[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]
HEALTHCARE INEQUALITY: CONFRONTING RACIAL
AND ETHNIC DISPARITIES IN COVID-19 AND
THE HEALTHCARE SYSTEM
=======================================================================
VIRTUAL HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON ENERGY AND COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
SECOND SESSION
__________
JUNE 17, 2020
__________
Serial No. 116-114
Printed for the use of the Committee on Energy and Commerce
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
govinfo.gov/committee/house-energy
energycommerce.house.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
54-856 PDF WASHINGTON : 2024
-----------------------------------------------------------------------------------
COMMITTEE ON ENERGY AND COMMERCE
FRANK PALLONE, Jr., New Jersey
Chairman
BOBBY L. RUSH, Illinois GREG WALDEN, Oregon
ANNA G. ESHOO, California Ranking Member
ELIOT L. ENGEL, New York FRED UPTON, Michigan
DIANA DeGETTE, Colorado JOHN SHIMKUS, Illinois
MIKE DOYLE, Pennsylvania MICHAEL C. BURGESS, Texas
JAN SCHAKOWSKY, Illinois STEVE SCALISE, Louisiana
G. K. BUTTERFIELD, North Carolina ROBERT E. LATTA, Ohio
DORIS O. MATSUI, California CATHY McMORRIS RODGERS, Washington
KATHY CASTOR, Florida BRETT GUTHRIE, Kentucky
JOHN P. SARBANES, Maryland PETE OLSON, Texas
JERRY McNERNEY, California DAVID B. McKINLEY, West Virginia
PETER WELCH, Vermont ADAM KINZINGER, Illinois
BEN RAY LUJAN, New Mexico H. MORGAN GRIFFITH, Virginia
PAUL TONKO, New York GUS M. BILIRAKIS, Florida
YVETTE D. CLARKE, New York, Vice BILL JOHNSON, Ohio
Chair BILLY LONG, Missouri
DAVID LOEBSACK, Iowa LARRY BUCSHON, Indiana
KURT SCHRADER, Oregon BILL FLORES, Texas
JOSEPH P. KENNEDY III, SUSAN W. BROOKS, Indiana
Massachusetts MARKWAYNE MULLIN, Oklahoma
TONY CARDENAS, California RICHARD HUDSON, North Carolina
RAUL RUIZ, California TIM WALBERG, Michigan
SCOTT H. PETERS, California EARL L. ``BUDDY'' CARTER, Georgia
DEBBIE DINGELL, Michigan JEFF DUNCAN, South Carolina
MARC A. VEASEY, Texas GREG GIANFORTE, Montana
ANN M. KUSTER, New Hampshire
ROBIN L. KELLY, Illinois
NANETTE DIAZ BARRAGAN, California
A. DONALD McEACHIN, Virginia
LISA BLUNT ROCHESTER, Delaware
DARREN SOTO, Florida
TOM O'HALLERAN, Arizona
------
Professional Staff
JEFFREY C. CARROLL, Staff Director
TIFFANY GUARASCIO, Deputy Staff Director
MIKE BLOOMQUIST, Minority Staff Director
Subcommittee on Health
ANNA G. ESHOO, California
Chairwoman
ELIOT L. ENGEL, New York MICHAEL C. BURGESS, Texas
G. K. BUTTERFIELD, North Carolina, Ranking Member
Vice Chair FRED UPTON, Michigan
DORIS O. MATSUI, California JOHN SHIMKUS, Illinois
KATHY CASTOR, Florida BRETT GUTHRIE, Kentucky
JOHN P. SARBANES, Maryland H. MORGAN GRIFFITH, Virginia
BEN RAY LUJAN, New Mexico GUS M. BILIRAKIS, Florida
KURT SCHRADER, Oregon BILLY LONG, Missouri
JOSEPH P. KENNEDY III, LARRY BUCSHON, Indiana
Massachusetts SUSAN W. BROOKS, Indiana
TONY CARDENAS, California MARKWAYNE MULLIN, Oklahoma
PETER WELCH, Vermont RICHARD HUDSON, North Carolina
RAUL RUIZ, California EARL L. ``BUDDY'' CARTER, Georgia
DEBBIE DINGELL, Michigan GREG GIANFORTE, Montana
ANN M. KUSTER, New Hampshire GREG WALDEN, Oregon (ex officio)
ROBIN L. KELLY, Illinois
NANETTE DIAZ BARRAGAN, California
LISA BLUNT ROCHESTER, Delaware
BOBBY L. RUSH, Illinois
FRANK PALLONE, Jr., New Jersey (ex
officio)
C O N T E N T S
----------
Page
Hon. Anna G. Eshoo, a Representative in Congress from the State
of California, opening statement............................... 2
Prepared statement........................................... 3
Hon. Michael C. Burgess, a Representative in Congress from the
State of Texas, opening statement.............................. 4
Prepared statement........................................... 6
Hon. Frank Pallone, Jr., a Representative in Congress from the
State of New Jersey, opening statement......................... 7
Prepared statement........................................... 9
Hon. Greg Walden, a Representative in Congress from the State of
Oregon, opening statement...................................... 10
Prepared statement........................................... 12
Hon. Eliot L. Engel, a Representative in Congress from the State
of New York, prepared statement................................ 110
Witnesses
Rhea Boyd, M.D., M.P.H., Pediatrician and Child Health Advocate,. 14
Prepared statement........................................... 16
Answers to submitted questions............................... 261
Oliver T. Brooks, M.D., President, National Medical Association.. 34
Prepared statement........................................... 37
Answers to submitted questions............................... 275
Avik S. A. Roy, President, Foundation for Research on Equal
Opportunity.................................................... 42
Prepared statement........................................... 44
Answers to submitted questions\1\
Submitted Material
Statement of June 17, 2020, by Asian & Pacific Islander American
Health Forum, submitted by Ms. Eshoo........................... 112
Statement of June 17, 2020, by Association of American Medical
Colleges, submitted by Ms. Eshoo............................... 123
Letter of June 17, 2020, to Ms. Eshoo and Mr. Burgess, by LaVarne
A. Burton, President and Chief Executive Officer, American
Kidney Fund, submitted by Ms. Eshoo............................ 133
Letter of June 17, 2020, to Ms. Eshoo and Mr. Burgess, by Monica
M. Bertagnolli, M.D., Chair of the Board, Association for
Clinical Oncology, submitted by Ms. Eshoo...................... 136
Report of June 16, 2020, ``Race gaps in COVID-19 deaths are even
bigger than they appear'', by Tiffany Ford, et al., submitted
by Ms. Eshoo................................................... 138
Statement from the Center for Reproductive Rights, submitted by
Ms. Eshoo...................................................... 145
Letter of June 10, 2020, to Mr. Hahn, from Alliance of
Multicultural Physicians, submitted by Ms. Eshoo............... 152
Article of April 7, 2020, ``Communities of Color at Higher Risk
for Health and Economic Challenges Due to COVID-19'', from
Kaiser Family Foundation, submitted by Ms. Eshoo............... 157
Report on June 16, 2020, from the Robert Wood Johnson Foundation,
submitted by Ms. Eshoo......................................... 167
----------
\1\ Mr. Roy did not answer submitted questions for the record by
the time of publication.
Report on May 2020, ``The Fierce Urgency of Now: Federal and
State Policy Recommendations to Address Health Inequities in
the Era of COVID-19'', from Families USA, submitted by Ms.
Eshoo \2\
Report ``Disparities in Outcomes Among COVID-19 Patients in a
Large Health Care System in California'', by Kristen M. J.
Azar, et al., Health Affairs Journal, submitted by Ms. Eshoo... 171
Letter of June 17, 2020, to Ms. Eshoo and Mr. Burgess, Jane M.
Adams, Vice President, Federal Affairs, Johnson & Johnson
Services, Inc., submitted by Ms. Eshoo......................... 179
Letter of June 17, 2020, to Ms. Eshoo and Mr. Burgess, from the
National Council of Asian Pacific Americans, submitted by Ms.
Eshoo.......................................................... 184
Article of April 8, 2020, ``Virus is Twice as Deadly for Black
and Latino People Than Whites in N.Y.C.'', from New York Times,
submitted by Ms. Eshoo......................................... 193
Article of June 9, 2020, ```The direct result of racism': Covid-
19 lays bare how discrimination drives health disparities among
Black people'', STAT News, submitted by Ms. Eshoo.............. 198
Article of June 15, 2020, ``To understand who's dying of Covid-
19, look to social factors like race more than preexisting
diseases'', STAT, submitted by Ms. Eshoo....................... 204
Statement of June 17, 2020, from American Cancer Society Cancer
Action Network, submitted by Ms. Eshoo......................... 211
Statement of May 13, 2020, ``President Donald J. Trump is
Committed to Providing Support to Undeserved Communities
Impacted by the Coronavirus Pandemic'', White House Press,
submitted by Ms. Eshoo......................................... 214
Statement of June 11, 2020, ``President Trump unveils vision to
rebuild our cities'', White House Press, submitted by Ms. Eshoo 217
Document title ``HHS Initiatives to Address the Disparate Impact
of COVID-19 on African Americans and Other Racial and Ethnic
Minorities'', from HHS, submitted by Ms. Eshoo................. 219
Statement of June 16, 2020, from Infectious Diseases Society of
America's HIV Medicine Association, submitted by Ms. Eshoo..... 223
Report of November 2019, ``Quantifying the Distribution and
Completeness of Select Demographic Variables in 2016'', from
Center for Medicare and Medicaid Services, submitted by Ms.
Eshoo.......................................................... 228
Statement of June 17, 2020, from Alzheimer's Association and
Alzheimer's Impact Movement, submitted by Ms. Eshoo............ 242
Letter of June 17, 2020, to Mr. Pallone, et al., by Scott P.
Serota, President and Chief Executive Officer, from the Blue
Cross Blue Shield Association, submitted by Ms. Eshoo.......... 245
Statement of June 17, 2020, from the Biotechnology Innovation
Organization, submitted by Ms. Eshoo........................... 248
Article of June 10, 2020, ``To eliminate health disparities,
Parkland must address the root issues in black communities'',
Dallas Morning News, submitted by Ms. Eshoo.................... 249
Letter of June 15, 2020, to Ms. Eshoo and Mr. Burgess, by Robert
W. Carlson, M.D., Chief Executive Office, National
Comprehensive Cancer Network, submitted by Ms. Eshoo........... 252
Article of June 17, 2020, ``Frosh: Virus' Unequal Devastation in
Communities of Color Must Guide the Response'', Maryland
Matters, submitted by Ms. Eshoo................................ 254
Statement of June 17, 2020, from American Diabetes Association,
submitted by Ms. Eshoo......................................... 257
----------
\2\ The information has been retained in committee files and also
is available at https://docs.house.gov/meetings/IF/IF14/
20200617/110812/HHRG-116-IF14-20200617-SD012.pdf.
HEALTH CARE INEQUALITY: CONFRONTING RACIAL AND ETHNIC DISPARITIES IN
COVID-19 AND THE HEALTH CARE SYSTEM
----------
WEDNESDAY, JUNE 17, 2020
House of Representatives,
Subcommittee on Health,
Committee on Energy and Commerce,
Washington, DC.
The subcommittee met, pursuant to call, at 11:57 a.m., via
Cisco Webex online video conferencing, Hon. Anna G. Eshoo
(chairwoman of the subcommittee) presiding.
Present: Representatives Eshoo, Butterfield, Matsui,
Castor, Sarbanes, Lujan, Schrader, Kennedy, Cardenas, Welch,
Ruiz, Dingell, Kuster, Kelly, Barragan, Blunt Rochester, Rush,
Pallone (ex officio), Burgess (subcommittee ranking member),
Upton, Shimkus, Guthrie, Griffith, Bilirakis, Bucshon, Brooks,
Mullin, Hudson, Carter, Gianforte, and Walden (ex officio).
Also present: Representatives DeGette, Schakowsky, Clarke,
and O'Halleran.
Staff present: Jeffrey C. Carroll, Staff Director; Tiffany
Guarascio, Deputy Staff Director; Timothy Robinson, Chief
Counsel; Waverly Gordon, Deputy Chief Counsel; Kaitlyn Peel,
Digital Director; Joe Orlando, Executive Assistant; Kimberlee
Trzeciak, Chief Health Advisor; Meghan Mullon, Policy Analyst;
Nolan Ahern, Minority Professional Staff, Health; Jennifer
Barblan, Minority Chief Counsel, Oversight and Investigations;
Mike Bloomquist, Minority Staff Director; S. K. Bowen, Minority
Press Secretary; William Clutterbuck, Minority Staff Assistant;
Jordan Davis, Minority Senior Advisor; Theresa Gambo, Minority
Human Resources/Office Administrator; Caleb Graff, Minority
Professional Staff Member, Health; Tyler Greenberg, Minority
Staff Assistant; Tiffany Haverly, Minority Communications
Director; Peter Kielty, Minority General Counsel; Bijan
Koohmaraie, Minority Deputy Chief Counsel, Consumer Protection
and Commerce; Ryan Long, Minority Deputy Staff Director; James
Paluskiewicz, Minority Chief Counsel, Health; Brannon Rains,
Minority Policy Analyst; Kristin Seum, Minority Counsel,
Health; Kristen Shatynski, Minority Professional Staff Member,
Health; and Everett Winnick, Minority Director of Information
Technology.
Ms. Eshoo. The Subcommittee on Health will now come to
order.
Due to COVID-19, today's hearing is being held remotely.
All Members and witnesses will be participating via video
conferencing.
For the witnesses and all the Members, you will need to
unmute--remember that--you will need to unmute your microphone
when you wish to speak and when you are recognized. So please
remember that. I will kindly remind everyone. But know that you
are muted now and when you speak, you will have to unmute.
Documents for the record can be sent to Meghan Mullon at
the email address that we provided to your staff. And all
documents will be entered into the record at the conclusion of
this hearing.
The Chair now recognizes herself for 5 minutes for an
opening statement.
OPENING STATEMENT OF HON. ANNA G. ESHOO, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF CALIFORNIA
My colleagues and witnesses and those that are listening in
to our hearing, our country is in pain, our country is
grieving, and our country is angry. Over 2.1 million Americans
are sick, 44 million Americans are jobless, and most
tragically, we have lost over 116,000 of our fellow Americans.
The United States of America has more reported cases of
COVID-19 and more deaths than any other country in the world.
And this pain falls most heavily on communities of color, and
that is why we are having this hearing today.
The COVID mortality rate for Black Americans is 2.3 times
higher than the rate for White Americans. Other groups are
disproportionately impacted as well. For example, in my region
in Silicon Valley, Santa Clara County, 24 percent of the
county's population is Latino, but Latinos represent nearly 32
percent of all COVID deaths.
While this virus is new to our it country and the world,
the plague of racism is not. According to the CDC, Black
Americans are more likely to die at early ages from all causes.
Black Americans are more likely to die from heart disease or
stroke at a young age. As we know from our subcommittee's work,
Black mothers are three and a half times more likely to die
during childbirth even when they have--even when they have
higher incomes and more education than their White
counterparts.
In the wake of the murder of George Floyd, we must
acknowledge the public health impact of police brutality.
According to the National Academy of Sciences, one in every
thousand Black men can expect to be killed by police. Black men
are about 2.5 times more likely to be killed by police over the
course of their life than White men.
Our expert witnesses, Dr. Boyd and Dr. Brooks, describe the
interaction of racism in COVID-19 as a pandemic within a
pandemic.
Sadly, the administration has failed to anticipate, track,
and respond to the pandemic's effect on communities of color.
The latest example of this failure is a final rule issued last
week by the Department of Health and Human Services that
repeals nondiscrimination protections for individuals with
limited English proficiency, LGBTQ people, people with
disabilities, and women.
Another example is that two months after Congress passed a
law requiring the administration to provide COVID racial
analysis, the CDC finally announced that it will require COVID
testing labs to report demographic data. However, that
demographic data will not be required until August 1, 8 months
after we first learned of this disease.
So my colleagues on the subcommittee, led by Congresswoman
Robin Kelly, chair of the Congressional Black Caucus Health
Brain Trust, have introduced the Equitable Data Collection and
Disclosure on COVID-19 Act in response to the administration's
failure to act.
I have about a minute and a half left, so I am just going
to say that there is so much more work that Congress needs to
do to deliver on the belief that ``Black Lives Matter'' in
healthcare and our society, and I look forward to hearing the
witnesses and what they suggest to us.
A vital part of the work will be the newly formed Energy
and Commerce Racial Disparities Working Group, and I am pleased
to yield the remainder of my time to its co-leader, our
colleague, Representative Yvette Clarke, to announce their
work.
[The prepared statement of Ms. Eshoo follows:]
Prepared Statement of Hon. Anna G. Eshoo
Our country is in pain. Our country is grieving. And our
country is angry.
Over 2 million Americans are sick. 44 million workers are
jobless. Most tragically, we have lost over 115,000 of our
fellow Americans.
And this pain falls most heavily on communities of color.
The COVID mortality rate for Black Americans is 2.3 times
higher than the rate for White Americans. Other groups are
disproportionally impacted as well. For example, near my
district in Santa Clara County, 24 percent of the county's
population is Latino, but Latinos represent nearly 32 percent
of all COVID deaths.
While this virus is new to our country, the plague of
racism is not.
According to the CDC, Black Americans are more likely to
die at early ages from all causes. Black Americans are more
likely to die from heart disease or stroke at a young age. As
we know from our Subcommittee's work, Black mothers are 3.5
times more likely to die during childbirth, even when they have
higher incomes and more education than their white
counterparts.
In the wake of the murder of George Floyd we must
acknowledge the public health impact of police brutality.
According to the National Academy of Sciences, 1 in every 1,000
Black men can expect to be killed by police. Black men are
about 2.5 times more likely to be killed by police over the
course of their life than are white men.
Our expert witnesses, Dr. Boyd and Dr. Brooks describe the
interaction of racism with COVID-19 as a ``pandemic within a
pandemic.''
Sadly, the Administration has failed to anticipate, track,
and respond to the pandemic's effect on communities of color.
The latest example of this failure is a final rule issued
last week by the Department of Health and Human Services that
repealed nondiscrimination protections for individuals with
limited English proficiency, LGBT people, people with
disabilities, and women.
Another example is that two months after Congress passed a
law requiring the Administration to provide COVID racial
analysis, the CDC finally announced that it will require COVID
testing labs to report demographic data. However, that
demographic data will not be required until August 1st, eight
months after we first learned of this disease.
My colleagues on the Subcommittee, led by Congresswoman
Robin Kelly, Chair of the Congressional Black Caucus Health
Braintrust, have introduced the Equitable Data Collection and
Disclosure on COVID-19 Act in response to the Administration's
failure to act.
Until a vaccine or therapy is available, intensive testing
will be necessary to safely reopen. However, systemic barriers,
such as lack of insurance and paid leave, keep Americans from
seeking COVID-19 testing and treatment. The HEROES Act breaks
down those barriers by creating a national testing strategy,
extending eligibility for paid sick leave, covering the
uninsured for COVID treatment, and strengthening the Medicaid
program.
There's so much more Congress needs to do to deliver on the
belief that ``Black Lives Matter'' in healthcare and our
society and I look forward to hearing suggestions from our
witnesses.
A vital part of this work will be the newly-formed Energy
and Commerce Racial Disparities Working Group, and I'm please
to yield the remainder of my time to its Co-leader,
Representative Yvette Clarke, to announce that work.
Ms. Clarke. Let me thank Chairwoman Eshoo for convening
this timely hearing today and to discuss the racial disparities
that have been evidenced by the COVID-19 pandemic and thank all
of my colleagues and our witnesses for being with us here
today.
All across the Nation, we are currently in the midst of a
time of reckoning. For years now, issues of health disparities
in the United States have been simmering beneath the surface of
public discourse. But in these past few months alone, we have
seen, in no uncertain terms, the ways in which Black, Hispanic,
and Native Americans have faced the brunt of this pandemic.
We must work together to find a solution to these
disparities, and that is why I am proud to co-lead the Racial
Disparities Working Group, along with my colleague, the
chairwoman of the Health Brain Trust of the Congressional Black
Caucus, Representative Robin Kelly of Illinois.
The working group will raise awareness, find solutions, and
address racial inequity within the jurisdiction of our
committee. It is my hope that the Racial Disparities Working
Group will be a major step along the road to racial justice as
we embark, once again, on a mission to achieve equality and
equity.
I look forward to working with all of my colleagues on
these important issues and to hear from our witnesses today.
With that, Madam Chairwoman, I yield back, and I thank you
for the opportunity to address the committee today.
Ms. Eshoo. Thank you. The gentlewoman yields back.
The Chair now recognizes Dr. Burgess, the ranking member of
the Subcommittee on Health, for 5 minutes for his opening
statement.
OPENING STATEMENT OF HON. MICHAEL C. BURGESS, A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF TEXAS
Mr. Burgess. And I thank the Chair. And as the Chair will
recall, I sent a letter last month requesting a hearing to
address the issue of racial and ethnic disparities in this
novel coronavirus environment. I want to thank you for honoring
that request by calling this hearing.
This novel coronavirus, along with the deaths of George
Floyd, Ahmaud Arbery, Breonna Taylor, Patrick Underwood, and
David Dorn, have reminded us of the importance of addressing
the realities of race within our healthcare system.
I began my medical career at Parkland Hospital. I saw
firsthand the challenges of caring for a primarily Medicaid and
underserved population.
Last week, Michael Horne, the chief executive of the
Parkland Foundation, and Dr. Fred Cerise, the chief executive
of Parkland Hospital in Dallas, wrote an opinion piece that hit
home for me. Let me share some of their words with you. I am
quoting here.
``This work, our work of healing deep-seated wounds
necessitates that we deliver our healthcare service upon the
foundations of care, compassion, and community. To provide
excellent clinical care. To approach that care with compassion,
literally translated, 'to suffer with.' We have to make it
personal. And to be connected to our communities.
``Removing real and perceived barriers, we must actively
seek to build relationships across lines of difference. It is
only through proximity that we can understand the challenges we
must confront.'' Close quote.
And then on Sunday, I was surprised to read another opinion
piece, from Dallas County Commissioner John Wiley Price.
Typically I don't agree with Commissioner Price, but I found
myself in agreement with most of what he had written. And he
said: ``The discrimination that existed in the 1960s was often
very overt and extreme, and as a result it appeared to be far
easier to determine who was racist and who was not,'' close
quote.
And then, actually, he went on to observe at the end of his
article that we all ought to bear in mind what we learned from
our mothers: Do unto others as you would have them do unto you
and try to put yourself in the shoes of the other person.
So we are here today to listen. We have a chance to make a
difference and to change things for the better. I hope this
discussion today moves us in that direction. We should use this
information to draft commonsense, bipartisan legislation that
can actually become law.
I do want to remind everyone of the work that this
subcommittee, this subcommittee, has done this Congress and the
last Congress. We passed an authorization to increase research
for sickle cell disease, which President Trump signed into law
in December of 2018. This is the first stand-alone sickle cell
authorization that I can remember in my congressional career
and the first authorization since one was tacked on to a tax
bill in 2004.
So this subcommittee did that work and got it across the
finish line, and then eventually got it in for a signature.
Since then, I have spoken with patients in the National
Institute of Health trials and heard of the promising
treatments that are in our pipeline.
And let's not forget the Preventing the Maternal Deaths
Act, the first law to address maternal mortality that was
signed into law and is enabling States to establish and
strengthen robust maternal mortality review committees.
And then this Congress, the Energy and Commerce Committee
has approved two bills, H.R. 4995 and H.R. 4996, that would
further address maternal mortality and racial disparities in
pregnancy outcomes.
This is not the time to take our foot off the gas. I have
read articles about the disproportionate impact of coronavirus
on racial and ethnic minorities near my district in the Dallas-
Ft. Worth area. It is possible that we do not even know the
full effects because some of the data is either missing or not
collected. I do worry about the convergence of the novel
coronavirus in individuals who are suffering from other chronic
conditions, such as diabetes.
There is so much we do not know about the biological
behavior of this virus. We are learning new details every day.
This is a critical hearing because there is a lot to unpack and
about the disproportionate impact of the novel coronavirus on
racial and ethnic minorities.
Again, to the chair, once again my appreciation for your
working with me to call this hearing and committing to a
productive hearing and all the agenda of this subcommittee. And
I would ask unanimous consent that the articles that I
referenced, the opinion piece by Dr. Cerise and the opinion
piece by Dallas County Commissioner John Wiley Price, be
included as part of our record.
And I yield back my time.
[The prepared statement of Mr. Burgess follows:]
Prepared Statement of Hon. Michael C. Burgess
Thank you, Madam Chair. As you recall, I sent a letter to
you last month requesting a hearing to address the issue of
racial and ethnic disparities in COVID-19. Thank you for
honoring that request by calling this hearing. This virus along
with the deaths of George Floyd, Ahmaud Arbery, Breonna Taylor,
Patrick Underwood, and David Dorn have reminded us of the
importance of addressing the realities of race within our
healthcare system.
My medical career began at Parkland. I saw firsthand the
challenges of caring for primarily a Medicaid and underserved
population.
Last week, Michael Horne, Chief Executive of Parkland
Foundation, and Dr. Fred Cerise, Chief Executive of Parkland
Hospital in Dallas, wrote an op-ed that hit home for me. Let me
share some of their words with you.
``This work, our work of healing deep-seated wounds,
necessitates that we deliver our healthcare service upon the
foundations of care, compassion and community. To provide
excellent clinical care. To approach that care with compassion,
literally translated, `to suffer with.' We have to make it
personal. And to be connected to our communities. Removing real
and perceived barriers, we must actively seek to build
relationships across lines of difference. It is only through
proximity that we can understand the challenges we must
confront.''
Coming into this hearing I hope we will heed the words of
Dallas County Commissioner John Wiley Price. ``The
discrimination that existed in the 1960s was often very overt
and extreme. As a result, it appeared to be far easier than to
determine who was ``racist'' and who was not.''
What we are here to do today to listen. We have a chance to
make a difference and change things for the better. I hope that
this discussion today moves us in that direction. We should use
this information to draft commonsense, bipartisan legislation
that can become law.
I do want to remind everyone of the work that this
subcommittee has done in this space over the past four years.
We passed an authorization to increase research for sickle cell
disease, which President Trump signed into law in 2018. Since
then, I have spoken with patients in NIH trials and heard of
the promising treatments in our pipeline.
Let's not forget the Preventing Maternal Deaths Act, the
FIRST law to address maternal mortality, was signed into law
and is enabling states to establish and strengthen robust
maternal mortality review committees. This Congress, the Energy
and Commerce Committee has approved two bills, H.R. 4995 and
H.R. 4996, that would further address maternal mortality and
racial disparities in pregnancy outcomes. This is not the time
to take our foot off the gas.
I have read numerous articles about the disproportionate
impact of COVID-19 on racial and ethnic minorities near my
district in the Dallas Fort Worth area. It is possible we do
not even know the full effect because some of this demographic
data is not being collected.
I particularly worry about the convergence of COVID-19 and
individuals who are suffering from other chronic conditions,
such as diabetes. Before the COVID-19 pandemic, African
Americans and American Indians/Alaska Natives have historically
been more prone to chronic conditions like asthma, diabetes,
obesity, and hypertension -underlying conditions that, no
matter race or ethnicity, increase the risk of contracting and
dying from the virus. Additional factors, such as condensed
living situations and multigenerational households, may
exacerbate some of the issues in these minority communities.
There is a lot we still do not know about this virus. We
are learning new details every day. This is a critical hearing
because there is a lot to unpack about the disproportionate
impact of COVID-19 on racial and ethnic minorities. Madam
Chair, once I again express my appreciation for you working
with me to call this hearing and committing to a productive
COVID-19 agenda at this subcommittee.
Ms. Eshoo. I thank the gentleman. And all documents where
there is a request to be placed record will be taken up at the
end of the hearing.
It is now a pleasure to recognize the chairman of the full
committee, Mr. Pallone, for his 5 minutes of questions, and
please remember to unmute.
OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF NEW JERSEY
Mr. Pallone. Thank you, Chairwoman Eshoo, for convening
this really important hearing that confronts the alarming
racial and ethnic disparities in the COVID-19 pandemic as well
as the inequities within our larger healthcare system.
Today's hearing comes at a time of reckoning for racial
justice in America. As the Black Lives Matter movement works to
bring about structural change, including addressing police
violence in America, we are also faced with a public health
crisis that is disproportionately afflicting communities of
color.
And we have long known that people of color experience
disparities in healthcare in the United States. While we have
made progress to close these gaps in recent years, including
with the passage of the Affordable Care Act, people of color in
America continue to experience disparities in care and worse
health outcomes compared to White Americans.
And these long-term trends are rooted in several social
determinants that are often driven by structural discrimination
and institutionalized racism, which has created systematic
health inequity.
The tragic result of these long-term trends is that people
of color are more likely to suffer from underlying health
conditions, and have a much harder time gaining access to care,
and when they do, they are far more likely to experience bias,
discrimination, and poor health outcomes.
And predictably, these factors left minority communities
especially vulnerable to the COVID-19 pandemic. In my home
State of New Jersey, Black residents account for nearly 20
percent of all coronavirus deaths despite representing just 13
percent of our overall population. And for our neighbors in New
York City, Black and Latino residents are twice as likely to
die from the virus than their White counterparts. Obviously
that is heartbreaking and demands urgent action from Congress
and the administration.
Now, over the past few months, this committee has taken
steps to better understand and begin to address these health
inequities, but that requires data, and, unfortunately, we are
not getting a lot of crucial data from the Trump
administration.
In April, I wrote to the Centers for Medicare and Medicaid
Services, CMS, Administrator Verma requesting that she make
public Medicare data related to COVID-19 health outcomes based
on race, ethnicity, and gender. It should have been an easy
request for her to fulfill, considering she had publicly
committed to releasing that data a week before my request. CMS'
claims data is uniquely insightful because of the agency's use
of specific coding, which gives CMS access to information that
could inform our efforts to improve health outcomes for
communities of color.
But, unfortunately, we are nine weeks after my request and
ten weeks after she committed to releasing this data, and CMS
has yet to release any of it. So yesterday I wrote to
Administrator Verma reasserting this request.
And data is so important to our understanding of
disparities, and that is why the committee also worked to
include provisions in the Paycheck Protection Program and
Healthcare Enhancement Act requiring the Trump administration
submit to Congress a comprehensive report on COVID-19 health
disparities. But, unfortunately, instead of taking this
congressional mandate seriously, the Trump administration
submitted a four-page document with a list of links to already
publicly available web pages, and, again, this is a wholly
inadequate response.
The House has taken several additional actions in passing
the HEROES Act last month, which requires a comprehensive
update of the four-page demographics report and the development
of an evidence-based response strategy to reduce disparities
related to COVID-19. And the HEROES Act would also require the
administration to develop a national testing strategy with
specific requirements to help reduce disparities in testing.
But, unfortunately, as you know, the Senate so far refuses to
take action on the HEROES Act. We hope that they will.
And, finally, while I was glad to see that the Trump
administration announced plans for more extensive demographic
reporting on COVID-19 testing, I am concerned that this is too
little, too late. These new reporting requirements will only go
into full effect in August, which leaves me concerned that we
may never have a complete understanding of the harm this virus
has inflicted on communities of color during the first six
months of this pandemic.
So I am hopeful that this hearing will help basically
another step forward in better understanding and addressing
these heartbreaking inequities with both COVID-19 and our
overall healthcare system.
And, you know, I really--I know several members have
mentioned it to me earlier that the data is really important.
So I hope that we see the administration step up on these data
problems that we have seen and their inadequate response.
But I do thank our witnesses for joining us to share their
expertise. I know you have a good panel. I look forward to the
testimony. And, again, thank you, Madam Chairwoman, and also
thank you, Mike Burgess, as well, for putting this together.
I yield back.
[The prepared statement of Hon. Frank Pallone follows:]
Prepared Statement of Mr. Pallone
Thank you, Chairwoman Eshoo for convening this really
important hearing to confront the alarming racial and ethnic
disparities in the COVID-19 pandemic as well as the inequities
within our larger healthcare system.
Today's hearing comes at a time of reckoning for racial
justice in America. As the Black Lives Matter movement works to
bring about structural change, including addressing police
violence in America, we are also faced with a public health
crisis that is disproportionately afflicting communities of
color. We have long known that people of color experience
disparities in healthcare in the United States. While we have
made progress to close these gaps in recent years, including
with the passage of the Affordable Care Act, people of color in
America continue to experience disparities in care and worse
health outcomes compared to White Americans.
These long-term trends are rooted in several social
determinants that are often driven by structural discrimination
and institutionalized racism, which has created systemic health
inequity. The tragic result of these long-term trends is that
people of color are more likely to suffer from underlying
health conditions, have a much harder time gaining access to
care, and when they do, they're far more likely to experience
bias, discrimination and poor health outcomes.
Predictably, these factors left minority communities
especially vulnerable to the COVID-19 pandemic. In my home
state of New Jersey, Black residents account for nearly 20
percent of all coronavirus deaths despite representing just 13
percent of our overall population. And for our neighbors in New
York City, Black and Latino residents are twice as likely to
die fromthe virus than their White counterparts. That's
heartbreaking and demands urgent action from both Congress and
the Administration.
Over the past few months, this Committee has taken steps to
better understand and begin to address these health inequities,
but that requires data and, unfortunately, we're not getting a
lot of critical data from the Trump Administration. In April, I
wrote to Centers for Medicare & Medicaid Services (CMS)
Administrator Verma requesting that she make public Medicare
data related to COVID-19 health outcomes based on race,
ethnicity and gender. It should have been an easy request for
her to fulfill, considering she had publicly committed to
releasing this data a week before my request. CMS's claims data
is uniquely insightful because of the agency's use of specific
coding, which gives CMS access to information that could inform
our efforts to improve health outcomes for communities of
color.
Unfortunately, here we are, nine weeks after my request and
ten weeks after she committed to releasing this data, and CMS
has yet to release any of it. Yesterday, I wrote to
Administrator Verma reasserting this request .
Data is so important to our understanding of disparities
and that's why the Committee also worked to include provisions
in the Paycheck Protection Program and Health Care Enhancement
Act requiring the Trump Administration submit to Congress a
comprehensive report on COVID-19 health disparities.
Unfortunately, instead of taking this Congressional mandate
seriously, the Trump Administration submitted a four-page
document with a list of links to already publicly available web
pages. This is a wholly inadequate response.
The House then took additional action in passing the Heroes
Act last month, which requires a comprehensive update of the
four-page demographics report and the development of an
evidence-based response strategy to reduce disparities related
to COVID-19. The Heroes Act would also require the
Administration to develop a national testing strategy with
specific requirements to help reduce disparities in testing.
Unfortunately, the Senate refuses to take action on the Heroes
Act.
Finally, while I was glad to see the Administration
announce plans for more extensive demographic reporting on
COVID-19 testing, I'm concerned that this is too little too
late. These new reporting requirements will only go into full
effect in August, which leaves me concerned that we may never
have a complete understanding of the harm this virus has
inflicted on communities of color during the first six months
of this pandemic.
I am hopeful this hearing will be a step forward in better
understanding and addressing these heartbreaking inequities
with both COVID-19 and our overall healthcare system. I thank
our witnesses for joining us to share their expertise and I
look forward to hearing your testimony.
And with that, Madam Chairwoman, I yield back.
Ms. Eshoo. The gentleman yields back.
It is now a pleasure to recognize the ranking member of the
full committee, Mr. Walden, for his 5 minutes for an opening
statement. And remember to unmute.
OPENING STATEMENT OF HON. GREG WALDEN A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF OREGON
Mr. Walden. Thank you, Madam Chair, and thanks for holding
this hearing.
Before I start, I have a question for the chairman of the
full committee. As far as I can tell, this is the first we have
heard of this new working group on the Republican side, and I
wondered if it will be open to Republican participation or if
it is a partisan working group?
I believe you are muted, Mr. Chairman.
Mr. Pallone. My understanding was that it was open to and
bipartisan. If you are not aware of it, then we will just have
to, you know, find out. I don't want to really interrupt the
meeting. I will talk to you afterward about it. But my
understanding is that it is meant to be bipartisan.
Mr. Walden. I would hope so because I think the spirit of
this whole hearing is bipartisan, but this is the first--
[inaudible] That we would like to participate in that----
Mr. Pallone. So let me get back to you later in that day,
Greg, on that.
Madam Chair.
Mr. Walden. Thanks, Chairman.
The last few months have seen an unprecedented and
challenging time. Americans all over the country are raising
their voices to raise long overdue awareness to the systematic
challenges facing the Black community in America.
Meanwhile, COVID-19 has shaken the very fabric of our
country, with more than 2 million positive cases and over
115,000 deaths. There is no question the pandemic has had a
disproportionate impact on communities of color, seen primarily
in terms of poorer health outcomes, but it is also manifested
both socially and economically.
According to the data from the Centers For Disease Control
and Prevention, American Indian, and Alaska Native persons have
a COVID-19 hospitalization rate about five times that of White
people, followed by Black people, who have a hospitalization
rate four and a half times that of White people. Hispanics and
Latinos have a hospitalization rate three and a half times that
of Whites.
We know this isn't just an American problem as well. All
over the globe, minority and underserved communities have
suffered disproportionately from the pandemic.
For example, in the United Kingdom the Office of National
Statistics found that COVID-19-related deaths for this ethnic
group in England and Wales exceeded those of White ethnicity.
In the U.K., Black males and females are over four times more
likely to die from a COVID-19-related death than their White
counterparts. The same was found to be true for people of
Bangladeshi, Pakistani, Indian, and mixed ethnicities.
After seeing these alarming trends last month, Dr. Burgess,
the Republican leader on the Health Subcommittee, sent a letter
to the majority requesting a hearing on this very issue,
including how Congress can help reduce these disparities. And I
would like to express my appreciation to Dr. Burgess and to the
majority for having the hearing we are having today.
We know that chronic health conditions, and older age,
congregate living increase the risk of complications and death
from COVID-19. However, these facts do not explain the full
story as to why certain racial and ethnic groups have come to
bear an undue burden of the public health crisis. We need to
better understand these differences in healthcare outcomes and
how best to improve them.
At a hearing earlier this month with some of our Nation's
governors, the committee heard the disastrous and devastating
consequences of some States actually forcing COVID-positive
patients back into nursing homes. And we now know that upwards
of 40 percent of the fatalities in America are coming out of
our nursing homes.
This misguided policy, unfortunately, exacerbated the
suffering and mortality left in the wake of the virus and its
tragic effects were felt disproportionately across many
minority communities.
The Trump administration has already taken steps to ensure
vulnerable populations have access to testing, care, and other
critical resources during this pandemic. It is my hope that
every member of this committee will be willing to work
alongside the administration to address disparities in all
vulnerable populations.
As we know, for data collection, this has always been a
province of the States, and we find that the reporting from the
States was lacking. So I applaud the administration for
demanding States step forward with unified reporting
requirements.
The economic downturn caused by the stay-at-home orders and
lockdowns has exacerbated the impact of COVID-19 on vulnerable
communities. While these policies were needed to flatten the
curve and slow the spread of infections, they have had an
undeniable impact on minority communities.
In fact, a recent study by the National Bureau of Economic
Research found that the number of opened Black-owned businesses
fell 41 percent. That is an astounding and very, very troubling
number. Opened Hispanic-owned businesses fell by 32 percent,
Asian-owned businesses fell 26 percent, and immigrant-owned
businesses dropped by 36 percent.
Many hourly workers have lost their jobs and are without
work. Unemployment claims have skyrocketed despite thebetter-
than-expected jobs report for the month of May.
We know that unemployment and financial strains are
associated with higher stress, increased risk of mental
illness, and increased risk for substance abuse, all of which
lead to poorer health outcomes.
So I believe that safely reopening the economy--safely--
maintaining targeted social distancing, and focusing resources
where they are most needed will help minority communities the
most. As I stated in the last hearing, listen, learn, act.
As a country, we should be listening to others with
different viewpoints and backgrounds, learning about their
experiences and feelings, and taking actions to ensure justice
and equality are available to all Americans regardless of skin
color.
I look forward to [inaudible] And I, again, thank Chair
Eshoo and Chairman Pallone for having this hearing.
And I yield back whatever balance of time I have.
[The prepared statement of Mr. Walden follows:]
Prepared Statement of Hon. Greg Walden
The last few months have been an unprecedented and
challenging time. Americans all over the country are raising
their voices to raise long overdue awareness to the systematic
challenges facing the black community in America.
Meanwhile, COVID-19 has shaken the very fabric of the
nation, with over 2 million positive cases and over 115,000
deaths. There's no question the pandemic has had a
disproportionate impact on communities of color--seen primarily
in terms of poorer health outcomes, but it has also manifested
both socially and economically.
According to the data from the Centers for Disease Control
and Prevention, American Indian/Alaska Native persons have a
COVID-19 hospitalization rate about five times that of white
people, followed by black people, who have a hospitalization
rate four and a half times that of white people. Hispanics and
Latinos have a hospitalization rate three and a half times that
of whites.
We know this isn't just an American problem. All over the
globe, minority and underserved communities have suffered
disproportionally from the pandemic. In the United Kingdom, the
Office for National Statistics found that COVID-19-related
deaths for ethnic groups in England and Wales exceeded those of
white ethnicity. In the UK, Black males and females are over
four times more likely to die from a COVID-19-related death
than their white counterparts. The same was found to be true
for people of Bangladeshi, Pakistani, Indian, and mixed
ethnicities.
After seeing these alarming trends, last month, Dr.
Burgess, the Republican Leader on the Health Subcommittee, sent
a letter to the majority requesting a hearing on this very
issue, including how Congress can help reduce these
disparities. I'd like to express my thanks to the majority for
fulfilling Dr. Burgess's request today.
We know that chronic health conditions, older age, and
congregate living increase the risk of complications and death
from COVID-19. However, these facts do not explain the full
story as to why certain racial and ethnic groups have borne an
undue share of the burden of this public health crisis. We need
to better understand these differences in health outcomes and
how best to improve them. At a hearing earlier this month with
some of our nation's governors, the Committee heard the
disastrous and devastating consequences of some states forcing
COVID positive patients back into nursing homes. This misguided
policy unfortunately exacerbated the suffering and mortality
left in the wake of the virus, and its tragic effects were felt
disproportionately across many minority communities.
The administration has already taken steps to ensure
vulnerable populations have access to testing, care, and other
critical resources during this pandemic. It is my hope that
every member of this committee will be willing to work
alongside the administration to address disparities in all
vulnerable populations.
The economic downturn caused by the stay at home orders and
lockdowns has exacerbated the impact of COVID-19 on vulnerable
communities. While these policies were needed to flatten the
curve and slow the spread of infections, they have had an
undeniable impact on minority communities. A recent study by
the National Bureau of Economic Research found that the number
of open black-owned businesses fell 41 percent--that's an
astounding and extremely troubling number. Open Hispanic-owned
businesses fell by 32 percent, Asian-owned businesses fell 26
percent, and immigrant-owned businesses dropped by 36 percent.
Many hourly workers have lost their jobs and are without
work. Unemployment claims have skyrocketed, despite the better-
than-expected jobs numbers for the month of May. We know that
unemployment and financial strains are associated with higher
stress, increased risk of mental illness, and increased risk
for substance abuse -all of which lead to poorer health
outcomes.
I believe that safely reopening the economy, maintaining
targeted social distancing, and focusing resources where they
are most needed will help minority communities the most.
As I stated in the last hearing--Listen, learn, act. As a
country, we should be listening to others with different
viewpoints and backgrounds, learning about their experiences
and feelings, and taking action to ensure justice and equality
are available to all Americans, regardless of skin color.
I look forward to hearing from our witnesses today on this
important topic, and I again thank the Majority for having this
hearing.
With that, I yield back.
The Chair would like to remind members that pursuant to
committee rules, all Members' written opening statements shall
be made part of the record.
I now would like to introduce our witnesses and thank them
for being with us today and also for your patience as we had to
deal with some of the technological problems at the beginning
of the hearing.
Dr. Rhea Boyd is a pediatrician and a child health
advocate. She serves my constituents at the Palo Alto Medical
Foundation. She has taught on structural inequality and health
at Stanford University's Pediatric Residency Program and she
serves on the board of California Chapter 1 of the American
Academy of Pediatrics.
Thank you, Doctor, for your service as a frontline
healthcare worker, as well as the work that you do to ensure
that the children in my congressional district and our Nation
grow up healthy and equitably.
I now will yield to Representative Barragan to introduce
Dr. Oliver T. Brooks, since he serves her constituents as a
physician in her district.
Ms. Barragan. Thank you, Chairwoman Eshoo.
What an honor it is for me to introduce Dr. Oliver Brooks,
the president of the National Medical Association. The NMA is
the largest and oldest national organization representing
African American physicians and their patients in the United
States.
Dr. Brooks is an esteemed physician in my district. He is
the medical director and past chief of pediatric and adolescent
medicine at the Watts Healthcare Corporation in Los Angeles. He
also serves as the medical director of the Jordan and Locke
High School Wellness Centers.
His resume is very lengthy. He served as the medical
director for L.A. Care Health Plan, whose mission is to provide
access to quality healthcare for Los Angeles County's
vulnerable and low-income communities and residents.
He has various appointments to hospitals, including MLK
Hospital in my district, and he is the chairman of the
Community Clinic Association of Los Angeles County, a group of
30 community health centers in southern California.
Most importantly, Dr. Brooks has been working on the issues
of racial health disparities and looking at the racial
injustices to our healthcare system for many, many decades. I
can't think of anybody more qualified and more important for us
to hear from in this crisis that we are going through today.
And lastly, he is a graduate of Morehouse College and
Howard Medical School, so he brings a wealth of information to
our committee.
Thank you, Doctor, for your service, for your years of
service, and for testifying here today.
And with that, Chairwoman, I yield back.
Ms. Eshoo. We thank the gentlewoman.
We also want to welcome back to the subcommittee Mr. Avik
Roy. He is the president of the Foundation for Research on
Equal Opportunity. And as I just said, he has testified before
our subcommittee on multiple occasions.
So thank you to you, Mr. Roy, and welcome back.
Dr. Boyd, you are now recognized for 5 minutes. Please
unmute so that everyone can hear you.
STATEMENTS OF RHEA BOYD, M.D., M.P.H., PEDIATRICIAN AND CHILD
HEALTH ADVOCATE, PALO ALTO MEDICAL FOUNDATION; OLIVER T.
BROOKS, M.D., PRESIDENT, NATIONAL MEDICAL ASSOCIATION; AND AVIK
S. A. ROY, PRESIDENT, THE FOUNDATION FOR RESEARCH ON EQUAL
OPPORTUNITY
STATEMENT OF RHEA BOYD, M.D.
Dr. Boyd. Good afternoon, Chairwoman Eshoo, Ranking Member
Dr. Burgess, and members of the committee and subcommittee. I
sincerely appreciate this opportunity to place the health and
well-being of those most affected by COVID-19 at the forefront
of our Nation's public health response.
I am testifying today as a pediatrician who works
clinically, a public health advocate who partners with
community-based organizations, and a scholar who writes and
teaches nationally on the relationship between structural
racism, inequity, and health.
Racial health inequities in the population level
distribution of infections and deaths related to COVID-19 are
alarming. The scourge of COVID-19 is that this virus could have
harmed anyone. Indeed it has stretched across the globe. And
yet, because of racism and it is pervasive hold on every
institution in America, this novel virus has disproportionately
harmed indigenous Americans, particularly those in Navajo
Nation; Latinx Americans, particularly those in Tennessee,
Illinois, Wisconsin, and New York; Native Hawaiian/Pacific
Islander Americans, particularly those in California, Oregon,
and Washington; and Asian Americans, particularly those in Iowa
and Nevada.
This is a national tragedy, but all together COVID-19 has
been the most devastating and deadly for Black Americans. To
date, Black Americans have the highest overall mortality rate
and the broadest distribution of death. In total, one out of
every 1,625 Black Americans have died from COVID-19.
And compared to White Americans, Black American mortality
rates from COVID-19 are the highest right in our Nation's
Capital, Washington, D.C., where they are six times as high.
But similar racial mortality gaps exist for Black Americans
in States like Kansas, Wisconsin, Michigan, Missouri, New York,
and South Carolina.
As a result, national county-level-data reveals that the
COVID-19 death rate is six times higher for Americans who live
in areas that are predominantly non-White as compared to those
who live in areas that are predominantly White.
This inequity is not simply a function of the chronic
underlying illness that also unjustly plagues Black
communities. And it is not simply a function of poverty. Racial
health inequities in COVID-19 are the result of racism. And by
racism, I mean the legacies and current practices of racial
exclusion, discrimination, disinvestment, and violence that
concentrate disadvantage, create adversity, and provide
conditions for disease within communities of color,
particularly Black communities.
These intercepting forms of oppression, all linked by
structural racism, are why Black people are fighting for our
lives right now. Today, Black Americans are more likely to be
the essential workers forced to navigate the workplace hazards
of this new infectious disease. At the same time, they are more
likely to be killed by the State-sanctioned police violence
that renders our communities less safe.
Black Americans account for an outsized proportion of the
newly unemployed and a disproportionate amount of the
chronically underpaid. Black Americans have long held one of
the highest all-cause mortality rates of any racial and ethnic
group in the Nation, and they have nearly become the most at
risk for COVID-related death.
But before COVID-19 was a pandemic, Black Americans were
already weathering an epidemic of premature death. Before we
were devastated by the public murder of George Floyd, we
watched in terror while Ahmaud Arbery was lynched for running.
Before Tony McDade was gunned down by police in Tallahassee,
Breonna Taylor was slain by police in her own home.
Before COVID-19 killed Black Americans at two to six times
the rate of other populations, our tiered healthcare system
left Black folks to disproportionately die from all manners of
disease. Before gentrification disrupted Black neighborhoods,
redlining undervalued our homes. Before Jim Crow terrorized
Black people across the U.S., slavery tortured our bodies and
fractured our families.
Ms. Eshoo. Dr. Boyd, can you just sum up? You are past your
5 minutes.
Dr. Boyd. Yes, racism is making America sick and it is
killing a disproportionate number of our mothers, fathers,
aunts, uncles, neighbors, coworkers, and friends. These are
members of our beloved community, and the injustice of
inequitable disease is that it is wholly preventable.
To address these harrowing inequities, our Nation's
lawmakers must be bold. We need universal healthcare, universal
workplace protections, expanded Federal and State relief
programs, expanded access to housing and nutritional programs,
equitable access to COVID testing and treatment, and a dramatic
reduction of our Nation's homeless, incarcerated, and detained
populations.
We must move to abolish racism from every institution,
every practice, every policy, and every social norm in which it
operates and too often hides. The future health and well-being
of our children and their children will be measured in how well
we succeed in this.
Thank you.
[The prepared statement of Dr. Boyd follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Ms. Eshoo. Thank you, Dr. Boyd.
I now would like to recognize Dr. Brooks for your 5
minutes, and thank you for joining us. And please remember to
unmute yourself.
Dr. Brooks.
STATEMENT OF OLIVER T. BROOKS, M.D.
Dr. Brooks. Good day, Chairwoman Eshoo, Ranking Member
Burgess, members of the Committee on Energy and Commerce, and
Representative Pallone for being on this meeting.
Thank you for the opportunity to appear before the
committee to discuss confronting racial and ethnic disparities
in COVID-19 and the healthcare systems. I am testifying as the
chief medical officer at Watts Healthcare Corporation, an FQHC
in south Los Angeles, and as president of the National Medical
Association, the NMA, which is the largest and oldest national
organization representing the interests of more than 50,000
African American physicians and the patients that we serve.
As the Nation's only healthcare organization devoted to the
needs of the African American physicians and their patients, we
are disturbed by the vast health inequities of vulnerable
populations. We have been and are on the front lines advocating
for patients who face numerous and often insurmountable
obstacles to receiving quality healthcare.
Black patients experience differences in access to
healthcare, the affordability of these services, implicit
biases by some providers, and limited participation in clinical
research, which has consequences around viable medical
treatments. We have been studying and reporting on this for
decades.
As a result of the coronavirus pandemic, a bright light has
recently been shown on health disparities that have always
existed in America. What the world is witnessing is that Black
patients are severely overrepresented among those who have
suffered the morbidity and mortality of COVID-19.
This pandemic is a painfully fresh reminder of these
disparities in our healthcare system that leave minorities
behind. COVID-19 has killed more than 115,000 Americans, with
the Black community accounting for a disproportionate number.
An example of this phenomenon is starkly chronicled in a
Washington Post article published on June 12th. Blacks and
Whites each account for about 46 percent of D.C.'s population,
according to Census Bureau data, yet Blacks account for 74
percent of COVID-19 deaths. And the wards of the city with the
largest Black populations have suffered the heaviest losses.
The disparity shows up not only in terms of who gets
diagnosed and infected with the virus, but who is dying from
the disease.
Data from 40 States that collect race and ethnicity data
show that White Americans are dying from COVID-19 at a rate of
22.7 per 100,000, whereas African Americans die at a rate of
54.6 deaths per 100,000.
For Native Hawaiians and Pacific Islanders, the available
data in ten States show percentages of COVID-19 cases and
deaths that are two to three times greater than their
percentage of the population.
The question is, why are we seeing such glaring differences
in who is dying from COVID-19?
The CDC has noted that those with hypertension, diabetes,
and obesity are more likely to have an adverse outcome. Blacks
are 2.2 times more likely to have diabetes, 20 percent more
likely to have hypertension, and 30 percent more likely to be
obese. Right there, we see a problem.
However, underlying health conditions alone cannot be
viewed as the predominant factor in COVID-19 mortality. Social
determinants of health, defined by the CDC as conditions in the
places where people are born, live, work, and play, are as
important a role in a person's health as genetics or medical
treatment. They include intangible factors such as
socioeconomic, political, and cultural structures, as well as
place-based conditions including educational systems and
accessible and affordable healthcare, healthy food
availability, environmentally safe living surroundings, and
well-designed communities.
Social determinants of health are an underlying cause of
today's major societal health dilemmas, including obesity,
heart disease, diabetes, and depression. Moreover, complex
interactions and feedback loops exist among the social
determinants of health. For example, poor health or lack of
education can impact employment opportunities, which in turn
can constrain income. Low income reduces access to
environmentally safe communities, healthcare, nutritious food,
and increases hardships. Hardships cause stress, which in turn
promotes unhealthy coping mechanisms.
Poor reporting of data, which initially masked the fact
that the disease was disproportionately affecting Black
communities, remains a problem even as States move to reopen
their economies. Today, Americans living in counties with
above-average Black populations are three times more likely to
die from coronavirus as those living in above-average White
counties.
The AAP, American Academy of Pediatrics, last year
published a policy statement on how racism is a core cause of
health problems in adolescents and children. What wasn't it? It
wasn't race. The paper drove home a crucial point. Racism, not
race, affects health, and race should not be used to explain
away disparities caused by racism.
Simultaneously, we are facing another deadly pandemic of
police brutality, which is also caused by the common thread of
systemic racism found in COVID-19.
Mr. Eshoo. Dr. Brooks?
Dr. Brooks. We have witnessed the killings of Ahmaud
Arbery, Breonna Taylor, George Floyd, and most recently the
shooting this past Friday of Rayshard Brooks in Atlanta. These
deaths, that have taken place in just the past six months, are
added to the countless other Blacks who have become victims of
police brutality. Blacks are three times more likely than
Whites to die from----
Ms. Eshoo. Dr. Brooks, you are a minute over so you need to
sum up, please.
Dr. Brooks. Wrap it up. Yes, I am.
Ms. Eshoo. Excuse me.
Dr. Brooks. So, where do we go from here? We advocate for a
health system that protects all people. We advocate for
equitable housing, healthy food, healthcare services,
employment opportunities, and justice. We call on you for
universal healthcare, call on the Federal Government to endorse
policies that address food insecurity, call on policies that
bring more African American physicians and decrease the digital
divide, and more data on COVID-19.
Our fight for a better public health system in the United
States must center on fighting for a public health system in
which Black lives truly matter. I have a vision of transcending
COVID-19 to a healthier Black America and, therefore, a
healthier America, because in the end we are all Americans.
[The prepared statement of Dr. Brooks follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Ms. Eshoo. Thank you, Dr. Brooks.
We will now recognize Mr. Roy. You are recognized for your
5 minutes of testimony. Thank you, again, for joining us. And
please unmute.
STATEMENT OF AVIK S. A. ROY
Mr. Roy. Chairwoman Eshoo, Chairman Pallone, Mr. Burgess,
Mr. Walden, and members of the Health Subcommittee, thanks for
inviting me here today.
The Foundation for Research on Equal Opportunity, or FREOPP
for short, is a nonpartisan think tank that focuses exclusively
on ideas that can improve the lives of Americans on the bottom
half of the economic ladder. I welcome the opportunity to
discuss our work on COVID-19 racial and ethnic disparities.
My written statement contains a more detailed discussion of
our findings. In my oral remarks, I am going to focus on three
topics. First, I will discuss the mortality impact of COVID-19
on major U.S. racial and ethnic groups. Second, I will discuss
our research on the critical subpopulation, vulnerable seniors
who live in nursing homes and assisted living facilities.
Third, I will discuss how economic restrictions put in place by
States and localities have disproportionately harmed
minorities.
We have good reason to believe that minorities are at
higher risk from COVID-19. Severe illness and death from COVID-
19 are associated with patients with preexisting cardiovascular
or metabolic conditions, like high blood pressure, heart
disease, and diabetes. These conditions are disproportionately
prevalent in African Americans, as we know.
As we have been discussing, the latest data from the CDC
indicates that indeed Blacks represent a greater share of COVID
deaths than they do of the general population, even when
adjusted for the fact that COVID is more prevalent in cities.
Mortality rates are also higher in Native American communities,
especially in Arizona and New Mexico.
What may be surprising is that Whites are also dying of
COVID at higher than predicted rates. On the other hand,
Hispanics and Asians represent a lower share of COVID deaths
than would be implied by their geographically adjusted share of
the U.S. population.
The likely reason for these differences is that morbidity
or mortality from COVID-19 is most common among the elderly.
Eighty-one percent of all COVID deaths in the U.S. have
occurred in people aged 65 or older and Whites are the oldest
racial group in the U.S. with a median age of 44. Asians have a
median age of 37, Blacks 34, Hispanics 30. Hence we should
expect to see higher fatality rates in Whites relative to
Asians and Hispanics due to their age and, indeed, we do. On
the other hand, African Americans are relatively young, but we
are still seeing higher mortality among Blacks.
Here is another way to think about it. Overall, 81 percent
of all COVID deaths have taken place among those 65 or older.
But 89 percent of White deaths are among the elderly, 78
percent of Asian deaths, 73 percent of Black deaths, and 59
percent of Hispanic deaths.
On the other hand, overall people aged 45 to 64 represent
17 percent of COVID deaths overall, but only 9 percent of White
deaths, 20 percent of Asian, 24 percent of Black, and 30
percent of Hispanic.
Many of you are familiar with our research on the tragedy
taking place in our nursing homes and assisted living
facilities; 0.6 percent of Americans live in long-term care
facilities, and yet, within this 0.6 percent of the population
lies 42 percent of all deaths from the novel coronavirus--42
percent.
As you know, nursing homes are residential facilities for
medically vulnerable seniors who have challenges with
activities of daily living such as taking a shower or getting
dressed. Nursing home residents are disproportionately poor,
non-White, and enrolled in Medicaid. We wanted to see if States
with high death rates in long-term care facilities were also
associated with higher proportions of Black residents or
residents enrolled in Medicaid.
As my written statement details, we found no such
correlation at the State level. We are working on a county and
facility level analysis that may yield greater insight and we
will be happy to share it with you when it is completed.
When it comes to the economic lockdowns of States and
localities imposed on people and businesses in response to the
pandemic, there is no ambiguity regarding racial disparities.
In late 2019, Black unemployment reached its lowest rate in
history, 5.4 percent. Today the Black unemployment rate is 16.8
percent. Hispanic unemployment reached 3.9 percent in late
2019, also a record. Today it is 17.6 percent.
In my written testimony, I detail how disparities between
White and non-White unemployment rates also reached their
lowest levels in history just before the pandemic. But the
economic lockdowns have brought those disparities back to
levels seen a decade ago.
Compared to Whites and Asians, Blacks and Latinos are less
likely to work in white-collar occupations where working from
home is feasible. Instead, they are seeing their jobs and hours
slashed; hourly wage work is down 50 percent on average, and
even more in places with the most stringent lockdowns.
But Black-owned businesses have been also hit far harder
than White-owned businesses. As Mr. Walden noted, it is
estimated that Black-owned businesses have experienced losses
of 41 percent between February and April versus 32 percent for
Hispanic-owned businesses and 17 percent for White-owned
companies.
Put simply, racial and ethnic disparities are worse when
the economy is worse and especially during the government-
mandated shutdowns of the economy we are experiencing today.
There is much more to say, but let me stop there, and I look
forward to our discussions today.
Thank you.
[The prepared statement of Mr. Roy follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Ms. Eshoo. [inaudible] Your testimony and thank you for it
being within the 5-minute timeframe.
We are now going to move to member questions, and the Chair
recognizes herself for 5 minutes.
Dr. Brooks, when it became clear that COVID-19 was going to
be a public health emergency, what, in your view, should have
been done to prepare for and prevent the health disparities by
race?
Dr. Brooks. First of all, it would have been very helpful
to have aggressive testing in the African American community.
With the knowledge that there would be disparate outcomes based
on the higher incidence of diabetes, obesity, and hypertension,
we should have known early on that we needed to test that
population.
Number two, we needed to really focus on the access to
healthcare and the access for PPE of those that are practicing
on the front lines where these patients would be showing up in
the hospital and the urgent cares, such that those treating
would be comfortable coming into contact with those that could
possibly have COVID-19.
And then lastly, a focus on telehealth, telemedicine, and
getting access to these patients who have hypertension or
diabetes. The studies show that if you have hypertension and
have it controlled, you are less likely to have an adverse
outcome. Same with diabetes.
So those would have been some actions that would have been
helpful at the time.
Ms. Eshoo. Thank you very much.
Dr. Boyd, Mr. Roy, do you want to add anything to that
response?
Dr. Roy. Well, Madam Chairwoman, I would talk about nursing
homes. If we had been aggressive in testing both workers and
residents of nursing homes early on and restricting
visitations--some States did it, but many States went the other
direction--that would have had a big impact because nursing
homes, as you know, ma'am, are disproportionately non-White,
disproportionate Medicaid enrollees, and that is a population
that has really gotten hammered.
Ms. Eshoo. Thank you.
Dr. Boyd.
Dr. Boyd. Yes. I would add that data that actually came out
of your district showed us that, as Dr. Brooks said, African
Americans are less likely to be tested and particularly less
likely to be tested in the outpatient setting.
So African Americans had higher rates of hospitalizations
and ICU visits likely is because, as they presented to care,
they were not adequately tested and identified and then able to
quarantine themselves and not continue to spread in their
communities.
I will also say that because we know African Americans make
up a disproportionate amount of essential workers, we also
needed to distribute and we still need to widely distribute
universal access to protective equipment, particularly for
people who need to work indoors.
Ms. Eshoo. To Dr. Boyd and Dr. Brooks, you both make the
point that racism, not race, affects health outcomes. How has
racism affected our Nation's response to the current pandemic?
And, Dr. Boyd, you can go first.
Dr. Boyd. Thank you for that question.
I think one of the--what I was trying to say in my earlier
testimony is that racism is really pervasive throughout
society. And so the answer is, it partly affected it because
African Americans were already at higher risk of having, as
other folks have said, chronic illness, which is not a function
of their race, but is a function of their access to resources
that racism shapes; and also had higher rates of poverty,
which, again, is a function of how racism distributes resources
by racial group in this country.
Ms. Eshoo. Thank you.
Dr. Brooks, would you like to add something to that?
Dr. Brooks. I would only that in the early days and even
now the data was not clear. The CDC was not collecting racial
and ethnic data on COVID-19 cases and even now is getting it
piecemeal. So there is a feeling that there was just a neglect
on getting information about the racial aspect of COVID-19.
Ms. Eshoo. Thank you.
Well, let's see, I just have a minute. So let's see what
else I can get in.
These questions are for all the witnesses. You can answer
yes or no.
Dr. Boyd, would having free COVID-19 treatment available
help address racial disparities?
Dr. Boyd. Absolutely.
Ms. Eshoo. Dr. Brooks.
Dr. Brooks. Somewhat, but then there is still going to be
the access issues with transportation and getting off from your
work, et cetera.
Ms. Eshoo. Mr. Roy.
Dr. Roy. Yes, but I worry if you just mandate coverage of
everything, the providers are off the hook in terms of what
they charge. So you have to make sure if you mandate coverage,
you also keep an eye on the prices that providers are charging
for those services.
Ms. Eshoo. I think the issue of Federal data collection is
really very important. So I am not going to ask what you think
about that. It has been spoken to not only by the witnesses,
but by the chairman of the full committee.
I think that my time is up, and so I will recognize Dr.
Burgess, the subcommittee ranking member, for his 5 minutes of
questions.
And please remember to unmute.
Mr. Burgess. Great. Thank you.
And thanks to our witnesses for being here with us this
morning. Thanks for your time in helping us in these
evaluations.
Dr. Roy, I just need to ask you a question because so much
of your testimony is data driven, and then the concern that our
information is only as good as the inputs that it receives.
So what is your opinion right now of what, both from the
administration standpoint and what the States are doing, to
improve reporting for coronavirus and other health data to
ensure the inclusion of racial information?
Dr. Roy. Well, what I would say, Dr. Burgess, is that the
data collection is improving. We are now starting to see more
granular data from the CDC on race, particularly race by age. I
testified before another committee, the House Coronavirus
Select Subcommittee, a few weeks ago and we talked about this
issue of not seeing age-based breakdowns by race, which is
really important because, as we know, 81 percent of all deaths
are among people over 65.
So seeing how that breaks down by age given, that the
median age of each ethnic group or race is different is really
important. So we are now starting to see that data.
The other thing I would say is the nursing home data.
States had very different reporting policies of nursing home
data. Now the CDC is requiring nursing homes to directly report
their fatality data directly to the CDC, going around the State
governments. And I think that is helping a lot because that is
giving us consistent reporting from States like Michigan.
Michigan has yet to report on a State basis their data.
They are only now starting to because the CDC is requiring it.
Mr. Burgess. And thank you.
And this committee, the subcommittee and the full
committee, has a history of passing landmark legislation. One
piece of landmark legislation that we are all proud of is Cures
for the 21st Century. But having diverse participation in
clinical trials, and I know from talking to some of our
acquaintances in the pharmaceutical research and manufacturing
side and certainly, the language in 21st Century Cures did
attempt to improve diversity in medical research.
So I guess, Dr. Brooks, if I could ask you, to the extent
that you understand what we did in 21st Century Cures,
recognizing we will be doing a follow-up on to that bill at
some point, Cures 2.0, have we made substantial improvements in
including all ethnicities in collection of the data? And do you
have thoughts about what Congress, the NIH, and private sector
partners could do to significantly increase diversity amongst
clinical trial participants?
Dr. Brooks. So, yes, I do believe there has been some
movement forward with a group called the Alliance and we
submitted a letter to the FDA asking for more representation. I
think it will be very important to have representation in
clinical trials as relates to a vaccine that may become
available.
So I think that some has been done, but there is room for
more. And I appreciate where we are at this point, but where we
need to be, we are not there yet.
Mr. Burgess. Well, thank you.
And let me just say thank you for your service to the
National Medical Association. I know how important that is. And
I am grateful that you are doing that.
You raised the issue about disparate testing at the
beginning of the outbreak of this illness. This is a novel
coronavirus, nobody had ever seen or heard of it before, so no
surprise every aspect of it wasn't gotten right at the
beginning.
But to the extent that we have learned along the way and
you do reference vaccines and vaccine development, from the
standpoint of the National Medical Association, what are you
doing currently to ensure that when a vaccine does become
available, since we have identified the high-risk nature that
we are discussing today, what is the National Medical
Association doing to ensure the availability of those vaccines
when they do finally become available?
Dr. Brooks. So I am actually on the ACIP COVID-19 Work
Group, which is developing the potential for rollout of the
vaccine. And I, in that capacity, am advocating for ensuring
that those at high risk are one of the earliest recipients of
the vaccine.
I also am crafting messaging, because there is concern in
the African American community regarding vaccine hesitancy. So
I am ensuring that I study the data and can ensure my
constituents, my doctors, and my community that the vaccine is,
in fact, safe and effective.
Mr. Burgess. Yes. Of course, we need to ensure that it is
safe and effective and that is the first step. I thank you for
that. I have got a community, in my main county, and vaccine
hesitancy really across all races is a feature. And I do know
that is something that as physicians we are going to have to do
our parts in helping people understand the importance of not
just of a coronavirus vaccine when it becomes available, but
even the flu vaccine next fall. It is going to be critically
important.
So thank you all for your testimony, and your participation
today.
I will yield back to the chair.
Ms. Eshoo. The gentleman yields back.
A pleasure to recognize the chairman of the full committee,
Mr. Pallone, for your 5 minutes of questions.
And please unmute.
Mr. Pallone. Thank you, Madam Chair.
And I want to follow up on the data. I know that Dr.
Burgess mentioned it. But I just think that data is so
important in trying to achieve a clear picture of the problem
that we face with inequities.
And I mentioned before that we did include a number of
requirements in the HEROES Act that would require the Federal
Government to better track and more regularly make public
racial, ethnic, age, sex, and gender data as it relates to
COVID, as well as to require the various Federal agencies in
charge of data collection to modernize their data collection.
But, unfortunately, we are still waiting for the Senate to act
on HEROES.
So my questions of Dr. Boyd and Dr. Brooks, I am going to
kind of put it all together and then if you could just use half
the time to respond.
In your view, has data on COVID-19 cases, hospitalization,
and deaths stratified by race and ethnicity been sufficiently
collected and shared to get a comprehensive view of the
disparities issued? Is any key data still missing? What, in
your view, needs to change in the process of data collection
and sharing to achieve better information so we can address the
problem of disparities?
And I guess we will start with Dr. Boyd with about 2
minutes each here to respond.
Dr. Boyd. Thank you for that question.
I think one of the challenges at the Federal level is that
at the local level and at the State level there are lags in
reporting and there is a different specificity to which various
departments reported upwards.
So I think one thing that we need is comprehensive data. So
you don't just map the racial and ethnic group, as others have
said. It needs to be coupled with age, sex, or gender, and also
location, the county that you are in, so that youcan have an
idea of areas that are underserved by our current medical
infrastructure.
I think when you put those things together you are able to
answer questions like Avik presented, which is like is age
actually a driving risk factor for having COVID-19.
And data that recently came out of Harvard's Medical School
indicated that actually at every age cohort, African Americans
and Latinx populations, in particular, and for some age
cohorts, indigenous populations also, have exceedingly high
mortality rates. I think the most devastating data was that at
age 35 to 44 in the United States, African Americans have a
mortality rate that is nine times White Americans.
This is even for young folks. And you only get that level
of specificity that allows us to say something different to the
public about who is most at risk when you combine data values
like race and ethnicity with values like age.
Mr. Pallone. Well, thank you.
And, Dr. Brooks, again, you know, particularly, what key
data is missing, and you know, and what do we need to change
particularly at the Federal level, to get more accurate data or
statistics that would be useful in trying to deal with these
inequities?
Dr. Brooks. So I think one piece that is key that we don't
have is the rate of testing. We don't have clear data on the
racial and ethnic findings of the number of people tested. We
have the hospitalizations and deaths, but just tested, for
example, what percent of African Americans are testing negative
versus positive, and how does that correlate with the other
populations.
That in and of itself would be very helpful because that
indirectly reflects on access. It indirectly affects on
insurance coverage and the messaging in the African American
community in terms of getting tested. So I think that that
information would be very helpful.
It was data coming out of Connecticut that African
Americans had a harder time getting tested. So if we had more
data on testing, we would have more information on access.
Mr. Pallone. Well, can I ask you, is this just in order to
modernize and get better data--I mean, we talk about Federal,
but a lot of this has to be on a State and local level as well,
or is it mainly the Federal Government that has to act?
Dr. Brooks. So there was, in one of the recently passed
bills, demand that the administration get better data, and they
released a 4-page document that really didn't dig into getting
the data well.
So I think that there should be leadership at the Federal
level to set particular standards of what data needs to be
collected and reported to the national administration like the
CDC.
Mr. Pallone. Well, I think you heard me say in my opening
statement, I was very unhappy with that report, and one of the
reasons that we need the HEROES Act is because the HEROES Act
has language that I think does more towards getting to, you
know, national standards and requiring the Federal Government
to do a lot of this or even get the data from the States and
the localities.
So again, I think the HEROES Act is really important in
this regard.
But thank you so much, thank you both for your input and
for being part of this hearing. It is very important.
I yield back, Madam Chair.
Ms. Eshoo. The gentleman yields back. It is a pleasure to
recognize the ranking member of the full committee, Mr. Walden,
for his 5 minutes of questions, and please unmute.
Mr. Walden. Thank you very much, Madam Chair, and thanks to
our witnesses. This is really insightful, really helpful
information, as we are all trying to figure out what we got
right, what we got wrong, and more importantly, what do we need
to do going forward when a second wave hits as we should
anticipate it will in the fall.
And Dr. Brooks, I appreciated your comments about
telehealth. My districts would stretch from the Atlantic to
Ohio so we really need to ramp up our access to broadband, our
access to telehealth. We did a lot of that in the CARES Act in
a bipartisan way for Medicare--it is up to the States on
Medicaid--but I think it made a lot of sense.
I wanted to ask about the data, because this is something
we have all struggled with, and in the CARES Act and other
legislation we passed that President Trump signed into law, the
first time we put some requirements, maybe not as much as we
should and need to going forward, but there are data reporting
requirements.
As we dealt with this onset of the pandemic, I think we
were all looking to our local healthcare providers to
[Inaudible.] first. So let me ask, from your perspective, in
the facility where you are, were you reporting all of these
data points, and if so to whom? Was this to the State of
California? Was it on up to the CDC?
Dr. Brooks. So what happened is, for all the testing that
we did, it would be reported by the lab to the county. So the
county, therefore, collect the data. Then what the county did
with it, they would report it to CD--California Department of
Public Health.
Mr. Walden. And in that reporting, were you reporting
everything to the lab, and then the lab, in theory, to the
county, that you now, knowing what we know now, was that
fulsome enough? Did you have enough data there? Did it have
ethnicity and age and all of that?
Dr. Brooks. It had age but I believe not ethnicity.
Mr. Walden. So even the data out of your own lab, your own
testing, then, wasn't comprehensive, as we need it to be now?
Dr. Brooks. Well, because in general, lab data isn't
necessarily reported by----
Mr. Walden. Right.
Dr. Brooks [continue]. And we were relatively small in
number at that point in time as it began. And so----
Mr. Walden. Yes, that----
Dr. Brooks [continue]. We needed guidance.
Mr. Walden. Yes, I appreciate that, and I think we all
learned along the way, but it was that area we found, I know,
that these labs generally didn't collect or report those data,
and now we learn that is really important to do and we need to
do it going forward.
Mr. Roy, thanks again for testifying. As we address the
issues within the United States and minority communities here,
and certainly the nursing home issue, I am so glad you raised
that. We saw what happened as a result of the governor of New
York putting COVID-positive patients back into those settings,
and obviously he has learned that was a bad idea.
But when I looked at the information coming from overseas--
and again, just one example in the United Kingdom, Black males
and females are four times more likely to die from COVID-19
than their White counterparts in the U.K. So this is more than
just a U.S. issue. And it also found the same thing true for
Bangladeshi, Pakistani, Indian, and mixed ethnicities.
What is it you are finding in the data about this disease,
if anything, that goes beyond some of the topics that have been
discussed so far? Is there something else here that we are not
seeing, if it is happening elsewhere?
Dr. Roy. So Mr. Walden, we haven't looked at the racial
disparities in other countries besides the United States, but
what the CDC has done that is very useful that I don't know if
those other countries' data that you are citing do, is, the CDC
data is adjusted for geography.
So for example, we know that about half the deaths from
COVID-19 in the U.S. have occurred in the tristate area around
New York City. The tristate area around New York City is
inherently more diverse than the rest of the country. So when
you adjust for the ethnic distribution of minorities, mostly
who live in cities--that is true in the U.K. as well--you see
that because cities are where the outbreaks are and there is
higher mortality in cities, minorities are disproportionately
affected.
So you have to adjust your analyses for that factor. And
when you do that, as the CDC has done, you still see a
disproportionate amount of mortality for Blacks, but not for
Hispanics and Asians.
Mr. Walden. Interesting. And have they gone further to look
at why that is? Is it the higher rates of diabetes and
hypertension and some of the things we now know this horrible
disease, virus, attacks?
Dr. Roy. The CDC has not, but, you know, one thing I want
to point out--and I mentioned this in my oral statement, as
well as in the written testimony--Whites are actually, if you
adjust for geography, White mortality is also overrepresented
in the U.S., and that is probably because Whites, on average,
are older. So I would say that the main thing is, it is a
combination of things we already know, which is age,
cardiovascular comorbidities, diabetes, things like that, and
then if you live in a nursing home. Those are the three big
correlations that we are seeing, and obviously in certain
minority populations, especially African Americans, you see the
perfect storm there--or the imperfect, worst storm.
Mr. Walden. I appreciate that. And Madam Chair, I have no
idea what time I have left, but I will yield it back, and thank
you again for doing this hearing. It has really been helpful.
Ms. Eshoo. Well, thank you, the gentleman does yield back.
It is a pleasure to recognize the gentleman from North
Carolina, Mr. Butterfield, for your 5 minutes of questions, and
please unmute.
Mr. Butterfield. Thank you very much, Madam Chair, and
thank you to the ranking member for yielding back a minus-10
seconds. But it is good to see all of you today, and thank you
to our three witnesses for your testimony.
You know, Dr. Brooks, I watched your interview with the BNC
news channel. It was very very enlightening on how COVID is
affecting physicians, not only patients, but it is affecting
physicians. You know, my dad was a dentist many years ago. And
the National Medical Association and the National Dental
Association were sister organizations. In fact, they often met
for their summer conventions at the same time and in the same
hotel, and our families looked forward to those conventions
every year. And sir, you are continuing that great legacy, and
thank all of you for your testimony.
The killing of George Floyd has finally forced our Nation
to address racism in policing. COVID is forcing us to confront
the impact that racism has on the health of African Americans
and other racial minority groups. These dual crises have
illustrated what so many of us have been saying for years. The
systemic racism and entrenched bias in all facets of our
society have not surprisingly resulted in inequities and
inequalities from top to bottom.
Black Americans face higher rates of poverty, and economic
insecurity, illness, and chronic conditions like diabetes and
heart disease and kidney disease. African Americans also face
higher rates of arrest and incarceration. These are
indisputable facts. The data show this, and the experiences of
our friends and family members prove it.
In my State of North Carolina, 34 percent of those who have
died from COVID were African American, despite the fact that we
are only 22 percent of the population. And of the total cases,
44 percent are Latinx, despite the fact that less than 10
percent of North Carolina's population is Latinx. We have seen
the reports linking kidney disease and its two leading causes--
high blood pressure, and diabetes--to an elevated risk of death
from COVID.
We also know that kidney disease had a disproportionate
impact on minorities long before the current crisis, but this
alone cannot account for these figures. And so Dr. Boyd, thank
you for your testimony. You note that blaming the
disproportionate impact of COVID on communities of color, on
higher rates of poverty and chronic illness, ignores--it
ignores the underlying issue of racism throughout our country's
history.
Dr. Brooks, you also noted in your testimony that in order
for us to effectively eliminate the health inequality gap, we
must address America's perpetual pandemic of racism and the
legacy that hundreds of years of discrimination has left on the
health and well-being of communities of color.
Dr. Boyd and Dr. Brooks--let me take a look at my time. I
am OK.
Dr. Boyd and Dr. Brooks, could you elaborate on this point
and explain to us, 1 minute each, why conflating the effects of
racism with poverty is not a good idea?
Dr. Boyd. OK, I will go first. Thank you so much for that
question.
First, not all patients that have COVID-19 are poor, and
not all African American patients that have COVID-19 are poor.
So first it is inaccurate.
The other problem is that racism shapes how resources are
distributed in this country, and so we have to think about what
that means in terms of healthcare service delivery. One example
we can use right now is how crisis allocation of healthcare
resources during COVID-19 use criteria like life expectancy to
determine whether individuals who presented to hospitals who
were overwhelmed, particularly in New York, who are overwhelmed
with the amount of sick patients, whether or not they got life
support.
If you use a metric like life expectancy--and we know who
in this country, African Americans, have a lower life
expectancy than other populations, a life expectancy gap as
high as ten years between White females and Black males--then
you automatically discount African Americans when you are
talking about who deserves life support in the hospital
setting. So----
Mr. Butterfield. Let me try Dr. Brooks in the 1-minute that
I have remaining. Dr. Brooks, why is it not a good idea to
combine racism and poverty in the same conversation?
Dr. Brooks. Because studies show that when you factor out
income, education, healthcare coverages, and other social
determinants of health, African Americans still have worse
outcomes. So in other words, the variable there is race.
Two people with the same income, healthcare coverage, and
education, you will have African Americans with worse outcomes.
This comes into implicit bias as one of the primary causes.
African Americans are just treated differently because of how
they are seen by the majority community. It is related.
Mr. Butterfield. Thank you. As both of you can see, 5
minutes goes very quickly.
Thank you, Madam Chair. I yield back.
Ms. Eshoo. The gentleman yields back. It is a pleasure to
recognize the gentleman from Michigan, the former chairman of
the full committee, Mr. Upton, for your 5 minutes of questions.
Unmute, please. You need to unmute, Fred.
Mr. Burgess. He states he is trying.
Ms. Eshoo. There you go.
Oh, no, that was someone else.
We can't hear you, Fred.
Mr. Upton. I am sorry. There we go.
Ms. Eshoo. There you go.
Mr. Upton. Well, thanks very much for doing this hearing.
You know, it is so critical that diverse populations,
especially those with vulnerable populations, be adequately
represented in the clinical studies. And the 2020 COVID
pandemic has amplified the existing inequalities that place
individuals and groups in markedly unequal positions. We know
that. We really appreciate the statistics today, particularly
even some of the worldwide numbers that you have shared with
us.
And early reports, of course, of deaths from COVID have
found a startlingly high rate of mortality among the African
American community. So Diana DeGette, my colleague, member of
this committee, and I released some initial policy ideas as we
have been beginning to consider and update what we did with
21st Century Cures. And Dr. Burgess mentioned a little bit
about that as part of our CURES 2.0 process.
In the release that we released--the concept report back in
March, included some ideas on ways to improve healthcare access
for diverse populations. We also included some reforms to
support the further use of real-world evidence to support the
approval in coverage of drugs.
And of course, one of the big things that 21st Century
Cures did was, we expedited the approval of drugs and devices,
but we allowed the clinical trials which were before siloed.
They didn't share information with others, to really change,
which is why when we get a vaccine for this, and better
therapeutics, we will be able to get them months, if not years,
faster because of the work that this committee did in pushing
that legislation onward, where President Obama signed it into
law back in 2016.
So I would like to ask each of you, as we do consider
opportunities to provide and improve healthcare access for
diverse populations, what are your thoughts on the importance
of ensuring that diverse populations are fully represented and
not excluded in the healthcare operations, such things as
clinical trials? And I guess just knowing that you all control
the button, maybe we will start with Dr. Roy, then Brooks, and
then Boyd. Take just a brief time here.
Dr. Roy. Sure, Mr. Upton. You know, the disparity in how
clinical trials have been conducted has been a problem since, I
was in med school 25 years ago. So I am glad to see some work
on that particular topic in Congress.
The one thing I would mention on top of that is that it is
great that your committee has been working hard to reduce the
cost and accelerate the pace of innovation in pharmaceutical
development, and vaccine development, but we also have to make
sure that innovative companies are socially responsible in the
way they price these drugs, particularly if they are going to
be guaranteed decades' long monopolies.
So I hope that your legislation will consider ways to think
about that problem as well, because that also harms access to
drugs for low-income or disadvantaged populations.
Mr. Upton. Exactly right. And Diana and I are working on
that aspect of it as well. It is no good to have a new drug and
have no one be able to afford it.
Dr. Brooks. This is Dr. Brooks. I concur with that
statement. The National Medical Association has had for years a
Project IMPACT, Improved Minority Participation and Access in
Clinical Trials, because we have understood that we needed
minority participation. I think that the actions that are being
taken are very helpful.
I think it critically important when there are more studies
that go forward with treatments for COVID-19, such as
hydroxychloroquine, which is somewhat of a nonstarter, but
Remdesivir and other treatments. We had a patient that just had
convalescent plasma got better overnight. So I just want to
make sure that there is more access to those treatments.
Mr. Upton. Great. Dr. Boyd?
Dr. Boyd. Yes. I will also say expanding Medicaid is really
critical. So most African Americans predominantly live in this
country in the 14 States that have yet to expand Medicaid. To
participate in a clinical trial, many need insurance coverage
to actually cover some of the services that they are receiving
as a part of the clinical trial.
And so the lack of Medicaid expansion disables some African
American populations from participating just on the basis of
affordability. So expansion of Medicaid would be a big boost.
Mr. Upton. Well, I thank you all. I have got 30 seconds
left, so let me just make a comment here at the end.
You know, when we get through this thing, it is because we
have got, in essence, really a three-legged stool. We got to
have the therapeutics, we got to have the testing, and we have
to have a vaccine.
And I know that as one of the provisions in the last bill
the President signed into law, there was $1.8 billion go to the
Shark Tank for home testing, and credit to Dr. Collins for
really putting together an organization literally within 48
hours. They have taken 80 to 100 different entities'
applications to see which private sector group may work.
In my district--excuse me--in my State, we have an entity
that has actually got a device about this size. It has been
patented already to go for two different universities. It has a
little receptacle for both saliva and blood, and it can test
within minutes the antibodies if one has been exposed to that.
And so far it survived the Shark Tank. We are hoping that
it may be the big winner, but it is so important because you
are going to be able to link that to an iPhone. And so wherever
you go, a restaurant, a U.S. capital, your school class, your
line at work, you will be able to show that you are green, and
therefore, you have not been exposed to this.
And it is so important that we get this into the field, we
get it into our homes, because this will be a major--a major
step forward in trying to stop this spread.
So with that, Madam Chair, I yield back my time, and thank
you again for the hearing----
Ms. Eshoo. The gentleman yields back. A pleasure to
recognize the gentlewoman from California, Ms. Matsui, for her
5 minutes. Unmute, please, so we can all hear you.
Ms. Matsui. Absolutely. Thank you, Madam Chair, for having
this hearing today. I want to thank the witnesses for their
mind-blowing testimony.
You know, police violence and racial inequities have long
contributed to levels of stress, toxic stress in the Black
community. In recent months, the police killing of George Floyd
and the unjust disproportionate impact of COVID-19 on Black
communities, have undoubtedly taken an extra toll on the mental
health of Black Americans.
In response to the pandemic, we have seen behavioral health
resource providers across the country make rapid shifts to
telehealth. In Sacramento, data emerging from our community
health centers, providing telesite services shows that no-show
rates for behavior health appointments dropping dramatically.
Dr. Boyd, from your perspective, what opportunities exist
to leverage technology in minority communities to address
mental health challenges? And how do we use telehealth in a way
that creates more access and reduces barriers to care without
exacerbating inequalities?
Dr. Boyd?
Dr. Boyd. Thank you. Telehealth is a great opportunity to
reach populations that might have had other barriers to
physically receiving their care within clinical settings. But
we know in this country that there are wide gaps in
availability to broadband internet, Wi-Fi access, and devices
that support the type of connection you need to have quality
video, to make your telehealth visit effective for your care.
And so to expand telehealth in a way that doesn't further
inequities, we need to ensure that people have access to
quality devices and to internet that makes it possible for them
to participate in this new form of care.
Ms. Matsui. Certainly. And that is really appropriate for
our committee moving forward also.
Community health workers have proven to be an effective and
versatile workforce capable of improving health outcomes for
diverse groups. These workers are able to foster the
relationship between communities and the healthcare system by
promoting trust between patients and providers and ensuring the
health system's ability to provide culturally censured care.
Dr. Brooks, what value do community health workers provide
in the fight against COVID-19, particularly in communities of
color?
Dr. Brooks. So what you will find is community health
workers are generally very similar to the communities in which
they work, so they relate directly to the patients in which
they are treating.
They also understand, therefore, the misperceptions that
may occur, and the issues with getting access. So they are
crucial. And so FQHCs, for example, are funded for 1 to 3
years. What would be helpful is if FQHCs could get funded for
up to five years without having to reapply for finances,
because that would give us more--long--more strategic planning
abilities.
Ms. Matsui. Well, certainly that was something that most of
us do support here.
You know, a recent study by Center Health provided stark
differences, differentials in access to testing for COVID-19,
which also delayed diagnosis and treatment, and led to higher
rates of hospitalization for Black Americans in Northern
California. The study found that Black Americans were less
likely to be tested in an outpatient setting before going to
emergency--before going to an emergency room.
Dr. Boyd, what do you believe can be helpful in a situation
like this? Most people, unfortunately, go to emergency rooms,
even though that is not the most appropriate way. What
consequences does utilizing the system in this way have on
health outcomes, households, and communities, and what
recommendations do you have for changing when and where people
seek care?
Dr. Boyd. Emergency rooms are the most costly setting in
which to seek medical care. In the setting of COVID when
patients may have the acute onset of severe symptoms, that is
an appropriate setting to seek care, but what that study found
is that most African Americans did not receive a test in the
clinic, in the outpatient setting, before they were severe
enough to have to go to the emergency room and be hospitalized.
So broader access to testing, even for patients whose
symptoms might be subclinical, those who are not yet severe, I
think early on we need to know if you have COVID early to be
able to treat you effectively.
Ms. Matsui. Absolutely. And that is why I really believe
that the setting has to be something that is culturally
sensitive, too. In many cases the community health centers
would be the appropriate place to do this too.
I see my time has gone, and I yield back. Thank you.
Ms. Eshoo. The gentlewoman yields back. The Chair now
recognizes the gentleman from Illinois, Mr. Shimkus, for his 5
minutes, and unmute, please.
You need to unmute, Mr. Shimkus. We can't hear you. We
can't hear you. Mr. Shimkus, are you still with us? We can't
hear you. Why don't we get your situation straightened out, and
the chair will recognize the gentleman from Kentucky, Mr.
Guthrie, for 5 minutes.
Mr. Shimkus. I think I got it.
Mr. Guthrie. OK. I will yield back to John and go to my
spot.
Ms. Eshoo. OK, thank you.
Mr. Shimkus. Yes, my apologies.
Ms. Eshoo. That is all right. You are recognized for 5
minutes.
Mr. Shimkus. Thank you very much, and I will try to be
brief.
Dr. Roy, I was really interested in the 0.6 percent of the
population having 42 percent of the deaths. And we all come and
bring our own personal stories. March 23rd, I started a 2-week
vigil on my mom's passing, and we were in the long-term care
facility with her. April 6, she passed. April 18, I took my dad
to emergency room. April 23, he got out of the hospital and
went to a rehab facility and a long-term care. And then he went
to another long-term care facility. Of course, he had to be
isolated in both those cases and in the hospital.
Now he is out of isolation but at a long-term care facility
that is really locked down. And they are doing, knock on wood,
everything right. You hate to tell these stories, because you
don't--you know, you fear that the bad news will come and--so
in my district, we have had 2,256 cases, 125 deaths. Fifty-five
have been in long-term care facilities. We have conducted
58,000 tests. So information is important.
Talk about this long-term care issue, and I know some
States have done other things, maybe not well, but in my
father's case, he has been fortunate to be handled
appropriately through the medical care folks in three different
locations--actually four and--can you talk about this issue on
long-term care?
Dr. Roy. Well, first of all, let me say, Mr. Shimkus, my
condolences for your loss and best of luck with your father.
One thing I should mention is that, you know, I mentioned
the point about how 42 percent of all deaths nationwide have
occurred in nursing homes even though they are 0.6 percent of
the population. Outside of New York State, it is actually over
50 percent. So in places like your district, in places like
Illinois, it is over 50 percent. And there are some States--
Minnesota, I think, is at 80 percent. We--I think in my written
testimony, I have some of those maps in there that go State by
State.
So the problem is especially severe in certain parts of the
country, and policy has had an impact on that. We have talked
about, and I know you all are aware, of how some States, like
New York, New Jersey, and Michigan, forced nursing homes to
accept patients who had active COVID infections even though
those nursing homes did not have the wherewithal to quarantine
those patients effectively.
Other States went the other direction. Florida did a good
job of locking down nursing homes, and you know, what they will
tell you, it was very hard to tell loved ones, family members,
that they couldn't visit their relatives in nursing homes. That
was not something that was a politically or morally easy
decision to take, but they did it because they took the threat
seriously.
And I think now that we have learned more and more about
this problem, when I started talking about this two months
ago----
Mr. Shimkus. Dr. Roy, let me go to Dr. Brooks real quick
because----
Dr. Roy. Sure.
Mr. Shimkus [continue]. My time is running out. So Dr.
Brooks, we are all big fans of FQHCs and community health
centers, and I have stats from my local one and how they meet
the needs of the Medicaid, the minority, Hispanic. They also
create--have Spanish-speaking attendants, so for those who need
English as a second language.
And I didn't want to go through all the stats, but the FQHC
survived based upon benefits--and I think you raise a good
issue--3- to 5-year extension would be a helpful thing. That is
the things that we need to hear, as far as other opportunities.
I know my community health clinics, I had a conference call
with them a week or two ago, and they were addressing their
response. They were very thankful for the $2 billion to help
the FQHCs. Were you able to take advantage of that additional
money for your community health center?
Dr. Brooks. Yes, we were. We got $454,000 for testing,
$67,000 just given, and then 927 in the CARES Act. So we did
get some support, and we are actually appreciative of it.
Mr. Shimkus. And I thank you for that, and there is always
more to do. We appreciate your testimonies. This has been a
great hearing.
Madam Chairman, I appreciate the time. Sorry about my--
because it took me 25 seconds to get on, I will yield back my
time.
Ms. Eshoo. All right, the gentleman yields back. A pleasure
to recognize the gentlewoman from Florida, Ms. Castor, for your
5 minutes, and please unmute.
Ms. Castor. Yes. Thank you, Chairwoman Eshoo, for holding
this important hearing on health disparities. The COVID
pandemic certainly has highlighted the unfortunate health
disparities across America.
A recent press announcement, here in Florida of, Florida
Department of Health data showed that coronavirus is twice as
high among our Black and Latino neighbors here in this State,
and now we are seeing an uptick in positive cases in Florida.
So we are very concerned about this and the fact that we really
do not have modern data reporting systems.
So Dr. Brooks, thank you very much for encouraging us to
provide greater leadership on the standardization of data. I am
especially sensitive to this because there has been a troubling
pattern in my State about data reporting and transparency.
For example, the State previously withheld important data
regarding nursing home infections and deaths. They had withheld
certain data reported by our medical examiners. That is public
record in Florida. And they also fired a data scientist. They
said they did that largely because she was asked to censor
certain data.
And, you know, we need this, public health experts need
this information so that we know that it is safe to go back to
work, to go to school, to go out in public, and where to target
resources.
Chairman Pallone, I want to thank you very much for
pressing the CMS administrator, Seema Verma. She had said she
would report the Medicare coding data in March, and here we are
in the middle of June and we still don't have it. And I bet Dr.
Brooks and Dr. Boyd can share with us why the Medicare coding
data is so important and how that kind of data can improve the
analysis on COVID-19 by race and ethnicity. So I want to turn
it over to them and ask them to weigh in on that.
Dr. Brooks. So I will speak first. So, yes, that would be
extremely helpful. We are in the 21st century in the United
States, and technology and data is what drives our decisions.
So if you don't have that, you cannot make wise decisions.
Those 65 years and older, those are the ones that are dying
the most, getting hospitalized the most, and those who are on
Medicare. So if we have the data coming in, we can make
calculated decisions on how to employ testing, how to employ
healthcare services, how to employ public health messaging. So
without that data, we are somewhat flying blind.
Ms. Castor. Dr. Boyd?
Dr. Boyd. I will add that--oh, yes. Thank you.
Ms. Castor. Go ahead.
Dr. Boyd. Thank you. I will add that in addition to the
Medicare population, as a pediatrician, it is also incredibly
important that we are capturing the emergence of COVID among
our younger civilians, and I think all insurers should be
collecting this data so that we can have it in real-time
because the data lags affect how well we can respond to it.
Ms. Castor. So Dr. Brooks, I have heard from a lot of my
local public health experts and practicing physicians. They say
reporting to CDC is completely antiquated. Sometimes they are
still accepting fax information from various sources. I mean,
if these come from multiple sources, from counties and health
departments and States and hospitals, but this seems to be
really outdated.
What kind of advice do you have--and I know Mr. Walden
asked you about reporting from your lab, or from your office,
and you may want to talk about or clarify what you are
reporting and what your local health departments are reporting.
Dr. Brooks. So now all our data is captured, including
race, and ethnic data on testing. Also, on our ICD10, or our
coding that we submit, we call it encounter reporting. But the
broader question is what you are raising. There needs to be
national standards for data collection and reporting and a
national clearing house that manages this. And it is--like, you
spend money on administration, but that is where there needs to
be some money spent.
And there needs to be a laser focus on this. It is really
not that difficult in the computer age. The data is in there.
So it is a matter of demanding it, collecting it, analyzing it,
and acting upon it.
Ms. Castor. Great. Thank you very much. I yield back.
Ms. Eshoo. The gentlewoman yields back. I now recognize
again, the gentleman from Kentucky, Mr. Guthrie.
Mr. Guthrie. Thank you, Madam Chair. I appreciate you
holding this hearing and how much we are all coming together to
try to address this issue. And I am glad we are here today to
better understand these issues.
But I want to specifically talk briefly about the Medicaid
population. They are some of the most vulnerable, and the data
on this population is less than optimal. The lack of data is
evident in a CMS report published in November, titled,
Quantifying the Distribution and Completeness of Select
Demographic Variables in 2016. And I know we are going to do
this at the end, take action at the end, but I would like to
submit this for the record.
And the report finds that most States don't have race or
ethnicity data for more than ten percent of their population,
and this is vital information for fighting the coronavirus and
other diseases.
And before I get to my question, I will just mention about
our colleague, if I can get through this. Dear friend of mine
and a fellow Kentuckian, yesterday, you know, Andy Barr lost
his wife, Carol. And it just reminds me, as we talk about all
these statistics and numbers--and they are important as Dr.
Brooks said. You have to understand them or you are going to
make the wrong policy decisions.
But everybody that we are talking about is a life. It is a
tragedy, it is a family, it is just people affected, and that
is why it is so important that we address this and get this
right.
I was talking with Andy or communicating with him mid-
afternoon yesterday, had no idea anything was wrong at all, and
we still don't know exactly what happened, but she seemed to be
healthy this time yesterday. And it is just tragic, but--so we
need to understand the numbers but also understand the faces
behind the numbers is just what I want to share.
But with Dr. Roy, I want to ask you, and the others could
comment as well--I guess I have used up a couple of my minutes
already, but--you mentioned in your testimony that more data is
needed, and I think everybody has talked about more data is
needed.
And I guess getting back to the personal side of it and
addressing the issues, once we have data, how quickly or how
fast do you think, Dr. Roy and the others, we can pivot to
address these disparities?
Dr. Roy. Well, Mr. Guthrie, I would say that there are
certain aspects of it that we can address very quickly in the
sense--for example, the nursing home piece. There is a lot that
States and localities and the Federal Government, Congress, can
do today to address the nursing home disparities.
Then I would talk about Medicaid. You mentioned Medicaid.
There are a lot of challenges with Medicaid, both in terms of
the way Medicaid steer first people into nursing homes, instead
of facilitating them getting the care they need in their own
homes.
And also just the fact that Medicaid, because it pays so
little to providers, particularly primary care physicians, that
people enrolled in Medicaid don't get access to primary care,
therefore, have poor management of chronic diseases, which, as
we have seen in COVID, is lethal.
Those are two things I would talk about in terms of things
that, you know, short-term, midterm. And then obviously the
issues related to the legacy of slavery and segregation,
structural racism, because they are big challenges that we
obviously need to put a lot of attention into, and I welcome
all Members of Congress doing so.
Mr. Guthrie. And Dr. Brooks and then Dr. Boyd, if you would
like to comment, I have a couple of minutes left.
Dr. Brooks. Sorry had to unmute myself.
I think that one thing is to focus on right now is implicit
bias training. We are all talking about race [Inaudible.] There
are studies that show that when police officers, healthcare
providers, have implicit bias training, they make better
decisions, better informed decisions.
And we did talk about this once, but the digital divide.
[Inaudible.] More access to broadband. We know right now, that
that would have a positive effect, just in terms of access to
information, beyond telehealth. So those are two acts that I
would say I would look at immediately beyond any other data
that may come subsequent.
Mr. Guthrie. Thank you. And Dr. Boyd?
Dr. Boyd. I would also say, we have an enormous amount of
data already that we can start acting on. Part of that data is
that 8 out of 10 of the COVID clusters have actually been in
correctional facilities. In addition to thinking about nursing
homes, we have to think about all congregate living sites--
homeless shelters, correctional facilities, detention
facilities--and what we are doing to focus on those
populations.
So I would call us to act on the data we already have that
is alarming that multiple people have noted.
Mr. Guthrie. OK, thank you. And then I am also on the
Education and Labor Committee, and we had a hearing on the
length of the summer and summer learning loss, and a lot of it
came up. So particularly there was the superintendent of the
Cleveland schools, and just--even though that is a big city and
has broadband, is access to the devices and just the disparity
of families that have higher incomes and lower incomes and just
in terms of access to broadband and that doesn't just affect
health, it affects education.
So I appreciate you all being here, and this is important.
And I thank you, Chair, for bringing this hearing together, and
I yield back.
Ms. Eshoo. The gentleman yields back. The Chair now
recognizes the gentleman from Maryland, Mr. Sarbanes, for 5
minutes of questions, and please unmute.
Mr. Sarbanes. Thank you, Madam Chair. Can you hear me?
Ms. Eshoo. I can, very well. Thank you.
Mr. Sarbanes. Appreciate this hearing. I want to thank the
witnesses who joined us today. This is an extremely important
topic.
Maryland, like the rest of the country, is suffering, and
communities of color in Maryland have been particularly hard
hit by the coronavirus pandemic. There are lots of different
reasons for this, and our witnesses today have discussed those,
but among them certainly are the longstanding issues of
inequality and racism that we experience in our country.
In my State, African Americans are now accounting for 29
percent of the population but 41 percent of the coronavirus
deaths. Hispanic or Latinx individuals are ten percent of the
population but represent 33 percent of the diagnosed
coronavirus cases. So these numbers obviously are unacceptable.
We are working hard, in this committee and in Congress, to
address the root causes. I would like to have submitted--I know
at the end of the hearing, you will be accepting a unanimous
consent request from Members to submit things for the record,
but our attorney general, Brian Frosh, authored an article
today which discusses the health disparities, and the
disproportionate impact. It is an excellent overview of what
the experience in Maryland has been, and so we have submitted
that for the record.
Dr. Boyd and Dr. Brooks, thank you for your testimony. I
would like to merge together two topics that have already been
alluded to in earlier discussion today.
One has to do with distribution of vaccines, if we can
ultimately get the vaccine into communities that have been
disproportionately impacted, and the other has to do with the
sort of culturally sensitive and competent workforce and how we
deliver treatments, vaccines, and other things in various
communities.
If you could speak again to how critical it is, and maybe
let's use the availability of a vaccine as the way of doing
this, how critical it is to make sure that the delivery of a
vaccine is done in an equitable fashion, and how important in
accomplishing that is, that we have a healthcare workforce that
has a sense of understanding and connection to the communities
that we are trying to reach.
Because I know those are issues that both of you put front
and center in the work that you do. So why don't we start with
Dr. Brooks and then go to Dr. Boyd.
Dr. Brooks. So the equitable distribution of the vaccine is
critical, and it may not be as easy as it sounds. Should you
give it to those in long-term care facilities? Should you give
it to first responders? Should you give it to doctors on the
front line? Should you give it to an 80-year-old Black man with
diabetes and hypertension?
So it will also be the amount of vaccine that we can
produce per month. That being said, I do know that that work is
ongoing, and I am very happy with the way that the decisions
are being made thus far.
As it relates to in the communities, yes, the issue with
police and police brutality, there are issues with race, and it
would be better if we had more representation by community
advisory boards, and other actions that address implicit bias
and racism in police and that flows over to the vaccines.
Mr. Sarbanes. Dr. Boyd, could you speak to what it means to
do outreach in certain communities and what it means to have
that cultural sensitivity, particularly when it comes to
delivering healthcare opportunities?
Dr. Boyd. Yes. I think we have already seen, as a
pediatrician, that we have had lower rates of vaccination
because of how COVID-19 disrupted preventative care, primary
care access for patients. And so as we, as a healthcare system,
flex to go to telehealth and outdoor clinic settings, I think
we also have to think about accessible platforms for patients
to get the vaccine, even for kids to get their regularly
scheduled vaccines, and definitely for families and communities
to get the COVID-19 vaccine.
Having platforms that are available in folks' communities,
that they can walk up to and not have to have a car to drive
into, I think, would go a long way in making sure that access
is more equitable.
Mr. Sarbanes. Thank you very much. I yield back.
Ms. Eshoo. The gentleman yields back. A pleasure to
recognize the gentleman from Virginia, Mr. Griffith, for his 5
minutes. Are you unmuted?
Mr. Griffith. I believe I am. Can you hear me?
Ms. Eshoo. Yes, you are.
Mr. Griffith. Thank you, Madam Chairman, I appreciate that.
Dr. Brooks, you brought up, in your testimony and some of
your comments, that hypertension and diabetes are a concern. I
thought that was interesting because I was reading an article
over the weekend that talked about how food deserts,
particularly in poorer communities, African American
communities, et cetera, lead the folks in those communities to
be overweight, thus, more hypertension and diabetes.
Do you think that that is something that we should look at
as a part of all of this that we are looking at?
Dr. Brooks. Absolutely. That is one of the primary social
determinants of health that is leading to adverse outcomes.
African Americans are more likely to be food insecure, 22
percent versus 12 percent. And you all know that it is hard to
get to the marker. We are doing this now.
So if it--even under COVID, if you don't have that access,
it is going to even be worse. So, actions that reduce food
insecurity will directly lead to better health outcomes.
Mr. Griffith. Well--and correct me if I am wrong on this--
part of what I interpreted from that article was that there may
be some--like a corner store or something that they are
carrying potato chips, frozen pizzas, you know, Vienna
sausages, et cetera, all things that are high in sodium and
which are not particularly healthy, and because there is not a
full-service grocery store, even though they might be able to
get some food, they are not getting the healthy foods that
would help them with their weight issues, hypertension, or
diabetes. Is that also fair?
Dr. Brooks. That is true. And that is part of what directly
informs the statistics of food insecurity. So access to healthy
foods and the ability to purchase it are what define food
insecurity.
Mr. Griffith. Appreciate that. I also appreciate you
bringing up telehealth. I represent a very rural community
where telehealth is also important. It is one of those things I
am now curious that there be a study because the most rural
parts of my district also have higher levels of hypertension
and diabetes as well. Even though it is not a minority
population, it is a poor population that is separated from easy
access to full-service grocery stores.
So that is an interesting point. I mean, telehealth is
going to be huge. We have got to get the broadband out there,
whether it be through wide spaces, whether it be through lower
satellite, or whether it be through laying of [Inaudible.] but
I appreciate that.
Dr. Roy, I am going to switch gears completely and go with
you about something that you were talking about nursing homes,
and you noted the older population in nursing homes had been
particularly, because of the congregate care, subject to both
getting the disease and then obviously causing the morbidity
and fatalities.
I had a concept that was brought to me a number of years
ago when I was in the State legislature. We actually got a law
passed in Virginia to allow a zoning variance for this--and
then North Carolina followed suit--and you would basically
create a medical cottage which then could be placed into
somebody's backyard so that if I wanted to put my mother-in-law
out there in the backyard because she had some issues, and if
there were requirements that you have to needs for daily
medical help. But if I want to do that, I could then have her
in the backyard instead of putting her in a nursing home.
The concept has never taken off because Medicare and
Medicaid don't reimburse that at all, and obviously, unless you
are extremely wealthy, you can't afford to rent a medical
cottage and stick it in the backyard.
But the data that we looked at when we were developing
this, the data indicated it would actually be cheaper than
nursing homes, and you would still be closer to family. Do you
think that is something that this might--the time might have
come for us to push Medicaid and Medicare to reimburse
something like this, so that not only would people be closer to
their family, but they also wouldn't be in congregate care
settings where people are susceptible to getting a virus like
this?
Dr. Roy. Well, Mr. Griffith, what I would say is that in
the nonpublic programs, among people who can afford to do it,
home-based care is exploding. So overall, it is a trend that we
are seeing. It is just that Medicare and Medicaid were designed
at a time when none of these things were a part of the thought
process or equation.
So, absolutely we need to update and upgrade Medicaid and
give States the flexibility to do more, to pay for care in a
home-based setting.
Right now, Medicaid, basically, as you said, because of the
way it reimburses Medicare to a--you know, also, but it is
particularly a Medicaid problem. It really steers people to
these congregate facilities. So that is very, very important.
More people should be taken care of at home. It is less
expensive, and it is also safer.
And then we are going to have to really do a much better
job of overseeing the way--you know, oversight of nursing
homes. There is, in theory, all sorts of oversight in place,
and for whatever reason, it just doesn't seem to ever work.
And so nursing homes don't have the ability to do adequate
infection control. There are lots of GAO reports and others
about this problem.
Mr. Griffith. Well, I appreciate that, and we will be
looking into that more, and I may contact you. And I don't know
how much time I have, if any, but I am happy to hear from
either of the other witnesses on that concept of----
Ms. Eshoo. I think time has expired, Mr. Griffith.
Mr. Griffith. Then I yield back. Thank you, Madam Chair.
Ms. Eshoo. OK, thank you. The gentleman yields back.
A pleasure to recognize the gentleman from New Mexico, Mr.
Lujan, for your 5 minutes of questions, and unmute, please.
Mr. Lujan. Thank you, Madam Chair. Great to be with you,
and thank you to each of our witnesses for joining us today.
The coronavirus pandemic has exacerbated many of the
longstanding health disparities in our country. In my home
State of New Mexico, some rural and Tribal communities don't
even have access to running water to wash their hands, to
bathe, to cook, to drink, which we know is essential to
preventing the spread of the virus, let alone broadband for a
telehealth visit for their Doctor.
Dr. Boyd, these are exactly the types of COVID-19
protections and COVID-19 supports that you describe in your
testimony as being inequitably distributed, correct?
Dr. Boyd. Yes. In our country, instead of income, racial
group is the strongest predictor of access to clean water. And
Native Americans are 19 times more likely to lack access to
clean water in their homes than White households, so, yes,
absolutely.
Mr. Lujan. So Dr. Boyd, how has the inequitable
distribution of COVID-19 protections and supports impacted the
spread of the virus?
Dr. Boyd. So, just speaking of clean water, if you don't
have access to clean water--and hand-washing is one of the
primary ways that we limit the spread of infectious disease in
this country--it then affects your ability to keep yourself
safe, your kids safe, your family safe.
So if we know that clean water access is determined by a
racial and ethnic group in this country, that means that we are
limiting the protections we provide communities by their racial
and ethnic group, and that is what is unjust.
Mr. Lujan. You said it best, Doctor. The results have been
devastating. And, for example, 9,845 COVID-19 cases in New
Mexico, nearly 58 percent have been Native American. The Navajo
Nation has more cases per capita than any other State in the
Nation. This wasn't inevitable, though. It was caused by
systemic inequities in our healthcare system and in our
society, and--well, I know this may be hard for some of my
colleagues to say today--the Trump administration's failed
response to this crisis.
The Indian Health Service, which has been chronically
underfunded long before this pandemic, faced long delays in
receiving requested testing supplies for the Navajo area and
the Albuquerque his hospitals.
When I called the White House to push for the delivery of
these supplies, the administration could not give me a straight
answer as to whether it was going to deliver these supplies or
how it was going to meet the needs of the Navajo Nation and the
Pueblos.
The Trump administration also awarded a $3 million for his
contract to an 11-day-old company run by a former White House
staffer, which delivered thousands of substandard masks that
were unfit for use.
Then we learned the CDC is not sharing critical data with
Tribal epidemiology centers the way they share it with State
health departments. Tribes need this data to protect their
communities, and they are entitled to access it as sovereign
entities.
And just this last week, the State of New Mexico is
investigating allegations that a private hospital racially
profiled Native American mothers and separated them from their
newborn infants during the first crucial days while awaiting
COVID-19 test results. If it is true, it is horrific and
completely unacceptable.
So, Dr. Brooks, can you speak to how instances like those I
just described, contribute to mistrust of the healthcare system
in many minority communities and some of the history behind
that?
Dr. Brooks. So what you described does not sound too
different from what happens in the African American community.
As a pediatrician, I do understand the critical nature of that
bonding of the first four hours after the baby is born, so that
separation was untenable and is not being done anywhere else.
So I almost want to say Native American lives matter, and to
add that to the list.
It just speaks to systemic inequities, and what concerns me
is that, you know, the inequities have been going on in Native
Americans' populous, say, 200 years, African American
population, 400 years. Though it is the same. We are asked,
what do we do now? So it is hard to reverse 2- to 400 years of
inequity. I think the main thing is what you did, call-- I
would call the White--I mean, I am not you, but I would call
the White House again, and you probably did.
I have been telling my patients and my people to stomp
their feet. In other words, just get active and stay active;
don't take no for an answer. It may be easy for me to say
because you are talking to the White House and not getting
responses. But that is the best I can say now. I feel for you
and those that you represent.
Mr. Lujan. And then Dr. Brooks, as my time concludes here,
can you just elaborate on why diversity in clinical trials is
so important, both in ensuring equitable access to the latest
treatments but also in ensuring that researchers have all the
data they need to demonstrate that new treatments are effective
for all patients?
Dr. Brooks. So, yes, what you just said, make sure the
treatments are effective, but also I think it is the general
concept of these people matter. We need to include African
Americans, Native Americans, Pacific Islanders, because we are
thinking about them. They are on our radar. We are just not
made to do it.
Mr. Lujan. Thank you, Madam Chair, and I yield back. And I
will also be submitting some information into the record at the
end of the hearing. Thank you.
Ms. Eshoo. The gentleman yields back. Is Mr. Bilirakis
prepared to question? I don't see him or hear him. I did
before. Let's move to----
Mr. Bilirakis. I am here, I am here.
Ms. Eshoo. Oh, there you are. And you are unmuted, so you
can begin your questioning. It is a pleasure to recognize you.
Mr. Bilirakis. Yes. I was concerned about my hair, but then
when I saw Fred's hair, I----
Ms. Eshoo. Well, you look great.
Mr. Bilirakis. I am OK, yes.
Ms. Eshoo. Not to worry.
Mr. Bilirakis. All right. Dr. Brooks, approximately 36
percent of African American Floridians experience obesity, the
highest percentage of any racial or ethnic group in the State,
and 31 percent of the Hispanics experience obesity, compared
with 27 percent of Caucasians. As of June 8, 2020, 27 percent
of COVID-19 hospitalizations and 21 percent of deaths statewide
were among African Americans, and only 17 percent of the
population in Florida is African American.
According to a June 3, 2020 analysis, conducted by the CDC,
Hispanic Floridians make up 46.5 percent of the COVID-19 deaths
when weighted population distributions are considered,
reflecting a disproportionate burden of COVID-19 mortality.
While Congress and the administration have taken actions to
increase access to telehealth, enhance State flexibility under
Medicaid, and appropriate hundreds of billions of dollars to
combat the COVID-19 pandemic, what can be done to ensure that
seniors have prompt access to treatments for obesity once they
are approved by the FDA?
Dr. Brooks. So obesity does directly lead to diabetes.
Diabetes is diet, exercise, and healthcare. So diet, if you are
food insecure, you are not going to eat well. If you live in
crowded housing, you are not going to exercise as much. And if
you don't have insurance, you won't get the medical care.
So we really need to look at those underlying conditions.
The treatment for diabetes is actually lifestyle more so than
anything else.
As relates to medications, like, for example, Metformin,
glimepiride insulins, you are more likely to get medical
treatment if you have health insurance. I would say Medicaid
expansion and universal healthcare. These are the actions that
would drive a decrease in diabetes and, therefore, decrease in
adverse outcomes.
Mr. Bilirakis. OK. Now, there are medications also in the
market that treat obesity specifically.
Dr. Brooks. OK.
Mr. Bilirakis. I know about Metformin as well.
But what are the effects of those medications? Have they
been successful? I am also concerned about any adverse effects
of those medications. Can you elaborate quickly on that,
please?
Dr. Brooks. Yes. There are some medications that treat
obesity, you know, diet suppressants. But in general those
haven't been that successful. The main treatment for obesity,
at this point, other than managing it with diet, is the
surgery, fundoplication or gastric bypass surgery. So better
access to that surgery by Medicaid would actually help quite a
bit.
Mr. Bilirakis. Does that include--are those surgeries
included, reimbursement under Medicaid or Medicare? I know
private insurance takes them.
Dr. Brooks. At least in California, yes, if you meet
specific criteria, yes.
Mr. Bilirakis. OK. Thank you.
The next question is for Mr. Roy.
Do stay-at-home orders disproportionately impact racial and
ethnic minority communities, and, if so, how?
Dr. Roy. Well, thank you for the question because we have
been talking a lot about health outcomes and they are very
important, but we have not been talking enough about the
economic disparities that have been created by the lockdowns,
which is an incredibly important problem. It affects tens of
millions of Americans.
Yes. So as I mentioned in my oral testimony, it is also in
my written testimony, because non-Whites are more likely to be
hourly wage earners or in other jobs or occupations that
require physical presence, they can't work from home, they
can't Zoom all day to do their jobs, they are both more at risk
if they are in a high-risk occupation from COVID and they are
also more at risk of facing unemployment.
So this has been a huge problem, particularly in the
lockdowns. We have talked a lot about nursing homes today. The
flip side of the fact that half the deaths are happening in
nursing homes outside of New York State is that younger
Americans, in general, are at lower risk. That both affects
schools--we have had these schools closures which have huge
economic consequences not only for the children, but for the
parents, particularly single parents, who can't go to work
because going to work means leaving their children unattended
at home--and also the people who have lost their jobs due to
the economic lockdown.
So there are a lot of problems when it comes to disparities
on the lockdowns, and I think we need to do a lot more to
refine and target our economic restrictions to the populations
who are most at risk.
Mr. Bilirakis. Thank you. Thank you. I appreciate that.
Dr. Brooks----
Ms. Eshoo. I think that the gentleman's time has expired.
Mr. Bilirakis. Oh, OK. All right. I will submit it for the
record.
Thank you very much, Madam Chair.
Ms. Eshoo. All right. Thank you, Mr. Bilirakis.
Next up is the gentleman from Oregon, Mr. Schrader.
Are you there?
If not, then we will go to Mr. Kennedy of Massachusetts.
Voice. Let's go to Ms. Kelly. She is on camera.
Ms. Eshoo. All right. Then, we will go to the gentlewoman
from Illinois, Ms. Kelly.
Ms. Kelly. Oh, I didn't think I was going to come up that
quick.
Thank you so much, Madam Chair, for having this.
You know, this is something near and dear to my heart as
chair of the Congressional Black Caucus Health Brain Trust. We
have been working so hard around this issue, but not just
around COVID, around maternal mortality and other issues also.
So I just want to thank the witnesses for their comments,
because if we don't do anything about the social determinants
of health, we are going to revisit this with other illnesses
over and over and over.
And also the statement that it is racism, not race, is so
true. I lost my uncle to COVID. So I appreciate my colleague
saying that it is not just statistics. We know it is real live
people. And he worked all his life. He lived a good life. He
wasn't poor. But he lost his life also.
The church he went to had 60 steady people that went to the
church. Sixteen of the 60 people are now dead because of COVID
in New Jersey.
So we have been in Chicago, not now, but 72 percent of the
people that died were African American, and I think we are 29
percent of the population. So, I mean, we have just seen it all
around. Things have improved.
But if you could--all of you can just answer if there is--
because we can have hearings and we can do all this, but if we
don't implement anything, if we don't do anything, then the
hearing is in vain.
So if each of you can mention just one thing that we have
to do in leaving this hearing, what would it be?
Dr. Brooks. This is Dr. Brooks now. I will speak first.
First, I want to just pause and thank Representative Robin
Kelly for all she has done for the NMA and supporting us,
including gun violence, which is not a discussion today. But
she has been there and we thank you, thank you, thank you.
If I would say one thing, I would go to implicit bias
training, because I do believe that the racism that occurs, a
lot of it is subconscious. Some are conscious. We have two
people that were hung in California. That scares me right now,
quite frankly.
But when you have implicit bias training, it makes you,
first of all, this is a White person's think about it, and
then, second of all, makes you do something about it.
And so that, racism that is inherent in our society needs
to be addressed. So that would be my method of addressing it.
Ms. Kelly. And just real quickly. We spoke to a Black
doctor who gave an example that he had tennis elbow and he went
to a doctor and the doctor was White, but he didn't tell the
doctor he was a doctor. And all the things the doctor said that
he should do, and then he would say, well, shouldn't you be
doing this or shouldn't you be doing that? And the doctor
eventually said, oh, you must know something about healthcare.
After he told him he was a doctor, that is when he said, oh,
OK, let's do this or let's run this test.
So, Dr. Boyd.
Dr. Boyd. Yes. I would also like to begin by just saying, I
am so sorry for you and your family's loss. It is so
devastating.
I think if there was anything we were really going to push
other than universal healthcare it is to end segregation.
Studies have shown that if you end residential segregation, you
will close the Black-White gap in income and unemployment and
education. And those are powerful social determinants of health
that are shaping our COVID inequities that we have seen. So
ending residential segregation has to be a priority.
Ms. Kelly. We see that in Chicago, a nine-mile difference
between the South Side and I believe the West Side. My
colleague, Bobby Rush, can correct me. And the people that live
north, nine miles difference, a 30-year difference in life
span.
So, Mr. Roy.
Dr. Roy. Yes. Well, building on what Dr. Boyd said,
educational attainment is the most important social determinant
of health in terms of its correlation to health outcomes and
that is obviously driven a lot by residential segregation.
The other thing I would mention is, we have talked a lot
about Medicaid. Medicaid reform, particularly Medicaid reforms
that increase access to primary care for management of chronic
diseases, and also getting people out of congregate facilities
and into more home-based care, those are extremely important
things that Congress could address today if it wanted to.
Ms. Kelly. Thank you all for that you do, and thank you for
being witnesses today. I really appreciate you.
And I yield back early.
Ms. Eshoo. The gentlewoman yields back.
The Chair will now recognize the gentleman from Indiana,
Dr. Bucshon.
Mr. Bucshon. Thank you, Madam Chairwoman. I am just
restarting my own clock here.
As you may or may not know, I was a cardiothoracic surgeon
before coming to Congress. And as I look at the available
medical data being reported on COVID-19, it is clear this virus
has disproportionately affected racial and ethnic minority
communities, in particular our Nation's Black communities,
although, as we have heard, more accurate data is needed.
There are still many questions as to why this is the case
and what all factors contribute to it, but I am deeply troubled
by reports that show it is not necessarily infection rate that
is disproportionate, but rather the mortality rate for minority
patients who have become infected with the virus, which is so
strikingly disproportionate. This is happening to communities
all over America in urban settings and in rural settings alike.
Through my medical practice, I understand that there are
real racial healthcare access disparities that exist, and in
certain underlying health conditions, such as diabetes,
hypertension, and heart disease, the prevalence is greater in
some of our minority populations.
This committee has recently dedicated work to addressing
racial and ethnic health disparities and maternal mortality. It
has been eye opening yet informative to hear from hospitals
across the country on steps they are taking to improve in this
area. It helps showcase how no one urban or rural setting is
the same.
In fact, we heard from Parkland Hospital in urban Dallas,
who shared impressive stories on how they are improving
maternal mortality in their community. Their data is
impressive. This can be done.
As for COVID-19, I think there are similarities, and I have
tried to focus my efforts on providing access to quality care,
a suggestion each of you had in your testimonies. This is why I
recently teamed up with Representative Diana DeGette to
introduce two bills which would increase diagnostic testing
capabilities of public health laboratories and expand testing
access to hospitals, physicians, and other health service
providers.
H.R. 7025 and 7026 both prioritize underserved populations
to help provide better access to those disproportionately
affected by public health emergencies such as COVID-19.
Dr. Roy, as my colleagues and I work to build up our
Nation's testing capability so that Americans can better access
these tests, what can be done simultaneously to help ensure
individuals actually receive these services once access is
there? This is particularly important because a concern of mine
relates to future vaccines for COVID-19 once it is developed.
Dr. Roy. Well, Dr. Bucshon, I would mention the geographic
location of the test is really important. My family, my wife,
and I had to get tested for COVID-19 recently due to a possible
exposure. We had to drive 35 minutes from our house to get to a
place and sit there for several hours to get the test.
Now, some people don't have the luxury of doing that
because of their jobs or other situations. So making sure that
the test availability is close to your house and very rapidly
accessible is really important. Obviously that has been a
challenge.
Mr. Bucshon. That has been a challenge, and transportation
issues are obviously a challenge in different communities. But
we want to, obviously, we want to get out ahead of this as we
look forward to having a vaccine.
In that vein, Dr. Brooks, is there a disparity in
vaccination rates in general between ethnic groups?
Dr. Brooks. Yes, there is. African Americans are less
likely to be vaccinated, both at the NIS national kindergarten
survey that is done on a yearly basis and then in vaccines for
influenza.
Some of this is directly related to access. If you are less
likely to be insured, you are not going to get vaccinated.
So when we come forward with a vaccine against COVID-19,
that has to be kept in mind, and I think imperative will be the
messaging. The message has to be culturally sensitive, come
from messengers that the African American community can
identify with, and, again, have African Americans involved in
the clinical trials so we can speak to the safety and efficacy
for African Americans.
Mr. Bucshon. Well, you answered my second question, which
was going to be, how do we avoid disparities? Because cost
probably will not be the issue, because I think the Congress
will make sure that people will have access to free vaccines
for something as critical as COVID-19. But I appreciate you
answering that question.
And since we know this may be an issue, I think we all need
to work towards making sure that when we actually have a
vaccine, the historical problems that we have getting access to
vaccinations for minority communities don't apply to COVID.
Thank you very much. And, Madam Chairwoman, I yield back.
Ms. Eshoo. The gentleman yields back.
The Chair now recognizes the gentleman from Massachusetts,
Mr. Kennedy, for 5 minutes.
Are you unmuted?
Mr. Kennedy. I believe so. Can you hear me?
Ms. Eshoo. Good.
Mr. Kennedy. Great.
Madam Chair, thank you for calling this extremely important
hearing.
Thank you to our witnesses for being here and for your work
and your dedication to this.
Massachusetts has been hit extremely hard by this virus. We
have had over 100,000 people infected and over 7,500 deaths.
One of the most memorable moments for me will be spending
some time in Chelsea, a community just east and slightly north
of Boston that has a rate of infection about six times higher
than the State average. It is largely immigrant, largely
working class, largely Hispanic, disproportionate percentage of
essential workers.
I was a Peace Corps volunteer. I served in the Dominican
Republic for about two and a half years. I have visited or done
work in development in many countries around the world. I have
never seen lines so long for food in my entire life than I did
in Chelsea, Massachusetts.
I spoke to the head of one of the community health centers
that operates in the neighborhood and I asked him how they were
doing and he said that they had received new mapping software--
this is about a month ago--and that they were looking for cool
spots with infection.
And I asked him, I said, why cool spots? Why don't you try
to mitigate against hot spots?
And he said, no, no. We know everybody is infected,
everybody has been exposed. We need to see where we haven't
tested.
And the biggest cool spot on that map was the affordable
housing development where out of the 900 residents there, only
4 had been tested.
So when you talk about these infection rates, they are also
a reflection of access to testing that are in and of itself
subject to these disparities and structural inequities that we
have been talking about today.
And so let me be clear about this. We have not only failed
lower income and Black and Brown communities with regards to
this virus, we failed them long before anybody uttered the word
coronavirus or COVID-19 or knew what social distancing was.
We failed them in a million ways that extend far beyond
whether the President took this pandemic seriously or whether
he thought it was going to impact his political survival. We
failed because our government had dismissed workers' rights and
living wages for people across our entire country. We have
failed members of our community over and over again. We have
underfunded education and healthcare and food insecurity in
communities of color. We have failed by letting our public
transit options crumble and our public housing deteriorate. And
right now we cannot fail them again.
So I think back to those lines for food in Chelsea and I
can't help but think of what might happen when we do have an
eventual vaccine. If we are going to be sure that history does
not repeat itself, which it will if we do not act, wealthier
and White communities won't see those shortages or long waits,
but others certainly will.
And so with that, Dr. Boyd, what policies should we be
enacting now to ensure that those communities that have been
hardest hit and least prepared are going to be able to receive
access to that vaccine?
Dr. Boyd. Thank you, Congressman Kennedy.
I think we should prioritize those communities alongside
other groups we determine are high-risk. For example, if
healthcare workers are the first to receive the vaccine because
they are most high-risk for exposure, only 5 percent of
physicians in this country are African American.
So we have to ensure that the communities that are affected
are also prioritized alongside healthcare workers and other
highly prioritized groups.
Mr. Kennedy. Dr. Brooks.
Dr. Brooks. I believe that messaging, again, getting the
word out there that there is a vaccine, that it is safe and
effective.
I do also believe that healthcare workers should be
prioritized but also understand that African Americans that are
elderly and with underlying conditions are at the highest risk
for death. So it should be clear messaging to that population.
Mr. Kennedy. And at the beginning of this pandemic, we
focused our attention on elderly and those with pre-existing
conditions as parts of a high-risk population.
Dr. Boyd, starting with you, I understand there has been
some recent research that has also come out about age being a
driver in these disparities. Can you talk to me a little bit
about that?
Dr. Boyd. Absolutely.
So a study was just released from Harvard School of Public
Health that looked at age-specific mortality rates, and
actually among African Americans those aged 35 to 44 have the
largest gap. They are nine times more likely to die of COVID-19
than White Americans.
They also calculated the years of life lost, and more than
45,000 years of life had been lost per 100,000 African
Americans. That is more than the 33,000 years of life lost for
White Americans, despite White Americans having a larger
population.
So how we talk about age actually has to change. Younger
communities of color are more affected.
Mr. Kennedy. Do you know--walk me through the reasons that
account for that. I mean, what we have heard over and over and
over again is obviously that the virus--the statistics seem to
show that it is far more deadly for older people, the impact
that you just articulated.
I am out of time, so forgive me, but maybe I will ask you
about that to flesh that out when you can. And I apologize, but
I do have to yield back.
Ms. Eshoo. Dr. Boyd, can you answer that in 30 seconds?
Dr. Boyd. Yes. One mechanism that we have to consider is
allostatic load and weathering, that experiences of
discrimination and racism actually age cells faster. And so
although your chronological age will be younger, your cells may
actually be sicker and older if you have experienced cumulative
exposures to racism and discrimination.
Mr. Kennedy. Thank you.
Ms. Eshoo. The gentleman yields back.
It is a pleasure to recognize the gentlewoman from Indiana,
the wonderful Congresswoman Brooks.
Are you unmuted?
Mrs. Brooks of Indiana. Yes. Can you hear me?
Ms. Eshoo. Yes, we can.
Mrs. Brooks of Indiana. Good to see you and good to see
everyone. Thank you to all of the doctors for your really
important testimony.
Something that we haven't talked about yet are the
importance of using electronic health information exchanges and
all of the data. And all of you are so involved in the data
collection and understanding it.
We have in Indiana called the Regenstrief Institute
celebrating its 50th year, and it is all about modeling and
information sharing and data collection. And they have
partnered with IU Health here in Indiana and they just did a
study that talked about the quality of healthcare data varies
greatly based on how, oddly, how user friendly the collection
system is. And that seems like something just so very basic,
but I am--they found that still many people on all of this data
submit it by fax.
And I am curious, in this modern age where we are all
communicating through Webex and so forth, can each of you
comment on what you know on current data collection standards
for COVID-19 and what may be suggestions you might have for
Congress for standardizing data collection because--and not
that I am necessarily questioning this data, but I don't think
we are getting all of the data in the most accurate way we can
and should be getting it.
So maybe Dr. Roy--I would love to hear from each of you
about this whole issue about the manner in which data is
collected.
Maybe start with you, Dr. Roy.
Dr. Roy. Yes. So, Mrs. Brooks, the first thing to talk
about is the HITECH Act, which was passed as part of the
stimulus legislation in 2009, that transformed a lot of the
mandates around the way electronic health records must be taken
and transmitted. So that is the governing statute right now, is
the HITECH Act, which has been, I think, tweaked and modified
here and there.
The one thing I would say on top of whatever you want to do
in terms of thinking about how the HITECH Act governs these
processes is that there is actually a lot of technological
innovation going on in electronic health records.
To give one example, you are starting to see people use
voice recognition software in a physician's office to use
artificial intelligence to record a patient encounter and
thereby streamline some of the generation of patient notes.
That, plus lab data, can be more seamlessly integrated.
Part of the problem is anti-kickback statutes and HIPAA and
other privacy laws that basically restrict data liquidity, so
it is very hard for your primary care physician and a hospital
and your endocrinologist and your cardiologist to communicate
with each other about your situation as a patient because of
all these privacy restrictions.
And obviously, privacy restrictions are important to a
degree, but we need to modernize those laws. The Trump
administration has put out some proposals, recommendation rules
and changes, and final rules to modernize the regulations at
least, but I think you need statutory modifications as well to
streamline and modernize these old, outdated statutes so that
patient data can bounce back and forth between providers and
patients.
Mrs. Brooks of Indiana. Thank you.
Dr. Brooks, does your association talk about the whole data
collection challenges and your concern about the data?
Dr. Brooks. Yes, we do. I would focus first on what you
said on health information exchanges. We are almost there, but
there is the devil in the details. Dr. Roy mentioned the HIPAA
concerns.
There are no, to my knowledge, clear standards of COVID-19
data collection and there needs to be. And I would even look
back to health information exchange in African Americans.
African Americans are more likely to get fragmented care,
get care in the ER, get care at a health center, than to go to
a county facility for a referral. So that data ends up getting
lost. And so not having that data sharing does adversely affect
African Americans. So it kind of all goes full circle.
Mrs. Brooks of Indiana. Thank you very much.
Dr. Boyd, do you have anything to add in my 30 seconds
remaining?
Dr. Boyd. I will also say biased data in leads to biased
learning out. So if we also only collect this data for
populations that already receive government-sponsored health
insurance, for example, or Medicaid populations, and not for
all Americans regardless of your health insurance status, we
also aren't learning about the full population level burden of
infections and deaths.
Mrs. Brooks of Indiana. Thank you.
Thank you, Madam Chairwoman.
Thank you all.
I yield back.
Ms. Eshoo. The gentlewoman yields back.
A pleasure to recognize the gentleman from California, Mr.
Cardenas, for his 5 minutes of questions.
Mr. Cardenas. Thank you very much, Madam Chair, for giving
me the floor. And thank you so much for having this important
hearing. I don't know if you can see me, but I hope you can
hear me.
Ms. Eshoo. Both. You look great.
Mr. Cardenas. OK. Thank you. My screen just went blank.
As Dr. Brooks said in his testimony and others have
discussed, as a result of the coronavirus pandemic a bright
light has recently been shown on the health disparities and
inequities that have always existed in the United States.
There are several factors that experts have pointed out to
explain these trends. For example, regardless of their
profession, Black American, Latino, and indigenous populations
also have disproportionately less access to paid sick leave,
garner the lowest median wages, and predominantly live in
States that fail to mandate critical worker protections like
paid sick leave and living wages.
Black American, Latino, and indigenous populations are also
overrepresented among the homeless, the incarcerated, and
detained populations in the U.S., which confines people in
crowded facilities that also dramatically increase risk for
COVID-19 exposure.
Accordingly, eight of the ten largest clusters of COVID-19
infection have occurred in correctional facilities--which, by
the way, affects the people who work there, not just the
incarcerated.
While the number of insured individuals across all
demographics increased following the Affordable Care Act's
passage, Blacks, Latinos, American Indians, Alaskan Natives,
Native Hawaiians, Americans in our territories or other Pacific
Islands are also more likely to be uninsured compared to Whites
and more likely to report going without needed care due to
cost.
Studies also show that racial and ethnic minorities receive
lower quality healthcare even when insurance status or severity
of conditions are comparable.
As we are the country with the most and best research and
the largest economy in the world, what I report today and what
we are hearing is shameful. We can and must do better.
One area that needs more attention is mental and behavioral
health. Before the pandemic and the worldwide protests
condemning the recent police murders of Black Americans, our
mental health system was in bad shape. And now these events
have made our collective stress levels skyrocket and our mental
and behavioral health continues to be disjointed and
disconnected from any other type of healthcare.
Experts are warning that a historic wave of mental health
problems is approaching--depression, substance use disorders,
anxiety, Post-Traumatic Stress Disorder, and suicide. Over the
weekend, new reportings show that the rates of clinical
depression have more than tripled since the coronavirus first
emerged and Black Americans have experienced a particularly
high evidence of major depression disorder.
We also know that racial and ethnic minority groups in the
U.S. are less likely to have access to mental health services,
less likely to use community mental health services, and more
likely to receive lower-quality healthcare.
In 2017, 42 percent of youth aged 12 to 17 received care
for a major depressive episode, but only 35 percent of Blacks--
Black youth--received services and 33 percent of Hispanic youth
received treatment for their condition. Black individuals with
mental health and substance use disorders are more likely to be
incarcerated rather than placed in community-based divergent
programs.
What are some of the things we could do at the Federal
level and to advance health equity within the mental and
behavioral health space? Also, what will be the consequences if
we don't act to address racial and ethnic health disparities
within the mental health space?
Dr. Boyd, can you elaborate perhaps on what we could do?
Dr. Boyd. Yes. Particularly for youth, we know that mental
health impairments are the number one cause of school dropout
rates, and kids who don't finish school have higher rates of
entering the criminal justice system, as you mentioned.
And so we have a healthcare-to-prison pipeline that we have
to address. One way to address it is to broaden access to
mental health supports. Many health insurances don't cover
counseling, in-school supports, and other community-based
programs that help kids address their mental health needs. We
can do it for all ages, but I would advocate starting with
kids.
Mr. Cardenas. Thank you.
And, Dr. Brooks, if people are unable to get information on
treatment in their language and the CDC has only translated
into four languages when there are 200 languages spoken in
America, is that going to adversely affect our ability to end
this pandemic in America?
Dr. Brooks. Yes, it will. You need information in your own
language. And America is a multicultural society, and that is
what makes us great. So more translation services, and that
would lead to more access, especially as it relates to mental
health.
So with better mental health, you get better physical
health. So I think that is crucial also in terms of your point
about being disjointed. You need integrated behavioral health
services which will lead to better physical health.
Mr. Cardenas. Thank you, Madam Chair.
I yield back the balance of my time.
Ms. Eshoo. The gentleman yields back.
It is now a pleasure to recognize the gentleman from
Oklahoma, Mr. Mullin, for his 5 minutes of questions.
Mr. Mullin. Madam Chair, can you hear me, OK, or is my
connection messed up again?
Ms. Eshoo. Yes. Yes.
Mr. Mullin. OK. Well, thank you. And if my connection gets
bad, please interrupt me so I am not just talking to myself.
Ms. Eshoo. OK.
Mr. Mullin. While I am very happy we are having these
important discussions on health disparities, as you guys know,
I am Cherokee, Native American, and it is very disappointing to
me that we don't have a tribal witness here today.
I know when Chairman Burgess had brought this up to you,
Madam Chair, that you had said we are going to possibly do a
field hearing, is that correct, on Native American issues?
Ms. Eshoo. I would very much like to do that, and I think
that there should be interest on the part of enough members in
order to do that. And I also believe that we need to--this
should not be the only hearing we have on racial disparities of
our subcommittee.
Mr. Mullin. Chairwoman Eshoo, my concern is that with COVID
going on, that a field hearing probably isn't going to be
possible. And Native Americans are disproportionately left out
on these studies, on things moving forward. And we see pockets
breaking out in our reservations and parts of the Indian
Country.
And so I just hope that you will commit that the next one
we have will have a tribal witness there, hopefully someone
that maybe you would even allow me to bring in as a witness,
because I do have close ties with them.
And it is a nonpartisan issue, this should be a bipartisan
approach, because Native Americans, as you know, Madam Chair,
greatly underfunded already, and then they are extremely
stressed with the COVID crisis going on.
Ms. Eshoo. We will work with you, Mr. Mullin. Thank you.
Mr. Mullin. Thank you.
Dr. Brooks, I would like to talk to you for a little bit.
As I was stating, American Indians experience a
disproportionate rate of individuals with diabetes. In fact, it
is three times more likely if you are an American Indian to
have diabetes than any other race. And when you start talking
about inside the United States, autism is also the highest in
Indian Country.
Can you discuss how social determinants over health can
play roles in chronic conditions not just with COVID, but other
diseases out there, too?
Dr. Brooks. Yes. So thank you.
So interesting you mentioned autism. There is some early
data showing that environmental exposure to toxins can lead to
autism. And you obviously get that when you have underserved
communities, and I would certainly consider the Native
Americans.
As relates to diabetes, diabetes is a condition of diet and
exercise, and 90 percent of diabetes is Type 2. Diet, exercise,
and medication. So food deserts, lack of access to high-quality
foods, you are going to get diabetes.
If you live in an area where you don't feel comfortable
exercising or where exercising isn't promoted, where you are
too busy doing other things to have time to exercise, it is
going to lead to higher incidents of diabetes.
And then medication, if you don't have access. Diabetes, if
it is controlled, can be much less harmful to the body. You
don't have the medication without the healthcare access.
Mr. Mullin. If you certainly look at some of the reports
coming in, there is over half the States, they label Native
American patients as ``others,'' not as a unique ethnic group,
but as ``others,'' which is disappointing for me because we are
not others. We are Native Americans.
And when you don't have the right data, Dr. Brooks, does
that play a role in how we treat the pandemics going on either
with the COVID or even the diabetes or autism that is happening
in Indian Country?
Dr. Brooks. So from the discussions today, data informs.
Data directs. Data provides crucial information. And I also
would say that it implies that somebody cares about you.
Mr. Mullin. I agree.
Dr. Brooks. In fact, if you are ``other,'' there is an
implication in that. I am just going to leave it to that. So I
think that that leads to being neglected.
So I concur with the need for data on the Native American
population.
Mr. Mullin. And, in fact, I had to fill out a bill the
other day for my son and it didn't have Native American as a
race and it had ``others,'' and it said ``explain.'' And I put
``first Americans.'' So it was frustrating to me because it
shouldn't happen.
Dr. Brooks, I appreciate it.
As I said, Madam Chair, I appreciate you holding this
hearing. I appreciate you working with Congressman Burgess on
it or Dr. Burgess on it. I hope, when we have another one, as I
said, work with me please and let's get a witness from Indian
Country in.
And with that, I yield back.
Ms. Eshoo. The gentleman yields back. I will certainly work
with you. And I think you working with Mr. Lujan together will
really strengthen the case as well. So thank you very much. And
we are all praying for your son. And I think our prayers are
being heard. So thank you very much.
Mr. Mullin. Thank you. Thank you.
Ms. Eshoo. Yes.
The Chair is happy to recognize the gentleman from Vermont,
Mr. Welch, for his 5 minutes of questions.
You need to unmute. Are you unmuted?
Mr. Welch. I am unmuted.
Ms. Eshoo. There you are. OK. Wonderful.
Mr. Welch. Thank you very much.
First of all, Markwayne, I certainly support your effort,
and I know our chair and I am sure ranking member will as well.
It is a great idea.
Second, I want to thank you, Madam Chair, and also Dr.
Burgess, for your very eloquent opening statements that I think
put this whole hearing, this very important hearing, in
perspective.
And number three, the witnesses have been really
tremendous, and I thank them.
I want to go back to something that G.K. Butterfield asked
and it was about poverty versus racism. I think it is very
apparent with COVID and the extraordinary impact, the
disproportionate impact it has had on Black and Brown people,
it is raising the question about why, and we have been
discussing that.
But it is also in a context where we have had the horror of
Minneapolis and the murder that occurred there, where we had a
man who was bird watching in Central Park accused because he
was an African American, of a violent attack. And then we also
had that young man jogging in Georgia who was shotgunned to
death.
And what is clear is that this question of poverty and
racism is now a very active question in our country or should
be. That behavior that was not just an incident of a rogue
police person, but it was other White individuals against very
innocent African Americans, has ripped off the cover of racism.
And we don't have in this country a social insurance
program that helps Black, Brown, White, or Native Americans who
don't have the income when, through no fault of their own,
something happens like COVID, the social insurance of the
healthcare that is universal, the childcare, the family leave,
and so on, and that is an ongoing debate in Congress.
But, Dr. Brooks, I am going to go to you first. You said
something that really captured my attention. There is also an
element called racism. And it is time, in my view, that we talk
about that. And I would ask you to elaborate on your statement,
because as I heard what you said, it was that because of the
color of the skin, people were just treated differently.
And I turn to you and then would like to hear from Dr. Boyd
about that as well. Thank you.
Dr. Brooks. Four hundred years of institutionalized racism,
starting with slavery, which was encoded in the Constitution.
You had to pass an amendment to remove it. We had to have civil
rights legislation in 1964. We had to have the Voting Rights
Act in 1965. Right now my primary concern with the upcoming
November election will be voter suppression.
All of this is directly linked to racism. And it is
interesting because the worry is now, if African Americans have
their chance to speak, what may happen.
It was against the law to teach a Black person to read. It
is ingrained in the fabric of America. To me the first step in
removing this stain in the fabric is to talk about it.
As the loss of life of George Floyd occurred, maybe there
is some good to come out of it. My personal belief is watching
someone get suffocated for 8 minutes and 46 seconds is just
unprecedented. I mean, if you get shot then you die in, what,
less than a second.
Mr. Welch. Well, thank you so much.
I want to hear from Dr. Boyd and I only have a little bit
of time, but I really appreciate your testimony.
Dr. Boyd.
Dr. Boyd. Yes. We also have to think about racism and how
it functions structurally beyond just how it functions as
individual prejudice.
Structural racism is what drives systematic changes in how
populations are treated. These are things like the distribution
of insurance access in this country or the distribution of
clean water access like we talked about.
Those are major things that determine how racial and ethnic
populations access services and vital supports and resources
that are distributed by race. That is not just a prejudice that
is baked into our laws, and that is something that we have to
confront.
Mr. Welch. Mr. Roy, do you have anything to add on this in
your view on what our other two witnesses have said?
Ms. Eshoo. Mr. Roy, do you hear us? You need to unmute.
I don't think he hears us.
Mr. Welch. All right. My time is up. Again, I want to thank
our witnesses. This is tremendous. We have got a lot of work to
do.
Ms. Eshoo. I agree with the gentleman. We have a great deal
of work to do.
The gentleman yields back.
Mr. Griffith. Madam Chair? Madam Chair?
Ms. Eshoo. Yes?
Mr. Griffith. Can we see if Mr. Roy can hear us for future
questions? He can. OK. Thank you, Madam Chair.
Ms. Eshoo. I don't know what he is motioning to us.
Can you hear us, Mr. Roy? You can. We can't hear you.
It is a pleasure to recognize the gentleman from North
Carolina, Mr. Hudson, for his 5 minutes of questioning.
Mr. Hudson. Thank you very much, Madam Chair, for holding
this very important hearing.
Thank you to our expert witnesses for the time you have
given us today. I think it has been an excellent discussion.
As you may recall, a month ago, at our last hearing, I
asked for this hearing and noted that in my experience,
particularly in my district, minority communities are
experiencing gaps in outcome. So I am very appreciative of this
opportunity to talk about this today.
Across the Nation, there is alarming data that people of
color are more likely to be affected by coronavirus than White
individuals. Native Americans are five times as likely, African
Americans are four and a half times as likely, and Hispanics
are three and a half times as likely, according to the CDC.
In Fayetteville, North Carolina, a city in my district, the
leadership at Cape Fear Valley Hospital told me that African
American patients make up 57 percent of their COVID-19
patients. However, in Cumberland County, where the hospital is
located, the population is only 34.9 percent African American.
This is not just a local or national issue, it is also
global. As Dr. Roy said in his testimony, minorities have been
negatively affected in Canada, the U.K., France, and Norway,
among other countries.
This is both alarming and concerning. So I am happy to see
this committee exploring this issue.
On another note, I am very concerned about how the economic
shutdown in response to the coronavirus has disproportionately
affected minority communities. I saw this firsthand with
problems with access to the banking system among minority-owned
business owners in my district.
To draw upon, again, the testimony of Dr. Roy, the effects
of unemployment and business ownership have been staggering.
African American unemployment has dropped from a record low in
late 2019 of 5.4 percent to 16.8 percent, Hispanic employment
dropped from a record low of 3.9 percent to 17.6 percent, and
Asian employment dropped from a record low of 2.1 percent to 15
percent. Further, African American-owned businesses fell 41
percent, Hispanic-owned businesses 32 percent.
I agree with Dr. Brooks and many of my colleagues who have
said today that we need more data so that we can dive deeper
into these issues.
The other thing I have heard from the leadership at the
hospitals in my district is the impact of the lack of education
and access to resources on disproportionate outcomes with
coronavirus.
Patients at the hospitals I have talked to have noted that,
while they may know about coronavirus and are generally afraid
of the danger it represents, they do not have access to
critical information about stopping the spread of the disease
and best practices to avoid contracting it.
This isn't for want of trying, though. The hospitals across
my district are making concerted efforts to educate their
communities about coronavirus, including taking out ads in
newspapers that are focused on underserved communities, hosting
weekly townhalls on radio, and posting weekly videos on their
websites with updates from CDC. But even with these efforts, it
is apparent these educational efforts are not enough.
I don't know if, Dr. Roy, if we can hear from you, but I
would love to hear from you on whether you agree with me----
Dr. Roy. Can you hear me now?
Mr. Hudson. I can.
Dr. Roy. OK. Great. I just re-logged in. Apologies.
Mr. Hudson. Great. Well, Dr. Roy, would you agree with me
that the gap in education on coronavirus on how to make
preventative measures is hurting our communities, especially
communities of color?
Dr. Roy. Well, it is hard to know. I mean, I haven't done
enough work to understand exactly how attitudes in terms of,
you know, or understanding, education, information is
transmitting to various communities.
I would say the biggest problem remains--we have talked a
lot about nursing homes. I am glad that Dr. Boyd mentioned
incarceration. That is another problem area. We have talked a
little bit about Native American communities, particularly in
Navajo Country.
These concentrated areas where we are seeing the
combination of geography, vulnerability in terms of age, and
preexisting conditions, that is the nexus where the
information, in particular, needs to go.
One thing I would mention since we are talking about
information here is that a lot of people are telling me, and I
think telling members of your committee as well, that if they
have a relative, a loved one in a nursing home, they are not
able to access information about that individual and how they
are doing, whether they are being adequately quarantined, et
cetera, or protected from people who are infected.
So that information is tough to find. Information about
testing is hard to find. If and when vaccines happen, that is
going to be a challenge, too.
But one thing I want to mention. We have talked a bit about
vaccines today. We have no assurance that there will be a
vaccine for SARS-CoV-2 in the next 12 to 18 months, as a lot of
people have been talking about. It could be 5 years, it could
be 20 years before we have a vaccine for SARS-CoV-2.
We have been working on a vaccine for HIV for 40 years, and
we still don't have one. We have been working for a vaccine for
hepatitis C for even longer than that, and we still don't have
one.
So we have to make sure that we can operate and environment
in which vaccines do not happen in the event that they don't
and we have to operate in an environment where treatments,
effective treatments, cures, are longer away than we hope they
are. And that is where the information in terms of prevention,
physical distancing, et cetera, is so important.
Mr. Hudson. Thank you.
Madam Chair, I see my time is expired, so with that, I will
yield back.
Ms. Eshoo. The gentleman yields back.
The Chair now recognizes Dr. Ruiz from California for his 5
minutes of questions.
Please unmute.
Mr. Ruiz. Thank you. Thank you for this hearing on health
disparities. And I, too, look forward to the tribal policy
hearing, specifically on the Indian Health Service, that we
have talked about, Chairwoman.
COVID-19 has shined a spotlight on the inequity that we
already knew existed in our healthcare system. You see, I grew
up in a trailer park in Coachella, a farm worker community in
southern California, where my family and neighbors did not have
adequate access to healthcare.
It is what motivated me to become a doctor in the first
place and what eventually motivated me to run for Congress, and
most recently motivated me to fight to sit on this very
subcommittee, because I want to make our healthcare system
better, more affordable, more equitable for everyone.
And before I came to Congress, I served as an emergency
physician in the Coachella Valley right here in my district. I
conducted an intensive study on barriers to care and I found
that in our region there was only one doctor per 9,000
residents. For context, the medically appropriate number is
about one doctor for every 2,000 residents.
So it is easy to see why we have egregious health
disparities in historically underserved and minority
communities, which, of course, are brought to the forefront
during a public health crisis like COVID-19 pandemic.
The fact is that we don't have enough providers in
marginalized communities. We don't have enough residency
programs there.
We know that the two biggest predictors of where a doctor
practices is where they are from and where they last trained.
So recruiting students from underserved communities and
training doctors in those communities is critical.
And I worked on creating pipelines to address the provider
shortage crisis in a meaningful way right here in the district.
Back in 2009, I started the Future Physician Leaders program,
which is a mentorship program for high school and college
students who are aspiring doctors from underserved areas where
I grew up. I subsequently became a founding senior associate
dean of the UC Riverside Medical School and helped pave the way
to create residency training programs in our underserved
communities.
I am the first generation in my family to graduate from
high school. So I know the importance of having that type of
pipeline support through what can be a difficult process for a
kid from Coachella.
The Future Leaders program started with seven kids after a
discussion with me at Starbucks and is now housed at the UCR
School of Medicine with over 200 students. And since coming to
Congress, I have introduced legislation to help increase
providers in these historically underserved communities of
color, such as accessing the Higher Education Act, which allows
grants to Hispanic-serving institutions to be utilized for pre-
med mentoring.
The Building a Health Care Workforce for the Future Act
would establish a matching State scholarship program to
financially support students from resource-poor communities.
The Physician Shortage GME Cap Flex Act, which I introduced
with my friend Dr. Bucshon, would help extend the time
hospitals could have in underserved areas to create these
residencies. And the Training the Next Generation of Primary
Care Doctors Act, which I introduced with Congresswoman
McMorris Rodgers, would expand the time that teaching health
centers have for training in these underserved areas.
My question to Dr. Brooks, understanding that you have not
seen the details of these bills, would you agree that
establishing more residency programs and slots in historically
underserved areas is one key step to addressing some of the
health inequities that currently plague our system?
Dr. Brooks. Yes. Without seeing the legislation and the
details, I would support that. The NMA strongly supports
directing the young into STEM and developing ultimately into
physicians and other healthcare providers, especially if it
incorporates African American children.
Mr. Ruiz. Dr. Brooks, the teaching health center program
that I mentioned was created in the Affordable Care Act as a
way to train doctors in underserved areas with the hopes that
those physicians would stay there to practice after completing
their residencies and we are seeing that that is happening.
Would you agree that because of the population the health
centers serve in our communities that expanding that program
and ensuring that they have long-term funding stability is
important?
Dr. Brooks. I am an example of a National Health Service
Corps scholar who went to work in Watts and has been there for
31 years. So I do support that activity.
Mr. Ruiz. It has to be longer than three years. It has to
be a longer term to provide that stability as well.
So my final question is, Dr. Brooks, according to the
California Health Care Foundation, while Latinos represent
nearly 40 percent of the total population in California, they
only make up approximately 5 percent of California doctors.
From your perspective, what are the reasons that racial and
ethnic minority communities are underrepresented in the
healthcare workforce?
Dr. Brooks. I think it is exactly what we discussed, not
being channeled into STEM, not having the proper education,
maybe being intimidated to apply to medical school. So the
focus of your program that you have I think would be very
helpful.
Mr. Ruiz. Thank you very much.
I yield back.
Ms. Eshoo. The gentleman yields back.
I would like to recognize the gentleman from Montana, Mr.
Gianforte, but I don't see him. Going once, going twice. OK.
Then we will turn to recognize the gentlewoman from
Michigan, Mrs. Dingell, for her 5 minutes.
Mrs. Dingell. Thank you, Madam Chair and Ranking Member
Burgess. I want to thank you for convening this hearing today.
We really need to have this discussion about racial and ethnic
disparities in our healthcare system.
And we all keep saying that the African American community
is being disproportionately impacted, but Michigan, my home
State, is one of the most significant examples in the country.
African Americans are 14 percent of our population; 32
percent of the COVID cases in the State have been African
Americans and 41 percent of the deaths have been African
Americans. And, unfortunately, I have known more of them than I
want to admit.
We have got to do better. Our Governor has created the
Michigan Coronavirus Task Force on Racial Disparities to seek
what the issues are and how we can start to address them.
But State-level action has to be complemented by strong,
forward-thinking action at the Federal level. And in Congress,
we have got to recognize the magnitude of the problem that we
face.
I also want to follow-up on Mr. Roy's concerns about
Medicaid. I agree we need to invest more in getting people home
in community-based services, and that is why I fought to
increase dedicated funding for HCBS and we put it in the HEROES
Act in the House. It included a 10-point FMAP increase
specifically for HCBS. And it is my hope that the Senate will
do the same when they take up the HEROES Act, which I hope will
be sooner than later because it is something we have to do.
But my questions right now are for Dr. Boyd.
Dr. Boyd, in your testimony you discuss the need to expand
programs like Medicare and Medicaid to address the health
inequities that have been so apparent in this COVID pandemic.
It is backed up by evidence, as I just talked about. And also,
in my State of Michigan, 37 percent of the uninsured are people
of color in Michigan.
States don't have the resources to meet the healthcare
needs that they have during this pandemic in spite of--my State
has probably the record rainy day fund, including $1.2 billion
in Michigan. States are having to make hard choices about how
to address their budget shortfalls, especially with States like
mine that have a balanced budget requirement.
If we don't act, we are going to be facing scary,
significant, and I don't know what the impact will be on these
budget shortfalls.
Dr. Boyd, how would significantly increased emergency
Federal funding for Medicaid, like the provisions included in
the House-passed HEROES Act, address the need of minority
communities hardest hit by the virus?
Dr. Boyd. Two primary things it would do.
One, in terms of the COVID pandemic, it would increase
access to testing, hospitalization, and any needed treatments.
And two, it would increase access to primary care services
that would help treat the chronic, undertreated, and
underserved medical conditions that communities of color are
disproportionately plagued with.
Mrs. Dingell. I should have asked this question first, but
what are the risks to communities of color as all of the States
are facing these budget shortfalls? We are not passing the
HEROES Act and they are really making tough decisions that they
shouldn't have to make.
Dr. Boyd.
Dr. Boyd. The risk of the budget shortfalls is that we will
also lack enough supports to support all of the other public
and social service functions that our tax dollars pay for. So
we have been talking today about social determinants of health,
but many social determinants of health are supported,
nutritional programs, workforce placement programs, and
childcare programs are supported by our tax dollars. And
without those dollars, those social determinants of health are
at risk, too.RPTR MOLNAREDTR HUMKE[2:56 p.m.]
Mrs. Dingell. Thank you.
Dr. Boyd, you have discussed the need for universal
workplace protections, including personal protective equipment.
Without these, we know we are going to see another surge in
cases as Americans begin to go back to work. We have seen the
impact on workers of color in places like meat-packing plants
when they are forced to work without PPE or basic protections.
How will this lack of workplace protection further compound the
racial health inequities if not addressed?
Dr. Boyd. To make it safe to reopen our economy, we have to
make sure that workers, particularly essential workers, have
mandated paid sick leave, they have hazard pay when they go in,
they have access to protective equipment. These are things that
will keep the supply chains open that keep our economy running.
We have to make sure that it is safe for folks to go into
an indoor workplace before we ask them to take that risk,
because asking them to take that risk is why we have higher
rates in our communities of color.
Mrs. Dingell. Thank you, Dr. Boyd.
I just want to make one observation, Madam Chair, that
three months ago, we didn't think a whole lot of people were
worth even paying $15 an hour, and now our country is dependent
upon these very people that we are talking about, who are only
being paid $15 an hour and not given PPE equipment, and we need
to think about the value of our frontline workers to all of us.
Thank you. I yield back.
Ms. Eshoo. The gentlewoman yields back. It is a pleasure to
recognize the gentleman from Georgia, Mr. Carter, for 5
minutes.
Mr. Carter. Thank you, Madam Chair. Can you hear me, OK?
Ms. Eshoo. Very well. Very well.
Mr. Carter. Oh, good. Thank you, thank you.
Thank you all for participating. This has truly been a good
hearing, and I appreciate it very much.
Dr. Roy, I wanted to start with you. During the discussion
today, in your testimony you have said that the economic
shutdown has exasperated health disparities. I know that in
April you released a plan of how we could safely reopen the
economy. How do you anticipate that those ideas would be
helpful and beneficial to minority communities?
Dr. Roy. Well, thanks, Mr. Carter, for bringing it up, and
just for reference, it is in the written testimony, but the
plan is at FREOPP.org, F-R-E-O-P-P.o-r-g. And I believe that
the title is something like, a new strategy for reopening the
economy even during COVID-19 pandemic, and the reason why it is
titled that way is because we are very concerned that we are
all waiting for a best-case scenario, that there is a vaccine
or a treatment, and boom, everything can go back to normal.
But what if we don't? What if we can't get a vaccine in the
next 18 months? What if a treatment doesn't arrive that is
really effective in the near term? Then these disparities will
persist over time and become even costlier. Imagine if the
entire next school year becomes difficult to execute on.
So for all those reasons, our plan really focuses on two
areas--three areas, in particular, I would say. First, let's
make sure we are focused on nursing homes and the at-risk
populations--the elderly and people with preexisting
conditions, cardiovascular, endocrinological conditions.
Secondly, let's safely reopen schools, and let's safely
reopen workplaces where it is feasible for--you know, where it
is going to particularly help those low-income, hourly-wage
workers who right now have lost their jobs because their jobs
have been defined by the government as nonessential, and their
livelihoods have been defined by the government as
nonessential. And that has been a huge problem right now in
terms of widening disparities.
So the plan talks about that in terms of how you can
strategically increase testing and use--and reopen businesses
where they are able to safely reopen and take into account the
latest data on cleanliness, safe practices, et cetera.
Mr. Carter. Let me ask you something. It has been said
that, you know, if there is a silver lining in this pandemic,
it may be telehealth. It has been said that we have had ten
years of progress in one week in telehealth. How can telehealth
and the expansion of telehealth in the minority communities,
how can that help to resolve some of these racial disparities?
Dr. Roy. Well, listen, telehealth absolutely can make a
difference in terms of getting timely access to care for the
kinds of care that can be administered in a remote setting, but
there is a lot of care that can't be administered in a remote
setting, and so it is very important to be aware of that.
And this brings us back again to Medicaid. You know, I have
talked a lot today about how access to primary care, management
of chronic diseases, access to testing, all that is challenging
in the Medicaid program because of the way Medicaid pays
doctors and providers.
I want to mention something else, Mr. Carter, if I may,
which is, let's talk about the dual-eligible population, right,
the elderlylow-income population that right now is in this
completely dysfunctional system where they have two different
Federal programs, one a Federal State program, one a Federal
program, that don't really interact with each other that well.
One thing we talk about in a different FREOPP policy paper,
called Medicare Advantage for All, is giving States more
flexibility to integrate their dual-eligible populations into
Medicare Advantage-like plans that are available to some today,
but could be much more widely adopted so that low-income,
vulnerable seniors can get integrated coverage and better
access to that primary care that they need. That is something
that is really important that Congress could do something
about.
Mr. Carter. Right. Thank you.
Dr. Brooks, I wanted to ask you in the minute I have got
left, in your testimony, you talked about the importance of
considering social determinants if you want to address health
disparities. And one issue that I have been working on is
ensuring that Medicaid beneficiaries have access to nonmedical
transport.
In fact, Representative Cardenas and I have introduced
Protecting Patients Transportation to Care Act, and that
codifies the NMET--the EENEMT benefit in the Social Security
Act. We have seen some progress on this bill, and I hope that
we are going to be able to get it passed, it needs to be
passed. Can you talk about the importance of addressing things
like transportation and other social determinants in order to
tackle health disparities?
Dr. Brooks. Yes. So transportation is a major barrier to
achieving access. We have transportation service at my health
center, but now they are shut down because of COVID. So
nonemergency medical transportation would be very helpful.
And just very briefly, the telehealth. So telehealth is
very important. I mean, that reduces the need for
transportation. It issub-optimal to a physical evaluation, but
it is much better than no evaluation. So addressing
transportation, I think, is very important. It will lead to
better outcomes.
Mr. Carter. Good. Again, thank all of you for your
participation today. Thank you, Madam Chair, and I yield back.
Ms. Eshoo. I thank the gentleman. He yields back. I now
would like to--I don't see--oh, there you are. I recognize the
gentlewoman from New Hampshire, the patient gentlewoman from
New Hampshire, Ms. Kuster, for your 5 minutes.
Ms. Kuster. Thank you so much, Chairwoman Eshoo, for
holding this important hearing today. It is not possible to
overstate how important it is that we address systemic racial
disparities in our healthcare system, and COVID-19, as well as
the pain and violence inflicted upon our Black neighbors,
friends, colleagues, and fellow human beings, has brought to
the forefront of our conversation the impact of racism on
health and well-being in our communities of color.
We know and we have heard a great deal today that the
COVID-19 pandemic has disproportionately impacted communities
of color, and we have widespread evidence of institutional
discrimination leading to poor health outcomes.
As a member of this committee and the Black Maternal Health
Caucus, we have explored and legislated on the racial
disparities in maternal health. But it goes beyond maternal
health, and I am very hopeful that today's conversation will
lead to more work by this committee on addressing racial health
inequities and social justice.
Here in New Hampshire, White people account for 90 percent
of the population, but they are a shrinking proportion of our
COVID-19 cases. Just weeks ago, White people made up 81 percent
of the COVID population in New Hampshire. Now that number has
dropped closer to 75 percent.
But meanwhile, the proportion of cases among Black and
Latinx granite staters has grown. Among Latinx, who make up 3.9
percent of our population, they now account for 10 percent of
COVID cases. Among our Black community, that make up only 1.4
percent of our population, they now represent 6.3 percent of
the total infections from COVID-19. So these numbers do not
lie.
Manchester, New Hampshire Health Department Director Anna
Thomas recently said, the health of our community is only as
strong as the health of our most vulnerable residents, and by
any measurement, we must do better. She also recently requested
city-wide data. And without this data, it is difficult to
understand where to target resources that are needed.
Dr. Brooks, can you provide some examples of initiatives
that could help turn city-level data into actionable insight
and connect with community organizations to provide resources?
Dr. Brooks. Yes. So there is modeling, there is modeling
software that if you provide data, and accurate data and up to
date, it can tell you where to direct healthcare services,
where to direct testing, where to have food supply giveaways,
so--that is one way.
And the other way would be to have, again, standardized
data reporting. If we have standardized data reporting,
everyone would be reporting the exact information, and then it
will be apples to apples.
Ms. Kuster. Thank you. And I wanted to just address the
vaccination inequities that has come up. Can you speak to the
root causes of racial disparities--I think you have mentioned
this in vaccinations--but as we look ahead, what are some
suggestions that you would have for making sure that we have
equitable distribution of vaccinations?
And I just quickly would mention the bill that I am leading
with Congressman Hakeem Jeffries, H.R. 7104, Coronavirus
Vaccine Development Act, requiring the administration to plan
ahead for the coronavirus, COVID-19 vaccine distribution. What
suggestions would you have, in the limited time that we have
left?
Dr. Brooks. Yes, I note that. I would say, first of all, it
helps if States or the Federal Government mandate that if you
do not get vaccinated, you don't get, let's say, WIC or SNAP.
That is helpful.
Number two, is, again, access. So Medicaid expansion is
crucially important in terms of children, and adults for that
matter, getting vaccinated.
And lastly, I would say messaging. I mean, we know how to
sell soap or fabric softener, but we really need to message
into the communities the importance of vaccination, and as a
vaccinator, as a pediatrician, the safety and efficacy of the
vaccines that we have.
Ms. Kuster. Great. Thank you. I do have one more question
on incarcerated workers, but I can submit that for the record.
Thank you--our incarcerated population that has been hit so
hard.
Ms. Eshoo. I thank the gentlewoman, and she yields back. I
now would like to, let's see, is--do we have any Republicans
that have not been--haven't been--I don't think so. Mr.
Griffith was the last----
Mr. Griffith. I don't see any, Madam Chair.
Ms. Eshoo. I don't either. Then I will recognize the
gentlewoman from California, Ms. Barragan, and thank you again
for inviting Dr. Brooks. You are recognized for 5 minutes, and
make sure you unmute.
Ms. Barragan. Great. Thank you, Madam Chairwoman, and thank
you to all our panelists today. I represent the communities of
Compton and Watts. It is a very working-class community, almost
90 percent Latino and African American community combined. I
have seen firsthand what COVID-19 has done in our community and
the systematic racism that is happening across a lot of
different areas including healthcare.
Dr. Brooks, in your testimony, which I thought was very
powerful, you asked the prominent question, why is it we are
seeing the glaring differences in dying from COVID-19. And in
that, you respond and talk about social determinants of health,
which I couldn't agree with you more about, which is why I
introduced a bill, called The Improving Social Determinants of
Health Act, which would provide funds to the CDC, to establish
program focus specifically on social determinants. It would
also establish a grant program for local, public health
departments to tackle this issue.
Dr. Brooks, can you, again, highlight for us, the
importance of addressing social determinants of health and why
Congress needs to do more and act in this area? Specifically,
can you maybe explain what social determinants of health have
impacted your patients in Watts, and what it means for long-
term health consequences of people in our community and how
these conditions are impacting our community's fight against
COVID-19?
Dr. Brooks. Yes, thanks, and I would like to pause just a
second to thank you very much for the warm introduction, and
for the work you are doing in your district. You represent my
employer in your district and you do great work on the Federal
and local level.
Ms. Barragan. Thank you.
Dr. Brooks. Social determinants of health tend to determine
about 40 percent of health outcomes, which is more than
genetics or access to care, slash, medicine, slash, surgeries
or treatments. So it is the most important determinant of how
you will be, in terms of your life, as it relates to health.
So your focus with legislation on the social determinants
of health gets directly at the issue. And I might add, if
passed, or if that focus occurs, it will help all Americans. I
think that is really very important. It will help African
Americans, but it will help Latin Americans, Latinx, Native
Americans, et cetera. So social determinants--main one that I
see really in our area is food insecurity. I am really focused
on diet. If you eat well, you will likely be more healthy.
And I also say mental health, it was mentioned, allostatic
load. When you are stressed, you release excess cortisol, which
is a marker for inflammation, and you have worse outcomes.
And then education, the focus was there. If you have good
schools, if you have a focus on education, then you will have
better health outcomes. Education is directly linked to health
outcomes.
Ms. Barragan. Great. Thank you, Dr. Brooks.
Next I want to talk in discussing points of research
endowment program at the National Institutes of Health on
minority health and health disparities. This is a program that
funds to the endowment of academic institutions across the
country, institutions such as Morehouse School of Medicine
Atlanta, SUNY Downstate Medical Center in Brooklyn, Florida
International University in Miami, and Charles Drew University
in my very own district.
The goals of the program include promoting minority health
and health disparity research capacity and infrastructure,
things like increasing the diversity and strength of the
scientific workforce, and enhancing the recruitment and
retention of individuals from health-disparity populations that
are underserved in the scientific workforce.
Dr. Brooks, in your testimony, you state that poor
reporting of data, which initially masked the fact that the
disease was disproportionately affecting Black communities,
remains a problem even as States move to reopen their
economies.
Do you agree that providing funding to academic
institutions, to encourage research in minority health, plays a
crucial role in reducing the minority health disparities,
including during this current crisis?
Dr. Brooks. Clearly. Very interestingly, all of those
institutions reside in African American communities. So they
have a focus on the community that surrounds them. And they
have an academic bend, they do clinical research, they publish
articles. So that type of research, that type of funding, and
directed into funding, would reap great benefits in terms of
the data that would come from it and the actions that would
come from that data. So I highly endorse that.
Ms. Barragan. Well, thank you, Dr. Brooks. I recently
introduced a bill called the NIMHD Research Endowment
Revitalization Act with Congressman Carter. It is a bipartisan
bill. I am happy to say that the Senate--the Senate--has passed
this bill. It is on to the House. And so it is upon us to move
this in the House and get it through to the finish line, so it
will be one part of helping address this crisis.
And with that, Madam Chairwoman, I yield back.
Ms. Eshoo. The gentlewoman yields back. I now would like to
recognize the gentlewoman from Delaware, Ms. Blunt Rochester,
for your 5 minutes of questions. And are you unmuted? I don't
think so. You need to unmute.
Ms. Blunt Rochester. I am unmuted.
Ms. Eshoo. There you are.
Ms. Blunt Rochester. There you go. Thank you, Madam
Chairwoman, and thank you to the panelists. This has probably
been one of the most important panels that we have had. And
around the country and in my home State of Delaware, and as
others have mentioned, we have seen the disproportionate impact
of COVID-19 on communities of color.
As one of my favorite writers and activists, James Baldwin,
said, not everything that is faced can be changed, but nothing
can be changed until it is faced.
This pandemic brought to light the health disparities that
have long existed in our country, and we have this very moment
to really act and address them.
The root of health disparities are complex as all of you
have shared. There have been a lot of conversations about the
social determinants of health on this call--or on this zoom.
Some State Medicaid and children's health insurance
programs are exploring opportunities to address the social
determinants of health, like access to safe, affordable
housing, availability of healthy food and drinking water, and
healthcare services. But there is not clear guidance on how
States can leverage existing or waiver authorities to do so.
That is why my colleague, Congressman Bilirakis, and I,
introduced a bipartisan bill, H.R. 4621, the CARING for Social
Determinants Act, to let States know what works and how to
deploy the strategies, particularly for the pediatric
population.
Dr. Brooks, if more State Medicaid programs knew how to
build strategies to address the social determinants into their
demonstration projects and contracts, could we reduce health
disparities, and more specifically, can you give us some
examples?
Dr. Brooks. So the answer to your question is yes, it would
reduce disparities. An example I would give would be one of
those that was mentioned earlier--transportation. If there were
more Medicaid coverage of transportation, you would see better
outcomes.
I would also say integrating mental health. In L.A. County,
mental health and physical health are separated. So an
integration into the physical health side, the medical side, of
behavior health services, as a demonstration project, funding
it however you see, I believe, would show directly improved
health outcomes, which I want us to remember, that is the
goal--healthy outcomes.
Ms. Blunt Rochester. Exactly. Exactly. And you actually
shifted into what I wanted to talk about next, which is really
the toll that chronic stress from exposure to law enforcement
violence has on the Black community. Chronic stress can lead to
diseases like hypertension and heart disease as we know, and
both are linked to the COVID-19 mortality.
Because of existing mental health disparities, we know that
if we don't get the treatment, or if there is stigma attached,
there will be challenges. And I am working on legislation to
look at health consequences of law enforcement violence on
communities of color, and reduce barriers these communities
face in accessing mental health services.
Dr. Boyd, are there additional research gaps in our
understanding of chronic stress on Black Americans that
Congress should be focused on or should be filling? And what
still do we need to do to learn about the intergenerational
nature of stress and trauma?
Dr. Boyd. Thank you for that question. One of the gaps you
outlined there. We have yet to fully acknowledge and address
police violence as a public health crisis in this country. We
need to both study it that way, and we need to equip our public
health departments to address it in that way.
So one of the gaps that we have is better understanding
some of the health impacts of police violence. We know that
police violence increases risk, as you said, to illnesses
associated with chronic stress, like hypertension, diabetes,
heart disease, cancer.
We also know it has a disproportionate impact on mental
health for all African Americans who are witnesses. So I think
it is really paramount that we focus on police violence,
particularly at this time.
Ms. Blunt Rochester. Thank you for that answer. You know, I
was going to talk about cultural competency as not just a
program but an underlying pillar to advance health equity. It
is something I would really like to follow up with you on, with
both of you on, because I feel this issue of mental health and
healing, particularly when you marry COVID on top of the issues
that we are dealing with right now, and what we are witnessing,
for many of us, this is not--these are not new issues.
So much so that even as Deputy Secretary of Health and
Social Services, when I was working in Delaware years ago, I
got high blood pressure, just trying to create an office of
minority health. So we need to deal with these underlying
issues, and I thank you all so much for your work, Mr. Roy as
well.
Thank you.
Ms. Eshoo. Thank you. The gentlewoman yields back.
And now it is a pleasure to recognize the gentleman from
Illinois, Mr. Rush, for your 5 minutes, and make sure you
unmute yourself.
The gentleman is recognized. Can you hear me?
You need to unmute, Bobby.
He has been waiting for so long, too.
The gentleman needs to unmute. We can't hear you.
Voice. I don't think he can hear us.
Ms. Eshoo. He can't--I know. I am trying to motion to him.
Why don't we see if the staff can assist Mr. Rush. And we have
four Members that are with us that are part of the full
committee, and according to our rules, they can waive on to the
subcommittee, and the first one that I wish to recognize is the
gentlewoman from Colorado, Ms. DeGette, for 5 minutes. Welcome.
Ms. DeGette. Thank you so much, Madam Chair. Thank you so
much. I really appreciate you allowing me to waive on to the
subcommittee, and I want to thank the witnesses for their
testimony. Your insights are really, really helpful to us as we
confront the coronavirus challenge, and particularly the issues
of racial disparities.
I just want to say, my district is a highly urban district.
It is the City of Denver and some other areas around it.
According to Denver Health, the Latino population accounts for
58 percent of COVID-19 cases in Denver, while only making up 30
percent of Denver's population.
And, of course, when you look at the health risks, they are
even greater now during the pandemic. And so I want to ask a
couple questions, and I know some of the Members have touched
on this, but I would like to ask a couple of follow-up
questions.
As the number of underinsured or uninsured Americans has
increased, because of the economic impact of COVID-19, with
people losing their jobs, people of color are going to face a
greater risk of morbidity and mortality associated with the
disease due to delayed or foregone treatment.
Dr. Boyd, can you talk about the importance of ongoing
healthcare coverage for Americans, and especially coverage for
minority populations, when it comes to facing, then, a great
health challenge like this?
Dr. Boyd. Yes. Because we linked healthcare to employer-
based health insurance, when populations lose their job--and we
know nearly half of African Americans have lost their job as a
result of COVID-19--they lose their health insurance. So
ensuring that insurance is not a barrier to healthcare is
really critical, particularly for African Americans, Latinx,
and indigenous populations who have the highest rate of
uninsurance and under insurance, less insurance than they need
to meet their health needs.
Ms. DeGette. Right. And Dr. Boyd, I also wanted to ask
then, if somebody loses their job and their health insurance,
then they start to get sick, it would seem to me, as a
layperson--but you are a doctor--that it would make it even
less likely that that individual would try to go for medical
treatment if they had symptoms of COVID-19, causing potential
even greater illness.
Dr. Boyd. Absolutely. The evidence indicates that your
economic status--your economic status informs how you utilize
healthcare. And so if you don't have sufficient financial
resources at home, you stay home from healthcare as well, which
makes you more likely to present later in your case, which in
the case of COVID means you may be more severe and more likely
to suffer a bad outcome.
Ms. DeGette. Yes. Now, you know another issue I have been
working on a lot is--and actually several of our witnesses--
several of our witnesses--I think Sir Roy and also maybe Dr.
Brooks--talked about this--is, COVID is going to be around us
for a long time, and we need to be able to learn how to deal
with these issues. And part of it is going to be testing and
contact tracing.
Congresswoman Shalala and I are working on legislation to
make coronavirus tests free for anybody with employer-based
insurance or a plan under the ACA.
And I know this has been included in several of the relief
packages, but I am worried what is going to happen with
uninsured individuals. If they don't want to pay for testing or
treatment, then how are we going to do the testing and then the
subsequent contact tracing? And will this cause just a greater
magnified effect?
Dr. Brooks, I am wondering if you can talk about what is
known about access to testing and tracing among minority
populations?
Dr. Brooks. So first of all, your presumption is correct,
those that are uninsured will be less likely to get tested. And
we also need aggressive testing and contact tracing. So right
here in California right now, we do have something called
presumptive eligibility, where some people that are uninsured
can get tested. But I would say that that helps, but we--that
is a bandaid. OK? We need Federal legislation that would cover
testing for everyone and aggressive contact trace.
We have all these unemployed, 16 percent unemployment rate.
Employ them, give them a living wage, and have them do the
contact tracing.
Ms. DeGette. Right. Because even if you can give someone a
free test, if they do the contact tracing, those people may not
want to go get tests then. So it just--it just magnifies.
Thank you very much, Madam Chair, and thanks for letting me
sit on. Appreciate it.
Ms. Eshoo. You are always welcome. So the gentlewoman
yields back. I am going to go back to the gentleman from
Illinois, Mr. Rush. Thank you for being here.
Mr. Rush. Ms. Chairwoman can you hear me now?
Ms. Eshoo. Yes, I can hear you very well. Thank you.
Mr. Rush. Well, I have been diligently listening and on
since the beginning----
Ms. Eshoo. We thank----
Mr. Rush [continue]. And I want to thank you for having
this hearing.
As a Black man in America, because of episodic racism and
systemic racism, I find myself an unapologetic, angry Black
man, even after all these decades of fighting on the frontline
for freedom, justice, and equality. And if not for my faith, I
really don't know where I would be.
Dr. Boyd, I fully agree that we, as a Nation, and certainly
we, as in Congress, are at risk of becoming data addicts,
addicted to more and more data when we already have sufficient
data to act courageously and willfully to solve this endemic
problem.
I also absolutely agree with you, Dr. Boyd, when you stated
that according to one study, eliminating segregation brought--
erased Black/White differences in income, education, and
unemployment. A recent public investigative piece found that in
Chicago, lenders have invested more in a single White
neighborhood than all the Black neighborhoods combined.
And as you eloquently stated, this disparity snowballs to
disparities and explodes into air pollution, access to clean
water, employment, educational opportunities, and many other
impacts that are clearly the bedrock of systemic racism.
Dr. Boyd, can you expand on how Congress and the Federal
Government can best take action to address the underlying and
ongoing residential segregation that is all too widespread in
our society?
Dr. Boyd. Thank you for those powerful words. Yes. I think
one thing that I will underscore that you mentioned is that we
know communities of color are disproportionately exposed to
toxins and pollutants in the air. That is because they are
concentrated in communities that have been shaped by redlining,
segregation, White flight, suburbanization, and zoning laws
that allow industry to live right next to where kids play and
where schools are.
We can't allow that anymore. So I would love it if our
Nation's lawmakers would respond to the disproportionate
environmental racism suffered upon communities of color.
One study even showed increases--that exposures to
particulate matter in the air, like air pollution, can increase
the COVID-19 mortality rate 15 percent more. So it is not just
overall, you know, environmental racism, it directly affects
your risk for COVID-19 mortality.
Mr. Rush. Thank you.
Dr. Brooks, I have a bill, the Communities Act, which will
increase loan forgiveness for doctors who practice in
underserved communities. What impact would a program like this
have on increasing the number of physicians, and particularly
physicians of color, who serve in medically underserved
communities?
Dr. Brooks. Loan repayment would be a great support
mechanism to allow primary care physicians to come into
medically underserved areas. As you know, the debt of--average
debt is somewhere around $250,000, coming out of medical
school. So that would drive the younger ones to give care in an
underserved area. And the younger ones have new energy, new
ideas.
And number two, where you start working, you are more
inclined to stay. There is a shortage of primary care providers
in the underserved communities. Federally qualified health
centers, one of which I am the chief medical officer, we are
constantly looking for physicians, and specifically physicians
of color, because again as I stated earlier, physicians of
color provide better care to African Americans. And there is
also a study that show they are less likely to have implicit
biases related to race.
Mr. Rush. Dr. Boyd, you talked a few minutes ago about the
impact of police misconduct, police violence, as a permanent
health issue. Can you expound upon that, police violence as a
public health issue?
Dr. Boyd. Yes. Particularly during this COVID-19 pandemic,
we have to acknowledge the intercepting forms of violence that
are facing communities of color. We have talked about the
violence of segregation, the violence of disinvestment in their
communities, but we also have to talk directly about State-
sanctioned violence by police that we know drives up increased
rates of mental health conditions, for kids, of headaches,
sleeping trouble, trouble with school performance, and for
adults, for risks of chronic disease.
If we don't address that, then we are leaving unaddressed
some of the drivers that are contributing to higher rates of
COVID-19 mortality right now.
Mr. Rush. Thank you, Madam Chair. I yield back.
Ms. Eshoo. The gentleman yields back, and I thank him.
I know that Congresswoman Schakowsky and Congresswoman
Clarke were both waiving on. I saw them earlier, but because I
don't see them now, I am going to recognize the gentleman from
Arizona, Mr. O'Halleran. Welcome. Wonderful to see you. Are you
unmuted?
You have to unmute.
Mr. O'Halleran. Thank you, Madam Chair.
Ms. Eshoo. There you are. OK. Wonderful.
Mr. O'Halleran. Thank you for allowing me to waive on. This
has been an outstanding committee meeting. I am very pleased
that we were discussing such an essential topic at this point.
Quite frankly, the response to the COVID-19 pandemic has not
been adequate for our Tribal Nations, our communities of color,
and basically across America.
For our Tribal Nations, which I represent the Navajo and
the White Mountain Apache out in Arizona's First Congressional
District, up until very recently, Navajo Nation had their
highest per capita COVID-19 infection rate in the Nation. This
was just surpassed by the White Mountain Apache, also in my
district.
White Mountain Apache currently have over 1,300 cases of
COVID-19 out of an enrollment of just 12,000 people. This is a
small tribe that is--I just talked to the chairwoman this
morning. It was just sad to have that discussion.
But the common thread amongst many of these communities,
communities of color, Tribal Nations, it is the deserts. It is
the healthcare that is in those communities. It is the food,
the health, the infrastructure, the housing, all of those
deserts that are out there.
I am looking out at a desert right now, but I am close to a
store. I am close to healthcare. I have banks around the area.
These areas don't have that.
I grew up on the west side of Chicago, and Representative
Kelly and Representative Rush know that well. And I have to
tell you, I am just in shock. And we have bills to make sure we
get some epidemiology information for Tribes, but it has to go
so much further to address the critical issues of racial
segregation, racial impacts, and the lack of this Congress and
this country to acknowledge that we have trust and Tribal
obligations and treaty obligations.
This pandemic has exposed those of us who live in rural and
underserved America already know. We lack access to healthcare
providers. It is estimated that over 100,000 homes on Tribal
lands lack access to running water and adequate sanitation
infrastructure.
On Navajo, roughly 30 percent of the population lacks
access to running water at all. I introduced a bipartisan bill
to address this very issue here, and I hope to see it move in a
future House package.
Now, before the COVID, the unemployment rates across the
district, Navajo was at 40 to 50 percent unemployment before
COVID, and the White Mountain Apache was close to 80 percent
unemployment. Dr. Boyd, thank you for noting in your testimony
that Native Americans are 19 times more likely to have access
to clean drinking water than White Americans.
And I also want to ask you a question. Do you believe that
better reporting and information sharing of illness in minority
communities can inform better the treatments to improve health
outcomes and create better policy? Specifically, how can we do
this to ensure that we can identify issues and allow them to be
addressed in a culturally appropriate manner, with Federal
support when and where it is needed? Thank you.
Dr. Boyd. Yes. Just to bring up the clean-water example
that you brought up, which is so devastating for indigenous
communities, that is not a function of what we don't know. We
already know that residential segregation onto reservations and
that public divestment in the Indian Health Service has left so
many indigenous communities without the resources they need,
including basic resources like clean water.
We don't need further data to say we need to further invest
in indigenous communities and their healthcare infrastructure
to further address what their needs are.
Obviously, though, data is really important, and I will
only underscore one more point, which is that indigenous
communities are often left out. If they aren't counted as
``other,'' they aren't counted at all because their populations
are often very small, which is, again, a function of genocide
in this country.
So we also have to be committed to counting at smaller
rates who is affected and how, so that we make sure we always
encompass what is happening with indigenous communities.
Mr. O'Halleran. Thank you, Doctor.
Dr. Brooks, in your testimony you mentioned that implicit
bias training is necessary for physicians and all healthcare
professionals. I believe it is also implicit for the Congress
of the United States.
When patients are subjected to biased treatment from their
healthcare provider, how does that impact their decisions to
seek care in the future, and does it also contribute to poor
racial and Tribal healthcare outcomes?
Dr. Brooks. Yes. If a person feels that they have suffered
from implicit bias and, therefore, poor care, they may be less
likely to go seek care the next time. So--and it can happen
with the Native American population certainly. So that is why
it is critically important to have implicit bias training,
because then we can--that is just one hurdle that we can get
past and now get to the more mundane--treating illness.
Mr. O'Halleran. Thank you, Madam Chair, and I yield.
Ms. Eshoo. The gentleman yields back. It is always a
pleasure to have you join us. I am just going to do one more
call-out for Representative Schakowsky and Representative
Clarke. I don't see them on the screen.
I would like to bring the hearing to a close. Thank you,
Mr. Griffith, for being with the committee from before the
gavel went down to the rest of the gavel--you know, the gavel
going back down again, as well as Ms. Kelly. You have spent
hours with the committee, and I want to acknowledge that and
thank both of you. And as I said, Mr. O'Halleran, you are
always welcome.
To our witnesses, I think you have been so highly
instructive to us today. We have an enormous amount of work to
do. But with this enormous challenge that we have--and they are
enormous challenges--I think come enormous opportunities. And I
think that that is the set of bookends.
I would like to recommend for those Members that represent
Native Americans, that I would really like to see you come
together and hopefully put a package of bills together. We have
Members from both sides of the aisle that are so eager to
address the meagerness, and shamefulness, in the Native
American community in the Tribal Nations.
To both of the doctors, you have been outstanding
witnesses. We have learned a great deal from you, and I know
that you will continue to make yourselves available to Members
as we seek to put together legislation that will be highly
effective and help turn the page of shamefulness in our country
around.
This is our responsibility. I believe that there is the
political will in our subcommittee. It is an outstanding
subcommittee on both sides of the aisle. And to Mr. Roy, thank
you once again for being a witness at our subcommittee. You are
always welcome, and you gave excellent testimony to us as well.
So what I would like to do, to submit the following
statements for the record, and I also want to remind Members
that pursuant to committee rules, they have ten business days
to submit additional questions for the record, to be answered
by the witnesses who have appeared.
So I ask the witnesses to respond promptly. I know you have
your hands full, but we ask that you respond promptly to any
questions that you may receive from Members.
So with that, I am requesting unanimous consent to enter
the following documents into the record--a statement from the
Asian and Pacific Islander American Health Forum; a statement
from the Association of American Medical Colleges; comments
from the American Kidney Fund; a statement from the Association
for Clinical Oncology.
A Brookings report entitled, Race Gaps and COVID-19 Deaths
Are Even Bigger Than They Appear; testimony from the Center for
Reproductive Rights; a June 10, 2020 letter from the Alliance
of Multicultural Physicians to the FDA Commissioner, Stephen
Hahn; an April 2020 Kaiser Family Foundation issue brief,
entitled, Communities of Color at Higher Risk for Health and
Economic Challenges Due to COVID-19.
A June 16th, 2020 report from the Robert Wood Johnson
Foundation; a May 2020 report from Families USA, entitled, The
Fierce Urgency of Now, Dr. King's Words; Federal and State
policy recommendations to address health inequities in the era
of COVID-19.
A Health Affairs Journal report, entitled, Disparities in
Outcomes Among COVID-19 Patients in a Large Healthcare System
in California; a statement from Johnson & Johnson Services----
Mr. Griffith. Madam Chair? Madam Chair?
Ms. Eshoo. Yes.
Mr. Griffith. Madam Chair, how much longer is your list? I
am happy----
Ms. Eshoo. Well, they are not numbered. I am going
Mr. Griffith. I am happy to waive the remainder of the
list, assuming that all of those have also been seen by the
minority staff.
Ms. Eshoo. And with that, the entirety of this list--maybe
the staff can tell me if they actually have to be verbally read
into the record or if we can just, by unanimous consent, place
the rest in the record.
Well, the Republicans agree, according to Mr. Griffith.
Mr. Griffith. That is correct.
[The information appears at the conclusion of the hearing.]
Ms. Eshoo. So I thank you, Mr. Griffith, for that.
And once again, let me thank the witnesses for your superb
testimony. I began the hearing by saying that America is in
pain, America is in anger, America is doing something that I
think is very healthy, and that is questioning. And that there
is really, I think, a coalition of conscience across the
country, responding to the wrongs that need to be made right.
So with your good help, your testimony, and the political
will of the members of this subcommittee, that I am so
privileged to chair, I thank you. I know that there will be
outreach to you, and I know that you will respond.
And with that, I will now adjourn the subcommittee, the
Health Subcommittee of Energy and Commerce now. Thank you,
everyone. Good afternoon.
[Whereupon, at 3:46 p.m., the subcommittee was adjourned.]
Prepared Statement of Hon. Eliot L. Engel
``From the protests in Minneapolis to the marches in New
York City, our nation has heard and loud clear-centuries of
systemic racial injustices must come to an end. Most of these
public demonstrations have focused on cases of police brutality
towards minority communities such as the murder of George
Floyd. In the backdrop of these demonstrations, however, the
coronavirus pandemic continues to claim American lives,
particularly those from communities of color.
My district, which includes Bronx and the Westchester, has
been at the epicenter of the nation's coronavirus outbreak. It
is unconscionable to me that my constituents who are African
American and Hispanic are twice as likely to die from this
virus than their White counterparts. This pandemic has brought
to the forefront the health inequities that the Energy and
Commerce Committee has been trying to close for years with
historic legislation such as the Affordable Care Act, which I
helped author, and has enabled nearly 100,000 of my
constituents gain health coverage.
Like many of my colleagues on this panel, I believe that
access to high-quality affordable healthcare is a basic human
right, regardless of one's race or ethnic background. This
pandemic's disproportionate impact on African American and
Hispanic communities highlights the pressing need for a
universal healthcare system that guarantees every American
access to health care. To that end, I have been a supporter of
Medicare for All since it was first introduced in 2004 and I am
a Founding Member of the Medicare for All Caucus. This caucus
was successful in securing the first-ever Medicare for All
hearing in the Energy and Commerce Committee as well as the
Ways and Means Committee this Congressional session.
We have a unique moment in our nation's history to move
forward truly transformational legislation, which will help
communities of color access their basic human right to
affordable, high-quality healthcare.''
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