DEPARTMENTS OF LABOR, HEALTH AND HUMAN 

SERVICES, EDUCATION, AND RELATED AGENCIES 

APPROPRIATIONS FOR 2010 

HEARINGS 

BEFORE A 

SUBCOMMITTEE OF THE 

COMMITTEE ON APPROPRIATIONS 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED ELEVENTH CONGRESS 

FIRST 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 

JAMES P. MORAN, Virginia 

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. 

CHERYL SMITH, SUE QUANTIUS, NICOLE KUNKO, 

STEPHEN STEIGLEDER, and ALBERT LEE, 

Subcommittee Staff 

PART 6 

STATEMENTS OF MEMBERS OF CONGRESS AND OTHER 

INTERESTED INDIVIDUALS AND ORGANIZATIONS 

( 

Printed for the use of the Committee on Appropriations 


hsrobinson on PROD1PC76 with HEARING
Part 6 


hsrobinson on PROD1PC76 with HEARING
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, 

AND RELATED AGENCIES APPROPRIATIONS FOR 2010 


hsrobinson on PROD1PC76 with HEARING

hsrobinson on PROD1PC76 with HEARING
DEPARTMENTS OF LABOR, HEALTH AND HUMAN 

SERVICES, EDUCATION, AND RELATED AGENCIES 

APPROPRIATIONS FOR 2010 

HEARINGS 

BEFORE A 

SUBCOMMITTEE OF THE 

COMMITTEE ON APPROPRIATIONS 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED ELEVENTH CONGRESS 

FIRST 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 

JAMES P. MORAN, Virginia 

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. 

CHERYL SMITH, SUE QUANTIUS, NICOLE KUNKO, 

STEPHEN STEIGLEDER, and ALBERT LEE, 

Subcommittee Staff 

PART 6 

STATEMENTS OF MEMBERS OF CONGRESS AND OTHER 

INTERESTED INDIVIDUALS AND ORGANIZATIONS 

( 

Printed for the use of the Committee on Appropriations 

U.S. GOVERNMENT PRINTING OFFICE 

50–545 WASHINGTON : 2009 


hsrobinson on PROD1PC76 with HEARING
COMMITTEE ON APPROPRIATIONS 

DAVID R. OBEY, Wisconsin, Chairman 

JOHN P. MURTHA, Pennsylvania 

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 

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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(1) 

DEPARTMENTS OF LABOR, HEALTH AND 

HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR 

2010 

TESTIMONY OF INTERESTED INDIVIDUALS AND 

ORGANIZATIONS 

WEDNESDAY, MARCH 18, 2009. 

Mr. OBEY. Well, good morning, everyone. Thank you all for coming. I am pleased to open the Subcommittee’s first hearing for the 

new fiscal year. 

Let me first start by welcoming our new Ranking Member, Todd 

Tiahrt. He and I have long experienced changing tires with each 

other in the middle of nowhere, and I am looking forward to our 

relationship on this Subcommittee. 

I also want to welcome the other new members of the Subcommittee: Congressman Jim Moran; we have a returning member, 

Congressman from Montana, Mr. Rehberg; we also are being joined 

by Congressman Rodney Alexander; Congressman Jo Bonner; and 

Congressman Tom Cole from—I cannot say it is my home State, 

but it is my birth State—Oklahoma. 

We are happy to have all of them on the Subcommittee. 

We are starting off the hearings for this Subcommittee at a time 

when the Country is in a deep recession, and that impacts people 

all throughout the Country. I am sure we will see evidence of that 

by people’s testimonies here today. 

We are somewhat handicapped because any time you have a new 

President, that sort of discombobulates the budget schedule. With 

a new President, they want time to prepare their own budget, so 

we are not yet in receipt of the President’s budget, which I understand will be coming down some time this year. [Laughter.] 

I hope it comes down sooner than that. And, when it does, we 

will deal with it in as much depth as time permits so that we can 

try to stay on schedule this year. 

We also hope that the Budget Committee will move its product 

ahead in a timely fashion so that we can meet our own schedule. 

I am going to ask every witness to please adhere to the four 

minute limit. We are not trying to be rude, but if you do not adhere 

to the four minute limit, there are other people who will not get 

a chance to testify, because we are going to be interrupted from 

time to time by things called roll calls. This would be a great job 

if we did not have to interrupt our work to go vote once in a while, 


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but, unfortunately, we have to, so I would ask for your cooperation. 

I appreciate your being here today. 

With that, I would turn to Congressman Tiahrt for whatever 

comments he would like to make. 

Mr. TIAHRT. Thank you, Mr. Chairman. It is a pleasure to join 

you on this Committee. I am looking forward to the interesting 

work that you have been carrying on. I know that this Committee 

has been a passion of yours, so I know that you will reflect that 

and the witnesses that we get to hear from. I am pleased to be 

joined by my members here. I think the way you explained this 

birth in Oklahoma and end up in Wisconsin was I was born in 

Oklahoma by the grace of God, I am a Wisconsinian. 

Mr. OBEY. I think that is how that worked, Todd. [Laughter.] 

Mr. TIAHRT. I know we have a full schedule today. I am looking 

forward to working with the members and listening to the testimony. Thank you, Mr. Chairman. 

Mr. OBEY. I should explain. I have explained to people many 

times. My father was the only man in America who moved to Oklahoma during the Depression to get a job. [Laughter.] 

I also want to just bring to the attention of our new members, 

as well as the audience, the pictures on the wall there. What we 

have tried to do in this Committee is to remind people that this 

Subcommittee has a distinguished heritage, and the heritage is 

best exemplified by the members on the wall, starting with John 

Fogerty up on the left, who chaired this Subcommittee for many 

years. He was a bricklayer by profession before he fell into a life 

of sin and got elected to Congress. His ranking member for many 

years was Mel Laird, who was my predecessor in the Congressional 

district that I now hold. 

If you take a look at the men pictured there, you will see a history of bipartisanship and a history of doing some really remarkable things for the Country. This Subcommittee, in the past, 

oversaw the spectacular growth of the National Institutes of 

Health; the birth of the Department of Health, Education, and Welfare; the splitting up of that agency; the creation of the Department 

of Education; and very major changes in budget trends in the 

Country through the years. I would hope that we can continue that 

tradition. 

With that, our first witness will be introduced by the gentleman 

from Illinois, Mr. Jackson. 

Mr. JACKSON. Thank you, Mr. Chairman. Let me also congratulate you and thank you for the pictures that you have hung in the 

Subcommittee hearing room. It gives me something to aspire to. I 

can see that I am still probably 30 or 40 years away having my 

picture hung. [Laughter.] 

Mr. OBEY. Members are generally hung before their pictures are. 

[Laughter.] 

Mr. JACKSON. Thank you, Mr. Chairman. Let us hope that is not 

the case. 

It is my pleasure to welcome Mr. J.B. Pritzker to our Subcommittee. Mr. Pritzker is a partner of and founded New World 

Ventures in 1996 and is also a managing partner of the Pritzker 

Group. Mr. Pritzker also heads the J.B. and M.K. Pritzker Family 

Foundation, a Chicago-based philanthropy. The Foundation is a 


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private family foundation deeply committed to the pursuit of social 

justice and to shaping innovative and effective strategies for solving society’s most challenging problems. 

As Mr. Pritzker will describe, The Children’s Initiative, a project 

of the J.B. and M.K. Pritzker Family Foundation, seeks to enhance 

the early learning capabilities of infants and toddlers, with a special focus on at-risk children. Inspired by the early childhood development work of the late Chicago entrepreneur and philanthropist 

Irving Harris, and motivated by the relief and the belief that all 

children are born with great potential, The Children’s Initiative 

supports policies, programs, research, and advocacy to allow at-risk 

children to achieve better economic, educational, and social outcomes. 

Mr. Chairman, a number of us back in Chicago have worked with 

J.B. for a number of years. We have, at various moments in his 

philanthropic career, encouraged him to consider entering this 

body. He would make a fine United States Representative and certainly, if he ever desired, a fine member of the other body. 

Ladies and gentlemen, Mr. Chairman, Mr. J.B. Pritzker. 

Mr. OBEY. I could not understand why anyone would ever want 

to be a member of the other body, but that is beside the point. 

[Laughter.] 

Mr. Pritzker, you are recognized for four minutes. 

WEDNESDAY, MARCH 18, 2009. 

THE CHILDREN’S INITIATIVE 

WITNESS 

J.B. PRITZKER 

Mr. PRITZKER. Thank you, Mr. Chairman. Fortunately, I do not 

live in the 2nd Congressional District, so my chances are improved 

somewhat if I ever decide to do that. 

Thank you, Chairman Obey, for inviting me to be here today. It 

is a great honor to sit here in front of you as a champion of children and the disadvantaged. You have done so much and I am personally very grateful. 

Congressman Jackson, thank you for the kind introduction. Our 

long personal relationship goes back probably even before you may 

remember, to when I worked for Senator Terry Sanford and you 

were on the campaign trail or working with your dad, and the two 

of them met early morning in a hotel room in North Carolina to 

talk about the future of the Democratic Party. So I got to be witness to maybe your political birth. 

Thank you also to the entire Committee for your advocacy on behalf of disadvantaged children, for all the wonderful successes that 

you have already accomplished this year and for all that you do 

and will do for our Nation’s children. 

In my day job, I worry non-stop about making good investments 

about building businesses and growing capital, and behind you on 

the wall, Chairman Obey, I understand you had painted on the 

wall the quote from Hubert Humphrey that begins ‘‘The moral test 

of government is how it treats those who are at the dawn of life, 


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the children.’’ I might add, for everybody else, that it is also the 

mark of a fiscally responsible Government to invest in early childhood. 

In my philanthropic work, I have similar goals, that is, to make 

good investments. I face far less worry, of course, in that, and enjoy 

much more certainty. By supporting early childhood education, I 

know I am making an investment in fostering human capital that 

is guaranteed to pay dividends. 

We all know that everyone is born with potential, but we often 

do not have the facts to say how much society should invest in 

maximizing potential from an early age or whether financial risk 

makes sense. Well, finally, the work of economists like Nobel Laureate Jim Heckman, at the University of Chicago, developmental 

psychologists, sociologists, statisticians, and neuroscientists provides the answer with decades of research, solid data, and multidisciplinary analysis. 

Investing in early childhood development for disadvantaged children and their families provides a real return on investment, 

around 10 percent—it has been calculated by not liberal, but even 

conservative economists—through increased personal achievement 

and social productivity. It improves the health, economic and social 

outcomes not just for individuals, but for society at large. 

In these complicated and tumultuous times, we face a litany of 

problems we would like to fix and goals we would like to achieve: 

fostering economic competitiveness; achieving better educational 

outcomes; increasing the opportunity for health; reducing crime; 

building a capable, productive, and competitive workforce. Anyone 

looking for upstream solutions for the biggest problems facing 

America should understand that the great gains to be had by investing in early and equal development of human potential exists 

in investing in early childhood. 

If I leave you with nothing else today, I hope you will take away 

the following: Your efforts in early childhood development are an 

investment yielding real dollar returns. Early childhood development is not just an education issue, it is also a health issue that 

affects the health of our economy. A vast body of research shows 

that early childhood development from the ages of zero to five 

greatly affects cognitive development, social and emotional health, 

and the ability to learn as a child and later function at a high level 

as an adult. Effective early childhood development has the potential to reduce teen pregnancy, crime, and other social burdens, 

while increasing human productivity that drives economic security 

for all. It will produce a smarter, stronger, healthier, and more 

prosperous Nation, helping America stay the top competitor in the 

global economy. 

In the long run, it will cost us less than it is costing us now to 

remediate the consequences we suffer by not providing effective 

early childhood development investment. 

Mr. OBEY. Could I ask you to wind up, because your time has 

expired? 

Mr. PRITZKER. Yes, sir. 

We know our investments need to begin at birth and have a particular focus on infants and toddlers, who currently have the greatest needs and receive the fewest services. 


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Implementing effective early childhood education programs can 

be done because it is being done, with measurable results. I invest 

in Educare of Chicago. It is one solution to this. It is the gold 

standard of high quality early education, providing full day, full 

year care and education for disadvantaged children from birth to 

five with high quality and highly qualified teachers. 

Thanks to the investments made in American Recovery and Reinvestment Act, you have provided a down payment to help serve 

more children and improve the quality of the education they are receiving. But there is much more to be done. For millions more children in poverty who do not have access to early learning opportunities, closing that disadvantage gap would prove to be of great advantage to all Americans. Please continue to support Head Start, 

Early Head Start, the Child Care and Development Block Grant, 

and the President’s Early Learning Challenge Grants. 

We do not have to reinvent the wheel when it comes to effective 

early childhood development programs; we simply need to get the 

wheel rolling across America to benefit all. 

Thank you very much. 

Mr. OBEY. Thank you very much. 

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Mr. OBEY. Next, Mr. Ryan. 

Mr. RYAN. Thank you, Mr. Chairman. I would like to take this 

opportunity to introduce Linda Lantieri, who is going to testify. 

She is on behalf of the Collaborative for Academic Social and Emotional Learning. This is a collaborative that actually exists in Congressman Jackson’s district at the University of Illinois at Chicago. 

Let me just quickly say I think this is a transformational education program for our country, and this is based on a lot of the 

research and work that was done from the book Emotional Intelligence by Dan Goldman, and this is something, Mr. Chairman, 

that I am taking up now as a personal mission in my life to support you. 

With that, Ms. Lantieri. 

WEDNESDAY, MARCH 18, 2009. 

COLLABORATIVE FOR ACADEMIC, SOCIAL AND 

EMOTIONAL LEARNING 

WITNESS 

LINDA LANTIERI 

Ms. LANTIERI. Thank you, Congressman Ryan. 

I appreciate the opportunity to speak to you today from the perspective and experience of someone who has been in the field of 

education for four decades, as a classroom teacher and administrator in East Harlem, and as education faculty at Hunter College, 

New York City. More recently, I have been deeply involved in the 

healing and recovery efforts in 12 schools in Lower Manhattan in 

which 8,000 children and 200 teachers fled for their lives on the 

fourth day of school, September 11th, 2001. 

Today, I am representing the Chicago-based Collaborative for 

Academic, Social, and Emotional Learning. CASEL is the world’s 

leading organization advancing research, school practice, and public policy to establish social and emotional learning as an essential 

part of education, pre-K through 12. 

The field of social and emotional learning is informed by scholarly research that demonstrates that the systemic teaching of emotional and social skills as part of a student’s regular school day 

adds to the lessons needed for life: improving self-awareness and 

confidence, managing disturbing emotions and impulses, increasing 

empathy and cooperation. These skills also provide students with 

the essential tools they actually need to be effective learners as 

well. 

A recent review of 31 studies on social and emotional learning 

showed that improvements in students’ academic scores were an 

average of 11 percentile points over students who did not receive 

social and emotional learning. For example, one of the studies in 

the review that by the time they were 18, students who received 

social and emotional learning in grades 1 through 6 had significantly higher grade point averages, showed lower school misbehavior and delinquency, and showed lower heavy alcohol use 

from students who were in the control group. 


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The academic and life success returns on the investment in SEL 

are substantial. These are also the same very skills that our Nation’s business and government leaders have defined as essential 

for effectiveness in the modern workplace. 

I am happy to say that Illinois and New York have already 

passed legislation and released guidelines to move this agenda forward. However, too few students have access to this critical programming, and the schools that do need training and technical assistance so their SEL efforts are maximized. 

Because SEL requires serious commitment at the Federal, State, 

school district, and community levels, CASEL is advising in the development of authorizing legislation to support SEL programming 

in the field. The proposed legislation would establish both a National Training and Technical Assistance Center and a State and 

local grant program to promote SEL nationwide. 

We look forward to sharing with you more about this as this proposed legislation progresses. 

There is, however, much we can do right now to further this 

agenda by using existing Federal funding. I ask you to support report language to the Labor, HHS, Education Appropriations bill 

that will encourage States and local agencies to use Federal funds 

for SEL programming, particularly as part of Title I school improvement, Title II teacher quality enhancement, and effective use, 

of course, of Title IV, Safe and Drug Free Schools funding. 

Unfortunately, many of our young people today would describe 

school as a place that prepares them for a life of tests, instead of 

preparing them for the tests of life. I hope you agree with me that 

we can do better, and I thank you for the opportunity to speak to 

you today. 

Mr. OBEY. Thank you very much, and thank you for staying 

within the time. 

Ms. LANTIERI. You are very welcome. 

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WEDNESDAY, MARCH 18, 2009. 

CENTER FOR LAW AND SOCIAL POLICY 

WITNESS 

DANIELLE EWEN 

Mr. OBEY. Next, Center for Law and Social Policy, Danielle 

Ewen. 

Ms. EWEN. Chairman Obey, members of the Subcommittee, 

thank you for the opportunity to testify today about the importance 

of continuing to grow Federal investments in Head Start and Early 

Head Start in order to support our most vulnerable: infants, toddlers, preschoolers, and their families. Your support for these birth 

to five programs, most recently demonstrated by the funding increases they received in the economic recovery package, has long 

been critical to their success. 

I am testifying today on behalf of the Center for Law and Social 

Policy, or CLASP. CLASP is a national nonprofit that works to improve the lives of low-income people. CLASP’s mission is to improve 

the economic security, education and workforce prospects and family stability of low-income parents, children, and youth, and to secure equal justice for all. 

AS you know, Head Start and Early Head Start are the only federally-funded programs providing comprehensive early education 

and support services for poor children and their families. Both 

Head Start and Early Head Start have proven their effectiveness 

in national studies that show gains in cognitive development and 

physical and mental health. More importantly, both programs have 

proven their effectiveness by improving the lives of children and 

families. 

Head Start and Early Head Start serve a diverse array of children and families living in poverty. Seventy-seven percent of participants across all Head Start funded programs are in families 

earning below the Federal poverty level. Another 15 percent qualify 

because they receive public assistance. Thirty-one percent of participants in the programs come from homes where English is not 

the primary language. A greater proportion of African-American 

and Latino children participate in Head Start than do white or 

Asian children. 

One-third of all parents with children in Head Start have less 

than a high school diploma or GED. But Head Start and Early 

Head Start families are working hard to become self-sufficient. Seventy percent of all Head Start families include at least one working 

parent, and 13 percent of families include a parent in school or job 

training. Yet, despite their best efforts, most of these families still 

live in poverty and lack access to basic supports. 

We know that children living in poverty face many risk factors 

to healthy development, risks that often go undetected until the 

children enter school. The majority of participating families receive 

health and social service referrals through Head Start. Eighty-four 

percent of families in Early Head Start and 73 percent in Head 

Start accessed at least one service in 2008. Importantly, half of all 

children in Head Start with disabilities were diagnosed during the 

program year. Without the intervention of the program, it is likely 


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that these issues would have gone undetected until children entered kindergarten or even first grade. 

To expand their reach, Head Start providers are partnering with 

State pre-kindergarten, child care, and other early childhood programs to provide high quality full day and year experiences. 

In Hamilton County schools in Chattanooga, Tennessee, the 

school district uses Title I funds in conjunction with Head Start 

funds to expand the availability of high quality classrooms. 

In Birmingham, Alabama, the Head Start agency has partnered 

with family child care providers to provide Head Start services in 

family child care homes. Providers are trained in the model and receive the full range of professional supports. Providers also meet all 

of the performance standards for every child and are monitored on 

a regular basis. 

Yet, even as they leverage as much support as possible, Head 

Start and Early Head Start programs are unable to serve the majority of eligible children and families. Head Start is serving only 

about half of eligible preschoolers and Early Head Start is serving 

less than three percent of babies and toddlers. 

Infants and toddlers are more likely to live in poverty, and economists predict that this recession will be longer and more severe 

than any the United States has faced in recent decades, suggesting 

that many more families will need the comprehensive supports that 

Head Start and Early Head Start provide. 

CLASP looks forward to working with the Committee to continue 

to reverse the losses in recent years and ensure that early childhood programs, including Head Start, Early Head Start, and the 

Federal Child Care Assistance Program, stay firmly on the growth 

path set out in the recent economic recovery package and the 2010 

budget proposal from the Administration. These investments are 

vital components of economic recovery because they support the important early years of a child’s development, and that is critical to 

our Nation’s future success. 

Thank you. 

Mr. OBEY. Thank you very much. Appreciate your time. 

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WEDNESDAY, MARCH 18, 2009. 

NATIONAL ASSOCIATION OF CHARTER SCHOOL 

AUTHORIZERS 

WITNESS 

GREG RICHMOND 

Mr. OBEY. Next, Mr. Greg Richmond, National Association of 

Charter School Authorizers. 

I do not know if we should let any authorizers in the room. 

[Laughter.] 

Mr. RICHMOND. Good morning, Chairman Obey, Ranking Member Tiahrt, members of the Subcommittee. My name is Greg Richmond and I am the President and Chief Executive Officer of the 

National Association of Charter School Authorizers, or NACSA. 

Thank you for the opportunity to testify before your Subcommittee 

on actions that the Federal Government can take to improve quality within the charter school sector. 

NACSA is a trusted resource and innovative leader for charter 

school quality. We are a professional membership organization, but 

our members are not charter schools; our members are the agencies 

or the authorizers that oversee public schools on behalf of the public. We have many members and perform work in many of the cities and States that you represent on this Committee. 

We know that a number of cities and States across the Country 

have many quality charter schools. Recent studies in Boston, New 

York, Chicago, New Orleans, and Oakland are showing that charter schools can raise test scores, graduate more students, and send 

more students to college. 

But we also know that there is nothing easy or automatic about 

charter school quality, and that there are some places where there 

are too many weak charter schools. We support President Obama’s 

call, stated last fall and again last week, for increasing the number 

of charter schools and for raising our standards for charter school 

quality. 

Since 1995, the U.S. Department of Education has spent more 

than $1,700,000,000 on its Federal Charter School Program, or 

CSP. While these funds have promoted the growth of the charter 

school sector, they have done less to promote consistent quality 

within that sector. 

Currently, the CSP requires charter schools to meet very few requirements, such as admitting students via random lottery and following basic civil rights laws. Absent are critical standards and 

practices that would strengthen charter school operations and outcomes. Congress should take several small, but important, steps to 

put academic and financial quality controls in place within this important Federal program. These quality controls can be achieved 

through four steps: contracts, student performance requirements, 

audits, and proper monitoring. 

First, contracts. The charters held by charter schools are multiyear, multi-million dollar arrangements under which schools provide education services in exchange for receiving public funds. Yet, 

by our estimate, between 10 and 20 percent of charter schools 

across the Nation do not operate under a basic legal contract. This 


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is unacceptable and the CSP should require all charter schools to 

operate under the terms of a legal contract. 

Second, student performance requirements. Accountability is at 

the core of the charter school philosophy. Yet, too many low performing charter schools remain open because charter school accountability requirements in their State are vague and not centered on student performance. We need to close these low performing charter schools because they are not serving students well 

and because they are undermining those charter schools that are 

excelling. The Charter Schools Program should require that charter 

schools meet the same objective measurable student performance 

standards that apply to all other public schools in a State. 

Third, audits. Some of the most troublesome problems in the 

charter school sector have occurred due to a lack of adequate financial controls at a small number of schools. Most States, but not all 

States, require charter schools to conduct annual independent, financial audits. The Federal Charter School Program should require 

all charter schools to do so. 

Finally, monitoring. We know that passing new strong laws that 

incentivize quality is only the first step. Laws are of little value if 

no one is monitoring or enforcing them. The role of the authorizer 

is to provide that oversight on behalf of the public. To this end, 

Congress should require that a small portion of Federal Charter 

School Program funds be used to improve the quality of authorizing. 

Since the program’s inception, State education agencies have 

been allowed to use five percent of funds for their own general administration. In the future, a portion of these funds should be used 

to improve the practices of authorizers and thereby improve the 

quality of monitoring. Taken together, these small but important 

steps—contracts, student performance requirements, audits, and 

monitoring—will go a long way toward achieving the shared goal 

of President Obama and U.S. Secretary of Education Arne Duncan 

to promote, support, and strengthen the charter school sector. 

I appreciate this opportunity to testify on the need for quality 

controls among charter schools and authorizers. By establishing 

these quality controls, we will take a strong step forward in our efforts to provide all of our students with the greatest educational 

opportunities possible. Thank you. 

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Mr. OBEY. Thank you. Just a quick question. Do you happen to 

know how many charter schools we would find in a small town or 

rural area as opposed to how many we would find in your major 

metropolitan areas? 

Mr. RICHMOND. More charter schools are in major metropolitan 

areas, but it does vary by State to State. Wisconsin has a pretty 

significant population of charter schools outside of major metropolitan areas relative to other States. Colorado also has more charter 

schools outside of major metropolitan areas. But in some States it 

is the opposite; they are concentrated in big cities. And that is a 

function of State laws and the role of school districts in supporting 

those schools. 

Mr. OBEY. Thank you. 

Mr. Tiahrt. 

Mr. TIAHRT. Thank you, Mr. Chairman. 

Mr. Richmond, you mentioned Chicago in your testimony. Are 

you familiar with Secretary Duncan? 

Mr. RICHMOND. Yes, I know him well. I used to work with Arne 

at the Chicago Public Schools. 

Mr. TIAHRT. And there are charter schools in Chicago. You mentioned in here that part of the plan was that if they were not working, you would close the charter schools. How would you measure 

that and how did you determine success or closure? 

Mr. RICHMOND. We put forward some very straightforward measurements: not only test scores, but also attendance, graduation 

rates, and then we did look at finances to make sure the finances 

were being properly managed, and we audited those every year. 

But we defined very clear measurable outcomes. In each school 

we had a contract; with each school, we signed it, they signed it, 

and said these are the performance expectations. If you achieve 

these you will be renewed, you will stay open; if you do not achieve 

them, you are at risk of being closed. During my time there, we 

closed two schools. 

Mr. TIAHRT. Out of how many? 

Mr. RICHMOND. Out of about 30. 

Mr. TIAHRT. Interesting. Thank you, Mr. Richmond. 

Mr. JACKSON. Mr. Chairman? 

Mr. OBEY. Thank you. 

Mr. JACKSON. Very quickly. 

The President said, in his most recent address to Congress, that 

we cannot be a Nation—if I remember correctly—that is satisfied 

with just graduating students from high school, and that someone 

who is dropping out of school is not just dropping out on themselves, they are also dropping out on every citizen and on the society. 

Has your association ever thought about adding the college acceptance rates as a criteria to the effectiveness of the charter 

school? Not that you are just graduating students from high school, 

but that they are being accepted to college; that they are attending 

college; and that they have a low matriculation out of the institution as one of the criteria? 

Mr. RICHMOND. We are actually working on that as we speak in 

a joint project with ourselves, the National Alliance for Public 

Charter Schools, and a center at Stanford University, where we are 


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putting forward, with Federal support, a broader set of school quality measures that include test scores, but then also include tracking how many students go on to college. 

This was a very important lesson that we learned in Chicago 

that came out of the charter sector. There was a school on the west 

side in North Lawndale, in the late 1990s, that was doing a fantastic job preparing kids to go to college, actually helping them 

apply and make sure they got in. 

Nothing like that had been happening in the regular city high 

schools. Arne Duncan saw that happening at the charter school on 

the West Side, he hired that gentleman from the charter school to 

come into the central office of the school district and put that in 

place for all high schools in the city. It is tremendously important 

that all kids have the opportunity to go on to college. 

Mr. OBEY. Thank you. 

Ms. LEE. Question. 

Mr. OBEY. Go ahead. 

Ms. LEE. Good morning. 

Mr. RICHMOND. Good morning. 

Ms. LEE. Thank you, Mr. Chairman. Let me just ask a quick 

question about the distinction between public charter schools and 

private charter schools. I have been one who has been very skeptical of charter schools, and I am trying to hear a compelling case 

to make my mind up whether I support or do not support charter 

schools, because I have seen evidence both ways. 

Mr. RICHMOND. Right. Except in Arizona, where they do have 

something that is called private charter schools—and I honestly do 

not even know what they are—everywhere else in the country, all 

charter schools are public schools and, to me, the thing that makes 

them public is the fact that they are publicly funded, they are publicly monitored—they are accountable for finances and test scores— 

and they are open to all students, they serve students on behalf of 

the public. Those are the things, to me, that make them public 

schools, because they have the funding, the monitoring, and the 

service to all students. They cannot discriminate, they cannot administer tests. They have to be open to all. 

Mr. OBEY. Mr. Cole. 

Mr. COLE. Thank you, Mr. Chairman. 

It is my understanding, Mr. Richmond, that, in the wake of Hurricane Katrina, your organization did a lot to get charter schools 

up and operational in New Orleans. Obviously, you have got a pretty concentrated experience there, and experiment. I am just curious 

what your observations are, what role they played, how successful 

they have been. 

Mr. RICHMOND. I think that the work has been very successful. 

It certainly is not something we have done alone, but I traveled to 

Louisiana shortly after Hurricane Katrina, first met with State Superintendent Cecil Picard. I now work closely with State Superintendent Paul Pastorek. Every charter school that has opened in 

New Orleans since the hurricane, our association has evaluated on 

behalf of the State of Louisiana and made those recommendations. 

But it is not just us. The real strength of this is that New Orleans public education before the hurricane was really almost a lifeless system. There was no hope in the city that anyone could fix 


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what was happening in the traditional school district. Afterwards, 

by opening up so many charter schools has really created a lot of 

opportunity. There is a much greater level of engagement: community engagement in schools, parent engagement in schools, teacher 

engagement. Much greater optimism. 

And the real importance of that, when all is said and done, the 

charter schools that have opened in New Orleans since the hurricane are performing 50 percent higher on the State’s academic performance system than the schools that the State opened at the 

same time. Same kids; same neighborhoods; anyone can go to either school. The charter schools are performing 50 percent higher 

than the traditional schools opened by the State. 

Mr. OBEY. Thank you. 

Mr. RICHMOND. Thank you. 

Mr. OBEY. Let me simply observe that I hope people understand 

that just because members on the Committee do not ask questions 

of most witnesses, that is not because of a lack of interest; we are 

trying to stifle ourselves so that as many people have an opportunity to talk here today as possible. Something about Mr. Richmond’s testimony or else the subject matter itself triggered an unusually long round of questions. So you ought to try to figure out 

what that was, because you certainly had everybody’s interest. 

Mr. RICHMOND. I am a native of Wisconsin, Mr. Chairman, so 

that has to be what it was. 

Mr. OBEY. Aha. Well, I hope it is Northern Wisconsin. 

WEDNESDAY, MARCH 18, 2009. 

NATIONAL ASSOCIATION OF STATE DIRECTORS OF 

SPECIAL EDUCATION 

WITNESS 

MARY WATSON 

Mr. OBEY. Okay, next, Helen Blank, National Women’s Law Center. 

Oh, I am sorry, I got ahead of myself. First it is National Association of State Directors of Special Education, Mary Watson. Sorry 

about that. 

Ms. WATSON. Good morning, Mr. Chairman and members of the 

Committee. My name is Mary Watson, Director of Exceptional 

Children Division for the Department of Public Instruction for the 

State of North Carolina. I am speaking to you today as President 

of the Board of Directors for the National Association of State Directors of Special Education. NASDSE is the national not-for-profit 

association that represents State directors of special education. I 

thank you sincerely on behalf of NASDSE for the opportunity to 

appear before you this morning to talk about funding for special 

education programs under the Individuals with Disabilities Education Act, known as IDEA. 

Mr. Chairman and members of the Committee, I first want to 

thank you sincerely for including support for special education in 

the American Recovery and Reinvestment Act. In North Carolina, 


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this came at a critical time, when services for students with disabilities were about to be suspended or teachers laid off. 

While these funds are going to help States in the short term, for 

the next two years, we remain concerned about the long-term funding for IDEA. Even with the national budget crisis, no child with 

a disability can be turned away from our public schools. 

My testimony will briefly address four parts of IDEA and funding 

for each of these parts. 

The first is the Part B program, which serves children ages 3 

through 21. When IDEA was reauthorized in 2004, the authorizers 

spoke about putting IDEA on a glide path to full funding. We ask 

you to appropriate funding for Part B for the fiscal year 2010 that 

will bring it closer to the full funding. 

Section 619, a program that serves children ages 3 to 5. President Obama and Secretary Duncan have made pre-K programs one 

of their educational priorities. Section 619 was level-funded in fiscal year 2009, which represents a funding cut due to the acrossthe-board spending cuts in fiscal year 2008 appropriations. We urge 

you to provide a 10 percent funding increase for the Section 619 

program. 

The Part C program serves infants and toddlers from birth to age 

two. We have compelling evidence that indicates if services are received early on, they can help mitigate the services required at a 

later date, thus reducing costs of special education when children 

enter school. It is important that these children be identified and 

services be provided as soon as possible. While this Committee has 

increased funding slightly for Part C in fiscal year 2009, we request 

the Committee again consider increasing fund for the Part C program in recognition of the importance of identifying and meeting 

the needs of this young and vulnerable population. 

The Part D program, the fourth part, provides valuable support 

to State education agencies and through State education agencies 

to the local education agencies. NASDSE would like to thank this 

Committee for increasing funding for several of the Part D programs in the fiscal year 2009 Omnibus bill. I would especially like 

to mention two of the programs of critical importance. 

The Regional Resource Centers that are funded through the technical assistance and dissemination line item in Part D is the first. 

These centers, over the years, have provided invaluable, hands-on 

support to States. 

The State Personnel Development Grants, known as the SPDGs. 

From my own personal experience, I thank you for restoring the 

SPDGs in the fiscal year 2009 Omnibus bill that President Obama 

has just signed into law. This program is critical to supporting the 

personnel programs and special education which caused increased 

outcomes for students with disabilities. 

In North Carolina, because of the professional development that 

was made possible through this funding, students with disabilities 

have more than double the progress made by their non-disabled 

peers in reading. For students with disabilities who were taught 

math by teachers who were trained using the SPDG funding, these 

students increased 27 percentage points, while regular education 

students only increased 3 percentage points. With respect to discipline of schools implementing positive behavior supports, office 


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discipline referrals have decreased, increasing instructional time, 

thus increasing achievement scores. 

Across the States, the SPDG funding is used in various ways. In 

sum, this funding remains critically important to States and to students. NASDSE requests that you return this program to its original funding level by adding just $2,000,000 and provide a 10 percent increase for the other Part D programs. 

Mr. Chairman, this concludes my testimony. I would be happy to 

answer any questions. Thank you. 

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WEDNESDAY, MARCH 18, 2009. 

NATIONAL WOMEN’S LAW CENTER 

WITNESS 

HELEN BLANK 

Mr. OBEY. Now, we will hear from Helen Blank, National Women’s Law Center. 

Ms. BLANK. I am from Michigan. Not close enough, I guess. 

Chairman Obey, members of the Subcommittee, thank you for 

the opportunity to testify. The National Women’s Law Center 

works to increase low income women’s access to Head Start, Early 

Head Start, and child care because they are all key to ensuring a 

family’s economic security and their children’s futures. We welcome 

your strong support for these programs. 

Head Start was founded on one very common sense principle: 

children do not come in pieces. Helping children to exceed involves 

addressing the full array of factors that affect their development, 

most notably, the role that their parents play in their lives. 

With its comprehensive approach to early childhood, Head Start 

and Early Head Start are fundamental building blocks of a highquality early education system. Data is clear that low-income children such as those targeted by Head Start often start out at a disadvantage. Head Start is dedicated to these children who need the 

most intensive help. It offers them high-quality early education, as 

well as other supports. This comprehensive approach is not replicated in most other early education programs. 

In Head Start, social workers help stressed families work 

through the challenges of unstable jobs, abusive relationships, and 

inadequate housing, as well as the depression and sense of hopelessness that comes from living on the edge. Health workers make 

sure children are screened and treated, and help parents navigate 

the community’s health system, bringing children in rural areas to 

dentists that are miles away. Staff help parents become partners 

in their children’s education. Programs collaborate with job training programs and local colleges to aid parents in gaining skills and 

returning to school. Fathers are helped to strengthen the connection they need with their children and their families. 

What does this mean? A four-year-old boy came to an organ program quiet and withdrawn. The annual screening process identified 

him as hearing impaired and, after a referral to a local pediatrician 

and audiologist, he was found to be profoundly deaf. Through the 

efforts of Head Start staff, the child received intensive sign language education. Staff worked with the family, who only spoke 

Spanish, to access high-quality medical services. They also assisted 

the family in obtaining Cochlear implants for their son. 

Head Start is also comprehensive in its approach to early learning, addressing language, math, literacy, science, as well as physical health, approaches to learning, social and emotional development, and creative arts. 

Head Start is dynamic; it is constantly improving and updating 

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ers, tougher accountability requirements for boards of directors, increased program reviews, a requirement for more programs to compete to renew their grants, increased requirements for collaboration 

with local school districts, and, very importantly, an increased 

focus on infants and toddlers. 

Unfortunately, until the much welcomed increase for Head Start 

in the ARRA and the Omnibus bill, Head Start funding had been 

virtually flat since 2002. Instead of focusing on the goals of the reauthorization, programs had to make due with less: cutting the 

number of hours and days, reducing staff, cutting training, not replacing equipment or buying new books, reducing or eliminating 

transportation for children to the core program and to medical and 

dental appointment, threatening the poorest children’s access to 

Head Start. 

Programs have had less access to child care funds, making it 

more difficult to support full day services. The lack of child care 

funding is a significant challenge for Head Start parents and for 

countless others. That is why we are also grateful for the increase 

in CCDBG included in the ARRA and the Omnibus bill. 

The funding included in the economic recovery legislation demonstrated a recognition that Head Start helps our economy today 

and in the future. We look forward to working with this Committee 

to ensure that Head Start, Early Head Start, and child care continue on the growth path the Administration has set out, because 

it underscores the importance of investing in the critical early 

years of a child’s development. 

It is essential, in fiscal year 2010, to enable these programs to 

continue to meet the needs of the low-income young children and 

families they serve, as well as reach the growing numbers of 

unserved children ages zero to five. 

Thank you very much for all your support. 

Mr. OBEY. Thank you. 

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WEDNESDAY, MARCH 18, 2009. 

UNITED TRIBES TECHNICAL COLLEGE 

WITNESS 

DAVID GIPP 

Mr. OBEY. Next we will hear from Dr. David Gipp, United Tribes 

Technical College. 

Mr. GIPP. Thank you, Mr. Chairman. It is an honor to be here. 

I might say this is only the third time in the 35 years I have been 

in Indian education and education that I have been able to appear 

before this Committee, so it is a great honor to be here. 

Mr. OBEY. Well, you have been lucky to avoid us so far. 

[Laughter.] 

Mr. GIPP. Thank you for having here, on behalf of our tribal communities. I am President of United Tribes Technical College, which 

has been around for about 40 years. We celebrate our fortieth anniversary this coming year here and we appreciate the opportunity. 

I am going to get straight to the point and note our request, Mr. 

Chairman, and that is that we are requesting that the authorized 

programs under the Carl Perkins law, Section 117, that the 

amounts of $8,500,000 or $727,000 above the fiscal year 2009 enacted level be provided for principally two schools, United Tribes 

Technical College and Navaho Technical College, which benefit by 

this. Together, we serve close to 2,500 students and about 500 children on our campuses. 

United Tribes is located in Bismarck, North Dakota, and we 

serve, as I mentioned, between 20 to 60 different tribes from 

throughout the region and throughout the Nation, along with 400 

to 500 children on our campus, and we offer a comprehensive 

model that includes both early childhood centers, as well as a K 

through 8 elementary school that works principally with our adult 

population in 17 different areas of career and technical education. 

This is part of the benefit from the Carl Perkins law. 

The second request that I will speak to is also providing for 

added funding under Title III and Title III–A of the Higher Education Act for the tribal colleges and universities, of which there 

are 37 throughout the United States, serving approximately 30,000 

students throughout the United States of America. So we ask that 

those not only be reauthorized, but that the funds be provided for 

adequacy so that these institutions can continue in the development phases of their post-secondary programs, as well as needed 

construction facilities. All of these schools, with the exception of 

one or two, do not receive State appropriated dollars and they do 

not have the benefit of local tax bases, as is the case with United 

Tribes. 

I mentioned, in the case of United Tribes, that we are a comprehensive model, and I mentioned some of the array of services 

that we provided. I will also highlight that we have about an 80 

percent retention rate, a 94 percent job placement rate in the fields 

for which students graduate and go on, in many cases, to four-year 

institutions. We have a very good return on our investment and we 

have achieved our highest level of accreditation through the North 


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Central Association for Tenures. In 2011 we are up for our comprehensive, and we look forward to expanding our programs. 

I should mention the need for providing these funds, and that is 

that about 51 percent of our population throughout Indian Country 

or where there are tribal populations is now under the age of 25, 

and, in many cases, 51 percent or more of that population is under 

the age of 18. We have a growing population. So the challenge is 

to meet the needs of this population in terms of education and 

training, so that is the role for us as we see it. 

We will grow, in the case of United Tribes, from about an average of 1,100 students to about 5,000 students in the course of the 

next five years. That is how we look at it in terms of what is happening throughout our various communities. We offer courses that 

range from the licensed practical nursing, to criminal justice, to 

auto mechanics and the standard trades, to online education and 

five degrees that we provide therein. 

So those are just some of the things that I mentioned, Mr. Chairman, and we would greatly appreciate the continuation of support 

of these institutions, given the fact that the previous Administration tried to zero us out this past year and Congress saw the wisdom of continuing the support of these very valuable institutions. 

Thank you. 

Mr. OBEY. Thank you. 

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WEDNESDAY, MARCH 18, 2009. 

ASSOCIATION OF UNIVERSITY CENTERS ON 

DISABILITIES 

WITNESS 

MICHAEL GAMEL-McCORMICK, PH.D. 

Mr. OBEY. Next, Dr. Michael Gamel-McCormick, Association of 

University Centers on Disabilities. 

Mr. GAMEL-MCCORMICK. Good morning, Chairman Obey, Ranking Member Tiahrt, and members of the Subcommittee. Thank you 

for the opportunity to testify today regarding fiscal year 2010 appropriations. My name is Michael Gamel-McCormick. I am the 

President of the Association of University Centers on Disabilities 

and the Interim Dean of the College of Human Services, Education 

and Public Policy at the University of Delaware. 

I want to talk to you about two of our programs today, the University Centers for Excellence in Developmental Disabilities, what 

we sometimes call UCEDDs, and our Leadership Education in 

Neurodevelopmental and Related Disabilities, or LEND, Programs. 

The mission of the UCEDDs is to advance policy and practices 

for and with people with developmental and other disabilities. As 

a network of 67 interdisciplinary centers across the United States 

and its territories, we work to ensure that individuals with all 

types of disabilities are full members of their communities. 

Our LEND programs help to ensure that the more than 3.8 million children with disabilities in the United States can find appropriate medical care from highly qualified professionals who have 

been trained on the most up-to-date interdisciplinary practices. 

The general education and training of health care professionals 

and other elements of the health care system have not necessarily 

kept pace with the needs of these children. LEND programs are designed to address this shortage of highly qualified health care professionals for the needs of those children today and into the future. 

The LEND program in Representative Obey’s State is at the University of Wisconsin-Madison, and the Waisman Center is leading 

the way in looking at new treatments for Parkinson’s, spinal muscular atrophy, Rett Syndrome, Fragile X, and Down Syndrome, 

training professionals on how to use science-based interventions in 

order to improve the quality of life of thousands of children and 

young adults. 

Our university centers work to develop and evaluate promising 

practices that improve the lives of children and adults with disabilities and their families, conducting research in such areas as 

causes and prevention of disabilities and chronic conditions, and 

then translating that research into practice. 

I will give you an example from my own university center. We 

have a child care facility called The Early Learning Center. It 

serves 240 children living in poverty, living in foster care settings, 

or with disabilities. The ELC is a site where over 500 university 

students observe best practices, participate in practical experiences, and conduct research. 

In one of the most exciting examples of combined research, training, and service, we are in the middle of conducting a robot-asVerDate Nov 24 2008 23:05 Jul 06, 2009 Jkt 050545 PO 00000 Frm 00069 Fmt 6602 Sfmt 6602 E:\HR\OC\A545P2.XXX A545P2

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sisted mobility study with infants and toddlers. Preliminary results 

indicate that providing these children with disabilities with mobile 

devices at 18 years of age or younger actually increases their social, 

their language, and their cognitive abilities. 

The good thing is that people have already recognized this and 

we have been able to attract partners to help create these mobility 

devices and then get them into children’s and families’ hands and 

feet already. 

I now want to shift gears for just a little bit and talk about some 

of the challenges our Nation faces and how our network can help. 

I will address four things: Autism Spectrum Disorder, returning 

veterans with disabilities, racial and ethnic health and mental 

health disparities, and the increasing aging population. 

Regarding health disparities, children and adults of color with 

developmental disabilities experience poorer health and have more 

difficulty finding and paying for health care as compared to other 

populations. Our network proposes to partner with minority-serving institutions of higher education to better engage research, education, and service efforts for African-Americans, Hispanic-Americans, Native Americans, Pacific Islanders, and Asian-Americans. In 

partnership with our existing university centers, minority-serving 

institutions of higher education would be well positioned to train 

future leaders, conduct necessary research, and disseminate pertinent information widely into communities. 

We also want to extend our efforts from the university centers 

and the LENDs to reach out to returning veterans, to address the 

aging population, and especially to address the increasing number 

of individuals who are being diagnosed with Autism Spectrum Disorder. 

Mr. Chairman, there are many challenges that we see and are 

ready to accept through our network. AUCD urges the Congress to 

provide sufficient funds that continue to take advantage of our 

highly effective and productive national network, and to continue 

the research, education, and service to address these critical emerging needs. Our written testimony outlines funding recommendations. Thank you, and I would be glad to take any questions that 

the Committee has. 

Mr. OBEY. Thank you. 

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WEDNESDAY, MARCH 18, 2009. 

THE AD HOC GROUP FOR MEDICAL RESEARCH 

WITNESS 

MARY J.C. HENDRIX, PH.D. 

Mr. OBEY. Next, The Ad Hoc Group for Medical Research, Dr. 

Mary J.C. Hendrix. 

Ms. HENDRIX. Good morning, Mr. Chairman and members of the 

Subcommittee. My name is Mary Hendrix, and I serve as the President and Scientific Director of the Children’s Memorial Research 

Center at Northwestern University’s Feinberg School of Medicine. 

I am testifying on behalf of The Ad Hoc Group for Medical Research, a coalition of more than 300 patient and voluntary health 

groups, medical and scientific societies, academic and research organizations, and industry. 

As an active cancer researcher who runs an institute that employs more than 500 staff, I thank and commend Congress for including the extraordinary investment in medical research through 

the National Institutes of Health in the American Recovery and 

Reinvestment Act, as well as the $938,000,000 in NIH funding in 

the Omnibus Appropriations Act for fiscal year 2009. 

In particular, I am deeply grateful to the Chairman and this 

Subcommittee for your longstanding leadership in support of the 

NIH. These are difficult times for our Nation, for everyone around 

the globe, and investing in science is a key step to a better future 

and is a strategic approach. 

The funding increases in the Recovery Act and the fiscal year 

2009 Omnibus will provide an immediate infusion of funds into the 

Nation’s highly competitive medical research enterprise so that we 

can pursue new diagnostics, prevention strategies and treatments, 

and also so we can provide state-of-the-art scientific facilities and 

support our scientists and their support personnel. 

As a result of this Subcommittee’s prior investment in NIH, we 

have made critical advances in many different areas in research, 

including Parkinson’s Disease, including infectious diseases and 

cancer. And I would say that all of these advances are leading us 

to an area of more effective, personalized medical treatment. 

However, the discovery process often takes a long, lengthy, and 

unpredictable path; and the infrastructure that we are creating 

needs to be maintained so large fluctuations in funding will be disruptive to training, to careers, to long-term planning and projects, 

and ultimately to progress. The research engine needs a sustained 

investment in science to maximize our investment globally. We 

must ensure that, after the stimulus money is spent, that we do 

not have to dismantle all of our progress and newly built capacity. 

In 2011 and beyond, we need to be able to continue to advance 

the new directions chartered with the Recovery Act support. So, 

Mr. Chairman, as you noted in your recent press release, the fiscal 

year 2009 Omnibus and the Recovery Act provided $38,500,000,000 

for NIH to provide over 16,000 new research grants for lifesaving 

research into many diseases. So keeping up with the rising cost of 

medical research in the 2010 appropriations will help NIH begin to 

prepare for the post-stimulus era. 


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In 2011 and beyond, we need to make sure that the total funding 

available to NIH does not decline and that we can resume a steady, 

sustainable growth consistent with the President’s vision for investment in basic research. Consistent with the President’s proposal, we respectfully urge this Subcommittee to increase funding 

for NIH in fiscal year 2010 by at least 7 percent. 

As we appreciate the ravages of disease are many and the opportunities for progress across all fields of medical science are profound, investing broadly in biomedical research is key to ensuring 

the future of America’s medical enterprise and the health of our 

citizens. 

We thank you again for your leadership and for the Subcommittee’s leadership in improving the health and quality of life for all 

Americans and for the opportunity to speak to you today. Thank 

you. 

Mr. OBEY. Thank you. 

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Mr. OBEY. Mr. Tiahrt. 

Mr. TIAHRT. Thank you, Mr. Chairman. 

You mentioned personalized treatment. Is that as a result of the 

genome project, that you can tailor treatment for an individual? 

Ms. HENDRIX. Yes, sir. I am glad you asked about that. So, based 

on the sequencing of the human genome, which took over two decades and finished in 2003, we are now able to look at the genes 

responsible for many different diseases; and as these are being discovered almost on a daily basis, we now can apply them to predict 

diseases at the earliest possible time and then to think about prevention strategies. So that is where we are going. 

Mr. TIAHRT. It is not just applicable to cancer, it is to other diseases as well? 

Ms. HENDRIX. To diseases across the board, sir. Yes. Thank you. 

Mr. TIAHRT. Thank you. 

Mr. JACKSON. Mr. Chairman, if I might pick up on what Representative Tiahrt said. 

Mr. OBEY. Yes. 

Mr. JACKSON. And, I gather, design specific medications that can 

be personalized to the individual based upon the genome sequence 

in that individual, leading to a designer drug? 

Ms. HENDRIX. That is exactly correct, and then predicting which 

patients will be more receptive to receiving these particular drugs 

based on their genetic background. 

Mr. JACKSON. Thank you, Mr. Chairman. 

Ms. HENDRIX. Thank you. 

Thank you, sir. 

WEDNESDAY, MARCH 18, 2009. 

CROHN’S AND COLITIS FOUNDATION OF AMERICA 

WITNESS 

GARY SINDERBRAND 

Mr. OBEY. I understand Mr. Jackson would like to introduce our 

next witness. 

Mr. JACKSON. Thank you, Mr. Chairman. I appreciate the opportunity to introduce Gary Sinderbrand to the Subcommittee. Gary 

is the Chairman of the Board of Trustees for the Crohn’s and Colitis Foundation of America. CCFA is the Nation’s oldest and largest 

nonprofit organization dedicated to finding a cure for these devastating disorders. Gary will share with us his daughter’s courageous story of living with Crohn’s Disease. Unfortunately, I know 

all too well the challenges these patients face, having watched my 

chief of staff endure a similar struggle. 

Mr. Chairman, I want to personally thank you and the Subcommittee and the staff for all of the work that you have given to 

this important cause over the years. I look forward to continued 

progress in this Congress. 

Gary, thank you for being with us today. We look forward to your 

testimony. 

Mr. SINDERBRAND. Congressman Jackson, first, let me extend my 

heartfelt thanks on behalf of the 1.4 million Americans suffering 


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from these diseases for all of your ongoing support. We truly appreciate it. 

Let me say at the outset how appreciative we are for the leadership this Subcommittee has provided in advancing funding for the 

National Institutes of Health. Hope for a better future for our patients lies in biomedical research, and we are grateful for the recent investments that you have made in this critical area. 

Crohn’s Disease and ulcerative colitis are devastating inflammatory disorders of the digestive tract that cause severe abdominal 

pain, fever, and intestinal bleeding. Complications include arthritis, 

osteoporosis, anemia, liver disease, and colorectal cancer. We do not 

know their cause and there is no medical cure. They represent the 

major cause of morbidity from digestive diseases and forever alter 

the lives of the people they afflict, particularly children. I know because I am the father of a child living with Crohn’s Disease. 

Seven years ago, during my daughter, Alexandra’s sophomore 

year in college, she was taken to the ER for what was initially 

thought to be acute appendicitis. After a series of tests, my wife 

and I received a call from the attending GI who stated coldly, your 

daughter has Crohn’s Disease. There is no cure and she will be on 

medication the rest of her life. 

The news froze us in our tracks. How could our vibrant, beautiful 

little girl be stricken with a disease that was incurable and has ruined the lives of countless thousands of people? 

Over the next several months, Alexandra fluctuated between 

good days and bad. Bad days would bring on debilitating flares 

which would rack her body with pain and fever as her system 

sought equilibrium. Our hearts were filled with sorrow as we realized how we were so incapable of protecting our child. 

Her doctor was trying increasingly aggressive therapies to bring 

the flares under control. Each treatment came with its own set of 

side effects and risks. Every time Alexandra would call from school, 

my heart would jump before I picked up the call, in fear of hearing 

that my child was once again in pain from the flares. 

Ironically, the worst call came from one of her friends to report 

that Alexandra was back in the ER being evaluated by a GI surgeon to determine if an emergency procedure was needed to clear 

an intestinal blockage that was caused by the disease. Several 

hours later, a brilliant surgeon at the University of Chicago removed over a foot of diseased tissue from her intestine. The surgery saved her life but did not cure her. We continue to live every 

day knowing the disease could flare at any time with devastating 

consequences. 

Fortunately, the scientific community is making tremendous 

strides in the fight against IBD. We have terrific partners at the 

NIH and CDC, and I will now turn my attention to CCFA’s fiscal 

year 2010 recommendations for these agencies. 

Throughout its 40-year history, CCFA has forged successful research partnerships with the NIH. CCFA provides crucial seed 

funding to researchers, helping investigators gather preliminary 

findings, which in turn enables them to pursue IBD research 

projects through the NIH. For fiscal year 2010, CCFA joins with 

other patient and medical organizations in recommending a 7 percent increase in funding for the NIH. 


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Mr. Chairman, as I mentioned earlier, CCFA estimates that 1.4 

million people in the United States suffer from IBD, but there 

could be many more. We do not have an exact number due to these 

diseases’ complexity and the difficulty in identifying them. We are 

extremely grateful for your leadership in providing funding over 

the past five years for an epidemiology program on IBD at the Centers for Disease Control and Prevention. The program is yielding 

invaluable information about the prevalence of IBD and increasing 

our knowledge of the demographic characteristics of the patient 

population. 

Finally, Mr. Chairman, the unique challenges faced by children 

and adolescents battling IBD are of particular concern to CCFA. In 

recent years, we have seen an increased prevalence of IBD among 

children, particularly those diagnosed at a very early age. To combat this alarming trend, CCFA, in partnership with the pediatric 

gastroenterology community, has instituted an aggressive pediatric 

research campaign empowering investigators with HIPAA-compliant information on young patients from across the Nation that will 

jump start our efforts to expand basic and clinical research on our 

pediatric population. 

We encourage the Subcommittee to support our efforts to establish a pediatric IBD patient registry within the CDC in fiscal year 

2010. 

Mr. Chairman, once again, thank you for the opportunity to testify. I would be happy to answer any questions. 

Mr. OBEY. Thank you. 

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WEDNESDAY, MARCH 18, 2009. 

AMERICAN COLLEGE OF CARDIOLOGY 

WITNESS 

JACK LEWIN, M.D. 

Mr. OBEY. Next, we will hear from Dr. Jack Lewin, American 

College of Cardiology. 

Dr. LEWIN. Good morning, Chairman Obey and Ranking Member 

Tiahrt and members of the Committee. I am a physician and the 

Chief Executive of the American College of Cardiology. It is a real 

privilege to be here with you today. Thank you. 

I would like to just take some excerpts from my testimony, which 

has a lot of details I hope that you will appreciate. 

The American College of Cardiology represents veritably all the 

practicing cardiologists in this country. We also represent many 

thousands of international cardiologists. We represent advance 

practice nurses and pharmacists and others who practice cardiovascular medicine in teams with us. 

We are concerned about the fact that the burden of cardiovascular disease in this country is rapidly growing. We estimate 

about $475,000,000,000 of health services, medications, lost productivity due to cardiovascular disease will occur in 2009. It is still, 

by far and away, the number one cause of morbidity and mortality, 

the number one killer in this country. In Medicare, 

$420,000,000,000 we spent in Medicare last year, 43 percent of it 

will be cardiovascular cost. That is over $180,000,000,000. 

Twenty-four hundred people die each day from heart disease, one 

every 30 seconds or so. About 1.5 million people will have a heart 

attack, one will die about every minute in this country. We can do 

a lot to improve that. 

Now, despite all that, since 2000, there has been a 29 percent reduction of morbidity and mortality in this country in heart disease 

because of new imaging modalities, new treatment modalities in 

terms of angioplasties and stents, improvements in surgical outcomes and prevention. And that is great, but disparities exist in 

cardiovascular disease. Gender and ethnic disparities are just inexcusable. More women die than men of heart attacks in this country 

today, and most people do not seem to understand that. 

We can do far better. We are spending far more than we need 

to for what we need in this future to build prevention and other 

health care services. So this ought to be a new era in which some 

of the colleges’ most proud traditions could be better implemented 

with your help. 

We have, for 25 years, translated science into guidelines, performance measures, and, lately, appropriate use criteria for technology to make sure the best evidence gets to the patients at the 

point of care. The Rand Corporation estimates that about 50 percent of the time people in this country are getting that evidence. 

We have got to improve upon that, not only with electronic health 

records and clinical decision support systems to make sure that 

does get better, but by tracking how we are doing. 

The college runs something called the National Cardiovascular 

Data Registries. CMS actually requires some of the use of some of 


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our registries in Medicare programs. We run these in 2,400 major 

hospitals where cardiovascular services are provided and we measure outcome across these, over hundreds of measures in these hospitals. 

In the last year, for example, we demonstrated that while the 

science says if you are having a heart attack in the emergency 

room, you need to get that heart attack treated and the blockage 

opened within 90 minutes to prevent permanent damage to your 

heart, as we measured across the country, and people thought we 

were doing this in about an hour, hospitals were shocked to learn 

that the average was well over two hours. In just one year we have 

gotten almost all of American hospitals down to under 90 minutes 

just by giving them the data. 

So these registries are critically important and we need your help 

to expand the use of these registries through Federal agencies and 

others to systematically improve quality, address misuse and overuse of technologies, and go out and try to find those people who 

need services that are not getting them today. That is our professional accountability. 

So we are asking that NIH get a 7 percent increase, to 

$3,200,000,000, to help NIH and NIHLBI with some of the research 

needs to deal with some of the gaps in knowledge that still exist 

to help us improve the evidence-based care at the point of care. 

We would like to see AHRQ, Agency for Health Research and 

Quality, get an increase of $32,000,000 to $405,000,000 to help us 

with the registry activities and to help us with comparative effectiveness research that would, again, advance these causes. 

We would like to see CDC get some more money, another 

$20,000,000 to $74,000,000, for heart disease and stroke prevention 

activities; and the Health Resources and Services Administration 

also needs more resources for emergency defibrillation and for 

rural and community health activities. 

The research needs are critically important. The comparative effectiveness research is critically important to us. So, in conclusion, 

Mr. Chair and members of the Committee, we believe this increased investment in NIH and NIHLBI, AHRQ, CDC, and HRSA 

will pay off with huge dividends for our society, huge return on investment there. The social and economic costs are great, but the 

opportunities are great. We have made great progress in cardiovascular disease, but the epidemic is increasing as America grays 

and as the diabetes and obesity problems multiply. 

So thank you very much for listening to the testimony and receiving the details of it. We look forward to working with you. It 

has been an honor to be with you today. 

Mr. OBEY. Thank you. I would just point out that, in the stimulus package, we did provide $300,000,000 to AHRQ and 

$400,000,000 to NIH for the kind of research you are talking about. 

Dr. LEWIN. And we are so grateful for that. Thank you, sir. 

Mr. OBEY. Thank you. 

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WEDNESDAY, MARCH 18, 2009. 

PARKINSON’S ACTION NETWORK 

WITNESS 

MARY McGUIRE RICHARDS 

Mr. OBEY. Next, Mary McGuire Richards, Parkinson’s Action 

Network. 

Ms. RICHARDS. Thank you. Thank you, Chairman Obey, thank 

you, Ranking Member Tiahrt for inviting me to testify on behalf of 

the Parkinson’s Action Network regarding the National Institutes 

of Health. I am the Deputy Chief Executive Officer at the Parkinson’s Action Network. We are also known by our acronym PAN. 

PAN represents the entire Parkinson’s community, including 

more than 1 million Americans living with Parkinson’s Disease, 

their families, and all of the major national Parkinson’s organizations across the Country. You may have indeed met with some of 

your Parkinson’s constituent advocates yesterday, when more than 

300 people living with Parkinson’s Disease were here on Capitol 

Hill to communicate with their elected representatives about the 

issues that are facing them back at home. 

Parkinson’s Disease is a chronic, debilitating, neurological disorder that results from premature death of dopamine-producing 

neurons in the brain. Parkinson’s patients experience devastating 

physical and mental symptoms, including tremors, debilitating slow 

movements, postural instability, profound sleep disturbances, and 

a variety of cognitive impairments. 

Parkinson’s is the second most common neurodegenerative disease in the United States and it is currently without a known cure. 

Parkinson’s state-of-the-art treatment is currently based on a 40- 

year-old therapy. This therapy only provides some relief for some 

of the motor symptoms of the disease. There is nothing that slows 

or stops progression of disease. All of our current treatments are 

simply symptomatic relief and not disease modifying. As such, people living with Parkinson’s Disease are desperately awaiting innovative disease modifying therapies that will relieve their pain and 

ultimately halt the unrelenting march of the disease. 

Before I begin discussing 2010 funding issues, I would like to 

thank members of this Committee for their support for the National Institutes of Health, including the $10,000,000,000 in the 

stimulus bill for the NIH. PAN not only applauds your commitment 

to biomedical research funding, but we will continue working with 

the NIH to ensure strategic investment of this one-time infusion of 

money to the NIH. 

PAN continues to support the research advocacy communities’ 

NIH request; however, we are also invested not only in how much 

money is spent at the NIH, but how those dollars are best spent. 

To truly deal with the public health needs facing this Nation, disease modifying therapies, those that slow or stop progression of disease, are needed for untreated and under-treated diseases such as 

Parkinson’s Disease. To accomplish this, NIH must launch a large, 

coordinated effort to overcome the scientific valley of death. Simply 

put, the valley of death is the gap between basic discoveries and 

potential therapies to treat disease. It is also known as 


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translational research. This science is new, it is challenging, it is 

costly, but it is essential if our aim is ultimately to develop those 

therapies that will meet an increasingly burdensome public health 

need. 

NIH funds world-class basic science, but translational research is 

new science that requires new thinking. A consequence of tremendous discovery, such as the human genome project, has been additional science sophistication, but also somewhat less hopefully, it is 

a further separation from the researcher and that researcher’s 

science to the people who might benefit from such science. A new 

model is required that will fill that gap. 

NIH must rethink how we support the unique needs of 

translational science. The same systems that have supported basic 

science so well are not aiding in the application of that knowledge. 

Different expertise, leadership, and training are necessary to tackle 

complicated translation issues that are preventing or slowing research from moving into potential therapies. 

NIH must develop a unique infrastructure, as well as systems to 

support translational science. Infrastructure must include things 

such as intellectual property and FDA expertise, which are essential to this part of the research endeavor. 

Many existing efforts at the Institute must be bolstered or remodeled, and new systems called for under NIH reform must simply be funded. Unfortunately, a lack of dedicated resources at NIH 

has resulted in slowed implementation of NIH reform, which the 

Parkinson’s community strongly supported. NIH reform aimed to 

enhance NIH’s transparency, accountability, portfolio management, 

and strategic planning efforts, all of which will hasten basic discoveries and their translation into better therapies and treatments for 

all Americans facing diseases and disorders. 

Without the commitment of resources to implement these reform 

activities, the struggle between any new efforts, such as the ones 

we would think are necessary in translational science, and the 

need to continue funding new ideas and research is increasingly 

difficult. 

Let me be clear that PAN continues to support basic research 

discoveries coming out of NIH. Robust research at the beginning of 

the pipeline is essential for continuing to grow our knowledge of 

biomedical and disease processes, as well as to provide a feeding 

ground for new and novel ideas in science. 

Of course, should novel ideas show promise, additional funding 

must be directed at translating these discoveries into the treatments to alleviate the suffering of people living with diseases. 

As a patient advocacy organization, PAN is ultimately concerned 

with improving the health of people living with Parkinson’s Disease. However, this is not a disease-specific problem, nor does it require a disease-specific approach to a solution. 


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I do appreciate the Committee’s time. We do advocate for the 

Committee to continue asking NIH to maintain the dedicated funding resources and systems necessary to support patient-oriented research and finding a cure for all Americans. I am happy to take 

any questions. We really do appreciate your time and your consideration. 

Mr. OBEY. Thank you. 

Ms. RICHARDS. Thank you. 

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WEDNESDAY, MARCH 18, 2009. 

AMERICAN LUNG ASSOCIATION 

WITNESS 

ALBERT A. RIZZO, M.D. 

Mr. OBEY. Next, Dr. Albert Rizzo, American Lung Association. 

Dr. RIZZO. Thank you, Chairman Obey and Committee members. 

I am a board certified practicing physician in pulmonary sleep 

medicine and critical care, and currently the Chief of Pulmonary 

and Critical Care Medicine Section at the Christiana Care Health 

Systems in Newark, Delaware. 

I am also a long-time volunteer of the American Lung Association and currently serve as Speaker of the Nationwide Assembly, 

which is the body of that volunteer organization that oversees the 

mission work. I am pleased to present the American Lung Association’s recommendations today. 

The public health and research programs funded by this Committee will prevent lung disease and improve and extend the lives 

of millions of Americans who suffer from lung disease. 

First and foremost, we want to thank you, Mr. Chairman and 

Committee members, for the investments in health you made in 

H.R. 1, the American Recovery and Reinvestment Act. We particularly appreciate the investments in research and funding for prevention and wellness programs. These investments will have net a 

near-term and long-term dividend for the health of American people, as well as people worldwide. 

Many lung diseases are chronic diseases and, as such, are huge 

drivers of cost and human suffering. We urge the Committee to 

focus resources on reducing the burden of such chronic diseases. 

While our focus is on lung disease, we know that America must 

maintain a renewed commitment to medical research in general, 

and strongly support increasing the investment in research across 

the entire NIH. 

A growing, sustained, predictable, and reliable investment in the 

National Institutes of Health provides hope for millions afflicted 

with lung disease. A new and sustained investment in prevention 

and wellness will lead to a healthier, more productive population 

and reduce health care costs. Investments in proven interventions, 

like smoking cessation and the Healthy Committees Program at 

the Centers for Disease Control and Prevention, reduce the burden 

of disease. 

Progress in these areas was made in fiscal year 2009 and in the 

stimulus bill. But as you well know, Mr. Chairman, to see the outcomes that we all seek, these investments must be sustained over 

time. 

The toll of lung disease is enormous. It is responsible for one in 

every six deaths, and more than 33 million Americans suffer from 

a chronic lung disease. Chronic obstructive pulmonary disease, or 

COPD, which is more commonly known as emphysema or chronic 

bronchitis, is the fourth leading cause of death and the only leading 

cause of death in this Country that continues to increase. 

The cost in human toll of COPD is staggering. I see patients 

every day who suffer from this disease. Mary G. was a patient of 


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mine who developed COPD and sent the last six months of her life 

on a ventilator or breathing machine. Mary’s daughter, Beth, who 

I now treat for asthma, lived with and loved a very significantly 

impaired mother who could not participate in the day-to-day activities that a mother should participate in because she was so short 

of breath. 

Despite the enormity of this problem, COPD receives far too little 

attention at CDC or in health departments across the Nation. The 

American Lung Association strongly supports the establishment of 

a national COPD program within CDC’s National Center for 

Chronic Disease Prevention and Health Promotion, with a funding 

level of at least $1,000,000 for fiscal year 2010 to create a comprehensive national action plan for combating this disease. This 

plan will address the public health role in prevention, treatment, 

and management of this disease. 

So, in concluding, besides COPD, the American Lung Association’s recommendations are that NIH needs to have significant and 

sustained increasing and funding research for lung cancer to improve the terribly low lung cancer survivorship; adequate funding 

for the CDC’s Office on Smoking and Health that can help prevent 

so much of the disease I see in my office every day; asthma research and asthma programs for the nearly 23 million afflicted individuals with that chronic lung disease; tuberculosis, especially 

multi-drug resistant TB, needs research because of the significant 

threat it poses to public health; and influenza, since the Nation 

must continue to invest and be prepared for a significant pandemic, 

as well as providing yearly annual vaccination. 

Many patients with these diseases are literally fighting for air 

every day, sometimes from breath to breath, so, Chairman and 

members of the Committee, I thank you for your time, and please 

consider the Nation’s urgent lung health needs in 2010 appropriation bill. 

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WEDNESDAY, MARCH 18, 2009. 

OVARIAN CANCER NATIONAL ALLIANCE 

WITNESS 

SUSAN BUTLER 

Mr. OBEY. I regret to inform the Committee that I am told that 

we are going to have two votes sometime between 11:30 and 11:45, 

which will mess up the lives of the last three people on this list 

unless we can keep tightly to the time. 

So, next, can we call Susan Butler? 

Mr. Moran, I think you wanted to introduce her? 

Mr. MORAN. Yes. Thanks, Mr. Chairman. 

Susan, back in 1995, was diagnosed with ovarian cancer. At that 

time, the prospects were very harsh and the treatment options few. 

She was fortunate enough to enroll in an NIH clinical trial and it 

saved her life. Since then, she has devoted her life to the 22,000 

additional women every year that are diagnosed with ovarian cancer, giving them hope and comfort. 

I could go on and on—I will not—about the other things she 

does. She is a CEO; she has had award-winning websites; she has 

gotten the NIH Director’s Award for her commitment to enhance 

patient care and service at NIH’s Clinical Center. 

But she is a great witness and thank you for having her, Mr. 

Chairman. 

Mr. OBEY. Thank you. 

Please proceed. 

Ms. BUTLER. Mr. Chairman, Mr. Ranking Member, distinguished 

members of Congress, and especially Congressman Moran for your 

steadfast support of cancer and cancer research all of these years, 

I am Susan Lowell Butler, the Executive Director of the DC Cancer 

Consortium, and I am a proud cofounder of the Ovarian Cancer 

National Alliance, the national advocacy organization for ovarian 

cancer. As Congressman Moran has said, I am a 13–year survivor 

of simultaneous breast and ovarian cancer, and I am here today to 

ask you to fund programs in the Labor, HHS and Appropriations 

bill that will help combat this cancer. 

In considering this request, please think of the sobering statistics 

of this cancer. About 22,000 women are diagnosed with ovarian 

cancer each year, and about 15,000 die from the disease. It is the 

fifth leading cause of cancer deaths among women, a statistic that 

has been unfortunately true for many years. 

Fewer than 20 percent of women with ovarian cancer are diagnosed with early stages of the disease, where survival is the greatest, and only 45 percent of women diagnosed will live more than 

five years. 

More than 70 percent of women who get the disease will have at 

least one recurrence; and when recurrence happens, within months 

after individual treatment, as is the case for many women, the cancer then responds to fewer and often less effective treatment options. 

I am happy to say that, so far, despite the classic late diagnosis 

and the presence of another cancer, I have beaten the odds, and I 


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am pleased to be here more than 13 years after diagnosis and one 

year after a recurrence. I wish I had more company. 

There are three major programs that address ovarian cancer in 

this bill that will help me have more company. 

First is Johanna’s Law: The Gynecologic Cancer Education and 

Awareness Act. Many of you have been vocal champions for this 

bill and I thank you for your work. The program has been funded 

for the past two years, allowing the Centers for Disease Control to 

begin a national awareness campaign about the signs and symptoms of gynecologic cancer. 

The law is named for Johanna Silver Gordon, who, like many 

women, had symptoms of ovarian cancer that she missed, as did 

her health care providers. Without a reliable early detection screen, 

our best hope now is for early detection is awareness among 

women and their health care providers of the signs and symptoms 

of the ovarian cancer. On behalf of the thousands of women that 

experience these symptoms, we ask that you appropriate 

$10,000,000 for this program for fiscal year 2010. 

But symptom awareness is just the beginning. We need better 

treatments for women who have the cancer, as well as a real understanding of how it works in the body. We do not know enough 

about who is at risk, how this disease develops, how to detect it 

early, and how to keep it in remission. Other than that, we are in 

good shape. Without sufficient basic and translational research, we 

will never have that knowledge. 

The National Cancer Institute funds SPORE programs, Specialized Programs of Research Excellence, which are cross-institutional 

research programs and an important research collaboration. One of 

these SPOREs is run by the Gynecologic Oncology Group, which 

runs many much needed clinical trials on ovarian cancer. In fiscal 

year 2008, NCI funded more than 500 research grants on ovarian 

cancer across a wide array of important issues. Please keep this 

critical research going and increase the appropriations for NCI to 

$6,000,000,000 for fiscal year 2010. 

Finally, CDC runs the Ovarian Cancer Control Initiative, a research program that includes risk perception and screening for 

women at high risk, clinical practices in the follow up of ovarian 

masses, and in the relationship between symptoms and time to diagnosis. This research is of critical importance, and on behalf of the 

women and families who are touched by or at risk of being touched 

by ovarian cancer, we request you increase its funds to 

$10,000,000. 

Despite these grim statistics, the research you have funded over 

the years has brought progress and years of life for women with 

ovarian cancer. On behalf of all of us, thank you for what you have 

done and we hope very much for your continued support in the future. I will take any questions you may have. 

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WEDNESDAY, MARCH 18, 2009. 

AMERICAN SOCIETY OF CLINICAL ONCOLOGY 

WITNESS 

RICHARD L. SCHILSKY, M.D. 

Mr. OBEY. Next, American Society of Clinical Oncology, Dr. Richard Schilsky. 

I am going to ask people to please hold it to four minutes so that 

we do get to hear everybody before the bells mess us up. 

Go ahead. 

Dr. SCHILSKY. Good morning, Chairman Obey, Ranking Member 

Tiahrt, members of the Subcommittee. Thank you for the opportunity to testify today. My name is Richard Schilsky. I am a medical oncologist at the University of Chicago and President of the 

American Society of Clinical Oncology. On behalf of ASCO’s 27,000 

members who treat people with cancer and conduct oncology research, I want to thank you first for your longstanding commitment 

to cancer research and highlight the critical importance of sustaining a robust and vibrant national clinical trial system through 

NIH and NCI. 

My testimony today will focus on the following points: We thank 

Congress and the President for the recent stimulus funding for 

NIH that will help cancer patients and provide significant boost to 

our local economies. We urge the Subcommittee to support the 

President’s fiscal year 2010 budget proposal for NIH and a sustained multi-year commitment to increasing funding for cancer research. 

This Federal funding for cancer research is critical for a number 

of reasons, including to advance the best interest of U.S. patients, 

to support our next generation of cancer researchers, and to answer 

important questions about cancer diagnosis and treatment. 

ASCO applauds President Obama’s call to cure cancer, and we strongly support the President’s request of over $6,000,000,000 for 

cancer research within NIH and, importantly, his pledge to provide 

a multi-year plan to double Federal funding for cancer research. 

We believe that most of this funding should support work carried 

out through the extensive NCI network. 

This Country is poised to deliver on the challenge to cure cancer. 

Cancer deaths are decreasing and the survival rates for many cancers are increasing. These successes are largely the result of our 

publicly funded research system. However, the underlying research 

infrastructure is at a critical break point, endangered by a lack of 

predictable funding and the failure to keep pace with the growing 

costs of conducting research. 

We commend Congress for the additional $10,400,000,000 for 

NIH included in the stimulus bill. However, this funding has some 

limitations: it cannot fund multi-year research or stave off the impact of the 15 percent decline in purchasing power that NIH has 

lost since 2003. Only sustained funding into NIH and NCI’s baseline can ensure the long-term viability of the U.S. research system. 

Sustained funding will also bolster our researcher workforce, our 

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novation. These young people are questioning whether to pursue 

careers as clinician investigators. Most importantly, lack of adequate funding threatens the important trials being performed 

through NCI that provide access to innovative therapies for Americans in virtually every community where cancer care exists. 

Federally funded research answers questions that are fundamentally different from the studies that typically are supported by private companies. Federally funded research answers important 

questions regarding cancer diagnostics and treatments that improve patient care. As one example that reflects the movement toward personalized medicine, we now know that 40 percent of colon 

cancer patients have tumor with a particular gene mutation that 

makes certain drug treatments ineffective. By testing each patient 

with a colon tumor, we can customize their treatment regimens 

and care plans. Such research, while resource-intensive, promotes 

better outcomes for patients, avoids unnecessary treatments, and 

results in savings for our health care system. 

Thank you for the opportunity to present ASCO’s views to the 

Subcommittee today. We look forward to continuing our longstanding collaborative work with you to provide improved clinical 

outcomes for all Americans who are faced with cancer. Thank you. 

Mr. OBEY. Thank you. 

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WEDNESDAY, MARCH 18, 2009. 

ASSOCIATION FOR CLINICAL RESEARCH TRAINING 

WITNESS 

HARRY P. SELKER, M.D. 

Mr. OBEY. Next, Dr. Harry Selker, Association for Clinical Research Training. 

Dr. SELKER. Thank you for inviting me here today. My name is 

Dr. Harry Selker. I am past President and current Chair of the Advocacy and Public Policy Committee for the Association for Clinical 

Research Training, ACRT. 

ACRT is committed to improving the Nation’s health by increasing the amount and quality of clinical research through the expansion and improvement of clinical research training. We also serve 

as a host organization for the National Alliance for Societies for 

Clinical Research Resources that coalesces in support of these 

goals. 

I want to start by thanking the Subcommittee for its strong commitment to improving health through the recently passed fiscal 

year 2006 Omnibus Appropriations package and the economic stimulus legislation. Both bills provided meaningful funding increases 

for our Nation’s health sciences agencies, specifically National Institutes of Health and Agency for Healthcare Research and Quality. 

These will translate into improved treatments and health for our 

citizens. 

I want to address three issues that are critical to optimally 

leveraging the Country’s investment in research and health care. 

To not address these is to not take advantage of the world’s greatest biomedical research and medical care capabilities just when we 

need to. 

First, I want to talk about the importance of fully funding the 

NIH Clinical and Translational Science Awards, the CTSAs. In 

2005, NIH announced an ambitious plan to create CTSAs at 60 

universities, with the goal of transforming our Nation’s biomedical 

research enterprise and become more effectively translational into 

improved health care. This is a major undertaking for NIH, but 

with the understanding that it will repay that investment many 

times over. 

Funding started for the first 12 CTSAs in 2006 with great promise; however, with increasingly constrained resources at NIH, 

NIH’s National Center for Research Resources that administers the 

CTSAs and the Office of the Director curtailed CTSA funding. 

Thus, for the CTSAs started in 2007 and in 2008, upon funding, 

there were deep cuts, sometimes exceeding 50 percent of their 

budgets, as they had constructed them based on the RFA. 

Now, with improvements at NIH funding brought by the stimulus package and the fiscal year 2009 appropriations, NIH and 

NCRR could potentially restore full funding for the current 38 

CTSAs going forward, but it is concerned about doing so because 

of the long-term commitment that would be needed for full funding 

of their goal of 60 fully-funded CTSAs. This deserves the attention 

and support of this Subcommittee. 


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Second, I would like to bring to your attention the importance of 

restoring and growing K-Awards and T–32 awards for research, 

training, and career development. Last year, the Subcommittee 

showed strong leadership and urged NCRR to continue K–30 Clinical Research Curriculum Awards to support core needs in research 

training and career development at those institutions that do not 

have CTSAs. I am pleased to inform you that NCRR has complied 

with this request and recently issued the K–30 re-competition announcement. 

However, these K–30 awards support the curriculum to train the 

needed new generation of clinical and translational researchers, 

but they do not have funds for stipends or the tuition for the young 

physician investigators to actually take the courses. Thus, to leverage this growing capacity for training, there is a need to grow at 

NIH and AHRQ—not cut back, as they have done recently—K series research career development awards and T–32 training awards 

so that young researchers can participate in these K–30 and CTSA 

training programs. 

Third, and lastly, I want to emphasize the importance of continuing your support for Comparative Effectiveness Research, CER. 

The American Recovery and Reinvestment Act of 2009 contained 

$1,100,000,000 for CER activities, as was mentioned, at NIH and 

AHRQ. AHRQ has been the Federal focus for CER, especially since 

the Medicare Modernization Act, and NIH has been supporting 

CER for some time. We are pleased that Congress recognizes the 

importance of this work and that CER’s proper home is in the 

health sciences agencies, where peer review process and infrastructure are in place to ensure the highest quality science, rather than 

at a new, untested funding entity. 

Thank you for this opportunity to share my views with you. 

Mr. OBEY. Thank you. 

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WEDNESDAY, MARCH 18, 2009. 

GENETIC ALLIANCE 

WITNESS 

SHARON F. TERRY 

Mr. OBEY. I am going to ask the remaining three witnesses to 

try to hold their testimony to about three minutes, because, otherwise, the last person on the list is going to have to wait about 45 

minutes to be heard because of these votes. 

Next, Sharon Terry, Genetic Alliance. 

Ms. TERRY. Chairman Obey, Ranking Member, and the Subcommittee, thank you very much for the opportunity to testify before you today on behalf of all Americans who seek therapies and 

treatments for genetic diseases. I did not choose this work as my 

career; this vocation was bestowed on me more than 14 years ago 

when my own children were diagnosed with pseudoxanthoma 

elasticum. In my capacity as President and CEO of Genetic Alliance, I serve the 10,000 health-related organizations in our network. 

I have four requests and one statement, all in the context of the 

organic linkages we as a society are experiencing in global finance, 

social networking, and so on. 

Number one, we ask that you focus a substantial amount of funding on health information technology that balances privacy with access; two, that HHS develop a strategic, long-term plan that involves innovative translational tools to enhance the clinical adoption of discovery research. We envision two projects under this: the 

first, a large cohort study enrolling millions of Americans; and, the 

second, increased and substantial funding for the newly established 

NIH Rare and Neglected Diseases Initiative. 

Through the NIH road map libraries, we have been able to identify disease probes, and it is time to bring them through to drug 

development. 

Three, a mandatory registry for genetic and genomic tests should 

be developed, and oversight of the clinical laboratory quality systems by the CLIA program should be strengthened. 

Four, the Health Resources and Services Administration should 

receive funding commensurate with its sister agencies so the focus 

can shift from basic research to treatment and services. 

And, finally, we must take our advocacy, research and services 

and policy to the next level and establish a collaborative approach. 

Until now, earmarking has been reflective of our collective understanding of this system and how to approach it. We now recognize 

that earmarking represents fragmentation and segmented communication. It is time to work together to bring us a systemic response. 

The collaboration that we seek on the Federal level must also 

take place in the nonprofit community. Many disease advocacy organizations move forward in an isolated manner to address their 

specific issues and needs, and historically, though progress has 

been made, these lessons are not shared with the community at 

large. This impedes the advances we need. Biology is systems 

based and, since sequencing the human genome, we know there are 


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gene families, pathways, and other more effective ways to understand diseases. There are many examples of treatments and cures 

for diseases coming from an unexpected direction. 

Congressional earmarks for specific diseases have contributed to 

a siloed effect and have stifled progress for the greater good. It is 

possible they also stymie progress on that very disease. It is time 

to move away from earmarking as a solution. 

Every effort must be made to disseminate success and to learn 

from failures. We acknowledge that the budget and appropriation 

process must include prioritization and differentiation. We can go 

much further together. Let us step into the future as collaborators 

who build shared infrastructure that accelerate our work beyond 

anything what anyone can do alone. 

We look forward to partnering with you and the Federal agencies 

to create this network model. Thank you. 

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WEDNESDAY, MARCH 18, 2009. 

MEDICAL LIBRARY ASSOCIATION 

WITNESS 

HOPE BARTON 

Mr. OBEY. Next, Medical Library Association, Hope Barton. 

Ms. BARTON. Thank you very much for the opportunity to be here 

today. I am going to go in fast forward mode and maybe speak in 

some phrases and bullet points. 

My name is Hope Barton. I am a medical librarian from the University of Iowa, and I would like to thank the Subcommittee very 

much for the opportunity to speak today. I am here on behalf of 

the Medical Library Association and the Association of Academic 

Health Sciences Libraries, and we work very hard to support the 

critical role of the National Library of Medicine within the NIH. 

We are very pleased that in the 2009 funding package NLM received an $8,000,000 increase. This is the first meaningful increase 

we have received in a number of years, and we hope this is a very 

positive indication of momentum going forward and that there will 

be increased adequate increases as well every year. 

For 2010, we feel that a 7 percent increase would be adequate 

to keep momentum going, as we have gained a little bit of financing here, and we feel it is important for the databases and the programs that NLM serves. 

Our mandates have grown over the years and, as an example of 

this, the last session of Congress passed FDA amendment legislation that required NLM to play an increased role in the 

clinicaltrials.gov database. Unfortunately, no monies came with 

that mandate, so the NLM budget was stretched even further. 

NLM also plays a very important role in disaster preparedness 

and management, and got very important health information, environmental information to the Katrina area shortly after that hurricane. 

Very importantly, we would like to thank the Subcommittee for 

its leadership in the NIH public access policy. We feel this policy 

is very important for expediting medical research and also for getting health information out to the citizens of the Country. After all, 

it is taxpayers’ dollars that helped to support the research and the 

new information that has generated, and we certainly hope that 

this Subcommittee will continue to support and defend this policy. 

Thank you again for the opportunity to speak today. 

Mr. OBEY. Thank you. Appreciate it. Thanks for your cooperation 

on time. 

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WEDNESDAY, MARCH 18, 2009. 

FEDERATION OF BEHAVIORAL, PSYCHOLOGICAL, AND 

COGNITIVE SCIENCES 

WITNESS 

JAMES McCLELLAND 

Mr. OBEY. And, last, Dr. James McClelland, Federation of Behavioral, Psychological, and Cognitive Sciences. 

Mr. MCCLELLAND. Thanks very much. Today, I will argue that 

it is essential for Congress to increase support for mind research 

at NIH because it will have a real impact on human health and 

human potential. 

Mr. OBEY. Especially on the Congress itself. 

[Laughter.] 

Mr. MCCLELLAND. You know, scientific questions can be examined at many levels, and, in the case of the human sciences, these 

levels range from genes and molecules to organ systems, including 

the brain, to behavior, to social and cultural context. At the nexus 

of all these levels is the mind, our thoughts, perceptions, and emotions, the things we identify as ourselves. Mental process is influence and our influence by processes occurring at all other levels. 

This is why the sciences of mind, brain, and behavior are so relevant to human well-being and human productivity. 

It may seem natural to think of heart disease, physical injury, 

and illnesses ranging from cancer to the common cold as physical 

conditions disconnected from the mind and brain. But, in fact, research shows that people who have social relationships with many 

others are healthier and live longer than those with fewer relationships. 

What are the mechanisms, the biological and mental processes 

that lead from social support to better health and longer life? One 

study focused on married couples. Both members of the couple were 

admitted to the hospital and received a small skin wound. This occurred on two occasions. On one occasion, they had a discussion 

about how they support each other; on the other occasion they were 

induced to have a bit of an argument about a subject they usually 

disagree on. After the supportive discussion, their wounds actually 

healed faster. 

The work provides a striking demonstration of links across levels 

of analysis. There is a sound basis for thinking that social support 

works through the mind to affect more critical illnesses as well, including cancer and heart disease. Building on this base, NIH funding can now support research on the mental processes triggered by 

social support and on the effects of these processes on the biological 

response to illness and injury. 

If I have one more minute, I just want to make the point that 

research on the mind can have a huge impact on our children’s success in school; not just figuring out how better to teach math or 

science, but figuring out how to help children think about their 

own abilities. A common theory is that it helps people to tell them 

that they are inherently capable, they have an innate intelligence. 

But recent research suggests that this is actually counterproductive. If you tell people that their brains are flexible, that 


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they can make them grow, they are like a muscle and they can be 

strengthened with practice, it actually has a much better effect on 

their responses to challenge and their attitudes towards school and 

their ultimate educational achievements. 

This is new research, it is evidence-based, goes against intuition, 

and it is a very important demonstration that research at the level 

of the mind can really have an impact on outcomes. 

In my written testimony, I note many other issues that research 

on mind, brain, and behavior can address. These further points 

support the conclusion that sustained funding for research at NIH, 

including research on mind, brain, and behavior, will lead to significant discoveries and improved health for the American people. 

We urge the Subcommittee to support this important work. We 

recommend an increase for NIH of 7 percent over the fiscal year 

2009 appropriations. We also urge comparable support for research 

on mind, brain, and behavior in other agencies under the Subcommittee’s jurisdiction. 

Thank you very much. 

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Mr. OBEY. Thank you very much. We have five minutes to make 

that vote, so we stand adjourned. 

AFTERNOON SESSION

WEDNESDAY, MARCH 18, 2009. 

TESTIMONY OF INTERESTED INDIVIDUALS AND 

ORGANIZATIONS 

Mr. OBEY. Well, good afternoon, everybody. Let me thank all of 

you for coming. 

Let me thank the witnesses who will appear before us here 

today, and let me explain a couple of matters of procedure. I am 

going to have to insist that people limit their testimony to four 

minutes. If we don’t, there are people who are never going to get 

heard because we have other things to do after this hearing is over 

today, and we can’t ignore those responsibilities either. 

We also have a practical problem. There will be a number of 

votes that occur on the House Floor sometime around 3:00, and 

that will eat substantially into the time of the witnesses available. 

So I am going to ask all of the witnesses to hold their testimony 

to four minutes sharp. When that red light goes on, I am going to 

have to ask you to conclude your statement. 

As I said this morning, we have finished action on the recovery 

package, and we finished action on the Omnibus Appropriation 

Bill. Now we want to turn to the new budget for fiscal year 2010. 

The problem we have is that every time we have a new President, 

it takes a while for the Executive Branch to send down their budget request, and we do not yet have a budget request from the White 

House. 

I don’t say that by way of criticism. It is normal, given the turnover of administrations, but it does create an inconvenience for this 

Committee and makes it much more difficult for us to do our work 

on the schedule we set. 

So we are trying to get as much work under our belts as possible, 

including public witnesses, and a number of other hearings, so that 

when we do get the budget we can move swiftly to analyze it, mark 

it up, and move on with the process. 

At this point, let me call on our new Ranking Member, Mr. 

Tiahrt, for any comments he has before we listen to the witnesses 

today. 

Mr. TIAHRT. Thank you, Mr. Chairman. Thank you for keeping 

us on track. We have covered a lot of territory today, and we appreciate the cooperation from the witnesses, and we are anxious to 

hear your testimony. 

Thank you, Mr. Chairman. 

Mr. OBEY. One other thing, as I said, this morning. Please understand if you don’t get questions from the panel, which is normal 

during this testimony, as it is not because of a lack of interest. We 

are simply trying to save as much time as possible for the witnesses. 


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We have all heard each other’s dulcet tones often. We will try to 

limit our enthusiasm, or, as Archie Bunker said to Edith once, we 

will try to stifle ourselves. [Laughter.] 

With that, let me ask Ms. Roybal-Allard to begin the process. 

Ms. ROYBAL-ALLARD. First, Mr. Chairman, let me thank you for 

having these very important public testimony hearings. 

And I just want to apologize in advance to the witnesses for having to leave early because I also have another hearing going on at 

the same time as this one, so I will to leave. 

Mr. Chairman, I have the privilege of introducing Mikayla 

Minnig, who will be testifying about the importance of funding arthritis research. Mikayla is a fifth grader who lives in the City of 

Downey in my Congressional district. Like many active 10-yearolds, Mikayla divides her time between school, Girl Scouts and 

cheerleading. But what makes Mikayla remarkable is that she has 

done all of this while battling juvenile rheumatoid arthritis that 

was diagnosed at the age of three. 

Mikayla is a courageous young lady who has chosen not to let 

this frequently debilitating disease control or limit her life. She has 

also chosen to be an active advocate for the Arthritis Foundation. 

Besides coming to Washington, D.C. to encourage Congress to increase funding for arthritis research, she has also raised money for 

that research herself by participating in the Orange County Foundation Arthritis Walk. 

Mikayla, I want to thank you for your courage and for taking the 

time to come to Washington to share your story before this Committee. You truly are an inspiration to all of us. 

Mr. OBEY. We are glad to have you here. I hope you are getting 

better grades in the fifth grade than I did when I was in fifth 

grade. [Laughter.] 

Go ahead. 

WEDNESDAY, MARCH 18, 2009. 

ARTHRITIS FOUNDATION 

WITNESS 

MIKAYLA MINNIG 

Ms. MINNIG. Good afternoon. My name is Mikayla Minnig, and 

I live in Downey, California. I am here today on behalf of the nearly 300,000 kids like myself who have juvenile arthritis. I am 10 

years old and in the fifth grade. 

I was diagnosed with pauciarticular juvenile rheumatoid arthritis when I was just three years old. Pauciarticular means it affects 

four or fewer joints and usually large joints. For me, it affects my 

left knee and ankle. I also am at high risk for eye inflammation 

and must have them checked often so I don’t become blind, which 

could happen. 

It all began when I felt a lot of pain and swelling in my neck. 

I couldn’t walk or run like the other kids, and I couldn’t turn my 

head. 

For many months, I went to a lot of different doctors to figure 

out what was wrong with me. Some of these doctors told my parVerDate Nov 24 2008 23:05 Jul 06, 2009 Jkt 050545 PO 00000 Frm 00185 Fmt 6602 Sfmt 6602 E:\HR\OC\A545P2.XXX A545P2

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ents I must have bad growing pains or must be faking the pain and 

tears. Finally, we were sent to a pediatric rheumatologist, a doctor 

who treats kids like me with juvenile arthritis. Dr. Starr said I had 

arthritis. 

My parents were surprised. They didn’t know, like most people, 

that kids got arthritis too. In fact, most people don’t know that juvenile arthritis is one of the leading causes of disability in common 

childhood diseases in the United States. 

People are surprised when I tell them I have arthritis because 

I don’t look very different from other kids. But unlike other kids, 

I take a cancer drug every week plus daily medication to help control my arthritis, and it helps me try and lead a normal kid life. 

I have met other kids through the Arthritis Foundation who are 

not as lucky as me. The drugs don’t work for them, and they end 

up in wheelchairs or have to have joints replaced. In fact, juvenile 

arthritis is the leading cause of disability in kids. 

I also am lucky to be able to see a doctor who understands and 

can treat my disease. Kids in nine States don’t have a single specialist to see them. 

I am here today to ask Congress to focus more attention on kids 

like me with arthritis. Research is the key to a cure. Research has 

led to newer drugs that help kids stay out of wheelchairs, but these 

drugs can have really bad side effects. We need a cure. Right now, the government spends $9,800,000 at the National Institutes of Health for juvenile arthritis research. That sounds like 

a lot of money to me, but when you think of the nearly 300,000 

kids, that works out to be just about $32 per child. 

There is a group of pediatric rheumatologists who are working 

together to study and treat children with arthritis, but they need 

your help. With more funding and attention from Congress, more 

research studies can move forward to help find a cure. 

The Arthritis Foundation supports at least a doubling of juvenile 

arthritis research over the next few years. Also, the NIH should 

spend more money training future doctors. 

Thousand of kids around the country are diagnosed too late to 

prevent damage. Please help change this. 

I hope one day when I tell people I got arthritis at age three and 

they say, but kids don’t get arthritis, I can tell them, you are right, 

not any more because research has found a cure. 

Thank you for the opportunity to speak to you today. 

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Mr. OBEY. Thank you. [Applause.] 

Thank you very much for sharing your story with us. 

Next is Dr. Schraufnagel, TB Coalition. 

We are sorry about the order that we put you in. You get extra 

points for that. [Laughter.] 

WEDNESDAY, MARCH 18, 2009. 

TB COALITION 

WITNESS 

DR. DEAN SCHRAUFNAGEL, M.D. 

Dr. SCHRAUFNAGEL. That is a tough person to follow. 

I am Dean Schraufnagel. I am a professor of medicine in the Department of Pulmonary and Critical Care Medicine at the University of Illinois in Chicago. 

And, for Congressman Obey, I grew up in Mason, Wisconsin, a 

town of only about 65 people these days. 

Mr. OBEY. They vote right. [Laughter.] 

Dr. SCHRAUFNAGEL. I also serve as Vice President of the American Thoracic Society, and I am here to speak on behalf of the TB 

Coalition which is a network of public health research professional 

and advocacy organizations working to support policies to eliminate 

tuberculosis in the United States and around the world. 

There are three points I want to make: First, tuberculosis is a 

problem in the United States. Second, we will never defeat tuberculosis until we develop new diagnostic tools, anti-tuberculosis 

drugs and an effective vaccine. Third, Congress passed an historic 

law reauthorizing the Nation’s domestic TB program. Appropriate 

funding of this law will put the U.S. back on the right path toward 

tuberculosis elimination. 

As you know, TB is an airborne infection caused by a bacterium. 

It is spread by cough, so that we are all vulnerable. 

It is the second leading global cause of death for infectious disease, claiming about 1.7 million lives per year. It is estimated that 

nine to fourteen million Americans have latent tuberculosis. According to a February, 2008, World Health Organization report, resistant TB accounts for about 5 percent of all new TB cases in the 

world. 

Although drugs, diagnostics and vaccines for TB exist, these 

technologies are antiquated. The most commonly used TB diagnostic in the world, sputem microscopy, is more than 100 years old 

and lacks the sensitivity in many HIV/TB cases and in children. 

Current diagnostic tests to detect drug resistance take at least 

one month to complete and in that time the TB can spread to others. 

The TB vaccine, BCG, provides some protection to children but 

has little effect in preventing adult pulmonary tuberculosis. 

There is an urgent need for new anti-TB treatments and particularly for a shorter drug regimen. There is also a critical need for 

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velopment and hold promise for shortening TB from six to nine 

months to two to four months. 

In the United States, TB cases continue to decline, although the 

progress has slowed in the last few years. 

Foreign-born and ethnic minorities bear a disproportionate burden of the domestic TB rate. U.S.-born blacks make up almost half, 

45 percent, of all TB cases among U.S.-born. Border States and 

States with high immigration such as California, Texas and New 

York are among the highest burdened TB States. 

Drug resistance poses a particular challenge to domestic TB control due to the high costs and intensive treatment required. The 

costs for treating drug-resistant tuberculosis may range from 

$100,000 to $300,000 per case, which can be a significant strain on 

the State public health budget. In-patient costs have been estimated by the California XDR for extremely drug resistant TB to be 

up to $600,000 per patient. 

The U.S. Public Health Service has the expertise to eliminate 

TB, but many State programs are seriously under-resourced. 

In recognition of the need to strengthen domestic TB control, 

Congress passed the Comprehensive Tuberculosis Elimination Act 

of 2008. This historic legislation was based on the recommendations of the Institute of Medicine to revitalize the CDC and NIH 

programs. We recommend that you give the full level of 

$210,000,000 in fiscal year 2010 for CDC’s Division of Tuberculosis 

Elimination as authorized by the Comprehensive TB Act. 

In conclusion, Mr. Chairman, the U.S. stands on the brink of 

being able to eliminate tuberculosis. What is needed is U.S. leadership to reduce the global pandemic as called for by the LantosHyde Leadership Against AIDS, TB and Malaria Act and the appropriate allocations of resources for domestic TB control and research that are called for in this Act. 

Thank you. 

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Mr. OBEY. Thank you very much. We appreciate your testimony. 

Next, Mr. Neil Horikoshi, Aplastic Anemia and MDS International Foundation. 

WEDNESDAY, MARCH 18, 2009. 

APLASTIC ANEMIA AND MDS INTERNATIONAL 

FOUNDATION 

WITNESS 

NEIL HORIKOSHI 

Mr. HORIKOSHI. Good afternoon and thank you very much for the 

opportunity, Chairman Obey and Ranking Member Tiahrt. 

Most of the people in this room today have probably never heard 

of bone marrow failure disease, let alone the words, aplastic anemia, myelodysplastic syndromes, as well as PNH. But this strikes 

home very close to Congress as these diseases have hit members 

of your family, including Congressman Joe Moakley and Congressman Bob Matsui. 

So, for me, I am affiliated with this organization, the Aplastic 

Anemia and MDS International Foundation as Chair in part because I am an aplastic anemia patient myself, and I came within 

48 hours of death. In my darkest hours, I looked exactly like this. 

If you think about your colleagues and what happened just before Christmas of 2004, Congressman Bob Matsui was in his office. 

On January 1, 2005, he passed away. He looked like me. He looked 

exactly like me. He went to the office. 

So what happened? 

What happens is it happens inside of one’s body. Bone marrow 

fails. You fail to produce blood. And I am going to explain what 

that means for the various diseases. 

In my case, it was all about taking the last physical, getting a 

blood exam and finding out I didn’t have any blood in me. That is 

coming very close. So, hence, I dedicate myself to supporting this 

organization and what bone marrow failure means to other Americans. 

Aplastic anemia is the condition where one’s body is not able to 

produce any blood. MDS, which is what Bob Matsui and Joe Moakley had, are the conditions where they were able to produce some 

blood, but the blood was defective. And PNH is the condition where 

you are able to produce blood, but your immune system ends up destroying that blood. 

These are all very, very rare diseases often called orphan diseases, in a nutshell. So, hence, there hasn’t been much focus on the 

topic overall. Roughly, 20,000 to 30,000 Americans get these types 

of diseases each year. 

One of the things that I will ask for, and I know it is not within 

the jurisdiction of this Subcommittee, but I would ask all members 

sitting before me today to look at H.R. 1230, the Bone Marrow Failure Disease and Treatment Act of 2009 which increases the surveillance efforts at CDC and also creates a Bone Marrow Failure Registry. This legislation was introduced by Congresswoman Doris 


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Matsui after she lost her husband, and I am sure your colleague 

and friend, Bob Matsui. 

I would also ask this Subcommittee to seriously consider the appropriate appropriations once this bill is passed. 

And I also urge this Subcommittee to continue to focus on its ongoing research to NIH because but for the work that individuals 

such as Dr. Neal Young, who did the necessary work some years 

ago to find at least treatment for aplastic anemia, I really wouldn’t 

be here in front of you today. Twenty-five years ago when our organization was founded, the death rate of anyone with aplastic anemia was 100 percent. One hundred percent. 

Fifteen years ago, had I received this disease, it was still about 

50 percent. I am one of the lucky few that made it through in the 

50 percent. So ongoing funding to NIH is extremely important to 

us. 

Lastly, I ask that the full Appropriations Committee continue to 

be very cognizant of the work that is going on for the Bone Marrow 

Failure Disease Research Program that DOD has embarked upon 

and to fund this program to the increased funding of $7,500,000 

from $5,000,000 today. 

Thank you very much. 

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Mr. OBEY. Thank you very much. We appreciate your sharing 

your story with us, and we wish you well. 

Next, Ms. Linda Rosenberg, National Council for Community Behavioral Healthcare. 

WEDNESDAY, MARCH 18, 2009. 

NATIONAL COUNCIL FOR COMMUNITY BEHAVIORAL 

HEALTHCARE 

WITNESS 

LINDA ROSENBERG, MSW 

Ms. ROSENBERG. Thank you. Good afternoon, Chairman Obey 

and members of the Subcommittee. 

My name is Linda Rosenberg, and I am the President and CEO 

of the National Council for Community Behavioral Healthcare. 

The National Council represents 1,600 community mental health 

centers and safety net agencies. Collectively, they serve over six 

million low-income children and adults with mental health and addiction disorders. 

Mr. Chairman, the public mental health system confronts twin 

crises. First and foremost, the mortality rates among persons with 

serious mental illnesses are shocking. According to a 2006 

SAMHSA survey, persons with conditions like schizophrenia and 

bipolar disorder die, on average, 25 years sooner than other Americans. Most people with serious mental illnesses will not live to see 

their fiftieth birthday. 

This constitutes the highest death rate among any population by 

any agency of the U.S. Public Health Service that receives funding 

from this Subcommittee. These horrific mortality rates are primarily caused by co-occurring medical illnesses: asthma, diabetes, 

cancer, heart disease and pulmonary conditions. 

That is why, Chairman Obey, we owe you a great debt. In the 

appropriations legislation passed last week, you fought for the inclusion of $7,000,000 to co-locate primary care capacity in community mental health organizations. This integrated care model will 

enable us to do little things like take a patient’s blood pressure and 

big things like make sure a person who has schizophrenia and 

heart disease gets to see a cardiologist. 

We always appreciate your willingness to both listen and to take 

action. 

A parallel crisis we confront is the economic downturn. The State 

of Illinois is preparing to close 5 community mental health centers 

in Chicago, cutting psychiatric capacity in that city by 40 percent. 

In Iowa, the counties are running out of mental health dollars, and 

the State just announced a 6.5 percent mental health cut across 

the board. 

And I should note that these consumers do not just disappear. 

Their outcomes are bad. They wind up in State mental hospitals. 

They wind up in nursing homes. They wind up in jails, and they 

wind up on the streets. 

At the same time that these cuts are being enacted, community 

mental health centers are reporting a surge of newly unemployed 


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people seeking services. A survey we took indicates a 20 percent increase in psychiatric intakes. In Colorado, members are serving a 

record number of people, 90,000 men, women and children. In New 

York, providers report a 30 percent increase in demand for psychiatric treatment. 

We cannot also ignore the ravages of addiction. Addiction affects 

one in ten Americans and one in four children. State and local governments fund half of the substance abuse treatment in this country, and the current economic downturn is resulting in addiction 

service reductions across the country. 

While the Recovery Act was helpful to us, particularly the Medicaid policy changes, we are turning to this Committee for additional Federal support, and, specifically, we have three priorities. First, a $35,000,000 increase for the Integrated Mental Health 

Primary Care Program. As you well know, these funds help us to 

save lives. Furthermore, the funding increment we are asking for 

is consistent with the second year of funding for the Children’s 

Mental Health Services Program, another vital program that you 

started. 

Second, a $100,000,000 increase for the SAMHSA Community 

Mental Health Services Block Grant. I should note that the block 

grant has not had an increase in a decade and has lost 50 percent 

of its purchasing power. The additional funds would flow directly 

to community mental health providers and States hit with budget 

deficits and high unemployment. Third, a $150,000,000 increase to the Substance Abuse Prevention and Treatment Block Grant. This increase will go a long way 

to ensuring that our Nation’s addiction treatment system can respond to increasing demand. 

We know that you are confronted with difficult choices in the 

2010 appropriations cycle, but, Mr. Chairman and members, we 

can assure you these new dollars would be wisely spent, helping 

those in need and providing central primary care services to persons with serious mental illness. 

We thank you for the opportunity to testify. 

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Mr. OBEY. Thank you. Just two comments, I guess. 

With respect to your comments about State budgets squeezing 

mental health services, what I find frustrating is that whenever we 

have tough times, well, especially when we have tough times, we 

usually see a squeeze on those services. People seem to think that 

both of those aren’t real problems, and, as you know, they are. Secondly, I am pleased that we were able to provide the $7 million last year. 

What we are trying to do is to see that the patients are handled 

in an integrated manner, and I think that is fully consistent with 

what the Administration is talking about with respect to creating 

incentives in their health reform legislation that will see to it that 

the treatment of patients, while they are being treated, is on an integrated basis and, that there is still an after-the-event coordination as well. 

Ms. ROSENBERG. We thank you so very much, all of you. 

Mr. OBEY. Next, Dr. Paul Kirwin, American Association for Geriatric Psychiatry. 

WEDNESDAY, MARCH 18, 2009. 

AMERICAN ASSOCIATION FOR GERIATRIC PSYCHIATRY 

WITNESS 

DR. PAUL D. KIRWIN, M.D. 

Dr. KIRWIN. Thank you, Mr. Chairman and members of the Subcommittee, and thank you for the privilege of being here to be able 

to talk about the mental health needs of the elderly. 

I am a practicing geriatric psychiatrist and on the Board of Directors of the American Association for Geriatric Psychiatry. I also 

serve as the program director for a geriatric psychiatry fellowship 

at Yale University School of Medicine. 

As medical school faculty, I often ask my own students if they 

have a grandparent that is still alive, so that our teaching points 

can be relevant and real and personal. 

As I look at the members of this Committee and the staff behind 

you, I wonder how many of you have an aging grandparent or parent that might need assistance one day. 

Mr. OBEY. I am an aging grandparent. [Laughter.] 

Dr. KIRWIN. You don’t look it. 

I saw patients in my clinic yesterday, one man, a decorated Korean War veteran, frozen with Parkinson’s disease, now in social 

isolation in a nursing home, struggling with depression. I also saw 

another gentleman with a new onset diagnosis of prostate cancer, 

who also was struggling with depression. And, an 80-year-old 

woman who was searching to remember the names of her own children and memories that kept her life cohesive and intact, now ravished with progressive dementia. 

These could be our loved ones, and maybe you have people in 

your family with similar ailments—a favorite raucous uncle who 

used to take you skiing with your cousins, a grandmother who 

brought you to her home for Sunday dinner, a mother who laughed 

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These people are with us now in our lives. This is not an abstract 

concept. 

As you know, the Baby Boom generation is nearing retirement. 

Shortly, there will be approximately 40 million people in the 

United States over the age of 65. Many estimates predict that at 

least 20 percent of those people will suffer with some form of mental illness in the sunset of their lives. 

The economic, emotional and family costs of dealing with late life 

mental illness are staggering, as you know. Efforts to prevent and 

treat these disorders are critical to our Nation’s health. 

The AAGP believes that three key issues need to be addressed. 

First, workforce issues. As a training director, I know how dire 

it is to recruit people into our field to treat people with late life 

mental illness. Last spring, the Institute of Medicine released a 

study of the Nation’s health care workforce to meet the needs of 

an aging population which called for immediate investments in preparing our health care system to care for older Americans and their 

families. 

While providing vital information on many issues regarding the 

health care of older adults, the 2008 report didn’t delve deeply into 

the mental health care needs. The AAGP believes that a complementary study must be undertaken to consider vital areas of 

concern. We have the support of the IOM for an additional study 

and have been advised by IOM staff that the study would cost 

about $1,000,000. 

Second, the lack of funding for mental health research focused on 

older adults. Funding for increases in the NIH and NIMH budget 

are critical and to have those funds focused on not just the broader 

mental health needs but those specifically of older Americans. 

And, lastly, the need for adequate funding for mental health outreach and treatment programs for the elderly under the Center for 

Mental Health Services. 

I appreciate the Committee’s patience and having us present before you. Thank you. 

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Mr. OBEY. Thank you very much. We appreciate your testimony. 

The next party on the list I am told is not here, and so we will 

move to Christine Lubinski, Infectious Diseases Society of America. 

WEDNESDAY, MARCH 18, 2009. 

INFECTIOUS DISEASES SOCIETY OF AMERICA 

WITNESS 

CHRISTINE LUBINSKI 

Ms. LUBINSKI. Good afternoon. 

IDSA is pleased to testify about the urgent need to increase 

funding for HHS programs that address two deadly global 

pandemics: HIV/AIDS and tuberculosis. 

IDSA and its sister organization, the HIV Medicine Association, 

represent more than 8,000 infectious disease and HIV physicians 

and scientists. 

In 2008, IDSA and HIVMA launched the ID Center on Global 

Health Policy and Advocacy to address global HIV, TB and HIV/ 

TB co-infection. 

U.S. leadership has been a catalyzing force in saving millions of 

lives from HIV, but only about one-third of persons in developing 

countries who are clinically eligible for treatment are receiving it, 

and prevention strategies to reduce the more than 7,000 new HIV 

infections that occur daily are urgently needed. 

CDC’s Global AIDS Program helps poor countries prevent HIV 

infection, improve treatment care and support for people living 

with HIV and build health care capacity. An fiscal year 2010 funding level for CDC GAP of $225,000,000 is essential to fulfill its mission as the lead agency on global HIV prevention and public health 

systems strengthening. 

TB is the second leading global infectious disease killer, claiming 

more than 1.7 million lives every year. 

Highly drug-resistant forms of TB have emerged. Drug-resistant 

TB is a direct result of human failure—failure to adequately treat 

TB and develop the tools necessary to address this ancient and 

deadly scourge. The increase in multi-drug resistant TB and the 

emergence of extremely drug-resistant TB raise concerns about the 

potential for an untreatable XDR TB epidemic. 

The global spread of drug-resistant TB presents a persistent public health threat to the U.S. TB is an airborne infection. Drug-resistant TB anywhere in the world translates into drug-resistant TB 

everywhere. 

Last year, Congress passed the Comprehensive TB Elimination 

Act of 2008 to enhance our capacity to address drug-resistant TB 

and escalate development of new tools, drugs, diagnostics and vaccines. Promises made in this law can’t be fulfilled without funding. 

The $210,000,000 funding level authorized in the law should be appropriated for the CDC Division of TB Elimination. 

IDSA is extremely pleased that the stimulus bill contained an infusion of desperately needed dollars for NIH. This long overdue increase must be maintained and enhanced in this year’s bill. 


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The success of HIV research is a testament to the value of research investment. A comprehensive research portfolio was responsible for the rapid and dramatic gains in HIV knowledge that led 

to an 80 percent reduction in AIDS mortality in the U.S. and in 

developing countries. Continued investment is essential to develop 

more effective prevention strategies and better treatment to aid 

prevention. NIH funding for TB totaled $160,000,000 in fiscal year 2008, a 

modest level for an infectious disease that kills millions through a 

pathogen that is showing increased resistance to available drugs. 

We must have resources for trials on new TB drugs, to test 

diagnostics, to evaluate vaccine candidates. 

Research activities focused on HIV/TB co-infection must continue. TB is the leading cause of death among persons with AIDS, 

and it is more difficult to treat in people with HIV. Living with 

HIV and dying from TB has become an all too familiar mantra. 

A doubling of funding for TB research is a reasonable response 

to the world disease burden and the scientific opportunities. 

Finally, we support funding for the Global Fund to Fight AIDS, 

TB and Malaria. It provides a quarter of all international financing 

for AIDS globally, two-thirds for tuberculosis and three-quarters for 

malaria. The Global Fund has helped save 3.5 million lives in 140 

countries. 

Thank you very much. 

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Mr. OBEY. Thank you very much. We appreciate your testimony. 

Next, Helen Keller International, Robert Thomas, Jr. 

WEDNESDAY, MARCH 18, 2009. 

HELEN KELLER INTERNATIONAL 

WITNESS 

ROBERT M. THOMAS, JR. 

Mr. OBEY. Who is that strange fellow with you? 

Mr. THOMAS. I think it is someone you know, actually. 

Mr. OBEY. Okay. 

Mr. THOMAS. Thank you very much for this opportunity for 

Helen Keller International and me to testify on behalf of HKI’s 

ChildSight Program. 

My name is Bob Thomas. I am a volunteer trustee of HKI. HKI 

was co-founded in 1915 by the deaf and blind crusader, Helen Keller, as a lead nonprofit organization dedicated to preventing the 

causes and consequences of blindness, poor vision and malnutrition. 

I am requesting that you recommend continued funding of 

ChildSight through the U.S. Department of Education in fiscal year 

2010. 

ChildSight’s mission is to improve the vision and academic potential of school children living in urban and rural poverty. Uncorrected refractive error, what most of us know more commonly as 

nearsightedness, farsightedness and astigmatism, two of which I 

have, significantly affects a child’s academic performance and overall development. 

ChildSight’s data, collected over 15 years, confirm that up to 1 

in every 4 children between the ages of 10 and 15 fail standard vision screenings. There is a simple, very cost-effective solution: prescription eyeglasses. However, millions of children in the U.S. suffer from uncorrected vision due to social, economic, transportation 

barriers as well as inadequate treatment under existing school 

health programs. 

ChildSight tackles this challenge by going directly into schools 

with populations of children from poor families. The hallmark of 

the ChildSight program is the provision of prescription eyeglasses 

at the school. 

I recently visited one of our sites in New York City. This was a 

middle school on the edge of Chinatown. The population there was 

mainly Oriental, children of Oriental extraction from various parts 

of the Far East, and African American children. 

It was done in the school library, which was a very warm and 

well-used place I might note, and I am afraid it was the first time 

I had been in a public school for a long time. 

We had volunteers there who conducted initial screenings which 

basically consist of reading the eye chart with the big E at the top 

that we are all familiar with. Anyone that showed any possible 

problems was then referred to one of the two optometrists that we 

had there that day. They were both extremely good with these children, very engaged with them, and you could see that the children 


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easily talked to them about what their problems were. They examined their eyes and wrote a prescription. 

The child was then sent to a table where we had 30 or 40 different frames for these glasses available, and this is a key part for 

the children because if we can’t find them something that either is 

acceptable or even cool they won’t wear them. And they pick out 

the frame. 

One week later, after we have sent off the prescriptions to a 

manufacturer, we come back and the frames, and the glasses are 

distributed to the kids and adjusted as necessary. 

I brought a couple of pictures of the results here. One might say 

some of our satisfied customers. 

With support from this Committee, the Department of Education 

and private donations, ChildSight has now screened over 1.2 million children in 7 States and has delivered free eyeglasses to 

139,000 students since the program’s inception in 1994. 

Teachers report that a majority of the students who have their 

vision corrected with ChildSight glasses exhibit increased class participation and improved grades. 

I ask the Committee to recognize our concern that much more 

needs to be done. Children who need eyeglasses must have them 

while they are in school, so they can make full use of their educational opportunities. I ask the Committee to recommend at least $1,800,000 in fiscal 

year 2010 to support ChildSight in its current locations and to expand our sites so that, as we say, we can bring education into 

focus. 

Thank you, Mr. Chairman. The attention and consideration of 

the Committee are greatly appreciated. 

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Mr. OBEY. Thank you. We appreciate your testimony. 

Next, National Association of State Alcohol and Drug Abuse Directors, Flo Stein. 

WEDNESDAY, MARCH 18, 2009. 

NATIONAL ASSOCIATION OF STATE ALCOHOL AND 

DRUG ABUSE DIRECTORS, INC. 

WITNESS 

FLO STEIN 

Ms. STEIN. Chairman Obey, Ranking Member Tiahrt, members of 

the Committee, I am Flo Stein. I am the President of the National 

Association of State Alcohol and Drug Abuse Directors. We call it 

NASADAD. The members of NASADAD manage the publicly-funded addiction services in all of the States and territories. 

I serve as the Director of Substance Abuse in the State of North 

Carolina, and I want to thank you very much for offering us this 

opportunity to provide testimony. We are very grateful for this 

Committee’s leadership in providing funding for the States’ addiction and treatment and prevention systems. 

I have submitted a more detailed report that you can look at. It 

shows some of the issues going on in particular States and some 

of the outcomes those States are having. 

For today, I am going to focus on three important points regarding our top priority, and that is an increase in the Substance Abuse 

and Prevention Block Grant of $150,000,000. That program currently receives $1,780,000,000. 

It is a very large block grant, but I think it is important to remember that it is the foundation of the Nation’s treatment system. 

The block grant represents half of all the dollars available in my 

State, for instance. In the State of Wisconsin, it represents about 

48 percent of all the dollars spent. 

The other primary source of financing for the public addiction, 

prevention, treatment and recovery system is State appropriations. 

So it is sort of like very limited streams of funding that come to 

the addiction treatment system. 

A second point that I think is really important that I think we 

might finally be successful is that we are getting outstanding results. We have partnered with the Substance Abuse and Mental 

Health Services Administration on the National Outcome Measures. 

The States are showing very much improved outcomes for people 

gaining recovery. For example, in 2008, all the States together, 63 

percent of the people who received treatment were abstinent from 

illicit drugs, having come in being drug users and leaving treatment and recovery, and 7 percent abstinent from alcohol use. 

The third point is one that you are hearing about quite a bit, and 

that is that the system, because it is so dependent on this important block grant, is very much under stress right now. We have increasing numbers of people needing services as the economy declines. Unfortunately, more and more people cope with the stress 

of their situation by sometimes using alcohol and other drugs. And, 


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as you have heard, alcohol and drug abuse contribute to all the 

leading causes of death: the chronic illnesses, heart disease, stroke 

and cancer. 

So it is an important investment. 

That is the backdrop to the request that we are asking for $150,000,000 increase in the block grant. 

The block grant has been stable for a number of years. We are very grateful to this Committee for the additional $19,900,000 this 

past year. It is going to make a big difference. But because the 

block grant had been level funded for a number of years since 2004, 

we are not quite back to the original purchasing power that we 

had. 

So I think it is an important investment in the future of our 

Country. 

Again, thank you for your leadership, and we stand ready to answer any questions or provide additional information. 

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Mr. OBEY. Thank you. 

Ms. LEE. Mr. Chairman, may I just ask one quick question, 

please? 

Mr. OBEY. Sure. 

Ms. LEE. Thank you very much. 

Let me ask you, and I know this would entail a longer discussion, but I want to ask you about the treatment approaches and 

funding now for prescription drug use as it relates to recovery 

versus the illicit drug use. How is that working at this point? 

Ms. STEIN. I can specifically for my State, but we have also had 

a number of discussions with the States that are members of 

NASADAD. This is our fastest growing problem both for children 

and adults but more alarmingly for children. 

What we are doing is just refocusing our dollars. We have the 

same number of dollars, and we are trying to develop new intervention techniques and especially working with families because the 

source of a lot of prescription drugs is actually people’s homes. So 

we want parents to be more aware and be watching their children. 

We would be glad to send you some further ideas about what can 

be done. 

Mr. OBEY. Thank you. Thank you very much. 

Let me tell the Committee that I am told that between 3:00 and 

3:30 we will have the next series of votes. That means that we will 

be gone for 30 to 40 minutes. So, if we get lucky and that vote 

comes closer to 3:30 than 3:00, we might be able to finish all of our 

witnesses before we have to leave them in the lurch. 

Let me next call upon the Association of Maternal and Child 

Health Programs, Phyllis Sloyer. 

WEDNESDAY, MARCH 18, 2009. 

ASSOCIATION OF MATERNAL AND CHILD HEALTH 

PROGRAMS 

WITNESS 

PHYLLIS SLOYER, PH.D., R.N. 

Ms. SLOYER. Good afternoon, Mr. Chairman and Subcommittee 

Members. I am grateful for the opportunity to testify on behalf of 

the Association of Maternal and Child Health Programs, its members and the millions of women and children that we serve through 

the Title V Maternal and Child Health Services Block Grant every 

year. 

I am Dr. Phyllis Sloyer. I am the current President of AMCHP, 

and I am also a division director in the State of Florida. 

I am here today to respectfully ask the Subcommittee to support 

full funding for the Maternal and Child Health Services Block 

Grant at its authorized level of $850,000,000, and I want to begin 

with Adam’s story. 

Adam is a 15-year-old from Milwaukee, Wisconsin, a cute guy. I 

am going to paraphrase in his words the benefits that he has received from this Title V block grant. 

He says: Hi. My name is Adam, and I live in Milwaukee, Wisconsin. I have a very rare genetic disorder that affects my ability 


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to see, to learn and to move, and Title V services have been very 

important to me. 

His mother says: It is great to see that more services are becoming available through the funding, especially the five regional centers in the State of Wisconsin. These centers are dedicated to meeting family needs through information referral, follow-up services, 

parent-to-parent support and the building of a tremendous network 

of providers who help children with special health care needs. 

He wants you to know that families with kids who have special 

needs really do benefit from these services, and he wants us to help 

him so that other kids can get the services as well. 

He says, thanks. 

Now we know that two of these centers are actually in Chairman 

Obey’s district. One is at the Chippewa County Courthouse, and 

the other one is at the Marathon County Health Department, and 

they are not unusual. We have used Title V funds throughout the 

Nation to develop similar centers and similar networks to help children like Adam. 

But I would like to point out a few high points about Title V and 

Title V of the Social Security Act. It was created during the Great 

Depression. It is a unique Federal-State partnership that is dedicated solely to improving the health of all mothers and children including children with special health care needs. 

I can’t begin to tell you the millions of people that have received 

early prenatal care, child health screening, preventative services, 

support services because of this block grant. I also can’t begin to 

tell you the kinds of systems of services that we have developed because of these funds. 

While we have made great strides in preventing long-term problems, the data are indicating now that we need to bolster our actions. Every 18 minutes, a baby dies before his or her first birthday. Basically, a dozen of them will die before the end of my testimony. 

Globally, we are 29th in infant mortality. We are failing to adequately screen all young children for developmental issues. I think 

you all know about the obesity problems and the health disparity 

problems. And only 50 percent of children with special health care 

needs actually receive comprehensive care through a medical home. 

Third, we have a proven track record of measuring what we do, 

and that data are fairly transparent, but it is beginning to tell us 

that we have a demand for services that is going beyond our capacity. 

Our States are facing significant economic challenges. Frankly, 

every day, I have a ten-fold increase in the number of people that 

are coming to us for services, whether they are prenatal care, 

whether they are preventative services, whether they are screening 

services. 

Our block grant is at its lowest funding level of $662,000,000 

since 1993. We need the additional resources not for us but for the 

women and children who come to us. I urge you to consider full 

funding at $850,000,000. 

And I close with the story of Ashley in my State, whose mother 

had to make a decision between getting the eyeglasses her daughter needed to stay in school or the drugs that her daughter needed 


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to be in a regular classroom. Through the efforts of Title V and coordinating with other agencies, she is in a regular classroom, and 

she is grateful that she is as a teenager. 

For all the Adams and Ashleys and the millions served by this 

remarkable block grant, thank you for the opportunity to share our 

story and thank you for your leadership. 

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Mr. OBEY. Thank you very much. 

Now, Health Professions and Nursing Education Coalition, Dr. 

Tina Cheng. 

WEDNESDAY, MARCH 18, 2009. 

HEALTH PROFESSIONS AND NURSING EDUCATION 

COALITION 

WITNESS 

DR. TINA L. CHENG, M.D. 

Dr. CHENG. Good afternoon. My name is Tina Cheng, and I am 

Chief of the Division of General Pediatrics and Adolescent Medicine 

and Professor of Pediatrics and Public Health at Johns Hopkins 

University up the road, and it is a pleasure to speak to you today 

on behalf of the Health Professions and Nursing Education Coalition or HPNEC in support of $550,000,000 in fiscal year 2010 for 

the health professions education programs authorized under Title 

VII and VIII of the Public Health Service Act and administered 

through HRSA. 

HPNEC is an informal alliance of more than 60 national organizations representing schools, programs, health professionals and 

students dedicating to ensuring the health care workforce is 

trained to meet the needs of our diverse population. 

As you know, the Title VII and VIII health professions and nursing programs are essential components of the Nation’s health care 

safety net, bringing health care services to our under-served communities. These programs support the training and education of 

health care providers to enhance the supply, diversity and distribution of the health care workforce, picking up where traditional market forces leave off. In particular, the programs emphasize primary 

care and training in interdisciplinary settings to meet the needs of 

special and under-served populations. 

We are thankful to the Subcommittee for the $200,000,000 provided for the health professions programs in the American Recovery and Reinvestment Act. We also greatly appreciated the recently 

enacted fiscal year 2009 Omnibus Appropriations Bill provides increases for most Title VII and VIII programs. 

The Nation is indebted to you, Mr. Chairman, as well as members of the Subcommittee for your forward-thinking vision. 

We cannot achieve universal access to health care and quality 

care unless we ensure that a well-prepared health care workforce 

is in place to provide that care. Today, however, we remain a long 

way from realizing that vision. 

According to HRSA, an additional 30,000 health practitioners are 

needed to alleviate existing health professional shortages. Combined with faculty shortages across health professions disciplines, 

racial and ethnic disparities in health care and a growing chronically ill and aging population, these needs strain an already fragile 

health care system. 

In my own experience at Johns Hopkins, in collaboration with 

the University of Maryland Family Medicine Program, Title VII 

dollars have allowed us to train clinician educators and researchers 


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who are the primary care faculty across the Country. We have a 

commitment and a strong track record of training under-represented minorities and, in the last two decades, have trained almost 100 pediatric and family medicine trainees, 61 percent of 

them, under-represented minorities, most all serving under-served 

populations today and most doing research on health disparities. 

As noted while I was on HRSA’s Advisory Committee on Training in Primary Care Medicine and Dentistry, the education and 

training of our health care providers is an integral part in preparing our Country to meet the health needs of the future as well 

as current and growing health needs, many that you have heard 

about already today: mental health, global health issues, et cetera. 

Because of the time required to train health professionals, we must make appropriate investments today. HPNEC’s $550,000,000 

recommendation for Title VII and Title VIII health professions programs will help sustain the health care workforce expansion supported by funding in the recovery package. Further, this appropriation will restore funding to critical programs that still have not recovered from the substantial funding lost in the drastic fiscal year 

2006 cuts. 

We are grateful to President Obama for his support of the health 

professions program throughout his tenure in the Senate. We also 

appreciate the pledge in his fiscal year 2010 budget to invest in 

strengthening the health professions workforce. 

We look forward to working with the Subcommittee to help 

achieve this goal and to reinvest in the health professions program. 

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Mr. OBEY. Thank you very much. 

Next, American Dental Education Association, Dr. James Swift. 

WEDNESDAY, MARCH 18, 2009. 

AMERICAN DENTAL EDUCATION ASSOCIATION 

WITNESS 

DR. JAMES Q. SWIFT 

Dr. SWIFT. Good afternoon, Mr. Chairman and members of the 

Subcommittee. I am Dr. Jim Swift, I am the Director of the Division of Oral and Maxillofacial Surgery at the University of Minnesota, and I am here today as the Immediate Past President of 

the American Dental Education Association which is also called 

ADEA. 

Thank you for your unwavering support of the SCHIP legislation 

which recognized that oral health care was an important component of children’s overall health care, and I also appreciate your 

earlier comment about the mental and dental component, of the 

importance of dental care to systemic health. 

We request a build-upon funding of the American Economic Recovery and Reinvestment Act and your Committee’s 2010 fiscal 

year appropriations. 

We applaud, Chairman Obey, your decision to provide 

$500,000,000 to address health care professional shortages and 

$200,000,000 to the Title VII health professional programs and 

$300,000,000 through the Recovery Act. 

Additionally, President Obama’s budget blueprint for 2010 builds 

upon the down payment made in the economic stimulus package by 

investing $300,000,000 to increase the number of physicians, 

nurses and dentists practicing in under-served areas of this Country. 

This afternoon, I would like to discuss our budget recommendations under three areas: dental education, dental research and access to oral health care. Specifically, I would like to urge Congress 

to provide $16,000,000 for dental Title VII health profession programs and $117,000,000 for Title VII diversity and student aid programs. 

The dental health professional programs support general practice 

residency training programs as well as pediatric dental training 

programs to provide access to care and the training that is necessary to provide our dentists to be trained in a way to be able to 

access this patient population. 

The diversity and student aid support will allow us to get underrepresented minorities into our profession to provide care that is 

needed in those communities. 

Secondly, we urge Congress to provide $33,000,000,000 for the 

National Institutes of Health, specifically of which $441,000,000 

would be allocated to the National Institute of Dental and 

Craniofacial Research. I think many of you are aware of the oral 

systemic connection of the association of periodontal disease with 

cardiac disease and the utilization of salivary markers to determine 


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disease in disease-risk population. All these entities were studied 

by the NIDCR, and funding would be appropriate. Thirdly, we recommend $19,000,000 for the dental program Part 

F of the Ryan White HIV/AIDS Treatment and Modernization Act. 

This dental reimbursement program is a cost-effective mechanism 

to allow care to those individuals that need it through our dental 

education institutes as well as through community-based partnerships that allow the type of treatment to be rendered, to train our 

students to be able to render it and have an appreciation for the 

care that is needed and the special type of care that these patients 

have to have. 

We also recommend $10,000,000 for the Dental Health Improvement Act. This newly reauthorized program supports the development of innovative dental workforce programs specifically to States’ 

specific dental workforce needs. Grants are being used to support 

a variety of initiatives including but not limited to loan repayment 

programs, to recruit culturally and linguistically competent dentists to work in under-served areas and with under-served populations. 

We also request $17,000,000 for the oral health programs at the 

Centers for Disease Control and Prevention which allows technical 

assistance to provide preventive programs with fluoridation of 

water as well as sealant programs to prevent disease. Lastly, we recommend $235,000,000 for the National Health 

Service Corps which allows loan repayment programs for dentists 

to be able to work in environments. They have significant debt 

when they are finished with their dental training. If they have an 

opportunity to repay their dental educational debts by loans, then 

they are more likely to go into areas where the access to care is 

important. 

In conclusion, I want to thank the Committee for considering our 

budget request for dental education and research in fiscal year 

2010. Any comprehensive reform of the U.S. health care system 

should provide universal coverage and access to high quality care 

of which dental is a component. 

Thank you very much for the opportunity to present. 

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Mr. OBEY. Thank you. I appreciate it. 

Let me tell the Committee that we obviously have an effective 

sabotage operation going on, on the House Floor. [Laughter.] 

We have eight votes coming up, including a Motion to Recommit 

with ten minutes debate. So, when we break up, I don’t have the 

foggiest idea when we are going to get back here. We will try to 

make it as quickly as we can. 

Let’s see how many people we can get through before, so we inconvenience as few people as possible after the vote. 

Next, Academic Family Medicine Advocacy Alliance, Dr. Jerry 

Kruse. 

WEDNESDAY, MARCH 18, 2009. 

ACADEMIC FAMILY MEDICINE ADVOCACY ALLIANCE 

WITNESS 

DR. JERRY KRUSE, M.D., M.S.P.H. 

Dr. KRUSE. Mr. Chairman, members of the Committee, I am 

Jerry Kruse, professor and Chair of Family and Community Medicine at the SIU School of Medicine in Springfield, Illinois, and I am 

here on behalf of the academic family medicine organizations that 

are listed in the written statement. 

I thank you for the opportunity to testify in support of funding 

for Title VII primary care medicine and dentistry and in support 

of funding for primary care research at AHRQ and the NIH. 

The U.S. health care system is out of balance, over-reliant on 

specialty care, very expensive and trails the wealthy nations of the 

world in health care outcomes. 

We know that health systems with strong foundations in primary 

care have the best health care outcomes, the best quality indicators, significantly lower costs, more equitable care, and they eliminate disparities in health care outcomes. Abundant evidence like 

this over the past 30 years proves that primary care is the essential foundation of the best health care system. So, for the best 

health care system, we need to train more family physicians. 

We are very concerned about the production pipeline of family 

physicians in the United States. For the past 3 years, only 15 percent of U.S. medical school graduates chose careers in primary 

care, one-third of what we need to have the best system. 

What can be done? 

Two key steps come under the purview of this Committee: Primary care training and primary care research. So we ask your help 

to increase funding for key programs that work: primary care 

training under Title VII and primary care research at AHRQ And 

NIH. 

So, how will increased funding in these areas help our health 

care system? I will give an example. 

Since 2003, the funding for community health centers, CHCs, has 

doubled by $2,000,000,000. The Recovery Bill has added 

$1,500,000,000 to this, and this is laudable. However, over the 

same period of time, the funding for programs that train physicians 


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most likely to practice in these places, the Title VII programs, has 

been cut by 55 percent. 

So here is an analogy. Do you think that new sports stadiums 

would be built if there were not a pipeline of players and coaches 

to attract the fans to fill the seats? No, of course, they wouldn’t. 

Mr. OBEY. Unless you are a Cubs fan. [Laughter.] 

Dr. KRUSE. I am a Cardinals fan. 

Likewise, funding for CHCs must be accompanied by corresponding significant increases funding to train and to attract 

family physicians and the health care professionals that are needed. 

Are these programs effective? Yes. Important organizations like 

the Institute of Medicine, CRS, the GAO, the Medicare Payment 

Advisory Commission and others all testify to the fact that these 

programs are effective and undervalued. In addition, these programs are stimulants to local economies. 

We appreciate that this Committee proposed to double the current Title VII primary care funding in the Recovery Bill, but today 

we don’t know how much of the $200,000,000 available will be distributed to primary care medicine and dentistry. We ask that Congress rebuild its investment in primary care medicine and add to 

the investment made in the Recovery Bill by providing an annual 

appropriation of $215,000,000 for primary care medicine and dentistry health professions training grants. 

With respect to primary care research, we are pleased with the 

Recovery Bill’s infusion of funding for comparative effectiveness research at AHRQ, but more core funding is needed at AHRQ to fulfill its mission. We support the request of the Friends for AHRQ 

for base funding of $405,000,000 annually. The Institute of Medicine believes AHRQ is critical to retooling the American health 

care system and goes further, recommending $1,000,000,000 annually. 

For NIH, we are encouraged by the NIH road map and the emphasis on translational research. We support an increase in NIH 

funding directed toward primary care research and populationbased translational research. This research is key to building the 

type of practice that attracts and supports family physicians and 

improves health outcomes. 

In conclusion, as the U.S. moves toward major health care reform, we urge the Committee to support programs that emphasize 

an increased supply of family physicians and emphasize primary 

care research. These programs will work together for the health of 

all Americans. 

Thank you. 

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Mr. OBEY. Thank you very much. 

Now let me call on Congresswoman Lowey. 

Mrs. LOWEY. Well, thank you. And I am sorry I couldn’t be here, 

but, thank you, Chairman Obey, for giving me the privilege of introducing Lindsay Farrell who works fast, talks fast, is doing a 

great job in one of my community health centers, and I am very 

proud of her. 

Lindsay, your work has been an absolutely critical part of the 

strategy to keep our community healthy, and we all thank you so 

much for appearing before us today. 

Thank you, Chairman Obey. 

WEDNESDAY, MARCH 18, 2009. 

NATIONAL ASSOCIATION OF COMMUNITY HEALTH 

CENTERS 

WITNESS 

LINDSAY FARRELL 

Ms. FARRELL. Thank you, Congresswoman Lowey, Chairman 

Obey, Ranking Member Tiahrt, members of the Subcommittee. 

I am the President and CEO of Open Door Family Medical Center located in the suburbs north of New York City in Westchester 

County. We operate 8 health centers and serve 32,000 patients. 

While Westchester is one of the wealthiest counties in the Country, the income disparity between the rich and the poor is huge. 

More than 55 percent of our patients have no health insurance 

whatsoever. The rest of our patients are covered by essential programs like Medicaid, SCHIP and Medicare. A small number are 

covered by commercial insurance, only 3 percent, provided through 

their employers. 

And so, on behalf of Open Door as well as the 18 million patients 

served by community health centers nationwide, I want to thank 

you for your unyielding support and for your dedication to our mission of providing affordable, accessible primary health care to all 

Americans. In this time of enormous challenges for our health care 

system and our economy, your faith in us and your support 

through the Recovery Act will allow us to rise and meet the challenges and continue to excel. 

Over more than 40 years, the Health Centers Program has 

grown to become a critical component of our Nation’s primary care 

infrastructure. 

My health center serves as the family doctor and dentist to people who would otherwise have to seek care in hospital emergency 

rooms. Because we are open six days a week and evenings or we 

are on call 24 hours a day, we prevent countless non-urgent emergency room visits. 

Open Door is also dedicated to comprehensive primary and preventive care. For example, we provide our State’s prenatal care assistance program. Our obstetricians and midwives delivered nearly 

600 babies last year. 

At Open Door, doctors, dentists, nutritionists and social workers 

all work as a health care team under one roof. We are a health 


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care home that provides an array of health screenings, works to 

prevent disease and treat illnesses, but, importantly, we also strive 

to engage patients so that they will do what they need to in order 

to be healthy. We know this is the best way to use health care dollars effectively. 

We sincerely appreciate the funding increases for the Health 

Centers Program that the Subcommittee has approved over the last 

several years. This expansion has brought access to care to millions 

who were previously medically disenfranchised. 

Despite this record expansion, hundreds of communities have 

submitted high-quality applications over the past few years for a 

new health center that could not be funded. An investment of 

$2,600,000,000 for the Health Centers Program in fiscal 2010, the 

level authorized in the recently enacted Health Care Safety Net 

Act, could expand care to millions of new patients. Carving out $66,000,000 of that increase for base grant adjustments for existing centers would ensure that we keep pace with rising health care costs and increasing numbers of under-served patients. 

This funding will also keep the Health Centers Program on a 

path toward reaching our goal of servicing 30 million patients by 

2015. 

I know that the members of the Subcommittee are well aware 

that the Health Centers Program is an unprecedented health care 

success story. However, the reason I am most proud to be here representing health centers nationwide is my own center and the way 

we are transforming health care at the grassroots. 

Health centers sit at the intersection of private practice and public health. We are unique in our vantage point and have much to 

contribute to the debate over health care reform. 

As Mrs. Lowey heard at her meeting on Monday, I know you 

forced to make difficult decisions in these tough times. However, 

health centers provide a documented value to the government and 

to all who benefit from our services. Please continue your outstanding support of our efforts once again this year. 

Thank you. 

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Mr. OBEY. Thank you very much. 

And next—I am going to try to get at least one more in before 

we have to run to the Floor—National Black Nurses Association, 

Dr. Debra Toney. 

WEDNESDAY, MARCH 18, 2009. 

NATIONAL BLACK NURSES ASSOCIATION, INC. 

WITNESS 

DR. DEBRA A. TONEY, PH.D., R.N. 

Ms. TONEY. Good afternoon, Mr. Chairman and members of the 

Subcommittee. 

The National Black Nurses Association requests $215,000,000 for 

Title VIII, the Nursing Workforce Development Program. 

For 11 years, our Nation has faced a critical nursing shortage 

which is expected to last through the next decade. This shortage 

threatens the safety and well being of the patients whom we are 

charged to care for in our health care systems. The nursing shortage only exacerbates health disparities among people of color, especially women and children. 

A study by Dr. Peter Buerhaus and others estimates that a half 

million new nurses will be needed by 2025. The U.S. Bureau of Statistics estimates that over 140,000 nursing positions remain vacant 

in hospitals, nursing homes, health departments, community 

health centers, schools and other work places. Using the State of 

California as an example, it is estimated that the State would have 

a nursing shortage of 12,000 by 2014. 

Many factors contribute to the nursing shortage including: an 

aging nursing workforce with the average age of a nurse being 47 

years old, 66 percent of the nurse faculty is expected to retire in 

the next 5 to 15 years, an aging population demanding access to 

high quality, culturally competent health and nursing care, a population that has preventable chronic diseases that overwhelm the 

nursing workforce and health care systems, leading to high health 

care costs. 

An investment in Title VIII will support the education and training of registered nurses at all levels including advanced practice 

nurses, nurse faculty and nurse scientists. The use of advanced 

practice nurses is critical to the elimination of health disparities, 

managing chronic disease and promote adoption of culturally relevant self-care management practices. We must provide funding to 

ensure an adequate pipeline of advanced practice nurses if we are 

going to improve access to healthcare. 

Funding for the Nurse Education Loan Repayment Program is 

essential as it allows for new nursing graduates to enter health facilities deemed to have critical shortages such as departments of 

public health, community health centers and disproportionate 

share hospitals. 

Funding for the education of nurses of diverse backgrounds is 

vital to improving the delivery of culturally competent nursing care 

to close the health disparities gaps. Studies have shown that people 


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are more comfortable receiving care from providers of similar ethnic and cultural background. 

In the academic year 2005–2006, the National League for Nursing found that 88,000 applicants were turned away because of the 

lack of capacity such as lack of faculty, lack of technology, low salaries, classroom space, laboratories and limited clinical education 

sites. Hospitals and other facilities that are already understaffed 

cannot handle the patient workload and facilitate the training of 

nursing students. 

It has been found in California State Schools of Nursing that 

there are more qualified students than there are slots. Moreover, 

California associate degree nursing schools use a lottery system to 

admit applicants because there are more applicants than there are 

openings. 

In a report by the National Black Nurses Foundation it was 

found that because of the nursing shortage, patient safety issues 

become more frequent, there are longer waits for clinical appointments and admissions into hospitals, staffing for acute care beds 

are declining, more medical errors occur, and failure to rescue 

events go up. 

Without interventions by nurses, the health disparities gap will 

only increase. NBNA is requesting $175,000,000 for the National Institute of 

Nursing Research. Nurse scientists conduct clinical and behavioral 

research that may be translated into nursing practice. These effective interventions improve quality of life, offer approaches for self 

management, symptom management and care giving. 

Moreover, there is a need for more nurses to be trained to design, 

implement and lead clinical trials. 

I appreciate your time today. 

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Mr. OBEY. Thank you very much. 

Next, National Alliance of State and Territorial AIDS Directors, 

Heather Hauck. 

WEDNESDAY, MARCH 18, 2009. 

NATIONAL ALLIANCE OF STATE AND TERRITORIAL 

AIDS DIRECTORS 

WITNESS 

HEATHER HAUCK 

Ms. HAUCK. Good afternoon, Mr. Chairman and members of the 

Subcommittee. 

My name is Heather Hauck. I am the Director of the Maryland 

Department of Health and Mental Hygiene’s AIDS Administration. 

I am also the incoming Chair of the National Alliance of State and 

Territorial AIDS Directors, NASTAD. We represent AIDS directors 

and adult viral hepatitis coordinators in all States and territories 

in the United States. 

Thank you for inviting us to address you today. State AIDS directors appreciate the opportunity to highlight the needs of State 

HIV, STD and viral hepatitis public health programs and thank 

the Subcommittee for its longstanding support of these programs. 

State and local health department HIV programs work to eliminate health disparities based on race, ethnicity, gender, sexual 

identity and class. HIV prevention and care efforts must be aligned 

to meet the needs of those who bear the greatest HIV burden in 

our United States. 

As you are aware and as has been eluded to, States across the 

Country are facing significant budget deficits. NASTAD has surveyed the State HIV programs and found that over half of the 36 

States responding have received cuts in their State funding and 

staff for their programs. The anticipated cuts in State fiscal year 

2010 HIV programs funding totals over $87,000,000. 

People living with HIV need access to trained HIV clinicians, lifesaving and life-sustaining therapies and a full range of support 

services to live healthy lives and to ensure adherence to complicated treatment regimens. 

All State Ryan White Part B Base and AIDS Drug Assistance 

Programs or ADAPs have reported to NASTAD that we are all seeing a significant and in some cases a doubling of new clients seeking HIV care and support services. This is certainly due to a number of factors including an increase in HIV testing efforts and also 

increasing unemployment. The continuing increase in clients and 

cuts to State contribution to AIDS Drug Assistance Programs certainly puts the fiscal future of ADAPs on very uncertain ground. 

We respectfully request a minimum increase of $362,000,000 for 

State Ryan White Part B Grants which includes an increase of at 

least $113,000,000 for the Part B Base and at least $269,000,000 

for ADAPs. 

NASTAD also supports a $200,000,000 increase for a total of 

$610,000,000 for the Minority AIDS Initiative which assists us in 

addressing health disparities further. 


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Turning from care to prevention, our Nation’s efforts to prevent 

HIV must be ramped up. Every 9.5 minutes, someone in the United 

States is infected with HIV. 

Investing in prevention is cost effective. CDC estimates that 

every year there are over 56,000 new HIV infections which result 

in approximately $9,500,000,000 in treatment costs. 

Unfortunately, over the past 5 years, CDC funding to State and 

local health department prevention cooperative agreements has decreased by $21,000,000. Additionally, core HIV surveillance funding 

has also eroded over the last decade. 

While the importance of this data has become paramount for targeting prevention efforts and directing Ryan White resources, CDC 

has identified the need for a funding increase of $878,000,000 for 

a total funding of $1,600,000,000 for HIV prevention. 

NASTAD would respectfully request at least an initial increase of $249,000,000 in State and local health department HIV prevention and cooperative surveillance agreements. 

In addition to testing efforts and additional HIV prevention resources, State HIV programs need resources and flexibility to utilize a range of public health strategies to reduce transmission. We 

urge the Subcommittee not to include language banning the use of 

Federal funds for syringe exchange programs in the fiscal year 

2010 Labor, HHS Appropriation Bill. 

We also urge you to eliminate funds for the three separate Federal abstinence only until marriage programs and, instead, create 

a dedicated Federal funding stream of at least $50,000,000 to fund 

medically accurate, comprehensive sex education programs. 

We certainly also, as representatives for adult hepatitis, would 

urge the Committee to increase funding for the Division for Viral 

Hepatitis at CDC, and, lastly, we would encourage you to increase 

funding for sexually transmitted disease prevention, treatment and 

surveillance activities with the State and local health departments. 

Thank you. 

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Mr. OBEY. Thank you. 

We have a dilemma. We have three people left on the sheet, and 

with the number of votes that are occurring it could be as much 

as an hour before we get back here. So I am going to ask you what 

you want to do. 

We can either give each of you the opportunity to summarize 

your statement in about a minute, so that everybody gets a chance 

to say something, or we can ask that you simply hold it until we 

get back in about an hour. What is your choice? 

Mr. WRIGHT. I will take a minute. 

Mr. OBEY. All right. Grab the mic. 

You are David Wright? 

Mr. WRIGHT. David Wright, yes, sir. 

Mr. OBEY. Do we have Charmaine Ruddock and Robert Pestronk 

in the room? 

Ms. RUDDOCK. Yes. 

Mr. OBEY. What are your choices? 

Mr. PESTRONK. I will do it in a minute. 

Mr. OBEY. Okay. 

Ms. RUDDOCK. I will as well. 

Mr. OBEY. All right. Let’s try to do it in one minute. 

WEDNESDAY, MARCH 18, 2009. 

ALLIANCE FOR BIOSECURITY 

WITNESS 

DAVID P. WRIGHT 

Mr. WRIGHT. Thank you very much, Mr. Chairman and members 

of the Subcommittee. 

I am here today on behalf of the Alliance for Biosecurity. The Alliance is a consortium that includes the Center for Biosecurity from 

the University of Pittsburgh and about 13 biopharmaceutical companies. 

The Alliance is here today to request that the Subcommittee provide $1,700,000,000 in their fiscal year 2010 appropriation for 

BARDA specifically to support advanced development of medical 

countermeasures against bioterrorism. 

This is a large amount of money. However, bioterrorism is real. 

In the recent report by the bipartisan Commission on the Prevention of Weapons of Mass Destruction, it was predicted that in 2013 

a weapon of mass destruction is most likely to be used during that 

time and will be a biological agent. 

We need to support biodefense and in a way that is consistent 

with the way we support our troops. This is very much needed, and 

I look forward for an opportunity to talk to you about this in the 

future. 

Thank you. 

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Mr. OBEY. All right. Thank you, and I apologize for cutting you 

short. 

Next, Charmaine Ruddock. 

WEDNESDAY, MARCH 18, 2009. 

NATIONAL REACH COALITION 

WITNESS 

CHARMAINE RUDDOCK 

Ms. RUDDOCK. Good afternoon, Chairman Obey, Ranking Member Tiahrt and other members of this distinguished Committee. 

I am Charmaine Ruddock, Project Director for the Bronx Health 

REACH New York program funded by the CDC. My testimony 

today is on behalf of the National REACH Coalition, which represents more than 40 communities and coalitions in 21 States, 

working to improve the health of African Americans, Asian Pacific 

Islander, Native American and Latino populations and communities. 

Expanding funding for REACH programs provides a sound 

science-based approach that improves the health of these communities while also rebuilding infrastructure, creating jobs and stimulating the local economy. 

In 2007, more than 200 communities applied for funding in the 

last CDC REACH program application cycle, but only 40 were 

funded. Of the 160 who applied that were unfunded, 42 alone were 

from States and districts from members on this Committee. 

REACH communities have spent the last decade leveraging CDC 

funding with public-private partnerships to effectively address 

health disparities. Using innovative science-based approaches, we 

have demonstrated that health disparities, once considered expected, are not unsolvable. 

Thank you. 

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Mr. OBEY. I’m sorry. But thank you. 

And Robert Pestronk. 

WEDNESDAY, MARCH 18, 2009. 

NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH 

OFFICIALS 

WITNESS 

ROBERT PESTRONK 

Mr. PESTRONK. Thank you, Mr. Chairman. 

I really have four points to make. 

First, that local health departments have a unique and distinctive role and a set of responsibilities in the larger health system 

and within every community. They are the grassroots entity, source 

of data for State and Federal departments of health as well. 

Second, that local health departments depend upon Federal funding. About 20 percent overall, without Medicare and Medicaid, of 

the funding for local health departments comes from Federal 

sources. Yet that funding continues to be inadequate and shrinking, both in real terms and in absolute terms. 

Third, that the Nation’s recession is further diminishing the capacity of your health departments in three areas: to measure population-wide illness and death, to organize efforts to prevent disease 

and prolong quality of life and to serve the public through programs in each of your communities. Seven thousand local health 

department jobs were lost in 2008, and we expect at least that 

many or more in 2009 to be lost. 

Our recommendations are in the written material, and I thank 

you very much for your time this afternoon. 

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Mr. OBEY. All right. Thank you, and I apologize again for the 

screwy schedule we keep around here. 

The Committee is adjourned. 


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TUESDAY, MAY 12, 2009. 

MEMBER REQUESTS 

WITNESSES 

HON. SAM FARR, A REPRESENTATIVE IN CONGRESS FROM THE STATE 

OF CALIFORNIA 

HON. MADELEINE BORDALLO, A DELEGATE IN CONGRESS FROM 

GUAM 

HON. PETE OLSON, A REPRESENTATIVE IN CONGRESS FROM THE 

STATE OF TEXAS 

HON. RODNEY ALEXANDER, A REPRESENTATIVE IN CONGRESS FROM 

THE STATE OF LOUISIANA 

Mr. OBEY. This afternoon the subcommittee convenes its Member 

Day hearing for the fiscal year 2010 budget cycle. I want to welcome Members who will be testifying on behalf of their requests. 

This hearing is part of the package of additional earmark process 

reform that I announced earlier this year with Speaker Pelosi that 

expands on the transparency and accountability measures adopted 

since January of 2007. 

Congressionally-directed funding is part of Congress’s power of 

the purse. At the same time, we have to protect the integrity of the 

process and ensure the proper use of taxpayers’ money. I think that 

is what this committee has consistently tried to do. 

But there is another reason also for this hearing, frankly. I know 

that some Members have expressed their unhappiness in the past 

because we have not been able to fund some of their significant priorities. Because of that, and because we have got a finite amount 

of resources that can be devoted to these projects, I wanted to give 

any Member who had a special interest in the projects that they 

are promoting. I wanted to give them an opportunity to appear before the committee to make their case, and I appreciate the fact 

that you have come here today. 

So why don’t we simply start with Mr. Farr? Why don’t you give 

us whatever information you care to impart on your project? 

Mr. FARR. Thank you very much, Mr. Chairman. This is the first 

time I have appeared on behalf of one of my asks, and I appreciate 

you giving me this opportunity. 

This one is really very, very important. It is a million and a half 

dollars for a program called the Silver Star Program. It is in Monterey County. And just to put you in perspective, Monterey County 

is in the central part of California. It is the Salinas Valley, which 

a good chance that the food you eat for lunch and dinner tonight 

will come from the Salinas Valley. It is the biggest agricultural 

area in the United States. It is row crops, and all of those crops 

have to be taken out by trucks. So you have about 5,000 trucks 

coming in and out of Salinas every single day. 


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It is also the home, Monterey County, of the largest State prison 

in California. 

And what has happened over the years, because of this, low-income ag workers, culture of poverty, it has really become a center 

of the State for a huge international gang war that is being fed by 

the cartels between the Nortenos from the north and the Surtenos 

from the south. And we are just geographically located right in that 

midspot. 

And what has happened is the small town, the City of Salinas, 

about 150,000, largest town in my district, but certainly small in 

the big perspective, is having the responsibility of breaking the 

back of international cartels with just local law enforcement resources. And they can’t do it alone. So I have gotten very involved 

in this because I used to serve in local government. The fact is, if 

you want to stop this, and I was looking at Dwight D. Eisenhower’s 

quote right here, there should be an unremitting effort to improve 

those health, education and social security programs which have 

proven their value; to bring all of those assets, that are at, some 

at the county level, some at the city level, some at the State level 

and some at the national level, to try to develop a really comprehensive package to try to stop organized crime. 

And how are we doing that? We are taking kids out of the breeding grounds for these gangs, which are their neighborhoods, early 

in the morning and taking them to this Silver Star Program, which 

deals with education; truancy abatement; health care and addiction 

services; family counseling; career counseling; job training; psychiatric care; mental health and related care. It is a one-stop program that is really successful. 

And what we are trying to do is, there is a surge going on because we are finding now second- and all third-generation; imagine 

in your district if you had had a killing a week in a small town. 

That is what has happened. We have had 15 killings this year. It 

is shocking the community. It is hurting the economic development 

of the community, on top of what is, this is the city that ranked 

12th in the Nation in drop of home prices, and one of the top cities 

in foreclosures. We are designated as one of the High Intensity 

Gang Area, the HIGA jurisdiction. There were 77 robberies in Salinas; 40 of them committed by firearms. 

So we think we have got some ability to really tackle this thing 

in a comprehensive way. And that is why I am putting all my effort 

into this earmark, to try to make sure that we can pull together 

all the resources, and particularly those of the Federal Government. 

I might just conclude by telling you that I have done one thing 

that I think is going to be really effective. We have the Naval Postgraduate School in Monterey County; it is in Monterey, not in Salinas. That school has, inside the school, a center for Homeland Security, where you have both the military folks and the civilian folks 

looking at, what are the root causes of violence around the world? 

They are the ones that are coming up with plans of, how do we 

bring peace to Afghanistan and Iraq through a combination of military and civilian activities? 

I have sort of said to the school, if you are so smart, why don’t 

you go over and look at a town in there and look at the assets of 


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what this is. This is like a town in a foreign country with probably 

more assets than most foreign countries. But if you can figure out 

how we can curtail the root causes of violence that are culturally 

driven and poverty driven and so on, and deal with the issues that 

people deal with, illegal guns, drugs and so on, maybe we can, if 

we can be effective in our own hometown, maybe we can be more 

effective overseas, particularly in Afghanistan. 

So hopefully this is going to be the year where we bring all of 

that together, where the leather meets the road. And I would appreciate your consideration of this earmark. 

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Mr. OBEY. I appreciate that. 

Any comments? 

Mr. TIAHRT. I think that this is, human nature is human nature. 

I think you made a good point about if we are successful in our 

own communities, we can transfer this to elsewhere. 

One of the things that we have noticed in Wichita, and it probably is true with human nature, is that many gangs have a strong 

personality that stirs everybody up. And when they take that 

strong personality out of that setting, many of the kids just go back 

to their regular lives, and they quit stealing. They are not as involved in drugs. It is sort of what gives them an opportunity to get 

away from that strong personality. And it would be nice if your research would confirm that that is an effective way of dealing with 

gangs. 

Mr. FARR. We have already done that, and I would be glad to 

share that with you. One of the difficulties you have is, because 

there is so much peer pressure on gangs, I mean, I am told that 

there is about 100 different social gangs, little kids. These houses 

are so crowded, kids play in the street. They are starting at young 

ages. You get this buddy on the street, a little bit older kid, who 

becomes your protector for that little block. And that is sort of the 

social gangs that you belong to. And then, maybe, as you get older 

and into your teenage years, and the problem with the Nortenos 

and Surtenos is one of your sort of life passages is you have got 

to kill somebody. 

And what you find, the kids who are taken out are saying, we 

don’t want to go back in. We love this program. We love the diversion. We love being on probation. Don’t put us back in the high 

school. 

So we are going to have to figure out ways to continue that alternative success rather than, you know, just take them out and 

throw them back in. Then you are going to get recidivism. Thank 

you. 

Mr. OBEY. Thanks for your time, Sam. 

Next, our colleague, Madeleine Bordallo. 

How is Guam doing these days? 

Ms. BORDALLO. It is doing very well, and it still afloat, in spite 

of the large build-up that we expect. 

Good afternoon, Chairman Obey and Ranking Member Tiahrt. 

My testimony today emphasizes four of the priority projects that I 

have requested and also includes a request for legislative language. 

These were outlined in my letter to the subcommittee submitted 

last month, but given the time constraints, my testimony today will 

focus on the priorities most in need of Congressionally-directed 

funding. 

The first priority, Mr. Chairman and Ranking Member, is a project that I request for an appropriation of $725,000 to renovate 

and expand a nursing education and training laboratory at the 

University of Guam. The University of Guam provides the only 

nursing education program on the island and in the region, and 

there is no shortage of interest in the nursing program. But due 

to the overwhelming number of applicants this past academic year, 

the nursing program had to turn away individuals who were interested in pursuing a degree in nursing. 


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By renovating the laboratory, the university expects to expand 

the number of graduates and also provide them with an environment that will help them to continue developing their skills. Skill 

enhancement, in turn, enables its nursing graduates to provide a 

more current and more sophisticated level of the care for the people 

of Guam. And this was a request from a former Member of Congress who is now the president of the University, the Honorable 

Robert Underwood, who I am sure you know, Mr. Obey. The second priority project that I request is for $300,000 for a 

collaborative project entitled the Guam Seamless Education Path 

Program, between the public school system of Guam, the Guam 

Community College and the University of Guam. This important 

pilot program, if funded, will assist students enrolled in Guam’s 

public elementary and secondary schools in identifying and pursuing a college or professional trade education. 

This project is timely, given the current statistics presented by 

the superintendent of the public schools, which indicate that only 

65 percent of public school students completed high school last 

year, and only a third of these students are expected to pursue 

higher education. 

Overall, only one in five Guam public high school freshmen enrolled in a college or university. So as a collaborative program between the three main educational institutions on Guam, the Guam 

Seamless Education Path Program is essential to enhancing the 

overall educational outcomes for all the students on Guam. 

Now, the third priority project that I request for, Mr. Chairman and Mr. Ranking member, is for $300,000 to support training programs in the construction and the electrical trades at the Guam 

Community College. This funding would be used to expand the current program through recruitment of students and the purchasing 

of educational materials. There is a great need for the Guam Community College to expand its existing programs because of the demand for workers with these specific skill sets on Guam. 

Guam is increasingly significant as a result of the greater Federal investment in construction programs on Guam. Based on current measures, there is a shortage of trained workers to build the 

facilities as a result of the oncoming military buildup. With the 

booming construction activity, including the execution of $747 million in military construction projects on Guam that is included in 

the President’s budget request for Fiscal Year 2010, the funding I 

am requesting would expand existing job training programs offered 

in the construction and electrical fields in order for residents of 

Guam to be trained for and to compete for these jobs. 

And my fourth priority project is for $200,000 to the Chamorro 

Studies and Special Projects Division of the Guam public school 

system to implement innovative language instructional programs 

promoting and preserving our Chamorro language and our culture. 

This would be the second phase of the project, as this has been congressionally funded in the past, in 2007. Chamorro, our language, 

is traditionally an oral language, and there is a lack of books, magazines, audio-visual and other media resources in Guam’s indigenous language, causing a decline in Chamorro fluency and literacy 

among younger generations. So funding will help continue the efforts to revive and maintain the indigenous language and the culVerDate Nov 24 2008 23:05 Jul 06, 2009 Jkt 050545 PO 00000 Frm 00367 Fmt 6601 Sfmt 6602 E:\HR\OC\A545P2.XXX A545P2

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ture of Guam by providing additional resources to develop and implement innovative curriculum and unit lessons for Chamorro language instruction. Such curriculum may involve the production of 

Chamorro language audio and video programs and the development 

of new Chamorro language and grammar books and activities. 

And finally, a language request. I respectfully request that the 

bill include a section with language authorizing the outlying areas 

to consolidate funds received as a result of its enactment, as well 

as any remaining funds received under prior year appropriation 

acts for the Department of Education pursuant to Title V of the Elementary and Secondary Education Act. Now, similar bill language 

was enacted into law as Section 306 of the Department of Education Appropriations Act of 2009. 

The loss of consolidation authority under Title V resulted two 

budget cycles ago from a realignment of national budget priorities 

under the budget submitted to Congress by the President. So the 

Department of Education continues to work with the local educational agencies in the outlying areas to determine the best means 

for consolidation, flexibility of Federal funds received under the Elementary and Secondary Education Act. 

Until such time as an alternative solution is identified and 

agreed to, it is important that the outlying areas and the Department of Education be granted the legal authority to an option of 

consolidating grants in a manner similar to past practices. 

So I want to thank you, Mr. Chairman and Members, for your 

consideration of all the requests I have submitted to the committee, 

and for your attention to the health, educational and work force 

needs of Guam. And I appreciate the assistance that the subcommittee has provided in the past, and hope that you will include 

Congressionally-directed funding for the projects I have outlined 

today. 

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Mr. OBEY. Thank you. 

Let me simply say with respect to your point on nursing, the Department of Labor statistics show that even though we have a huge 

wave of unemployment in this country, one of the few areas of job 

growth in the economy is in the area of health care professions, especially nursing. 

Ms. BORDALLO. And social workers. 

Mr. OBEY. Well, I have to be for social workers because my wife 

is a social worker. 

But with respect to nursing, if we are serious about health care 

reform, we are going to have to expand the capacity of the health 

care system through developing a lot more primary care physicians 

and other health professions, including nursing. So I appreciate 

your being here today. 

Any other comments? 

Okay. Next, Congressman Olson. 

Mr. OLSON. Chairman Obey, Ranking Member Tiahrt, Congressman Rehberg, thank you for the opportunity to speak with you 

today in support of a very worthwhile project that needs funding 

in the Fiscal Year 2010 Labor/HHS Appropriations bill. 

And this is the only request I have before the committee and 

humbly feel that the benefits of this program justify the use of Federal taxpayer dollars. Within the Department of Labor, Employment and Training Administration, Training and Employment 

Services Account, I am requesting $350,000 for San Jacinto College 

for a project designed to help displaced workers in the Houston 

area obtain training to re-enter the work force in high-demand positions. The college is going to match this level of funding with 

$350,000 of their own. 

This project would train new workers and retrain and upscale existing workers to become welders, pipe fitters and nondestructive 

testing personnel for the U.S. petrochemical industry. This initiative is not important only to the economy of the 22nd District of 

Texas but to our Nation as well. 

The mission of San Jacinto College is to deliver accessible, affordable high-quality secondary education programs designed to meet 

the needs of the citizens of southeast Texas and America. The college’s primary focus is helping students achieve their personal and 

professional goals, create seamless transitions among educational 

levels, and to prepare students to enter the job market or transfer 

to 4-year institutions. Through its programs and services and partnerships with industry, the college supports the economic growth 

of the community, the region and the Nation as well. 

Current labor and skills shortages in key occupational clusters 

are inhibiting economic development. The Houston metropolitan 

area is fortunate in that workers can be trained in cross-cluster 

skills in order to be employed in either the aerospace or petrochemical industries. By combining training and education with specific career pathways that lead to advanced skills, entry-level workers can then move through a predetermined pipeline to higherskilled and higher-paying jobs. 

Among the industry employment positions to be advanced by the 

Workforce Development Training Project are nondestructive testing 

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er, stick pipe welder and structural welder. That is all I know 

about welding. 

As workers are trained for new jobs, their existing positions become available, opening up vertical movement and higher wages for 

others. 

The project will also enable the college instructors to move from 

a board-drafting lab to a computer-aided drafting lab and will involve training in basic math skills. Many displaced workers need 

only basic math skills to qualify for workforce training programs so 

they may re-enter the work force with more marketable skills. 

The Workforce Development Training Program enjoys the support and involvement of San Jacinto College’s public and privatesector partners, a list of whom I would like to include for the 

record. 

This is the proverbial win-win situation in my mind. It helps provide jobs to those who need them, while supplying a skilled work 

force to an industry that is short of workers and can help fuel our 

Nation’s economic recovery. The program is slated to help 600 students upon its creation to start filling the thousands of available 

positions in the region. 

I come before this committee humbly and with the utmost respect for the allocation of taxpayer funds, and firmly believe that 

this project is a wise investment for our Nation to further educate 

a needed work force and to help strengthen our national economy. 

And thank you for the opportunity to testify before you today. I 

am happy to answer any questions. 

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Mr. OBEY. Thank you. 

I would simply observe, given your comments on welding, I have 

never seen a community college in my district that feels that it is 

producing enough welders. There is a constant demand for them. 

Mr. OLSON. Yes, sir. Certainly with our petrochemical industry 

there in the greater Houston area, they need more than they can 

get. The pipeline can’t get full enough. Thank you. 

Mr. OBEY. Okay. Thank you very much. Appreciate your time. 

Our colleague, Mr. Alexander. 

Mr. ALEXANDER. Thank you, Mr. Chairman and Mr. Tiahrt and 

the Ranking Member on the Louisiana Purchase Delegation. 

I am here today, my number one programmatic request was for 

Even Start. And the President has zeroed that out, perhaps because it looked like a duplicate program. 

But Congress must continue to support family literacy programs 

as an important delivery model in the provision of adult education 

and early childhood services. 

There is a direct correlation with the education of the parent, the 

poverty status of the home, and the likelihood of the child’s success 

in school. We must focus on the interconnectedness of the program, 

which will lead us to real long-lasting solutions, educating the entire family. 

Adult education does just what it emphasizes. It educates the 

adult, and early childhood likewise educates the young child. But 

to make a difference, we must educate the family. By addressing 

the needs of parents and children simultaneously, we are outperforming stand-alone programs. 

Even Start participants are 13 percent poorer than Head Start 

families, and over 75 percent of our participants have not gone beyond the 9th grade. Despite these obstacles, families exceed state 

benchmarks in adult education proficiency, preschool vocabulary, 

and preschool alphabet knowledge. As a result, more adults are obtaining their GEDS and vocational credits, making them more employable. And our children are entering school ready to learn and 

equal to their peers of higher socioeconomic background. 

No other program is evaluated as deeply as family literacy as to 

the impacts of the family, because no other program does what is 

being done, delivering services from birth to through adulthood. 

Losing Even Start will impact services to families that I have described. 

Thank you, Mr. Chairman. 

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Mr. OBEY. Thank you. 

As you know, our old colleague, Bill Goodling, cared strongly 

about Even Start. He worked for it when he was ranking member 

and chairman of the Educational Labor Committee in the House, 

and he is still putting in a pitch for it whenever he can. I am sure 

he would be happy with your testimony today. 

Any others? 

Well, that represents all of the witnesses we have before us 

today. I thank you for showing up, and we will see you on the floor 

Thursday. 


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pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 678 here 50545A.386
478 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 679 here 50545A.387
479 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 680 here 50545A.388
480 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 681 here 50545A.389
481 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 682 here 50545A.390
482 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 683 here 50545A.391
483 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 684 here 50545A.392
484 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 685 here 50545A.393
485 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 686 here 50545A.394
486 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 687 here 50545A.395
487 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 688 here 50545A.396
488 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 689 here 50545A.397
489 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 690 here 50545A.398
490 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 691 here 50545A.399
491 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 692 here 50545A.400
492 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 693 here 50545A.401
493 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 694 here 50545A.402
494 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 695 here 50545A.403
495 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 696 here 50545A.404
496 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 697 here 50545A.405
497 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 698 here 50545A.406
498 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 699 here 50545A.407
499 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 700 here 50545A.408
500 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 701 here 50545A.409
501 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 702 here 50545A.410
502 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 703 here 50545A.411
503 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 704 here 50545A.412
504 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 705 here 50545A.413
505 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 706 here 50545A.414
506 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 707 here 50545A.415
507 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 708 here 50545A.416
508 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 709 here 50545A.417
509 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 710 here 50545A.418
510 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 711 here 50545A.419
511 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 712 here 50545A.420
512 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 713 here 50545A.421
513 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 714 here 50545A.422
514 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 715 here 50545A.423
515 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 716 here 50545A.424
516 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 717 here 50545A.425
517 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 718 here 50545A.426
518 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 719 here 50545A.427
519 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 720 here 50545A.428
520 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 721 here 50545A.429
521 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 722 here 50545A.430
522 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 723 here 50545A.431
523 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 724 here 50545A.432
524 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 725 here 50545A.433
525 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 726 here 50545A.434
526 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 727 here 50545A.435
527 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 728 here 50545A.436
528 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 729 here 50545A.437
529 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 730 here 50545A.438
530 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 731 here 50545A.439
531 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 732 here 50545A.440
532 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 733 here 50545A.441
533 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 734 here 50545A.442
534 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 735 here 50545A.443
535 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 736 here 50545A.444
536 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 737 here 50545A.445
537 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 738 here 50545A.446
538 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 739 here 50545A.447
539 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 740 here 50545A.448
540 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 741 here 50545A.449
541 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 742 here 50545A.450
542 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 743 here 50545A.451
543 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 744 here 50545A.452
544 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 745 here 50545A.453
545 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 746 here 50545A.454
546 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 747 here 50545A.455
547 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 748 here 50545A.456
548 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 749 here 50545A.457
549 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 750 here 50545A.458
550 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 751 here 50545A.459
551 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 752 here 50545A.460
552 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 753 here 50545A.461
553 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 754 here 50545A.462
554 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 755 here 50545A.463
555 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 756 here 50545A.464
556 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 757 here 50545A.465
557 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 758 here 50545A.466
558 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 759 here 50545A.467
559 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 760 here 50545A.468
560 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 761 here 50545A.469
561 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 762 here 50545A.470
562 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 763 here 50545A.471
563 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 764 here 50545A.472
564 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 765 here 50545A.473
565 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 766 here 50545A.474
566 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 767 here 50545A.475
567 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 768 here 50545A.476
568 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 769 here 50545A.477
569 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 770 here 50545A.478
570 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 771 here 50545A.479
571 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 772 here 50545A.480
572 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 773 here 50545A.481
573 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 774 here 50545A.482
574 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 775 here 50545A.483
575 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 776 here 50545A.484
576 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 777 here 50545A.485
577 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 778 here 50545A.486
578 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 779 here 50545A.487
579 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 780 here 50545A.488
580 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 781 here 50545A.489
581 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 782 here 50545A.490
582 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 783 here 50545A.491
583 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 784 here 50545A.492
584 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 785 here 50545A.493
585 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 786 here 50545A.494
586 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 787 here 50545A.495
587 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 788 here 50545A.496
588 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 789 here 50545A.497
589 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 790 here 50545A.498
590 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 791 here 50545A.499
591 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 792 here 50545A.500
592 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 793 here 50545A.501
593 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 794 here 50545A.502
594 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 795 here 50545A.503
595 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 796 here 50545A.504
596 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 797 here 50545A.505
597 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 798 here 50545A.506
598 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 799 here 50545A.507
599 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 800 here 50545A.508
600 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 801 here 50545A.509
601 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 802 here 50545A.510
602 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 803 here 50545A.511
603 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 804 here 50545A.512
604 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 805 here 50545A.513
605 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 806 here 50545A.514
606 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 807 here 50545A.515
607 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 808 here 50545A.516
608 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 809 here 50545A.517
609 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 810 here 50545A.518
610 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 811 here 50545A.519
611 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 812 here 50545A.520
612 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 813 here 50545A.521
613 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 814 here 50545A.522
614 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 815 here 50545A.523
615 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 816 here 50545A.524
616 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 817 here 50545A.525
617 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 818 here 50545A.526
618 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 819 here 50545A.527
619 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 820 here 50545A.528
620 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 821 here 50545A.529
621 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 822 here 50545A.530
622 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 823 here 50545A.531
623 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 824 here 50545A.532
624 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 825 here 50545A.533
625 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 826 here 50545A.534
626 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 827 here 50545A.535
627 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 828 here 50545A.536
628 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 829 here 50545A.537
629 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 830 here 50545A.538
630 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 831 here 50545A.539
631 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 832 here 50545A.540
632 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 833 here 50545A.541
633 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 834 here 50545A.542
634 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 835 here 50545A.543
635 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 836 here 50545A.544
636 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 837 here 50545A.545
637 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 838 here 50545A.546
638 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 839 here 50545A.547
639 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 840 here 50545A.548
640 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 841 here 50545A.549
641 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 842 here 50545A.550
642 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 843 here 50545A.551
643 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 844 here 50545A.552
644 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 845 here 50545A.553
645 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 846 here 50545A.554
646 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 847 here 50545A.555
647 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 848 here 50545A.556
648 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 849 here 50545A.557
649 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 850 here 50545A.558
650 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 851 here 50545A.559
651 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 852 here 50545A.560
652 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 853 here 50545A.561
653 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 854 here 50545A.562
654 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 855 here 50545A.563
655 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 856 here 50545A.564
656 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 857 here 50545A.565
657 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 858 here 50545A.566
658 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 859 here 50545A.567
659 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 860 here 50545A.568
660 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 861 here 50545A.569
661 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 862 here 50545A.570
662 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 863 here 50545A.571
663 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 864 here 50545A.572
664 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 865 here 50545A.573
665 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 866 here 50545A.574
666 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 867 here 50545A.575
667 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 868 here 50545A.576
668 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 869 here 50545A.577
669 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 870 here 50545A.578
670 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 871 here 50545A.579
671 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 872 here 50545A.580
672 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 873 here 50545A.581
673 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 874 here 50545A.582
674 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 875 here 50545A.583
675 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 876 here 50545A.584
676 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 877 here 50545A.585
677 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 878 here 50545A.586
678 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 879 here 50545A.587
679 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 880 here 50545A.588
680 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 881 here 50545A.589
681 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 882 here 50545A.590
682 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 883 here 50545A.591
683 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 884 here 50545A.592
684 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 885 here 50545A.593
685 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 886 here 50545A.594
686 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 887 here 50545A.595
687 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 888 here 50545A.596
688 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 889 here 50545A.597
689 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 890 here 50545A.598
690 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 891 here 50545A.599
691 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 892 here 50545A.600
692 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 893 here 50545A.601
693 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 894 here 50545A.602
694 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 895 here 50545A.603
695 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 896 here 50545A.604
696 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 897 here 50545A.605
697 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 898 here 50545A.606
698 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 899 here 50545A.607
699 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 900 here 50545A.608
700 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 901 here 50545A.609
701 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 902 here 50545A.610
702 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 903 here 50545A.611
703 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 904 here 50545A.612
704 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 905 here 50545A.613
705 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 906 here 50545A.614
706 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 907 here 50545A.615
707 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 908 here 50545A.616
708 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 909 here 50545A.617
709 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 910 here 50545A.618
710 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 911 here 50545A.619
711 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 912 here 50545A.620
712 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 913 here 50545A.621
713 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 914 here 50545A.622
714 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 915 here 50545A.623
715 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 916 here 50545A.624
716 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 917 here 50545A.625
717 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 918 here 50545A.626
718 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 919 here 50545A.627
719 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 920 here 50545A.628
720 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 921 here 50545A.629
721 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 922 here 50545A.630
722 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 923 here 50545A.631
723 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 924 here 50545A.632
724 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 925 here 50545A.633
725 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 926 here 50545A.634
726 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 927 here 50545A.635
727 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 928 here 50545A.636
728 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 929 here 50545A.637
729 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 930 here 50545A.638
730 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 931 here 50545A.639
731 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 932 here 50545A.640
732 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 933 here 50545A.641
733 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 934 here 50545A.642
734 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 935 here 50545A.643
735 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 936 here 50545A.644
736 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 937 here 50545A.645
737 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 938 here 50545A.646
738 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 939 here 50545A.647
739 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 940 here 50545A.648
740 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 941 here 50545A.649
741 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 942 here 50545A.650
742 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 943 here 50545A.651
743 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 944 here 50545A.652
744 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 945 here 50545A.653
745 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 946 here 50545A.654
746 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 947 here 50545A.655
747 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 948 here 50545A.656
748 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 949 here 50545A.657
749 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 950 here 50545A.658
750 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 951 here 50545A.659
751 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 952 here 50545A.660
752 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 953 here 50545A.661
753 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 954 here 50545A.662
754 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 955 here 50545A.663
755 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 956 here 50545A.664
756 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 957 here 50545A.665
757 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 958 here 50545A.666
758 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 959 here 50545A.667
759 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 960 here 50545A.668
760 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 961 here 50545A.669
761 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 962 here 50545A.670
762 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 963 here 50545A.671
763 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 964 here 50545A.672
764 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 965 here 50545A.673
765 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 966 here 50545A.674
766 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 967 here 50545A.675
767 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 968 here 50545A.676
768 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 969 here 50545A.677
769 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 970 here 50545A.678
770 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 971 here 50545A.679
771 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 972 here 50545A.680
772 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 973 here 50545A.681
773 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 974 here 50545A.682
774 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 975 here 50545A.683
775 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 976 here 50545A.684
776 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 977 here 50545A.685
777 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 978 here 50545A.686
778 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 979 here 50545A.687
779 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 980 here 50545A.688
780 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 981 here 50545A.689
781 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 982 here 50545A.690
782 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 983 here 50545A.691
783 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 984 here 50545A.692
784 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 985 here 50545A.693
785 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 986 here 50545A.694
786 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 987 here 50545A.695
787 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 988 here 50545A.696
788 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 989 here 50545A.697
789 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 990 here 50545A.698
790 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 991 here 50545A.699
791 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 992 here 50545A.700
792 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 993 here 50545A.701
793 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 994 here 50545A.702
794 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 995 here 50545A.703
795 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 996 here 50545A.704
796 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 997 here 50545A.705
797 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 998 here 50545A.706
798 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 999 here 50545A.707
799 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1000 here 50545A.708
800 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1001 here 50545A.709
801 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1002 here 50545A.710
802 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1003 here 50545A.711
803 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1004 here 50545A.712
804 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1005 here 50545A.713
805 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1006 here 50545A.714
806 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1007 here 50545A.715
807 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1008 here 50545A.716
808 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1009 here 50545A.717
809 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1010 here 50545A.718
810 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1011 here 50545A.719
811 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1012 here 50545A.720
812 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1013 here 50545A.721
813 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1014 here 50545A.722
814 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1015 here 50545A.723
815 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1016 here 50545A.724
816 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1017 here 50545A.725
817 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1018 here 50545A.726
818 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1019 here 50545A.727
819 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1020 here 50545A.728
820 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1021 here 50545A.729
821 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1022 here 50545A.730
822 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1023 here 50545A.731
823 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1024 here 50545A.732
824 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1025 here 50545A.733
825 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1026 here 50545A.734
826 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1027 here 50545A.735
827 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1028 here 50545A.736
828 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1029 here 50545A.737
829 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1030 here 50545A.738
830 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1031 here 50545A.739
831 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1032 here 50545A.740
832 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1033 here 50545A.741
833 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1034 here 50545A.742
834 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1035 here 50545A.743
835 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1036 here 50545A.744
836 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1037 here 50545A.745
837 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1038 here 50545A.746
838 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1039 here 50545A.747
839 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1040 here 50545A.748
840 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1041 here 50545A.749
841 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1042 here 50545A.750
842 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1043 here 50545A.751
843 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1044 here 50545A.752
844 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1045 here 50545A.753
845 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1046 here 50545A.754
846 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1047 here 50545A.755
847 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1048 here 50545A.756
848 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1049 here 50545A.757
849 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1050 here 50545A.758
850 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1051 here 50545A.759
851 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1052 here 50545A.760
852 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1053 here 50545A.761
853 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1054 here 50545A.762
854 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1055 here 50545A.763
855 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1056 here 50545A.764
856 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1057 here 50545A.765
857 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1058 here 50545A.766
858 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1059 here 50545A.767
859 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1060 here 50545A.768
860 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1061 here 50545A.769
861 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1062 here 50545A.770
862 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1063 here 50545A.771
863 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1064 here 50545A.772
864 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1065 here 50545A.773
865 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1066 here 50545A.774
866 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1067 here 50545A.775
867 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1068 here 50545A.776
868 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1069 here 50545A.777
869 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1070 here 50545A.778
870 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1071 here 50545A.779
871 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1072 here 50545A.780
872 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1073 here 50545A.781
873 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1074 here 50545A.782
874 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1075 here 50545A.783
875 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1076 here 50545A.784
876 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1077 here 50545A.785
877 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1078 here 50545A.786
878 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1079 here 50545A.787
879 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1080 here 50545A.788
880 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1081 here 50545A.789
881 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1082 here 50545A.790
882 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1083 here 50545A.791
883 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1084 here 50545A.792
884 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1085 here 50545A.793
885 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1086 here 50545A.794
886 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1087 here 50545A.795
887 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1088 here 50545A.796
888 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1089 here 50545A.797
889 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1090 here 50545A.798
890 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1091 here 50545A.799
891 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1092 here 50545A.800
892 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1093 here 50545A.801
893 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1094 here 50545A.802
894 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1095 here 50545A.803
895 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1096 here 50545A.804
896 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1097 here 50545A.805
897 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1098 here 50545A.806
898 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1099 here 50545A.807
899 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1100 here 50545A.808
900 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1101 here 50545A.809
901 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1102 here 50545A.810
902 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1103 here 50545A.811
903 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1104 here 50545A.812
904 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1105 here 50545A.813
905 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1106 here 50545A.814
906 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1107 here 50545A.815
907 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1108 here 50545A.816
908 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1109 here 50545A.817
909 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1110 here 50545A.818
910 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1111 here 50545A.819
911 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1112 here 50545A.820
912 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1113 here 50545A.821
913 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1114 here 50545A.822
914 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1115 here 50545A.823
915 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1116 here 50545A.824
916 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1117 here 50545A.825
917 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1118 here 50545A.826
918 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1119 here 50545A.827
919 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1120 here 50545A.828
920 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1121 here 50545A.829
921 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1122 here 50545A.830
922 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1123 here 50545A.831
923 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1124 here 50545A.832
924 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1125 here 50545A.833
925 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1126 here 50545A.834
926 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1127 here 50545A.835
927 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1128 here 50545A.836
928 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1129 here 50545A.837
929 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1130 here 50545A.838
930 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1131 here 50545A.839
931 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1132 here 50545A.840
932 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1133 here 50545A.841
933 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1134 here 50545A.842
934 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1135 here 50545A.843
935 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1136 here 50545A.844
936 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1137 here 50545A.845
937 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1138 here 50545A.846
938 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1139 here 50545A.847
939 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1140 here 50545A.848
940 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1141 here 50545A.849
941 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1142 here 50545A.850
942 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1143 here 50545A.851
943 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1144 here 50545A.852
944 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1145 here 50545A.853
945 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1146 here 50545A.854
946 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1147 here 50545A.855
947 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1148 here 50545A.856
948 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1149 here 50545A.857
949 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1150 here 50545A.858
950 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1151 here 50545A.859
951 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1152 here 50545A.860
952 


pwalker on DSK8KYBLC1PROD with HEARINGInsert offset folio 1153 here 50545A.861
953 


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W I T N E S S E S 

Page 

Acquaviva, K.D ........................................................................................................ 713 

Adams, B.R ............................................................................................................... 941 

Aldrighetti, Rino ...................................................................................................... 923 

Alexander, Hon. Rodney .......................................................................................... 361 

Alexander, Jay ......................................................................................................... 993 

Amundson, Sara ....................................................................................................... 744 

Anderson, David ...................................................................................................... 855 

Assmann, Dr. S.M .................................................................................................... 565 

Ayers, Jennifer ......................................................................................................... 519 

Bailey, Don ............................................................................................................... 837 

Bardeguez, Arlene ................................................................................................... 736 

Barton, Hope ............................................................................................................ 165 

Beall, R.J .................................................................................................................. 663 

Beavo, J.A., Jr .......................................................................................................... 562 

Bednash, Geraldine ................................................................................................. 977 

Beer, Kimberly ......................................................................................................... 434 

Bell, Dr. F.W ............................................................................................................ 471 

Blank, Helen ............................................................................................................ 50 

Block, T.M ................................................................................................................ 730 

Bockerstette, J.A ...................................................................................................... 826 

Bonta, Paul ............................................................................................................... 499 

Bordallo, Hon. Madeleine ........................................................................................ 361 

Breidenstine, Adrienne ............................................................................................ 841 

Butler, Susan ........................................................................................................... 128 

Carew, T.J ................................................................................................................ 946 

Cheng, Dr. T.L ......................................................................................................... 270 

Clanon, Kathleen ..................................................................................................... 938 

Clark, Donald ........................................................................................................... 808 

Cohen, Hon. Steve ................................................................................................... 380 

Connors, S.H ............................................................................................................ 616 

Coyle, J.T .................................................................................................................. 480 

Coyle, Kevin ............................................................................................................. 888 

Davis, T.S ................................................................................................................. 631

Dent, Hon. C.W ........................................................................................................ 381 

Desrosiers, Ronald ................................................................................................... 855 

Donaldson, Tom ....................................................................................................... 717 

Donoff, R.B ............................................................................................................... 708 

Eberle, Dr. Francis .................................................................................................. 875 

Eckstein, E.C ............................................................................................................ 519 

Elias, C.J .................................................................................................................. 911 

Epperly, T.D ............................................................................................................. 425 

Ewen, Danielle ......................................................................................................... 19 

Farr, Hon. Sam ........................................................................................................ 361 


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ii 

Farrell, G.M ............................................................................................................. 646 

Farrell, Lindsay ....................................................................................................... 300 

Felknor, S.A ............................................................................................................. 603 

Finkelman, L.G ........................................................................................................ 867 

Fleshman, Julie ....................................................................................................... 906 

Gamel-McCormick, Michael .................................................................................... 69 

Gardner, Timothy .................................................................................................... 509 

Gibbons, Jim ............................................................................................................ 722 

Gipp, David .............................................................................................................. 60 

Girard, David ........................................................................................................... 760 

Gonzalez, R.I ............................................................................................................ 533 

Gorden, Susie ........................................................................................................... 612 

Green, W.R ............................................................................................................... 466 

Haigwood, Nancy ..................................................................................................... 855 

Harris, Dr. J.P ......................................................................................................... 490 

Harrison, Patricia .................................................................................................... 391 

Hauck, Heather ........................................................................................................ 319 

Heft, Marc ................................................................................................................ 444 

Helms, W.D .............................................................................................................. 634 

Hendrix, Mary J.C ................................................................................................... 80 

Herrin, D.M .............................................................................................................. 977 

Hill, J.O .................................................................................................................... 559 

Hille, Amy ................................................................................................................ 551 

Horikoshi, Neil ..................................................................................................... 203, 577 

Hurwitz, Dr. T. Alan ............................................................................................... 883 

Hyde, Anna ............................................................................................................... 485 

Hyde, Dallas ............................................................................................................. 855 

Ingenhousz, Flora .................................................................................................... 782 

Jernigan, Donna ...................................................................................................... 599 

Johns, Harry ............................................................................................................ 420 

Johnson, Ronald ....................................................................................................... 407 

Kagan, Jill ................................................................................................................ 870

Kanjorski, Hon. P.E ................................................................................................. 383 

Kay, Peter ................................................................................................................. 504

Kemnitz, Joseph ....................................................................................................... 855 

Kerger, Paula ........................................................................................................... 594 

Kever, J.F ................................................................................................................. 396

Kim, Paula ............................................................................................................... 853 

Kirwin, Dr. P.D ........................................................................................................ 218 

Klein, Hon. Ron ....................................................................................................... 386 

Kobor, Patricia ......................................................................................................... 541 

Kruse, Dr. Jerry ....................................................................................................... 291 

Kutler, Stephanie ..................................................................................................... 970 

Lackner, Andrew ...................................................................................................... 855 

Lacy, James .............................................................................................................. 933 

Lang, William ........................................................................................................... 461 

Lantieri, Linda ......................................................................................................... 11 

Levering, Carolyn .................................................................................................... 848 

Levi, Jeffrey .............................................................................................................. 981

Lewin, Jack .............................................................................................................. 97 

Lewis, Rosalie .......................................................................................................... 674 

Lewis, Van ................................................................................................................ 668 

Liss, Cathy ............................................................................................................... 573 

Lomax, M.L .............................................................................................................. 986 

Lopeman, Dave ........................................................................................................ 966 


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iii 

Lubinski, Christine .................................................................................................. 229 

Malone, Beverly ....................................................................................................... 977 

Marchase, R.B .......................................................................................................... 687 

Margolis, Todd ......................................................................................................... 584 

McClelland, James ................................................................................................... 173 

McGovern, Patrick ................................................................................................... 726 

McKnight, Evelyn .................................................................................................... 740 

Meltzer, David .......................................................................................................... 529 

Minnig, Mikayla ....................................................................................................... 185 

Modell, Fred ............................................................................................................. 763 

Modell, Vicki ............................................................................................................ 763 

Mori, Floyd ............................................................................................................... 823 

Nolan, Martha .......................................................................................................... 956 

Norton, N.J ............................................................................................................... 756 

Olson, Hon. Pete ...................................................................................................... 361 

Osthus, Rebecca ....................................................................................................... 538 

Parry, Hugh ............................................................................................................. 918 

Patton, R.M .............................................................................................................. 977 

Peel, Ann .................................................................................................................. 914

Peluso, Karen ........................................................................................................... 897 

Perez, D.P ................................................................................................................. 678

Perry, Daniel ............................................................................................................ 417 

Perry, Nancy ............................................................................................................ 748 

Pestronk, Robert ...................................................................................................... 350 

Pierson, Carol ........................................................................................................... 832 

Pollick, A.S ............................................................................................................... 579

Pressley, P.L ............................................................................................................. 654 

Price, S.T .................................................................................................................. 961 

Pritzker, J.B ............................................................................................................. 3 

Raines, Fay ............................................................................................................... 977 

Ream, K.A..................................................................................................... 569, 844, 977 

Richards, M.M .......................................................................................................... 108 

Richmond, Greg ....................................................................................................... 29 

Rieger, Paula ............................................................................................................ 901 

Rizzo, A.A ................................................................................................................. 118

Robinette, Travis ..................................................................................................... 968 

Robinson, S.P ........................................................................................................... 449 

Roman, Frankie ....................................................................................................... 878 

Roman, Nan ............................................................................................................. 789 

Rosenberg, Linda ..................................................................................................... 209 

Rowles, Jackie .......................................................................................................... 475 

Ruddock, Charmaine ............................................................................................... 340 

Ryan, D.G ................................................................................................................. 893 

Sangalli, Ramona ..................................................................................................... 767 

Schiller, Vivian ........................................................................................................ 863 

Schilsky, R.L ............................................................................................................ 133 

Schmid, Carl ............................................................................................................. 412 

Schraufnagel, Dr. Dean ........................................................................................... 195 

Schwartz, Colin ........................................................................................................ 735 

Schwartz, M.S .......................................................................................................... 396 

Scott, R.A .................................................................................................................. 776 

Selker, H.P ............................................................................................................... 144 

Shannon, S.C ............................................................................................................ 458 

Sharpe, A.L .............................................................................................................. 639 

Shoemaker, Janet .................................................................................................... 553 


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Sidman, Larry .......................................................................................................... 594 

Sinderbrand, Gary ................................................................................................... 88 

Skogsbergh, J.H ....................................................................................................... 404 

Sloyer, Phyllis .......................................................................................................... 261 

Smith, Tiffany .......................................................................................................... 799 

Soler, Esta ................................................................................................................ 683

Sonntag, Chief David .............................................................................................. 691 

Speakman, V.M., Jr ................................................................................................. 396 

Stacey, Dr. Gary ...................................................................................................... 565 

Stein, Flo .................................................................................................................. 252 

Stewart, B.D ............................................................................................................. 589 

Stierle, L.J ................................................................................................................ 977 

Swift, Dr. J.Q ........................................................................................................... 282 

Tagliareni, M.E ........................................................................................................ 977 

Terry, S.F ................................................................................................................. 154

Thomas, R.M., Jr ..................................................................................................... 239 

Thompson P.A .......................................................................................................... 977 

Tolbert, J.A ............................................................................................................... 794

Toney, Dr. D.A ......................................................................................................... 311 

VandeBerg, John ...................................................................................................... 855 

Veazey, Reverend C.W ............................................................................................ 928 

Wade, Kerri .............................................................................................................. 608 

Watkins, Dr. J.M ..................................................................................................... 658 

Watson, Mary ........................................................................................................... 38 

Watts, M.L ................................................................................................................ 559 

Wein, Olivia .............................................................................................................. 818 

Weinberger, Dr. S.G ................................................................................................ 778 

Weiss, Dr. M.L ......................................................................................................... 771 

White, Dale ............................................................................................................... 858 

Wigode, Emil ............................................................................................................ 703 

Witherspoon, N.O .................................................................................................... 626 

Wolkoff, Allan .......................................................................................................... 524 

Wright, D.P .............................................................................................................. 329 

Wright, Janel ........................................................................................................... 504 

Young, M.T ............................................................................................................... 972 

Zola, Stuart .............................................................................................................. 855 


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(v) 

I N D E X 

Page 

3M Company ............................................................................................................ 401 

Academic Family Medicine Advocacy Alliance ...................................................... 291 

Advocate Health Care ............................................................................................. 404 

AIDS Action ............................................................................................................. 407 

AIDS Institute .......................................................................................................... 412 

Alliance for Aging Research .................................................................................... 417 

Alliance for Biosecurity ........................................................................................... 329 

Alzheimer’s Association ........................................................................................... 420 

American Academy of Family Physicians .............................................................. 425 

American Academy of Ophthalmology ................................................................... 429 

American Academy of Physician Assistants .......................................................... 434 

American Association for Cancer Research ........................................................... 439 

American Association for Dental Research ........................................................... 444 

American Association for Geriatric Psychiatry ..................................................... 218 

American Association of Colleges for Teacher Education .................................... 449 

American Association of Colleges of Nursing ........................................................ 453 

American Association of Colleges of Osteopathic Medicine ................................. 458 

American Association of Colleges of Pharmacy ..................................................... 461 

American Association of Immunologists ................................................................ 466 

American Association of Museums ......................................................................... 471 

American Association of Nurse Anesthetists ......................................................... 475 

American Brain Coalition ....................................................................................... 480 

American College of Cardiology .............................................................................. 97 

American College of Obstetricians and Gynecologists .......................................... 485 

American College of Physicians .............................................................................. 490 

American College of Preventive Medicine ............................................................. 494 

American Dental Education Association ................................................................ 282 

American Diabetes Association .............................................................................. 504 

American Heart Association ................................................................................... 509 

American Indian Higher Education Consortium .................................................. 514 

American Institute for Medical and Biological Engineering ................................ 519 

American Liver Foundation .................................................................................... 524 

American Lung Association .................................................................................... 118 

American National Red Cross ................................................................................ 529 

American Nurses Association ................................................................................. 533 

American Physiological Society .............................................................................. 538 

American Psychological Association ....................................................................... 541 

American Public Health Association ...................................................................... 546 

American Public Power Association ....................................................................... 551 

American Society for Microbiology ......................................................................... 553 

American Society for Nutrition ............................................................................... 559 

American Society for Pharmacology and Experimental Therapeutics ................ 562 

American Society of Clinical Oncology ................................................................... 133 


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vi 

American Society of Plant Biologists ..................................................................... 565 

Americans for Nursing Shortage Relief ................................................................. 569 

Animal Welfare Institute ........................................................................................ 573 

Aplastic Anemia and MDS International Foundation .......................................... 203 

Arthritis Foundation ............................................................................................... 185 

Asian and Pacific Islander American Scholarship Fund ...................................... 577 

Association for Clinical Research Training ........................................................... 144 

Association for Psychological Science ..................................................................... 579 

Association for Research in Vision and Ophthalmology ....................................... 584 

Association of American Cancer Institutes ............................................................ 589 

Association of Maternal and Child Health Programs ........................................... 261 

Association of Public Television Stations .............................................................. 594 

Association of Rehabilitation Nurses ..................................................................... 599 

Association of University Centers on Disabilities ................................................. 69 

Association of University Programs in Occupational Health and Safety ............ 603 

Association of Women’s Health, Obstetric and Neonatal Nurses ........................ 608 

Big Brothers Big Sisters of America ...................................................................... 612 

Brain Injury Association of America ...................................................................... 616 

Center for Disease Control and Prevention Coalition .......................................... 619 

Center for Law and Social Policy ........................................................................... 19 

Children’s Environmental Health Network ........................................................... 626 

Close Up Foundation ............................................................................................... 631 

Coalition for Health Services Research ................................................................. 634 

Coalition for the Advancement of Health Through Behavioral and Social 

Science Research .................................................................................................. 639 

Coalition of Northeastern Governors ..................................................................... 644 

Collaborative for Academic Social Learning .......................................................... 11 

Commissioned Officers Association of the U.S. Public Health Service ............... 646 

Consortium of Social Science Associations ............................................................ 654 

Corporation for Public Broadcasting ...................................................................... 391 

Council on Social Work Education ......................................................................... 658 

Crohn’s and Colitis Foundation of America ........................................................... 88 

Cystic Fibrosis Foundation ..................................................................................... 663 

Doctors Opposing Circumcision .............................................................................. 668 

Dystonia Medical Research Foundation ................................................................ 674 

Facioscapulohumeral Society, Inc. ......................................................................... 678 

Family Violence Prevention Fund .......................................................................... 683 

Federation of American Societies for Experimental Biology ................................ 687 

Federation of Behavioral, Psychological, and Cognitive Sciences ....................... 173 

Fight Crime: Invest in Kids .................................................................................... 691 

First Five Years Fund ............................................................................................. 3 

Friends of the Health Resources Services Administration ................................... 696 

Friends of the National Institute of Child Health and Human Development .... 703 

Friends of the National Institute of Dental and Craniofacial Research ............. 708 

Friends of the National Institute on Aging ........................................................... 713 

Friends of the National Institute on Alcohol Abuse and Alcoholism .................. 717 

Genetic Alliance ....................................................................................................... 154 

Goodwill Industries International .......................................................................... 722 

Harlem United Community AIDS Center, Inc. ..................................................... 726 

Health Professions and Nursing Education Coalition .......................................... 270 

Hellen Keller International ..................................................................................... 239 

Hepatitis B Foundation ........................................................................................... 730 

Hepatitis C Appropriations Partnership ................................................................ 735 

HIV Medicine Association ....................................................................................... 736 

HONOReform ........................................................................................................... 740 


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vii 

Humane Society Legislative Fund ......................................................................... 744 

Humane Society of the United States .................................................................... 748 

Infectious Diseases Society of America .................................................................. 229 

International Foundation for Functional Gastrointestinal Disorders ................. 756 

International Myeloma Foundation ....................................................................... 760 

Jeffrey Modell Foundation ...................................................................................... 763 

Lions World Services for the Blind ........................................................................ 767 

March of Dimes Foundation ................................................................................... 771 

Medical Library Association ................................................................................... 165 

Mended Hearts, Inc. ................................................................................................ 776 

Mentor Consulting Group ....................................................................................... 778 

Montgomery County Stroke Association ................................................................ 782 

National Alliance for Eye and Vision Research .................................................... 784 

National Alliance of State and Territorial AIDS Directors .................................. 319 

National Alliance to End Homelessness ................................................................ 789 

National Association for State Community Service Programs ............................ 794 

National Association of Anorexia Nervosa and Associated Disorders ................. 799 

National Association of Charter School Authorizers ............................................ 29 

National Association of Community Health Centers ............................................ 300 

National Association of County and City Health Officials ................................... 350 

National Association of State Alcohol and Drug Abuse Directors, Inc. .............. 252 

National Association of State Directors of Special Education, Inc. ..................... 38 

National Association of State Mental Health Program Directors ....................... 803 

National Black Nurses Association, Inc. ................................................................ 311 

National Coalition of STD Directors ...................................................................... 808 

National Congress of American Indians ................................................................ 813 

National Consumer Law Center ............................................................................. 818 

National Council For Community Behavioral Healthcare ................................... 209 

National Council on Asian Pacific Americans ....................................................... 823 

National Down Syndrome Society .......................................................................... 826 

National Energy Assistance Directors Association ............................................... 828 

National Federation of Community Broadcasters ................................................. 832 

National Fragile X Foundation ............................................................................... 837 

National Health Care for the Homeless Council ................................................... 841 

National League for Nursing .................................................................................. 844 

National Marfan Foundation .................................................................................. 848 

National Melanoma Alliance .................................................................................. 853 

National Primate Research Centers ....................................................................... 856 

National Psoriasis Foundation ............................................................................... 858 

National Public Radio ............................................................................................. 863 

National REACH Coalition ..................................................................................... 340 

National Recreation and Park Association ............................................................ 867 

National Respite Coalition ...................................................................................... 870 

National Science Teachers Association .................................................................. 875 

National Sleep Foundation ..................................................................................... 878 

National Technical Institute for the Deaf .............................................................. 883 

National Wildlife Federation .................................................................................. 888 

National Women’s Law Center ............................................................................... 50 

Nephcure Foundation .............................................................................................. 893 

Neurofibromatosis, Inc. ........................................................................................... 897 

Oncology Nursing Society ....................................................................................... 901 

Ovarian Cancer National Alliance ......................................................................... 128 

Pancreatic Cancer Action Network ........................................................................ 906 

Parkinson’s Action Network ................................................................................... 108 

PATH ........................................................................................................................ 911 


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viii 

Prevent Blindness America ..................................................................................... 918 

Public Broadcasting Service .................................................................................... 391 

Pulmonary Hypertension Association .................................................................... 923 

Railroad Retirement Board ..................................................................................... 396 

Religious Coalition for Reproductive Choice ......................................................... 928 

Rotary International ................................................................................................ 933 

Ryan White Medical Providers Coalition ............................................................... 938 

Scleroderma Foundation ......................................................................................... 941 

Society for Neuroscience .......................................................................................... 946 

Society for Public Health Education ...................................................................... 951 

Society for Women’s Health Research .................................................................... 956 

Spina Bifida Association ......................................................................................... 961 

Squaxin Island Tribe ............................................................................................... 966 

Sun Life Family Health Center .............................................................................. 968 

TB Coalition ............................................................................................................. 195 

The Ad Hoc Group for Medical Research ............................................................... 80 

The Endocrine Society ............................................................................................. 970 

The Society for Healthcare Epidemiology of America .......................................... 972 

Tri-Council for Nursing ........................................................................................... 977 

Trust for America’s Health ..................................................................................... 981 

United Nations Foundation .................................................................................... 529 

United Negro College Fund .................................................................................... 986 

United Tribes Technical College ............................................................................. 60 

We Can Take It ........................................................................................................ 993 

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