest suburbs, 

around O’Hare Airport, there are three jobs for every one person. 

Just under $1,000,000,000,000 to bail out the banks, but for a fraction of that number, let us say $300,000,000,000, my math says 

that $300,000,000,000 could employ 7.5 million Americans at about 

$40,000 a year. 7.5 million Americans put to work at $40,000 a 

year is about $300,000,000,000, a fraction of the $1,000,000,000,000 

that we spent to bail out the banks. 

Are not sometimes the simplest ideas the best ideas? What does 

your budget do to address the chronically unemployed? And my colleague who asked the question about how many Federal employees 

have been hired over the last year, if I had my say, it would be 

7.5 million more Federal employees, doing everything from painting bridges to cleaning up highways, to cleaning up vacant lots 

across this Country. And I fundamentally believe that the Federal 

Government has a responsibility during these tough economic 

times to shore up unemployment and put the American people back 

to work. 


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Madam Secretary, your budget, what does it do to address the 

chronically unemployed? 

Secretary SOLIS. One of the things I would like to respond to, 

Congressman Jackson, is that through the Recovery Act money, we 

were able to help, set a good foundation to begin this holistic approach to really trying to assist people that were out of the workforce, the dislocated workers, the folks who lost their jobs recently 

in the automobile industry, the financial institutions, people who 

were also highly qualified. We are talking about people that had 

different skills sets. 

Through our Workforce Investment Act monies, we made grants 

available just through the green job approach, the partnerships 

that we established, about $500,000,000 went there. And we are 

asking for a bump-up there because we think it works and we 

know that there is a big interest. 

We know that there are people out there that may have lost their 

job because the assembly plant or manufacturer is no longer here, 

and we are trying to get people identified to get the appropriate 

type of counseling and assessment that they need. We plan to 

make sure that our one-stops are more accessible and that these 

grants that we provide through the Workforce Investment Act— 

and that is something that I believe you will want to be involved 

in by helping us with the reauthorization—to really reach down 

and touch those neighborhoods and communities like yours that 

may not have benefitted in the past from these types of efforts and 

targeted funding. 

We also make a special attempt through our Pathways Out of 

Poverty program to identify high unemployment areas; of 15 percent and higher, that require people to come together, partners, 

business, community colleges, apprenticeship programs, CBOs, and 

stakeholders that have a better sense of where these individuals 

are that could obtain this job skill. 

Keep in mind our effort is to make sure that we connect the business with the job training. I do not actually create the job. What 

I do is bring partners together that then say, at the end of the program, we expect to hire so many people. We fund those slots. That 

is really what the Workforce Investment funds and the partnerships that we have been able to put together are focused on. 

But we try to make the best assessment to make sure that we 

are getting the people in, and it is taking a long time because we 

have had to change guidelines, we have had to change the way that 

we even bring people on to read proposals. Much of that had not 

changed in the past 10 years. And I do not have to tell you communities like yours and others have been left out, quite frankly, from 

many of these job training programs. 

So our attempt is to, look at green jobs, health care jobs, as well 

as careers where we think there will be continual growth. We have 

actually seen that is the one spot where we see that there will be 

job growth, where we can integrate our local communities to get 

into those entry level health careers. 

Mr. OBEY. The gentleman’s time has expired. 

Mr. Cole. 


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JOB SECTORS FACING CONTRACTION

Mr. COLE. Thank you very much. 

Madam Secretary, great to see you again. You and your folks in 

your Department probably see more data on what is happening in 

the labor force than anybody else in the Government. I am very curious. We know we have lost about 8 million jobs over the course 

of the recession, and there are a lot of articles now beginning to 

appear to suggest a lot of these jobs ‘‘are not coming back.’’ What 

are the areas that you think, frankly, we will not be able to recover 

in, the particular sectors or kinds of work that, looking forward, 

you suspect there will be considerably less of in the future than we 

had in the past? 

Secretary SOLIS. Well, thank you, Congressman Cole. That is a 

good question. One figure that I continue to see that is not recovering as quickly is obviously in construction, and a lot of it has to 

do with the housing industry and the fact that we are just not 

building more houses. We have inventory, in fact, an overwhelming 

number of houses that now are in foreclosure. So that is creating 

a strain in terms of that workforce. 

REBOUNDING JOB SECTORS

I would say also that in manufacturing overall we are just finally 

seeing an up-tick. The most recent report, issued in February, saw 

about 1,000 jobs added in manufacturing. 

What I do see happening, the positive sign, is that businesses are 

bringing on temporary workers. But, when you talk about temporary workers, it is not the clerk; these are engineers, architects, 

very highly skilled individuals that are helping that business come 

back and hopefully, with the Recovery Act and all the funds that 

you all have made available, and with the credit and capital market changing its direction, that businesses will feel more confident 

in bringing people on. 

The health care industry, as I said earlier, helped to create 

about, I would say, close to 500,000 or 600,000 jobs this last cycle. 

I also see growth in IT technology energy efficiency, and the renewable energies. That is why I think other countries are taking full 

advantage of that and we should also be heading in that direction. 

And I know that there has been a tremendous amount of investments made by different Cabinet secretaries, Department of Energy, in our railway system, as well, high speed rail. If we can get 

those projects on the ground ready to go—and much of that money 

has already now been given to different States—that is going to 

create jobs not just for the two-year period of the Recovery Act, it 

will go on for ten years because of all the other jobs that will be 

created around that rail system. 

JOB SECTOR CONTRACTIONS

Mr. COLE. If you could just have somebody from your Department give me a list of where you really expect the contractions. We 

clearly are going to have a lot of very skilled people that do not 

have a future that you are going to want to redirect. 

[The information follows:] 


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SHORTAGES IN TRADITIONAL ENERGY INDUSTRY

Let me ask you. You mentioned energy and I had a particular 

question about that. I am not one who is critical of the money going 

to training on green jobs; I see a lot of wind power sprouting up 

in my State. I think there is no question there is going to be a market there. 

But there are also pretty critical shortages now in what I call the 

traditional energy industry as well. We are now doing a lot more 

natural gas in a lot more places; it is a much cleaner fossil fuel. 

I can tell you it is hard to find people that know how to drill in 

Western Pennsylvania or New York now, or that have a lot of 

knowledge of that particular business. Plus, we have some shortages in our own industry. 

So while you are incentivizing the movement—and I think appropriately—of people into the so-called green sector, what are we 

doing to help the industries that have critical shortages that 

produce traditional forms of domestic energy? 

Secretary SOLIS. Congressman Cole, that is an excellent question. I have actually seen many of our programs training up again 

in the area of hard manufacturing, and I am talking about jobs 

that you just mentioned, welding as an example. 

I have been to some of our programs that we have funded and 

find very regularly that the business components out there in the 

industry are saying I cannot find a qualified welder. And the salary 

levels that they offer are anywhere from $60,000 to $100,000. If the 

public were made more fully aware of what the potential is, I am 

sure people would not mind relocating to where those jobs are, because they do pay very good salaries. 

And because we are going into, say, renewable energies, I think 

there are going to be more opportunities. I know that the folks that 

we have been working with in partnership in public and private entities know that this is where we need to move our training programs, and I am acutely aware of that and know that that is an 

important factor in our recovery. 

We have to bring back, also, some steady skill sets, but also that 

manufacturing base, and we have to have that workforce staying 

here because there are a lot of people that are retiring from those 

industries. Same thing in the coal mine industry; you see a lot of 

retirees. We are still going to need people to be trained to go into 

those mines. 

Mr. COLE. I know my time has expired. I would just urge you to 

look at these traditional areas too. Green energy is the new buzz 

word, but there are going to be a lot of jobs in natural gas going 

forward and it is going to be national in scope; we are going to be 

way outside of traditional areas where people will have some new 

opportunities that have not had them in the past. 

Thank you, Mr. Chairman. 

Mr. OBEY. Mr. Honda. 

Mr. HONDA. Thank you, Mr. Chairman. 

CONTINUING EDUCATION

Again, welcome, Madam Secretary. It is good to see you. A couple 

of things just real quick off the top of my head. I really appreciated 


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the allocation of $5,000,000 to San Jose State University, where we 

will be able to look at health care and biotechnology training programs, and the vision I think that you are providing the Department is we are doing a lot of innovation and a lot of emphasis on 

green employment and green careers, but in order to have the 

workforce there that support that also, we need to have higher education. Some of these other institutions are prepared to do that. 

One of the things that we did in Santa Clara County was have 

an AA program, a pilot program to have folks who were in the 

labor industry, laborers, who want to pursue a AA degree in contract managing. Where, before, those folks were always the ones 

who were managed, now they have that background experience and 

can take a traditional job that Congressman Cole had talked about 

and upgrade them and convert them into other jobs that are going 

to be in high demand, especially when we have more activities in 

the green industries. 

So looking at the AA, hopefully somebody in your Department 

might work with the education department to look at how we can 

link the AA to a BA into the four-year college, where they can continue their education and their life skills into something more productive. 

GREEN JOBS

In terms of the green jobs issues, I think that if people visited 

Santa Clara County and Silicon Valley, that although we have 

companies like Applied Materials that make machines that allow 

us to have photovoltaic gadgets or panels or flat screens, the instruments that are being sold and made by this company have a 

ripple need that goes upwards towards folks who do work like design and do work like creating the machine parts. There are skilled 

laborers and skilled artisans out there that are necessary. So those 

are traditional jobs that still exist that need to be continued and 

supported. So a green job could support more than five other jobs 

that are necessary for them to do that. 

I just wanted to have some of our colleagues understand that 

there are supportive groups that are out there. Even Caterpillar. 

When you have heavy machinery, you just do not have one kind of 

worker. So I think that in the green area we are expanding our vision and making this a better place. 

And the term greener and green, I think that that is probably 

a good term to use because we have to have every individual in this 

Country, and globally, understand that we all have individual impacts on our carbon footprint, and collectively we need to be constantly aware of it. So in your Department I really do appreciate 

that constant attention to that, because otherwise, as a Nation, we 

are not going to be able to effect any changes in our attitudes. 

I have no questions, Madam Secretary, but I just wanted to feed 

back some of the things and observations I have had over the past 

few months. 

Mr. Chairman, closing comments. Folks asked me in my internet 

town hall meeting I had last night one of the interesting questions 

was that if these things are happening and we are creating more 

jobs, why is unemployment looking like it is getting more. 


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And I think that those who understand the statistics is that people who are not in the job market are not coming back in the job 

market, so that is going to create a blip in that unemployment, and 

then it goes down as they secure jobs. So folks who would be negative, we need to just respond in kind to let people know the information, what it really means in real life and people’s jobs and the 

situation in this Country. 

Thank you very much for your work, Madam Secretary. 

Mr. OBEY. Mr. Moran. 

EMPLOYEE READINESS TO ENTER JOB MARKET

Mr. MORAN. Thank you very, Mr. Chairman. 

Let me just say ditto for all the nice comments that have been 

addressed to you, Madam Secretary. We are delighted you are in 

this position and we appreciate all your diligent efforts. 

I represent an area that has a preponderance of technology 

firms, a lot of jobs. We are in pretty decent shape relative to the 

rest of the Country. But we are trying to make the most of the employment training opportunities that are available for those who 

are underemployed or unemployed because we have a lot of jobs. 

So we want to bring them in to this knowledge-based economy. 

But the employers tell me that there is a very serious deficiency 

in terms of employment training programs that the Federal and 

State government operates; that, in fact, they cannot use the skills 

that are taught through these training programs. At best, if they 

find that somebody shows up every day, is reliable, that is one of 

the best indicators that they can hire them, but they have to hire 

them at pretty low entry level skill levels and, thus, compensation 

levels. 

And they tell me the problem in an area like computer skills, 

where the jobs are available, is that the trainers are really not up 

to speed on the computer skills that are needed; that in many cases 

the trainer is teaching what they knew when they last left the private sector and came in to be a trainer. And because the computer 

skills advance at such a rapid pace, what they know is kind of outdated, and they either do not have the inclination or do not have 

the time, really, to bring themselves up to speed on the latest technology. 

Can you address this? Do you think this is an unfair criticism 

or is it something that you have observed and are addressing? 

Secretary SOLIS. Thank you, Congressman Moran. You hit the 

nail on the head. In my travels across the Country visiting different workforces and workplaces, I often hear from the employer 

that it is very tough to find someone who is really prepared that 

they can hire right way with the set of skills that they need. 

Therefore, the need to have reform with respect to some of the 

programs that we operate in the Department of Labor and, we are 

proposing in our budget to provide some new and better methods 

of trying to make our systemic approach more targeted so that we 

really do get at what the business owner needs, and make sure 

that those skill sets are really going to lead to a good job, and are 

marketable and timely. 

So it is going to require, I think, a lot of support on the part of 

the Congress, as well, as we look at revamping the Workforce InVerDate Mar 15 2010 08:35 Nov 16, 2010 Jkt 058233 PO 00000 Frm 00039 Fmt 6633 Sfmt 6602 E:\HR\OC\A233P2.XXX A233P2

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vestment Act, because we do have some traditional partners who 

have been used to doing things for the last decade a certain way, 

and many times those folks are not going out as they were intended to to really talk to the business community, the entrepreneurs, the new inventors of this new technology that is coming 

out not just in the green industry, but just IT overall. 

I think that one of the incentives that we want to use is reward 

those programs that can demonstrate that there are some good 

methods being used. We want to be able to replicate them and we 

want to support innovation. So I am very much interested in your 

ideas and would like to learn more about how we can work together to help craft these kinds of activities so we make this a 

more effective program. 

EXTENSION OF RETIREMENT AGE

Mr. MORAN. Thank you, Madam Secretary. I was not supposed 

to ask questions that elicited long answers, but that was a superb 

response. I have one other question. 

The President is putting together a group of people to address 

structural deficit problems and, invariably, they will look at entitlement programs, Social Security especially, and I am sure one of the 

recommendations is going to be that they extend the retirement 

age. 

Now, in my district, a significant portion of the workforce is not 

going to be bothered by that. In fact, I think they would welcome 

it, to be able to keep working until 70. The problem is that we have 

a cookie-cutter approach in entitlement programs, and people who 

work with their back and their legs and their arms all their life, 

they cannot keep working until 70. So what are you going to do for 

those 15 years or so when the body wears out? 

I mean, I really am serious about this. It is not fair to manual 

workers to extend that retirement age. But if we could come up 

with a more sophisticated retirement system that was more correlated to the physical, as well as the mental demands of various 

workforce classifications, then it would be fairer to extend the retirement age; people would be more comfortable. We would have a 

more productive economy and probably save substantial sums in 

our entitlement programs for retirees. 

Is there any research, any thought that is being given to that 

within the Department of Labor, Madam Secretary, that might 

help us in this difficult decision-making arena? 

Mr. OBEY. The gentleman’s time has expired. 

Secretary SOLIS. I would like to get back to you in more detail 

about what we are looking at in terms of approaches now in EBSA 

and also the PBGC, because we are really talking about retirement 

security too, so people do not have to stay longer in the workforce 

for those folks that work in very hard assembly line and very laborintensive jobs. We are looking at some creative mechanisms there 

and I would love to work with you on that. 

[The information follows:] 


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Mr. MORAN. Thank you, Madam Secretary. 

And thank you for your indulgence, Mr. Chairman. 

Mr. OBEY. Ms. Roybal-Allard. 

PROTECTING MIGRANT FARM WORKER CHILDREN

Ms. ROYBAL-ALLARD. As always, welcome, Madam Secretary. Let 

me begin by thanking you for hosting a briefing last September at 

the Department of Labor on the serious issues confronting migrant 

farm worker children. 

Last year, as you know, I introduced the CARE Act to give the 

estimated 400,000 youth working in agriculture the same child 

labor workplace protections that safeguard children in all other industries; and I know that you have been a champion for a very long 

time of child labor rights, and I look forward to continuing to work 

with you and your staff on this legislation as it moves forward. 

But in the meantime, children in agriculture are not equally protected by our child labor laws. They work in the fields at younger 

ages for longer hours and under very dangerous conditions that 

would not be permitted in any other industry. For example, a 

Human Rights Watch study found that while there are only 8 percent of children in agriculture, approximately 40 percent of all 

workplace deaths and nearly half of all workplace injuries suffered 

by children occur in agriculture. 

Until the CARE Act is passed into law, these findings highlight 

the critical need for oversight and enforcement of our current laws, 

which at least provide some protections to our children. Yet, in 

2005, the average civil penalty assessed by the Department of 

Labor was only $1,011, or just 9 percent of the maximum penalty 

for child labor infractions; and in 2006, of the 1,344 child labor investigations by the Department, only 28 were in agriculture. This 

lack of enforcement obviously gives employers little incentive to follow the laws that do exist to protect these children. 

Now that the Wage and Hour Division staffing has been restored 

to the 2001 levels, can we look forward to increased investigations 

and meaningful penalties for child labor violations in agriculture? 

Secretary SOLIS. Thank you, Congresswoman Roybal-Allard, and 

I also want to commend you for introducing your legislation, the 

CARE Act, and I want to applaud your work and the work of those 

that helped to work behind the scenes to bring this issue before the 

Congress. It is something that all of us deeply care about, and I 

certainly am putting forth as much effort as possible to see that 

our Wage and Hour Division, working in conjunction with the Migrant Seasonal Agricultural Worker Protection Act, or Field Sanitary Standards in OSHA, are all working together in a strong effort 

to focus in on combating child labor. 

The Wage and Hour Division is conducting training right now 

with our investigators; they are out in the fields so that we can detect and get those parties involved in this egregious behavior to understand that this is not the direction that we need to be going in. 

It is also working with stakeholders, with parents, and also with 

the community, and even religious groups and organizations that 

can help to provide more information. We are rolling out a campaign to provide assistance to those most vulnerable populations, 


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which will include, by and large some of the farm worker and farm 

worker children. 

It is egregious that this goes on. I was very upset when I heard 

about the violations that were occurring in the blueberry fields up 

in the northeastern part of our Country, where young children of 

ages 5 to 8 were out picking blueberries, and parents were allowing 

their children not to attend school because they needed the money; 

and they were out there through contractors who would bring these 

folks in and kind of move them around different farms. 

Well, when I heard that news, I ask that there would be immediate action taken by our staff, and I am happy to say that we have 

been able to now begin a more robust process, because we have 

more field investigators and the staff, and even people who speak 

their languages, so we can ascertain actually what is going on on 

the ground without intimidating people and them not being fearful 

of sharing information, because you know that is a big barrier that 

we face also with this population. 

But I would tell you that civil penalties, I have a list and I can 

give you the details of where we have gone after some of these 

egregious cases just in this past year that I think would be noteworthy for you. And we know we want to work with you to continue this effort. 

EXPOSURE OF CHILDREN TO HAZARDOUS MATERIALS

Ms. ROYBAL-ALLARD. Thank you. In May of 2002, the National 

Institute for Occupational Safety and Health issued a report recommending that more than half of the existing regulations pertaining 

to children working in hazardous jobs, such as those exposing them 

to pesticides and lead, be revised and 17 new regulations be added; 

and although the Department of Labor has taken some steps to 

amend non-agricultural hazardous odors, those pertaining to agriculture have yet to be put on the Department’s regulatory agenda 

for updating. 

Given the dangerous conditions, again, that these children face 

working in agriculture, what is the Department of Labor’s time line 

for reviewing and acting on the recommendations for this specific 

industry? 

Mr. OBEY. Very short answer, please. 

Secretary SOLIS. I would love to get back to you on what our activity and our plan is, because it is something you know I care very 

deeply about with respect to pesticide use and hazards that find 

their way to our children who are forced to work in the fields. 

Ms. ROYBAL-ALLARD. Thank you. 

Mr. OBEY. Mr. Ryan. 

Mr. RYAN. Thank you, Mr. Chairman. 

Thank you, Madam Secretary. Let me first thank you and your 

staff. We had a visit recently from Assistant Secretary Oates and 

just had a tremendous visit. We had some steelworkers who were 

having issues with unemployment and she was just terrific, and it 

looks like we have fixed some of the issues; and you and your staff 

were ahead of the curve, as always. So thank you for being so 

great. 

I wanted to just mention, one, what Mr. Cole talked about, natural gas. We sit in Ohio under the Marcellus Shale, which is a 


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huge natural gas opportunity for all of us, so talking about the 

Pickens plan, as far as retrofitting diesel engines and buses and 

trucks, I think it is an opportunity for all of us to say this is a 

clean fuel, and areas like Northeast Ohio and Western Pennsylvania have an opportunity to really, I think, resuscitate some longterm chronic problems that we have had. 

LEVERAGING STIMULUS FUNDING

I want to make a comment about the stimulus package, too, because there has just been so much said about it. You are someone, 

and this Administration, I think, believes that we need to make investments into our communities, and we were able to take some 

stimulus money, not just stabilizing police and fire and a lot of 

school teachers did not get laid off in my district because of money 

that came, but we were able to take $20,000,000 from the State to 

do some site prep work, move a rail line, and it leveraged a 

$650,000,000 investment from a French tubing company that does 

a lot of natural gas tubing. 

And I bring this up because I want you to bring back to the Administration and to your colleagues that you work with in the Cabinet that there are communities in our Country, as you know, that 

just do not have money to make deals go down. So whether it is 

training money or community development block grant money, we 

need more opportunities to make things happen when you do not 

have that local tax base to make deals work for businesses. 

So I just wanted to put a bug in your ear to bring that back. I 

know you believe in it, and we need to continue to recognize that 

community development block grants and those kinds of things are 

very, very important. 

I want to thank you for all that you have done for Ohio with 

green collar jobs and the training money that you have sent. We 

also are benefitting from some high speed rail lines that are going 

from Cleveland to Columbus to Cincinnati, and your money will 

come in handy to make sure that we have the workforce available 

to do that. So the stimulus package has been good to us. We need 

more, there is no question, but it has been good to us. 

REEMPLOYMENT OF HIGHLY-SKILLED WORKFORCE

I have one question that hopefully you can touch upon. We have 

in our area a distressed auto community. We have lost a lot of very 

high-skilled work. A lot of high-skilled workers are unemployed 

now. What are we doing within the Department of Labor or in conjunction with the Department of Labor–Department of Commerce 

to take these very high-skilled people, engineers, people who have 

made companies like Delphi and General Motors a lot of money 

over the years? How do we take these people and help them start 

their own business? 

And I know that may not be directly related to the Department 

of Labor, but they are unemployed workers. I think there is an 

enormous amount of opportunity for them to get creative, especially 

with the green economy. They have a history in manufacturing 

and, as we heard today, five spinoffs for every one manufacturing 

job. We have to get back to making things in this Country. So how 

do we take these brilliant engineers from General Motors or Delphi 


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and corporations like that and help them with business plans and 

opportunities to create their own businesses? 

Secretary SOLIS. Well, thank you, Congressman Ryan. It was 

very kind of you to mention some of the things that we have done 

out in Ohio. I have to give you credit also for having a great leadership delegation there; everyone working together, and also your 

governor. I was down there when we actually issued the 

$400,000,000 for that high speed rail, and I can tell you there were 

a lot of delighted people there in the room to see that there is going 

to be an investment made on the part of the Federal Government 

to jump-start a project that will last into the next decade. Job creation is what we definitely want to see. 

But to your point about how we can try to deal with the highly 

qualified workforce that is out there looking for jobs, you now have 

the privilege of also working with Dr. Ed Montgomery on our Department of Labor staff, who is addressing the whole automobile 

industry displacement, and what he has done is brought together 

the different Cabinet offices—Department of Energy, Commerce, 

EPA—to try to put together plans regionally so that we can start 

structurally looking at how we get these dollars out to those most 

distressed areas; and yours is one that is on target for us to bring 

those resources. 

We know that capital still remains a big obstacle, making sure 

that there is more credit available. I think the President is moving 

in that direction to see that we can provide incentives for businesses, tax cuts, research and development, more assistance targeted in a fashion that will help to spur that innovation so that 

businesses will not think that they can just have maybe support for 

two years, but be able to make a plan for 15 years. 

So I understand clearly where your thought process is and would 

want to work with you more to see how we can maybe learn from 

some of the things that are happening in your State and share with 

other industries. We also have some issues in California with some 

of our auto plants that are closing there. If we can use those best 

known practices and share them, I think we can all win in the long 

run. We have other industries, for instance aerospace is affected 

and we would be at a disadvantage if we do not also do something 

for these highly skilled individuals. 

Mr. RYAN. Thank you. 

TRAINING FOR HIGH-GROWTH INDUSTRIES

Mr. OBEY. The gentleman’s time has expired. 

Let me just ask two questions before we end the hearing. 

First of all, as you know, in the Jobs for Main Street Act, which 

we passed in the House in October, we provided $500,000,000 for 

Workforce Investment Act Youth Activities; we provided 

$750,000,000 for job training grants; and I am happy to see that 

the Administration has picked up both of those items in your statement that you made today. 

I do have one question about your choice of priorities, however. 

Can you explain the Administration’s request to fund additional 

green jobs or green jobs training grants, when there is a more immediate need for additional health care professionals? 


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And in that context, in the Recovery Act, Congress provided $250,000,000 for training in high-growth industries with an emphasis on the health care sector; and my understanding is that 

DOL received an overwhelming number of applications for those 

grants. Can you tell the Subcommittee what percentage of the 

grant proposals you were able to fund for those items and whether 

there are additional high-quality applications that were denied due 

to a shortage of funding? 

Secretary SOLIS. First of all, Chairman Obey, I do want to give 

you credit for your outstanding work in helping us look to where 

the high need areas are, and you did that for us last year in our 

budget. With respect to the over-subscription of grants that we received in health care, we received 800 applications, and I would say 

that a good portion of them, a large portion, were eligible for funding. 

But we did not receive the amount of funding to be able to go 

beyond 8 percent of that fully-eligible population of applicants that 

came in. We were only able to fund 55 awards. And I know that 

this is a very sensitive issue for you, as it is one for me. I recently 

visited one of our nursing programs that we provide assistance to 

in Sacramento, a community college program, and to hear the testimony that I heard from some of the students there that had to wait 

years just to get into an entry level position was mind-boggling. 

But these were the students that persisted and some, by accident, were actually able to get enrolled into the program. Many 

were already well above 21 years of age; one was even 50 years of 

age, but felt so compelled because of the need to get into these careers that pay well that we know we have a shortage of. 

I know that the Department of Health and Human Services has 

a more robust budget than I do in nursing, and we want to collaborate with them to see how we can work on improving and expanding this effort, because there is a shortage and I think this is something you and I can talk about and figure out a way to work together. 

Mr. OBEY. We are really missing an opportunity if we do not recognize that possibility. 

IMPROVING JOB LOSS PICTURE

Just one other point. With respect to the stimulus package, I 

frankly find it quite tiresome to be in an argument about whether 

or not the stimulus package ‘‘worked or not.’’ This is a pretty badly 

hand-drawn chart, but what it shows is that, beginning in March 

of 2008, this downward line represents the average monthly job 

loss that we were experiencing in the economy. This line represents 

zero job loss and, as you can see, by December of 2008 we were losing 750,000 jobs per month the last three months of that decline. 

Since then, we have had a steadily improving picture in terms 

of job loss, so that today, over the last three months, we have averaged 35,000 job losses each month. That is a 95 percent improvement. 

Now, it certainly is not good enough because we still have not 

reached positive growth in the economy, but before a ball can 

bounce, it has to stop falling, and that is pretty much what I think 

we were able to do with the Recovery Act. The bill was never large 


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enough to plug the entire $3,000,000,000,000 hole in the economy 

that we were facing, but what it did do is soften the blow, lessen 

the pain, reduce the number of people who were losing jobs. And 

let us hope that we have enough imagination, enough luck, and 

enough help and cooperation between the public and private sectors to actually turn that into a positive job growth area in the 

months ahead. 

CONCLUSION

But I thank you for your testimony here today. Sorry we had to 

delay you by an hour, but it is good to see you. 

Secretary SOLIS. It is good to see you. Thank you very much, Mr. 

Chairman and members of the Committee. 

Mr. OBEY. You bet. 


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THURSDAY, MARCH 18, 2010. 

FY2011 BUDGET OVERVIEW: DEPARTMENT OF 

EDUCATION 

WITNESS 

HON. ARNE DUNCAN, SECRETARY OF EDUCATION 

CHAIRMAN’S OPENING REMARKS

Mr. OBEY. Good morning, everybody. 

Today we are pleased to have the Secretary of Education, Arne 

Duncan, to testify. 

Mr. Secretary, don’t interpret the lack of Democratic members 

here as a lack of interest. We are having a Democratic Caucus on 

a new-fangled idea that we have been rushing at breakneck speed 

through Congress over the past year, so people are still having 

some last-minute thoughts on that, and that is where they are this 

morning. I assume they will be by shortly. 

But we are here today, of course, to discuss the fiscal 2011 budget. Let me say, Mr. Secretary, that I know you and I share the 

same goal of seeing every kid in this country having access to a 

school that can provide them with a top-notch education and 

produce a good strong skill set. In addition, I know that we both 

agree that the funds we provided for education last year in the Recovery Act were absolutely imperative and have been essential in 

keeping our schools from drowning. 

I am not so sure we are on the same page when it comes to immediate needs and priorities about how to proceed from here. The 

work of the Education Department is more critical than ever. 

Today we face record high unemployment nationwide, while State 

school districts and colleges are in economic crisis. Educational opportunity, at all levels, is our most powerful tool in helping the 

poor and the middle-class climb up the economic ladder. 

AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009

The underutilization of our human potential in the United States 

imposes heavy consequences on our society: lower productivity, 

lower earnings, poorer health, higher rates of incarceration and 

less civic involvement. That is why I was pleased to participate in 

the efforts to provide an unprecedented $98 billion investment in 

education in the Recovery Act which, among other things, was responsible for creating more than 300,000 education jobs. But we 

need to do more, in my judgment. 

According to the Center on Budget and Policy Priorities, State 

budget gaps will total $180 billion in fiscal 2011 and $120 billion 

in 2012. The consequences of that for our education system are 

staggering, and the numbers are daunting. Twenty-nine States and 


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the District of Columbia have cut K–12 services, even with the Recovery Act funds. In California, though I am always reluctant to 

cite that State because of their wacky budget process, aid to local 

school districts has been reduced by billions of dollars. Cuts to 

early childhood funding in Illinois will leave 10,000 children ineligible for services. Mississippi cut its fiscal 2010 K–12 funding by 

nearly 5 percent. In New Jersey, more than 11,000 students will 

likely lose access to after-school programs. And the list can go on 

and on. 

In light of all of this, in my judgment, we need to do more to help 

States and school districts weather this financial crisis, and I hope 

that the Administration will put the full weight of its efforts behind 

efforts to do so. We also should make sure that any emergency financial assistance is broadly distributed and available for purposes 

like avoiding teacher layoffs and keeping the lights on. 

SCHOOL REFORM

I know you and the President are very focused on using Federal 

aid to promote certain types of school reform. I am certainly in 

favor of improving our schools. I voted for No Child Left Behind, 

though I had huge misgivings about the details, because I felt, as 

I said yesterday, that it was the President’s first initiative out of 

the box and he deserved the benefit of the doubt and because I 

wanted to see reform. I get just as tired as anybody else of seeing 

non-performing schools and dull teachers. 

But, nonetheless, we can be for improving schools, but it seems 

to me that right now our most immediate problem is that school 

districts are drowning in red ink. As I said yesterday, I like to sail, 

but when the sailboat is sinking, my top priority would not be to 

put a new coat of varnish on the deck. I would want to protect the 

hull first. 

FY 2011 BUDGET REQUEST FOR EDUCATION

Secondly, in the interest of brevity, let me skip that and simply 

say, on your 2011 Budget, that request includes over $3.5 billion 

for new and untested initiatives, for which you will control how the 

funding is allocated to State school districts and other providers. In 

times like this, we need to worry about our core foundational programs, which go out by formula and are widely shared across the 

Nation. A school district’s ability to attract funds should not depend upon its capacity to write a grant application. 

ELEMENTARY AND SECONDARY BUDGET REQUEST

I want to support this Administration in your education priorities, but not at the expense of reliable and predictable Federal 

support that thousands of districts across the country rely upon. 

Perhaps most troubling is the lack of any increase at all in Title 

I funds, which are broadly distributed by formula to all school districts in need. At the same time, the budget includes an extra $500 

million to expand the Innovation Fund, which makes grants 

through competitions run by your Department. Similarly, it seeks 

to more than double the appropriation for Teacher Incentive Funds, 


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even though your Department has yet to complete any rigorous 

evaluation of this 5-year-old program. 

Overall, in the Administration’s budget, funding for ESEA, funding for formula grants go down by almost $700 million, while narrowly targeted competitive grant programs increase by $3 billion. 

It seems to me that is not the correct balance, particularly during 

these hard economic times when most school districts need immediate help. 

HIGHER EDUCATION BUDGET

I also want to express reservations about your higher education 

budget. I believe that a more educated citizenry is vitally important 

to our economy, especially in our changing economy. But we need 

to make sure that a student’s brain, not their bank account, is the 

only determinant on whether they can get a college degree. 

Would you put that chart up, please? 

We put this chart up earlier this week, and I want to emphasize 

it again. What the chart demonstrates is that a student who in the 

8th grade was in the top 20 percent of performers in mathematics 

had a 29 percent chance of graduating from college if they come 

from a poor family and a 75 percent chance of graduating from college if they come from a rich one. That, in my view, is an indictment of our indifference to the needs of children who are stuck in 

low-income families and stuck in poverty-related schools. And it 

seems to me our number one priority needs to be to redress that 

imbalance. 

PELL GRANTS

I would also say that a key tool to increasing access to higher 

education for students of modest means is the Pell Grant. These 

grants currently help over 8 million students get the college or 

technical education they need to qualify for a decent job. Over the 

past 5 years, this Congress has worked to increase the maximum 

Pell Grant award by $1,500. We are facing a real challenge in continuing that policy. 

The cost of maintaining Pell Grants at that level is rising. You 

have large numbers of students going back to school because they 

recognize the tightness of the job market, and they are trying to 

upgrade their skills. Unfortunately, as we look for a solution to Pell 

funding, the administration’s budget leaves me somewhat confused. 

It proposes to somehow move Pell Grants over to the entitlement 

side of the budget. I have no idea how well that is going to be received by the Congress. But we understand that if enacted, the 

Higher Education Reconciliation Act would provide a portion of the 

shortfall that we are facing today. 

But even counting that funding, it still leaves a substantial 

shortfall, and we need the Administration’s help in finding a solution. It is not just good enough to ask us for the money, without 

suggesting how it is going to be paid for. So, I hope you can explore 

those issues over the next couple of hours, Mr. Secretary. 


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RANKING MEMBERS OPENING REMARKS

Mr. Tiahrt, I would invite you to make whatever comments you 

think are appropriate. 

Mr. TIAHRT. Thank you, Mr. Chairman. 

I want to begin by thanking Secretary Duncan and Mr. Skelly for 

showing up today before the committee. 

Welcome to the committee. 

EDUCATION SPENDING AND BUDGET DEFICIT

We all know that education is critical, and I think we can all 

agree it is very important that we give the tools to every child to 

achieve their view of the American dream as well as equipping our 

economy for the skilled workforce needed to keep us competitive in 

a global economy. 

To do this, we need a world-class education system that puts the 

needs of students, parents and teachers first, while partnering with 

our local schools. I know there are differences on how we intend 

to accomplish this, particularly when the Federal Government 

would continue hemorrhaging red ink under the President’s budget 

as far as the eye can see. The deficit this year under the President’s budget will reach $1.5 trillion and never dips below $700 billion over the next decade, 

while our national debt would nearly double, despite an economy 

that is projected to have recovered and the war in Iraq ended. Beyond the next 10 years, the current path is unsustainable, as 

spending on the big three entitlement programs will continue to 

consume all of the available resources under current law. 

So as we look at the Department’s budget request, tough choices 

will have to be made. We are putting the burden of today’s spending on the kids who will be working tomorrow. So we have a tradeoff: a good education system with frills that the students have to 

pay off in the future, or a system that meets the needs to give them 

the tools so they can achieve their dreams without the frills. 

While I have questions and concerns about many of the specifics 

in the Department’s budget proposal, I look forward to the opportunity to continue discussing with the Secretary and the members 

of this subcommittee how we can responsibly invest in educational 

excellence, both today and going forward. 

Thank you, Mr. Chairman. 

Mr. OBEY. Thank you. 

Mr. Secretary, please proceed. Why don’t you take 5 or 10 minutes to summarize your statement. And we will put the full statement in the record. 

SECRETARY ARNE DUNCAN’S OPENING STATEMENT

Secretary DUNCAN. I will be brief. Thank you so much, Chairman 

Obey and Ranking Member Tiahrt, for the opportunity to appear 

before the entire committee today. 

I want to begin by thanking you for what you have done to keep 

America’s teachers in the classroom and to keep America’s children 

learning. The Recovery Act saved nearly 325,000 education-related 

jobs and another 75,000 non-education jobs at the State level, and 

that is just through our Department. This funding not only helped 


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stabilize the economy and avoid a depression, but it absolutely 

averted an educational catastrophe. 

And, Chairman Obey, I want to personally thank you for all your 

leadership in making that happen. All told, we have obligated over $70 billion from the Recovery Act. We have $25 billion left, most of which will be out the door 

over the next few months. That money will help States balance 

budgets, help young people pay for college, and help drive the 

change we need in our classrooms to prepare our children for the 

jobs of the future. 

DEPARTMENT OF EDUCATION FY 2011 BUDGET REQUEST

Let me turn to our proposed 2011 education budget. As you 

know, while most Federal spending is frozen, President Obama is 

proposing an historic increase in education funding. He understands that education is the key to our economic security, and even 

in these challenging times, he remains deeply committed to this 

issue. 

DISCRETIONARY FUNDING REQUEST

The President is requesting a 7.5 percent increase in discretionary spending, from $46.2 billion to $49.7 billion. It supports our 

cradle-to-career agenda, from preschool through college. Our K–12 

budget is focused on six areas, all of them about supporting students and teachers. 

COLLEGE AND CAREER READINESS

‘‘College and Career Ready Students’’ is our new proposed name 

for the Title I formula grant program, which we continue to fund 

at historic levels. The Title I program will also receive substantial 

Recovery Act dollars next year. 

We also propose more funding for School Turnarounds, from $546 

million to $900 million, so we can continue to focus on the lowestperforming 5 percent of each State’s schools. 

PROMOTING WELL-ROUNDED EDUCATION

Second, because students need a well-rounded education, we pro- pose a $100 million increase for learning programs beyond tested 

subjects like reading, writing, math and science, that is, for programs such as technology, the arts, foreign languages, history and 

other subjects. All told, we will request more than $1 billion next 

year to promote a well-rounded education. 

ENSURING PROPER LEARNING ENVIRONMENTS

Third, student supports are needed to ensure a proper learning 

environment. Our budget proposes a $245 million increase over 

2010 for a total of $1.8 billion to improve school climate, student 

health, student safety, parental engagement and community involvement. This includes continued support for the 21st Century 

Community Learning Centers program. We also want to work with 

the Congress to refine this program so that it lifts student outcomes and incorporates enrichment activities through community 

partnerships. 


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PROMISE NEIGHBORHOODS

We are also proposing a major investment in a new program 

modeled on the Harlem Children’s Zone. It is called Promise Neighborhoods, and it seeks to transform whole communities with 

schools as neighborhood anchors. It provides wrap-around social 

services from birth through college for students and families at 

risk. 

RESOURCES FOR DIVERSE LEARNERS

The fourth area of reform we are calling Diverse Learners. This 

includes students with disabilities who will benefit from a requested $250 million boost to the IDEA formula grant program. 

Like Title I, substantial IDEA Recovery Act dollars will continue 

to be available this year. 

Other diverse learning populations include English-language 

learners, which will get a $50 million boost under our proposal, and 

we are maintaining dedicated funding for migrant students, homeless students, rural students and Native American students. 

EFFECTIVE TEACHERS AND SCHOOL LEADERS

The fifth area of reform is called Teachers and Leaders. No one 

is more essential to educational success than the person in front of 

the class and the person who is running that school building. This 

proposed budget seeks $3.9 billion, a $350 million increase, to elevate the teaching profession and get effective teachers and leaders 

into the schools that need them the most. 

We are also requesting a large investment in teacher and principal leadership programs so States and districts can recruit and 

train the very best people possible. 

We further support both traditional and nontraditional pathways 

into teaching so people from all walks of life can bring their experience and knowledge into the classroom. And our budget invests in 

programs to reward educators for raising achievement and working 

in hard-to-staff schools and subjects. 

COMPREHENSIVE CHANGE NEEDED

The final area falls under the category of innovation. We are proposing almost $2.5 billion to increase high-quality charter and magnet schools and other autonomous public schools and to continue 

the Race to the Top and the Investing in Innovation programs. 

With so many children at risk of failure, America cannot accept the 

status quo. We have to be bold. 

The facts are both startling and disturbing. Today, 27 percent of 

America’s young people drop out of high school. That means 1.5 

million teenagers are leaving our schools for the streets. And this 

is a national problem, urban, suburban and rural. Our 15-year-olds 

rank 24th out of 29 countries in math. In science, 15-year-olds rank 

17th. And just 40 percent of young people earn a 2-year or 4-year 

college degree, and the U.S. now ranks 10th in the world in the 

rate of college completion. We used to lead the world. We have 

flatlined. Many other countries have passed us by. 


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We must embrace new approaches to learning and expand upon 

proven models of success. We must hold everyone accountable for 

results, and we must aim higher. 

Our States recognize the problem, and that is why 48 of them 

are working together to raise standards, and 40 of them, along 

with Washington, D.C., have developed bold reform plans in their 

bid for Race to the Top funding. And everyone who applied is a 

winner. Those good, courageous, tough conversations are happening 

around the country, and we are seeing huge progress. 

FY 2011 BUDGET AND ESEA REAUTHORIZATION

We are also seeing considerable bipartisan interest—both in the 

States and here in Congress—in our reauthorization proposal. 

I would like to briefly touch on some of the key elements which 

are organized around three main goals: first, raising standards so 

the students truly graduate from high school ready for college or 

the world of work; second, rewarding excellence and growth; and, 

third, increasing local control and flexibility while maintaining the 

focus on equity and closing those stubborn achievement gaps. 

We believe that States do not need a prescription for success. 

States and districts need a common definition of success. And we 

need a better system of accountability. 

As you know, No Child Left Behind greatly expanded the Federal 

role in holding schools accountable. It required States, districts and 

schools to report test scores disaggregated by student subgroups, 

bringing much-needed transparency around achievement gaps. 

NCLB was right to create a system based on results for students, 

not just on inputs. 

But there are far too many perverse incentives, and we must fix 

that. NCLB’s accountability system actually encouraged States to 

lower standards. It doesn’t measure growth or reward excellence. 

It prescribes the same one-size-fits-all interventions for schools 

with very different needs. 

It also led to a narrowing of the curriculum and excessive focus 

on test preparation. And it labels too many schools as failing, regardless of the progress they are making. 

Our proposal will use student academic growth and gain as the 

measure of whether schools, districts and States are making 

progress. It is a fairer, more honest and much more useful indicator. Most educators say they want to be evaluated on growth, not 

proficiency. 

As I said before, our proposal supports a well-rounded education, not only by requesting more than $1 billion for the arts, science, 

history, languages and other subjects, but by allowing, not mandating, States to use these subjects in their accountability systems. 

Under our plan, we will reward schools that are making the most 

progress, and we will be tough-minded with our lowest performing 

schools and schools with large achievement gaps that aren’t closing. All other schools will be given flexibility to meet performance 

targets working under their State and local accountability systems. 

SUPPORT FOR RURAL DISTRICTS COMPETING FOR FUNDS

Now, we understand there are concerns that small rural districts 

cannot compete with large urban districts for grants, so here is 


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what we will do: First, we will continue funding the Rural Education Achievement Program, also known as REAP. In our budget, 

it has not been consolidated with any other programs or funding 

streams. 

Second, we will look at competitive priorities for rural districts 

where it makes sense and is needed, and we welcome that discussion with you. We recently did exactly that with the Investing in 

Innovation Fund, the $650 million I–3 fund. 

Finally, we are also identifying foundations and nonprofit organizations to partner with rural districts. I have traveled to many 

rural areas in the past year and seen firsthand both the challenges 

they face as well as their capacity to address them. And I am confident that our Department can support rural school districts as 

they work to improve—and compete. 

So those are some of the highlights. I encourage you and your 

staff to review the blueprint for reauthorization which is now available online. 

PROGRAM CONSOLIDATIONS AND SAVINGS

I want to make one additional point about efficiency and our obligation to taxpayers. In our proposed 2011 budget, we list $340 million in savings by cutting ineffective programs and eliminating earmarks. We also consolidated 38 programs down to 11 funding 

streams to reduce red tape and paperwork for local educators, and 

they have been very appreciative of that. 

The bottom line is that, between our budget and our blueprint, 

we have a coherent and comprehensive vision for education in the 

21st century that builds on core values shared by Congress and by 

the Administration: high standards and better assessments, rewarding excellence with real incentives based on student growth, 

and a smarter, more limited Federal role that supports rather than 

directs State and local educators. 

STATE OF EDUCATION BUDGETS NATIONWIDE

Let me just close by voicing my concern for education budgets 

around the country. Even with the remaining Recovery Act dollars, 

States are facing teacher layoffs, cutting school days and furloughing teachers to balance their budgets. For many States, that 

funding cliff arrives this July. 

I want to thank the House for supporting an education jobs bill. 

I appreciate that there is growing concern that the Federal Government cannot continue funding States indefinitely. But America cannot neglect its obligation to children now. Somehow, we must find 

a way to continue to support our teachers and principals, parents 

and students, so that we emerge from this difficult economic period 

stronger and better prepared for tomorrow. 

Thank you so much. I am happy to take your questions. 

PREPARED STATEMENT OF SECRETARY DUNCAN

[The statement follows:] 


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Mr. OBEY. Thank you. 

Mr. Tiahrt. 

Mr. TIAHRT. Thank you, Mr. Chairman. 

PELL GRANT PROGRAM COSTS

Mr. Secretary, there is a huge rise in cost in Pell Grants since 

fiscal year 2007. The maximum Pell Grant award under the Housereported Labor-HHS bill was $4,150 per student at a total cost to 

taxpayers of about $13 billion. That represented an increase of 

$100 in the maximum award over the previous year. Since then, 

Congress has increased the maximum award to $5,550, the bulk of 

which is this committee’s responsibility. Your request for that 

amount is an increase to $5,710, for a total cost of $36 billion. 

When you consider the increase for the amount coupled with the 

number of students, which in the last 4 years has gone up by about 

50 percent, it is a lot of money that we are setting aside. 

How has the cost of this important program skyrocketed so much 

in just 4 years? 

Secretary DUNCAN. What we are trying to do is make sure—and 

I think Chairman Obey’s slide is very compelling. There are so 

many students around this country who want to go to college who, 

due to difficult financial circumstances, simply can’t afford it. And 

we want to make sure that those dreams don’t die young. 

I don’t worry just about our seniors and juniors. I worry about 

those 9- and 10-year-olds around the country whose mom or dad 

loses their job or takes a huge pay cut, and they start to think that 

college isn’t for them. We have to continue to invest. We have to 

educate our way to a better economy. 

If we simply stop subsidizing banks and put those savings behind 

Pell Grants, we can close that shortfall in the Higher Education 

Act. And the bill, I appreciate Chairman Obey and Chairman Miller for their leadership on that. If we choose to invest in education 

and stop subsidizing banks, we can do the right thing by the country. 

Mr. TIAHRT. And we are very proud of our institutions in Kansas, 

and especially around March Madness, I have seen some brackets 

where the finals is KU versus K-State. 

Secretary DUNCAN. I am picking Kansas. 

Mr. OBEY. What are they playing, badminton? 

RISING TUITIONS AND COST TO STUDENTS

Mr. TIAHRT. My concern is that, as we put more money and dollars in the system, it seems like the universities just bump up their 

tuition costs, and we end up with the kids in the same problem. 

By putting more money in the system, doesn’t necessarily open the 

doors for them; as a matter of fact, it may be more difficult for 

them, because they don’t get enough, they start borrowing money, 

and by the time they get through their 4-year program, they owe 

$100,000. 

Secretary DUNCAN. It is a great question. I share that concern. 

And it is really interesting. If you look across a couple thousand 

higher education institutions, you see folks doing different things. 

You see some with absolutely runaway costs, way above the rate 


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of inflation. You see other universities going to 3-year programs, 

going to no-frills campuses, doing some very creative things. 

And I think our students and families are very, very smart, and 

they are going to vote with their feet. They are going to do their 

homework, and where the costs are out of control and the value is 

not there, folks are going to stop going. You have seen a number 

of universities start to go in the other direction, reducing costs even 

in tough times, going to 3-year programs, no-frills campuses. 

So I think our students and parents through the marketplace are 

going to help drive more universities to go where they need to. But 

where schools have runaway costs, I think you are going to see students and parents choose to go in a different direction. 

FINANCING PELL GRANTS AND DIRECT LENDING PROPOSAL

Mr. TIAHRT. Well, we are going from $13 billion in fiscal year 2007 to now a total cost of more than $36 billion. That is almost 

three times the increase. My concern is, these kids are going to end 

up paying for this because it is borrowed money. It is money we 

don’t have. 

Secretary DUNCAN. Again, this is money we can invest in students without going back to taxpayers for another dime. We simply 

stop subsidizing banks. So this is a real chance for America, I 

think, to get its priorities right. I think we have to stop subsidizing 

banks. If we can do that, we can invest unprecedented resources 

to make college more accessible and affordable for our Nation’s 

young people. 

DIRECT LENDING PROPOSAL—TERMINATING LENDER SUBSIDIES

The President has drawn a line in the sand. He says, by 2020, 

we want to again lead the world in college graduation rates. We 

have to educate our way to a better economy. Again, we used to 

lead the world. We have flatlined. Many other countries have 

passed us by. And making college more accessible and affordable 

is very important. 

There is a piece of that legislation that is something else called 

income-based repayment, IBR. Again, simply by stopping those 

subsidies to banks, we could reduce those loans and repay them at 

the back end. 

Mr. TIAHRT. Mr. Secretary, we just had Secretary Geithner here 

a couple days ago, and he is very proud of subsidizing the banks. 

And I don’t think he is going to stop. 

It doesn’t prevent our kids from having to pay back this borrowed money. I think you are absolutely right; we have to quit bailing out the buddies on Wall Street. 

It is tragic that our kids that are in school today, the kids that 

are going to qualify for these Pell Grants, are saddled with the burden of paying back not only the money that is being allocated for 

education now, higher education Pell Grants, but also what we 

paid to bail out the banks. 

We are overdrawn by $655 billion this year alone. We are going 

to have to start making some tough choices, and it seems like this 

is a dramatic increase. 

Secretary DUNCAN. Again, I think we are trying to make some 

tough choices. I agree with you. We are trying to make a tough 


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choice to stop subsidizing banks and put that money behind young 

people. 

Mr. OBEY. The gentleman’s time has expired. 

Ms. Lowey. 

Mrs. LOWEY. Thank you, Mr. Chairman. 

21ST CENTURY COMMUNITY LEARNING CENTERS

And thank you, Mr. Secretary, for your leadership and creativity. 

However, I want to ask you a couple of questions about the afterschool programs. This has been very important to me and to many 

of our communities. 

The budget request includes $1.6 billion for the 21st Century 

Community Learning Centers program. So this appears to be the 

same as fiscal year 2010, but after I look closely, I realize that $10 

million of the request would fund full-service community schools, 

and $3 million would stay at the Department to run a national 

competition. So it is actually a $13 million cut. 

Now, we know that after-school programs serve more children 

than 5 years ago. There are more children, however, unsupervised 

each afternoon. The demand for programs is higher than ever. In 

fact, parents of 18.5 million children not currently participating in 

after-school programs say they would enroll their children if one 

were available. 

Now, my constituents say that reducing funds for after-school 

programs is like pulling the rug out from under working families 

who are struggling right now. So I am not opposed to extending the 

school day, but it is important to delineate between extended day 

and after-school programs. 

The vast majority of after-school programs last until 5 to 7 p.m., 

whereas extended-day programs often run only until 4 p.m. Afterschool programs just keep children safe longer, giving them enrichment and education activities until their working parents get 

home. 

IMPACT OF ECONOMY ON AFTER-SCHOOL PROGRAMS

There was a survey conducted by the Afterschool Alliance that 

looked at how the economy is affecting after-school programs. It 

found that 95 percent of after-school programs report that the recession is affecting their community. Approximately 6 in 10 programs report a loss in funding due to the recession; 86 percent say 

more kids in their community need after-school programs; and 83 

percent report that funding for their program is less than secure 

for the next 3 to 5 years. 

So the gap between the proposed funding level and the authorized level of $2.5 billion leaves as many as 1.5 million children behind and many States unable to make new grants, and that prevents new programs from getting off the ground and turning away 

established programs looking to renew grants. 

AFTER-SCHOOL PROGRAMS

So I would like to ask you three questions: One, why is the Department proposing to effectively reduce after-school funding by 


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using these funds for other purposes, as good as they may be, besides funding 21st Century Community Learning Centers? 

How does extending the school day fill the gap between what 

would otherwise be accomplished through after-school programs? 

And given the obvious need for more after-school programs, did 

the Department consider increasing funding for the program? You 

have asked for an overall increase in the budget. So I would say, 

why didn’t you increase these programs when the need is so obvious? 

I want to make it clear, I am not against extended-day, but I 

don’t think it takes the place of the after-school programs. 

Could you respond? 

Secretary DUNCAN. Sure. Those are really powerful questions. 

Let me just say I got my start in education in my mother’s afterschool program. I was raised as part of that and ran my own afterschool program for 6 years before I went to join the Chicago public 

schools. So, throughout my life, I have seen the extraordinary benefits. 

Our streets often aren’t as safe as we want them to be. As you 

know, we have more and more children on their own after school, 

and whether it is two-parent working families or a single-mom 

working two or three jobs, those hours, I would say, not just 3 

o’clock to 5 o’clock, but 3 o’clock to 7 o’clock, 8 o’clock, are times 

of high anxiety for parents. And we have to find ways to address 

that. Let me start talking in bold strokes and then answer your 

question specifically. 

We talk about what our priorities are. One of the six buckets is 

student supports, and the total pot there is $1.8 billion. That is a 

16 percent increase. That is for after-school and extended-day. It is 

trying to create safe and healthy students, and it is this idea of creating more—replicating the ideas behind Jeffrey Canada’s Harlem 

Children’s Zone to make sure we have entire communities that are 

supporting students, enabling them to—— 

Mrs. LOWEY. Kid’s Day does a great job, too. We have that in 

New York as well. 

Secretary DUNCAN. It does a great job. I will also tell you the 

President has requested an additional $1 billion if the reauthorization passes, and we want to put a large chunk of that money into 

after-school programs. So if that passes with Congress’s support 

this year, there is another huge funding source. 

We are not looking to cut funding. We are challenging grantees 

to tackle both of those two things. 

Mrs. LOWEY. Wait. You are not looking to cut it, but you are, for 

something else that is good. 

Secretary DUNCAN. Again, we are going to challenge grantees to 

do these things. I don’t see these two ideas as in conflict. I think 

folks can work on these things together. 

Mrs. LOWEY. How? 

Secretary DUNCAN. Community schools can integrate after-school 

programs. 

Mrs. LOWEY. Where are they going to get the money? 

Secretary DUNCAN. Again, these are through the grants we are 

going to put out. So there is a chance here for folks who are being 


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creative to add time. We couldn’t agree with you more; we want to 

add more time after school. 

Mrs. LOWEY. Okay, let me just say this: I think your extendedday, your other programs are all great and all wonderful, but in 

the meantime, there are over 1 million kids who will not be able 

to get services of after school. 

So what I would just say, and I am hoping we can work together 

on the budget, is, I might adjust those figures, because I think it 

is important to address the after-school program. And we are certainly willing to support your creativity and extended-day, and I 

am familiar with CIPS and all the others. So I hope we can work 

together on that. 

Secretary DUNCAN. Thank you so much for your thoughtfulness. 

Mr. OBEY. Mr. Rehberg. 

Mr. REHBERG. Thank you. 

I want to thank minority staff for sticking around for my questioning this time. 

COMPETITIVE GRANT PROGRAMS AND RURAL DISTRICTS

Welcome. Nice to have you. And if you haven’t checked my biography, I am from Montana. I represent 147,000 square miles. And 

we wish we would be rural education, but we are not; 85 percent 

of my kids are either rural or frontier. 

I had lots of problems with the No Child Left Behind as well, but 

I always found the Administration and the Secretary of Education 

to be fairly amenable to changes, flexibility. 

So if I could make some suggestions: Moving to the grant program does not necessarily work for a State like Montana, because 

we just don’t have the economy of scale. There aren’t grant writers 

in these schools. They are so small, that we especially see it in 

other areas like fire grants. There are other grant programs within 

the Federal Government, and we have struggled. We have tried to 

do education programs to help them learn how to write grants. We 

even offered in my office to help them write grants. And to expect us to try to make up $12 million for our schools 

in Montana through grant writing is practically impossible. And I 

plead with you, don’t move so quickly in that direction. 

TURNING AROUND LOW-PERFORMANCE SCHOOLS

The second area is the Race to the Top. Once again, the four 

model categories you have created are nice, but the difficulty is 

they don’t really reflect our kind of schools. It is not that easy for 

us to get rid of a principal, fire half our teachers, restructure the 

way you have done it. 

I guess if you could give me some assurances of your desire or 

willingness to be flexible, and can you work with the Rural Education Caucus that we have here in Congress to address some of 

the lack of flexibility in the creation of the models in the first 

place? 

Secretary DUNCAN. Absolutely. I had a wonderful visit to Montana and learned a tremendous amount. 

Mr. REHBERG. Did you fly, or drive around? 

Secretary DUNCAN. We flew in, and we drove around. So we got 

a good sense of the issues. We traveled with the Governor and 


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spent some time with the State school superintendent. I went to 

Northern Cheyenne country as well. It was a fascinating day, and 

I got a lot from it. 

Mr. REHBERG. As you know, we did not, our Office of the Public 

Instruction did not compete for the grants. 

Secretary DUNCAN. They can come in, in the second round. To be 

clear, we are not looking for fancy grant proposals. We want to go 

where the need is, and we have been very, very clear about that. 

We are looking for folks who have a heart, who want to get dramatically better, who want to raise the bar for all children, close 

achievement gaps. Again, we are not interested in fancy grant proposals or consultants or anything like that. We just encourage everyone to put their best ideas forward. And please rest assured, we 

want to go where the greatest need is. 

SCHOOL IMPROVEMENT INTERVENTION MODELS

In our proposals, I think you are talking about the school Turnaround model, the Transformational Model doesn’t require you to 

move staff out. We can continue to have the conversation and be 

flexible with that model put in place. We thought about it to make 

sure in those rural communities where you—— 

Mr. REHBERG. Can those other models be added? You are not 

dead set on those four? 

Secretary DUNCAN. We can have that conversation. We had lots 

of conversations with rural superintendents about that model. We 

didn’t just sort of come up with these models—which also include 

the Restart and School Closure Models—in a vacuum. There were 

a number of conversations there. Frankly, there was pretty good 

support. But if we missed something, we are happy to continue 

those conversations. 

Mr. REHBERG. That is probably the thing I hear most from the 

school administrators: It is not practical or does not work. Maybe 

you are hearing from other areas of the country that it does, but 

my rural administrators—— 

Secretary DUNCAN. Okay. We will continue to vet it. I will absolutely commit to you to continue those conversations. I have tried 

to travel throughout the country, so whether it is Montana, whether it is West Virginia, whether it is Wyoming—— 

HELPING STRUGGLING POPULATIONS

Mr. REHBERG. Let me switch gears rather quickly because the 

one thing I liked about No Child Left Behind was the testing, but 

the problem was we didn’t do anything once we had the test done. 

We know it is our Native American schools in Montana. Clearly, 

we knew it before we went in that is what it was going to show. 

But the money didn’t follow the tribes, didn’t go into the reservations. Now we are seeing the consolidation of those accounts within 

your budget proposal as well. 

How do you hope to address them specifically when you slip 

them in with the African American districts and all the other districts that are identified as some of the trouble spots? 

Secretary DUNCAN. Again, our budget proposes the largest increase in spending for education ever. And so we want to put resources everywhere. At the time when the President is level-fundVerDate Mar 15 2010 08:35 Nov 16, 2010 Jkt 058233 PO 00000 Frm 00081 Fmt 6601 Sfmt 6602 E:\HR\OC\A233P2.XXX A233P2

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ing most other domestic spending, this is a major investment. And 

that is how we see it, as an investment. There is huge unmet need 

around the country in every community, urban, rural, suburban, 

frontier, and we want to work as hard as we can to meet that need. 

Mr. REHBERG. Thank you, Mr. Chairman. 

Mr. OBEY. Mr. Kennedy. 

Mr. KENNEDY. Thank you, Mr. Chairman. 

Welcome, Mr. Secretary. 

CHARTER SCHOOLS IN RHODE ISLAND

I wanted to just reiterate, my State being a small State, we have 

about the same size school district, if you will, as a major city like 

Dallas, about 160,000 kids. We have full implementation of charter 

school laws in our State. It has really been a partnership with the 

Speaker, leadership, and our superintendent, both in our biggest 

city and also our smallest community. All of the partners are 

signed on. 

We have an approach where we fully fund and hold accountable 

both our public schools and our charter schools, and we are prepared to defund both charters and public if they don’t perform. We 

actually have criteria-based hiring for teachers, and we are putting 

teacher quality and evaluation into the system already. 

For that reason, we get a ‘‘green’’ just among the National Council for Teacher Quality, green for those that should be proceeding 

forward with the Race to the Top measurement. I just wanted to 

highlight that, just in case you are deciding who to give the money 

to. 

ADULT LITERACY

I want to bring to your attention the notion that the collaboration, if you can just elaborate for us, the collaboration with the Department of Labor on literacy. 

We have in this country a growing challenge in terms of adult 

literacy. And you can’t divorce a parent’s literacy and the fact that 

that impacts their child’s challenges in terms of learning. So I 

would like to ask you, in terms of your Innovation Fund whether 

you couldn’t explain—I mean, a lot of these families, the parent 

can’t get into college if they don’t first have the basic skills. 

PELL GRANTS AND COLLEGE TUITION

I want to echo what Mr. Tiahrt said in terms of the increase in 

Pell Grants. Frankly, I know this is politically not even good politics, but we ought to be spending this money on public universities 

and community colleges to make it go the furthest. The notion that 

we are spending it on Ivy League colleges that have no cap on expenditures and do not make the most of their dollars in terms of 

access to the average middle-class family to me is another challenge I think for the Administration to make the most of those educational dollars. If they really want to take on the status quo, that 

would be the way to do it. Because I have kids waiting for classes 

to get into the Community College of Rhode Island, and they can’t 

do it because there is not enough money. And yet we are spending 

Pell Grants to go to the Ivy Leagues like Brown and other places, 


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albeit they are great universities. But frankly, I want to see more 

kids go to higher education, get access to basic skills and higher 

education than spend this money on a bunch of Ivy League universities that don’t need it. 

ADULT LITERACY AND TRAINING

So if you could talk about the adult literacy challenges that we 

have and how you are going to work with the Department of Labor 

and Secretary Solis on literacy issues. 

Secretary DUNCAN. Thank you. It is a huge issue for us as a nation, and we think we have about 90 million American adults who 

need to go back to school to get basic training, to be able to take 

that next step. So we have had a very, very good collaboration so 

far with the Department of Labor. Secretary Solis has been a wonderful partner. 

I have as my Under Secretary a former community college president, a visionary, Martha Kanter, the first time in the history of 

the Department that a community college president has been in 

that position. We want to make a significant increase in community colleges. 

We think they are this unrecognized gem along the education 

continuum. And whether it is 18-year-olds or 38-year-olds or 58- 

year-olds going back to school to retrain and retool, in green jobs, 

community jobs, tech jobs, health care jobs, we think as families 

get back on their feet, the country is going to get back on its feet, 

and we think community colleges can drive a lot of that. 

We also recruited, who happens to be from your State, just an 

absolute superstar who works with Martha, Brenda Dann-Messier, 

who is a phenomenal leader, passionate, has devoted her life to this 

issue of getting adults the skills they need and the basic skills to 

be retrained. 

So a lot of hard work is ahead of us. But I want you to know 

we are absolutely committed. We have a laser-like focus on community colleges, and Brenda is just an absolute champion for adult literacy. 

Mr. KENNEDY. Well, what are you doing to partner with the technology sector to provide these technology boards, if you will, so 

there is no stigma to people who may have literacy issues, they can 

learn both literacy for their job, but also basic literacy skills without people having a sense of maybe what the challenges are? 

Secretary DUNCAN. We have had great relationships with the 

community. Then we have conversations. Folks want to be part of 

the solution, so we are not seeing resistance. We are not seeing 

silos. We are not seeing egos, and I think we have a chance to get 

dramatically better. 

Mr. KENNEDY. If I could suggest, if we could bring all of the technology CEOs to the White House, tell them let’s get a cut rate and 

just get a bunch of these technology boards access to people so they 

can learn at their own pace and be able to get both the skills and 

literacy without people having a sense as to where they are, because there is huge stigma to literacy, I just encourage that. I also 

encourage Rhode Island in the Race to the Top. 

Thank you very much. 

Mr. OBEY. Mr. Alexander. 


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Mr. ALEXANDER. Thank you, Mr. Chairman. 

Good morning, Mr. Secretary. 

STUDENT LOAN INTEREST RATES

So it doesn’t look like we just hate banks more than we love children, let’s talk about the student loan program a little bit. What 

is the average interest rate today that banks would charge? 

Secretary DUNCAN. That banks can charge? 

Mr. ALEXANDER. Yes. 

Mr. SKELLY. For students, for subsidized loans, this year the interest rate students will get charged is 6 percent this year. It will 

be 5.4 percent as of July. It goes down for a couple more years. For 

unsubsidized loans, the rate is 6.8 percent. 

Mr. ALEXANDER. So if we take it away from the banks and handle it in your Department, what will the interest rates be? 

Mr. SKELLY. Under current law, the rates would be the same. 

The interest rates are the same for the Direct Loan Program and 

for the Guaranteed Student Loan Program. 

Mr. ALEXANDER. So the students will be paying the same thing. 

So what we are doing is just taking it away from the banks because we dislike banks and we are going to put it in you, is that 

right? 

Secretary DUNCAN. It is a little more complicated than that. We 

have basically been subsidizing banks, and we bear all the risk. 

And the banks have had a very, very good deal for a long time. And 

they have, because they have had a good deal, right now, and this 

is a matter of public record, they are spending millions of dollars 

on lobbyists who are running around town. They are running ads 

in a variety of places. And we think, again, when there is so much 

unmet need out there, when middle-class, working-class families 

are struggling to go to college, for us to continue to put money into 

banks when we can put money into students—— 

Mr. ALEXANDER. But if we are not going to let them have the 

loan at a cheaper rate, how are we benefiting the student? 

Secretary DUNCAN. Because of those savings by not subsidizing 

banks, we can put billions of dollars in increased—— 

Mr. ALEXANDER. Is that what we are going to do? 

Secretary DUNCAN. Yes, sir. 

Mr. SKELLY. In the SAFRA legislation, the legislation will be incorporated into the Reconciliation Act . . . 

Mr. ALEXANDER. And we know that that money won’t be spent 

in other places? 

Mr. SKELLY. I was just going to say that the rates will revert to 

a variable rate under a lot of the proposals under consideration. 

There would be a drop in the student loan interest rate under current laws. 

EVEN START PROGRAM—FAMILY AND ADULT LITERACY

Mr. ALEXANDER. Okay. Let’s go back and talk about something 

Mr. Kennedy was talking about. I, too, am concerned about adult 

literacy. 

I have been a proponent of Even Start, Head Start, those programs, and it is very moving to go into a setting and see an adult 

learn to read and write along with their children. I am afraid if you 


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mix all of those programs in and put them under competitive bidding, that that program, Even Start, is going to get lost in the mix. 

Can you ease my concerns? 

Secretary DUNCAN. I will try to. I appreciate your leadership 

there so much. I am a huge fan of family literacy. Again, if we are 

trying to change children’s lives, you have to change parents’ lives. 

Again, this is something I learned growing up as part of my mother’s program, that she makes parents come in and read with their 

kids, and helps them if they don’t know how to read to their kids. 

And if you are really trying to change that child’s life trajectory, 

you have to change what is going on inside that home. 

So I am a huge, huge proponent of family literacy. We increased 

the funding for literacy by about 9 percent, so we are putting more 

money there. Even Start programs, family literacy programs generally can absolutely have a chance not to just maintain funding, 

but potentially increase their funding. 

Mr. ALEXANDER. Good. Thank you. 

Mr. OBEY. Ms. Lee. 

Ms. LEE. Thank you, Mr. Chairman. 

Good morning, Mr. Secretary. 

TEACHER SUPPORT AND CHRONIC LOW-ACHIEVING SCHOOLS

Let me first say I recognize change is hard, and this is an entirely new approach to our educational system, which is sorely 

needed, but I have a lot of questions about this new direction. 

First, I may as well say, probably one of the votes that I regret 

most is voting for No Child Left Behind, and I don’t say that about 

many of my votes. Of course, I wanted to see it repealed, but it 

looks like you all are trying to fix it. But let me ask you a couple 

of things, because I am not so sure that the issue of teacher support—and I cite the example in Rhode Island where all teachers 

were fired. Historically, teachers have not had the resources. They 

have not had the support. And I look at your budget for counselors, 

you know; I look at all of the supports that need to be in the school, 

especially in low-achieving schools, schools in urban and rural 

areas where you have low-income students, the supports have not 

been there historically for teachers. 

So for schools now to have to race to try to help teachers teach 

and then have the punitive measures that you all have decided 

upon, such as what happened in Rhode Island, if they hadn’t been 

able to teach the way we want them to teach, to me just seems 

wrong. 

Teachers should be the highest-paid profession in the world. 

Really. They are securing our future. We have historically had a 

problem with low teacher salaries, and that is an issue that needs 

addressing. 

We haven’t had the type of counseling at our public schools that 

teachers need, nor the curriculum, nor the supplies, nor the computers, the technology. 

In my area, in Oakland, an entry level teacher is paid $37,000, 

but yet in a higher-income area, a teacher gets $45,000. Both salaries are much, much too low. It doesn’t make any sense to put the 

onus on teachers, I don’t believe. Teachers have families. They 

have children. 


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So to say we are going to lay off or fire teachers if they don’t perform is a bit shortsighted, rather than do what we need to do to 

support teachers in terms of classes. You know what all we need 

to do. 

Had your budget been in place before the firing of teachers in 

Rhode Island, what do you think would have happened? 

Secretary DUNCAN. Let us be just very clear on that situation. 

We have actually worked very hard, and the union and the district 

are going through mediation and working together. So this story 

isn’t finished yet, and we have been very encouraged by that. 

You never want teachers to get fired. That is not what anyone 

wants. And these guys are going to continue to talk and work 

through this. It is a tough situation. It is a tough conversation. But 

we are very happy they are back bargaining, and we are hopeful 

for a good resolution there. These conversations are never easy at 

a school like that. 

Reading rates have gone up, but in math I think 7 percent of students are at math proficiency levels. So 93 of students aren’t. A 

dropout rate of 52 percent—— 

Ms. LEE. Sure. In my district, we have schools that are very 

similar. 

HOLDING SCHOOLS, DISTRICTS AND STATES ACCOUNTABLE

Secretary DUNCAN. So we need to work together. 

I think your point is very well taken. The partnership with 

teachers is hugely important. One of the many things I thought 

was broken about NCLB is to put all the onus onto teachers, and 

we are trying to say this is a shared responsibility. So for the first 

time we are going to hold not just schools but districts and States 

accountable. We are going to have a laser-like focus on equity. 

To your point, often—and Congressman Jackson knows this— 

often, the poorest communities get the least resources. There are 

huge funding inequities—— 

Ms. LEE. That is all the time. 

FUNDING FOR LOW-ACHIEVING SCHOOLS

Secretary DUNCAN. I lived on the poor side of the tracks for a 

long time. In Chicago public schools that were 90 percent minority, 

85 percent living below the poverty line, we received less than half 

the money of wealthier districts, less than half of districts 5 miles 

north of us. And think about the compounded difference that 

makes over 12, 13 years of education. It makes no sense whatsoever. 

What we want to do is we want to be very, very creative. The 

School Improvement Grants, which haven’t gotten much discussion, 

you know, Race to the Top is $4 billion and, School Improvement 

Grants is $3.5 billion. We have put all that funding on the table 

just for that bottom 5 percent of schools. 

SUPPORT FOR TEACHERS

So teachers need more time to collaborate. They need more support. We want to fund that. I think we should be paying—this is 

controversial—math and science teachers more. We have got a 


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shortage of math and science teachers; and I think we need to reward them to work in disadvantaged communities, rural or innercity, urban. 

INCREASED RESOURCES, SHARED RESPONSIBILITY

So we are going to put unprecedented resources out there, and 

what we are going to do is say, with these resources, we have to 

challenge the status quo. Where we have dropout factories where 

50, 60, 70 percent of students aren’t graduating, we have to collectively do something better. 

So we are trying to make a huge investment there, but it has to 

be a shared responsibility. I absolutely agree. Teachers can’t begin 

to do this alone. I always say, if children aren’t fed, they can’t 

learn. If children aren’t safe, they can’t learn. If children can’t see 

the blackboard, they can’t learn. 

So this idea of the student supports emphasis, trying to create 

the climate in school and in the communities, the Geoffrey Canada 

work around schools to give students a chance to concentrate and 

think about algebra, trig, and biology. We have to do all those 

things, and I promise you we are committed to doing that. 

Mr. OBEY. Mr. Cole. 

Mr. COLE. Thank you, Mr. Chairman. 

PROGRAMS FLAT-LINED IN FY 2011 BUDGET

Mr. Secretary, thank you for being here; and thank you for what 

you are trying to do. I think you have got really one of the toughest 

jobs in government, and you do it well. 

But, like everybody else, I have concerns; and I think I share the 

chairman’s concern about not funding programs that we think work 

or flat-lining them and moving toward the competitive grant system. Because I think it is very difficult. You need certainty in education, and you need to have some sort of timeframe, and if every 

year you are sort of up for a grant you have got a lot of problems 

and a lot of concerns. 

But I want to ask you about some specific areas where you flatlined programs that, frankly, are of great interest to me. 

There is no increase in TRIO funding, and one of the major aims 

appropriately is to try to help disadvantaged kids get through 

school. There is no increase in GEAR UP funding, which helps kids 

get to college in the first place, again, usually disadvantaged. These 

are programs I see in my district and in my State and I think work 

exceptionally well. 

I am concerned frankly—I remember your testimony vividly last 

year, and you talked about going to reservation schools and seeing 

the real needs and the real challenges there. But we are flat-funding tribally controlled, postsecondary career and tech institutions, 

and we are flat-funding Indian student education programs again. 

So if these are areas of real need—and they are, and I know you 

recognize that—why are we flat-funding in all these areas and 

moving toward grants—which again I share some of the concerns 

voiced by several of the members on the panel. Quite often, these 

are institutions or student groups that are going to find it very difficult in competing at that sort of thing. 


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Secretary DUNCAN. Again, just to be very, very clear, in the big 

picture, almost three-fourths of our budget is continuing to be formula based. So the overwhelming majority of our money will be 

formula based. We are moving some money in the competitive direction, and we want that money to go where the greatest need is. 

So part of what we wanted in the higher education bill was a college Access and Completion Fund so GEAR UP and TRIO and 

other programs like that would have a chance to grow and expand 

where they are doing a good job. 

We think we want to continue to go where the need is. Again, 

we are not looking at fancy presentations, not looking at fancy 

Powerpoints but where there is significant need and a real desire 

to get better. Those are the kinds of places where we want to invest. And we think we have to get dramatically better and address 

those dropout rates. If we just keep doing the same thing, I don’t 

know if we are going to get the better results we need. That is the 

balance we are trying to strike. 

Mr. COLE. That is a fair point, Mr. Secretary. Although you could 

make an argument—particularly in the four cases I have mentioned—we are not doing better because those programs aren’t anywhere near completely funded. It is not like every kid eligible for 

TRIO is in TRIO or every Indian kid who could be educated is getting that. 

So maybe we actually—sometimes we do need to do more of the 

same thing. We just haven’t done enough. And it is very difficult, 

I think, when you show up and everybody wants to do something 

new and exciting and everybody wants to do something innovative 

and there are lots of good ideas, but there tends—particularly in 

tough economic times—— 

And you are better off than most. As you say, the President has 

clearly made a decision here to try to give additional resources. I 

would have thought maybe in some areas at least this was an opportunity to catch up and to fund places that haven’t been funded. 

These programs really do work extremely well, and they didn’t get 

any increases last year. I guess $20 million for TRIO, which the 

chairman made available, that wouldn’t happen. That wasn’t in the 

President’s Budget. 

INDIAN EDUCATION

And, again, there is nothing here to reward or build on a program that is pretty good; and there is nothing directed again toward Indian kids, which are the most disadvantaged, lowest completion rate in high school, fewest—lowest percentage in college, 

lowest number of college grads of any ethnic group or racial group. 

I think those programs really need a whole lot more in them before we sort of start trying something new. 

INCREASED FUNDING IN CONSOLIDATIONS

Secretary DUNCAN. And those programs that, you know, have a 

demonstrated track record of effectiveness, that are doing a great 

job, will absolutely have an opportunity to receive more funding. So 

that chance is still there. 

And in all of these areas often, you know, when agencies consolidate budgets, they use it as an excuse to cut. We actually increased 


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funding in every single one of our buckets. So that opportunity is 

there for them. 

Mr. COLE. Well, I am somewhat skeptical, but we will talk about 

this more. 

Thank you, Mr. Chairman. 

Secretary DUNCAN. I appreciate your thoughts. 

Mr. OBEY. Mr. Moran. 

Mr. MORAN. Thank you, Mr. Chairman. 

GRADUATION RATES OF NCAA ATHLETES

I am just reading an article here relevant to March Madness, 

which starts today. And I want to applaud the Secretary for pushing a proposal that if the NCAA teams are going to participate in 

post-season play, they ought to graduate at least 40 percent of 

their athletes. It doesn’t seem to be a particularly high bar, and I 

am disappointed to see that Kentucky would fail, the number one 

seed, but it is disgraceful to only graduate less than a third of their 

players. And, likewise, Maryland at 8 percent; California at 20 percent; Washington, 29; Tennessee, 30. 

And the most disturbing thing is that only 20 teams graduated 

at least 70 percent of their African American players. 

I appreciate the fact that you are addressing this. We turn our 

back on these issues because we enjoy the entertainment of competitive basketball, but we are not doing any favors to these athletes. 

I don’t know that you need to comment on it. You can if you 

want. 

REAL ESTATE MARKET IMPACT ON SCHOOL FUNDING

The other thing, though, that I am very much concerned about, 

Mr. Secretary, is that we have a disfunctionality in the way in 

which we fund elementary and secondary education in this country. 

It really relegates the Federal Government to little more than gap 

filling or capacity building, as you know. It is going to be particularly exacerbated, given the real estate market. 

We were told by our three principal economists this week real estate values are going to continue to decline. The principal way we 

fund elementary and secondary education is through property values, and the people who pay the most in property taxes are the 

least likely to send their children to public schools. They are the 

least likely to have school-age children, and if they do, they send 

them to private schools. 

Here you are with all of these initiatives, but you are bringing 

them out at a time when real estate values are not going to recover, where, despite what you are tying to do, the likelihood is 

that schools are going to have to continue to eliminate teacher positions, administrators, and the like because we don’t fund public 

education in a manner that would give us a national workforce that 

is capable of competing globally. And you may want to discuss that. 

Unfortunately, the decline in real estate values is going to be 

particularly exacerbated next year because the stimulus bill runs 

out. So do you want to comment on that, Mr. Secretary? 


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EDUCATION FUNDING AS INVESTMENT IN NATION

Secretary DUNCAN. I will comment on both of your points, and 

I couldn’t agree more and just appreciate your moral leadership on 

this. 

As a country, we dramatically underinvest in education; and we 

do it at our own peril. And, again, I don’t see this as an expense, 

I see this as an investment. You could take the poorest child from 

the toughest community with the toughest home situation and you 

put that child in a great early childhood program and send him to 

a great elementary school and put him in a serious high school, 

and that child is going to be very, very successful. 

There is a school that we started in the heart of the toughest 

community in Southside. Inglewood High School used to have a 60 

percent dropout rate. It just made the national news. Started a 

new school, all young men, 141 graduates—I think 107 graduates 

all going to 4-year universities. 

You give students from tough communities great opportunity, 

and they can do well. Other countries simply invest more than we 

do, and we are paying the price for that. 

So what we want to do is continue to push as hard as we can 

to make sure that scarce resources are going to education; and the 

more we can demonstrate success and that we are getting better, 

the more I hope people will see this is the right investment to 

make. But we have to educate our way to a better economy. 

DISPARITIES IN NCAA GRADUATION RATES

Quickly, on the NCAA, it is not just the graduation rates but, to 

your point, the huge disparities between white ball players and African American ballplayers. I grew up with too many players who 

got used by the universities, made millions of dollars off of them. 

No one cared about their education; and when the ball stopped 

bouncing for them, they had very, very tough lives. So that is something that scarred me from the time I was a little guy, and to be 

in a position now to try to speak out against that—— 

What is interesting is so many universities do the right thing. 

There was an article in the New York Times on Xavier University 

that has a phenomenal 77-year-old nun who is in charge of academic affairs, and they graduate 100 percent of their players and 

have for decades. 

This is all about effort. It is all about culture. And you have 

other places that simply want players to entertain and to make 

them money, and they care nothing about their lives beyond that. 

And that is what we have to challenge. 

Mr. MORAN. Good for you. Good point. 

Thank you, Mr. Chairman. 

Mr. OBEY. Mr. Bonner. 

Mr. BONNER. Thank you, Mr. Chairman. 

Mr. Secretary, I agree with really all of my colleagues and especially Mr. Cole. You have got one of the toughest jobs in government, and we wish you success. 


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NATIONAL EDUCATION POLICY DISCUSSIONS

This is not the right place to make this request, but, Mr. Chairman, I would really like for us to think about one day if we could 

impose on the Secretary’s demanding schedule allowing us to have 

a conversation where we could talk about local issues. Because we 

are all mentioning—or most of us are mentioning—things that we 

know from our congressional district that are important to us, and 

I am going to do that in just a second, but also where we could talk 

about national policy. Because it would make for an interesting debate if we could just focus on national policy versus things that are 

near and dear to our hearts. 

But, again, I won’t make that request at this point. I would just 

throw it out for your consideration. 

But let me bring a local matter to my State to your attention and 

just ask for your input. 

I did not vote for the stimulus bill, although I have admitted 

multiple times that one of the good things that it did was it helped 

save thousands of jobs, tens of thousands of teachers’ jobs throughout the country, including in my district; and I have told teachers 

in my district that that was one of the things—I don’t know that 

it has created any new jobs in any district, but it certainly has 

saved some jobs. 

FORMULA-DRIVEN STIMULUS BILL FUNDS

But one of the areas of concern in Alabama is we have three 

schools, a school for deaf and blind citizens, we have a school for 

math and science, and we have a school for the fine arts. The fine 

arts school is in Birmingham. The deaf and blind school is in 

Taladega. Those are not in my district. The school for math and 

science is in my district. 

Unfortunately, because they are not subject to the annual formula of our State legislature but through direct appropriations of 

the legislature, they did not receive any assistance from the stimulus bill. And knowing firsthand about the school for deaf and 

blind and also the school for math and science, these are good 

schools, residential campuses that serve the entire State of Alabama. Is there anything that we can do to try to make sure that 

they are included and not excluded from these formulas? 

HELPING SCHOOLS NOT IN FORMULA CALCULATIONS

Secretary DUNCAN. I think there is. Your State of Alabama received $1.16 billion, and I have had a great working relationship 

with your Governor, and I think we have saved a very significant 

number of education jobs in a State that has been critically important. 

I was in Selma, Alabama, 2 weeks ago. 

Mr. BONNER. That is where I was born. 

Secretary DUNCAN. It was a very moving experience and one of 

those amazing days. 

Tom Skelly can walk you through—I think we can help. 

Tom, why don’t you walk him through what is possible here? 


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STATE FISCAL STABILIZATION FUND

Mr. SKELLY. Mr. Bonner, I know there were some questions 

about the schools there in Alabama, and we looked into it for your 

office earlier in the week. It turns out that you can use the government services portion of the State Fiscal Stabilization Fund. It is 

just the education portion that is restricted to programs that Alabama funds at the local level that are elementary and secondary 

education programs. The school for the deaf, the school for the 

blind, the fine arts school, those still could be funded through the 

government services portion. 

Mr. BONNER. And, unfortunately, my State is like 46 or 47 other 

States. I think Oklahoma and North Dakota are the only two 

States that I know of that actually aren’t facing severe economic 

crises. So I am afraid that our State has already tapped into the 

fund, Mr. Skelly, that was available. But that is our problem, not 

yours. And I certainly acknowledge that, and I appreciate that. 

TAX CREDIT FOR PRIVATELY SCHOOLED STUDENTS

Let me throw a crazy idea out from left field just for your opinion. 

The chairman said in his opening comments—and he is right— 

our schools are drowning in red ink, but our Federal Government 

is drowning in red ink as well. And would it be totally off the wall 

to consider—and I know this would be a tax issue, which doesn’t 

come before our committee. But just your personal thoughts, Mr. 

Secretary, as a leader in education reform—for us to consider putting on the table a tax credit for families who send their kids to 

private schools or parochial schools or who home school? Because 

these kids are getting an education through a different means, but 

their families continue to support public education with their taxes. 

How crazy an idea is that? 

Secretary DUNCAN. I guess my primary concern is the vast majority of students in our country go to traditional public schools and 

I worry about how desperately underfunded our current public 

schools are. So my honest answer is my first priority is we need 

to do a much better job of supporting and investing—holding accountable for results, but investing in those public schools that 

serve the overwhelming majority of our country. 

Mr. BONNER. Thank you. 

Thank you, Mr. Chairman. 

Mr. OBEY. Mr. Jackson. 

Mr. JACKSON. Thank you, Mr. Chairman. 

FISCAL CONSTRAINTS ON NATION’S SCHOOL DISTRICTS

Mr. Secretary, welcome back to our committee. It is good to see 

you. I have a couple of global questions, and then I want to ask 

a couple of specific questions in the time that has been allotted me. 

We really have two processes here in the Congress. Today, you 

are here before our committee presenting your fiscal year 2011 

budget, which represents substantial increases in education. You 

have correctly stated that it is the most aggressive investment in 

education in recent memory. But the context for which you seek to 

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ously in the context of the worst economic recession since the Great 

Depression. 

Detroit public schools are in near collapse. They are expecting to 

close almost 40 schools this summer. 

The Chicago public school system, Ron Huberman said in yesterday’s paper, I believe it was, that 37 students per class will not be 

an unusual size if these budget negotiations don’t go well. But the 

expectations are that they will not go well, that the pension obligations, the local property tax issues, the inability of local taxpayers 

to shoulder the burden suggest major changes in the Chicago public school system. 

There are two processes. There is one process that shows your 

very aggressive budget that seeks to change the Nation’s education 

system in the current economic context, but the other process is the 

supplemental process that ushers truly the Nation’s priorities, 

whether they be for Afghanistan and Pakistan. 

FEDERAL VS. LOCAL SHARE IN EDUCATION FUNDING

The supplemental process bailed out our Nation’s financial institutions, as carefully articulated by the President. I am wondering, 

in light of the fact that the Nation’s top 50 school systems are experiencing shortfalls in revenue and, as the chairman indicated, 

drowning in red ink, why there is no emergency supplemental request by the Department of Education to provide relief for the 

major school systems that are near collapse by summertime. There 

will be no other process between now and the election, now and 

next year, to avoid many of these local disasters, and I am wondering why no supplemental request. 

Secretary DUNCAN. Obviously, Congressman, as you know, education in our country is primarily a local issue; and we are trying 

to help in every way we can. We provide usually 8, 9, 10 percent 

of funding. Most of the money comes from the State and the local 

level. 

It breaks my heart to see some of the decisions that folks are 

having to make out there; and, as you know, those are my colleagues and peers. Those are folks I work closely with. 

Situations are different in different places. A place like Detroit 

has seen declining enrollment for a long time, hasn’t had strong 

leadership, has put off tough decisions. I am actually very hopeful 

about where Detroit is going. They have a phenomenal leader there 

I think now who is doing a great job, who is getting their fiscal 

house in order. You had tremendous mismanagement there, adults 

using the system for their own benefit, not for students. And I have 

said repeatedly, Detroit, you know, may be ground zero; and we are 

going to do everything we can to support what they are doing and 

where they are going financially. Robert Bobb is financially—— 

Mr. JACKSON. I understand Mr. Secretary. No disagreement 

there. 

I don’t meant to cut you off. My time is obviously limited. 

But why no supplemental request from the Administration, 

which is now prioritizing education, to address the red-ink issues 

in the top 50 school systems just as we are looking at the red-ink 

issues for the banking sector? 


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Secretary DUNCAN. I hear the thought. I hear the concern. And 

it gives me something to think about. 

Mr. JACKSON. It is hard to imagine that it is a priority if we are 

not looking at the only vehicle that is leaving the station from the 

Administration. I have been watching the news the last couple of 

days that, while Congress is bogged down in a health care debate, 

which hopefully will end soon, the Administration seems to have 

already moved to education; and yet the vehicles that are leaving 

the station to address these areas are very, very serious; and they 

have enormous ramifications at the local level. And I am sure that 

and I hope that you will take my concerns seriously. 

ADDRESSING LOW GRADUATION RATES OF NCAA ATHLETES

I also want to ask a law, rules, and regulations question that followed what Mr. Moran indicated about the number of athletes that 

are graduating from NCAA schools. I am seriously hoping that you 

would use your good offices to seek a meeting with the NCAA and 

demand from them rules and regulations that provide the necessary tutoring and the necessary academic support for athletes 

not as a goodwill gesture or some hope that they will, but with 

some teeth. 

We have been discussing this too long, and the millions of dollars 

that basketball players make for many of these March Madness 

schools and the fact that they have shameful graduation rates, you 

would think that some of that money would go towards providing 

them with tutors, with mentors, with people to help them graduate 

and understand the significance of graduation. But it just seems to 

me the Secretary of Education’s office should be honcho’ing with 

the NCAA such rules and regulations. 

Your thoughts on that, Mr. Secretary. 

Secretary DUNCAN. I spoke before the entire NCAA commission 

2 months ago—I mean, the entire NCAA delegation, a couple thousand people, 2 months ago and said exactly the same things. We 

do plan to meet with the President, and Ben Jealous has joined me 

in this. When so many schools do it in the right way, it is inexcusable to me why we allow a few renegades to continue to operate 

the way they do. The vast majority of schools do this very well, but 

we have a couple bad apples and the fact that we tolerate that is 

mind boggling. 

Mr. OBEY. Ms. McCollum. 

Ms. MCCOLLUM. Thank you, Mr. Chairman. 

NATIVE AMERICAN AND ALASKA NATIVE STUDENT EDUCATION

Mr. Secretary, I want to thank you for being here today. I do 

want to thank you for your efforts to make sure that all children, 

including Native American children and Alaska Native children, 

have an opportunity to—— 

Mr. OBEY. Is your mike on? 

Ms. MCCOLLUM. I guess I need to go to the school of technology. 

Thank you, Mr. Chair. 

But when we talk about Native American children and Alaska 

Native American children and the work that you have done, we 

have to be mindful that they are included in two different budgets, 

the budget of the Bureau of Indian Affairs and the budget that you 


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have before you today that you are discussing with the committee. 

So, Mr. Chair, I really think in order to talk about doing what is 

in the best interest of our Native American children and Alaska 

Native children at some point if we could maybe figure out a way 

to have both the Bureau of Indian Affairs and the Department of 

Education in here at the same time, that would be very helpful for 

us to move forward. 

COMMON COURSE STANDARDS

Last week, 48 States announced their proposal for common 

course standards and I applaud their efforts, and I strongly support 

moving forward on the national standards reform. But I am concerned that two States, Alaska and, importantly, Texas, have not 

participated. 

TEXAS PROPOSED TEXTBOOK CHANGES

I am even more alarmed about decisions made on social studies 

education by the Texas Board of Education last Friday. Ten out of 

15 elected people in one State have effectively manipulated academic materials based on their personal ideology. 

I have here an article from the Washington Post, and it says, 

‘‘Historians criticize proposed textbooks changes as partisan.’’ In 

the article, the Post goes on to say that the Texas Board of Education is imposing a partisan, factually incorrect version of history 

on Texas students, in effect, students across America because of 

the way textbooks are purchased. 

It is outrageous and unacceptable, that a group of 15 people 

should be allowed to influence the education of all of America’s 

school children. And I don’t want this decision in any way to influence textbooks in Minnesota. So I want to be clear. I don’t want 

the Federal Government to write curriculum, but I don’t want the 

Texas Board of Education to be writing curriculum for an entire 

country either. 

So, Mr. Secretary, one of my questions to you at the end will be 

are you concerned and should our Nation’s school districts be concerned about this blatant manipulation of history? 

48 STATES WORKING TOWARD COMMON STANDARDS

Secretary DUNCAN. Obviously, as you said, the Federal Government does not and should not write curriculum. That is best done 

on the local level. But I share your hope in the way that 48 States 

are going together. And this is happening at the local level. If these 

are Federal standards, our national standard system dies. Because 

you have 48 governors, 48 school chiefs working together, you have 

the heads of both national unions working together on this, avidly 

supporting it, the business community has been crying out for this. 

This is a game changer. This is a game changer. We are still early. 

There is, you know, still a lot of hard work to go, but they have 

done phenomenal work. The leadership is exactly where it should 

be at the local level, and I think that is where we should focus our 

energy, and we should continue to move the country in the right 

direction. 


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Ms. MCCOLLUM. Thank you for alleviating some of my concerns. 

So we have it in front of us, and we know what we are doing. I 

am going to remain guardedly optimistic. 

ESEA REAUTHORIZATION

Your blueprint for the reauthorization of the Elementary and 

Secondary Education Act puts, in my opinion, primarily all the responsibility for success with teachers. But, as you pointed out and 

as was mentioned in an earlier question, it is a shared responsibility. 

In full disclosure, people should know I have been a classroom 

teacher. I know that the success of my student depended upon 

many factors, the ability of myself to teach but many outside classroom factors. Are the students having a bad test because they went 

to bed hungry the night before, because they don’t have proper vision, because their parents have not been involved in making sure 

that homework was done, because a family is losing their house to 

foreclosure? All of these factors, including violence in the home, affects a student’s ability to perform. 

Now, sometimes a student’s lack of performance will be a teacher, but it is not always. So if you could reiterate for me in a second 

a little bit more about that. 

SHEPHERD PROGRAM—POVERTY AND HUMAN CAPABILITY

And then we have focused primarily on K–12, but I want to talk 

to you more at some point about the Shepherd Program that provides a great interdisciplinary study focus on poverty and human 

capacity through the Shepherd Consortium in colleges and universities that I think will go to the heart of addressing disadvantaged 

youth and moving America forward. 

So, with that Mr. Chair, I will remain silent so you can answer. 

EFFECTIVE TEACHERS AND LEADERS FUNDING

Secretary DUNCAN. I am just thrilled that we have a former 

teacher on this committee. We need more educators in the rooms, 

and you have lived this. You have lived the challenges that students face every single day, and I appreciate your commitment so 

much. 

Again, a couple fundamental changes we are making from No 

Child Left Behind is all the accountability was on teachers before 

and, for the first time, we are saying this is a shared responsibility 

among schools, districts, and States. That is a fundamental change 

that I think folks haven’t quite appreciated yet. 

Secondly, we are trying to do everything we can to support teachers. A huge increase in funding to almost $4 billion, $3.86 billion, 

to create better mentoring programs, more time for collaboration, 

better pipelines, master teachers, giving teachers the time they 

need to work together and be successful. 

And to your point about students, you know, not arriving to 

school in a vacuum, this idea of student support. A 16 percent increase to create communities whose schools give students a chance 

to be academically successful—schools with safe climates where 


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students’ physical and emotional needs, and psychological needs 

are being met. 

There is so much we can do there, and we are trying to make 

an unprecedented investment to give teachers an opportunity to actually teach and give students a chance to actually concentrate on 

their academic study and think about their long-term futures. 

Ms. MCCOLLUM. Thank you, Mr. Chairman. 

Mr. OBEY. Mr. Honda. 

Mr. HONDA. Thank you, Mr. Chairman; and welcome, Secretary. 

EDUCATIONAL OPPORTUNITY EQUITY COMMISSION

These past few weeks I have enjoyed our past discussions about 

establishing equity among our schools. This subcommittee included 

language in the fiscal year 2010 Consolidated Appropriation Act directing the Department to establish an Educational Opportunity 

Equity Commission to conduct hearings and community engagement meetings about how the Federal Government could improve 

education and eliminate disparities. I am glad to hear from my 

staff that your Department has been to work on this effort, and I 

look forward to working with you on this moving forward. 

I notice that your Blueprint for Reform released the other day 

prominently features the words ‘‘equity’’ and ‘‘opportunity’’ on the 

cover and includes equity and opportunity for all students as a key 

goal. Can you outline for me the approaches you are proposing both 

in the Blueprint for Reform proposal for the Elementary and Secondary Education Act reauthorization and your fiscal year 2011 

budget proposal that will help to meet the educational needs for 

each student, foster the maximum development potential for each 

student, and to ensure that each student has the knowledge and 

skills needed to participate effectively in community life? 

And in particular can you discuss a few items like what role do 

your proposals envision for the Federal Government in ensuring 

that States maintain levels of educational service to provide each 

student an equitable and sound basic education during times of declining State and local revenues? How you propose to assess the 

needs of each student, the effectiveness of schools in meeting the 

standards of an equitable and sound education for each student? 

How does the Administration propose to address and rectify the 

deep, abiding inequality that exists in public education in this 

country? 

And you will notice that instead of saying ‘‘all’’ students, I really 

emphasize ‘‘each’’ student, because I think that terminology will 

drive policy and the expression of policy. What are your thoughts 

on these questions? 

ENSURING EDUCATIONAL EQUITY

Secretary DUNCAN. First of all, Congressman, I just want to 

thank you for your leadership on this issue. This is one that I think 

is hugely important for the country. What I have said repeatedly 

is if we are serious about trying to close the achievement gap, we 

have to close what I call the opportunity gap. And I am convinced 

that children from, again, poor neighborhoods, poor communities, 

tough families, if they have the opportunities they can do very, 

very well. 


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As you know, I have brought in Russlynn Ali to lead the Office 

for Civil Rights. She is an absolute superstar. She has an absolute 

passion for this. 

We want to reinvigorate that office. We want to step up our enforcement of civil rights on behalf of students, and we will be working hard to make sure the rights of all students are protected. 

We are going to specifically focus on schools with large achievement gaps and ask them to implement data-driven decisions to 

close that gap, and we are going to hold districts accountable for 

closing the gap within districts. 

TEACHER AND PRINCIPAL EQUITY

We want to have a reinvigorated focus on teacher and principal 

equity. We have to do a much better job of supporting States and 

districts to ensure that the highest need schools have effective 

teachers and principals, and we are going to ask districts to show 

that the resources that they provide to high poverty schools are 

truly comparable to those they provide to low poverty schools. 

And, finally, we have in our proposed budget approximately $900 

million in school improvement grants to make sure those students 

who have been historically underserved have an opportunity to get 

a dramatically better education, and we do this with a sense of urgency. 

So, a lot of hard work ahead of us. I look forward to the collaboration with you, and I think we have a chance to do some very important work as we move forward. 

SCHOOLS AS A REFLECTION OF COMMUNITY

Mr. HONDA. The civil rights of youngsters—as you have said before, education is a civil right, and I agree with you. This country 

has attempted to correct that in terms of our efforts in desegregation. We are seeing resegregation in different ways now. 

Looking at the bigger picture of how schools are created, I think 

what we have learned from the desegregation effort is that a school 

reflects the community that it is in. Will there be a role in this effort where we will work with local entities in the zoning efforts? 

Because the zoning determines the community, and the community 

is from which the students are coming from. 

Looking at redevelopment projects where entire neighborhoods 

are gone and new ones are brought up without any consideration 

to its impact on schools, if we have environmental impact reports, 

should not the social impact of a neighborhood on children also be 

part of the consideration? If you have any thoughts on that. 

Secretary DUNCAN. Again, schools don’t exist as islands; and how 

we create communities to support those schools, how we fund 

schools equitably, all those things help to give students a chance 

to be successful. I think we can be much more creative and much 

more thoughtful on how we do that. And it troubles me that far too 

often the children who need the most help, the most resources, the 

best teachers, the best principals, the best facilities don’t receive 

them. 

Mr. HONDA. So it seems to me that we have to be looking at our 

cities and counties and our States in how they develop land use 


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rules and regulations and know that schools are part of the infrastructure of a new community. 

Thank you, Mr. Chairman. 

PROMISE NEIGHBORHOODS

Secretary DUNCAN. Critically, one of the big investments we 

want to make is in this Promise Neighborhoods initiative, again to 

create communities around schools to give those schools a chance 

to really help students learn. 

Mr. OBEY. Ms. Roybal-Allard. 

SHIFT TOWARD COMPETITIVE PROGRAMS AND CONSOLIDATIONS

Ms. ROYBAL-ALLARD. Welcome, Secretary Duncan. 

First, let me associate myself with Chairman Obey’s comments 

about funding new and untested competitive grant programs while 

districts struggle to provide children the education they need and 

deserve in the wake of devastating budget cuts. 

The Los Angeles Unified School District is a perfect example. 

With a $620 million deficit, it has been forced to issue 5,200 pink 

slips and shorten the school year by 5 days. LAUSD and districts 

like that desperately need funding from reliable tested programs 

like Title I to retain teachers and to keep classrooms open, and I 

want to thank the chairman for raising the issue, and I hope you 

will be giving it very serious consideration. 

EDUCATIONAL TECHNOLOGY STATE GRANT PROGRAMS

Mr. Secretary, the Administration has proposed the consolidation 

of many education programs that provide badly needed services. I 

find this to be very troubling because, from my experience, consolidation can and often results in the elimination of a program regardless of how great the need. 

EDUCATIONAL TECHNOLOGY STATE GRANT PROGRAMS

I am particularly concerned about consolidating the educational 

technology State grant programs which complements our $30 billion investment in broadband Internet access and other technology 

for our Nation’s classrooms. These grants have been essential to 

our State and local school districts’ efforts to coordinate the purchase of technology and the training of educators on how to use it. 

For example, the State grant funding received by the Los Angeles Unified School District is used to hire technology coaches who 

train teachers at its 680 campuses on the use of technology. Without a dedicated funding for this purpose, how will the district coordinate their technology programs and ensure that educators can 

effectively use the technology made available to them? 

Secretary DUNCAN. I appreciate your concerns. Obviously, we 

think technology is a hugely valuable tool going forward to accelerate learning and to help students who haven’t had those opportunities before; and we will work with Congress on reauthorization 

of technology activities. There has been no decision yet on whether 

nationally it will be formally competitive, so we look forward to 

working with you on these issues. 


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Ms. ROYBAL-ALLARD. So this is not going to become a competitive—— 

Secretary DUNCAN. No decision yet has been made. But we look 

forward to working with you on this issue. 

Ms. ROYBAL-ALLARD. That is great to hear. 

Secretary DUNCAN. And note, just big picture, we think that 

technology is a huge piece of the answer going forward; and we 

want to find ways to integrate it into everything we do. 

Ms. ROYBAL-ALLARD. Right. Because it makes no sense that we 

have spent already $30 billion if teachers don’t know how to use 

that technology. 

INCOME-BASED REPAYMENT OF STUDENT LOANS

When the Higher Education Opportunity Act was signed into law 

in August of 2008, a loan forgiveness program was authorized for 

service in areas of national need, including health care professions. 

In light of the critical and the growing demand for nurses, I find 

it surprising that this program has yet to be funded. Why did the 

Department not include the loan forgiveness for service in areas of 

the national need program in your budget proposal? 

Secretary DUNCAN. That is actually part of the higher education 

bill that is before Congress and before the Senate. So the IBR, Income-Based Repayment, we are a huge fan of. It significantly reduces loan repayments on the back end and brings folks into the 

public sector, great talent, and we will forgive that debt after 10 

years. 

So that is something that we think is very, very important; and 

we continue to advocate for right now, we have already reduced it 

to 15 percent of income in terms of loan repayments; and we want 

to take that down to be 10 percent and after 10 years of public 

service have all those loans forgiven. So whether it is nurses, 

whether it is folks working in medical clinics, or legal clinics, or 

teachers, folks going into the public sector, we want to create much 

better avenues so they are not handicapped by staggering debt that 

prohibits them from following their heart and helping out in the 

community. 

TRIO, GEAR-UP, HEP AND CAMP PROGRAM REQUESTS

Ms. ROYBAL-ALLARD. In the few seconds that I have left, I also 

want to express my concern about the flat-funding for the TRIO, 

GEAR UP, and the High School Equivalency and College Assistance Migrant Programs, especially when the President has this 

goal of, by 2020, having the United States to be first in the world 

in the percentage of citizens with college degrees. These are, again, 

proven college preparation and support programs that have successfully helped low-income students achieve; and particularly 

when we are having experts telling us that the education of poor 

and minority children is absolutely key to our Nation’s future economic success, I just find it incredibly surprising that the Department again is only level-funding these programs which could truly 

help us to reach the President’s goal of 2020. 


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COLLEGE ACCESS AND COMPLETION FUND

Secretary DUNCAN. I appreciate that; and, again, I am a big fan 

of those programs. They have done a great job, and we have proposed a College Access and Completion Fund that would enable 

those and other programs to actually significantly increase their 

funding based upon their ability to demonstrate exactly your point, 

that they are making a difference in student’s lives. 

Mr. OBEY. Mr. Ryan. 

Mr. RYAN. Thank you, Mr. Chairman. 

Thank you, Mr. Secretary. You are doing a great job. I really appreciate everything you are doing and using your bully pulpit to 

reach out to different areas like the NCAA issue. I really appreciate that. 

SOCIAL AND EMOTIONAL LEARNING PROGRAMS

Last year, in our report language we put some—this committee 

put some language in regarding social and emotional learning, and 

I have talked to you about this a few times. The committee believes 

that addressing the social and emotional development of students 

through evidence-based social and emotional learning programs is 

a highly effective way to promote safe and drug-free schools and to 

promote higher student achievement and attainment. The committee urges Federal support for the implementation of evidencebased social and emotional learning standards and programming. 

Can you just kind of comment on what you guys have done recently? 

Secretary DUNCAN. And what we will continue to do. 

In this budget, we are proposing $1.8 billion for a range of student supports, including social and emotional learning. That would 

be a $245 million increase, a 16 percent increase. So we are trying 

to put our money where our mouth is and say that we have to create climates again where students have a chance to be academically successful. And if we are not addressing those social and emotional needs, quite frankly, we are kidding ourselves. 

Mr. RYAN. I agree. 

SOCIAL, EMOTIONAL DEVELOPMENT AND DECISION MAKING ABILITY

I want to bring to your attention—Representative Kildee and I 

are sponsoring the Academic Social and Emotional Learning Act to 

provide technical assistance to schools to try to implement these social and emotional learning programs and hope we could get your 

support and hopefully get that passed and get some money into 

that as well. 

One of the recent studies I wanted to share with you, a casel 

meta-analysis of more than 700 positive youth development, SEL 

character education, and prevention interventions has shown that 

SEL programs improved students’ achievement test scores from 11 

to 17 percentile points. And, as we see, the brain science, you 

know, more and more backs up that we have got to teach these 

kids how to regulate their emotions. We now know that the part 

of their brain that has to handle the emotional situations that 

these kids are dealing with also deals with their short-term memory, their decision-making ability. So all of these issues that we 


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have talked about these kids making bad decisions, whether it is 

teen pregnancy, whether it is alcohol abuse, regardless, I think 

teaching these kids these skills is unbelievably effective. 

I have been to schools in Cleveland. We are starting a pilot program in three of the schools in my district. So I would just encourage you to stay focused on SEL. We are throwing a lot of money 

around, and I think this—which in many instances is needed—but 

I think this is a very, very effective, cost-effective way of doing 

business. 

Secretary DUNCAN. I appreciate your leadership so much, and 

you hit the nail on the head that these are learned skills. So children can have huge challenges, but if you help them learn how to 

handle those and deal with them, then you have a chance. When 

you don’t, they can’t get past those challenges and can’t begin to 

think about what is going on in class. But these are absolutely 

teachable, learned skills; and the more we can do that—and I think 

children today have probably never had more challenges—huge 

pressures, huge temptations, stresses at home—and if we are not 

addressing this, we are not in the game. 

So thanks so much for your leadership—— 

TEACHING STUDENTS TO UNDERSTAND EMOTIONS

Mr. RYAN. You have got it. There are a lot of good programs out 

there that really break it down in the curriculum, where they are 

teaching about the brain, they are teaching about the amygdala 

and the prefrontal cortex to first and second graders so that they 

understand what is happening to them when they get pushed on 

the playground or when they have a domestic issue at home. They 

know what is going on. 

And I think that level of awareness that the student has about 

what is happening to them is critically important for them to be 

able to then figure out how to not respond in a bad way. 

EARLY COLLEGE ENROLLMENT AND DUAL ENROLLMENT PROGRAMS

One other question. We have a great early college enrollment 

program in Youngstown, Youngstown city schools. We also have 

one in Akron as well in my district. One of the issues I wanted to 

bring up, because of budget constraints, Youngstown State University, they have cancelled the program. So what I wanted to ask you 

about is making Pell grants eligible for kids who are going into 

early college. 

I don’t think it is going to cost us any more money. I think in 

the end it will actually save us money, because we are front-loading the money. So paying for these kids to go to college with Pell 

grants their last 2 years of high school and so we are going to avoid 

the latter years of the cost of living or the increase in education 

costs had they waited 2 more years. 

So can you help us with that and comment on it, about creating 

that pipeline? 

Secretary DUNCAN. Our Administration is hugely supportive of 

early college and dual enrollment. What is interesting to me is so 

often historically this is seen as a thing for the advanced juniors 

and seniors to do. What I often see in different contexts, it is actually a dropout prevention program. 


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For students who may not be the highest performing but are in 

the middle of the pack, when they start to take a college class and 

get college credit and start to think, man, I can really function and 

be successful in this environment, it changes their whole perspective on life. So it is a very interesting range of students who can 

benefit from this. 

COLLEGE PATHWAYS

We have proposed in our budget $100 million for College Pathways, an accelerated learning program that would expand access to 

college, dual-enrollment, AP classes, the international baccalaureate program as well. So $100 million there. 

PELL GRANTS AND EARLY COLLEGE PROGRAMS

On the Pell grant issue specifically we have talked about, it is 

an intriguing idea. I think it has been considered in the past, and 

there are some challenges associated with expanding Pell grant eligibility to students during high school, but it is an idea worth kicking around, and I would be happy to look into this and other options. At the end of the day, your goal of significantly expanding 

access to early college programs, I don’t think we can do enough 

of this, and we have to be very creative in how we think about this. 

Mr. RYAN. I mean, we are going to spend this money on the Pell 

grant one way or the other—I mean, if they go to college, you 

know—and let’s spend it early and make sure they get into college, 

like you said, even the people in the middle of the pack. 

Thank you, Mr. Chairman. 

Mr. OBEY. Thank you. 

Ms. DeLauro. 

Ms. DELAURO. Thank you very much, Mr. Chairman. 

DISPROPORTIONALITY IN SPECIAL EDUCATION

Good morning, Mr. Secretary. It is great to see you. 

Just very quickly a point, I am going to send a letter to you 

about an important issue in my district regarding significant 

disproportionality in IDEA. I don’t want to take your time this 

morning. 

Secretary DUNCAN. Give it to me when we are done. 

Ms. DELAURO. I will get it to you, and hopefully we can take a 

look at this. 

Secretary DUNCAN. I will have Alexa Posny take a very close look 

at it for you. 

Ms. DELAURO. Great. Thank you. 

EARLY LEARNING CHALLENGE FUND

Mr. Secretary, I have been a long-time and a strong supporter of 

early childhood education and the resources for critical programs 

like Head Start, Childcare Development Grant, others. I was excited to see the Administration’s focus on early childhood through 

the initiative in the Early Learning Challenge Fund. I was proud 

to vote for this in the education bill that now will be part of reconciliation. 


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But, let me ask you, if we are not successful in including the 

Challenge Fund in reconciliation, what is the administration’s 

backup plan to make this important 

initiative a reality? 

Secretary DUNCAN. It is hugely important. And, Congresswoman, 

I would agree with you that probably the best investment we could 

make, the best return is in early childhood education. And what we 

all talk about is we are constantly playing catch-up. I keep saying 

we have to get out of the catch-up business, and the best way to 

get out of the catch-up business is to make sure that our 5-yearolds hit kindergarten ready to learn and ready to read. 

We have far too many children who—it is not just 3- and 4-yearolds, but what are we doing zero to 5 to make sure that we are leveling the playing field? I am convinced that if we did that well, so 

many of these challenges we face long-term, dropout rates and 

other things, would be dramatically lower. 

So, you know, we desperately want that Early Learning Challenge Fund to be in there. If it is not, we need to work through a 

different vehicle or do something. 

But this President, this Administration, is absolutely committed here. You know, we are asking for almost $10 billion over the next 

10 years. We have had some questions about collaboration. We 

have had a wonderful, wonderful partnership with HHS and Secretary Sebelius; and we all are working together. This is a huge opportunity for the country to break through, and we hope it goes 

through. If it doesn’t, we need to work together—— 

Ms. DELAURO. I, for one, will push to be a part of that effort. I 

think if it is not, we must really work together and collaborate to 

make sure that that happens. 

EVEN START

Let me ask a question about Even Start. That is something that 

I have talked about before. 

Last year’s House report reflects the priorities of this subcommittee and the members and, I might add, certainly of the 

chairman. And just very briefly, the committee strongly recommends $66 million for Even Start, which is the same amount as 

the fiscal year 2009 funding level. It provides grants to States, family literacy, integrating early childhood education, adult education, 

parenting education for low-income families and their children from 

birth to 7 years old. 

The committee goes on and says it does not agree with the Administration’s program to eliminate Even Start, and the view on 

that was that—the elimination, which our view is that it was based 

on results of flawed evaluation studies, studies that were not representative of Even Start participants and programs based on 

small samples, et cetera. 

I have to ask you this: Why have you come back again with a 

proposal to eliminate this program? This is a program that serves 

50,000 families nationwide. It is the only Federal education program that focuses specifically on parents and their children and the 

literacy learning skills that they can work on together. So I am 

having trouble understanding why you—why the Administration 

insists on ending this program. 


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Secretary DUNCAN. We talked about it earlier, and I am a huge 

fan and supporter of family literacy. Growing up, as part of my 

mother’s after-school program, she spent a lot of time not just 

working with children but working with parents and trying to 

make sure that she was changing what was going on inside the 

household and really making sure parents had the skills to function and to support their own children. 

So this is one that we are passionate about. Family literacy is 

something that is part of the literacy program in the proposed 

ESEA authority on a well-rounded education. We actually propose 

a 10 percent increase in funding. Even Start projects can absolutely 

apply—compete to do that. Brenda Dann-Messier, who is leading 

our adult ed work, is a passionate advocate and did phenomenal 

work in adult literacy. 

So this is something we are going to work very, very hard on, 

going forward. So it is part of an overall literacy package. We don’t 

have a line just for Even Start. 

Ms. DELAURO. Well, you know, I can’t be a predictor of where 

this committee will come out, but I can say for myself that I would 

be one and I suspect that there are others that are going to want 

to see that this program continues. 

Secretary DUNCAN. We are happy to have that conversation. 

Ms. DELAURO. Thank you very much, Mr. Secretary. 

Thank you, Mr. Chairman. 

Mr. OBEY. Thank you. 

EDUCATION JOBS SAVED BY RECOVERY ACT

Mr. Secretary, you indicated and witnesses did yesterday that 

about 325,000 teachers’ jobs were saved by the Recovery Act. We 

roughly filled about 40 percent of the hole in State budgets last 

year. This year that is going to drop about 20 percent. This program is meant to be temporary. Some people object to it; and they 

say, well, this is going to wind down. What good did you do? 

EDUCATION JOBS BILL

And the whole point of the program was to simply get us through 

the next 2, 21⁄2 years until the private sector could recover and pick 

up the slack again. To do that, last December the House passed a 

second jobs bill, which contained $23 billion in additional assistance to education because we don’t want to see 50 percent of the 

teachers whose jobs were saved last year lose those jobs in the coming year. 

So let me ask what will happen at the local school district level 

to their ability to retain those teachers if we do not pass that bill 

or something similar to it that provides at least a similar amount 

of assistance to States and local school districts. 

Secretary DUNCAN. Chairman, I appreciate your huge leadership 

on this. I share your concern. I am very, very concerned. 

As I travel around the country, everywhere I go, everywhere, no 

one is immune from this. Folks are hurting. And we are not just 

cutting through fat. We are beneath bone now. And to hear about 

skyrocketing class sizes, to hear about—I keep arguing for more 

time, Mr. Chairman. We see students going to 4-day work weeks. 


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Those are huge challenges, and we need to do something. We need 

to do something. 

Mr. OBEY. What will happen if we do nothing? 

Secretary DUNCAN. You will see some devastating cuts around 

this country. And folks that are making these cuts, fiscally responsible superintendents, school boards for the fall are planning budgets now, March and April. So this is not something that is going 

to play out in August. These things are happening in real time. 

Mr. OBEY. And won’t it also put additional upward pressure on 

local property taxes? 

Secretary DUNCAN. Sure. Sure. Absolutely. 

TITLE I, ESEA FUNDS FOR HIGH-POVERTY SCHOOLS

Mr. OBEY. I referred to this chart earlier, and what it shows is 

that, among students who scored in the top quarter—I said 20 percent earlier. I should have said top quarter—on eighth grade math 

tests, the child of a wealthy family graduated from college 74 percent of the time, while a child that came from a poor family graduated only 29 percent of the time, even though they demonstrated 

the same ability. 

I would point out a similar relationship exists between that 

eighth grade performance and the decision to even enter college. 

What is the one program for elementary and secondary education 

which we have relied upon for years to try to equalize that poverty 

situation? 

Secretary DUNCAN. Title I. 

Mr. OBEY. Right. How do we correct that if we don’t provide significant increases in Title I? 

SCHOOL IMPROVEMENT GRANTS

Secretary DUNCAN. A couple ways. One is, as you know, the 

school improvement grants are going to be directed to those lowperforming, high-poverty schools. So we are trying to make a very, 

very significant investment there. We have $3.5 billion that we 

want to put out to those schools now. 

We have to focus—and there aren’t simple answers here. You 

have to focus on getting great talent into those historically underperforming schools, and we want to work hard on that as well. 

And I would argue that Pell grants, making sure students have 

access to resources to go—we have so many families—you probably 

saw the same survey I saw a couple weeks ago. A lot of American 

families just don’t think college is for them. 

TITLE I FUNDING

Mr. OBEY. I understand about Pell grants, and I will get to that. 

But the fact is that if you want to provide assistance to all poor 

kids around the country, you don’t need to go through a targeted 

program that gets to a few school districts. Because there are 

many, many poverty districts around the country who will never 

get the grants that you are talking about. 


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ADDRESSING INEQUALITY IN EDUCATION

Which leads me to the same question that I was asking before 

and several others have been asking. Why if we want to close that 

gap would we not concentrate on Title I? I mean, I was elected in 

1969. That was at a time when the Federal Government had just 

started programs like Title I, and I sponsored Wisconsin’s first 

State version of Title I. I still remember the bill number, 51–A. 

That was a tiny little initiative at that time, $5 million for the entire State. That went a lot further in those days than it does now. 

But I mean I have been trying and so have most people on this 

panel been trying ever since to meet the needs of Title I by providing for more full funding. We have never come anywhere near 

close to where we should be in funding Title I. 

So, I don’t understand why I should be all that interested in focusing what meager additional resources there are in the education 

budget this year on a new program when we know that the basic 

program is there to deal with poverty stricken kids all over the 

country. 

Secretary DUNCAN. I think obviously what you and I absolutely 

share in common is a passionate desire to help disadvantaged children be successful, and Title I is a huge piece of that. 

But I would argue that everything we are trying to do is trying 

to address those inequalities. So trying to put money to attract 

great teachers into poor communities we think is hugely important. 

Trying to make sure that students have a well-rounded education, 

where so often it is narrowed, is very, very important. 

Chairman OBEY. I think that is important, too, but, to me, there 

are lots of ways we can provide incentives to put better teachers 

in some of those schools. But I question such a heavy focus on 

teachers. Yes, I want quality teachers, but let me give you an example: Me. 

When I was in 7th grade, I skipped school 2 days a week, and 

that is how I learned to play the harmonica. I was hiding out in 

the woods. 

Secretary DUNCAN. We need more music in school. 

Chairman OBEY. But I finally got turned around essentially by 

two teachers. Now, if I hadn’t gotten turned around, should those 

teachers have been blamed for my failure? 

Secretary DUNCAN. No. No, of course not. Nobody is suggesting 

that. No, of course not. Of course not. 

But great teachers turn around children, you and many others 

included. We all remember those teachers that changed our lives. 

And all we want to do is we want to shine a spotlight on excellence. 

What I will tell you is there have been very few incentives for those 

great teachers to go to historically underserved communities, very 

few rewards to do that, and we want to make sure the children 

who need the most help are getting it. 

Mr. OBEY. I understand, and you are focusing on heavily underserved communities. 

RACE TO THE TOP APPLICATION PROCESS

But let me make a point. In your Race to the Top package, I am 

told by my State education people and by my Governor that when 


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your Department considered their application, that all of the points 

that they would have earned in your evaluation system were 

roughly related only to six counties in the State—Milwaukee, Kenosha, Racine, Madison, Green Bay, and I have forgotten the other 

one. 

Secretary DUNCAN. I don’t know the specifics of your proposal, 

but I will say what we were trying to reward is States that had 

comprehensive plans—urban, rural, suburban, every child. 

Mr. OBEY. All I can tell you is that my State people think that 

the focus of your attention was almost exclusively on those six 

urban counties. 

FOCUSING INCREASED RESOURCES ON INEQUALITY

The point I would make is simply that we have got 72 counties 

in the State, and there are a lot of them outside of that area that 

are low income and have lots of poverty kids. I just do not understand why we do not—very frankly, I am a Democrat, as you know, 

and so are you. I do not understand why, when we finally have a 

shot at it, we are not greatly emphasizing Title I before we do others. 

I am all interested in reform, but, as Richard Nixon said, timing 

is everything in politics. And as I see it, I will be a whole lot more 

interested in putting additional money in reform efforts 2 years 

from now when the economy is through this recession than I am 

right now when everybody is sucking for air. I don’t understand 

why we do not have a greater emphasis on trying to help those 

school districts. 

Secretary DUNCAN. Obviously, I think we would agree we need 

to do both. We need to help stabilize schools under huge stress, and 

we need to get dramatically better, and we are trying to find that 

balance. 

HISTORY AND CIVICS EDUCATION

Mr. OBEY. Let me ask an additional question. I asked this yesterday of the panel, too. 

We seem to be fixated on improving performance for math and 

science, but I, frankly, am concerned that we are going to be producing a generation of societal and political illiterates. Because I 

think you see as the testing focuses on math and science, for instance, or math and reading, it isn’t just the arts that get squeezed 

aside, it is history, it is civics. 

As I said yesterday, I was in one class a few months ago where 

the kids couldn’t tell the difference between a State legislator and 

a third baseman for the Chicago Cubs. They were absolutely illiterate in terms of the things they would need to know to function 

as citizens in a democracy. 

How do you feel about this emphasis on math and science and 

how do we produce a much more well-rounded approach to education? Because, otherwise, we can set utilitarian goals, but it is 

not going to meet our other societal needs. 


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BUDGET INCREASE TO PROMOTE WELL-ROUNDED EDUCATION

Secretary DUNCAN. I will tell you, I was in 37 States last year— 

rural, urban, suburban. Everyone—teachers, parents, students—all 

expressed their huge concern about what we are seeing in this 

country, which is a narrowing of the curriculum. I couldn’t agree 

with you more. 

So yes, reading and math are important, but, again, one of our 

six big buckets is a well-rounded education for history, for arts, for 

financial literacy, which we haven’t talked about, which is a big 

one, for foreign languages—— 

Mr. OBEY. Financial literacy, we could start with Wall Street 

bankers. 

Secretary DUNCAN. And we ought to produce a next generation 

of students who do better than what we have seen today. I mean 

that very seriously. 

For all those things, civics education, history, social studies, we 

propose a 17 percent increase, $265 million. 

So the need for a well-rounded education—let me just say one 

more thing about it, Mr. Chairman. It is hugely important. It is not 

just important at the high school level, which is often what people 

think. I think that for first graders, second graders, and third graders, we have to give students a chance to find their passion—music 

for you, art for someone else, drama for someone else. We have to 

provide those opportunities; and if we don’t do that, we really put 

a ceiling, a limit on what students can accomplish. 

So math, reading, science, are very important. So is foreign language, literature, arts, PE. We need to get back to those things, 

and we are trying to do everything we can to encourage that. A 

well-rounded education is critically, critically important. 

Mr. OBEY. Mr. Tiahrt, why don’t we give everybody a shot at one 

last question or so before we shut down the hearing. Take a couple 

minutes yourself, if you want. 

CIVIL RIGHTS

Mr. TIAHRT. Thank you, Mr. Chairman. 

I have been hearing several times that education is a civil right. 

So I don’t recall it being in the 14th amendment or the Civil Rights 

Act of 1964. I checked the White House Web site. It is not included 

there under civil rights. It is not in Wikipedia. I don’t think it is 

a civil right. I think it is very important, but I don’t think it has 

the status of a civil right, and I think it diminishes those who are 

protected by our laws for civil rights by trying to broaden it. 

PROPOSAL FOR DIRECT LENDING FOR STUDENT LOANS

I have a question more directly about student loans and the government taking over the process of administering student loans. As 

I see it, we have these two avenues: One is where the government 

takes over student loans and takes money that we don’t have, so 

we have to go borrow money to loan to students. So the students 

end up going through school and then have to pay back not only 

the student loans but then the money that the Federal Government 

borrowed to provide the student loan. When you compare that to 

banks, banks already have money to lend. We don’t have to go borVerDate Mar 15 2010 08:35 Nov 16, 2010 Jkt 058233 PO 00000 Frm 00109 Fmt 6601 Sfmt 6602 E:\HR\OC\A233P2.XXX A233P2

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row from the Chinese. So the student just has to get his education 

and pay back the student loan. 

One can make the argument that the Federal Government is 

subsidizing the money and will have to borrow money to subsidize 

the interest. And I would say it is much cheaper to borrow just for 

the interest, rather than for the loan and interest, and I think you 

would agree that math is correct. 

So why are we doing this? Is it for control? Is it to limit what 

institutions can receive money or limit some curriculums? What is 

the purpose for borrowing money for student loans when we don’t 

have it? 

PROPOSAL TO INCREASE PELL GRANT FUNDING

Secretary DUNCAN. It is very, very simple. Taxpayers are already 

spending this money. Taxpayers are subsidizing banks today. This 

is not a new expense. 

Mr. TIAHRT. This program will continue, but we are not going to 

continue to subsidize banks. 

Secretary DUNCAN. Let me just finish. So we think we should 

stop subsidizing those banks; and we think we should invest scarce 

resources, taxpayer resources, yours and mine, into students. 

To be clear, what we want to dramatically increase is access to 

Pell grants. That chart that Chairman Obey put up there haunts 

me, and the lack of financial resources for poor families to go to college is a huge impediment and a huge killer of dreams. 

Mr. TIAHRT. Since my time is limited—— 

Secretary DUNCAN. Let me finish. These are Pell grants. Students don’t have to pay these back. These are grants. 

Mr. TIAHRT. I am talking about student loans, the student loan 

program that the government is trying to take over. 

Secretary DUNCAN. This is Pell grants that we are trying to increase. 

STUDENT LOAN REFORM

Mr. TIAHRT. I am talking about student loans. The government 

is trying to take over student loans, correct? 

Secretary DUNCAN. We are trying to stop subsidizing. We are trying, rather than have the private sector initiate those, we would 

initiate those. 

Mr. TIAHRT. The bank I received my student loan from is still in 

business today, and it did not receive any subsidized funds, even 

in the latest go-around. 

Secretary DUNCAN. I would beg to differ on that one, and I am 

happy to look at that specific situation. 

But we can dramatically increase Pell grants to students, we can 

invest in community colleges, we can lower loan repayments at the 

back end, the income-based repayment, simply by stopping subsidizing banks. 

Mr. TIAHRT. Well, there are students that will get access to college through student loans, do you agree? 

Secretary DUNCAN. Sure. 

Mr. TIAHRT. Okay. So why is the government taking over student 

loans? Why don’t we continue to pursue that through the private 

lending institutions, like I did when I got my college student loans? 


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Secretary DUNCAN. Because we can save tens of billions of dollars by initiating the loans ourselves. The servicing of the loans 

will all be done by the private sector. 

Mr. TIAHRT. How can we save money when we have to borrow 

money for the student loans and for the interest? 

Secretary DUNCAN. We are going around in circles here. We can 

save money because of subsidizing banks, and the—— 

Mr. TIAHRT. The bank that I got my student loan from is not 

subsidized. Which bank is subsidized that is providing student 

loans today? 

Secretary DUNCAN. This is across the country. The servicing of 

these loans would all be done by the private sector. It is not our 

sweet spot. We would do none of that. Good actors would get a lot 

more business. We have more and more people going back to college in this country, which is a good thing. Bad actors would lose 

business. The free market would play. 

Mr. TIAHRT. I think it is out of line for us to get into the student 

loan business, because we don’t have the money to start with. And 

it doesn’t save us money. It costs us money to do this. Private 

banks have the money available. So I think it goes beyond just the 

financial side. I think there is some control issue here, and I want 

to know what it is. 

Secretary DUNCAN. There is zero control issue. 

Mr. TIAHRT. What requirements would we put on student loans? 

Mr. Kennedy advocates cutting them out for Ivy colleges, and I 

think he makes a good argument for that. 

Secretary DUNCAN. Let me finish. The private market, before we 

have done anything, as you know, has been collapsing. This thing 

has been on life support. And before we got here, we have seen a 

huge migration of universities to direct lending, from about 1,000 

universities to 2,300 before we got to town. So this is something 

that has happened without us doing anything because the private 

market wasn’t working. 

Mr. TIAHRT. I would say if private institutions want to pursue 

that path, they should be open to doing it. I just think there is 

something beyond this, and it is in the element of control, and I 

think it is a bad path. 

The other thing I want to mention before my time runs out—— 

Secretary DUNCAN. I just want—for the record, I want to say we 

have zero interest in that. We simply want to stop subsidizing 

banks and put scarce resources behind students. 

INDIVIDUALS WITH DISABILITIES—GRANTS TO STATES

Mr. TIAHRT. I want to join with Congresswoman DeLauro about 

my concerns on IDEA as well. I want that for the record, that we 

need to get to our proportionate share, and it needs to be equitable. 

Secretary DUNCAN. We have a $250 million increase for IDEA 

grants to States. I hear that concern. 

Mr. OBEY. Ms. DeLauro. 

TEACHER RECRUITMENT AND RETENTION

Ms. DELAURO. Let me just echo something that the chairman 

said, and I guess many of my colleagues, because I arrived late, 

and that is it was Randi Weingarten who said a child’s education 


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should not be based upon how well adults write grant applications. 

I couldn’t agree more. 

When States start to lay off teachers—I just want to make this 

statement because it has been discussed here—they undermine our 

economy further, not to mention increasing class sizes. 

I know you believe that we have to have reform in a good and 

a bad economy, but I think what is key to all of us at the moment 

or at our core here is the timing and making this shift in education 

funding and the effect that it is going to have in terms of worsening the economy; and instead of providing that opportunity, a 

better education opportunity, we will be curtailing that. So I just 

want to add my voice to that. 

But let me ask about the Teacher Incentive Fund, if I can. 

Teachers, you know, we have said are the most critical factors in 

improving student achievement. We are doing everything that we 

can to make sure we can recruit and retain the best teachers. But 

we know from the research that the financial incentives are of limited value to attracting teachers to low-performing schools. 

A survey by Scholastic, Inc., and the Bill and Melinda Gates 

Foundation show that non-monetary rewards are the most important things in obtaining good teachers. I believe only 8 percent responded that pay-for-performance plans are key. 

What initiatives do you propose in your budget to attract the best 

and the brightest to serve the neediest kids, especially once the 

schools are labeled as the State’s worst schools? 

TEACHER INCENTIVE FUND

In a related question, how can we justify an increase of $800 million in the Teacher Incentive Fund, a program that 2 years ago was 

only $97 million and also a program that received $200 million in 

the Recovery Act and I believe that the funding has not gone out 

yet? 

Secretary DUNCAN. Many, many factors go into attracting great 

talent to underserved communities. I absolutely agree. Increased financial rewards is a small piece of that. 

A couple of things have to happen. You have to have a great 

principal. Teachers will follow a great principal to the end of the 

Earth. Great principals make a huge difference. Bad principals run 

off good teachers. That is part of the problem. Principal leadership 

is hugely important, and we have to invest there, and we are looking for a five-fold increase there. 

PROMISE NEIGHBORHOODS

You need a community to rally behind a school. So all the work 

we are trying to do around Promise Neighborhoods tries to create 

that community of support behind those troubled schools. 

Ms. DELAURO. That is the Comer Model, and I am very familiar 

with the Comer Model in schools, Jim Comer. 

Secretary DUNCAN. And when you put it in place, great teachers 

want to go to those tough communities. They want to have a 

chance to succeed. And if we can put in place the structure, more 

time for them, more time to collaborate, better resources, better 

data, we put those in place, I promise you great teachers will want 

to go to underserved communities. 


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Mr. OBEY. Mr. Cole. 

Mr. COLE. Thank you, Mr. Chairman. 

MOVE TOWARD MORE CONSOLIDATION AND COMPETITIVE PROGRAMS

Just an observation and a couple questions. 

I think what you are running into, Mr. Secretary, is there is a 

lot of confidence in you, quite frankly, but I don’t know who the 

next Secretary is going to be. And I worry about just the centralization of power and the grant approach that brings, the pickers of 

winners and losers, who is going to do it, how it is going to work, 

and how you are going to have any certainty at the receiving end 

of this process. I think you do need certainty over a period of time 

if you are going to make the kind of investments that are necessary. 

ASSESSMENT OF NO CHILD LEFT BEHIND

But let me ask a historical question, because I am struggling 

with trying to understand what we have done right and where we 

need to change, get better, and what you want to do. 

Under No Child Left Behind, which is now, of course, much maligned but actually had a couple of great virtues, one of which was 

actually bipartisan, which I think to move ahead here you need to 

be bipartisan; and, second, that it really did put a lot of focus on 

the consumer here, i.e., the kids, as opposed to anyplace else in the 

bureaucracy and how are we doing with them and are we really 

particularly looking, by breaking students out, at kids that are the 

most disadvantaged, the most challenged, and trying to target resources there. 

I am happy we are going through reauthorization, because that 

is why we have it. So what have we learned? What do we need to 

do different? 

Looking first at No Child Left Behind, could you tell me, did 

scores for kids broadly—and I mean very broadly—go up? Did we 

narrow differences, which is what we all wanted to do on both sides 

of the aisle? 

Secondly, going forward, could you just explain for me the differences in where you propose to go? And I actually look on this 

as building on. I don’t see this as antithetical efforts necessarily. 

But where are the differences, the course corrections you are making, in contrast to where we would have been had we just simply 

stayed on line, which never is a very good idea? 

Secretary DUNCAN. I appreciate that, and I want to assure you 

that we will only do this and want to do this in a bipartisan way. 

I consider that education has to be the one thing that rises above 

politics and ideology. We all have common interests. I have been 

so impressed here. The leadership of the House, the Senate, Republicans, Democrats, everybody is working hard on this together. 

DROPOUT RATE AND COLLEGE COMPLETION

My sense of urgency is—I go back—we have a 27 percent dropout 

rate. That hasn’t moved. We used to lead the world in the percentage of college graduates 21⁄2 decades ago. We have flat-lined. Everybody else has passed us by. You want to know why we are in 


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a tough economic position now? I think that explains a lot of it. So 

we need to get dramatically better, and we need to get better as 

fast as we can. 

FOCUS ON ACHIEVEMENT GAPS

What I will always give the previous Administration credit for 

was focusing on achievement gaps. We used to like to sweep that 

under a rug as a country, and it forced us to have those tough conversations. We need to continue to have them and the idea of 

disaggregating data, really looking at what is going on there. That 

is something we will never, never walk away from. And we have 

to have focus on achievement gaps. 

ASSESSMENT OF NO CHILD LEFT BEHIND

Having said that, I wasn’t here. I don’t know the history. There 

were a number of consequences intended, unintended I don’t know 

about, challenges that I have heard repeatedly around the country 

as I have traveled. The law was far too punitive. The law was very 

prescriptive. And this is well-documented. It actually lowered the 

bar. Due to political pressure, States lowered standards, which is 

absolutely the wrong thing to do, wrong thing educationally, wrong 

thing economically. But due to political pressure, the standards got 

lowered in many cases; and, to Chairman Obey’s point, we saw a 

narrowing of the curriculum. 

FOCUS ON GROWTH, GAIN; REWARD SUCCESS, EXCELLENCE

So what do we need to fix? We need to raise the bar, have meaningful standards, a high bar for every child. We need to reward excellence and success. 

Again, I want to look at growth and gain, how much are students 

improving each year. 

Let me give you one example I use. Let’s say you are a sixthgrade teacher, and I come to you, and I am three grade levels behind. I am reading at a third-grade level. I leave your class, I am 

one grade level behind. Under No Child Left Behind, you are a failure. You are a failure. Your school is a failure. Your State is a failure. 

I think not only are you not a failure, you are not just a good 

teacher, you are a great teacher. I had 2 years’ growth for a year’s 

instruction, and we should be recognizing that excellence. We 

should be learning from it. We should be encouraging it. We should 

get more of those teachers into underserved communities. 

So that is a huge problem we have to fix. I think by focusing on 

growth and gain, that is the right way to do it. So reward excellence and success, more local flexibility, essentially how you want 

to manage. 

FLEXIBILITY AND ACCOUNTABILITY

No Child Left Behind was very loose on goals: 50 different goalposts, 50 different standards, many got dummied down, very prescriptive, very tight on how you get there. We want to flip it on its 

head: tight on its goals, high bar for the country, college- and career-ready standards. But give much more local flexibility, hold 


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folks accountable for the results, let them move to get there. And 

then, finally, and we are trying to invest heavily here, our students 

need a well-rounded education. 

Mr. COLE. Thank you, Mr. Chairman. 

Mr. OBEY. Ms. McCollum. 

Ms. MCCOLLUM. Mr. Secretary, you talked about holding, and so 

I want to give you an example of why I think you need to do that. 

The State of Minnesota, for balancing its budget a couple decades 

ago, decided it would delay payments to school districts, not make 

them on time. School districts had to go out on the market and borrow money and pay interest. That money wasn’t going to children. 

That was one of the last actions I took. We corrected that before 

I ran for Congress. And now Governor Pawlenty is right back. That 

was the demand that he had in balancing the budget, that the 

school districts have to go borrow money in order to make their 

day-to-day payroll obligations so the State of Minnesota didn’t have 

to. That is wrong, and I hope you hold States accountable. 

PROPOSAL TO MOVE TO STUDENT LOANS DIRECT LENDING

I would like to give you an opportunity to walk through what we 

are doing with the Direct Student Loan program. It used to be, if 

I understand, the U.S. had the money, we gave it to the banks that 

then distributed it to the schools, and everybody took their cut on 

it, and we took the full risk. But now we are lending directly to 

the schools where the financial counselors and the students are sitting together. 

Would you walk through that for me? 

Secretary DUNCAN. You summarized it perfectly. We have subsidized banks where we have all the risk, and if we can just cut 

out the middleman there and do direct loans across the country— 

again, we are seeing a huge migration towards this anyway before 

we did anything because the private market was drying up. We 

saved tens of billions of dollars. 

I understand banks’ resistance to this. They have had a very 

good deal; and because of those subsidies—and this is all a matter 

of public record—they have been able to hire and spend millions of 

dollars on lobbyists to oppose this. They are running ads in States 

opposing this. And I understand it, from their perspective, it is a 

hard thing to give up. 

But if we can take tens of billions of dollars at a time of tremendous economic crisis and make college much more accessible and 

affordable for hard-working Americans, middle-class, working-class 

Americans, I don’t see how in good conscience we can stay on the 

sidelines. 

Ms. MCCOLLUM. Mr. Chair, I don’t see how we are taking over 

anything except an opportunity for more children to have a chance 

at college. Thank you. 

Mr. OBEY. Mr. Ryan. 

Mr. RYAN. I appreciate you doing that, too, Mr. Secretary. I 

mean, subsidizing the banks where they had no risk at all and, if 

someone bailed, we picked up the tab. I appreciate how you are 

doing that. 


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ROBOTICS COMPETITIONS

Two things. One, the issue of math and science. We have some 

programs in Ohio, robotics programs, they had the first competition 

and whatnot, just unbelievable, where you see kids get so excited 

and passionate about using their hands and conceptualizing what 

they are going to create. And the first competition is probably the 

most prominent competition around the country. 

When I think about robotics, I think about the old shop classes 

and how this is kind of like 2.0 in the shop classes. 

Secretary DUNCAN. The new shop. 

Mr. RYAN. Yes, exactly. Is there anything in this budget that 

would help local schools? Now a lot of schools can’t even afford the 

start-up to get the kit and to pay the supplemental for the teacher. 

Secretary DUNCAN. Yes, I am a big fan. We talk about wellrounded education. I am actually going to go to the national championships, the national finals of the first competition. I am a big 

fan. And we talk about a well-rounded education. It is those kinds 

of opportunities again, whether it is robotics, debate, academic decathlon, music. So I worry in tough times that those extra curricula 

are often the first things to get cut. Those are things that keep students engaged and keep them motivated. So we want to continue 

to encourage a well-rounded education. I love those robotics competitions. 

INCENTIVES AND PUBLIC-PRIVATE PARTNERSHIPS

Mr. RYAN. How can we create incentives? In Warren, Ohio, we 

have a great program at Warren Harding High School, and it is 

with non-traditional kids. They are not playing hoops, they are not 

on the football team, whatever. The reason they have been so successful is Delphi was a local corporation who was very involved in 

the start-up of the robotics program at the high school. 

So how do we create incentives for local manufacturers or local 

corporations to help contribute to these programs? 

Secretary DUNCAN. That is the thing. I think the start-up costs 

for the robotics competition are actually minimal, and it is easy. 

Again, that is where we can think about it at the Federal level. But 

I think that that is, at the local level, just going out to those businesses and saying, for a small amount of money, you create this 

huge life-changing, life-transforming opportunity for students. 

Those kinds of sponsoring partnerships are out there. Obviously, 

business is struggling now, and there are maybe fewer available 

dollars. But this is a low-cost, high-impact, high-visibility activity, 

where students from very non-traditional backgrounds are getting 

interested in science and engineering and thinking about a whole 

set of careers that they never would have thought about without 

this competition. So there is a huge amount of space for folks to 

be creative and innovative and build those public-private partnerships. 

Mr. RYAN. Most of these programs, you see these kids, they have 

like a 98 percent graduation rate, a placement rate in college, the 

military, something when they get out. 


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PARTNERING OF SCHOOL DISTRICTS TO SHARE SERVICES

One last question before we have to run, I am not for consolidating school districts or schools. I believe in the neighborhood 

school. I think that is very important. But there are a lot of services that I think school districts can share—buying the food, buying 

computers. 

Secretary DUNCAN. Textbooks. 

Mr. RYAN. Textbooks, those kinds of things. Is there anything in 

here to create an incentive for school districts to partner with each 

other on those services? 

Secretary DUNCAN. When times are tough, what would you rather do, increase your purchasing power or lay off a bunch of teachers? I would much rather increase my purchasing power and keep 

those desperately needed adults in the building. So where folks are 

doing all these things—HR, buses, food, textbooks—where they are 

doing it on an individual basis, that to me is just an absolute waste 

of money at a time of desperate need. 

Mr. RYAN. Are there any incentives in here? 

Secretary DUNCAN. We can think about it. I think this is one 

that is common sense. 

Mr. RYAN. Well, if we are relying on common sense—thank you, 

Mr. Chairman. 

Mr. OBEY. Thank you. 

Mr. Secretary, let me simply summarize by asking two questions 

and then making a point. 

PELL GRANTS

With respect to Pell grants, lest anybody think that we are being 

overly generous with them, when they were first instituted, the 

maximum Pell grant covered over 70 percent of the cost of going 

to a 4-year university. Today, despite the increases that we have 

had that has taken it from 32 percent upwards somewhat, we are 

still riding at about 37 percent. So we have hardly been overly generous. 

SAVINGS FROM DIRECT LENDING

Secondly, with respect to student loans, I just want to read something that appeared in Roll Call last week. I want to quote two sentences. 

‘‘The legislation deserves GOP backing first and foremost because 

it eliminates government waste and saves billions. The choice is 

simple. Do we help Citibank make millions of dollars in profits 

from zero-risk student loans or find other ways to use the up to 

$87,000,000,000 in savings?’’ 

That savings number comes from the nonpartisan Congressional 

Budget Office. 

The article was written by Dr. Susan B. Neuman, former Assistant Secretary of Elementary and Secondary Education under 

former President George W. Bush. 

IG AUDIT OF READING FIRST

Let me also ask this question: I am sure that you are familiar 

with the Inspector General’s alarming audit of the Reading First 


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Initiative under the previous administration. The investigation concluded that Federal officials violated conflict of interest rules when 

awarding grants to States under the reading program and steered 

contracts to favored textbook publishers. The IG’s report found that 

the program was awash with conflict of interest and woeful mismanagement. 

It also suggested that the Department of Education violated the 

law by attempting to dictate which curriculum schools must use. 

The report states that program review panels were stacked with 

people who shared the Reading First director’s views and that only 

favored publishers or reading curricula could obtain program funding. 

ELIMINATING CONFLICT OF INTEREST IN COMPETITIVE AWARDS

What is your Department doing to ensure that conflict of interest 

does not exist in competitive grant programs under your leadership? What kinds of measures have been put in place to prevent 

an outcome along the lines of the Reading First initiative? 

Secretary DUNCAN. First and foremost, we don’t think we should 

be involved in curricula decisions. This has always been down at 

the local level and should not be driven at the national level. So 

we have no opinion, no stance, no interest, no investment, and are 

absolutely dispassionate on it. So in that spot you can’t have a conflict of interest. 

We have tried to recruit people with the highest integrity and to 

do things the right way. We absolutely hope to be and should be 

and will be held accountable for that. All we want to do is invest 

in great ideas that are coming from the local level. 

But we have no agenda here, no interest in textbook publishers, 

and we don’t think we should be playing in the curricula field 

whatsoever. 

ACTIONS TO PREVENT CONFLICTS OF INTEREST

Mr. OBEY. I am concerned not just about that narrow approach 

but across the board in the agency. If you can get us some more 

information for the record, that would be helpful. 

Secretary DUNCAN. I will. 

[The information follows:] 

ACTIONS TO PREVENT CONFLICTS OF INTEREST

The Department has taken significant actions to prevent conflicts of interest in 

the implementation of our programs. On December 4, 2007, after the release of the 

Office of Inspector General reports on the Reading First program, the Department 

issued an internal directive, ‘‘Improving Administration and Management of Department Programs.’’ The directive provided all employees with program implementation 

guidance on a number of topics, including identifying a conflict of interest, prohibitions against controlling and directing curriculum and instruction, controls for the 

proper use of peer-review processes, and early and ongoing consultation with the Office of the General Counsel. The Department requires all employees to participate 

in annual training to ensure that they follow the policies described in the directive. 

The policies and procedures used in the Race to the Top competition provide a 

recent example of the emphasis that the Department places on ensuring that grant 

competitions meet the highest standard of integrity. The Department has taken several actions to ensure that the Race to the Top competition peer review process is 

conducted in an objective manner free from conflicts of interest. A document that 

describes the steps the Department took to identify potential, direct, and indirect 

conflicts of interest, as well as the appearance of a conflict of interest, is available 


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on the Department’s Web site at http://www2.ed.gov/programs/racetothetop/application-review.html. 

ORIGINS OF U.S. DEFICIT

Mr. OBEY. Let me say, lastly, with respect to the education budget, I hope that you will give no ground—I would ask you to put 

chart number one up. 

I would ask that you give no ground when people are suggesting 

that somehow the deficit is impacted in a major way by what we 

are doing in education. 

As that chart shows, if you take a look at the deficit which was 

inherited this year by the Obama Administration, $5.1 billion of 

that—I mean $5.1—I can’t read my own writing—— 

Secretary DUNCAN. I think it is trillion. 

Mr. OBEY. Yes, it is $5.1 trillion. I read better with my glasses 

off. These are new glasses, and they are not worth you know what. 

But $5.1 trillion of the 2009–2019 deficits were caused by tax 

cuts which were paid for with borrowed money and $1.8 trillion 

paid for by our entry into two wars, as I said yesterday, one I believe justified and one not. Then the economic collapse contributed 

$3 trillion to that deficit over that same period. Meanwhile, the Recovery Act—the entire American Recovery and Reinvestment Act, 

not just the education piece—the entire Recovery Act accounts for 

$1.1 trillion. 

I would simply suggest I don’t offer that chart to critique Administration performances, because you are not done yet. But what I 

do do is to offer it to simply suggest that, in judging whether debt 

is useful or not and whether deficits are useful or not, we have to 

differentiate between what the money was used for. 

If the money was invested in items that simply add to economic 

consumption and immediate gratification, we have done ourselves 

no favor by borrowing that money. But if that money is used to invest in the long-term efforts to make this country independent from 

foreign oil, so we aren’t shipping $400 billion a year to the Middle 

East to pay for our lack of foresight in energy; if we are investing 

in infrastructure that makes it cheaper to deliver products to market; if we are investing in education, which increases the competitiveness of our workforce and the quality of our individual lives, 

then those are investments worth making, provided that over time 

when the economy resumes its full level of performance, that we 

begin to pay that money back. 

To me, that is the way to look at it; and I would urge the Administration to give no quarter in setting the record straight on that. 

CHAIRMAN’S CLOSING REMARKS

With that, thank you for coming. 

Secretary DUNCAN. Thank you for the opportunity. Thank you so 

much for your leadership and hard work. 

[The following questions were submitted to be answered for the 

record of the hearing:] 


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WEDNESDAY, APRIL 21, 2010. 

FY 2011 BUDGET OVERVIEW: DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

WITNESS 

HON. KATHLEEN SEBELIUS, SECRETARY 

OPENING STATEMENT BY CONGRESSMAN OBEY

Mr. OBEY. Well, good morning, Madam Secretary. Sorry to be 

late. I don’t really have any good excuse. I just got involved in some 

things. 

Secretary SEBELIUS. I don’t think the chairman is ever late, sir. 

Mr. OBEY. Well, I think so. I detest being late. 

Anyway, let me welcome you here today. It is good to have you 

at a historic time, as you and your department begin to implement 

the health reform legislation we just passed. That debate has been 

going on a long time, and the Congress and the President have finally made some decisions. And, to me, the job at hand now is to 

try to implement it, make it work, see whether adjustments need 

to be made down the line, and make certain that it develops in a 

way which is beneficial to the American people. 

In this subcommittee, we have been doing a number of things to 

make health care more accessible, more affordable, and more effective. In the Recovery Act, for instance, we accelerated those efforts. 

For example, we have been expanding education and training programs to address the shortage of nurses, primary care doctors, and 

other health professionals and to encourage more practitioners to 

go into primary care and to practice in places where they are most 

needed. As far as I am concerned, that means especially rural 

areas. 

Our regular appropriation bills have increased funding for health 

professional programs by 35 percent over the past 4 years, and the 

Recovery Act included another $500,000,000 for that purpose. 

Another focus has been on prevention. We have provided a billion 

dollars for prevention and wellness activities to jump-start new efforts in this area. I should add at this point that one of my special 

concerns is the area of hospital infections. It just seems to me that 

that has to be at the top of our list, in terms of priorities. We don’t 

do people any favors if we give 30,000,000 people additional access 

to health care and then they wind up dying because of something 

that they caught in a hospital. That happens at a disgracefully 

high level lately, and I think we need to be very aggressive in 

doing something about it. 

Our subcommittee has also emphasized medical research. That 

includes basic and applied research supported by the National Institutes of Health. It includes patient-centered health research to 

help practitioners decide which treatment works most effectively 


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for their patients and thereby improves outcomes. The Recovery 

Act added $1,100,000,000 to support a major expansion of patientcentered research. 

Yet another priority has been to encourage a more widespread 

use of information technology and electronic health records to reduce medical errors and to make health-care delivery more efficient. In the 21st century, piles of paper are not the way we ought 

to be managing records that are vital to patient care. And, as you 

know, the Recovery Act included $19,000,000,000 to launch a major 

push for adoption of those technologies. 

Finally, we have the need to combat fraud and abuse in health 

programs. We increased discretionary funding for this purpose by 

57 percent last year to support a wide range of activities, from reviewing Medicare claims to prevent improper payments to conducting criminal investigations. We held a separate hearing on that 

issue several weeks ago. 

While these and other health-care priorities are at center stage, 

HHS also has many other responsibilities. Its human services programs help families with access to child care, help low-income people pay their winter heating bills, and assist older Americans 

through programs like Meals on Wheels, to give just a few examples. The need for these services has grown during the current recession, and we have given the Department resources to respond in 

both the Recovery Act and our regular appropriations bills. 

The President’s budget request provides further increases in 

some high-priority areas, including biomedical research at NIH, 

child care, Head Start, mental health and substance abuse programs, and health fraud and abuse control. 

On the other hand, I am not at all thrilled at the proposed 35 

percent cut to LIHEAP, and I am also concerned that we are not 

yet well prepared to deal with public health emergencies like a flu 

pandemic or bioterrorism. 

I should also mention again that the administration has put us 

in a box—not you, but, frankly, the White House has—by one aspect of their budget submission because they have left a very large 

hole to fill with respect to Pell grants. And if we are going to meet 

our obligations in that area, we need to have that problem addressed, or a lot of people’s priorities, including the administration’s, will suffer greatly. 

So, with that, let me welcome you. I look forward to hearing from 

you. But first let me call on Mr. Tiahrt for whatever comments he 

might have. 

Mr. TIAHRT. Thank you, Mr. Chairman. 

As always, it is good to have Secretary Sebelius, the former Governor of Kansas, before the committee today. I have a great many 

questions for the Secretary, so, in the interest of time and the hope 

that we will get to at least two rounds of questions, I am going to 

be brief. 

Like many Americans, I have some very serious concerns about 

the recently enacted government takeover of health care in this 

country, what many refer to as ‘‘Obama-care.’’ I have concerns 

about what it will do to the quality of care people in this country 

currently receive, what it will do to small businesses and the peoVerDate Mar 15 2010 08:35 Nov 16, 2010 Jkt 058233 PO 00000 Frm 00146 Fmt 6601 Sfmt 6601 E:\HR\OC\A233P2.XXX A233P2

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ple who work for them. And I have concerns about what it will do 

to our already-hemorrhaging Treasury. 

The level of spending authorized under this new law is breathtaking, not to mention the audacity of the Federal Government 

under this new law telling individual American citizens what they 

must do in regard to health insurance. Many of us opposed the new 

law and have serious concerns about what it means both in terms 

of the cost as well as the role of the government in health-care decisions. 

Over the last 2 years, the President has made a number of promises regarding this new health-care law. On June 15th, 2009, the 

President said, ‘‘If you like your doctor, you will be able to keep 

your doctor, period. If you like your health-care plan, you will be 

able to keep your health-care plan, period. No one will take it 

away, no matter what.’’ Well, with $130,000,000,000 in cuts to the 

Medicare Advantage plans, it sure seems like 11,000,000 seniors 

will be in jeopardy of losing their plan. 

The President also said, on March 25th of this year, that if you 

already have insurance, this reform will make it more secure and 

more affordable. Apparently, that is true unless you are one of the 

millions of Americans who buy an individual policy that you like 

and want to keep. 

I am also concerned about the pressure that the host of newly 

authorized programs will force on other important programs in this 

bill. There are at least $100,000,000,000 in specific authorizations 

that Congress will be expected to fund and countless billions in 

programs with wide, open-ended authorizations. We have no idea 

how high those costs will be. 

I could go on, but the bottom line for me is: What was promised 

isn’t what was delivered. I look forward to the opportunity to ask 

a few questions. 

And I thank the chairman and yield back. 

Mr. OBEY. Mr. Lewis. 

Mr. LEWIS. Mr. Chairman, I would prefer to wait and listen to 

the Secretary and then ask questions. 

Mr. OBEY. All right. Thank you. 

Ms. Secretary, please proceed. 

SECRETARY SEBELIUS OPENING STATEMENT

Secretary SEBELIUS. Well, thank you, Mr. Chairman. It is good 

to be here in the subcommittee with you, with Congressman 

Tiahrt, and other members of the subcommittee. 

I want to thank you, first, for inviting me here today to talk 

about the 2011 budget, and I look forward to the opportunity to respond to questions. But I want to spend just a couple of minutes 

framing our budget, which I think advances the Department’s central goals: improving the health of all Americans; expanding access 

to high-quality health care; and providing children, families, and 

seniors with the critical health services that give them a chance to 

thrive. 

To do that, we have tried to make prudent investments that actually echo the goals that the members of this subcommittee have 

championed for years: attacking health-care fraud with new tools 

and more resources; a new focus on preventing chronic disease and 


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promoting wellness; emphasizing a reduction in medical errors and 

improving the overall quality of care; and strengthening our public 

health system so that we will be better prepared for new threats 

that come at us. 

At a time when so many American families are trying to balance 

their own household budgets, we think it is appropriate that we not 

let taxpayer dollars go to waste. So the budget reflects the difficult, 

time-consuming work we have done over the last year to try to 

eliminate waste and fraud and focus our resources so they can 

make the biggest impact on Americans’ lives. 

Last month, you heard from our department’s Deputy Secretary, 

Bill Corr, about some of the expanded efforts to identify, prosecute, 

and prevent health-care fraud as part of the new partnership with 

the Justice Department known as HEAT. And this budget, Mr. 

Chairman, builds on that progress. It adds new fraud-fighting 

funds to help us expand proven strategies, like putting Medicare 

fraud strike forces in cities that we know are hubs for fraudulent 

activities, and invests in promising new approaches like the systems that will help us analyze claims for suspicious activity in real 

time. When the budget takes effect, it is going to be a lot harder 

for criminals to get rich stealing from seniors and from the healthcare system. And, over time, we believe the anti-fraud efforts will 

pay for themselves many times over. 

The budget also takes aim at medical errors. We know that the 

quality of health care in America varies widely, and, most tragically, in the case of tens of thousands of Americans who die every 

year from health-care associated infections, many of which are preventable. Chairman Obey, you have been a national leader for 

eliminating these unnecessary deaths, and our budget is aimed at 

helping to do that by doubling the size of the CDC National 

Healthcare Safety Network to 5,000 hospitals. 

You also mentioned the need to be ready for immunizations, and 

I want to thank you for your support of the CDC Section 317 immunization program, which we have asked to receive additional 

funds to make sure that all Americans have access to vaccines that 

are the best protection against some of our most dangerous diseases. 

Investments like these will help make sure that Americans get 

the best possible care when they are sick, but we also have to do 

a much better job keeping Americans healthy in the first place. So 

this budget builds on the Recovery Act’s significant investment in 

health information technology, which moves us closer to nationwide 

interoperability and helps providers make health IT part of their 

daily routine. 

We try to build on the historic investment in prevention and 

wellness that Congress made last year in the Recovery Act with 

new efforts that will reduce the harmful effects of chronic disease 

in our cities and create a new health prevention corps and aim at 

preventing unintended pregnancies. 

And because minorities and low-income Americans are likely to 

be sick and less likely to get the care they need, our fiscal year 

2011 budget makes critical investments in areas like community 

health centers and HIV/AIDS prevention and treatment so we can 


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address the disparities that have plagued our health system and 

our country for far too long. 

HHS has spent our Recovery Act funds responsibly, balancing 

the need for getting these dollars into the economy with assuring 

the proper stewardship of taxpayer dollars. By January 2010, HHS 

Recovery Act recipients reported having created at least 30,000 

new jobs and saving millions of jobs. The April report period has 

not yet concluded, but we fully expect those numbers to rise. By 

the end of September, we fully expect to obligate the remaining 

$6,800,000,000 in Recovery Act discretionary dollars available for 

fiscal year 2010. 

So these are just a few ways that our department will work to 

build a healthier America. At the same time, we will continue our 

work, which is already under way, to effectively implement many 

of the provisions in the historic health insurance reform legislation 

that Congress passed last month. The Affordable Care Act enshrines the principle that every American should have access to the 

health care they need. It also begins the transformation of our 

health-care system, with a wide range of new programs and incentives to promote the kind of coordinated, patient-centered, evidence-based care that has been shown to generate far better health 

outcomes. 

These changes, along with the investments in our fiscal year 

2011 budget, will mean that Americans getting access to care as 

part of the Affordable Care Act will be joining a health-care system 

that is more consumer-friendly, provides more security, and, more 

importantly, does a better job at keeping them healthy. 

Those are the goals, but we cannot accomplish any of them alone. 

We rely on partners across the Federal Government and States and 

communities across the country. And no one has a more important 

role than those of you in the United States Congress. 

So I want to thank you again for the opportunity to be here 

today, and I would be happy to respond to the questions. 

[Prepared statement of Secretary Kathleen Sebelius follows:] 


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Mr. OBEY. Thank you. 

Mr. Tiahrt. 

HEALTH CARE REFORM

Mr. TIAHRT. Thank you, Mr. Chairman. 

A while back, I found the comments made by our Speaker of the 

House, Ms. Pelosi, quite interesting. Specifically, she said on March 

9th before the legislative conference of the National Association of 

Counties that—and I quote—‘‘we have to pass the bill so that you 

can find out what is in it.’’ My preference is that the American people know what was in the bill before it is passed, but I suppose 

that is just a philosophical difference. 

I was even more interested in a recent Rasmussen poll that 

shows that 56 percent of Americans believe that we should repeal 

Obama-care. In Kansas, it is over 70 percent, probably because four 

out of five jobs are small-business jobs, and there is a great deal 

of concern about what it will do to small employers. To be honest, 

I am not particularly surprised by that number, and I expect it will 

grow, since the American people are only now beginning to find out 

what has been done in the bill. 

This bill is widely unpopular. What is the most difficult part for 

the administration to sell to the American people? 

Secretary SEBELIUS. That is—— 

Mr. TIAHRT. Yeah, which part of this bill will be the most difficult to convince the American people that it is going to be good 

for them? 

Secretary SEBELIUS. Well, Congressman, I think there has been 

an extraordinary amount of misinformation about what the law is 

and what it isn’t. And one of the jobs that we have, I think, moving 

forward and that I look forward to, frankly, is telling people what 

is in the bill. 

For instance, for small-business owners, there is a lot of misinformation about mandates that currently are not part of the law, 

and were never part of the law. So any employer who has less than 

50 employees has not only no mandate but may be eligible for tax 

breaks that begin this year at 35 percent, helping to secure employee coverage, and, eventually, in 2014, will have access to a new 

market. 

You and I know in Kansas that small employers are often 

squeezed out of the marketplace, priced out of the marketplace, 

don’t have the leverage, whether they are a farm family or a smallbusiness owner, that the large employers have. They don’t have negotiating power. And they will have—— 

COST OF INSURANCE PREMIUMS

Mr. TIAHRT. Bringing up the costs—— 

Secretary SEBELIUS [continuing]. Opportunity through a Statebased exchange. 

Mr. TIAHRT. I am sorry. I have limited time. 

Because of the cost, there was an article in the New York Times 

that talks about the effects the new law will have on insurance premiums that are routinely paid by ordinary Kansans, as you mentioned. Specifically, the article focuses on mandates contained in 


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the new law that have been in place in New York, in Massachusetts, and a few other States. 

The article concludes that people who buy their own insurance— 

and that includes the self-employed, people who work for small 

businesses, and early retirees, those who do not yet qualify for Social Security—will have to pay, on average, an additional $2,100 for 

their health insurance. 

How does the administration justify forcing Americans who form 

the backbone of our economy, specifically those associated with 

small businesses, to pay an additional $2,100 for their insurance? 

Did we learn anything from Massachusetts, New York, and other 

States that have been doing some of these things that are contained in this new law, or is the New York Times wrong? 

Secretary SEBELIUS. Well, I would suggest that the New York 

Times may be pricing a policy in Massachusetts but is not pricing 

what will eventually be a State-based exchange in Kansas. 

The law is set up in a way that Kansas will have an opportunity, 

if they choose, to put together a State-based exchange to have the 

policies and programs be State-based. It doesn’t import the mandates from Massachusetts and impose them on Kansas. It really is 

the law of the State of Kansas. 

So I haven’t read the article, but the State-based exchanges, I 

would suggest, will make it much more affordable for those in the 

individual market or the small-group market to have affordable 

care, because they currently don’t have the bargaining power and 

they are squeezed out or priced out of the market. 

Mr. TIAHRT. I will submit that article for the record, Mr. Chairman, if it is okay with you. 

[The information follows:] 


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INDIVIDUAL MANDATES

Mr. TIAHRT. While I am not a lawyer, I am aware—— 

Secretary SEBELIUS. I am not either. 

Mr. TIAHRT [continuing]. That the Supreme Court has declared 

unconstitutional many Federal laws that contain individual mandates. However, the new health-care law contains a provision that 

appears to mandate that every individual in the United States 

must have some form of health-care insurance. 

Regardless of the lessons we have learned in Massachusetts and 

New York with respect to individual mandates, what makes this 

administration think that it can constitutionally mandate that 

every American must buy health insurance? 

And I ask specifically because there appears to be a fairly large 

segment of the American population that chooses, for one reason or 

another, not to buy health insurance even though they can afford 

it. This is a basic issue of liberty for me, not unlike deciding to purchase a house or rather to rent. 

So what is it about the mandate that we think we can impose 

on the American people? And do you think it will survive a constitutional test? 

Secretary SEBELIUS. Well, Congressman, I am also not a lawyer, 

but I have discussed the constitutional challenges with both our 

legal team and the legal team at the Justice Department, who feel 

that the Commerce Clause gives strong constitutional basis for the 

personal responsibility section of this bill. 

As you know, when Governor Romney signed the Massachusetts 

law, he felt that a critical piece of expanding health coverage was 

personal responsibility, that those who could afford, actually, to 

purchase coverage would do so; and if they needed assistance, that 

the State, in that instance—and, in our instance, the Federal Government—would provide that assistance, and there would be a 

waiver for those who couldn’t afford it. 

It is the framework that we used to put together the Affordable 

Care Act, and I think at least the lawyers will debate this in the 

courtroom, but I am convinced that it does stand on the strong constitutional grounds. 

Mr. TIAHRT. Thank you, Mr. Chairman. 

Mr. OBEY. Mrs. Lowey. 

MEDICAL LOSS RATIO

Mrs. LOWEY. Thank you, Mr. Chairman. 

And welcome, Madam Secretary. 

Throughout the health-care debate, one of my highest priorities 

was to enable the Federal Government to better track and prevent 

premium increases for consumers. One of the provisions in the new 

law involves medical loss ratio, requiring insurance to spend at 

least 80 percent of premiums on health-care services. This will a 

great benefit to those who cannot continue to pay skyrocketing premiums. The law includes a host of other cost-control measures, including allowing exchanges to bar access to insurers with unreasonable premium increases. 

By the way, I found in my district—I had countless meetings 

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tors, and I cannot tell you how many people talked about their 

rates being doubled in the last 5 years. So we have to do something 

about this in this bill. 

And if you could share with us, how does the budget request enable HHS to police insurers and protect consumers from abusive 

practices? And, more generally, are there any changes to the budget request that are necessary now that health-care reform has been 

signed into law? 

First, let’s talk specifically about the medical loss ratio, and then 

whatever time is remaining, I would appreciate it. 

Secretary SEBELIUS. Well, the medical loss ratio, Congresswoman, as you suggest, is part of the Affordable Care Act. I am a 

former insurance commissioner, and I am familiar with looking at 

the kind of data that is currently going to be requested. So we have 

already reached out to the National Association of Insurance Commissioners to, as suggested by the law, have them help to frame 

the definitions that are used as part of the formula for the loss 

ratio. 

I have actually reached out, also, to my former colleagues, Governors across the country to remind them—and in some States 

there is the full range of rate review authority, and in other States 

they are really missing big pieces of it, like California and others 

who found themselves in a situation where they do not have prior 

approval of rate increases—to remind them that that may be a 

good thing to address in their legislative session. 

So we are aggressively putting together the framework for a review of medical loss ratios and working in very close connection 

with the State insurance commissioners and the Governors to do 

just that. 

I think that our budget, what we have done, Congresswoman, as 

part of the implementation of the Affordable Care Act is to stand 

up a new Office of Consumer Information and Insurance Oversight 

that is going to be charged with not only implementing the medical 

loss ratio standards but a whole host of the market conduct standards for insurance companies and working very closely with the 

State offices. 

STATE INSURANCE COMMISSIONERS

Mrs. LOWEY. Before we get to the next question, from your experience—and you interacted, I know, with other State commissioners before you took on these responsibilities—are there any 

States that are actually monitoring this issue effectively now? And 

I appreciate the fact that you said you had been meeting with the 

State commissioners of insurance. Are there any States that do it 

effectively? 

Secretary SEBELIUS. I think there are. There are some models 

out there that we look at very closely. 

Again, the State laws vary. So some States have what they call 

‘‘prior approval.’’ Before a company can actually impose a rate increase, they have to submit actuarial data to the Department, have 

it reviewed, look at administrative costs, overhead costs, CEO salaries, and what portion of the premiums they are actually paying 

out in health benefits. Others have what they call ‘‘file and use,’’ 

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crease and just files it with the Department. And some don’t even 

have that. So there is a wide range of oversight. 

We are very hopeful that we can—this isn’t, as you know, a Federal takeover of anything. It really is a State-based insurance regulatory system that stays a State-based insurance regulatory system. But we are working very hard with the States to remind them 

that this responsibility is theirs. 

We have asked—I actually went to the health insurers and asked 

that companies submit to our office at a minimum their actuarial 

information of what their overhead costs are, and what their benefit payouts are, so we can at least make it transparent to the 

American public. So far, we haven’t had a terribly robust response, 

but I am hoping that we will. 

Mrs. LOWEY. I look forward to your keeping us up to date on this. 

Because, from my perspective and many of my colleagues’, we were 

moved to pass this legislation because, frankly, everybody, from 

small business to large small business, was just getting rate increases. 

And my time is up. And I look forward to continuing to hear from 

you and getting this information. 

Thank you, Mr. Chairman. 

Mr. OBEY. Mr. Lewis. 

SINGLE-PAYOR SYSTEM

Mr. LEWIS. Thank you, Mr. Chairman. 

Welcome, Madam Secretary. I don’t envy you the challenge you 

have before you. All of us face the same thing, but you are in a 

very special hot seat. 

In general, I would like to talk about medical errors a bit and 

a bit about Medicare. But before getting to that, as we have gone 

through this debate over the last year, it has become very apparent 

to any observer who has looked closely that the key players on the 

majority side—the President; the Speaker; the Speaker’s closest advisor, Mr. Miller of Oakland; indeed, Henry Waxman—have been 

supportive of a single-payor system. 

Now, I know that is not the bill that we produced, but it lays the 

foundation for exchanges to become a lot more than State-based 

but, rather, Federal-dominated. And it concerns me an awful lot 

that we ignore that. 

Would you respond to you and your office’s view of a single-payor 

system at the Federal level? 

Secretary SEBELIUS. Certainly, Congressman. I would be glad to. 

I think, from the outset of this discussion, there were certainly 

those in the House and the Senate who favored a single-payor system and felt that that was by far the preferable option. From the 

beginning, the President made it very clear that he did not, in spite 

of the fact that he had, in years in the legislature and even when 

he came to the United States Senate, talked about that as an option that would be ideal. The more he looked at the situation, with 

180,000,000 Americans having insurance coverage that was preferable to them and that they liked, he felt that what we needed 

to do was build on the current system. And that is really the structure that the bill took from the outset, in spite of, I think, the disVerDate Mar 15 2010 08:35 Nov 16, 2010 Jkt 058233 PO 00000 Frm 00170 Fmt 6601 Sfmt 6602 E:\HR\OC\A233P2.XXX A233P2

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appointment of some in the caucuses who would have preferred to 

really dismantle the third-party-payor system. 

So this really starts at the States. States put together exchanges 

either as a single State or in a multi-State area, if that is what 

they choose. We provide technical assistance to the States to do 

that. And even though the timetable for exchanges doesn’t begin 

until 2014, we intend, starting next year, to begin very robust discussions so that we don’t wait until the last minute and have 

States in a situation where they can’t do this. 

We have already had lots of positive discussions, and States are 

very eager to do this. And I think it will very much be a Statebased program. And particularly, Congressman, it is not to dismantle what is in place right now. It is really to replace the market 

for self-employed Americans, many of whom cannot find affordable 

coverage, don’t have any leverage, a lot of small-business owners 

who find themselves in the same situation. 

MEDICAL ERROR RATES

Mr. LEWIS. Madam Secretary, if I could take you to medical errors—— 

Secretary SEBELIUS. Yes. Yes. 

Mr. LEWIS [continuing]. You suggest that, within the Department, you want to at least model some evaluation of medical errors 

to see how we can improve on that pattern within the health-care 

delivery system. Might I suggest that one of the major Federal 

medical health-care delivery systems lies within our military. 

There is plenty of evidence that there is rampant across this system an error-based system of delivery. 

I would suggest that you might start there and help us, with you, 

to evaluate what is going on in that medical health-care delivery 

system that supposedly is serving the most important servants we 

have in our society, the men and women who have fought for this 

country. 

Huge problem there. I would be interested in your reaction. 

Secretary SEBELIUS. I am sorry. I want to understand what you 

are saying, Congressman. We have begun, certainly, discussions 

with not only the VA but the Department of Defense on their system. But you are suggesting that there are rampant medical errors 

within the health-care system for—— 

Mr. LEWIS. That is correct. There is evidence at the highest levels that system deliveries are, at best, producing an awful lot more 

errors than the norm. And we might start that examination right 

there. 

Secretary SEBELIUS. Well, I think that is a good point, and I will 

follow up on that. Thank you. 

MEDICARE ADVANTAGE

Mr. LEWIS. One of the President’s major promises was that, if 

you like your health care, you can keep it. And yet, to pay for the 

new health-care plan, the law, it appears, would cut in a major way 

Medicare Advantage by more than $130,000,000,000. I have 

50,000–plus seniors in my district who enjoy Medicare, and, indeed, 

they are concerned about what these proposed cuts might do to 

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What can my seniors expect relative to implementing this program? 

Secretary SEBELIUS. Well, I think that there is a provision, as 

you know, as part of the law that, over a decade, a portion of the 

overpayment to the Medicare Advantage plans will gradually be 

phased out. There are about 400 companies right now offering 

about 1,100 plans throughout the country. About 11,500,000 seniors taking advantage of those plans. 

We have just actually put out the 2011 Medicare Advantage updates, which will have the same rate payments for 2011 as they did 

for 2010, and noticed plans across the country. There will be a robust array of choices for Medicare recipients, as there are right 

now. 

I don’t think there is any question that we are going to begin to 

pay more attention and collect more data, and the CMS, on medical 

outcomes, will be looking at not only the fee-for-service side of 

Medicare but also the Medicare Advantage side of Medicare to 

make sure that, if enhanced payments are going out the door, it is 

really for higher-quality health outcomes. And we know bundled 

care produces that, medical home models produce that. And there 

are a number of Medicare Advantage plans who are very eager to 

engage in that. 

But I think that the misinformation to seniors about the fact 

that Medicare Advantage is somehow not going to be a choice is 

just wrong. We anticipate that there will be no shortage of choices 

of Medicare Advantage plans throughout the country. 

Mr. LEWIS. Thank you, Mr. Chairman. 

I must say, Mr. Chairman, that what she just mentioned is a 

major stumbling block. But if I were going to point to the greatest 

stumbling block, it is when the average family, let’s say 25 to 45, 

suddenly finds a mandate, with the IRS looking over their shoulder, that they must start putting money into a pool for some future 

service delivery. 

Thank you. 

Mr. OBEY. Well, I would say the greatest stumbling block is when people with insurance have to pay $1,000 a year to subsidize 

people who don’t have it because we didn’t have, until now, a program like this. 

Ms. Lee. 

DIVERSITY IN HEALTH PROFESSIONALS

Ms. LEE. Thank you very much, Mr. Chairman. 

Good to see you, Madam Secretary. 

First of all, let me just thank you so much for your leadership 

in helping to move the historic health-care reform bill forward, for 

your steady leadership and your choice and your experience. 

And also, for those of us who were adamant about a public option 

in terms of keeping costs down and holding the insurance companies accountable, we are counting on you to make sure that that 

happens, short of having a public option. And so, thank you very 

much for understanding how important that is. 

Myself, Congressman Honda, Congresswoman Roybal-Allard, the 

Tri-Caucus was lockstep, very adamant, on addressing racial and 

health disparities as part of the health reform bill. And I would 


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like for you to elaborate on how this budget actually supports the 

goal of diversity in the health professions through recruitment and 

training; how you increase diversity at NIH institutions and researchers, ensuring that the racial and ethic minorities benefit 

from any new, innovative health research at NIH; also, in terms of 

the direct support for our Nation’s minority medical colleges, the 

targeted support to help eliminate these disparities within communities where we see them the most. 

And so, in this budget, I just want to see how you are shaping 

this. I know that this year the Office of Minority Health, through 

I think it is called the National Partnership for Action to End 

Health Disparities, has produced a draft report, a national plan of 

action on disparities. So I just want to get a sense of where you 

are on that. 

Secondly—and I will ask all my questions right away, and then 

you can respond. Secondly, national AIDS strategy: Current budget 

allocation? Who is going to lead the implementation of the national 

AIDS strategy? And what part of the current budget allocation— 

I think it is $70,000,000—that is going to HRSA and CDC will be 

dedicated to the national HIV-AIDS strategy? 

Thirdly, let me ask you about nursing, because I had a long conversation with the dean of the Samuel Merritt Nursing School in 

Oakland, and she indicated that just in the Bay Area alone, 40 percent of all new nursing graduates since October 2008 have yet to 

find a job. Yet I thought there was a nurses shortage in our country. 

I spend a lot of time, as I say to many, I spend a lot of time in 

hospitals. My mother is 85 years old. My sister has multiple sclerosis. And these are very good nurses, but we are always being 

treated by traveling nurses, nurses who have retired and who come 

to the hospitals to work because, I am told, that there is a shortage. And yet now the dean of the nursing school says nurses cannot 

find a job. 

So I would like to, kind of, get some sense of what you think is 

going on out there and what we can do to ensure that qualified 

nurses are being hired. 

And if I have any more time, I will ask some more questions, but 

go on and respond to those. 

Thank you again, Madam Secretary, and good to see you. 

Secretary SEBELIUS. Well, thank you, Congresswoman. I will try 

to hit the high points on the issues you raised. 

First, health disparities is, I think, a glaring failure of the health 

delivery system over years. And while our department I think has 

done a fairly decent job documenting health disparities, there has 

not been a very good strategy to actually reduce or eliminate health 

disparities. 

So the National Action Plan that you refer to is really the first 

time since 1985 that there will be a secretarial-level plan addressing health disparities. And it is one that I take very seriously. It 

is in draft form right now. We look forward to having a chance to 

preview it with you and to work on it. 

I don’t think there is any question that passage of the Affordable 

Care Act is one of the most important steps we can make toward 

closing the gap. Over and over again, it has been identified that the 


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lack of insurance, the lack of access to affordable health care is one 

of the underlying causes of health disparities. So a big step was 

made. 

Our budget, actually, will build on that effort in a number of 

ways. Not only will the Office of Minority Health focus with a strategic roadmap on this National Plan—and we see it not only within 

our department, but an across-government-agency effort, where 

health is impacted by neighborhoods, by food availability, and by 

the air you breathe. There are a lot of things that actually add or 

subtract from people’s health. So we see this as a government-wide 

effort. 

We do have additional resources in the 2011 budget that look at 

recruitment of health providers from minority communities to 

make sure that we have not only people serving in underserved 

areas, but actually minority providers—nurses, doctors, health 

technicians, mental health professionals. 

As you know, the Affordable Care Act also made the Center for 

Minority Health and Health Disparities into an Institute at the 

National Institutes of Health which raises it to a level where it will 

have serious strategic focus and attention. So there are a whole 

host of assets coming together in a way that really hasn’t been organized in our department. 

And, again, we look forward—I know this has been not only a 

cause that you have taken very seriously but your fellow Tri-Caucus members have been focused on for years, and I really look forward to working with you as we address these gaps and these underlying health causes. 

I would suggest, also, that the increased footprint for the Community Health Centers, which actually started in the Recovery Act 

and are, again, targeted to the underserved areas, as well as the 

efforts in wellness and prevention grants, will also help to close 

this gap. 

I can’t respond very well to the nursing job shortage situation 

that you talked about because that is the first time I have ever 

heard of nurses not being snapped up immediately to be hired. I 

hear the other side of the story over and over again, that people 

need more nurses in the pipeline. And that is exactly what we have 

been doing, is trying to fill that workforce pipeline with more scholarships being paid off, more increases to the National Health Service Corps, more people in underserved areas. So I need to follow up 

on that. 

And then, finally, in the AIDS area, there is a national AIDS 

plan that is currently being formulated. It is not finalized at this 

point. As you know, President Obama has identified the fact that, 

while we had a very robust international HIV-AIDS strategy, we 

had kind of lost the attention and focus at the national level. 

We have already launched, under CDC, an outreach program on 

testing and particularly identified some of the most vulnerable 

communities that we are beginning to interact with, using social 

networking. 

But we look forward to the strategic plan, which will be led by 

the White House Office of National AIDS Policy and others who are 

focused on AIDS. There is a new AIDS Council, which will have a 


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national and international focus. And we are going to be very intimately working with them. 

Mr. OBEY. Mr. Rehberg. 

HIGH RISK POOLS

Mr. REHBERG. Thank you, Mr. Chairman. 

Temporary high-risk pools in Montana—I understand you have 

been in contact with our auditor already about it. But I noticed in 

the appropriations $5,000,000,000 was taken out of the general 

fund to pay for the high-risk pools around the country, but CMS 

is suggesting that the money will run out in 2011 and 2012. And, 

of course, they don’t have to be in place until 2014. 

Why the shortfall? Well, why the anticipated shortfall? And are 

there other areas that you see it is already coming in over-budget? 

Secretary SEBELIUS. Congressman, we don’t know exactly how 

many people will be able to be enrolled in the high-risk pool. A lot 

of States offer high-risk pools right now. I think Montana— 

Mr. REHBERG. Which is one of the reasons we wondered why we 

did this in the first place. If we already had the high-risk pool in 

place, why supplant it with something created by the Federal Government to do something that we already had in place? 

Secretary SEBELIUS. Again, this is a totally voluntary program, 

first of all. Secondly, it won’t be created by the Federal Government. If Montana chooses to set up what is a parallel pool, the 

money that is allocated in the Affordable Care Act is to subsidize 

rates so—— 

Mr. REHBERG. The point is—— 

Secretary SEBELI [continuing]. They don’t rise above 100 percent 

in Montana. 

Mr. REHBERG. Correct. 

Secretary SEBELIUS. They are well over 100 percent of the market right now, and it makes it very unaffordable for lots of folks. 

Mr. REHBERG. But my question is, you asked for $5,000,000,000, 

you got $5,000,000,000, and CMS is already anticipating it will not 

last through 2011 or 2012. And the high-risk pools are not to be 

in place by 2014. A shortage, a shortfall, an overexpenditure. How 

are you going to deal with it? Are you going to limit access? 

Secretary SEBELIUS. Again, sir, this is not a Federal program. If 

Montana chooses to participate, they will have an allocated set of 

resources, which helps subsidize care for Montanans who currently 

are uninsured and uninsurable. 

Mr. REHBERG. Madam Secretary, you—— 

Secretary SEBELIUS. If they choose not to participate, that is a 

choice that the State will make. 

Mr. REHBERG. Let’s go back to the question. The question was, 

the legislation created high-risk pools, or the opportunity to create 

a high-risk pool—— 

Secretary SEBELIUS. That is correct. 

Mr. REHBERG [continuing]. By 2014. 

Secretary SEBELIUS. No, sir. Right now. This is the bridge strategy to a new market—— 

Mr. REHBERG. Correct. 

Secretary SEBELIUS [continuing]. In 2014. Not by 2014. 


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Mr. REHBERG. That is correct. But, by 2014, an alternative structure needs to be in place. 

Secretary SEBELIUS. The exchanges. 

Mr. REHBERG. Correct. But if the exchanges are in place in 2014 

but you are using Montana and the other States’ temporary pool, 

and if you appropriated $5,000,000,000 and it is not going to make 

it to 2014, you are going to have to come back to this Appropriations Committee and ask for more money. 

You have already anticipated that it is going to cost more than 

you told us it was going to, in asking that the legislation be passed 

in the first place. 

Secretary SEBELIUS. Sir, currently, the Federal Government pays a fraction of a State’s high-risk pool. It puts about $50,000,000 into 

an overall plan. This is an attempt to provide a safety-net coverage 

if the money actually is going to have a shortfall. 

Mr. REHBERG. Madam Secretary, with all due respect, that 

doesn’t answer the question of the shortfall. I understand the 

bridge. I understand that you are going to cooperate or participate 

or help the States. But you said it was going to cost $5,000,000,000, 

your anticipated expenditure, and it is not. 

Secretary SEBELIUS. Well, we don’t know what it is going to cost, 

and I would—— 

Mr. REHBERG. So you disagree with CMS? 

Secretary SEBELIUS. We don’t even know how many States want 

to participate in the program at this point. We put out a letter to 

Governors. I talked to my former colleagues yesterday. We will, by 

April 30th, have some idea. I mean, we really don’t know, at this 

point, sir. 

PROHIBITION ON LOBBYING WITH FEDERAL FUNDS

Mr. REHBERG. Okay. 

The second line of questioning that I would like to go down the 

path—in the stimulus package, the law certainly says you can’t 

lobby. 

Secretary SEBELIUS. Correct. 

Mr. REHBERG. You know, a bastion of information from CNN. 

State of New York, obesity, educate leaders and decision-makers 

about trans fat—this is a $3,000,000 grant award. Santa Clara, 

California, advocating for an increased statewide tobacco tax. The 

city of Chicago, tax increase at the city, county, and State levels. 

Iowa Department of Public Health, $3,300,000,000, inform local 

policymakers about evidence- and practice-based pricing. 

That sounds like lobbying. 

Secretary SEBELIUS. Congressman, I read the same information 

from the same news source. I can assure you that we will follow 

to the letter of the law the Federal law which prohibits Federal 

funds and has, not just in the Recovery Act but consistently, prohibited lobbying with Federal dollars. We will track that very carefully. We have already notified a whole host of folks that that is 

the law of the land. That was part of the grant application and will 

continue to be part of the monitoring. 

Federal funds will not be used for lobbying. 

Mr. REHBERG. Okay. Because those were all quotes from the 

grant application in the first place. 


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Secretary SEBELIUS. A lot of the applicants have a whole host of 

strategies that they employ, have employed historically, and will 

continue to employ. We are funding programs that are not lobbying 

programs. They are actual prevention—— 

Mr. REHBERG. But your oversight missed it in the initial grant 

application. 

Secretary SEBELIUS. Pardon me? 

Mr. REHBERG. Your oversight missed it in the initial grant application. The grant application had those exact quotes in it. 

Secretary SEBELIUS. They have been notified that there is an absolute prohibition for using any Federal funding for lobbying. And 

we will follow up on that very carefully. 

Mr. REHBERG. Thank you. 

Thank you, Mr. Chairman. 

Mr. OBEY. Ms. Roybal-Allard. 

Ms. ROYBAL-ALLARD. Welcome, Madam Secretary. 

PREVENTION AND WELLNESS FUNDING

Last year, the American Recovery and Reinvestment Act made $650,000,000 in prevention and wellness funding available for 

chronic disease prevention and management. And this year, when 

Congress passed the Affordable Care Act, it included a 

$15,000,000,000 Prevention and Public Health Fund, of which 

$500,000,000 is, I believe, available this year. And, as I understand 

it, these new funds are not restricted to chronic diseases but are 

meant to fund the entire spectrum of public health efforts. 

I have been told that your office is currently working on a system 

to distribute the funds this year. However, there seems to be significant concern in the infectious disease community that, in an effort to obligate the $500,000,000 by September 30th of this year, 

the Department will fund only existing grant applications for the 

ARRA of chronic prevention grants and that infectious disease programs will once again receive no funding. 

Can you please outline how you plan to allocate these funds and 

whether you will include new applications for prevention funds to 

target infectious diseases such as HIV-AIDS, viral hepatitis, sexually transmitted diseases, tuberculosis, many of which are at crisis 

levels in many communities? And what strategies is your department undertaking to address these infectious-disease disparities in 

our minority communities? 

Secretary SEBELIUS. Congresswoman, I would suggest that, at 

this point, as you have identified, conversations are going on with 

Members of the House and the Senate about the strategies for allocating these funds. So no decisions have been made, at this point, 

about either using traditional applications or not. But we absolutely want that kind of input and, you know, look forward to 

working with you on a plan. 

I think that the effort will be to actually build on—as you know, 

the investment in the ARRA funds was really a first-time-ever investment in wellness and prevention and strategically focused, at 

least in the community grant applications, on two underlying 

causes of chronic disease, which were tobacco cessation and obesity. 

This is likely to be a broader area. There are lots of ideas and 

good strategies about how to use this. We are looking carefully at 


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the scientific data, at the evidence-based programs. I can guarantee 

you that what actually has been demonstrated to work will be one 

of the guiding lights. 

But I would say that discussion is very much under way, and we 

would appreciate your input. 

Ms. ROYBAL-ALLARD. So they are still open with regard to funding infectious disease? 

Secretary SEBELIUS. Yes. 

REDUCING CESAREAN BIRTHS

Ms. ROYBAL-ALLARD. Okay. 

As you are aware, the United States spends more on maternity 

care than any other country in the world. However, we rank 41st 

in the world in maternal mortality and rank 30th in infant mortality. 

While we know there is an extensive body of research regarding 

best evidenced-based practices in maternity care, our health-care 

providers seem not to be following that research. For example, despite Healthy People 2010 goals of reducing Cesarean births to 15 

percent, the United States continues to have a 31.8 percent Cesarean section rate. 

Given the risks that are associated with medically unnecessary 

Cesareans and the extraordinary costs associated with Cesarean 

births, is the administration doing anything to refine our care system to support the best and most cost-effective, evidence-based care 

to reduce the rate of C-sections? 

Secretary SEBELIUS. Congresswoman, I am not sure I can speak 

with any specificity about what actions are currently being taken 

in dialogue with providers about the C-section rate beyond just 

publishing the data and highlighting the data. 

I can tell you that our Office of Women’s Health is very focused 

on maternal and child health issues and, frankly, what are pretty 

dismal health results, as you suggest—high expenditure and not 

terrifically good results. 

I, again, think that the Affordable Care Act makes a big step in 

the direction of getting affordable prenatal care to pregnant 

women. That will be a major step forward—— 

INCREASING BIRTHING CENTERS

Ms. ROYBAL-ALLARD. I am sorry to interrupt, because I see my 

time is up, but I did want to know whether or not, since the new 

law requires Medicare to cover care provided in all free-standing 

birth centers at a cost of $6,000 less, is there any consideration in 

the initiatives to increase the availability of licensed birthing centers across the country? 

Mr. OBEY. Very brief answer. 

Ms. ROYBAL-ALLARD. Is that being looked at? 

Secretary SEBELIUS. I can’t answer that, but I will look into it. 

[The information follows:] 

INCREASING BIRTHING CENTERS

Thank you for your interest in the Medicaid program and the availability of licensed, free-standing birthing centers. As you know, section 2301 of the Patient Protection and Affordable Care Act of 2010 (the Affordable Care Act) requires the 


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States to cover services provided by freestanding birth centers as a mandatory service under Medicaid. Currently, we are focused on implementing and providing technical assistance to the States on this provision. We expect that States with licensed, 

freestanding birthing centers will build a foundation for expanding these services 

to the Medicaid population and that their experience will be instructive to other 

States considering expanding the availability of such centers. 

Ms. ROYBAL-ALLARD. Okay. Thank you. 

Mr. OBEY. Mr. Alexander. 

FMAP FORMULA

Mr. ALEXANDER. Thank you, Mr. Chairman. 

Madam Secretary, I have two questions. One is about FMAP. 

Congressman Cao and all of the Louisiana delegation, as cosponsors, are supporting a piece of legislation to address Medicaid reimbursements or Medicaid costs. Governor Jindal is supporting the 

legislation, as well as Secretary Levine from the Louisiana Department of Hospitals. They are in a legislative session today dealing 

with the shortfall there of a half a billion dollars. 

My question is, what is being done to prevent States like Louisiana, who were unfairly, when you look at the FMAP formula— 

because we got a lot of money, as the State of Louisiana was recovering from the hurricanes. Louisiana was looked at as being a 

State that was financially better off than they really are. 

So what are we doing to prevent Louisiana or any other State, 

like yours, that received financial help from appearing to be 

wealthier than they really are and, therefore, suffering because of 

the Medicaid? 

Secretary SEBELIUS. Congressman, we have spent a good deal of 

time with not only your State health officials, your Medicaid director, the mayor-elect of New Orleans, and others, Senator Landrieu, 

on this situation. Frankly, one of the reasons I think that there is 

now a legislative discussion is because the law is pretty clear that 

we don’t have administrative flexibility to change the calendar 

years for which the income level is calculated; and that is really 

the situation, is when the count began what the income level is and 

how it was calculated. But we are working very closely with them, 

well aware of the anomaly that income appeared to go very high 

because half the population was, frankly, gone and not counted and 

probably inaccurately reflects what is the true medical count. 

And if we can have a legislative fix, we will try to move it very, 

very quickly. But we have our hands tied in terms of what administratively we can do for this situation. But I think it is really 

worth looking at. 

As you suggested, it is not only Louisiana but what happens 

post-disaster in an area where Federal funding may come in as an 

aid after the fact, but then the result is a calculation that isn’t a 

very accurate picture of what the financial wherewithal is. 

HEALTH CARE FRAUD

Mr. ALEXANDER. Thank you. 

Chairman Obey a little earlier said something about a meeting 

that we had a few weeks ago about fraud. During that meeting, we 

heard all kind of reports about the number of physicians and other 

health care providers that were using sometimes information obVerDate Mar 15 2010 08:35 Nov 16, 2010 Jkt 058233 PO 00000 Frm 00179 Fmt 6601 Sfmt 6602 E:\HR\OC\A233P2.XXX A233P2

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tained from the inside to defraud the taxpayers. I asked the question about the number of individuals from the inside that might 

have been found doing something wrong. 

Again, I am not pointing fingers, but I just find it almost impossible to believe that there are numbers of individuals on the outside committing fraud at the numbers that we are hearing about 

without getting some help from the inside. 

When we talk about organized crime—and that term was mentioned—organized means at least two. You can’t have organized 

crime with one. So I asked the question. I have not gotten an answer. I have had staff members to try to find out if in fact there 

are any individuals on the inside of any of the departments at all 

levels who have been found guilty of helping those on the outside. 

Can’t get an answer. There is no answer or either they won’t give 

it to us. 

Secretary SEBELIUS. Congressman, I can tell you I am not 

aware—and I will make sure we get this data and get it right back 

to you—I am not aware of if you are talking about State and Federal employees who have been charged and found guilty. I do know 

if ‘‘inside’’ means providers and not necessarily just doctors but socalled equipment providers and home health providers, there are 

dozens and dozens of insiders in that instance who have been 

charged and prosecuted, which is really the only way that we 

would be able to document if they have actually been found in 

some case. But I can get that information to you. 

That is the kind of thing that I think the new fraud effort is attempting to crack down on, people who pretend to be providers, if 

you will, set up sham operations, bill. But they are not necessarily 

part of organized crime. They are just operating as insiders but 

really conducting fraudulent activities. But we will circle back right 

away and get you that information. 

[The information follows:] 

HEALTH CARE FRAUD

The HHS Office of Inspector General’s (OIG) Office of Investigations (OI) has one 

known case where an employee was complicit in a health care fraud scheme. In the 

Los Angeles Region, two Centers for Medicare & Medicaid contractors admitted to 

receiving money, $15,000 and $5,000 respectively, from an outside source to process 

provider applications. One individual received 3 years probation and was fined 

$1,000, while the other received 2 years probation and was fined $5,000. 

Because many of the providers who had applications expedited are subjects of ongoing investigations, the total loss to the Medicare program has not been fully determined. However, it was determined that one provider involved in this scheme, 

caused a $3.2 million loss to the government. Additionally, it is believed that at 

least one entity bribing the employees in this case is connected to an organized 

criminal enterprise, and there may be additional employees identified in this 

scheme. 

Instance of ‘‘insider’’ fraud within the Department or involving its employees are 

extremely rare, and when identified, are taken very seriously and investigated to 

the fullest extent by our law enforcement partners. 

Mr. ALEXANDER. Thank you. 

Mr. OBEY. Ms. McCollum. 

MEDICARE REIMBURSEMENT

Ms. MCCOLLUM. Thank you, Mr. Chair. 

To the gentleman’s question, I know the Department, unfortunately, I have to report, in Minnesota found two internal problems 


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with fraud. So you do do internal audits, and I am sad to report 

that there were people in Minnesota involved in it. I am happy that 

they got caught. 

I would like first, though, however, to commend Chairman Obey 

for his ongoing instrumental leadership in fighting for the best 

value and quality in health care. That just leads to a lot of hearings that you have had before and the hearing we are having 

today. 

I would like to congratulate you on the passage of the health reform bill. Your work and the work of the administration were key 

to ensuring that health care reform became a reality. I believe that 

the current Medicare payment system is deeply flawed and too 

many hospitals and providers shoulder the burden of unfair Medicare reimbursement for high-quality, low-cost care that they deliver, my State being one of them. I look forward to working with 

you as you convene the National Summit on Geographic Variation, 

Cost, Access, and Value in Health Care this year. And on this issue 

and the timing implications for some of the fact finding that you 

are looking at and for the implementation of change, I am going 

to submit some of those questions for the record. 

HOSPITAL ACQUIRED INFECTIONS

Ms. MCCOLLUM. So I would like to spend my remaining time 

talking about hospital-acquired infections. We are here today to 

learn how to work more effectively with you to improve the quality 

of our health care system for all Americans. Hospital-acquired infections contributed to almost a hundred thousand deaths. In a recent report, HHS concluded that hospital infections merited urgent 

action. We know that hospital infections add $28 to $33 billion to 

our national health care costs. This is a serious public health care 

concern, because are we not only paying the cost, there are patients 

paying for these mistakes with their lives. 

HHS has set out a goal to reduce hospital-acquired infections by 

10 to 20 percent in 2 years, and 50 percent within 10. But we are 

far from reaching that goal. We know that most of these infections 

are preventable through low-cost techniques. There is a New York 

Times article that even talks about how we have had remarkable 

progress in reducing infection rates but how many of the hospitals 

have not yet worked to overcome these infection rates because they 

are in an entrenched medical culture which is not changing. 

My State has worked to lower infections, and I know others are 

doing that as well. You have examples at your Department on how 

we can reduce infection rates. But the report also points out that 

infection rates have gone up 8 percent. 

So here are my questions: 

Is the 8 percent increase because of better reporting, whether it 

is voluntary or mandatory? Because you can’t address a problem 

until you know and you face the fact that the problem exists. What 

are some of the obstacles to addressing this issue? Does the agency 

need this committee or the policy committee to work more closely 

with you to address this public health care concern moving forward? 

Secretary SEBELIUS. First of all, Congresswoman, I think your 

targeted concern is one that is a huge issue, and it is not only a 


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huge cost issue, it is a huge safety issue. I know the Chairman has 

been working with you and sort of focused like a laser beam on 

this. The notion that we have a hundred thousand deaths a year 

from what happens to people when they are in the hospital, not 

what brought them in the first place, is, frankly, totally unacceptable. And hundreds of thousands more in just high-cost, longer-care 

strategies and lingering diseases. So it is a very serious issue. 

We know what works. It has been demonstrated and proven. It 

has never been taken to scale. 

So I think a couple of things are happening simultaneously. First 

of all, the notion of increases, I would say, is a part of better reporting. It also is a snapshot of the past. We are hopeful that more 

current data gives more encouraging signs. This focus by the Department, by this Committee, through the Recovery Act, through 

the Affordable Care Act, and through our budgets, I think is relatively recent. 

Secondly, there is no question that it is a question of focus by 

hospitals. You have required as part of the Affordable Care Act 

that all hospitals now have to report, which is a big step forward, 

and that reporting will be much more transparent to consumers 

and others, which is, again, a big step forward. 

Third, we are putting real resources both to States for more frequent inspections and to hospital systems to encourage the adoption of the strategies that we know work. 

Fourth is the electronic medical records. I was in a hospital in 

Cincinnati 2 weeks ago, in Children’s Hospital, which does some of 

the most complicated surgeries on infants and even prenatally that 

I have ever seen. They have embedded into their electronic records 

system the checklist that we know works to reduce hospital infections. They have gone a thousand days without any safety concern. 

It is a great example of what meaningful use in an electronic 

records system can do, which is embed the kind of safety checklist, 

make sure it is done time and time again. If you can do it in that 

type of environment, we can do it everywhere. 

So I think there are some resources coming together, but I can 

tell you that it is something that we take very, very seriously. And 

I think it is not only huge costs, but we are killing people by our 

health care system. 

Mr. OBEY. Mr. Cole. 

MEDICARE REIMBURSEMENT RATES

Mr. COLE. Thank you, Mr. Chairman. 

Madam Secretary, thank you for being here today. 

As I talk to hospitals in my district, and it is a pretty rural district, a lot of small town, lot of Medicare- and Medicaid-intensive 

facilities, most of them are expecting, and this is not through your 

actions or through the health care bill, the Medicare reimbursement rates are being cut. They are going down. They look on the 

Medicaid new population that they will be getting under the health 

care bill as largely a break-even deal for them. They are really not 

making money off of that. They are very worried about what is 

going to happen to the private provider part of reimbursement. 

Because the point has been made here earlier, private insurance 

subsidizes the uninsured, but it also subsidizes Medicare and MediVerDate Mar 15 2010 08:35 Nov 16, 2010 Jkt 058233 PO 00000 Frm 00182 Fmt 6601 Sfmt 6602 E:\HR\OC\A233P2.XXX A233P2

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care to a large degree, because those programs don’t break even on 

costs. So they are looking at their future, and they are wondering 

where the dollars will come from for them to literally keep their 

doors open. And then the people in the larger cities wonder what 

happened to those smaller hospitals that closed and that population base is moved into their facilities. 

So I would like you to just walk through how you see hospital 

reimbursement rate developing over the course as you phase in the 

new health care bill. 

Secretary SEBELIUS. Congressman, I think that is a great question. Whether it is in rural areas in your district or in a State like 

Kansas, or in urban areas, I think every hospital administrator 

who I have talked to in the last 10 years has seen their uncompensated care rate rise. So there is currently a population with no payment stream at all and then insufficient payment streams and then 

private-payer streams. 

So I think one of the features of the Affordable Care Act is to 

actually have a payment stream arguably under every patient who 

comes through the door. It is one of the reasons that a lot of the 

hospital systems worked carefully with us on the framework of 

health reform. 

I do think that there also is an effort where the kind of bundled 

care strategies—again, hospital providers are very eager to have a 

payment system which actually looks at ways that they can be 

more appropriately compensated for keeping people out of the hospital. Right now, the only way they actually get compensated is if 

somebody actually comes back into the hospital. 

And the sorts of embedded directional changes in the delivery 

system for health homes and bundled care and accountable care organizations actually have, I think, some huge advantages for hospital systems to have a more appropriate reimbursement system 

and actually keep people healthier in the long term. I would say 

the third piece of the puzzle is a lot of hospitals right now, particularly through emergency rooms, are delivering care which could 

much more effectively be delivered in a primary care setting, in a 

community health center, in a variety of areas. They have begun 

to work on strategies to kind of triage that care so they don’t have 

to have this robust sort of preventive care, and that I think is also 

part of the new structure. 

Mr. COLE. A lot of, again, my facilities are concerned with, again, 

on the private end of it is where they make the money to, frankly, 

reinvest in technology and facilities. They don’t make that off Medicare. They don’t make it off Medicaid. So they are really worried, 

are we going to crowd out the private market here and they won’t 

have the money they need to give patients the best service that 

they possibly can give. 

Secretary SEBELIUS. Well, I think with the exchange opportunities, the private market, I would suggest, may be stronger. What 

is happening right now, and has happened over the last 5 years 

certainly, is more and more small employers have dropped their 

private coverage because they can’t any longer pay the premium. 

A lot of individuals lost insurance when they lost their jobs, but I 

think the restabilization of a marketplace, of a private marketplace 


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with larger purchasing pools but then stabilizing that coverage that 

people have is actually going to be good news. 

Mr. COLE. I hope so. I think that is a point worth making, 

though. Because a lot of my friends who favor the public option 

think, forget where the money comes from that actually allows 

health care to be delivered. It is very heavily from the private sector. You overpay, quite frankly, if you are on private insurance already. We know that problem was alluded to earlier. But that also 

supports Medicare, Medicaid, and, frankly, the new health care insurance bill as well. So I would be very careful about killing the 

goose that has actually provided the eggs for everybody else. 

Secretary SEBELIUS. Well, as you may know, of the 32 million or 

so estimated new enrollees in a health insurance system, the majority of those individuals will be in the private market, will not be 

in the public market. 

Mr. COLE. Thank you, Mr. Chairman. 

Mr. OBEY. Mr. Honda. 

HEALTH INSURANCE COSTS

Mr. HONDA. Thank you very much. 

Welcome, Madam Secretary. 

Just to pick up with your last comment, the additional 32 million 

that will be added to the population, would that tend to drive the 

costs down across the board in terms of insurance premiums if we 

have the other things in place like the antitrust provision and a 

public option? 

Secretary SEBELIUS. Congressman, what I think is anticipated to 

cost less is—first of all, the market right now is pretty fragmented. 

So if you are an individual buying your own coverage, or a small 

business owner, one health incident, one cancer survivor, one heart 

attack puts you in a very expensive category. Pooling that risk into 

an exchange, a much bigger purchasing pool, I think helps balance 

the costs overall. I think it is one of the reasons that costs will 

come down. Hopefully, a number of the underlying features that actually lower the overall health care costs also are impactful in 

terms of the health insurance costs. 

Mr. HONDA. It seems to me that that is something that we can 

work towards and anticipate. We do know, though, if we don’t do 

anything, we have 47 million people without insurance and the 

costs continue to rise. In the last 18 months, at least in California, 

the premiums have gone from 30 percent one year, 38 percent this 

past year, in terms of premiums increase, in light of the debate we 

had already. So I am not sure the word is arrogant, but it sure is 

pretty bold to do that while we are having a debate on the high 

cost of insurance. 

I want to thank you for taking on this job. It is a massive job; 

and I think it is a very complicated, complex job that you have. But 

I am looking forward to working with you on this. 

I would note that the State you do come from is a very active 

State and very vigorous folks. I was pleased to see that a 

Congressperson did vote for the bill. 

I think that in my own district, District 15, which is Silicon Valley, which has probably the highest per capita post-graduate folks, 

probably the highest average income in this country, I had someVerDate Mar 15 2010 08:35 Nov 16, 2010 Jkt 058233 PO 00000 Frm 00184 Fmt 6601 Sfmt 6602 E:\HR\OC\A233P2.XXX A233P2

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thing like 70,000 folks who were uninsured. That is almost 10 percent of my population. It doesn’t mean that they were unemployed, 

but they were uninsured. 

A fellow who ran against me for office when I first ran, a young 

man, a good friend of mine, said that in the current situation he 

would not be able to go into business for himself because his child 

has a pre-existing condition. My past opponent and friend said, go 

for it. It is important for our country. 

What is important for our country also is that we know that we 

have a viral hepatitis issue in America and globally, and we know 

that more Americans have chronic viral hepatitis. There is more of 

an incidence of that than HIV/AIDS, and the disease is 100 times 

more infections than HIV. While I am grateful to the President for 

requesting an increase for the division in your 2011 appropriation 

budget, I am glad that Assistant Secretary Koh, with whom we had 

met, had begun two major interagency tasks forces on this issue. 

We are very appreciative of that activity. 

PREVENTION AND PUBLIC HEALTH FUND

I am also aware that there is about $500 million for prevention 

and wellness funds that is made available through this bill. But 

there is nothing that says how it is going to be spent. Do you have 

any idea how your Department will be looking at that and how it 

will be spent? 

Secretary SEBELIUS. Congressman, I think that we are still seeking guidance from Members in the House and the Senate about 

that 2010 appropriation for the prevention funds. We did invest in 

prevention in 2009 and 2010 as part of the Recovery Act, and we 

see this as an opportunity to amplify and maybe look in some other 

directions, but those conversations are under way, and we would 

appreciate your feedback. 

Mr. HONDA. We certainly will be willing to do that. 

Mr. OBEY. The gentleman’s time has expired. 

Mr. Ryan. 

PREVENTION AND MINDFULNESS

Mr. RYAN. Thank you, Mr. Chairman. 

I want to personally thank you for all your leadership with regard to the health care reform efforts in trying to push it through. 

I think history will judge us well, bringing a level of social justice 

to this country that we haven’t seen. 

One of the things I mentioned before when you were here that 

I have been dealing with and working with for the past few months 

and years is the issue of stress in our society. I think as we talk 

about health care reform and the technology and everything else 

that there is a growing body of evidence, not just in the area of 

health care, of mindfulness and contemplative practices and their 

benefits on reducing stress levels and allowing our body to heal 

itself. 

So as we are moving 30 million more people into the system, 

there is inevitably going to be more costs, and I think we have 

dealt with that. And it will reduce costs, and I think we have dealt 

with that. 


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But we need to, I think, pursue—and Mr. Honda just mentioned 

prevention. I know there is going to be a panel to evaluate what 

preventive measures actually work. So if you can just talk about 

that. 

But I would also like to encourage you that on that panel should 

be somebody who has been in the field, working in the field of 

mindfulness-based stress reduction. I think it is the most cost-effective way to drive down health care costs. It is about individual responsibility. It is about teaching people to manage their own health 

right in line with everything else we are talking about. So I want 

to encourage you to do that. 

It is not just in the area of health. The Defense Department is 

now doing this for pre-deployment for soldiers who are going over, 

allowing them to—and hopefully prevent a lot of the post-traumatic 

stress that goes on when these kids go into battle. So I want to encourage you to do that. 

If you can talk for just a second about the panel that is going 

to be created to evaluate adequate preventive measures in the 

health care reform bill. 

Secretary SEBELIUS. First, Congressman, I am all for looking at 

any strategy we can find that is successfully reducing stress. I am 

at the front of that line. I would be grateful for that evidence. I 

think that whether it is in this instance or the framework for the 

services, with the exchanges or others, certainly we will put together a very broad-based group of experts and look at what the 

evidence says. And in this area I think there are a number of costeffective sort of patient-centered strategies that really do work. 

And so I look forward to getting the information from you and 

making sure that is part of the discussion. 

Mr. RYAN. I will get it to you. 

I was at a conference this past week and there was someone from 

Ms. McCollum’s district at the University of Minnesota. They are 

offering basically a stress reduction class for incoming freshman. 

There is a 50-person wait list. So this is something that is throughout our society. So I think your leadership on this could be critical. 

PRIMARY CARE PHYSICIAN SHORTAGE

Another question I have, and it is something one of my colleagues mentioned, the shortage of nurses, is the issue with primary care physicians. If you can touch upon that and how we are 

going to try to bridge our way through that. 

Secretary SEBELIUS. I think there is no question we need more 

health care providers altogether, but we also need more of the providers to choose primary care, gerontology, family practice. So a 

couple of strategies simultaneously. One is using more of our loan 

repayment and scholarship funds to attract people to those fields 

at the outset and pay off more of the debt for health care provider 

training in the areas that we see the biggest needs. 

As you know, the Affordable Care Act had a feature which actually, again, moves primary care providers for a couple of years with 

100 percent Federal funding from Medicaid rates to Medicare rates, 

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Mr. RYAN. How about the bridge between those kids that they 

are going into school now maybe and they are saying, yeah, it looks 

like primary care is going to be an opportunity for me. But in 2014 

they will be just getting their bachelor’s degree or their BS degree 

and moving on. 

Secretary SEBELIUS. We are changing the Medicare pay rates, 

also. I think payment of debt once you get your medical degree is 

also a pathway to a much more robust primary care system. That 

is what I hear from medical students all the time, that they are 

in a real financial box in terms of not being able to pay off their 

loans and being inadequately compensated once they become providers. So we are looking at both ends of that puzzle. 

Mr. RYAN. So you think they will move over immediately. 

Secretary SEBELIUS. I do. Actually, we have seen an increase already this year in primary care choices made by first-year residents. It is up about 20 percent. 

Mr. RYAN. Great. Thank you. 

Mr. OBEY. Ms. DeLauro. 

HEALTH REFORM COMPLIANCE AND ENFORCEMENT

Ms. DELAURO. Thank you, Mr. Chairman. 

Welcome, Madam Secretary. Thank you for your efforts in helping us to pass what is historic legislation. 

I know that your Department is working overtime to make sure 

that we begin the implementation of this legislation and that the 

people of this country can really experience the benefits as quickly 

as possible, whether they are small business owners or seniors or 

young adults or parents or people who have a pre-existing condition. 

We have already seen a couple of instances where insurance companies seem to be changing their behavior in response to the bill. 

On the positive side, we have seen several companies who plan 

to move ahead of schedule to let adult children stay on their parents’ plan until age 26. 

But there are instances in which we will need to watch insurance 

companies closely to make sure they are following the new rules 

that have been laid out. For example, some reports, including the 

Senate Commerce Committee, indicates that insurers may be manipulating their medical loss ratios, reclassifying certain expenses 

to make it look like they are spending at a higher percentage of 

the premium dollar on medical care in order to meet the standards 

in the law. The Affordable Care Act included rate review provisions, including grant funding to assist States carrying out rate reviews to stop insurance from hiking those premiums to unacceptable levels. This law now bans a host of insurance company abuses: 

rescissions, denials of coverage for pre-existing conditions, gender 

rating, and health status rating. 

Let me just lay out the three pieces of this question, and I will 

let you go. 

What resources and tools does HHS and the Department of 

Labor need for enforcement of health reform and holding insurance 

companies accountable? 

With regard to medical loss ratio, how are you going to work 

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sure that terms like clinical services, activities to improve quality 

are defined appropriately, that do not include more routine activities that are more typically classified as administration expenses? 

Today, in the New York Times, there is an article that says, Senate bill sets a plan to regulate premiums. The Federal Government 

could regulate rates in States where State officials do not have sufficient authority and capability to do so. Let me ask you to comment on that. 

So if you could address those three pieces, I would appreciate it. 

Secretary SEBELIUS. In terms of the resources and tools, Congresswoman, we are working very closely with both Labor and with 

Treasury that has a sort of piece of some of these puzzles on the 

initial regulations. That has gone pretty well. We have put together 

our Office on Consumer Information and Insurance Oversight. It is 

going to be led by a former insurance commissioner who also has 

worked in many States around the country on regulatory oversight. 

We are working very, very closely with my former colleagues at 

the National Association of Insurance Commissioners because this 

has got to be, frankly, a State-led, on-the-ground program. They 

are the ones who have this ability and information. 

I think there is a very robust discussion. They are in the midst 

of identifying the terminology and definition for the medical loss 

ratio. We are looking at some laws that are in place and work very 

well and what the actuaries can actually take a look at. So it is 

something we are going to take very seriously. 

In terms of the rate review, the original Senate bill had a provision that Senator Feinstein was promulgating of a rate authority 

that would actually be the interim strategy between the time the 

bill passed this year and the time that the new exchanges were in 

place. That rate authority was not part of the reconciliation measure and I think would set up a framework where, absent State review authority, there would be a fallback review authority. 

So I think that debate is likely to go on and may be an important 

piece of this puzzle, because, right now, unless a State changes the 

laws and takes on this responsibility, there really is not fallback, 

other than highlighting what rating is under way. But there is no 

rating authority right now with the Department of Health and 

Human Services, and we are encouraging States to do just that. 

Ms. DELAURO. I am really pleased to hear that. 

As you know, I come from the State of Connecticut. We probably 

are the insurance capital of the country. Over and over again, as 

my other colleagues have experienced, the insurance companies, we 

have lived in their world a very long time. It is now time for them 

to live in our world. 

Thank you, Mr. Chairman. 

Mr. OBEY. Mr. Moran. 

PREVENTION ISSUES

Mr. MORAN. Thank you very much, Mr. Chairman. 

Let me join the chorus of gratitude for your leadership, Madam 

Secretary. But it does seem as though you are paddling upstream 

against the current. When you look at your budget, about 85 percent of it is really not under your control. It is reimbursement after 


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people have gotten sick, and it is to the elderly. Medicare and most 

of Medicaid is still nursing home care for seniors. 

But something dramatic is happening in the health care of this 

current generation of young people that bodes ill for the future 

costs of care. Asthma rates have tripled in this past generation. 

One in every six American children now has a developmental disorder—attention deficit disorder, mental retardation, dyslexia. One 

in every 59 boys is diagnosed with autism today. After accidents, 

cancer is the leading cause of death among children. Primary brain 

cancer has gone up about 50 percent. Childhood obesity has quadrupled in the last 10 years. Diabetes is out of control, about 25 million people now. In fact, they now say one in two minority children 

will develop diabetes during their lifetime. That is unbelievable. 

So it would seem that somehow we have got to get a handle on 

prevention. What is causing all this? Because it really is a dramatic change in the last generation. The First Lady’s emphasis 

upon obesity, upon what people eat, is critically important. I would 

like to know how you are integrating that in terms of your program 

priorities. 

It also may have something to do with the chemicals in the air 

we breathe or the water we drink or the food we eat. In fact, there 

was an analysis of umbilical cord blood in 2007 and 2008 that 

showed that the average infant had 232 industrial compounds 

present in the umbilical cord blood. So many people think there 

may be an endocrine-disrupting effect on health care that is contributing to this massive increase in certain diseases. 

I ask you because you have responsibility for the National Institute of Environmental Health Sciences. I know they have some indication this may be what is behind these massive changes in 

childhood illnesses. I am wondering if you have any plans to enable 

them to take a more robust, aggressive approach in terms of the 

environment’s effect as well as what you are doing in coordinating 

with the First Lady’s initiative on obesity. 

Secretary SEBELIUS. Thank you, Congressman. 

The statistics you recite are alarming and, unfortunately, very 

real and ones that we have to take incredibly seriously. The shorthand is that we spend more, live sicker, and die younger than most 

developed countries; and there is something fundamentally wrong 

with that picture. 

The First Lady’s initiative, as you know, is not only focused on 

what you eat. That is a piece of the puzzle. But I think it is a strategy that really looks across the areas and understands that the 

health of kids is impacted by what they eat in and outside their 

houses, what goes on in school, how much exercise they get, whether there is a safe place to play and walk, a whole host of strategies 

that I think provide a template for the kind of thing that you are 

talking about. 

I don’t think there is any question that, first, reporting is better 

in this generation. Some of what you are talking about is probably 

highlighted by better monitoring, better reporting. But that doesn’t 

nearly compensate for the incredible increases. Some of it is preventable in terms of what we are doing to ourselves, and some of 

it is likely to have environmental impact. 


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My Assistant Secretary for Health, Dr. Koh, has reengaged our 

Department in a very robust fashion in working with the Environmental Protection Agency and others in looking at the health impact of environmental issues. HHS had kind of withdrawn from 

that space for a while, and we are very much back at the table. 

So whether it is looking at carbon content or water-based diseases 

or air quality, which has a huge impact on asthma, there are huge 

health impacts from environmental issues. And I would suggest 

also that the Food and Drug Administration is taking very seriously a whole host of investigations in terms of chemical content, 

which may well impact people not in terms what they are eating, 

but the kind of cans, the bottling, a whole host of other areas. 

So this is all something that I think we are reengaging in a very 

active way and share your alarm and what the current health profile is for this country. 

Mr. MORAN. Thank you, Madam Secretary. 

Mr. OBEY. Madam Secretary, I have a number of questions that 

I would like you to answer for the record, one on health professions 

workforce, another on pandemic flu, a third on LIHEAP, one on 

health-care associated infections, oral health, health information 

technology, and several others. 

HEALTH CARE REFORM

Mr. OBEY. But let me ask a couple of questions about the bill 

that we just passed. 

Mr. Tiahrt and I are friends, but we often disagree. We are not 

disagreeable friends, but we are disagreeing friends very often. But 

in light of his characterization of the health care bill as a government takeover, let me ask a few questions. Is the VA a government 

agency? 

Secretary SEBELIUS. Yes, sir. 

Mr. OBEY. Is Medicare a government program? 

Secretary SEBELIUS. Yes, sir. 

Mr. OBEY. Is Medicaid a government program? 

Secretary SEBELIUS. Yes. 

Mr. OBEY. I thought so, too. Is this health care bill like Canada 

or Britain, or is it more based on a private-sector system? 

Secretary SEBELIUS. The system is based on building out a private-sector strategy with new health exchanges. 

Mr. OBEY. Will the doctors under the system work for the government? 

Secretary SEBELIUS. Not unless they do right now. Some do for 

the VA, as you know, and for the Department of Defense. But, no. 

Mr. OBEY. What about the nurses? Are we adding millions of 

nurses to the Federal payroll? 

Secretary SEBELIUS. No, sir. 

Mr. OBEY. What are these things called insurance companies? 

Are they public entities or are they private? 

Secretary SEBELIUS. Private-sector companies. 

Mr. OBEY. Are they usually profit-making private entities? 

Secretary SEBELIUS. From everything I can tell, yes, sir. 

Mr. OBEY. I thought so, too. 

What does the health reform bill do for the fiscal solvency of the 

Medicare program? 


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Secretary SEBELIUS. Well, the estimate that was made when the 

reconciliation bill was proposed was that it added a minimum of 10 

years to the life of the Medicare trust fund. 

Mr. OBEY. What does it do to change the payment system from 

one based on frequency of procedures to one based on quality of 

medical outcomes? 

Secretary SEBELIUS. Congressman, it sets a direction for Medicare to become, I would say, a quality-based purchaser as opposed 

to the current strategy of fee-for-service, which is more about content than about quality. 

Mr. OBEY. I agree with all of that. 

Let me just tell you a story, because we have had such controversy and such points of disagreement about the details of this 

plan. 

Between 1930 and 1938, a fellow by the name of Gerry Boileau 

represented my congressional district. He was the last of the 

LaFollette Progressive Republicans. When Fiorello LaGuardia became mayor of New York, he succeeded LaGuardia as the spokesman for the Progressive Republicans in the House; and then he 

was beaten in 1938. 

My dad ran a supper club when I was much younger. Gerry came 

home and became a local judge. He came into our place one 

evening, and we started talking, and I finally asked him, Gerry, 

what beat you in 1938? 

He said, senior citizens. He said, I was strongly for Social Security and in my district the seniors were against it. 

I said, what on Earth are you talking about? How can seniors 

possibly be against Social Security? Not the seniors I know today. 

He said, in those days, it was different. He said, in those days, 

we had Social Security as one alternative, which is a contributory 

program. And then we had the Townsend plan, old Doc Townsend 

from California, who didn’t want a contributory plan. He just wanted, I think, a hundred-dollar-a-month welfare payment to every 

senior. And he said, we all knew that couldn’t survive very long because the country doesn’t like welfare. So he said, I strongly supported Social Security. And old Doc Townsend came into my district and helped organize Townsend clubs; and he said, they beat 

me. 

The point of the story is this: We look today, shortly after the 

health reform bill is passed, and we see all of these little fights 

that we had—regional, ideological, philosophical—but I think 20 or 

25 years from now we are going to look back at the bill and say, 

what on Earth was that fight all about? How on Earth could we 

ever have functioned without this program? I think all of these little fights that were so important to people as we were going 

through them, none of them are going to be remembered. What will 

be remembered is that we finally put this country in the rank of 

civilized societies that do not require people with very little money 

to beg in order to get health care. That, to me, is basically the lesson of Gerry Boileau’s story. 

I mean, I lost a whole lot more fights than I won on the health 

reform bill. I favored public option. I have no objection to single 

payer. I, frankly, didn’t care as long as we got two things, as long 

as we covered as many people as possible and as long as we 


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changed the rules of the game so that little people weren’t 

squeezed by corporate giants called insurance companies. That is 

basically all I wanted. Everything else is candy. 

I just want to thank you for the work that you did on this package and to thank everybody who voted for it and to thank those 

who opposed it and raised constructive questions along the way. 

Because, to me, regardless of all these little debates that we had, 

the obligation that all of us have now is to simply try to make it 

work and to think through whether there have to be adjustments 

down the line, make certain we have got plenty of oversight, and 

especially make certain we have got a huge expansion of our efforts 

to go after waste, fraud, and abuse. Because you have got lots of 

jerks in this society who will try to take advantage of this and rip 

off the taxpayer and rip off customers. If we believe in expanding 

these services, we just can’t let that nonsense happen. 

Secretary SEBELIUS. Well, I appreciate that, Mr. Chairman. 

I spent Easter weekend with my father, who turned 89 on the 

22nd of March. He served in the United States Congress on the Energy and Commerce Committee 45 years ago when Medicare was 

passed. He told me a number of stories about how ferocious that 

battle was, how ferociously a number of people opposed Medicare’s 

passage, and how differently it looked then than it does now, where 

he is now a pleased beneficiary, and reminded me that over 45 

years there have been changes, there have been a number of improvements, but the basic tenet that, once you turn 65 in this country, that you have health security, was a promise made then and 

a promise that we intend to keep now. It was interesting having 

his historic perspective on the beginning of this new chapter in 

American health security. 

Mr. OBEY. Thank you. I am going to have to go over to the House 

for action on a bill that is going to be pending shortly. And so if 

I have to leave before the hearing is done, it is nothing you said. 

I just have to get over there. 

Secretary SEBELIUS. I am pleased to hear that. 

Mr. OBEY. I will ask Ms. DeLauro to take over if we are not 

done. Meanwhile, I would like to run a second round for about 3 

minutes apiece. 

Mr. Tiahrt. 

UNFUNDED PROGRAMS IN HEALTH REFORM

Mr. TIAHRT. Thank you, Mr. Chairman. I want to remind you the 

hearing isn’t done, so maybe there will be something come up that 

won’t make you want to leave early. 

One of the things that concerns me greatly is about the cost of 

this. Because, quite frankly, we have overspent this year by more 

than $800 billion this fiscal year. We know that there are at least 

80 programs that are in the bill that require discretionary appropriations, and we have about $110 billion for these 80 programs. 

There are also 36 programs, at least—three dozen programs—that 

are open-ended. 

I have asked the Congressional Budget Office to give us some estimate as to what they are going to cost. They don’t sound like very 

cheap programs. Of the 36, community health insurance option, design and implementation of regional systems for emergency care, 


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trauma care centers and service availability, oral health care prevention activity, programs relating to congenital hart disease, 

multi-State qualified health plans, community-based collaborative 

care networks, to name a few. 

So, in addition, it is my understanding the CBO has estimated that CMS and the IRS will need an additional $20 billion in order 

to set up the systems just to implement ObamaCare. So has your 

Department developed a cost estimate for all these new programs 

that are not in the President’s budget, and when will you be sending an addendum to the President’s budget for next year to cover 

these costs, and where will the money come from? 

Secretary SEBELIUS. Well, Congressman, you have our 2011 

budget presentations; and there is not an intent to send an addendum to the budget. 

Mr. TIAHRT. How will you cover the cost of these programs that 

are not in the budget? It says in the law such sums as required. 

Where are such sums going to come from? 

Secretary SEBELIUS. Well, my understanding is, the way that 

process works, if there isn’t authorization in the bill itself, this will 

be a discussion that you and your colleagues will have here in Congress. 

Mr. TIAHRT. So we are going to have to come up for the funding 

for these programs? 

Secretary SEBELIUS. If the priorities are to move ahead on those 

programs, I assume they will be funded. But you have our 2011 

budget submission before you. 

Mr. TIAHRT. So the 302(a) allocation that we have and the 302(b) 

allocation for your Department right now doesn’t have a request 

from the President for such sums as required on these 36 programs. 

Secretary SEBELIUS. That is correct. 

Mr. TIAHRT. So, Mr. Chairman, where are we going to get the 

money for these programs that we don’t have any budget for and 

we won’t have any allocation for? 

I guess he is involved in another conversation. 

My concern is that we don’t have the funding for this and we 

have no idea how much it is going to cost and, again, we don’t 

know where the money is coming from. China is not lending us 

money on long-term Treasury bills now. The Fed has loaned money 

to the United States. They already owe us—or we owe them $5.5 

trillion as taxpayers. Where is the money going to come from? 

Secretary SEBELIUS. Congressman, again, I think that the programs are likely not to exist unless they are funded by Congress. 

That is not currently part of the authorized bill. I think the very 

good news for the American public is that, unlike the last major 

health initiative move forward, the prescription drug benefit, this 

bill is paid for. It is paid for over time. In fact, the Congressional 

Budget Office has estimated an $100 billion decrease in the deficit 

in the first 10 years and closer to a trillion dollars decrease over 

the next 10 years. This is fully paid for over the life of the program. 

Mr. TIAHRT. You can’t count Medicare dollars twice. We are taking money out of Medicare and adding them to the program that 

you are going to administer. Where is the money for the $500 billion for Medicare? There are a lot of programs, Mr. Chairman, that 


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don’t have funding. They are not in the President’s budget. We 

won’t get the allocation for them. I am just wondering how we are 

going to fund them. 

Mr. OBEY. First of all, the gentleman’s time has expired. 

But let me simply answer the gentleman’s question by saying 

there is a big difference between programs that are authorized and 

programs that are mandatory. These are not mandatory programs, 

to my understanding. 

Mr. TIAHRT. Are we not going to fund the community health insurance option, the oral health care prevention activities? 

Mr. OBEY. Given the fact that we have a good $17 billion hole 

in the budget on Pell Grants, I have no idea what we are going to 

be funding on anything. 

Mr. TIAHRT. Thank you, Mr. Chairman. 

Mr. OBEY. I don’t think anybody else does, either. 

Who is next? Ms. Roybal-Allard. 

UNDERAGE DRINKING

Ms. ROYBAL-ALLARD. Secretary Sebelius, Congresswoman 

DeLauro and I have been working together for over 10 years to reduce the dangerous incidence of underage drinking in this country, 

and we were very pleased that your administration recommended 

an increase to the STOP grants this year to enable more communities to address the critical problem. We have heard, however, 

that the HHS is looking to further expand its efforts in underage 

drinking prevention. 

The questions that I have are, first of all, CDC and NIH are recognized leaders in developing evidence-based strategies on underage drinking. So what are you doing to ensure that the rest of HHS 

uses their guidance and guidelines in implementing programs directed at preventing and reducing underage drinking? How will 

you ensure that the State public health agencies with their own 

rich experience in tobacco control and other public health insurance 

are fully engaged in collaboration with State substance abuse agencies? And what will be the roles and resources available to the various HHS agencies to ensure that all of this happens? 

Secretary SEBELIUS. Congresswoman, as you say, we do have a 

recommended budget increase for the STOP Act. I think that is a 

step of directing more resources. 

We also have a talented new leader in the agency as my Assistant Secretary of Substance Abuse and Mental Health Services, 

Pam Hyde, who not only has run State systems but has worked in 

the private sector and run medical systems and is very tuned into 

this issue and is very much at the table looking at collaborative 

strategies. 

So we have the Substance Abuse and Mental Health Services Administration at the table. We have our scientific-based evidence 

from CDC and the strategies that work on the ground, and we are 

working in collaboration with State and local partners to make 

sure what we know is effective actually is drilled down. So this is 

an effort. 

One of the things that the President made clear to all of his Cabinet officers is that he wants us to leverage our assets not only 


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across departments but within our own agencies. So we have a 

number of cross-agency collaborations, and this is one of them. 

SECTION 317 VACCINATION PROGRAM

Ms. ROYBAL-ALLARD. That is great to hear. 

In fact, you mentioned in an earlier statement, the 317 vaccination program. This program historically has been used for vaccinating children. However, each year, hundreds of thousands of 

American adults are hospitalized and tens of thousands die from 

diseases that could have been prevented through vaccination. 

It is estimated that the cost of the health burden to society from 

vaccination-preventable diseases is approximately $10 billion annually. How will HHS use existing funding streams to address the 

issue of increasing adolescent and adult vaccinations, and has the 

Department considered developing an adult immunization strategy? And, in particular, what could be done to increase vaccination 

rates among health care workers? 

Mr. OBEY. If we could have a fairly short response, please. 

Secretary SEBELIUS. We are working on this. I was just at the 

44th annual vaccination week-long conference. We learned a lot of 

lessons from H1N1 that we intend to apply across the board, and 

one of them is how to deal more effectively with not only minority 

communities but with health care workers. 

Ms. ROYBAL-ALLARD. Hopefully, we can follow up on this. 

Mr. OBEY. Mr. Cole. 

Mr. COLE. Thank you, Mr. Chairman. 

I was listening to that wonderful story about Gerry Boileau. And 

I must say, the moral I drew was that progressive Republicans always get beat by liberal Democrats that say they love them. So it 

is kind of a warning story there for me. 

On a more serious note, I share Mr. Tiarht’s—— 

Mr. OBEY. But he got beat by another Republican. 

PROJECTED COVERAGE RATES

Mr. COLE [continuing]. I share Mr. Tiahrt’s concern about some 

of the financial bases of the bill, the one he particularly highlighted 

about the transfer of Medicare funds out for, really, a new entitlement program at a point when we have a baby-boom generation 

hitting Medicare age. I just don’t think it is going to hold. 

Let me ask you about another part of it that concerns me greatly, 

Madam Secretary. Right now we assume that there is—and I think 

you said the majority of people moving into the system would be 

insured by private insurance. I am not 100 percent sure that is accurate, because the numbers I saw suggested about half were going 

to be, actually, Medicaid patients. So, at best, it is pretty close as 

to whether they are going to be purchasing insurance. 

And, as I understand the bill, frankly, those younger people are 

going to have an option—well, it is, quote, ‘‘mandatory.’’ They can 

pay a penalty as opposed to just buy insurance. The penalty that 

I have seen is cheaper than the insurance. And I would suggest a 

lot of them are going to do what most people in their 20s and early 

30s do, and that is take the cheaper road out. Whether that is wise 

or not is debatable, but I think that is true. 


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So how confident are you that the new people showing up to be 

insured, given the fact that many of them are Medicaid and given 

the fact that many of them have a way out when they are young 

and healthy, are actually going to provide the revenue stream that 

the bill envisions? 

Secretary SEBELIUS. Well, Congressman, the experience in Massachusetts, which is one that we looked to—and there are other 

States who have—Wisconsin, again, has a pretty near-universal insurance avenue. But in Massachusetts, a fairly similar structure— 

an individual mandate with a relatively low penalty for failing to 

buy insurance, plus a hardship waiver—has produced 97, 98 percent insurance coverage. 

The experience that they have found is that people really wanted 

insurance; they just felt that there were too many financial barriers or health barriers, frankly, to get into the marketplace. 

So, at least in the instance that that fairly similar structure has 

been tried, there actually was a very robust take-up in spite of 

some skeptics who thought that people would opt out if they were 

younger and healthier. 

PHYSICIAN-OWNED HOSPITALS

Mr. COLE. Let me ask you—my time is about to run out, and it 

is a totally unrelated question. But one of the provisions of the bill 

that really concerned me, the treatment of physician-owned hospitals—and I realize there is a philosophical divergence in Congress over that particular issue. In my State, they are some of the 

highest-performing hospitals that we have. By every rating they 

provide excellent care, and we have been very pleased with them. 

What is the general attitude of the administration toward physician-owned hospitals, looking forward? 

Secretary SEBELIUS. I can honestly tell you I haven’t ever been 

involved in a, sort of, philosophical discussion. There isn’t any directional discussion. I think it has more come from Congress, 

frankly, and the alarm in certain areas of the country of the proliferation to what some have seen as the disadvantage of community hospitals trying to run emergency rooms and contributing to 

graduate medical education and then being cherry-picked by provider-based hospitals. 

But I don’t think the Department, itself, has a directional strategy. It really is looking at high-quality, cost-effective health-care 

delivery. And, as you say, some are in physician-owned hospitals 

and others are sometimes in community hospitals. But that is really our goal. 

Mr. COLE. I would just say in closing on that, just so you know, 

in our State most of the physician-owned hospitals operate emergency rooms, they take Medicare patients. So they really stack up 

pretty favorably. And I would just commend you to consider that 

as one of the models, going forward. I am glad to hear that there 

is not an administration position per se. 

Thank you. 

Mr. OBEY. Mr. Honda. 

CHILDREN’S HEALTH TASK FORCE

Mr. HONDA. Thank you, Mr. Chairman. 


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The health reform issues are also going to be including our concerns of children’s health issues. And children probably compromise 

50 percent of our Medicaid rolls. Will there be any thought about 

establishing a children’s health task force? 

And leading up to that, my county of Santa Clara County recently has had the third-highest rate of TB in California, and it has 

really grown from almost an elimination of TB in our county to 

being third in the State of California. 

Given that rise and given the work that you are going to be required to do, as far as travelling and everything else like that, I 

was just concerned that you had sufficient resources to be able to 

do the kind of travel and create the kind of presence that is going 

to be expected when you are going around the country to make the 

negotiations and be an advocate for this program. 

Those two questions, if I could have a quick response. 

Secretary SEBELIUS. Congressman, I think in terms of the travel 

and presence responsibility, cloning would come in very handy in 

this instance, because I do think there is a lot of confusion and concern and also a lot of eagerness about people wanting to know 

about the bill, how it is going to work, how it is going to be implemented. And I can assure you, I am going to do my best, as are 

lots of members of our department, to be out and about everywhere. 

The Children’s Health Insurance Program, which you all extended in 2009 prior to the passage of the Affordable Care Act, I 

think is a great focus on making sure that children have appropriate intensive care, particularly at the youngest ages. And we are 

undergoing a very aggressive outreach effort in conjunction with 

faith-based and neighborhood groups, with health-care providers, 

with State and local partners, to identify and enroll the approximately 5,000,000 children who are eligible but currently not enrolled. It continues to be a challenge. 

The good news is, even last year in very difficult budget times, 

States and local governments signed up an additional 2,500,000 

American children. We would like to see that continue to rise. And 

I think that, as you know, the SCHIP program continues during 

the life of the Affordable Care Act. And I think that is going to 

focus that kind of attention and services on the children’s population and one that we take very seriously. 

Mr. OBEY. Mr. Ryan. 

FORUM HEALTH BANKRUPTCY

Mr. RYAN. Thank you, Mr. Chairman. 

Madam Secretary, you know Ohio well. I represent a district in 

Youngstown and Akron. And in the city of Youngstown, we have 

two health-care systems. One of them is Forum Health, which employs approximately 4,000 people in the region, and it is now trying 

to emerge from bankruptcy. Youngstown has about a 15 or 16 percent unemployment rate. The city of Warren has one very similar. 

In adding 30,000,000 new people to the system and many in Ohio 

and western PA, I don’t think now is a good time to see a hospital 

close down. And I was wondering if there is anything in your sights 

or from the administration that could help address this issue. 


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Secretary SEBELIUS. Well, my understanding is we solved one of 

the problems, in terms of a payment stream that will continue during the discussion, which I think is important. And, again, I think 

that the framework of having a payment system under the individuals who will seek hospital care in the future is a big step forward. 

And hospitals have really struggled. 

I also think that there were huge improvements made in the bill 

over the course of the discussion dealing with disproportionate 

share allocation, where originally there was a thought that it could 

disappear entirely, and I think that was recalculated appropriately 

based on the fact that there are huge disparities in terms of the 

patient load that is likely to hit various hospitals. 

But I think you are absolutely right that we need a robust 

health-care delivery system. And it is something that we are going 

to be working with local communities, looking at ways we can provide resources in this kind of bridge strategy to make sure they 

continue to provide services. 

Mr. RYAN. Well, in the meantime, until 2014 when everyone 

comes in, I mean, hospitals like this could potentially close down. 

And I think in the Department of Agriculture there are some loan 

guarantees. And maybe we can come up with some ways to help 

these hospitals refinance. Because, you know, between now and 

then, a lot could happen, and the other hospital in town can’t handle the influx that they could potentially receive. 

Secretary SEBELIUS. With the Community Development Block 

Grant money, I think which is in HUD, and some other funding 

streams, I think we have to be more creative about bringing other 

agencies in. HHS really doesn’t have either operational money or 

construction money, with regard to hospitals. But I think having 

that dialogue with my Cabinet colleagues is something that I am 

going to pursue, because it has come up in a number of areas, and 

it is a very critical piece of the health-care system. I think just like 

closing a school in a small town, you can’t close a hospital, or people won’t stay in the community. 

Mr. RYAN. Right. So I look forward to working with you on that, 

because it is urban development, it is health, it is education, it is 

everything. So I appreciate that. 

Mr. OBEY. Ms. DeLauro. 

FOOD SAFETY

Ms. DELAURO. Thank you, Mr. Chairman. 

Madam Secretary, let me just ask a food safety question of you. 

The volume of FDA-regulated imports has increased substantially 

over the past decade. The statistics say that FDA recorded 

8,200,000 imported food lines in 2007; fewer than 2,800,000 entry 

lines a decade earlier. 

You have just over 1 percent of these lines that were physically 

examined and/or tested. It is often reported that, even with increased funding that the Congress has provided to the agency in 

these past 3 fiscal years, the FDA will still inspect less than 2 percent of import lines in 2011. 

This is mainly because the FDA relies on a very weak border inspection system. I also might add that there are indications that 


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there potentially will be more inspectors but we could have fewer 

inspections. 

Again, can you tell us how do you think the FDA can improve 

in this area? There is the FDA food safety bill pending before the 

Congress in the Senate. How can that help to change this equation? And how do we deal with improving the inspection ratios in 

the next 5 years? 

Secretary SEBELIUS. Well, Congresswoman, first of all, thank you 

for your long-time leadership and expertise and interest in this 

area. And it is one that has changed dramatically over time. We 

no longer have an American-based food system, and I think that 

the regulatory framework is 20th-century at best and the system 

is global and increasingly global. Half our fruits and vegetables 

come from outside our borders; about two-thirds of the seafood 

comes from outside our borders, just to name a couple of products. 

No question that the new framework passed by the House and 

pending in the Senate is a huge step forward and has a lot of the 

expertise of this committee’s stamp on it—not this committee, but 

your expertise as part of moving that ahead. 

I do think that part of the strategy also is the FDA establishing 

a much more robust footprint in other parts of the world. So there 

are now four new offices in China, there are offices in Mexico, there 

are offices elsewhere, to not wait until products actually come 

across the borders, but look at the origins of those products. 

Secondly, I think it is critical that we have a much more robust 

and a different relationship with the private sector. The food industry often takes the hit. At a time of a recall, they have enormous 

financial risk, but have been, I think, not as engaged and involved 

in self-reporting, identification, quick recalls. The FDA needs some 

additional subpoena power and automated recall power, but also 

engagement of the industry at a much earlier stage, which, again, 

is part of the framework moving forward. 

Ms. DELAURO. Mr. Chairman, just one final comment. 

I just would say this to you, Madam Secretary. For years and 

years and years, the whole issue has been that trade in this area 

of food safety has trumped public health. I will be vigilant—I am 

hopeful, but vigilant that that will continue not to occur, that trade 

will get in the way of what we can do with regard to the public 

health as it regards food safety. Thank you. 

Thank you, Mr. Chairman. 

Mr. OBEY. Thank you. 

Madam Secretary, thank you for being here. We kept you a few 

minutes over, but not much. Good luck to you. 

Secretary SEBELIUS. I appreciate it. Thank you so much. 


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(279) 

WEDNESDAY, APRIL 28, 2010. 

FY 2011 BUDGET OVERVIEW: NATIONAL INSTITUTES OF 

HEALTH 

WITNESSES 

FRANCIS S. COLLINS, M.D., PH.D., DIRECTOR, NATIONAL INSTITUTES 

OF HEALTH 

ANTHONY S. FAUCI, M.D., DIRECTOR, NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES 

THOMAS R. INSEL, M.D., DIRECTOR, NATIONAL INSTITUTE OF MENTAL 

HEALTH 

GRIFFIN P. RODGERS, M.D., DIRECTOR, NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES 

CHAIRMAN OBEY OPENING STATEMENT

Mr. OBEY. Good morning, everybody. 

Today we will hear from a variety of witnesses on the President’s 

request for the National Institutes of Health. We will have as a 

principal witness Dr. Francis Collins, who has been here many 

times in his former role as the Director of the National Human Genome Research Institute at the National Institutes of Health 

(NIH). This is his first appearance before the Subcommittee in his 

new capacity as the Director of NIH. 

Accompanying Dr. Collins is Dr. Tony Fauci, Director of the National Institute of Allergy and Infectious Diseases; Dr. Tom Insel, 

Director of the National Institute of Mental Health; and Dr. Griffin 

Rodgers, Director of the National Institute of Diabetes and Digestive and Kidney Diseases. 

I think it is fair to say that supporting the work of NIH has been 

a priority of this Subcommittee, certainly for as long as I have been 

in the Congress, and I am pleased that the President has, in the 

context of a tight budget situation, still provided a request for a 

$1,000,000,000 increase proposed for NIH overall. 

Depending upon how you measure it, NIH has either had a 

meaningful increase in spending over the past 30 years or it has 

had a spectacular increase in funding. NIH was spending 

$1,800,000,000 when I joined the Subcommittee in 1973. The current fiscal year budget provided NIH with $31,000,000,000, so that 

is 16 times what it was spending when I joined the Committee, 

which sounds awfully big except that it is not adjusted for inflation. 

When you adjust it for inflation, we have not quite doubled in real 

dollar terms funding for NIH over that period. 

We have had, I think it is fair to say, a mixed bag with respect 

to success against various diseases. With some, childhood leukemia, we have had significant gains. We certainly have had gains 

in holding at bay, somewhat, AIDS in comparison to what we 

feared when the Subcommittee first started talking about it. And 


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yet there are other areas where very little progress has been made; 

example, pancreatic cancer, esophageal cancer, and a variety of 

other maladies. 

So today we want to hear from these witnesses about not only 

what they intend to do with their money, but what their observations are in terms of how we can develop a better track record in 

the future in attacking diseases that have not been the subject of 

much progress over the past two decades. 

And I have to say one thing before I ask Mr. Tiahrt for his comments. I have always been rather disappointed that, in my many 

conversations with people in the medical field, with providers in 

the field, that the discussion, when it turns to health care, so often 

is focused simply on issues such as reimbursement rates, what are 

hospitals going to get by way of compensation, what are doctors 

going to get paid. 

And that is all very legitimate, but I have personally been struck 

by the lack of comment or curiosity or, for that matter, the lack of 

visible political support for added medical research which, after all, 

lays the foundation for the product that the practitioners in the 

health care area have to offer their patients and their customers. 

So I think while there are many activists who have, for years, 

been pushing for additional funding for National Institutes of 

Health, I think in some ways I have been disappointed by the lack 

of aggressive activism on the part of so many professionals in the 

field. And I am not quite sure what to do about that, but I know 

since Dr. Collins is a very smart fellow, he will have an answer to 

that and everything else. 

The other thing I want to say, Doctor, I want to express my personal appreciation for the fact I think you have, by your public 

statements, made it quite clear that one does not have to believe— 

I am saying it backwards. You have made it quite clear that there 

is not necessarily any inconsistency between pursuit of science and 

the belief in religion. To me, I have never understood why people 

think that the two are at loggerheads; that has never been my conclusion either intellectually or emotionally. So I appreciate the role 

that you have played in driving that point home as well. 

With that, let me simply turn to Mr. Tiahrt to see what comments he might have. 

Mr. TIAHRT. Thank you, Mr. Chairman. It is always a mystery, 

what I am going to say, is it not? 

I am very pleased to see you gentlemen here today. Thank you 

for coming; appreciate your time. Dr. Collins, I am enjoying the 

Language of Life. The first chapter caught my attention when you 

say we are not in Kansas anymore. Being from Kansas, you do not 

know how many times I have thought that here in the District of 

Columbia. 

I think you do present genetics at a level that can be understood, 

and I think that is very important for our culture today. But certainly DNA research is proceeding at a very fast pace, and one of 

the concerns that I have is what we call the valley of death, the 

gap between our basic research and clinical development. 

We seem to have this void in the middle where we cannot get it 

into action sometimes, and you are coming across very critical research, and we want to find mechanisms to get it into the clinic 


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and get it into applying; I guess because I feel like basic research 

will not do us any good unless we get it in a practical application 

for those of us out here. And that is why we make the investment, 

so that we can get it into the clinics and into the cures. 

I am pleased to see that there are initiatives that are relatively 

new in your budget request, particularly the Therapeutics for Rare 

and Neglected Diseases, or TRND. I think that is exactly the type 

of effort we need to focus NIH’s resources so that we can get across 

this valley of death and start funding cures. 

So I look forward to your testimony and I have some questions 

once we get through it. 

Thank you, Mr. Chairman. 

Mr. OBEY. Mr. Lewis. 

Mr. LEWIS. Thank you very much, Mr. Chairman. I will wait to 

ask questions after we have heard from the witnesses. I appreciate 

being recognized. 

Mr. OBEY. All right. Dr. Collins, please proceed. Take as much 

time as you want, within reason. [Laughter.] 

DR. COLLINS OPENING STATEMENT

Dr. COLLINS. Well, thank you, and good morning, Mr. Chairman 

and distinguished members of this Subcommittee. It is a great 

honor to appear before you for the first time in my role as the Director of the NIH and to present the fiscal year 2011 budget, but 

especially to discuss my vision for the future of biomedical research. 

I would like for my written testimony to be included in the 

record. I am going to deviate from it quite a bit in my remarks this 

morning. 

So I would like to thank each of you for your steadfast support 

of NIH’s mission, which, as you can see—and I am going to show 

a few visuals on these screens—is a dual one: to support the discovery of fundamental knowledge about the nature and behavior of 

living systems, but to be sure that we are then applying that to extend healthy life and reduce the burdens of disability and premature illness and death. 

I want to thank the Committee for the support in fiscal year 2010 of $31 billion, as well as the $10.4 billion that was provided 

through the American Recovery and Reinvestment Act. And I have 

been very grateful, over 15 years leading the Human Genome 

Project, for the support of this Committee. As you know, that 

project finished ahead of schedule and under budget, and was supported strongly by this Congress and by this Committee even at 

times when there were controversies about it. 

But now, as steward of the entire portfolio of NIH, I believe that 

opportunities to turn discovery into health have never been greater. I am honored to have with me this morning three distinguished 

leaders from NIH that the Chairman has already introduced, Dr. 

Rodgers, Dr. Insel, and Dr. Fauci, and I am sure they will be happy 

to also engage you in the questions. 

But I also want to introduce you to some other folks today, just 

a few of the millions of Americans who have been helped by NIHfunded research. And let us begin with Kate Robbins. So let us 

hear from Kate. 


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[Video shown.] 

KATE ROBBINS. The message I got is make your plans, get your 

life in order, and enjoy the next few months; and I was enraged. 

[End of videotape.] 

Dr. COLLINS. So eight years ago, at the age of 44, this non-smoking mother of two was diagnosed with lung cancer and given a diagnosis essentially of terminal disease. She had non-small cell lung 

cancer that had already metastasized to her brain. And it continued to spread, after surgery, radiation, and chemotherapy, to her 

liver, her pancreas. But she enrolled in a clinical trial of a new 

drug called Iressa, or gefitinib, which is a new genome-based drug 

for cancer. And after Kate started the drug, dramatic things happened: most of her metastases vanished. 

As you can see in these CT scans of her liver before and after 

Iressa—this is before, six months later, and then today, seven and 

a half years later, those metastases shrank and disappeared and 

have not returned. There is no sign of cancer in her liver, her 

lungs, her pancreas. Her brain metastases are small and manageable; and, as you saw in the video, she is doing extremely well. 

So why does not Iressa work in all cases? Well, we understand 

that. The response depends on whether or not the tumor has a specific mutation in a gene called EGFR. And we now understand 

that, which demonstrates the potential of personalized medicine. 

This drug is a god-send for that subset of individuals with those 

mutations, but it is unlikely to work if that mutation is not 

present. 

We need a lot more stories like Kate’s, so NIH-funded researchers are now busy with projects like the Cancer Genome Atlas, mapping genomic changes in many types of cancer, including, Mr. 

Chairman, pancreatic cancer, which I agree is one where we desperately need new solutions. 

Next, I would like you to meet nine-year-old Corey Haas; his parents, Nancy and Ethan, shown up here in this photo. Corey was 

born with a disease which has quite a mouthful, Leber’s congenital 

amaurosis, and it is a cause of blindness; it gradually robs young 

people of their sight. It is caused by mutations in a gene called 

RPE65. 

Now, by age seven Corey was legally blind; he needed a cane to 

get around, had to use a special computer screen. But that all 

changed in 2008, when Corey enrolled in a gene therapy trial at 

the University of Pennsylvania, which involved injecting normal 

copies of this RPE65 gene into his left eye. Researchers shot this 

video, then, of Corey navigating an obstacle course, and let me explain here. I am going to show you a video that is in the lower left 

here. 

Basically, Corey is being asked to walk a maze pattern. There 

are arrows painted in the floor. In this image they have covered up 

his treated eye, so he is only able to navigate based upon the untreated eye; and you will see that he is very, very limited in his 

eyesight. 

[Video shown.] 

Unidentified SPEAKER. You do not see any lines on the floor that 

tell you which direction? 

COREY HAAS. No. No, I do not. 


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Unidentified SPEAKER. Do you want a clue? 

COREY HAAS. I cannot even see anything. 

Unidentified SPEAKER. Okay. 

[Video paused.] 

Dr. COLLINS. Now see what happens when they repeated the 

trial, same day, but now covering up his untreated eye and allowing him to use the eye that has received the gene therapy to find 

his way around. 

[Video resumed.] 

Unidentified SPEAKER. Okay, perfect. All right. And you can start 

whenever you are ready. 

Wow. Wow. 

[Applause.] 

[End of videotape.] 

Dr. COLLINS. Pretty amazing, though Corey is probably even 

more amazed he can ride a bike now and read the chalkboard like 

any other kid. 

Now finally meet Leslie Cook, a wonderful example of prevention-oriented research. Leslie smoked for 25 years, half of her life, 

a habit that put her at increased risk for heart attack, cancer, and 

many other diseases. 

[Video shown.] 

LESLIE COOK. I felt as though the drug nicotine was actually controlling me, I was not controlling it, and I just wanted control over 

my life again. 

[End of videotape.] 

Dr. COLLINS. So this high-powered real estate lawyer tried to 

kick the habit many times; she used the gum, the patch. You name 

it, she had tried it. Nothing worked. And then in 2006 she enrolled 

in a phase 2 clinical trial of an anti-nicotine vaccine called NicVAX. 

This vaccine actually stimulates the immune system to produce 

antibodies against nicotine. Those antibodies bind to the nicotine 

and keep it from entering the brain, therefore reducing the pleasure associated with smoking. 

NicVAX apparently did the trick for Leslie; she has not smoked 

in three and a half years. 

Now, hopefully her experience will soon be repeated on a much 

larger scale. A clinical trial of NicVAX involving about 1,000 smokers was recently launched. About $10 million in NIH Recovery Act 

funds are being used to support that effort, which is rooted in research-funded at NIH, and it is the first ever phase 3 trial of a 

smoking cessation vaccine. 

So I would like to thank Leslie, Corey, and Kate for allowing me 

to share their stories. I think their experiences show that science 

is not a 100-yard dash, it is a marathon. Each of those built upon 

years of research getting to that clinical advance. But thanks to 

discoveries you have funded through NIH appropriations, we have 

covered a lot of ground in this marathon. 

Let me tell you how NIH plans to meet that continuing challenge, because there is still a ways to go. 

So one of my first actions upon being named NIH Director was 

to scan the landscape of biomedical research for areas that were 

ripe for major advances that could yield substantial benefits downstream, because this is a unique time. While the list of specific 


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projects could go on forever, I have identified five areas of exceptional opportunity I want to very briefly tell you about, and they 

are in a paper that you have at your place published in Science 

Magazine on January 1st. 

The first of those opportunities is to use the high throughput 

technologies that have recently been invented to understand fundamental biology and how disease occurs. This includes genomics, 

nanotechnology, imaging approaches, computational biology, and a 

host of other new technologies that are truly powerful to understand the causes and the means to treat or prevent cancer, autism, 

infectious diseases, and a long list. 

A second opportunity—and this ties very much into what Mr. 

Tiahrt was asking about—is the effort to take these basic science 

discoveries that are pouring out of research laboratories and accelerate the translation of this into new and better treatments. This 

is not an easy process, as the picture shows you; there can be a difficult passageway between basic research and drugs. We need to 

build a bridge—by the way, that is San Francisco, in case the first 

picture was not so clear—and we are doing that with programs like 

TRND, which stands for Therapeutics for Rare and Neglected Diseases. 

And in the health care reform bill the cures Acceleration Network, which is a new provision that would give NIH additional 

flexibility to push this translational agenda even more robustly and 

in a more innovative way. And this includes cell therapy as well, 

the effort to use stem cells for therapeutics. If you noticed in this 

morning’s Washington Post, we have now approved another set of 

stem cell lines, bringing the total to 64 that are available for use 

by federally funded researchers. 

The third opportunity here, shown by these various banners representing programs that NIH has supported particularly to try to 

get information out there about the public health, is to put science 

to work for the benefit of health care. We, after all, need evidence 

to support the transformation of the practice of medicine that we 

all agree is necessary. Some of that is comparative effectiveness research, personalized medicine, the study and the attempt to solve 

health disparities, the efforts to focus on behavioral medicine; and 

even on health care economics, to understand what are the factors 

that play into better outcomes at lower cost. 

The fourth area, global health. Clearly we have a great opportunity now because science has moved forward rapidly in uncovering the nature of many pathogens that we previously did not understand that affect hundreds of millions of people in the developing world. We have the chance to push that agenda forward, 

building upon what NIH has done already in the past and focusing 

now not only on infectious diseases, but also on noncommunicable 

diseases like depression, which also become, in the developing 

world, major public health problems. It is the noncommunicable 

diseases that represent the most rapidly growing area of morbidity 

and mortality. 

And, finally, and fifth, we need to reinvigorate and empower our 

biomedical research community, our most important resource. That 

means we need to focus on innovation, making sure that we are 

giving ideas that are a little wacky and out of the box a chance to 


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get supported. We need to be sure that we are supporting earlystage investigators, giving them the confidence that there is a place 

for them in our research community, even at times when budgets 

are tight. And we need to focus on training the next generation, 

and particularly reaching out to diverse communities that are not 

adequately represented right now in our workforce. 

Those are the five themes that I have focused on. You also have 

at your place a new document that has just come out from NIH 

that talks more about these, and also the many advances that have 

occurred because of NIH research over the last few years. 

So, to summarize, if our Nation is bold enough to act today upon 

these unprecedented opportunities in medical research, I think we 

will be amazed at what tomorrow can bring. In the world I envision 

just a few decades from now, the one-size-fits-all approach to medicine will be a thing of the past. We will use genetic information to 

personalize our health care. We will use stem cells to repair spinal 

cord injuries; bioengineered bones and cartilage to replace worn out 

joints; nanotechnology to deliver therapies with exquisite precision. 

We will preempt heart disease with minimally-invasive image-guided procedures and use an artificial pancreas or other new technologies to manage diabetes better. 

As for infectious diseases, I look forward to having a universal 

vaccine with the power to protect against both seasonal and pandemic flu. I also hope, and that hope is based upon progress, for 

an AIDS vaccine and a malaria vaccine, which together would save 

millions of lives around the globe every year. 

And I dream of a day where, in ways yet to be discovered, we 

will be able to prevent Alzheimer’s disease, Parkinson’s disease, 

and many others that rob us much too soon of family and friends. 

Just imagine what that future could mean for our Nation, our 

economy, for all humankind. This is what keeps NIH in the research marathon and why we are asking you to go the distance 

with us. The fiscal year 2011 request for NIH from this Committee 

is $32 billion, an increase of $1 billion, or 3.2 percent above the fiscal year 2010 level. Those funds will enable the nationwide biomedical research community to pursue a whole number of substantial opportunities for major scientific and health advances. 

So thank you, Mr. Chairman and members of the Subcommittee. 

I would be pleased to respond to any questions you may have. 

[Written statement by Francis S. Collins, MD, PhD, follows:] 


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Mr. OBEY. Thank you. 

Mr. Tiahrt. 

COMPARATIVE EFFECTIVENESS RESEARCH

Mr. TIAHRT. Thank you, Mr. Chairman. 

Just reading on personalized medicine in this new publication 

here. I think one of the concerns I have had with the comparative 

effectiveness money that we have invested is that the good side of 

comparative effectiveness is we see what works and we communicate it well to physicians and clinics and hospitals and treatment 

centers. The part that concerns me is that when we start placing 

a dollar value on comparative effectiveness, that at some point we 

start making decisions based on costs that start rationing some 

care, rationing some treatments. 

And I think, during this health care debate that we have had 

over this past year and a half, that that has been part of the topic. 

Can you kind of give me some confidence that what we are doing 

at NIH now through comparative effectiveness research is not 

going to lead to rationing in the future. 

Dr. COLLINS. So, Mr. Tiahrt, I understand the concern. I think 

when we look at the kinds of research that NIH has done in the 

past and are planning to do now, the goal really is here to identify 

interventions that may be more effective and others that are less 

so, because evidence has to be valuable in making decisions about 

how we are going to put together a health care system that actually works. 

I might even ask my colleague, Dr. Rodgers, to tell you briefly 

about the Diabetes Prevention Program, the DPP, as an example 

of a comparative effectiveness research study that taught us something really important about how to prevent diabetes and which is 

now being implemented across the Country in a new and exciting 

way by United Healthcare. 

So, Griff, do you want to say a word about the DPP? 

Dr. RODGERS. Be very happy to. 

The Diabetes Prevention Program was a landmark study that 

was started over 10 years ago involving the NIH, the Centers for 

Disease Control and Prevention (CDC), and multiple institutes 

within the NIH, to identify those patients who are at high risk of 

developing diabetes. In this country, at the moment, there are 

about 24 million Americans who suffer with diabetes, but there are 

57 million Americans who are at high risk of developing diabetes 

based upon family history, racial and ethnic groups, the fact that 

they may be overweight or obese. And clearly we are understanding now that a lot of this has to do with the susceptibility 

genes for diabetes. 

This intervention, which was a comparative effectiveness study, 

involved patients being treated with just general instructions, a socalled placebo group; a second group with a standard therapy for 

diabetes, Metformin; and a third group with an intensive lifestyle 

modification. In these over 3,000 patients that were studied, there 

was about a 58 percent reduction in the risk of patients who are 

at high risk for developing diabetes who underwent this intensive 

lifestyle modification over the period of time. 


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That study was published in 2002, but just last year a follow-up 

study to that DPP, called the Outcome Study, was published which 

shows that there is an ongoing effect, even as long as 10 years. Patients who were randomized in this intensive lifestyle still maintain the ability to prevent or delay the onset of diabetes. 

Now, in a clinical research study, of course, we required one-onone counseling with these individuals, but it was clear that in 

order for this to be effective, we had to figure out a way to make 

it more reasonable and cost-effective. So we turned to the YMCA 

to do a translational study to determine whether—because, of 

course, YMCAs exist in all communities. We have estimated that 

most individuals in the U.S. live within a five-mile radius of the 

YMCA, and we wondered whether, rather than doing this on a oneon-one basis, if we do it in a group basis, whether we can cut the 

cost. In fact, we did. The cost for implementing this intensive lifestyle was reduced from the thousands down to $300 with the same 

effect. 

Mr. TIAHRT. Is that the dues at the YMCA? 

Dr. RODGERS. I am sorry? Yes. That is right. I have to say that 

this study was so effective, our colleagues at CDC got involved, expanded beyond the Indiana center that we initially funded, and 

just two weeks ago United Healthcare have, for the first time, decided to provide coverage for the use of this intervention at Ys and 

similar places to all of its members. Initially in six cities around 

the Country, but in fiscal year 2011 they plan to roll this out nationwide. 

Mr. TIAHRT. That is good, because diabetes is one of the leading 

causes for many things—amputation, blindness, heart disease. 

Dr. RODGERS. Absolutely. 

ADULT AND EMBRYONIC STEM CELLS

Mr. TIAHRT. One last question here, because my time is short. 

There are basically two kinds of stem cells—there is the adult and 

the embryonic—and you have come up with a third from skin cells 

that you can engineer. Can you tell me what the results have been 

as far as research? Which category has yielded the most results as 

far as getting cures available for people? 

Dr. COLLINS. Well, we are very interested in the research on 

stem cells and, of course, that is a very much discussed topic. Adult 

stem cells, as they are called, have been around longer and certainly bone marrow transplants, for instance, depend upon the idea 

that there are stem cells in the bone marrow that can expand and 

repopulate when needed. So we have the greatest clinical experience because that kind of study has been around for quite a while. 

Human embryonic stem cells have only been around for about 10 

years, and because of the concerns about safety and also some limitations in terms of who had the authority to work with those cells, 

we are not yet in a position of really knowing what their therapeutic potential might be, although many people are quite excited 

about that potential based on animal studies. There is so far only 

one Food and Drug Administration (FDA) approved trial for human 

embryonic stem cells, and that is for spinal cord injury, and it is 

too soon, by far, to know how that is going to turn out. 


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The most recent type, as you mentioned, derive from skin cells, 

the so called induced pluripotent stem cells, or iPS cells, are even 

much newer on the scene. Only about three years ago Shinya 

Yamanaka came up with this amazing observation that with just 

four genes you could take a skin cell and convince it to be 

pluripotent. 

The potential here is enormous, because that would mean these 

cells came from the individual, so they could potentially be used 

therapeutically without rejection by the immune system. But there 

are many concerns about safety, because pluripotent cells are also 

capable of growing when you do not want them to, and can even 

cause tumors. So we have to work that safety issue out very carefully before even beginning to propose a clinical trial. But I think 

there is a lot of excitement about getting there. 

I have just recently initiated an Intramural iPS Cell Center at 

NIH to try to accelerate our study of these cells and the way in 

which they could be used in therapeutics. 

Mr. TIAHRT. Thank you. 

Thank you, Mr. Chairman. 

Mr. OBEY. Ms. Lee. 

SICKLE CELL

Ms. LEE. Thank you very much, Mr. Chairman. 

Let me first thank you all for being here again and just say how 

important we all recognize and know that your work is at NIH. 

Following up on the issue that we have discussed, I think most of 

you were here on the A1C diabetes public awareness campaign. I 

wanted to see, Dr. Rodgers, if you had any kind of results, feedback 

from what took place. 

Just a bit of background. We learned—and I learned and we 

brought it to this Committee—and thank you for following up on 

this—that people who have the sickle cell trait, oftentimes the A1C 

test for diabetes gives or could give a false result, a false positive, 

false negative. So we developed a public awareness campaign to let 

physicians, labs, and what have you, and community clinics know 

that there are other tests. 

So I just want to see how that public awareness campaign developed, what were the results, and also could you clarify the whole 

issue around sickle cell testing? Is sickle cell testing required at 

birth? I know it is no longer required when people apply for a marriage license, for what that is worth. So how do we make sure that 

people are aware that they have the trait or, well, the disease or 

prone or susceptible to the disease? 

Dr. RODGERS. Thank you. Let me answer your second question 

first, and that is related to is it required to test for sickle cell disease. These are really done on a State-by-State basis, and it is my 

understanding that most States do now test at birth for the presence of the sickle cell protein. It can be done very easily, using 

blood samples to detect either sickle cell trait or sickle cell disease. 

When there are problems, the infant is called back and confirmatory tests are done. It is my understanding that most States currently do testing, but I would have to—— 

[The information follows:] 


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SICKLE CELL TESTING

Sickle cell (SC) disease testing is now universally required. Because of the testing 

used, ‘‘carrier status’’ is determined. While all states do report our carrier status to 

the responsible physician, where it goes from there (if anywhere) is highly variable, 

depending upon state and physician practice. In reality, it is likely a relatively small 

proportion of parents who are actually informed if their child is an SC carrier. 

Ms. LEE. And how are adults reminded of that test result when 

they become adults? How do they know that? How does that follow 

the adult in terms of their medical records? 

Dr. RODGERS. Right. Well, that is something that is certainly, 

with electronic health records and the ability to follow that as patients move from doctor to doctor and clinic to clinic would be very 

important. I would have to get information on how that is followed 

comprehensively. I am sort of aware of this from a limited number 

of experiences that I have, and I can certainly provide that information to you with our sister organization, the National Heart, 

Lung, and Blood Institute. 

[The information follows:] 

SICKLE CELL RESULTS

There is at present no system in place that ensures the orderly transition of 

health care information for an individual throughout his or her lifespan. Individuals 

diagnosed with sickle cell disease would ordinarily be aware of their diagnosis and 

in late adolescence the ongoing care of the child would be transferred from a pediatrician to either an internist or adult hematologist. 

The maintenance of information on being a carrier of sickle cell disease is a responsibility shared by an individual, his or her family members, and the team of 

health care providers. 

But back to your first question, and that relates to hemoglobin 

A1C. That is a very vital test that shows what the average level 

of blood sugar control is over the preceding three months. When we 

testified several years ago, you raised our attention to the fact that 

many patients are receiving this test done in the office and they 

may have sickle cell trait, and that is a confounding variable, and, 

as a result of that, we did develop this public awareness campaign, 

and in no small part due to that most of the tests that are done 

are now in compliance with the understanding that there is interference of the sickle cell and other genes that can cause a problem. 

So essentially all of the commercially available testing for A1C 

is done using systems that can—that having an abnormal hemoglobin is no longer problematic. 

Ms. LEE. Thank you very much. 

Mr. Chairman, let me just say to the Committee that this was 

very important because so many people I know—family members, 

friends, people in especially communities of color—there were a lot 

of people who had false positives because of the fact that they had 

been tested with the wrong test, and did not even know they had 

the sickle cell trait. So this was a very important effort that started 

in this Committee, and I just wanted to thank you all for that. 

And I am glad to hear now that they have changed the testing 

now is clear in what to do and look forward to your report back 

on the sickle cell trait, because I know a lot of people who I just 

talk to and say, look, do you have the sickle cell trait, and they say 

we do not know, and will ask their doctor to test them and, lo and 

behold, they have the trait, which, of course, means certain kinds 


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of medical tests would not be valid or they need to do certain 

things in terms of their health. 

But unless you follow from birth in the States that do do the 

testing and somehow people know as an adult they have the trait, 

they get in a lot of trouble. So we need to really figure out how to 

make sure that that happens, because most people I know, especially most African-Americans, do not ask their doctor to test them 

for the sickle cell trait. 

Thank you. 

Mr. OBEY. Mr. Lewis. 

FISCAL YEAR 2011 FUNDING

Mr. LEWIS. Thank you very much, Mr. Chairman. 

Gentlemen, very much appreciate your presence here today. The 

Chairman has appropriately outlined the pattern of funding for 

NIH over time. There is a piece of that that concerns me. You 

know, beauty lies in the eyes of the genuflector, and with NIH 

funding we had a very significant increase in the 2009 fiscal year 

as a result of the stimulus package. I have some questions about 

that, but, most importantly, I am concerned that even though the 

President’s budget has a $1,000,000,000 adjustment, if you take 

where we were in 2009 and that dollar amount, one could argue 

that there is an $8,000,000,000 reduction, if real value came from 

that stimulus funding. 

So I would like to have some commentary regarding that and 

how you have budgeted to try to deal with that adjustment, if it 

remains as a part of our pattern, and very much be interested in 

knowing—maybe Dr. Fauci would like to respond to this piece of 

it. 

There has been consistent adjustment also for Labor, Health and 

Human Services across the board, with a similar big adjustment in 

2009. If I were looking at those adjustments and readjusting budgets, I would make sure that continuing funding flowing to NIH 

would have very high priority in those considerations. There is a 

broadly based nonpartisan support for research, applied research 

as well as the basic research. Lots of discussion that is healthy, 

pushing you to get more in the direction of the applied research, 

but, nonetheless, we need to preserve this nonpartisan environment in this Committee and otherwise. 

So if you would start with that, Dr. Collins, I would appreciate 

it. 

Dr. COLLINS. Mr. Lewis, I appreciate the question and I do appreciate the strong bipartisan support for medical research that 

has characterized the actions of this Subcommittee for many years. 

The diagram that you see on the screen there shows you what the 

total funding allocated for NIH has been over the course of the past 

decade, and, as you can see, after a period of flat funding from 

2003 to 2008, with only modest increases, then, as shown in red, 

the Recovery Act dollars, $10.4 billion, were given to NIH, but obviously as a two-year enterprise, so roughly $5 billion each year. 

[The information follows:] 


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And the budget is here shown for fiscal year 2011, and I think 

you can see the delta there, and, in fact, this is the cliff that people 

are talking about, because effectively in fiscal year 2010, if you include the Recovery Act dollars, the total funding that NIH has had 

available is $36 billion. What is proposed in the President’s budget 

is $32 billion. 

Now, let me say that given the very difficult economic times, the 

President’s support of science and the willingness to put forward a 

$1 billion increase for NIH is reflective of the Administration’s 

strong support for research and what it can do, and we are deeply 

grateful for that, because certainly it could have been justified, at 

a time of growing deficits, to be even more conservative here in 

terms of providing support for this. 

So the $1 billion is certainly something we are delighted to see 

come forward, although it is a dollar figure which basically 

matches the inflationary index for biomedical research, just about 

3.2 percent. 

We were aware that this might be an outcome. What we have 

tried to do—although I would not tell you that we are going to be 

completely successful in reducing the consequences of this cliff— 

certainly some of the money funded by Recovery Act has been for 

one-time expenditures, special equipment needs, for instance, that 

universities across this Country have been clamoring for years during the flat funding; construction grants also to help those universities and institutes build up their physical plant or to do some 

renovations that are badly needed. 

We have tried to fund special projects that we thought could get 

done in two years. The Cancer Genome Atlas, which went from a 

pilot phase into a full-bore assault on understanding cancer, and 

which, with that accelerated funding, will tell us in two years the 

basic landscape of cancer for the 20 most common cancers at the 

DNA level, a dramatic series of advances. 

But we also funded a lot of innovative grants. We invited investigators out there to come forward with their best ideas, and they 

came forward in great numbers with exciting, innovative stuff. 

When I arrived at NIH in August, one of my first tasks in those 

first few weeks was to read a lot of these grants that came forward 

asking for support from the Recovery Act, and these were really exciting, innovative, many from investigators that had not previously 

come forward to NIH. 

But science is, as I said in my opening statement, not a 100-yard 

dash, it is a marathon, and two-year cycles are really not the way 

that advances occur. So we are going to face a crunch in fiscal year 

2011. We will be, I think, gracious to investigators who were funded during the Recovery Act for two years and who asked could they 

please have a no-cost extension for a third year. We will probably, 

with good justification, be willing to do that in order to try to 

smooth this out a bit. 

But there is no question that if you measure what happens in 

terms of success rates, that is, what is the chance that an investigator who sends a grant in to NIH is actually going to get funded, 

that is going to be a tough number in fiscal year 2011. That number used to be, back in the course of the last 30 years, around 25 


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to 35 percent. That was the success rate for grantees. It has trickled down more recently to 20 percent. 

Our predictions are that in fiscal year 2011, with this budget 

number, it will be more like 15 percent, one grant out of every. 

Mr. LEWIS. Dr. Collins, your response has taken up my time, 

but—— 

Dr. COLLINS. I am terribly sorry. 

Mr. LEWIS [continuing]. In the meantime, I would hope, as you 

see some of those vacuums or difficulties, that you and your people, 

Dr. Fauci, would keep very much in touch with this Committee so 

that we can try to be responsive in ways that will accelerate those 

opportunities. 

Dr. COLLINS. Will do. 

Mr. OBEY. Ms. Roybal-Allard. 

PANCREATIC CANCER

Ms. ROYBAL-ALLARD. First of all, let me thank you all for being 

here and for the really important work that you do. However, I 

have had some concerns with regards to NIH’s lack of responsiveness to this Committee on two particular issues. 

As you are aware, pancreatic cancer is the fourth most deadly 

type of cancer, with survival rates that have remained largely unchanged for the last 40 years. Yet, despite its lethal prognosis, only 

about 2 percent of the Federal cancer research budget continues to 

be devoted to pancreatic cancer. Recognizing the seriousness of 

pancreatic cancer, this Subcommittee requested, in fiscal year 

2009, in the appropriations report, that the National Cancer Institute give a detailed account of what it would do to increase research and training on pancreatic cancer. 

When that request was completely ignored, the Subcommittee, in 

fiscal year 2010, again made the request for a plan to address pancreatic cancer. The NCI once again ignored the request and has no 

plan, and we are being told now that there is going to be a meeting 

held in the future to address pancreatic cancer. 

Since the Subcommittee has always chosen to respect the integrity of the scientific community by not directing funds or micromanaging NIH’s activities, short of doing that, what does the Subcommittee have to do to get NIH to respect the requests of this 

Subcommittee and respond to an issue as important as pancreatic 

cancer? 

Dr. COLLINS. Congresswoman, I was unaware, until this moment, 

of this lack of responsiveness to that specific request about pancreatic cancer, and I would promise to give it my personal attention. Pancreatic cancer is a particularly lethal and very devastating 

type of cancer about which, as you point out, progress has been 

rather limited. 

We do have some, I think, exciting opportunities on the horizon, 

particularly trying to understand at the detailed molecular level 

what are the first steps that cause pancreatic cells to begin to grow 

into a cancer and what might we do in terms of developing early 

detection methods based upon that, because that is obviously much 

of the problem, is not detecting this disease until it is already far 

advanced; but, most importantly, to develop new treatments that 


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are targeted towards those specific pathways that seem to drive 

this cancer. 

Again, the Cancer Genome Atlas will provide that kind of information for our 20 most common cancers, and that includes pancreatic. But I am distressed that you feel that this Committee has 

not been answered in the requests you have made about this, and 

I will personally look into that. I will tell you that in the relatively 

near future we anticipate that a new Director of the National Cancer Institute will be named by the President, and I will be certain, 

if that happens, that this concern of yours is conveyed. 

CLASS B DEALERS

Ms. ROYBAL-ALLARD. I would appreciate that. Thank you. 

One other area of concern has been the use of Class B random 

source cats and dogs for NIH-funded research. We were pleased 

when NIH stopped purchasing dogs from Class B dealers for use 

in intramural research, but remain concerned that the practice still 

continues in some of the extramurally funded NIH research. So last 

year, once again, this Committee, in their report, asked NIH to 

submit a detailed plan for phasing out random source cats and 

dogs and extramurally-funded research. Again, NIH has ignored 

this Subcommittee’s request and we have seen no plan. 

So my question to you is how much progress has been made towards phasing out this practice and has NIH identified all current 

NIH-supported extramural projects using Class B dogs and cats? 

And, if so, how many? Also, does NIH have a plan that we have 

not seen for implementing a phase-out of the use of dealers by its 

grant recipients? 

Dr. COLLINS. Congresswoman, again, I am sorry that this response has not been forthcoming in a timely fashion. I know it was 

due on April 1st. I can tell you that it is very close to being finalized; we wanted to be sure that we had answers to all of those 

questions. I can tell you the substance of the response will be that, 

yes, NIH is making a plan to phase out the use of Class B dealers 

for animals. 

It is not possible to do that overnight because the needs for animals that currently have been coming from Class B dealers for cardiovascular research and transplant research would be injured 

rather badly if we did this in a precipitous way. But we will transition over the period of roughly three to four years into a circumstance where we no longer depend upon Class B dealers for 

animals, and we arrange to have the breeding Class A suppliers fill 

that need. 

Again, that report should be coming forward to you very soon. 

Ms. ROYBAL-ALLARD. Thank you. Appreciate that. 

Mr. OBEY. Mr. Rehberg. 

BREAST CANCER MAMMOGRAPHY GUIDELINES

Mr. REHBERG. Thank you, Mr. Chairman. 

Welcome. I always feel like apologizing to somebody with your 

talent and credentials. And you have entered into the political 

realm of our world, so I guess my questions probably will be a little 

more political from the perspective of the comparative effectiveness 

research that we were talking about before. 


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While this organization is not necessarily under your purview, 

the U.S. Preventive Services Task Force, they have certainly created perhaps a firestorm within the breast cancer community, and 

I would like you to talk a little bit about your own concept of personalized medicine as it relates, then, to some of the comparative 

analysis that you are going to be doing within your research, because I will just use breast cancer as an example. 

This was in the New York Times, an influential group, the one 

I referred to, provides guidance to doctors, insurance companies, 

and policy makers, and they have now made the recommendation 

that mammograms do not need to occur until 50, as opposed to 40; 

and that was wildly hailed as a step forward by the National Cancer Institute, National Breast Cancer Coalition, Breast Cancer Action, National Women’s Health Network welcomed the new guidelines, and, of course, the insurance companies will take that as, 

well, I guess we do not have to cover that until they are 50. Unfortunately, on the other side are the American Cancer Society and 

the American College of Radiology. 

So a fight has been created that will probably rage on for quite 

some time. How are you working or how do you intend to keep 

those kinds of food fights out of NIH? Because it has the potential 

of creating a lot of politics for you in an arena that research and 

science should not have politics. 

This is just one example, and it is the most recent example of 

something that is going to occur as a result of something similar 

to the comparative effectiveness research that is going on. 

Dr. COLLINS. Well, Congressman, I appreciate the question and 

this certainly is an example where those recommendations from 

the USPSTF on mammography created quite a firestorm of controversy. Specifically, NIH is not in the business of establishing 

practice guidelines, for the most part, and in that instance the National Cancer Institute stayed out of the fray, basically. Our role 

is to provide the kind of data that might allow the establishment 

of guidelines that improve outcomes, and that is something that we 

are very determined to do. 

When it comes to the mammography guidelines, I think you 

brought up the issue of personalized medicine. Perhaps the path 

forward here is for us to be more clear about how to utilize individualized information to make better predictions, because while there 

may be women who are not going to be benefitted by a mammogram in their 40s because they are at very low risk, there are others who are at higher risk for whom that is a highly appropriate 

procedure. 

The Task Force recommendations touched on that, but we did 

not have enough data to actually be able to say how do you factor 

that in. That would be one of the things that NIH very much wants 

to work on. 

FUNDING FOR COMPARATIVE EFFECTIVENESS RESEARCH

Mr. REHBERG. I feel very comfortable with your credentials. You 

are probably the right person at the helm of NIH at a time when 

we are spending a lot of money on this kind of comparative research. But the problem is—or not necessarily a problem—I do not 

want to create a problem—have you created an objective conclusion 


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for the various research? You are spending $400,000,000 on this 

kind of research, but if it does not come to a conclusion, all it does 

in this kind of a case is create more confusion in the minds of the 

patient, the poor 41-year-old woman who does not know what to do 

now. 

And again I go back to this is an influential group that is now 

making a recommendation that provides guidance to doctors, insurance companies, and policy makers. So are you going to have 

$400,000,000 worth of confusion created at NIH similar to this, 

which is what this has done? 

Dr. COLLINS. Well, we certainly do not want that outcome, Congressman, and, again, the mammography circumstance had data 

that fed into it from a variety of perspectives, much of it not supported by NIH. 

If you look at our comparative effectiveness research portfolio, 

what you see are things like the Diabetes Prevention Program that 

Dr. Rodgers described. Now, there is an example where we learned 

by rigorous data analysis that in fact an intervention to prevent diabetes—which many people were not that convinced was going to 

work—worked spectacularly, and it worked better than the alternatives that are commonly used in practice, and that is now—— 

Mr. REHBERG. Okay, so you will stay out of this controversy and 

anything else that is controversial? 

Dr. COLLINS. No. No, not at all. No, I am not trying to say that. 

Mr. REHBERG. Well, then what would be your conclusion here? 

Are you going to back the—— 

Dr. COLLINS. My conclusion is that NIH’s role is to do research 

that generates rigorous evidence that can guide conclusions that 

are based upon data, and we will do everything we can to provide 

that kind of data to guide those organizations outside of us that are 

going to try to decide what is right for the individual as far as their 

health care. 

Mr. REHBERG. So you are going to pick a fight. 

Dr. COLLINS. We are going to try to—— 

Mr. REHBERG. Because you are going to provide data to both 

sides and then step back and watch them duke it out. 

Dr. COLLINS. I think we believe that data that is based on evidence and reason is a good thing to add to any discussion, and we 

hope to be the providers of that. 

Mr. REHBERG. Thank you, Mr. Chairman. 

Mr. OBEY. Ms. McCollum. 

PRIVATE SECTOR INNOVATIONS FROM NIH INVESTMENTS

Ms. MCCOLLUM. Thank you, Mr. Chair. 

I think what I heard clearly you said is that more research needed to be done so that people could make a better informed decision 

between doctor and patient, and that is your goal and your focus. 

Dr. COLLINS. Well said. 

Ms. MCCOLLUM. Thank you for that. 

Mr. Chairman, members of the Committee, I see NIH as a public 

good. Like highways and clean waters, NIH is a benefit to our entire society. Those benefits are widespread, long lasting, and not always immediately profitable, where we see immediate return. That 

is why private business does not do and cannot often make the inVerDate Mar 15 2010 08:35 Nov 16, 2010 Jkt 058233 PO 00000 Frm 00319 Fmt 6601 Sfmt 6602 E:\HR\OC\A233P2.XXX A233P2

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vestments that NIH makes. So funding for the public good is one 

of the most important functions that the Federal Government has, 

and I think you gave us some excellent examples in the three patients that you provided, and I know you have hours and thousands, tens of thousands of success stories. 

So the investment that this Committee is getting ready to make 

in the NIH are not only critical to the health of our citizens, but 

they also contribute to the growth of our economy. 

Dr. Collins, I am going to take a little different track in some of 

the questions I am going to ask you and the panel here today. In 

your testimony, you state that every $1 of NIH funding directly results in more than $2 in economic output. The indirect and longterm benefits from NIH investments are greater, and I would like 

you to talk a little bit about that this morning. 

So could you please tell us how investments in NIH lead to private sector innovation, both directly and indirectly? Where would 

the drug industry, the medical device sector, or any of the other 

major aspects of the U.S. health care sector be without the basic 

research that is supported by NIH? 

Thank you. 

Dr. COLLINS. Thank you for the question. And we do believe that 

by medical research investments at NIH are, besides being a wonderful stimulus of advances in health care, also a wonderful stimulus of the economy, and the evidence is very compelling for that. 

Economists agree that American economic growth since World 

War II, more than half of that has been driven by science and technology. And if we are looking for an occasion to try to get our economy back on track, this sort of economic investment makes a lot 

of sense. 

You quoted the direct effects of NIH investment, this more than 

twofold multiplier effect in one year. But if you look at the indirect 

effects in terms of our interactions with the private sector, if you 

look, for instance, at the development of new drugs, roughly 60 percent of new molecular entities that are put forward by pharmaceutical companies for FDA approval cite an NIH publication or an 

NIH patent as being fundamental to how that came forward. 

And if you look at the jobs in the biopharmaceutical sector that 

are directly, therefore, related to things that NIH has supported, 

that is 3.2 million jobs at the present time; and these are highquality, high-paying jobs that we do not want to see go overseas 

instead of having them exist here. 

If you look at the way in which investments are being made by 

the pharmaceutical companies in research, again, much of that 

based upon the foundation that NIH provides, that is $56 billion 

of research investments done by the private sector exceeding what 

NIH is putting in at a little bit more than half of that. 

The whole landscape, then, I think you can see is very much triggered by this. Let me give you an example of a company called 

Affymetrix in California, which is the main purveyor now of these 

DNA chips which have become a revolution in research and in clinical practice. They are the reasons now that people can actually get 

personalized medicine readouts, as I have done myself. This was 

started on an NIH grant, as a single investigator with a great idea; 


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and here we are now with a company that has capitalized in the 

billions. 

I could give you many more examples. But I think your point is 

extremely well taken. People think of NIH—and we are glad about 

that—as the place where new cures for diseases are being sought, 

but it is also a place where our economy is getting one of the best 

kinds of stimulus it could. 

Ms. MCCOLLUM. Thank you, Mr. Chair. And I want to thank past 

members of this Committee for all the work they did in the genetic 

research that has led to the gene therapies that are out there now. 

If people were not willing on this Committee to invest in science, 

we would not only not have the cures, but we would find other 

countries getting far ahead of us in this technology and job creation 

field. So thank you, members. 

Mr. OBEY. Thank you. 

Mr. Cole. 

PRIORITY SETTING FOR RESOURCE ALLOCATIONS

Mr. COLE. Thank you, Mr. Chairman. 

Thank you for being here and thank you all very much for the 

work that you do; it is extraordinary. 

A number of years ago our Congress passed the Caroline Price 

Walker Conquer Childhood Cancer Act and we authorized 

$150,000,000 a year for pediatric cancer research over a five-year 

period. We, as a Committee, never chose to fund that, to appropriate money for that purpose. 

When you are confronted with a situation like that, where you 

have sort of congressional authorization on one hand, this Committee does not—because, frankly, I think it is very careful about 

trying not to interject itself into what are scientific decisions—how 

do you take something like that and balance it and make basic decisions? Or do you at all? 

Dr. COLLINS. Well, it is a daily discussion that goes on amongst 

the NIH leadership about how to set priorities, Congressman, and 

it is not an easy task when we have so many opportunities and the 

resources are not sufficient to chase after all of them. A lot of this 

depends on scientific opportunity. Simply throwing money at a 

problem, even if it is a critical problem for public health, is not necessarily going to get you where you need to go; you need to see is 

there an idea here, is there a research project that could push the 

ball forward? 

So we are always trying to both weigh public health needs, as 

well as scientific opportunities. We do not want to neglect rare diseases—and many pediatric cancers are rare—just because they do 

not affect that many people, because if it is your family where a 

child has been stricken with cancer, it does not matter a whole lot 

to you that that happens to be a rare disease. 

With pediatric cancer, we have certainly adopted that as an area 

of great priority because of the terrible toll this takes on young people and their families. We have made great strides in many of 

these cancers that occur in children, but we have many others, particular solid tumors, for which we are not as successful as we 

would like to be. 


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The good news here is I think we have the tools—and this was 

sort of a couple of the themes that I talked about in my opening 

statement—both in terms of really laying out the landscape of why 

cancer occurs in children and accelerating the process of going from 

that understanding to a therapeutic; and that is moving forward at 

a pace that would not previously have been imaginable, and we are 

empowering academic investigators to take a larger role in the development of therapies, which, in the past, was largely left to the 

private sector. And for pediatric cancers that are rare, there is not 

much of an economic incentive to develop a new therapy if it is 

going to be risky. If academic investigators could de-risk the 

project, then it becomes more attractive. 

The Cures Acceleration Network is another example of an authorized, but not yet appropriated, effort that I raised briefly in the 

opening statement that we are quite excited about because it would 

facilitate this process. 

PEDIATRIC CANCER RESEARCH

Mr. COLE. Well, quite often our colleagues count on this Committee to protect them from themselves, so this may be one of those 

instances, I do not know. 

Let me ask you a follow-up question. I have gotten two different 

sets of responses—and they are not dramatically different—on how 

much money is actually devoted toward pediatric cancer care. From 

Director Worzog I think we had a communication that suggested it 

was something like $215,000,000; from the NIC we got an estimate 

like it was $195,000,000. Do we have any idea what the range, relatively, of dollars devoted in this effort is? 

Dr. COLLINS. I do not have the numbers in front of me, Congressman; I can certainly provide them for the record. We do now have 

a better method of tracking how NIH is spending its dollars than 

we have had in the past, something that got unveiled about a year 

ago. So we are able to tell you, I think, accurate numbers based 

upon our entire portfolio. 

[The information follows:] 

PEDIATRIC CANCER RESEARCH

NIH has not set its tracking system on disease spending to be able to capture estimates for childhood cancers or pediatric cancer research funding across all of NIH. 

However, these estimates are available for research funded by NCI. The estimated 

funding level in Director Orszag’s letter reflects the NCI-projected FY 2010 funding 

level for pediatric research (approximately $215 million), which is a broader research category than childhood cancer alone, and includes research related to child 

health, childhood cancers, birth defects, multiple sclerosis, etc. In FY 2011, NCI expects to fund pediatric research at $233.7 million. NCI also projects funding in the 

category ‘‘childhood cancer research’’, which is a subset of pediatric research and includes only childhood cancer research (such as childhood leukemia and neuroblastoma). The National Cancer Institute (NCI) estimates it will spend $196.3 million in FY 2010 and $202.7 million in FY 2011 on childhood cancer research. This 

is the funding level that was provided in the recent NCI document. The key difference between these two categories of research is pediatric research is a broader 

category that includes research related to child health in general, whereas childhood 

cancer specifically deals with cancers affecting children. 


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NCI’s Pediatric Research and Childhood Cancer Funding, 2007–2010 

(dollars in millions) 

Year 2007 2008 2009 2010 

(estimate) 

Pediatric Research ......................................................................... 243.2 235.4 240.8 215.0 

Childhood Cancer ........................................................................... 172.7 189.7 192.9 196.3 

Mr. COLE. That would be very helpful. I would really appreciate 

that. And particularly if you could trend-line is over several years, 

if that was possible, so we could sort of see relatively where we are 

headed. 

Finally on this topic—and you have answered this partly, but I 

just want to give you an opportunity to add anything else you 

would like to—where do you see us going in pediatric cancer research over the next five or ten years? 

Dr. COLLINS. I think it is going to be a very exciting time. We 

will have the ability to identify what are the basic molecular drivers of a cancer that occurs by analyzing hundreds of these tumors 

and figuring out precisely what has gone wrong; what has made a 

good cell go bad and have it start growing in this fashion. 

I should say, by the way, there is a wonderful new partnership 

between St. Jude’s and the Genome Center at Washington University in St. Louis involving $60 million of private philanthropic donations to make this go forward for pediatric cancers on hundreds 

of tumors. 

We are going to, therefore, be able to say what are the targets 

for which we need magic bullets, and we should be able, in the next 

five or ten years, to transform our approach to pediatric cancer 

from the chemotherapies, which can be successful but which, as 

you know, are also quite toxic, into compounds that are much more 

directed, much more rational; more likely to be effective, less likely 

to be toxic. 

Mr. COLE. Terrific. Thank you. 

Thank you very much, Mr. Chairman. 

Mr. OBEY. Mrs. Lowey. 

FOOD ALLERGIES

Mrs. LOWEY. Thank you very much, Dr. Collins, Doctors all. I 

must say, having served on this Committee for many years, this is 

one of the most exciting hearings that we have, and I do wish we 

had hours, but we do not want to take you away from your important work, so let me just thank you for your service to the Country 

and to the people, and we look forward to continuing to increase 

the appropriations. 

A few particular areas, first with food allergies. It is very frustrating, to those who suffer, that the only advice doctors can give 

now is do not eat certain foods. And as you probably remember, 

shockingly, it took me five years, five years to get legislation 

passed that mandated clear labels on food. But now at least allergy 

sufferers and celiac disease people call me and tell me how grateful 

they are that we have those labels on food. 

So two questions. Allergies. I never had them until I got here to 

Washington. What progress are we making in understanding why 

the same amount of allergens has minimal impact on one person, 


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lethal to another? And we are any closer, Dr. Rodgers, to understanding why the number of children under the age of five who suffer from peanut allergies has grown so much between 1997 and 

2002? Every school has peanut tables; many schools do not allow 

peanuts to be served. Perhaps you can respond. 

Dr. RODGERS. We are going to redirect it. 

Mrs. LOWEY. Wrong directions. Dr. Fauci. 

Dr. RODGERS. I would be happy to talk about celiac, but let me 

turn to my colleague. 

Dr. FAUCI. Thank you for the question. It is obviously very—— 

Mrs. LOWEY. How could I forget my good friend Dr. Fauci? I do 

not know. Yes. 

Dr. FAUCI. It is very important, as you well know. Four percent 

of the people in the United States of America suffer from food allergy, peanut allergy being one of the most severe. Your question 

about the differences in individuals are clearly related to genetic 

predispositions. We do not know the exact genetic profile that 

would pinpoint someone who has a propensity, but clearly these 

are things that run in families, which strongly point to it being genetic factors, which, as Dr. Collins mentioned in many of his remarks related to other diseases, the more we get a better handle 

on the genomic basis of disease, the better opportunity we will have 

to do one of the things that Francis mentioned, more personalized 

medicine approach. And I think allergies and the response to allergies and the desensitization to allergies are going to very, very 

much fall into that category of personalized medicine. 

The other question you asked is that why does it seem like we 

have more peanut allergy now than we had before. Well, the honest 

answer is we do not know. But we do feel that one of the issues 

that may contribute to it is that, because of the greater sensitivity 

in the community to the possibility of peanut allergy, more families 

are withholding peanuts and peanut derivatives from children 

early on in their lives, which, in our research projects now, we are 

finding that that might actually, if a person is not allergic to peanuts, have a paradoxical, deleterious effect, because some studies 

are showing now that when you give children, at a very early age, 

exposure to peanut, you naturally desensitize them to any allergy 

they may have. There is a very interesting Israeli study that shows 

that early exposures to peanuts actually wind up having a lesser 

incidence of peanut allergy as the child gets older. 

So there is a lot of active research going on. We are very excited 

about it. We are getting new young investigators in the field, and 

I hope in a year or so we will be able to give you even more encouraging information. 

PEDIATRIC DIABETES

Mrs. LOWEY. Thank you very much. 

I was looking at you, Dr. Rodgers, because a group of children 

came to my office just this week who suffer from diabetes, and it 

is extraordinary to see the advances in treatment. Little children 

are taking care of themselves. But we are not preventing diabetes 

and we are not curing diabetes, and perhaps you can—I am not 

talking about adult onset diabetes; I am talking about those that 


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are affecting our children. Perhaps you can comment on the research there and what progress are we making. 

Dr. RODGERS. Thank you. We are actually making extraordinary 

progress on the treatments for kids with type 1 diabetes, the type 

that you are referring to. In fact, just to back up to one of the 

points that you made. What we are learning a lot about diabetes, 

actually type 1 diabetes, which is an autoimmune disease in which 

the body, for unclear reasons, turns against these insulin-producing 

islet cells in the pancreas, are actually giving us clues to patients 

with celiac disease. They share many features. So what we are 

learning in this particular disease may also have implications in a 

disease that perhaps affects about one percent of the U.S. population, that is, celiac disease. 

In diabetes, we are trying to—this is a disease that affects individuals who have a particular genetic susceptibility, and within the 

last few years the number of genes that account for this susceptibility has greatly increased. Today there are over 40 susceptibility 

genes, which account for more than half of the predilection for developing the disease, so what that means is that we can identify, 

early on, which kids are likely to develop type 1 diabetes and when. 

Now, it is thought that there are triggers associated with this, 

and understanding what the environmental triggers are is extremely important. We have almost, very recently, completed a 

study, a recruitment of about 7,800 infants who have this high type 

1 diabetes propensity to follow them for a period of 15 years to understand what it is in the environment that is leading to the disease is it something that they eat, is it something in the environment, et cetera? 

And this work is going on with other work that is funded by the 

NIH in specific areas, for example, the National Institute of Child 

Health and Human Development (NICHD) is funding a study comparing the effects of hydrolyzed infant formula to that of cow’s 

milk, because there are a number of people who believe potentially 

that cow’s milk may be that trigger. And that work is proceeding 

quite well. 

The NIH, in association with the CDC, has also, for the first 

time, developed a surveillance program to look for diabetes in 

youth. This includes both type 1 and type 2. But, importantly, having CDC’s involvement, and because of their ability to do surveillance within States, we can better understand the clustering of 

type 1 diabetes that we are seeing. This may point to specific triggers in certain locales. And this is just in the surveillance. I can 

provide you more, because I see my time— 

[The information follows:] 

PEDIATRIC DIABETES

If we find the trigger, we may be able to develop a vaccine or implement a change 

in diet that can prevent the disease. In addition to research to uncover the genetic 

and environmental components that contribute to the cause of type 1 diabetes, the 

NIH is pursuing research to prevent, treat, and one day cure type 1 diabetes. For 

example, Type 1 Diabetes TrialNet tests strategies for type 1 diabetes prevention 

and early treatment. TrialNet recently reported that the drug rituximab could preserve the function of the insulin-producing beta cells in people newly diagnosed with 

type 1 diabetes. Previous clinical trials have suggested that preserving patients’ remaining beta cell function can have dramatic, long-term health benefits. TrialNet 

has also launched a trial testing the ability of another agent, oral insulin, prevent 


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the disease in people who have high levels of insulin autoantibodies, a pre-clinical 

marker of the disease. TrialNet also has two other prevention trials that will launch 

soon or are under development. 

An earlier, landmark NIH-supported clinical trial showed that improved control 

of blood sugar beginning as soon as possible after diagnosis can greatly improve the 

long-term prognosis of type 1 diabetes and result in reduced rates of life-threatening 

diabetes complications. This research has contributed to the fact that people with 

type 1 diabetes are living longer and healthier lives than ever before. However, 

blood sugar control is not always easy and even the most vigilant patients are at 

risk for sudden, acute episodes of dangerously low or high blood sugar levels. The 

NIH is deeply committed to helping patients achieve good blood sugar control and 

is taking two approaches to realize this goal: beta cell replacement and development 

of an artificial pancreas. With respect to beta cell replacement, the NIH supports 

the Beta Cell Biology Consortium (BCBC), which is studying ways to grow beta cells 

in the laboratory for transplantation into people and examining strategies to promote new beta cell formation in the pancreas. BCBC scientists are gaining key insights about beta cell biology and development, which is paving the way toward new 

cell-based therapies. The NIH also supports research toward the development of an 

‘‘artificial pancreas’’—a mechanical system that links glucose monitoring to insulin 

delivery—and has the potential to alleviate an enormous amount of patient burden. 

Mrs. LOWEY. Thank you. I see that. But I look forward to it and 

thank you again, Dr. Collins. 

Mr. OBEY. Mr. Moran. 

ENVIRONMENTAL CAUSES OF ILLNESS

Mr. MORAN. Thanks very much, Mr. Chairman. 

I want to follow up somewhat on the line of inquiry of Mrs. 

Lowey and Mr. Cole. First of all, NIH, of course, has done wonderful work. The whole Nation is justifiably proud of all you have 

done. In your opening remarks you cite the extension of life and 

the progress particularly in cardiovascular disease, the fact that 

older people with chronic disabilities is down markedly. 

But much of the effort, at least in the past—now, I can sense 

kind of a shift here—has been on those called the dusk of life, and 

less emphasis on those at the dawn of life. That is why I was particularly impressed by a lot of the questions from the panel. 

Something is happening among our children. This past generation, for example, the rate of asthma has tripled. Cancer is now, 

for the first time, other than accidents, the primary cause of childhood death. One in every six children is born with a developmental 

disability now; attention deficit disorder, dyslexia, but in many 

cases significant mental disability. One in 59 children is autistic. 

And we have talked about obesity, and it is just stunning that one 

in three children now, we estimate, will suffer from some form of 

diabetes, we understand. 

There was a study commissioned by the Environmental Working 

Group that looked into umbilical cord blood, and they found that 

there were 232 industrial compounds in that umbilical cord blood. 

Many feel that what is happening with this most recent generation 

is a result of environmental factors; it is something we are breathing, we are eating or drinking. And it could well be the number of 

chemicals that we now depend upon for our food supply. Cow’s 

milk, I read a number of studies that it may have a direct link to 

diabetes. 

You have the National Institute of Environmental Health 

Sciences (NIEHS), and it is kind of a new thing. For a while it was 

sort of marginal in terms of focus. 


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Well, that is true, Doctor, you know that. You do not need to be 

defensive about it, but it really was not NIH’s focus. 

But I think, as we see what is happening in this new generation 

of young people, these dramatic statistics point to environmental 

causes that we need to coordinate with our research. The endocrine 

disruptors is one. In the Potomac River here, that we are all familiar with, every single small mouth bass—and that is a principal 

fish species—every single one of them is intersexed. Something is 

wrong. 

So I wonder—my first question really would be the extent to 

which we are integrating some of our findings with what the 

NIEHS is coming up with. 

Dr. COLLINS. I appreciate the question, Congressman, and I 

agree that studying the environmental impact on diseases of children and of adults is a very high priority. We may be able to understand hereditary implications, but we are not going to change 

those anyway, so it would be much better if we understood how 

those interact with the environment. 

And this has been one of the challenges, because a compound 

that in a certain concentration might be entirely safe for one person may actually be quite dangerous for another; and if we do not 

understand those differences, we have a very hard time identifying 

what in the environment we should pay attention to, because it all 

gets sort of blurred out by those individual differences. 

With regard to children, the National Children’s Study, which is 

in its pilot phase of enrolling participants—and we are working 

hard to figure out how to do that in the most effective and costeffective way—aims to follow 100,000 children preconception, all 

the way through pregnancy, and then until age 21. And a big part 

of that study is to collect the most sophisticated data we possibly 

can on environmental exposures, including in utero exposures, to 

try to see whether we can draw conclusions that so far have escaped us about what is causing these many different problems that 

we see in pediatrics. 

That is the most ambitious enterprise that has yet been mounted. But, meanwhile, there are specific efforts in specific diseases to 

try to collect that kind of information, for autism, for instance. Certainly for pediatric cancers, if you see a cluster, what is going on 

there in terms of environment? 

The difficulty we have oftentimes is we can measure the presence 

of many of these compounds, and we know that in larger concentrations they are not safe because animal studies have told us that. 

We often do not have the data to know what level would be safe, 

if any. 

So our environment, which is full of the consequences of industrialization, may have things in it that, if we understood them better, we would want to get out of there, but the data is often insufficient to be confident that we know that answer; and what is the 

safe level is often the question for which there is not a clear response. 

Mr. MORAN. Thank you. 

Mr. OBEY. Mr. Kennedy. 


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MENTAL ILLNESS AMONG VETERANS

Mr. KENNEDY. Thank you, Mr. Chairman. 

Welcome all of you. Thank you for your service to our Country 

in a very significant way in reducing the burden of illness for our 

people. One of the big burdens of illness for our people, and certainly an area where our budgetary dollars are so significant now, 

more than ever before—and if I could ask you all to comment on 

that with respect to the recent technology and the opportunities for 

that technology in the research that we have uncovered so far to 

make huge advances in this area as it relates to all of your institutes and every institute—is in neuroscience. 

And particularly, talking about the burden of illness, my colleague, Mr. Moran, just mentioned autism and the prevalence of 

autism. Others of my colleagues have mentioned the burden of illness of Alzheimer’s with the aging of America. And then, of course, 

you already have, as Dr. Insel knows, the huge burden of illness 

of mental illness in this Country, and addiction and substance 

abuse. And then on top of all of that you have a bow wave of needs 

coming down the line with our veterans population, and that is 

what I want to ask you about. 

I know that there is greater coordination within the institutes on 

sharing relevant science amongst yourselves. When you are under 

a budget that Mr. Obey understands is part of the cap on discretionary funding increases, but Department of Defense and the VA 

are not, what I would like to know from you is to what extent can 

you coordinate your neuroscience research and—by the way, they 

have a big portfolio in areas that you also do research—that affect 

the veteran. 

And I would like to know to what extent do you coordinate your 

work with perhaps medical research that is designed to help the 

veteran, because clearly the veteran is going to be—their challenges are going to also be the challenges of America with respect 

to all of these issues, because in finding out more about Traumatic 

Brain Injury (TBI) and Post Traumatic Stress Disorder (PTSD) and 

the complications of those, we are going to also find out the answers to many of these other issues. 

And I even point out diabetes because not only do we know the 

correlation between depression and diabetes, but I know that there 

has just been a drug approved for type 2 diabetes that relates to 

neurotransmitters in the brain. And it is ironic because most people think it has to do with the pancreas. Now we know it has to 

do with the brain, just to show the interconnections in whole 

health. 

So, Dr. Collins, if we could start with you. 

Dr. COLLINS. Well, Congressman, you put your finger on a very 

important issue, and that is the need for us to collaborate across 

agencies to try to improve health in the area of neuroscience, and 

I think it is fair to say that that is a topic of great interest. Certainly the topics you mentioned—traumatic brain injury, PTSD, 

Alzheimer’s—have all been areas in which we now have developed 

partnerships with the Department of Defense and with the Veterans Administration. 


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I am going to ask Dr. Insel, because he is intimately involved in 

several of those, to cite a few examples in answer to your question. 

Mr. KENNEDY. And, Tom, if you could—by the way, I loved meeting Laura the other day. Anyway, I just want to say do you know 

if there is the same collaboration within VA and DOD that you 

have within NIH with respect to the various institutes, in terms of 

their neuroscience collaboration? 

Dr. INSEL. Thanks for the question. I do not actually know what 

coordination goes on in terms of neuroscience between DOD and 

VA. It would be a great question to pose to each of them. I can tell 

you that for the collaboration with DOD, this is very tight and real, 

and it is a project that really came about because of the DOD’s concern, the Pentagon’s concern with the rising rate of suicide. As you 

know, there is a doubling of suicide amongst active duty soldiers. 

Last year, 160 suicides in the Army. That is actually more than the 

combat deaths in Iraq. 

Mr. KENNEDY. Can I mention something, just if you could comment? Anahedalcystine. Do you know the drug that reduces inflammation in the capillaries, if given, in the brain, because it only goes 

to those areas where there is blood, so it covers the brain blood 

barrier? There is Defense Advanced Research Projects Agency 

(DARPA) research that shows that it can minimize or eliminate 

mild traumatic brain injury. Do you know about that research? 

Dr. INSEL. We have a center that actually—it is a joint center between funded by the Veterans Administration and partly by DOD, 

but it is a joint center between the Intramural Program at NIH, 

National Institute of Neurological Disorders and Stroke (NINDS) 

and National Institute of Mental Health (NIMH), and the Uniformed Services University of the Health Services (USUHS), which 

is looking precisely at that issue. 

I just met with the folks from USUHS about a week ago and 

heard a little bit about their excitement about this, that this is perhaps a great way for an acute treatment for TBI. And they are also 

very interested in being able to visualize the changes using new 

neuroimaging techniques which are just coming online. 

So absolutely a very exciting area for science. It is not ready for 

prime time, but an area where it looks like we are getting some 

interesting advances. 

NATIONAL CANCER INSTITUTE CLINICAL TRIALS

Mr. OBEY. Dr. Collins, as you know, the New York Times published an editorial about a week ago which raised serious questions 

about waste of time and money with respect to clinical trials, and 

the editorial indicated that 40 percent of the clinical trials sponsored by NCI are never completed, and it quoted the Institute of 

Medicine as being quite concerned about the entire situation. 

I would like to know what your observations are, what your response would be to that report; where you agree with the concerns 

they raised, where you might disagree, and what you think ought 

to happen in order to correct the problem. 

Dr. COLLINS. I am very concerned about the outcome of that report. I should tell you that is a report the National Cancer Institute (NCI) asked the Institute of Medicine to conduct and brought 

in experts to look at the cancer Clinical Trials Network and draw 


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the conclusion that, as you have said, there are major difficulties 

in terms of not finishing trials that get started, in terms of trials 

that take very long to get on the ground after they have initially 

been designed. And they make a number of recommendations 

which NIH and NCI are going to now take very seriously. 

One of the problems is that the networks are complicated in 

terms of multiple centers, and that is the nature of phase 3 trials, 

that they generally involve multiple centers. But there is so much 

bureaucracy involved in trying to get a trial started, some of that 

just being the paperwork, some of it being the human subjects effort, where every center has to have its own Institute Review 

Board (IRB) that reviews the protocol. We clearly need to move in 

the direction of more centralized IRBs. 

It is clear that some of the clinical trials are not necessarily designed in a way that takes advantage of some of the newer discoveries about ways that you could optimize a trial by identifying 

those most likely to respond and, therefore, making a smaller, more 

tightly focused trial that would give you a result more quickly; and 

we need to think about that. 

Some of this, though, I think relates to the fact that many of 

these were for rare diseases, and they simply were not able to enroll enough subjects to get enough power; and perhaps that was an 

unanticipated problem that should have been anticipated. 

So clearly what needs to happen—and I think the IOM recommendations are actually very well put and will be a great starting point for NIH—is to worry more explicitly about efficiencies 

that could be achieved that are not being achieved. Maybe we do 

not need to have so many centers if they are only enrolling a few 

patients each; maybe we could do this more efficiently with a 

smaller number of centers with larger enrollments. 

Maybe we need to prioritize what trials are really critical to do. 

And maybe we need to come up with a better way to encourage 

participation by patients, because right now only 3 percent of adult 

patients with cancer participate in clinical trials, compared to the 

majority of pediatric patients; and we have to figure out why that 

is and why we have trials that we cannot manage to fill. 

Mr. OBEY. Well, my concern is that one out of every four Americans is expected to die of cancer, so this is not a minor problem. 

Dr. COLLINS. No. 

Mr. OBEY. And people look at clinical trials as being the gold 

standard, and when we get a report like this, it raises really significant questions. I would ask that you keep in close touch with 

the Committee as you review those recommendations and concerns, 

because we are talking about not just a lot of lives, but a lot of 

money as well. 

But what is the main reason why you think so many of those 

clinical trials do not finish? 

Dr. COLLINS. I think many of them are for conditions where it 

has just been difficult to find enough patients with the precise conditions that had to be present to be able to enroll in the trial. They 

cannot find—— 

Mr. OBEY. Would not that tell us something about what is going 

on at the front end, before those trials are ever started? How 

should that process be changed? 


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Dr. COLLINS. I agree with you, it does tell you something about 

the inability to plan effectively about whether a trial is likely to be 

able to meet its enrollment criteria or not; and that is something 

that has to be looked at very carefully. 

Imminently, we will see the appointment of a new Director of the 

National Cancer Institute. I guarantee you this will be a matter of 

the highest importance for that individual. And I think, as you 

have said, we have to get this right, because we are going to see, 

coming forward, in the next five or ten years, a very exciting list 

of new cancer therapeutics. But we will only know if they work if 

we have a clinical trials network that can test them quickly and 

efficiently. This has to be the highest priority. 

Mr. OBEY. My time has expired. 

Let me suggest we do a second round of about three minutes 

apiece. 

Mr. Tiahrt. 

BIODEFENSE RESEARCH

Mr. TIAHRT. Thank you, Mr. Chairman. This may have been 

asked by Dr. Fauci than you, Dr. Collins. Last year we ended up 

transferring $304,000,000 from the Bioshield Reserve Fund to the 

National Institute of Allergy and Infectious Diseases, and we justified that additional research was needed because, before we can 

purchase countermeasures for use in the event of a bioterrorism 

event. 

Now, I was opposed to this; I think that it is better spent at the 

Biomed Advanced Research and Development Authority 

(BARDA)—in their advanced development program. But if these 

funds go to NIAID, will NIAID work with BARDA to ensure that 

the research is supported by those funds that address the issues 

that we are concerned about, and that is a bioterrorism event? And 

through these applications can you ensure that the funding will be 

spent on biodefense research? 

Dr. FAUCI. Thank you for that question, Mr. Tiahrt. The answer 

is we work extraordinarily closely with BARDA. In fact, those very 

funds that ultimately came to us were spent in coordination with 

BARDA; they were allocated for the biodefense research and development. As you, I know, well know, we have an issue with regard 

to the far-end, downstream purchase of something to put into the 

strategic national stockpile, and what the NIH has been doing for 

decades, and does very well, is the fundamental basic research, 

concept development and preclinical development; and then there 

is a gap in the middle which many people refer to as the valley of 

death. Not a very good terminology, but it feels that way sometimes. 

And that is really what we needed to shore up with the funds 

that were technically transfers from BioShield, but really went into 

the research and development in close coordination with BARDA. 

So the answer to your question is yes, it will be. 

Second question, is it used for biodefense? Absolutely yes. 

CURES ACCELERATION NETWORK

Mr. TIAHRT. Okay. Thank you very much. 


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The valley of death, which we have referred to, I guess it was last authorization we put $500,000,000 in for the Cures Acceleration Network, or CAN, as we refer to it. Is CAN the best way to 

go about bridging this valley of death that we refer to, or are there 

other ideas that we should be considering? 

Dr. COLLINS. Well, I think CAN is a very exciting idea. The Institute directors will all be gathering for a retreat all day tomorrow 

to talk about this, because this is an opportunity in a very flexible 

way to try to push forward new and exciting approaches to therapeutics. 

The idea here is, as authorized, but not yet appropriated, is to 

provide large grants that include participation by public and private sector partners. It includes some flexible research authority to 

allow us, in a DARPA-like fashion, to move such projects forward 

rather quickly. And, if appropriated at a reasonable level, would 

allow multiple projects to go forward simultaneously with project 

managers that are authorized to both bring in resources when you 

need it and to kill projects that are failing, which is critical in this 

high-risk area as well. 

The idea here is to develop a new paradigm for how we come up 

with new therapeutic ideas, partnering in a new way with the private sector, where academics are de-risking projects, which, as soon 

as they become commercial viable, can then be out-licensed, so the 

companies can take them and run with them. And I think, from my 

perspective as a physician who is anxious to see therapeutic successes come forward, this is a mechanism that we very much need 

and hope to be able to utilize. 

Mr. TIAHRT. If I can just finish with a comment, Mr. Chairman. 

One of the things we saw in the DARPA program is that when we 

had new ideas that ended up not pursuing, failed, in other words, 

the people who were managing those programs got a black mark 

on their resume. 

And I hope that when you are pursuing new ideas, that just because the idea does not work out does not mean the person failed; 

it may have been a very successful way of finding out not to waste 

more money. So please look at the individual and not put a black 

mark on their record just because they happen to be managing a 

program that is not what we want to invest more money in. 

Dr. COLLINS. I agree with you, Congressman. Winston Churchill 

famously said that success is nothing more than going from failure 

to failure with undiminished enthusiasm. And one needs to keep 

that in mind. If we are not doing the kind of research that fails 

on a fairly regular basis, we are not pushing the envelope hard 

enough. 

Mr. OBEY. [Remarks made off microphone.] 

Mr. RYAN. Thank you. I have been watching from my office, so 

do not feel like I have not been paying attention. [Laughter.] 

BEHAVIORAL RESEARCH

Mr. RYAN. And I know not to ask about comparative effectiveness 

research. I know that ground has been covered. 

Just briefly, I know Mr. Moran has talked about this, and I 

heard Congressman Kennedy talk about it a little bit, the issue of 

behavioral sciences, behavioral research. And last time you were 


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here I talked to you a little bit about mindfulness and some of the 

other approaches that I know NIH is looking into doing some research. Can you just kind of update me as far as is there anything 

that you have been doing over the last year that I should know 

about? 

Dr. COLLINS. So, Congressman, we agree that this is a fruitful 

area for research. Clearly, the mind-body interaction plays a significant role in lots of illnesses, both in terms of their occurrence 

and their adaptation to those who are afflicted with them. Certainly, several of the institutes have significant portfolios in this 

area. I would think the National Center for Complementary and 

Alternative Medicine particularly comes to mind as a place that is 

devoted to trying to test out some of these what people might call 

unconventional therapies, but which clearly many people in the 

public are convinced are of value, and we need to develop the data 

to underscore what that is. 

Already those kinds of studies, for instance, have shown some 

value of yoga in terms of helping people cope with chronic disease, 

and many others are being tested as well. 

The National Heart, Lung and Blood Institute is also engaged in 

a number of these. We have a new program in basic behavioral and 

social science research called OPPNET, which we think also will 

provide some of the foundational information to help us understand 

the correlation between behavior and illness. 

And I might ask my colleague, Dr. Insel, at NIMH, if he has 

other comments he would like to make about the mind-body connection because, of course, that is a topic of great interest in that 

area of medicine. 

Dr. INSEL. Well, I would say it is a topic of great interest across 

much of NIH in the same way as Mr. Kennedy mentioned the development of the neuroscience effort across institutes so that it is 

not balkanized in any way. We have a neuroscience blueprint effort 

across 16 institutes and centers who are now doing this, as Dr. Collins mentions, for behavioral and social science research as well. 

So OPPNET is a new project; it is just getting off the ground at 

this point. It involves all of the institutes and centers at NIH and 

it will be a new forum, as well, for talking about these kinds of 

issues and their opportunities for taking those into a translational 

study of health. 

Our own institute has been very interested in the work of people 

like Richie Davidson in Madison. We fund a center that he runs on 

the study of mindfulness, not only understanding what its health 

implications might be, but also looking at the brain and looking at 

physiology to understand the biology of this process as well as the 

psychology. 

Mr. RYAN. Well, I appreciate that. I went out last year to see 

Richie’s lab, and the work he is doing there is just amazing. And 

we are talking about adding 30 million people to the health care 

system, and I think this kind of individual responsibility, where we 

are actually teaching people how to manage their own levels of 

stress. We know what stress does to all of us in our daily lives, but 

over the long term that kind of high stress level leads to a lot of 

the problems that we are researching and spending a lot of money 

trying to figure out and then deal with and manage over time. 


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So I would just encourage you to continue to go down this road. 

I was at a conference a couple weeks ago at the University of Massachusetts Medical Center was sponsoring, and across the board recidivism, education, health care, prevention, right down the line. 

There were some cops that were there from Portland, Oregon, talking about being more aware in these kind of intense situations. 

There were a couple of colonels there. There were military folks 

talking about building up some resilience in your mind before you 

even go off to battle so that, when you come back, you are more 

resilient, you respond better, and over time I think it will prevent 

a lot of the PTSD that Congressman Kennedy was talking about. 

So I just want to encourage you to go down this road. And whether it is health care or education, the idea that we can teach kids 

to focus—we always tell kids pay attention, but we never teach 

them how to pay attention. And this is a real way for us to teach 

kids how to pay attention, how to make better decisions, how to not 

get caught up in the moment and prevent problems. 

So I just want to encourage you, because the science is there. It 

is there, and I think the more your seal of approval and your street 

cred is on some of these initiatives, the better off I think we are 

all going to be. 

So I want to thank you for—the last point I wanted to make, too, 

in the field of education with social and emotional learning. I 

talked to the Secretary of Education about it when he was before 

this Committee. They have a metastudy that they did with 300,000 

kids. There was an 11 percentile point increase with social and 

emotional learning, with some mindfulness involved in it as well. 

Eleven percentile point increase. You are teaching kids how to pay 

attention. 

And we cannot just tell them to pay attention and not teach 

them how to pay attention; how to deal with their emotions and 

regulate. When you realize that your emotions are prohibiting your 

ability to concentrate, then we have to take step one. It does not 

matter how much money we throw— 

And I hope our friends on the Republican side, who do not want 

us to keep throwing money at problems, will join with us in some 

of this and realize we are going to teach kids how to concentrate, 

how to focus, and how to reduce their level of stress and save the 

health care system a lot of money. 

So I am glad I showed up, Mr. Chairman. Thank you. 

Mr. OBEY. Mr. Lewis. 

COORDINATION OF RESEARCH

Mr. LEWIS. Thank you, Mr. Chairman. 

The gentleman’s concern about health cost and quality is one I 

share with you, and it has nothing to do with partisan politics. But 

let me say this. Years ago a couple of our members suffered from 

Parkinson’s, and that led some of us to organize in a nonpartisan 

way an environment where people who were doing research and 

treatment across the country came together, spent like a day and 

a half together. 

The amazing thing to me at the bottom line was that they had 

never talked to each other in any significant level before, emphasizing that which has been said several ways here today, the need 


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to have voices within your institution pushing the kind of coordination that allows for us to tap many, many resources. 

Years ago we specifically were interested in the proton therapy 

process. At that time, NIH was not interested in the proton. I do 

not know if it was based upon cost or what, but they were not interested. So we took that issue to a hearing at the Energy and 

Commerce Subcommittee of Appropriations, rather than this Subcommittee; and, as a result of that, that subcommittee had about 

a dozen members on it and ten of them had cancer in their family. 

They were very interested and initial funding went forward. 

Since that time, it has been suggested this might be a great item 

for rationing because of relative cost for treatment, even though 

initially we knew there were prospects for small tumors in the 

brain, great success with prostate cancer; most recently, great success with non-invasive breast cancer treatment. But above and beyond that, NASA is very fascinated with this work because of how 

it can help them understand better the effects of radiation upon 

man perhaps in space. 

Well, that sort of coordination and communication could cause 

NIH to help us very much tenor and hold back the tendency of 

wanting to cut off avenues of research, as well as treatment, because of cost alone. So I would urge that to become a priority. 

Mr. KENNEDY. I would hope maybe we could work together on 

getting DOD and VA to really figure out how they are going to coordinate like the NIH has on their neuroscience, because, really, 

the biggest amount of additional science in brain research is going 

to happen on TBI for the veteran, and that is going to accrue to 

Parkinson’s, it is going to accrue to epilepsy, it is going to accrue 

to Alzheimer’s and autism, and everything, because once you start 

researching the brain—and the VA and DOD are going to be— 

those veterans are going to be kicking down the door, as they did 

overseas, to all of these diseases here at home. 

Mr. LEWIS. Mr. Chairman, he is referring to a project that Mr. 

Kennedy and I were going to begin to work on long-range relative 

to the problems with veterans and specific problems like alcoholism 

and drugs, et cetera, leading to homelessness. Unfortunately, Mr. 

Kennedy has made a decision not to run for re-election. 

Mr. KENNEDY. That is why I am leaving it all in your hands, 

Jerry. [Laughter.] 

Mr. LEWIS. Thank you, Mr. Chairman. 

Mr. RYAN. Mr. Chairman, I would like to intervene. I would love 

to help and make sure that this project continues. 

Mr. OBEY. Mr. Kennedy. 

TRAUMATIC BRAIN INJURY

Mr. KENNEDY. I want to go back to this anahedalcystine. From 

what I understand, the DARPA showed that within the first 24 

hours of a veteran suffering a concussion—and they can tell from 

your rapid eye movement whether you have—and there are objective standards—whether you have suffered this—that that goes 

right through the blood brain barrier because of the capillaries and 

it can have long-term impacts in terms of the suffering of the consequences of TBI. And it is sitting right now at the Surgeon GenVerDate Mar 15 2010 08:35 Nov 16, 2010 Jkt 058233 PO 00000 Frm 00335 Fmt 6601 Sfmt 6602 E:\HR\OC\A233P2.XXX A233P2

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eral’s Office of Review or whatever at I guess it is the Navy, because it is the Marine Corps. 

This is something that cannot be sitting around; it has to get out 

there. We already have FDA approval for this. This would be offlabel use of it. So I am just asking, with your basis of science at 

NIMH and coordination within your group, if you can offer research and support to whatever that surgeon general is going to 

have to review in terms of that DARPA research, please, as soon 

as possible, because this is going to help avoid a lot of that downward consequences as a result of TBI. 

Dr. INSEL. We are on it. 

ELECTRONIC HEALTH RECORDS

Mr. KENNEDY. And they show literally if you do not give it within 

the first 24 hours, you give it 72 hours later, the effectiveness diminishes dramatically. 

To go to David Obey’s question about the registries and clinical 

studies, tell us about how the new health bill and IT with the 

health bill offers us an opportunity, Dr. Collins, to have gene banks 

and registries of identify data to essentially do a lot of this that we 

are currently doing through clinical studies, but to really do it 

through the new health system. 

Dr. COLLINS. Well, we desperately need better systems to do 

those kinds of large-scale research projects and, frankly, in this 

Country, we have been significantly impeded by the lack of electronic health records. It is very difficult to do thorough, accurate, 

efficient, cost-effective studies when everything is scribbled on bits 

of paper and it is very hard to sort out exactly what is in the medical record at all, if you can even find it. So having the opportunity 

to see our health care system evolve into an electronic framework 

is going to help enormously. 

But there are a number of issues that we are engaged in here 

to make sure that we get the most out of this. There is whole term 

called meaningful use—— 

Mr. KENNEDY. Are you consulting with those IT folks on this? 

Dr. COLLINS. Yes, we are. Yes, we are. Obviously, one of the 

hopes is that that meaningful use will be defined for the standard 

medical record so that it is optimized for research questions to be 

posed. Obviously, this needs to be done, and shall be done, in a 

fashion that protects privacy and adheres to standards of informed 

consent, but I believe that those are pathways that can be negotiated. And we are really looking forward to the chance to greatly 

enlarge the ability to survey exactly what are the causes of illness 

by potentially having a much more robust system for doing so with 

the electronic record. 

Mr. OBEY. Mr. Cole. 

BIOMEDICAL RESEARCH IN THE UNITED STATES

Mr. COLE. Thank you, Mr. Chairman. 

Thank you, Dr. Collins. I want to ask you a series of questions 

just, frankly, will be easier if I just sort of laid it out, and then 

maybe you could educate me a little bit, since I am new to this 

Committee and certainly new to this topic, but very interested. 


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If you could, could you compare our national effort with other 

countries? Where would you rank us, obviously? Second, what percent of biomedical research done in the United States is actually 

done by NIH or something you fund? And, again, what percentage 

would that be nationally, if you know? And, finally, is there some 

realistic way—you implied in an earlier question that obviously you 

are at the foundation of a lot of very profitable research for people—that some of the money, some of the profits generated down 

the line in the private sector could, in some realistic way, flow back 

to you for the continuation and the augmentation of basic research? 

Not eliminating our role, but generating additional resources for 

you to do what you obviously do very well at NIH? 

Dr. COLLINS. Those are great questions, Congressman, and I 

would be happy to quickly go through them. 

As far as the national effort of the United States in biomedical 

research, I think it is fair to say we continue to lead the world, but 

that leadership is certainly being challenged substantially now by 

other countries—Europe, Japan, and increasingly China and India. 

And our trajectory in terms of the support and the numbers of individuals working in the field has tended to be fairly flat, while those 

are going up rapidly. 

We were grateful to hear the President announce a year ago an 

intention to raise the U.S. investment in research and development 

to 3 percent of GDP, which would be a big shot in the arm, but 

no timetable has been set for that. The time is right, certainly, in 

terms of taking advantage of opportunity and of investigators who 

are ready to come forward with their best ideas and pursue them. 

In terms of research that goes on in this Country, if it is research 

done in academia, that is, in our great universities and institutes 

all over the Country, and it is biomedical research, almost all of 

that is supported by the National Institutes of Health, with a 

healthy contribution also from philanthropy. Certainly, the private 

sector—I think I mentioned numbers a little bit ago—invests about 

$56 billion a year in biomedical research; NIH, at $31 billion is 

about 40 percent of the total, but in a good partnership. 

And your third question about profits that might actually be able 

to feed back in some way to support the research that goes on at 

NIH is something we have thought about. In this new model, 

where we might have a partnership where academic investigators 

get more involved in the front-end of developing new therapeutics, 

that will result in some identification of intellectual property. 

That intellectual property can then be licensed to a private company that is interested in taking it to the next step and all the way 

to FDA approval. And if a drug then actually gets approved and 

for which profits are made, some royalties stream back to the NIH 

would be highly appropriate, and most companies I have talked to 

are comfortable with that model as a good way to get the job done. 

Mr. COLE. Thank you. 

Thank you very much, Mr. Chairman. 

Mr. OBEY. Mr. Ryan. 

RECOVERY ACT INVESTMENTS

Mr. RYAN. Thank you, Mr. Chairman. 


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I just wanted to see if you can kind of outline—we put a lot of 

money into the Recovery Act, and I think you touched upon it a few 

times here. Can you just talk about, in your estimation, I know a 

lot of that money was needed to be spent years ago, and we were 

playing a lot of catch-up here in good measure to the leadership 

from Mr. Obey, but can you talk a little bit about how you feel the 

most impactful investments through the Recovery Act, where that 

went, what it is doing, and how we can—like you said, it is a marathon, not a sprint, and how we can continue to build on it over the 

years? 

Dr. COLLINS. Well, because this was such a significant investment, the list of projects that were possible because of it is much 

longer than I can fit into this three minutes, but let me give you 

a couple of highlights of maybe signature initiatives—— 

Mr. COLE. I mean, things like we want to go out and there is a 

bid across the Country. Stimulus bill is not working, some people 

say. Well, all the metrics show otherwise. But if you could give us 

some tangible information on what would resonate with people, 

what they would grasp onto. 

Dr. COLLINS. So Recovery Act dollars from NIH in fact went out 

to all 50 States, and we are in the process—quite clear we are creating or retaining 50,000 high-quality jobs in the biomedical research enterprise, which is a significant contribution. 

In terms of science that this supports that is going to have a 

large impact on health, I have mentioned the Cancer Genome Atlas 

as a rapid acceleration in the ability to understand exactly at the 

molecular level what is going on in cancer. Similarly, with heart 

disease. We have the Framingham study, which has been going on 

for three generations, which now, because of these dollars, is possible to move into a phase of getting even more detailed information about the environmental and genetic risk factors for cardiovascular disease. 

In the area of HIV/AIDS—and Dr. Fauci could tell you more details about this—this money has made it possible to tackle a couple 

of very novel and potentially very valuable ways to reduce the incidence of new cases of HIV/AIDS by identifying individuals who are 

infected and do not even know they are, and starting them on 

treatment which will reduce the likelihood that they can transmit 

the virus to others. 

Autism. The effort now is funded by the Recovery Act to obtain 

the complete DNA sequence of 300 cases of autism and their parents to finally really understand what are the genetic contributions 

to a disease which clearly can run in families, so there must be 

something going on there. 

All of those are things that we could not have done without Recovery Act dollars to provide that real opportunity to tackle things 

that are risky and expensive, but are potentially groundbreaking. 

Mr. RYAN. I appreciate it. Kent State University, I was there a 

couple weeks ago. They got a significant amount of money from the 

stimulus bill from NIH, and I just want to say thank you, because 

there were a lot of folks there who were working in hiring people 

in Portage County, Ohio, because of what we did through the stimulus bill and what your work is. So I want to thank you for that 

as well. Thank you. 


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Dr. COLLINS. And I could have mentioned the pandemic flu effort, which also was greatly benefitted by the Recovery Act dollars. 

Mr. OBEY. Mr. Kennedy, you had one question? 

HEALTH CARE REFORM AND RESEARCH

Mr. KENNEDY. Yes. 

Dr. Collins, you mentioned a new paradigm in terms of 

translational medicine perhaps working with the private sector. I 

would like to ask you, with this new health bill, the elimination of 

preexisting condition, the elimination of lifetime and annual caps 

puts a big onus on insurance companies now to come forward and 

develop models of care for different disease groups. How they put 

that together will ride on what the evidence-base is on how to best 

treat and care for groups. That is going to involve you talking to 

the President’s assembled people who are going to roll this out, but 

also to insurers and, like is said, that public-private partnership as 

to how they best meet their obligations in the most efficacious way. 

And, Tom, how do you think to do that, when it is not necessarily 

medical and clinical for autism, Alzheimer’s, you know, cognitive 

disorders, but functional? And how do you have a reimbursement 

system that is not based on the old model? And what are you doing 

now to help instruct them so they are not just blocking—which 

they are doing now—and suing against the system? But how do 

you help them meet their obligations by showing them what the 

evidence-base is? 

If you read this Sunday’s New York Times about the veteran, we 

are not even getting it right in the DOD and VA, and we are supposed to have the best in cutting edge of treating cognitive disorders as a result of TBI and PTSD, and it is a disaster if you read 

or take anything from that New York Times cover story on returning warriors. 

So I am wondering—hopefully, that is not the model, and I do 

not even know whether you guys are consulting with the VA or 

DOD. 

Dr. COLLINS. We are. But I think your question is even broader 

in terms of the health care of the Nation, and how are we going 

to come up with systems that work in the new health care reform 

environment. 

One of the things we are doing in that regard that might be 

worth mentioning is to try to work with HMOs that already have 

electronic medical record and are effectively well set up for experiments that we might be able to run in a research way to try to understand how could you provide different kinds of incentives to providers to be able to improve outcomes. Because that is the big sort 

of missing piece in much of where we hope to go. 

It is great to have all the data, and we generate a lot of that data 

to tell you what works and what does not. But how do you get it 

implemented and how do you implement it in a way where you 

have a health care system that actually responds to the right incentives instead of the wrong ones? 

Mr. KENNEDY. [Remarks made off microphone.] Are outcomes 

quality of life or outcomes blood pressure? 

Dr. COLLINS. Oh, I would think quality of life and blood pressure, 

because they are connected. 


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Mr. KENNEDY. Yes, but HMOs do not measure—or insurance do 

not measure quality of life. 

Dr. COLLINS. And you are right that we need better measures of 

whether quality of life is actually considered, and how would you 

define that in a rigorous way. Actually, we have a Common Fund 

Roadmap project on that, where patients actually are able to define, from their perspective, whether they are being benefitted by 

an intervention or not, which is often left out of the equation. 

Mr. KENNEDY. Tom. 

Dr. INSEL. If I may. I think you put your finger on what is going 

to be a very important challenge over the next couple of years. We 

are in a very interesting point in time for at least those with serious mental illness. We have the advent of parity for the first time 

as it rolls out—in spite of some suits, I think it is rolling out—and 

we have health care reform, which is going to have a tremendous 

impact for those with mental illness because of parity. 

What has been such a struggle for us is so much of the cost and 

so much of the challenge for those with serious mental illness is 

outside of the health care system. They are incarcerated, they are 

homeless, or there are problems that play out in the school system, 

where we just do not see them in the health care system and we 

do not think about them through health care dollars. 

And one of the challenges will be to figure out how do you throw 

that net so that all of those needs, as well as the needs of caretakers, get taken into account. We are in discussions with people 

and it has been a very interesting process, partly because of the 

parity in health care reform advances that we now are in discussions with payors, as well as everyone else, to think about what is 

the evidence that you need to make that extension? What would it 

take? 

So I think you know about our Recovery After an Initial Schizophrenia Episode (RAISE) effort, which was really developed almost 

in the reverse; started with the payors and said what would you 

need for someone with an acute psychotic break to cover everything, to cover all the things that we know are necessary for recovery? And what kind of evidence could we provide to you that would 

make you come to the table and say this is a good buy for us, this 

is worth supporting? 

And we are rolling this out; it is a large $25 million effort done 

with the Recovery Act funds, and we think this is actually going 

to be transformative for those people who end up being huge costs 

if we do not get it right on the front end. 

Mr. KENNEDY. Thank you very much. 

Mr. OBEY. Mr. Tiahrt. 

Mr. TIAHRT. Mr. Chairman, I ask unanimous consent to submit 

some questions for the record. 

Mr. OBEY. Sure. 

Mr. TIAHRT. Thank you. 

Mr. OBEY. Let me ask just two questions. Do not worry, you are 

not missing much. [Laughter.] 


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NEW STEM CELL LINES

Mr. OBEY. First of all, would you explain the significance of the 

story that appeared in the Post this morning with respect to stem 

cell? 

Dr. COLLINS. Yes, I would be happy to. As you know, President 

Obama, a little more than a year ago, issued an Executive Order 

indicating that stem cell lines—we are talking about human embryonic stem cell lines—that have been derived since August 

2001—which is when the Bush Executive Order took effect—ought 

to now be considered for Federal funding if they met certain standards as far as the way in which those lines were developed in 

terms of the consent, especially, to be sure that that was ethical. 

NIH was charged with putting together guidelines about how to 

do that review of stem cell lines, and those went into effect in July, 

and we have been receiving the information from many stem cell 

line developers since then and, as of today, there are 64 lines that 

have been approved. 

Today’s news was about two particular lines that go by the 

names H7 and H9, which were derived a long time ago, more than 

10 years ago, and were heavily utilized by researchers between 

2001 and now, and for which there was a lot of data. Those lines 

had not been submitted to NIH for review until about two weeks 

ago; there were some complications in terms of finding all the documentation. The materials were submitted, we reviewed them rigorously, and yesterday I approved them as now being appropriate for 

support by Federal funding. Those two lines actually accounted for 

a substantial amount of the publications that have occurred in this 

field up until now. 

So many people in the research community were hopeful for this 

outcome and I am glad to say we were able to get there with complete adherence to rigorous standards of consent, which were part 

of the Obama Executive Order. 

DR. RUTH KIRSCHSTEIN TRAINING AWARDS

Mr. OBEY. Okay, one other long observation. As you know, Dr. 

Ruth Kirschstein visited this Subcommittee many, many times. 

She was a legendary scientist and administrator at the National 

Institutes of Health, and she died October 6th of 2009 after a public service career that spanned more than 50 years. Dr. Kirschstein 

worked on polio research, made history as the first woman to head 

an NIH institute, and later served as Deputy Director and Acting 

Director of NIH. She was a pioneer. 

A significant part of her legacy is the way she served as a champion for the advancement of women and minorities in biomedical 

research. She was a strong advocate for research training, especially interdisciplinary pre-doctoral programs and programs to increase the number of minority biomedical scientists, physician scientists, and scientists trained in emerging or evolving areas. 

In 2002, as a fitting tribute to her many years of exceptional 

service, particularly in the area of research training, Congress renamed the National Research Service Award Program in her honor. 

The Ruth Kirschstein National Research Service Award is an important tool to ensure we have a pipeline of future investigators 


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ready to take over as the current workforce continues to age and 

move toward retirement. 

In 2001, NIH agreed to work towards increasing entry-level sti- pends under this program to $45,000 a year. Currently, NIH pays 

just under $38,000 a year despite their advanced degree in specialized technical skills that would allow them to earn considerably 

more in the open market. 

I understand that the President’s budget proposes an increase of 

6 percent in stipends under that program. How does that fit into 

your efforts to ensure a robust pipeline of young investigators? 

What is the current NIH policy for cost of living support in this 

program? And, more generally, how are we doing in attracting and 

keeping the next generation of biomedical researchers? 

Dr. COLLINS. Well, Mr. Chairman, I appreciate your citation of 

Dr. Kirschstein and her role at NIH. It is impossible to overstate 

the remarkable impact that she had on the institution and on 

many of us personally, and she is greatly missed. We are having 

a symposium on May 17th, inviting many of the Ruth Kirschstein 

awardees to come back and talk about the science they have done 

in order to recognize the way in which her contribution has had a 

very specific personal effect on each of them, and we are expecting 

that to be a day of great celebration of her legacy. 

In terms of what we are doing about training grants, yes, the 

President’s budget does propose a 6 percent increase, which I think 

is long overdue. If one looks at the stipends that have been proposed by NIH for such trainees, they have remained essentially flat 

for a long period of time, even as inflation has been eating away 

at the buying power. This has—I can tell you, because I recently 

met with the National Postdoctoral Association in Pennsylvania. 

This news of at least a proposed increase was a big morale booster 

for a group that has begun to worry about just how valued are 

they. 

Being in that kind of training circumstance, you can imagine 

why that might feel a little uncertain. You are not yet independent. 

You have a Ph.D., so you know some stuff, but you are not making 

much money and you are not necessarily sure where you are going. 

And to get that kind of pat on the back, saying we value you and 

we think you are a bit underpaid—probably a lot underpaid, but 

we are going to try to do something about it—was well received. 

How are we doing in terms of recruiting? I would say okay, but 

not great. And certainly when you look at the way other countries—for instance, China and India—are doing as far as bringing 

new talent into the scientific research community, they are surpassing us in terms of their reach and their ability to encourage 

people to find their careers in this path, and we are flagging a bit. 

More particularly, I am concerned about the fact that our trainees do not represent the complexion or the diversity of our Country, 

and we need to work harder on the diversity issue and recruiting 

more disadvantaged individuals into this area, because we need the 

best and the brightest no matter what their background happened 

to be; and some of our programs have succeeded at that and some 

have not, and we are looking at a new set of ideas through a Pathfinder Award to try to improve that outreach to groups that are 

traditionally not represented in our workforce and should be. 


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So we have a lot of work to do here between the graduate students and the post-docs, the clinical investigators, the M.D. Ph.D.s 

who I met with this past Saturday, who are also concerned about 

their future but enormously energized about the scientific potential; and this is one of my personal priorities, to be sure that we 

are not passing up the chance to be filling our pipeline with this 

next generation. 

And there are risks here, because they do hear their elders 

wringing their hands and complaining about the fact that it is hard 

to get a grant funded, and that one chance out of seven of having 

your grant actually receive funding may be a bit discouraging to 

some of the young people; and a few of them who met with me in 

Chicago talked about being on the brink of going off to do something else because of their uncertainty about whether there was a 

place for them. We have to work hard on that to be sure that they 

do see there is a place, even in difficult budget times, and hoping 

that, in the longer term, we might ultimately get to a point where 

we have stable, predictable kinds of trajectories for medical research instead of the feast and famine up and down experience, 

which has been pretty hard on everybody, but specifically on young 

trainees. 

TEN MOST IMPORTANT ADVANCEMENTS

Mr. OBEY. One last question. There is a very sour mood in the 

Country about a lot of things these days, and when that occurs people tend to overlook some very important things that have occurred 

in society and in government through the years. I mentioned earlier that I have been on this Committee since, I do not remember, 

1973 or 1974, one of those, and the way politics works, I guess, if 

you produce something that is physical and tangible, like a missile 

or a space vehicle, a shuttle, people can see visibly what they get 

for their tax dollars. But in a field like health care, there is not 

much that you can put your hands on to say, yes, this is what improvement in cancer research looks like. I mean, you cannot touch 

it. It is very different. And I think it is important that taxpayers 

understand that a lot of times, in lots of places, their tax dollars 

do some very good things. 

The problem is also that you cannot see that in any one year. 

But if you step back and look at it over time, then you can see 

some major changes that have occurred. 

What I would like you to do—and I do not expect you to do it 

now, but I would like you, at least for the record, to do this. If you 

take a look at what has happened because of NIH funding through 

the years, what are the ten biggest improvements, what are the ten 

most important steps forward? What are the ten ways in which the 

public’s health has been advanced because of what NIH and the researchers that it funds all around the Country have produced? If 

you can prepare that for the record, that would be useful. 

Dr. COLLINS. I would appreciate the chance to do that. 

[The information follows:] 


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Dr. COLLINS. Just very quickly, but not the full response that I 

know you expect, if one looks at what has happened to death rates, 

and the fact that we have seen longevity improve by one year about 

every six years, and that can be tracked to NIH research in a very 

large extent. That is a pretty good general indicator. Disability is 

dropping off. 

In this document (NIH: Turning Discoveries Into Health) that we 

left for you, we tried to capture some of these others, such things 

as, for instance, what has happened with HIV/AIDS, which used to 

be a death sentence and which now the average person diagnosed 

at age 21 can expect to live to age 70. When you look at something 

like deafness, where children born with congenital deafness would 

have cost the Country, in the past, $1 million of extra educational 

efforts and would therefore have had many limitations on them, 

now, with the ability to treat that, you can in fact expect, and we 

have seen for 50,000 kids, that they can be mainstreamed because 

of the ability to repair the problem. 

Heart disease dropping by 60 percent in the course of the last 30 

years in terms of the deaths is another very good one to cite. 

There is a lot there. But, you know, you are right, Mr. Chairman. 

I do not think that that is a story that is often told. It does not 

happen overnight; it happens over years. And when it does happen, 

people may not realize why it happened, and much of it is resting 

upon this foundation of medical research that this Subcommittee 

has supported down through the years. 

Mr. TIAHRT. Can you put that all in 28 seconds, please? 

RECOVERY ACT FUNDS

Mr. OBEY. What it really amounts to is—I mean, it is 35 years. 

It is a generation. And I think it is important people understand 

what has happened from one generation to another, what the taxpayer expenditures finally produce. 

The other question I would have is you mentioned feast and famine. Some people might take that remark to suggest that that demonstrates that we made a mistake when we put the funding in that 

we did for the recovery package. So, again, I would like to know 

would it have been better had the Committee not provided that 

money over the last two years? Is it worth the discombobulation 

that you have because it is a two-year temporary shot in the arm? 

And you know what I am getting at. 

Dr. COLLINS. I do. 

Mr. OBEY. Is it worth it? Was it worth it? Was it a mistake? And 

is it worth the complication, I guess I would put it that way? 

Dr. COLLINS. Well, Mr. Chairman, thank you for the opportunity 

to correct any misapprehension that might have arisen from my 

use of that particular phrase. It has been a wonderful investment 

in medical research. This $10 billion came at a time where there 

was a great pent-up demand and need, and a whole series of innovative ideas that were not possible to support; and they came forth 

in great numbers, and scientists supported by the Recovery Act are 

doing remarkable things right now, and we will see the consequence of those; not overnight, because science does not operate 

overnight, but in the long-run, as having been a very wise investment in advancing research. 


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It does create some stresses for the system when this comes forth 

in a two-year period and we cannot see sort of a more stable trajectory, and we are going to be experiencing those stresses, I fear, in 

fiscal year 2011, but it was worth every bit of it to get the research 

done that has been possible to support through the Recovery Act. 

Mr. OBEY. Any other last questions? 

ALZHEIMER’S FUNDING CARE VERSUS CURE

Mr. KENNEDY. On those questions that you would have Dr. Collins come back with, if there could be—we are spending a lot of 

money on the care of people with certain illnesses. I am thinking 

Alzheimer’s is one. Lots and lots of money is going to continue to 

go and it is going to go up. 

However, if we put a fraction of the money that we are going to 

be putting into long-term care into researching the cure, or even 

researching delaying the onset of Alzheimer’s, how does that 

budgetarily pay for itself by averting costs averted from the actual 

dollars that we would otherwise be spending in the costly care of 

folks with these illnesses? If you could try to figure out a way how 

we put some metrics to that. 

[The information follows:] 


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Mr. KENNEDY. And on Dr. Kirschstein, I too, David, want to just 

say what a pleasure it was working with her, and the fact that we 

were able to, with her help, put the network of basic behavioral research together, and encourage you to try to get med schools to incorporate behavioral education into their medical school curricula. 

I know that is a priority of yours. If you could keep the pressure 

going on our State boards to include that in their medical school 

curriculum. 

Dr. COLLINS. Point well taken. 

Mr. OBEY. Thank you gentlemen. Thank you all. 


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W I T N E S S E S 

Page 

Collins, F. S .............................................................................................................. 279

Duncan, Hon. Arne .................................................................................................. 59 

Fauci, A. S ................................................................................................................ 279

Insel, T. R ................................................................................................................. 279 

Rodgers, G. P ........................................................................................................... 279 

Sebelius, Hon. Kathleen .......................................................................................... 145 

Solis, Hon. Hilda ...................................................................................................... 1 

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I N D E X 

Department of Labor 

Page 

Chairman’s Opening Remarks ................................................................................ 1 

Secretary’s Opening Statement .............................................................................. 1–6 

Secretary’s Written Statement ............................................................................... 7–23 

Green Jobs ................................................................................................................. 24/38 

G–20 Summit ........................................................................................................... 25 

Bureau of International Labor Affairs ................................................................... 27 

OSHA Ergonomics Regulation ................................................................................ 27 

Worker Protection .................................................................................................... 28 

OSHA Staffing ......................................................................................................... 29 

Racial Disparities in Unemployment ..................................................................... 29 

Ex-Offender Grants ................................................................................................. 30 

Ratio of Job Seekers to Jobs ................................................................................... 31 

Number of Federal Employees ............................................................................... 31 

Foreign Government Subsidized Employment ...................................................... 31 

DOL Budget Request ............................................................................................... 32 

Addressing Chronically Unemployed ..................................................................... 32 

Job Sectors Facing Contraction .............................................................................. 34 

Rebounding Job Sectors .......................................................................................... 34 

Job Sector Contractors ............................................................................................ 34 

Shortages in Traditional Energy Industry ............................................................ 37 

Continuing Education .............................................................................................. 37 

Employee Readiness To Enter Job Market ........................................................... 39 

Extension of Retirement Age .................................................................................. 40 

Protecting Migrant Farm Worker Children ........................................................... 42 

Exposure of Children to Hazardous Materials ...................................................... 43 

Leveraging Stimulus Funding ................................................................................ 44 

Reemployment of Highly-Skilled Workforce .......................................................... 44 

Training for High-Growth Industries ..................................................................... 45 

Improving Job Loss Picture .................................................................................... 46 

Conclusion ................................................................................................................ 47 

Questions of Record.................................................................................................. 48–58 

Department of Education 

Chairman’s Opening Remarks ................................................................................ 59 

Secretary’s Opening Statement............................................................................... 59–66 

Secretary’s Written Statement................................................................................ 67–75 

Pell Grant Programs Costs ..................................................................................... 76 

Rising Tuitions and Cost to Students .................................................................... 76 

Financing Pell Grants and Direct Lending Proposal ............................................ 77 

Direct Lending Proposal-Terminating Lender Subsidies ..................................... 77 

21st Century Community Learning Centers ......................................................... 78 

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Impact of Economy on After-School Programs ...................................................... 78 

After-School Programs ............................................................................................. 78 

Competitive Grant Programs and Rural Districts ................................................ 80 

Turning Around Low-Performance Schools ........................................................... 80 

School Improvement Intervention Models ............................................................. 81 

Helping Struggling Populations ............................................................................. 81 

Charter Schools in Rhode Island ............................................................................ 82 

Adult Literacy .......................................................................................................... 82 

Pell Grants and College Tuition ............................................................................. 82 

Adult Literacy and Training ................................................................................... 83 

Student Loan Interest Rates .................................................................................. 84 

Even Start Program—Family and Adult literacy ................................................. 84 

Teacher Support and Chronic Low-Achieving Schools ......................................... 85 

Holding Schools, Districts and States Accountable .............................................. 86 

Funding for Low-Achieving Schools ....................................................................... 86 

Support for Teachers ............................................................................................... 86 

Increased Resources, Shared Responsibility ......................................................... 87 

Programs Flat-Lined in FY 2011 Budget .............................................................. 87 

Indian Education ..................................................................................................... 88 

Increased Funding in Consolidations ..................................................................... 88 

Graduation Rates of NCAA Athletes ..................................................................... 89 

Real Estate Market Impact on School Funding .................................................... 89 

Education Funding as Investment in Nation ........................................................ 90 

Disparities in CCAA Graduation Rates ................................................................. 90 

National Education Policy Discussions .................................................................. 91 

Formula-Driven Stimulus Bill Funding ................................................................. 91 

Helping Schools Not in Formula Calculations ...................................................... 91 

State Fiscal Stabilization Funds ............................................................................ 92 

Tax Credit for Privately Schooled Students .......................................................... 92 

Fiscal Constraints on National School Districts ................................................... 92 

Federal vs. Local Share in Education Funding ..................................................... 93 

Addressing Low Graduation Rates of NCAA Athletes ......................................... 94 

Native American and Alaska Native Students Education ................................... 94 

Common Course Standards .................................................................................... 95 

Texas Proposed Textbook Changes ........................................................................ 95 

48 States Working Toward Common Standards ................................................... 95 

ESEA Reauthorization ............................................................................................ 96 

Shepherd Program—Poverty and Human Capability ........................................... 96 

Effective Teachers and Leaders Funding .............................................................. 96 

Educational Opportunity Equity Commission ....................................................... 97 

Ensuring Educational Equity ................................................................................. 97 

Teacher and Principal Equity ................................................................................. 98 

Schools as a Reflection of Community ................................................................... 98 

Promise Neighborhoods ........................................................................................... 99 

Shift Toward Competitive Programs and Consolidations .................................... 99 

Educational Technology State Grant Programs .................................................... 99 

Income-Based Repayment of Student Loans ......................................................... 100 

TRIO, Gear-Up, HEP and Camp Program Requests ............................................ 100 

College Access and Completion Funds ................................................................... 101 

Social and Emotional Learning Programs ............................................................. 101 

Social, Emotional Development and Decision Making Ability ............................. 101 

Teaching Students To Understand Emotions ........................................................ 102 

Early college Enrollment and Dual Enrollment Programs .................................. 102 

College Pathways ..................................................................................................... 103 

Pell Grant and Early College Programs ................................................................ 103 

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Disproportionality in Special Education ................................................................ 103 

Early Learning Challenge Fund ............................................................................. 103 

Even Start ................................................................................................................ 104 

Education Jobs Saved by Recovery Act .................................................................. 105 

Education Jobs Bill .................................................................................................. 105 

Title 1, ESEA Funds for High-Poverty Schools ..................................................... 106 

School Improvement Grants ................................................................................... 106 

Title 1 Funding ........................................................................................................ 106 

Addressing Inequality in Education ....................................................................... 107 

Race to the Top Application Process ...................................................................... 107 

Focusing Increased Resources on Inequality ......................................................... 108 

History and Civics Education ................................................................................. 108 

Budget Increased To Promote Well-Rounded Education ...................................... 109 

Civil Rights .............................................................................................................. 109 

Proposal for Direct Lending for Student Loans .................................................... 109 

Proposal To Increase Pell Grant Funding ............................................................. 110 

Student Loan Reform .............................................................................................. 110 

Individuals With Disabilities—Grant to States .................................................... 111 

Teachers Recruitment and Retention .................................................................... 111 

Teachers Incentive Fund ......................................................................................... 112 

Promise Neighborhoods ........................................................................................... 112 

Move Toward More Consolidation and Competitive Programs ............................ 113 

Dropout Rate and College Completion ................................................................... 113 

Focus on Achievement Gaps ................................................................................... 114 

Assessment of No Child Left Behind ..................................................................... 114 

Focus on Growth, Gain; Reward Success, Excellence ........................................... 114 

Flexibility and Accountability ................................................................................. 114 

Proposal To Move to Student Loan Direct Lending .............................................. 115 

Robotics Competitions ............................................................................................. 116 

Incentives and Public-Private Partnerships .......................................................... 116 

Partnering of School Districts To Share Services ................................................. 117 

Pell Grants ............................................................................................................... 117 

Savings From Direct Lending ................................................................................. 117 

IG Audit of Reading First ....................................................................................... 117 

Eliminating Conflict of Interest in Competitive Awards ...................................... 118 

Actions To Prevent Conflicts of Interest ................................................................ 118 

Origins of U.S. Deficit ............................................................................................. 119 

Chairman’s Closing Remarks ................................................................................. 119 

Questions for the Record ..................................................................................... 120–143 

Department of Health and Human Services 

Chairman’s Opening Remarks ................................................................................ 145 

Witnesses Opening Statements........................................................................... 147–149 

Witnesses Written Statements............................................................................ 150–161 

Health Care Reform ................................................................................................ 162 

Cost of Insurance Premiums ................................................................................... 162 

Individual Mandates ............................................................................................... 168 

Medical Loss Ration ................................................................................................ 168 

State Insurance Commissioners ............................................................................. 169 

Single-Payor System ................................................................................................ 170 

Medical Error Rates ................................................................................................ 171 

Medical Advantage .................................................................................................. 171 

Diversity in Health Professionals ........................................................................... 172 

High Risk Pools ........................................................................................................ 175 

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Prohibition on Lobbying With Federal Funds ....................................................... 176 

Prevention and Wellness Funding ......................................................................... 177 

Reducing Caesarean Births .................................................................................... 178 

Increasing Birthing Centers ................................................................................... 178 

FMAP Formula ........................................................................................................ 179 

Health Care Fraud .................................................................................................. 179 

Medicare Reimbursement ....................................................................................... 180 

Hospital Acquired Infections ................................................................................... 181 

Medicare Reimbursements Rates ........................................................................... 182 

Health Insurance Costs ........................................................................................... 184 

Prevention and Public Health Fund ...................................................................... 185 

Prevention and Mindfulness ................................................................................... 185 

Primary Care Physician Shortage .......................................................................... 186 

Health Reform Compliance and Enforcement ....................................................... 187 

Prevention Issues ..................................................................................................... 188 

Health Care Reform ................................................................................................ 190 

Unfunded Programs in Health Reform .................................................................. 192 

Underage Drinking .................................................................................................. 194 

Section 317 Vaccination Program ........................................................................... 195 

Projected Coverage Rates ........................................................................................ 195 

Physician-Owned Hospitals .................................................................................... 196 

Children’s Health Task Force ................................................................................. 196 

Forum Health Bankruptcy ...................................................................................... 197 

Food Safety ............................................................................................................... 198 

Questions for the Record ..................................................................................... 200–277 

National Institutes of Health 

Chairman’s Opening Statement ............................................................................. 279 

1Witnesses Opening Statement .......................................................................... 281–285 

Witnesses Written Statement ............................................................................. 286–308 

Comparative Effectiveness Research ..................................................................... 309 

Adult and Embryonic Stem Cells ........................................................................... 310 

Sickle Cell ................................................................................................................. 311 

FY 2011 Funding ..................................................................................................... 313 

Pancreatic Cancer .................................................................................................... 316 

Class B Dealers ........................................................................................................ 317 

Breast Cancer Mammography Guidelines ............................................................. 317 

Funding for Comparative Effectiveness Research ................................................ 318 

Private Sector Innovations From NIH Investments ............................................. 319 

Priority Setting for Resource Allocations ............................................................... 321 

Pediatric Cancer Research ...................................................................................... 322 

Food Allergies .......................................................................................................... 323 

Pediatric Diabetes .................................................................................................... 324 

Environmental Causes of Illness ............................................................................ 326 

Mental Illness Among Veterans ............................................................................. 328 

National Cancer Institute Clinical Trials .............................................................. 329 

Biodefense Research ................................................................................................ 331 

Behavioral Research ................................................................................................ 332 

Coordination of Research ........................................................................................ 334 

Traumatic Brain Injury ........................................................................................... 335 

Electronic Health Records ....................................................................................... 336 

Biomedical Research in the United States ............................................................ 336 

Recovery Act Investments ....................................................................................... 337 

Health Care Reform and Research ......................................................................... 339 

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New Stem Cell Lines ............................................................................................... 341 

Dr. Ruth Kirschstein Training Award ................................................................... 341 

Ten Most Important Advancements ................................................................... 343–349 

Recovery Act Funds ................................................................................................. 350 

Alzheimer’s Funding Care Versus Cure ............................................................. 351–352 

Questions for the Record ..................................................................................... 354–437 

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