Treatment under federal programs, and the financial situation. And so the islands having been hit by actual disasters in turn including hurricanes, typhoons, earthquakes. Now those are we getting the aslth care infrastructure covid19. Local governments has been working to recover and rebuild under these events. But i believe there is more than needs to be done. Things that this virus has provided all of us is a perspective that as we go through and talk about recovery and relief, that there is a cumulative effect. And theres not been enough resources. Suddenly you are drowned economically and in terms of Health Response this very deadly virus. So it becomes a cumulative effect. Disparity at the beginning, and then you put disparity on top, you demand a response that is already taxing local communities and local governments. So i welcome this discussion. I think it is important. I think my colleagues, vice chair sablan of the full and internal affairs in. Particular. Thank you very, much for joining us as well. Insistence,cy and equity, and full attention to the territories has been very necessary and essential so that we can respond to this pandemic or any other issue at a federal level that there is inclusion and these gentlemen have been very effective at sharing that inclusion for not only the areas that they represent, but the totality of the territories, of the jurisdiction of our community. So i want to welcome the panelists to this format and introduce them each as we go along. Before i do, let me ask the vice chair if he has any opening comments before i introduce our panelists. And if there are any panelists in particular that you would like to introduce yourself. The time is yours. Tan thank you vice chair sablan thank you for holding this and thank everyone for taking part in this. Good evening. For those of us who are in d. C. , good afternoon to chairman gri jalva and in the caribbean, good evening as well. And good morning to those of you in the pacific. Thank you again to the participants for being here today. Hearing from individuals on the ground with your knowledge of the local situation and their respective challenges and needs. From esther muna, ceo of the health care operation. I could think of no one better to share about the Emergency Response in the northern islands. Nearly all the territories have been recovering from Natural Disasters before this pandemic hit our shores. Hurricanes, earthquakes in the caribbean, super typhoons and cyclones in the pacific have had on lives,ing Impact Infrastructure and our economies. In congress has already provided billions of dollars to recovery. And we are slowly starting to rebuild. Then the poll then the covid19 been amick pandemic started spreading. This Public Health disaster is unprecedented. Community and individually. The economies of every state and territory has been devastated. It will be felt for years to come. The economy was intrabiddable [indiscernible] shuttered,have residents have lost their jobs, pension payments have been reduced, and the arm felt throughout the islands continue to mount. Commonwealth was slow to recognize the severity. But since has done a commendable. Ob the number of cases has remained at 14. We have unfortunately had two deaths. Both were citizens and residents of the philippines who were missionaries on missionary work. Working with the stayathome orders, Public Education and the need for handwashing. It all seems to be working. I hope that continues. Hhs, dod andfema, a host of federal agencies have provided critical assistance. Thatnt to make sure continues if more is needed. Nicolas, the virgin islands, we are really having a difficult problem which the department of education is trying to get them to release the education stimulus fund. Yesterday bute then withdrew the notice yesterday. We are trying everything. So, its way overdue for our schools. But thank you again everyone for joining us. Comments anda introducing one of the guests from the district you represent . Thank you solas much again for your leadership and constant vigilance and constant vigilance in looking out for our territories that fall in the jurisdiction of the committee. I want to thank my colleague for his leadership and mentorship in making sure that the pacific territories in particular, but all the territories in general are constantly being looked out for and the responsibilities that we carry as members of the Natural Resources committee. Mr. Chairman, i was really moved by your opening statement, because it was very profound and it represented a profound insight of the circumstances in the territories, in part and how they become exacerbated when we face challenges like these. And i wanted to take this opportunity to kind of share how those preexisting challenges are circumstances that have become exacerbated in the most unamerican way. And this issue i wanted to kind of bring to the attention of this particular panel, is supplemental security income. The recent case in puerto rico, the circumstances in guam, we do not have supplemental security income in most of our territories. They were wise enough to negotiate receiving it when they negotiated their commonwealth relationship with the United States, but unfortunately the rest of the territories do not have it. And the absence of supplemental security income means that those at risk groups were not already receiving the most basic level of american decency in terms of support. And as a result of not receiving that support, they have been relying on caregivers and family members being able to supplement their needs and in these circumstances, those brave caregivers and family members who have been working extra hard to care for those who need their help, they are out of work. Their job prospects are unknown. Of we now have a Community Individuals who not only lacked supplemental security income, but even lengthy support of those who were taking care of them previously. So they have gone from not being supported, to downright destitute. And so as we move forward with these cares packages, and as we look for ways to try to preserve the american way of life, and the decency that we hold true to in this country, i believe that this is an opportunity for us to not only address the challenges that are being faced as a result of this pandemic, but to have a very keen understanding now of how leaving out our people and just territories is unacceptable. So we have an opportunity to not only address these challenges today, but to circle back and to correct these injustices that are, today, just are absolutely horrific for those that are being impacted. And so i wanted to thank you, mr. Chairman, for affording us the opportunity to be able to vocalize what we are going through. I wanted to recognize dr. Tom shieh, who has been a very vocal advocate for the necessary procedures and equipment. View ofeal good general the severity of what we are going through on guam and the necessary advocacy that our people have had to take on themselves in order to be able to fill the gaps that our people are facing on a daily basis. Thank you so much, and i yelled back. I yield back. Chair grijalva let me collectively thank each and everyone of you for taking the time, for bringing the perspective, for continuing to e territoriesat th are justified but in demanding that they get. And with that let me introduce ms. Esther muna. Shes executive officer of the islands health care corporation. Ms. Muna, the time is yours. Ms. Muna thank you chairman, vicechairman, and distinguished committee members. Last may i gave testimony to this committee under very different circumstances. I presented to you the powerful positive impact of equitable medicaid funding on our Health Care System. Last december the federal government took us to task by granting two more years of equitable medicaid funding for the territories. But only a couple months later, we were introduced to our greatest challenge yet, the coronavirus. In january they begin messaging coronavirus prevention and our community and screening patients for symptoms. Weearly february we spent sent our first it took 10 days to get a negative result. We took steps to reduce traffic on campus, inc. Coronavirus screening at the airport. On march 16 we activated our Area Operations command, diverting nearly one third of staff to the response. 28, we announced our first two positive cases with 12 more sense. In the past 40 days with support from our governor, his task force and staff, we have screened more than 500 walking ,atients walkin patients screened more than 1500 passengers at the airport, identified and interviewed more than 215 contacts of positive cases, responded to more than 700 phone calls about the coronavirus, overseen the care and release of more than 250 individuals from quarantine and isolation, had more than 300 specimens tested, including more than 200 and our own labs, and conducted more than 90 teleconsults with our patients. We began communitybased testing and collected samples of more than 400 people. Of the 14 confirmed cases, two have died. The other 12 have recovered. It has been nearly two weeks since our most recent case was identified. We had been vigilant, we had been effective, but we are still vulnerable. The cnmi is uniquely susceptible to upheaval should we experience a larger outbreak. The virus undercuts the power of our social capital. ,uilt on family gatherings multigenerational households, and close relationships. Noncommunicable disease crisis and threatens to tear away the gains we have made to our Health Care System. It has evaporated our livelihood. Throwing our tourismbased economy into a swift decline. Shut downovernment is and projecting a 65 million deficit. The island is closed, many employees have been furloughed, skyrocketing unemployment, retiree pensions cut 25 , rendering health care unaffordable for so many families. Resultcess thus far is a of a herculean effort requiring nearly 18,000 staff hours and over 17 million. And theo the governor, covid19 task force, and the federal partnership of hhs and dod from fema, further supported by the care staff, we have been able to secure additional ventilators, ppe, laboratory equipment, testing reagents, establish a temporary care site, and a longerterm alternate care site. We have received help to assess our search staffing needs our Surge Staffing needs. We can now test for the coronavirus on the islands. An ability that fell far from our reach this one month ago. This assistance has been core to our success, but we do need continued federal assistance to put an end to this war. We must fulfill our regular obligations while battling the coronavirus. Ambiguous feature to prepare for the worst. Our strengths and weaknesses are brought into focus while it has sparked innovation and illuminated improvement we need your help to establish a reliable, equitable supply chain for ppe and testing reagents. We need funding to keep our staff, including our robust Contact Tracing team at work. We need support for the longoverdue expansion and modernization of our 35yearold hospital. Along with our governor, his cabinet and task force, and congressman sablan, we are working hard to bring the rest of us back to work. Help us get there. Thank you. Chair grijalva thank you very much. Appreciate it. Shieh. Introduce dr. Sir, the floor is yours. Dr. Shieh thank you. Thank you mr. Chairman, vice andr, and our congressman, all the panelists. I do not work for the government , i am independent, and i will speak frankly as a person on the ground. Guam is small. As the tip ofred the spear. About just past 8 00 in the morning. And we are trying to adjust our Living Standards for the people here, because people are out of jobs and many are suffering. But covid19 has hit guam pretty hard. Its unexpected. The sad part about our first case is that from the very first island had the virus in our community. So far we have only had five deaths. Sadly, they are part of the veryy guam is compassionate. Even if it is just five deaths, it affects a lot of people, from the one death Aircraft Carrier theodore roosevelt. The island total right now is about 154 positives. We have tested about 1200 thus far. The u. S. Navy positive is approximately 1000, and they commitment i commend the navy to being able to test 5000 sailors within two weeks. I wrote to them, congratulating them on that task. It is not an easy task. We ask that as the sailors return to their ships, perhaps time has come for the u. S. Navy to actually help them get capacity, supplies, and personnel. I hope i get a positive response. Guam has always been good with the military, and that cannot be forgotten as you take our boys our voice to congress and to the president. Projectionsarent to coming from the Governors Office here have been way off course. The projected 3000 to 6000 deaths, and over 400 hospitalized patients or more by now, its just not happening. Luckily the hospitalization rate has remained flat, so that is good. I keep saying there are really no models to compare guam the new york city, wuhan, korea, japan. Our population of 160,000 compared to other places with over 8 million people. That being said, we cannot take the virus lightly. Guam is trying to add, i think the projection from the Governors Office, add another 2000 beds to the island. Seriously, it is like building a restaurant with 2000 sitting capacity, but you only have 100 waiters and 10 cooks. Theres just enough staff for 2000 additional beds. This is just to show you the lack of medical staff is part of it Big Health Care disparity our island is its periods in. That said island is experiencing. That said, im glad guam has received so much aid. I want our government to be transparent and where the dollars are being spent. The money should be directed to people first, and we ask our government to be transparent on that. Over these last three months, are people really have suffered a sacrifice, lost their jobs. Money for families, losing Health Care Insurance is so critical at this time. But the people really want to get back to work. Just to give you an example, i had a patient who was pregnant. She had four children. Her and her husband both work, but right now they are furloughed with no income coming in. They have some savings, but over the last 1. 5 months they really dug into their savings. They had a really hard time paying the bill, not to mention having a hard time buying cereal and milk for the kids. I gave them 100 to buy food the other day. These are hardworking people that are suffering. This is just one case, and i am sure there are thousands of them out there. The stimulus checks will help, but it is not enough. Be people cannot continue to living under these emergency declarations. I think they want to get back to work. There is stayathome, they social distance, they put on their masks. The key right now is to engage the community in how to reopen to a new normal. Not,is small, and we could and should not be forgotten by the United States of america. If we do not get our working force back, we are really going to hang onto an economic recession. Social distancing, handwashing, face masks is the new normal. So we ask the federal government to help us with funding, but at the same time we ask our government to be transparent on where every dollar is spent. And that dollar should be spent for the people of guam. Thank you. Chair grijalva you are welcome, sir. Let me introduce the next panelist, someone i know and have worked with. Jesus, Senior Advisor for puerto rico. Working on the issues affecting the island. I think you will speak to that cumulative effect as we go forward, as the other panelists have spoken as well. The time is yours. Mr. De jesus good afternoon. I am senior policy advisor for power for puerto rico. It is an honor to be here with you today. Me toyou for inviting share thoughts and concerns about the covid19 pandemic that affects the commonwealth of puerto rico. Thank you to the Committee Staff and my fellow panelists. Unfortunately not everybody has the luxury of spending time at home, working with comforts. Though this has been an effecting time for everyone around the world, it is important that the coronavirus outbreak is the Third StraightNatural Disaster to hit our island since 2017. Together with the manmade disasters of the botched federal hurricane response, as well as a fiscal crisis and economic depression from puerto rico in the last 15 years, this has puerto rico cannot effectively rebuild in a Sustainable Way while being hemmed by federal restrictions resulting from more than 120 years of u. S. Colonial rule. We hope the Natural Resources committee where people were akin to a natural park or gas line is denigrating for puerto rico and the u. S. Promised toeral quote, the greatest amount of liberty compatible with its military operation. 120 years later those words ring as hollow as and contradictory as ever before. How can this committee address many of the grievances in the shortterm while effectively fighting the pandemic, and also addressing medium and longterm challenges . It will become apparent as i go along. First of all, what is the situation on the ground . People have tested positive for covid19. 86 have unfortunately died. A proximally 30 five tests what explains the lack of testing . First off, the Trump Administration has refused to implement a National Testing strategy and is not properly invoked the defense production act. Games type ofger situation competing against each other and the federal government. Also, the government of puerto rico entered into a questionable contract for one million koba tests that never arrived. Had threeo since has Health Secretaries resign, and the current secretary has admitted mistakes. The Commonwealth Legislature is investigating the scandal. The reality is no other contracts have been signed to get a significant amount of tests. We have also barely begun addressing the earthquakes in january that less left thousands homeless. We have barely rebuilt since the hurricanes of 2017. There are still tens of thousands of homes with no roofs. Why is this the case . 20as been widely reported, billion that Congress Approved to rebuild puerto rico, they only sell they only sent 1. 5 billion. As acommittee in congress whole has a responsibility to investigate and shiny bright light on the federal funding delays and the government of the island for not sending the money intended for the people. This brings me to a painful issue about school lunches. Congress has appropriated funding for schools to be able to continue providing meals for needy students and their families. That would be paid for 100 by the federal government. Puerto ricos government instead has sent some food, many of it expired, to nonprofits that serve the population at large, not necessarily needy charge and needy children. Demanded the governor open school lunch kitchens and have refused to open school lunch counters. We immediately compel them to open the School Kitchens now. Whatever policies are needed, and i will be brief, we need to restore federal tax incentives for u. S. Manufacturing. Put uss eliminating it into a recession. This is also an Natural National problem. Puerto rico could be another gateway for the u. S. Manufacturer, and boost National Security manufacturing, pharmaceutical, and medical heroes, 80 of which are now made in china, and could return to u. S. Shores if these were restored. We need to cancel the debt. Puerto rico has 72 billion in debt. Thankfully this committee has supported the federal relief act. We need to mandate the fiscal board set aside 9 billion through paying wall street. We need that to be helping the people. We also need to pass the earthquakes supplemental. We need to get rid of the jones act. Ion everyus 1. 5 bill year. Organizations are treated as Small Businesses, but in puerto rico most nonprofits are not registered with the irs, but registered with the commonwealth state department. Governmentederal need to also get the benefits. The family paid sick leave act, we obviously got paid sick leave for our workers. Unfortunately the u. S. Department of labor is saying that will only start april 1. In the case of the island, 15. To rico left march this was the first and the strictest lockdown. It also included a curfew to prohibit people from leaving their house at all and night. Wow that was commendable, unfortunately there is much more to do. I really want to close by saying we need to lift the medicaid cap. Arbitraryo face an cap to the medicaid funding we need. Obviously dealing with a pandemic capping medicaid funding is no way to deal with a pandemic. In conclusion, it is selfevident most of these issues fall under the square purview of congress and the federal executive branch. Puerto rico never recovered from colonial restrictions. Bill whichnts addresses our concerns is such an important first step. We look forward to the discussion so the harmful effects can be reduced, and the law eventually repealed, and for congress to finally uphold its obligation to the colonized territories and puerto rico. Thank you. Chair grijalva our next encarnacion, justa commissioner for the virgin islands. Thank you for joining us today. I am sure you are extremely busy during this crisis. Appreciate your valuable time. Please, the time is yours. Ms. Encarnacion thank you very much. Good evening to you. I would also like to acknowledge congresswoman stacy. Welcome the 872f today we have tested persons, 732 negative, 62 positive, with 78 pending. 51 have recovered, leaving only seven active cases. Sadly we experienced four dead. After the first case was confirmed in the mainland u. S. , they activated its Virtual Emergency Operations Center on february 2. As commissioner and incident commander, i conveyed the first of weekly interagency assessments and planning meetings on february 7. On february 21 the department of health collaborated with Emergency Management agency to conduct a table exercise that over 65 agencies attended. For goals andgaps strategies. Our interagency meetings continue daily, which was sparked by the governors declaration of the state of emergency on march 13. First confirmed positive case of coronavirus. Like everyone else, we suffered from lack of sampling and testing supplies, and ppe, but we are proud to say that with a methods, we have traced everyone and monitored those quarantined daily. The division of epidemiology worked with members of cdc and created a model for covid19. The model predicted over 100 hospitalized patients, over 300 deaths, and thousands needing respiratory care. Restructure incapable ofity is meeting the projected surge. Bed, is an to lack of lack of staff and supplies. 14 ventilators. Epidemiology has established weat because of our efforts, are below and behind the expected peak. Recognizing this, our efforts have been focused on providing and preparing the facility, beds, recruiting staff, and ordering needed supplies and equipment. Fema, hhs and commercial entities. Unfortunatelyorts on the region, our request was either denied or placed on hold. As we meet the army corps of engineers and contractors to onome an inpatient facility st. Croix has been repaired, renovated, and equipped. The work will yield a total of hundred additional beds. As a result we began cobit testing in midmarch. With most of our cases being travel related we have worked with the National Guard the department of health joins the governor three times a week and press conferences that provide insight on data, trends, mitigation efforts. From the youngest to the oldest, resources for staying mentally healthy during this time. Virtual programs have also provided. We continue to expand. Most recently a truck carrying messages and catchy jingles through our communities have actually been very encouraging. We have worked hard and the test paid off in support of fema, hhs, private donors and others. We have enjoyed the unwavering support of the local administration. Governor bryan, lieutenant governor, i would be remiss if i did not acknowledge the work of our own congresswoman. Included. Thank you. We are also thankful to our staff for the dedication to ensure the community receives the Healthcare Services needed and their flexibility. Like other fellow officer areas, our particular vulnerabilities and distance from the mainland United States presents unique challenges that we ask you to keep in mind as you advocate and legislate on behalf of the entire nation. With gods blessing, covid19s roar will become a whimper. We know this will not be the last disaster we have to face. What we need from congress is not just the response to this pandemic, but to ensure we are better prepared for the future. We ask you help us to strengthen Public Health and infrastructure. Building a strong workforce, improving social determinants of health, and bringing equity to us in terms of medicare and medicaid, as many of us have already stated. Need. Nd other programs have given a we lot in every sector of american life. We are proud americans. Tools that would allow us to continue to serve and enhance our service. Thank you for the invitation to testify, and i am willing to answer any questions you may have. Thank you. Thank you for the insight, the information, and some of your pointed and necessary advice. Let me introduce our family final panelist, ms. Sandra king young. You may begin. The time is yours. Ms. Young thank you. To my fellowand colleagues from our sister territories. On behalf of the governor and the people of American Samoa, thank you for your leadership, and to the committee for all your support and work that you do for the territories. Are me who today joining me here today are two of our covid test members. Deputydemiologist, and director for the department of Human Resources overseeing our first responders. Our government and territory are operating under emergency covid19 declarations with oversight by the Governors Coronavirus Task force made up of multiple government agencies. As you may know, we are grateful here in American Samoa that today our territory has no confirmed cases of coronavirus. But we continue to operate on high alert, executing emergency protective calls. Our governor closed our borders from outside passenger travel on march 26, which was the last passenger flight to come to American Samoa. This closure will continue through may 31. Reopening our border will largely depend on readiness to accept passengers traveling from affected areas, particularly in our ability to test, which is going to be a problem if fema does not provide enough testing supplies for our territories, and an additional 50 ventilators in anticipation of reopening our borders. We tested 64 people and all six e4 are negative. We have and all 64 are negative. Our territory only has 13 ventilators on island. Further, the chronic issue that medicaid has in support of our Health Care System at providing Timely Services to our people is a local match. If there is anything that can be done to provide the territories with 100 hazmat during the pandemic that would be extremely helpful. Two other key challenges we are facing is the difficulty of our Small Business owners receiving help from the programs made available under the cares law, and the release of the u. S. Department of education funds based on our Poverty Level for American Samoa. The Economic Disaster insurance, all the funding was sent by the state. We need specific allocation for the territories. Many Small Business owners do not have professional Business Plan writers to submit these applications. 11 of our local tax was finally able to process applications, the very next day the program was closed. Although there is a new funding coronavirus, it is not yet up and they are still processing previous applications. Many of the issues that are challenges for us have already been shared by my colleagues from the other territories, so i do not want to repeat those. I would like to yield my time back to the committee so that we can give more time for questions. Again for the opportunity and we are ready to take questions from the committee. Chair grijalva thank you so much and thank you for yielding your time. Twore i turn to my colleagues, let me take a couple of brief questions. You talked about the obstacles. And thethings process of saving lives costs money, we all know that. And we see some of the economic consequences of doing those visor those very necessary and lifesaving strategies and policies that went into place, both by your territorial government and the federal government as well. Capacity, and i wanted to ask you, in terms of you mentioned obstacles you are facing in regard to federal agencies. And i appreciated the comprehensive way that the Small Business did not get there and other issues, waving the match until we have a clean goal of health. Regarding medicaid and other issues. In a comprehensive way, the response happened to this recovery. Part of it was the issue of testing. On thoseeflect obstacles and how you see them all interconnected . Ms. Young i am so sorry, i just got disconnected and mr. Whole question. And missed your whole question. Chair grijalva what are the obstacles American Samoa is missing regarding federal agencies . Two, you mention Small Business and medicaid, education. How areth response, these other issues interrelated in terms of the overall recovery . Testing is a real issue for us. As we prepare and anticipate reopening our borders, probably sometime in the summer can you hear me . We cannot reopen unless you have sufficient testing supplies on island. I will turn it over to my colleagues who can give more information on that. Chair grijalva quickly though because i want to make sure other people have opportunities. It took a while for us to get tests here. With the population of 56,000 people, its not enough to one,erve the intent of testing whether we had the virus or not, and if we want to open our borders we should be able to test those who are coming here to see if they are carrying the virus are not. We have zero cases and we have zero cases and want to maintain it that way. Were looking at the president s items for opening up our states and territory. The government is mindful that while the states are passing wepeak, American Samoa are trying to take a progressive effort. We are still keeping production is one of our biggest categories operating to meet our biggest demand. It is paramount to be able to whenin prevention efforts we decide to discuss probably the protocol for us to consider opening up our borders. Yield back. Chair grijalva that same dilemma is in many places in the mainland as well, how do we open up, how do we phase it in, what are the indicators. And usually the urgency of the other side is, do we have enough of a tasting Testing Capacity and data to be able to talk or strategize or plan for what that opening up is and isnt. And i think the same concern you justifiably raised, in particular for the situation in the territories, is even more pronounced than it is on the mainland. But the mainland is struggling with that question. How much, and have we had enough testing . I am in arizona, with the lowest testing in the whole country for the mainland. As such, how do you talk about opening up . Your point about capacity is really well taken. I appreciate that. Mr. Sablan, i will turn it over to you to any questions you may have. Vice chair sablan thank you, mr. Chairman. Noant to ask just a yes or answer to each one of you. This is not a new issue, but i want you to know that the delegates have gotten together, andwe have taken the lead we have sent letters to not just leadership, the chairman joined us as well, we sent it took apap, chc, Committee Chairs. Removerying to not just 2020,p to the end of 2021, and remove the cap permanently. The fmap cap. Since my firstve year here i have sponsored bills. Its really unfair. Im so thrilled with the Court Decision on the puerto rico case. Ause right now i used that they set up a phone call with the irs and i said, listen, this is similar to the puerto rico case where a person from puerto ssi. They lost their ssi are sending beneficiaries monthly, now you have to make the local government i mean, it is just discriminatory, it is so unfair. So, we are working together, trying to do the medicaid thing. The fmap. Ask, esther, can you you alluded to this, but has your experience been working and communicating with federal howcies such as fema, cdc, has that been . Ms. Muna thank you, congressman. The experience we had with fema has been actually very supportive. How to always an ask of strategize our laboratory capacity. As i mentioned, we have been testing already using the advet i. D. Platform. Barry been basically very supportive. One of the things we have been asking for is, because as you mentioned, without a strong Health Care System with fmap toching you need it remove the cap, to strengthen our Health Care System and be responsive. We have done so much already in the beginning, but yes, it is just necessary to continue the support. Continueoping it can because of the need to have adequate staffing, adequate ppes, and basically give us the armor to fight this, because we do not have that protective equipment, it is going to get worse. , weou alluded to earlier have a sick population already. We need to be able to protect everyone. Disparity, please remove that. Remove that disparity, because we really need to strengthen our Health Care System to empower our people. We are very weak if we do not have a strong Health Care System. And i appreciate all you have done. And thank you for the opportunity to fix that. But we need a better fix now because now we are falling back behind again. So thank you. Vice chair sablan yeah, and in the thousands of federal programs that applied to the over 700 little applied to territories. Theremong that 700 mix, are some that applied to just one territory and not the other. All kinds of mixtures in there. Were going to get there, its going to take some time. But listen, ms. Young, sandra, if i may, did i hear, i think, it was either your conductor or the director saying it is operational . Ms. Young yes. Our plan is fully operational. We are trying to meet the demands from president trumps call for manufacturing to meet our nations food security. Me and thenext to Governors Task force for coronavirus, making sure the industry has sufficient protocols in place to mitigate spread of the virus prior to now that we have begun a good two to three weeks here, we are comfortable to say there is no coronavirus. We are trying to make sure to sustain the production value. To cover this concern we have gone to 5050 level staffing. We are still paying the full workforce. Vice chair sablan thank you. From the i had a call ambassador to the United States, aboutly, just updating me how most of the federal states, the citizens who work in the processing plants, meat factories, animal farms, are actually doing ok. Areas bad as those plants reported to be. So, i was happy to hear that. H, let me admit my own guilt. Of actually publicizing and representing what fema has given to me, in terms of the the marianask for will be the end of may, early june. To 6000 will be 3000 people who are going to be infected. Isont know if Johns Hopkins just completely wrong, or those models do not work in the islands, or actually maybe because we are able to control so. Close our borders and but we are doing something right. I am very happy that i am wrong. That Johns Hopkins is wrong. I hope they do not make a mistake when they diagnosed me, but otherwise. Yeah. Ieh if i could thank you for your time, first of all, vice chairman. I think the projections based stateside are models based on big cities. Guam as you know is a flat island, and our population is 160,000. Communication with our people is actually not that difficult to reach. So, i think our community has responded. Almost let you know, every single one of our Community Doctors actually reached out to the people, to our patients. Psas. Outpsa out the media has helped us carry them for free. The patients in our Community Listen to the doctors. We have thousands of patients who see us every month, combined in all of our clinics. I encourage all the territories to use their Community Doctors to reach out to patients to say this is a crisis, stay home. That has worked for our community. They would rather listen to their personal doctors to do that. As far as projections go, i do not see fema s projection as being correct. And i think what theyre projection is in a worstcase scenario, you have to be realistic. You do not set up policy based on tabletop picture sites. You have to look at the uniqueness of each territory. Transparency is always very important. Just one morelan thing, if i may. I have a senior moment here. Yield for now. Chair grijalva before i ask thean nicolas, which begs question in your last response, at what point if the tabletop, based on urban areas is not applicable, and i would not disagree with you, to the territories and in particular lewvel of what level of data, testing, whatever you want to call it, would be sufficient to say we are ready, we have a clean bill of health, for lack of a better phrase . Dr. Shieh we should always be prepared. The islands, cnmi is in the same situation. The projections we have we have proven the projections wrong. We do not have hospitalization rate as predicted by the projections. If we went by the projections, we would have over 500 people covid19 positive. What is theva basis of study that would provide security both to the people, the community. Dr. Shieh security moving forward. I think the uniqueness to guam is you have to focus on the day we have right now. Res nothing like lewis like this we have experienced. The key is to look at our own hospitalization rate. Look at the rate of testing we have done. The Testing Capacity is important. If the navy contest 5000 people cant guam orwhy the navy help us test in the community . Of rise for our infectious covid19 is low, then we can create our own model. We cannot compare to puerto rico. Puerto rico has 4 million people. Guam, you have to look at local data and make your own projections moving forward. Ok. R grijalva rep. San nicolas again, thank you so much. As you know, i have always focus my advocacy, particularly during this crisis, on just making sure the territories are included. Just keep us included and as long as we are included, that is going to be already above and beyond in terms of where we have been in the past. I wanted to again thank you and thank our Senior Leadership for making sure that we have been included. And that brings me to my point with respect to the committee. Guam is receiving a record amount of federal dollars in order to be able to address the impacts of this covid19 situation. In order for our territories to be able to maintain the reputation necessary for us to be able to avail of these kind of resources in the future, it is important for us to make sure that we get the spending rights when it comes to the utilization of these federal dollars. Chairman,s time, mr. I would like to ask if the committee could consider more of an oversight role with respect to how these moneys are being deployed in the territories. I know the moneys come from various services sources. Ways and means, energy and commerce, financial services. But when it comes to the administration of the territories, that falls under us at Natural Resources. If our territories did not get the administration of these federal dollars right from the getgo, the outcome of any miss ed spending could impact us reputation only, rep utationally and give us difficulties in the future. You mentioned the need for transparency locally. Our colleague from puerto rico mentioned the need for transparency locally, and will we have a problem on guam. Theres a transparency issue. The governor is not being responsive even to local lawmakers. It has even been publicly stated by the governor that she does not need to local answer to local lawmakers federal dollars they are at a point now where the media is having to use freedom of information act requests to get basic answers. Even those basic answers are being put off by the request for an extension or even the statement that comes out from the freedom of information act being very contrary to what is already publicly known. I need to beg indulgence of the committee to help us find a can with ourow we responsibility here in the congress of territories and be these federal dollars going into our territories will be administered the way they need to. My telik from puerto rico, if you would like to my colleague from puerto rico, if you would like to elaborate and dr. Shay, if you would like to elaborate on some of these transparency concerns. You, congressman. You are totally correct. Has, because of the lack of transparency issues, unfortunately, the Current Governor with the Educational Program is not being transparent. But we also have issues with our fiscal control board that was imposed by the previous leadership of the committee. Because of our unique tax status, the 1200 check needs to be a block grant and then we see that it is approved by treasury. The 1200 check hasnt arrived. So that local governments created a 500 check and the fiscal board mandated by this committee is telling the governor she cannot send those checks. Our lockdown started on march 15th and people are waiting too long and we are still waiting for 20 billion to get there from the hurricane and all of these require transparency. We need radical transparency and we need congress to provide oversight and we need the government to act accordingly to the law. You, congressman. Transparency is very important. For example, our doctors and nurses over the last months, we had to go out and ask for donations for supplies, for face s, ppe. As doctors and nurses, we should be focused, not on getting supplies. For example, fema. We have asked fema to let us know what supplies, what ppe, what masks . Let us know the amount so that if we get donations we dont duplicate what you already have. The answer we got is those are above our pay grade or that is not information we share with the public, etc. Is not transparent. Dont tell us at all, if they have supplies, come and ask us. That is not right. Supply us with what youve got, but dont hide that information from the public. As far as the Governors Office goes, i think she told the senators she does not have to inform how the federal money is being spent. I think thats wrong. A transparent government is what we wrong is what we want and without transparency, there is no trust in leadership. As they federal money comes in, every dollar of the 28 million, every dollar should get counted for and that should be made they are we know how spending the money. That is all i have to add as far as transparency goes, but we should demand transparency, absolutely. Ask thee very generally folks who just spoke, one of the frustrations distance governors, which we are doing right now, online and virtual, is the fact very important function of the house of representatives, which is oversight and , you hear about smallappened to the business and paycheck protection plan, who got the money and who didnt. Mom and pops and independence are still waiting. You hear it about the distribution of masks. You hear about Indian Country that is still waiting in mainland to receive the support they need to fight the pandemic. Think accountability is something we need to stress and in the areas of jurisdiction which we have very direct , we should and we need to because that is the only way. Trillions of dollars are being of thend the intention legislation is a good one. I dont trust this administration to do it equitably and fair, i will be blunt about that. So the role of accountability by this house of representatives is paramount. And the other areas of jurisdiction in india in in Indian Country, i think we need to take them seriously. Whether the format is online or at some point we are able to do that collectively as a committee, we need to. If it ends up being online, we need to hold these people accountable because it is the Greater Public good that the intention of this money was. It was not meant as a supplement to supply when a local budget should be doing. It was meant to take care of those immediate relief needs before we even talk about recovery. If it is not being used for relief, if it isnt being used to build up capacity, and if it is not being used to test the maximum amount of people possible in order to get a good reading on when and how we reintroduce stability and normality, whatever that might be into our community, than it is not being used correctly. That is going to be a responsibility i take seriously and i know the Committee Chairs take as well. We need to pursue that as a mechanism do we do it online or do we do it in person . Either way, i would prefer in person but i think its going to be online soon. To that,add something mr. Chairman . Article, there was an in one of the papers about the absence of attention by the there was annment, op id opinion today, saying op ed opinion today, saying all the governors needs are being so untrue. Is just it never has been true. Those, mr. Chairman, you know me very well but i have advocacy is not something that should be a badge of honor for the department of interior. Nobody asked the assistant secretary to do an op ed but i guess he has to because hes got Nothing Better to do. But the money is never sufficient, number one, and number two, we very much appreciate it. Not like everything is hunkydory. Its not. Thats just my two cents. Left for ourime is prepaid time . We have 20 minutes left. Let me thank the panelists. I have to remove myself because i have a pending appointment in my other part of my backyard with the staff on another call. I apologize for leaving. Two things i want to add and then if i may turn over the meeting to my colleagues to on schedule, prior to the pandemic were some things and one of them was the discussion we were going to have about puerto rico, the whole discussion was necessary in terms of some of the sovereign see question around territory and the whole issue that was being asked in terms of the match for medicaid. And related issues. Then the pandemic hit, everything suspended and those valuable oversight discussions and change of direction in terms of policy have not occurred. They still need to occur. That is part of the backlog we are facing. We need to address it, we need to address it quickly, but i think right now, it is the relief and responsibility to this capacity issue. But we are going to have to redefine recovery for all of us in this instance, particularly in this discussion to the territories. What are we going to look like what are going to be the systemic policies in place that change the relationship . How are we going to look at disparate treatment in terms of resources . One of the things learned is the lack of preparedness. Some people might argue that in terms of the federal government to this pandemic. Its inability to react. Resources for Public Health, the lack of resources in terms of stockpiles for medical of planninghe lack and strategy to deal with a pandemic of this nature. Care who it affected and how it affected, but it has transformed the way we look at things and i think it applies to the territories as well, and im looking forward to what comprehensive steps we are going recoveryo make the relationship going forward. I want to thank all of you on for your very valuable information and input and to my two colleagues for their advocacy and looking forward to working with them on what that comprehensive response because it involves education, it devolves sba, it involves job training, it involves ssi, it involves all of those things anduse as the doctor knows all of you in the medical good health involves many factors. The economic and social factors as well. So i am looking forward to it to continue to put as much urgency into it as we need to going forward, but thank you so much and we will monitor in terms of the resources being applied to the territories at this point in real time and press on the issues of the medicaid match and the ssi because i think those are urgent ones that could provide immediately economic really. With that, thank you. I appreciate it to the panelists. Star sorry i have to scoot. Thank you. Thank you, mr. Chairman. Do you have Something Else customer there is a lot, of course. You got 10 minutes. Thisreally big thing and is something that is being shared in a lot of the territories and something we are talking about in the irs call. Irs needs more support because they only have one team working on five different territories that are in three different time zones that speak up to eight different languages, that have three different tax codes. We want to make sure the territories are going to be able the resources from this first round and future resources from any future rounds, irs is going to need workingn one sharp team , trying to have five different hats on. That is something i want to bring up. Herew a lot of the group is more healthcareminded, is there any specific Health Care Resources that have not touched down or that you do not foresee coming in that you are desperately or urgently hoping are going to materialize . I would like to answer that question. Correctiono make a in relation to the hurricane. I alluded to our category five so i19 and that was 2017, wanted to clarify that. One of the things we are looking forward to right now is some of our testing supplies. We are waiting for some of those to come in and right now, we are working with cdc and fema for that. They are asking us questions and we are providing information to them, but we would like to make sure we receive that as soon as possible so we can begin our mass testing. Reference things in to what we are going to do is not medical per se but we want to make sure everyone takes into consideration that we are about one month away from Hurricane Season and we have to not only look at covid and dengue fever, because we are due for a dengue outbreak. We have to take that into consideration. Covid, dengue, and hurricane, the three combined, that would be detrimental not just to our health care infrastructure, but to our economy as we are struggling as is everyone else. Say our funding is based on population size and one of the things i would like everyone who is negotiating for us to consider is our vulnerability in our population more so than the population itself. Of course the demographic location of where we are. They receivedoned ventilators and that is one of the items we have been requesting and we have been challenged as to the number of ventilators needed as a result of the current set up of our health care infrastructure. The number of vence we are using on a day to day basis. We are trying to get supplies to our territory before we needed. We dont want to have them travel to us the day after it is needed because it takes sometimes 72 hours when asked when are we going to get supplies . That may be too late for us. That is why i am asking your support to get those kinds of supplies we need to come covid. Dengue, which at also causes a lot of hospitalization, so we are asking for your support from an overall standpoint. Thank you very much. That was your closing statement . I know we dont have that h time, and i didnt want did want to ask, make sure we are focused on all the territories. So i just wanted to have an opportunity to say that. I also wanted to take an opportunity to thank all of the vice chairs and congressman send nicholas as well as the chairman. This is the first time ive actually than this and i know you have done this in the past, so it is an excellent opportunity for me to do this along with my colleagues, so i wanted to say thank you and i look forward to working with each and every one of you. I appreciate the opportunity you have given me. [indiscernible] right before coming on this broadcast, i was listening to the radio on puerto rico and the dj was saying only 22 people in the Government Health department are currently doing Contact Tracing. With 1400 positive cases, 22 people are not enough. I am not aware i just read it before coming here, is there any federal support to hire more tracers . Supporting for tracing is key if we are going to reopen, but without testing and tracing, we cannot do that. Only 22 tracers for 1400 kasers ofnot enough on an island three point 2 million. That is laughable. To over 2 got billion which is supposed to go related efforts or costs. The congressman mentioned the transparency issue, so if this committee is serious about it, we require transparency. Than somegotten more of the states. A base of contention here because you got four times more than the district of columbia. There has really been Speaker Pelosi in last weeks caucus meeting has had to step up and understand the territories because we did get 700 per 345. And the states got she had to step up because some members were asking why are the territories getting 700 per capita . I appreciated that she did stand up for us and put an end to that because she was getting phone calls about that. Over 2 billion for covid19related expenses. I think today, we are over 120. Transparency is so important. I can leave you with one of the final messages guam is the tip of the spear for the United States military. We are right here where the majority of conflicts with korea and china is right next to us. It is where one and the american day begins. Puerto rico, i feel for you. 4 million people, with covid19, we have 160,000, so i think we are in better shape than puerto rico, but youve got to billion dollars, thats pretty darn good. We just need to make sure it is spent right. I just want to say the support provided to the territories is very critical. I mentioned the fiscal summit the other day. We need to look at how the Health System in the territory, it needs to be a holistic approach of looking at it from prevention, hospital services, andresponding to medical Public Health emergencies, those things need to be there all the time. When aldnt be just pandemic happens. We need to be prepared all the time. I hope whatever funding is given to the territories, please keep not because wes only have two covid cases that are hospitalized. It is because we want to present, our people, we are not very populated here in the islands, so we need to be very healthy, we need to protect our children and protect everybody here. Do, whatevercan you all can do to strengthen us, that would be really appreciated. That is all i want to close. I apologize for breaking in. The allotted time for this call is at an end. If everyone could please wrap up now. Thank you. Backside agree with esther. We cannot always be crisis managing. Thank you, everyone. Nice to see everybody. If you have more to ask, send it to us and we will see what we can do. Im not making promises, but we will try. We appreciate your time. President trump has an event this afternoon on efforts to protect seniors from the coronavirus pandemic. We plan to bring you that live when he starts around 4 00 p. M. Eastern here on cspan. Washington journal primetime a special evening journalof washington on the response to the coronavirus pandemic. Jay inslee will join us to talk about the covid19 Pandemic Response in washington state, one of the first states to make widespread changes because of the virus. Also joining us is mike leavitt, former health and Human Services secretary under george w. Bush. Now a cochair at the high partisan policy centers prevention initiative. He will be talking about Public Health policy during the pandemic. Join the conversation tonight at 8 00 p. M. Eastern on cspan. All persons having business before the Honorable Supreme Court of the United States, give their attention for the court is now sitting. For the first time in history, here the u. S. Supreme court live stop in may, due to the coronavirus pandemic, the court is hearing oral arguments in 10 cases by teleconference. Cspan will provide live coverage of each of these sessions. First up on monday, at 10 a. M. Eastern, the justices here the case of u. S. Patent and Trademark Office versus booking. Com. The case confirms concerns the companys trademark fight. Listen to the Supreme Court oral arguments as they are heard by the justices live, monday at 10 00 a. M. Eastern, on cspan. On at cspan. Org, or listen on the free cspan radio app. Senate leader Mitch Mcconnell announced the senate will return for legislative work this monday. They will vote on an executive nomination and later in the week could work on coronavirusrelated legislation addressing lawsuits. House majority leader, steny hoyer said after resulting after consulting members, the house will not return for legislative work next week. Instead, they will continue to hold brief pro forma sessions every three days. I partisan negotiations continue on different options for voting remotely and committees and on the house floor. Follow live Senate Coverage on cspan two and the house on cspan. Withpresident trump meets new Jersey Governor Phil Murphy to discuss the response to