To hear about the virus response in American Samoa, northern mariana islands, guam, puerto rico, and virgin islands. More portly, we want to receive the perspective about how congress can help local governments adequately address this world pandemic. And for the territories, i think they have a better understanding when we say world pandemic as opposed to just trying to keep it to the mainland here. The territories face unique challenges. Based on geographic location, the unequal treatment under federal programs, and the dire financial situation. And so the islands having been hit by actual disasters in turn including hurricanes, typhoons, earthquakes. Now those are we getting the Health Care Infrastructure as covid19. And so local governments has been working to recover and we build under these events. But i believe there is more than needs to be done. And one of the things that this virus has provided all of us is and i hope it provides everyone in congress, is a perspective. But as we go through and talk about recovery and relief, that there is a cumulative effect. When there has not been enough resources. Suddenly, youre 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 its important. I thank my colleagues, vice chair sablan of the full committee, and internal affairs in. In particular. Mr. San nicolas, thank you very much for joining us as well. Their advocacy and insistence, equity, and full attention to the territories has been very , 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 two 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 territories under the jurisdiction of our community. So, i want to welcome the panelists to this format and introduce them each as we go along. But before i do, since they are with us, let me ask the vice chair if he has any opening comments before i introduce our panelists. And if there is any of the panelists, in particular, you like to introduce yourself, the time is yours. Vice chair sablan thank you for holding this and thank everyone for taking part in this. Every i want to thank everybody in the background for pulling this together. Good evening. For those of us who are in d. C. , good afternoon to chairman grijalva and in the caribbean, good evening as well. And good morning to those of you in the pacific. And thank you again to the participants for being here today. Welcome. Im thankful well be hearing directly from individuals on the ground with your knowledge of the local situation and their respective challenges and needs. And from the northern marina islands, well hear from esther muna, no stranger to the community, ceo of the health care operation. I could think of no one better to share about the Emergency Response in the northern islands. And, of course, nearly all the territories have been recovering from Natural Disasters before this pandemic hit our shores. And the hurricanes, the earthquakes in the caribbean, super typhoons and cyclones in the pacific have had a devastating impact on lives, on public infrastructure, on our economies. And congress has already provided billions of dollars to recovery. And we were slowly starting to rebuild. And then covid19 started to spread slowly around the globe. This Public Health disaster is unprecedented for the World Community and individually. The economies of every state and territory has been devastated. The fallout will surely be felt for years to come. An even before this, it was to 2018. Tributable but since the outbreak, the businesses have shattered. Residents have lost their jobs, teachers have been furloughed, pension payments have been reduced, and the arm felt throughout the islands continue to mount. So, i would say the commonwealth was slow to recognize the severity. But since, have done a commendable job at keeping the virus at bay. 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. And the measures that were set in place are working with the stayathome orders, public education, and the need for handwashing. It all seems to be working. I hope that continues. Congress and fema, hhs, dod and a host of federal agencies have provided critical assistance. We want to make sure that continues if more is needed. To mr. San nicolas, to the virgin islands, were really having a difficult problem which the department of education is trying to get them to release the education stimulus fund. We got a notice yesterday but the withdrew the notice they withdrew the notice yesterday. Were trying everything. So, its way overdue for our schools. But thank you, and thank you again everyone for joining us. Chair grijalva for comments and introducing one of the guests from the district you represent . Rep. San nicolas thank you so much, mr. Chairman, for your leadership and your constant vigilance in looking out for our territories that fall in the jurisdiction of the committee. I also 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 being constantly 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 very profound insight of the circumstances in particular 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. And the recent case in puerto rico, the circumstances in guam, we do not have supplemental security income in most of our territories. The commonwealth of the northern marianas 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 werent already receiving the most basic level of american decency in terms of support. And as a result of not receiving that support, theyve 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, theyre out of work. Their job prospects are unknown. And we now have a community of individuals who not only lacked supplemental security income, but even lack the support of those who were taking care of them previously. So, they have gone from not being supported to downright destitute. 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 in the territories, as keen as ssdi, is just 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 were going through. I wanted to recognize dr. Tom shieh, who has been a very vocal advocate for the necessary procedures and equipment. And just a real good general view of the severity of what we re going through in 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, mr. Chairman, and i yield back. Chair grijalva thank you very much, and let me collectively thank each and everyone of you for taking the time, for bringing the perspective, for continuing to prioritize what the territories not only need, but are justified in demanding that they get. And with that, let me introduce, well i dont need to 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 of months later, we were introduced to our greatest challenge yet, the coronavirus. In january, we begin messaging coronavirus prevention and our community and screening patients for symptoms. In early february, we sent our first kernel reverse testing to atlanta. 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 a third of staff to the response. On march 28, we announced our first two positive cases with 12 more cases confirmed since then. In the past 40 days with support from our governor, his task force and staff, we have screened more than 500 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 at our own labs, and conducted more than 90 teleconsults with our patients. Through years ago, we began communitybased testing and collected samples of more than 400 people. Confirmed, two have died and 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. Built on family gatherings, multigenerational households, and close relationships. It lays bare our 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. The cnmi government is shut down and is projecting a 65 million deficit. The island schools closed, many employees have been furloughed, skyrocketing unemployment, retiree pensions cut 25 , rendering health care unaffordable for so many families. The success thus far is a result of a herculean effort requiring nearly 18,000 staff hours and over 17 million. Thanks to the governor, the support of the governor, and the 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 Surge Staffing needs and develop a plan. 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 balancing the coronavirus response, and forging an ambiguous feature to prepare for the worst. Our strengths and our weaknesses are brought into focus while it has sparked innovation and eliminated opportunities for improvement. But 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 safely bring the rest of us back to work. Help us get there. Thank you. Chair grijalva thank you very much. Thank you, appreciate it. Let me introduce you dr. Shieh. Sir, the floor is yours. Dr. Shieh thank you. Thank you, mr. Chairman, vice chair, and our congressman, and all the panelists. I have to say i dont work for the government. Im independent, and i will speak frankly as a person on the ground. Guam is small. We are considered as the tip of the spear. Right now its 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 case, our island has already acquired the virus in our community. So the evidence was already there. So far, weve only had five deaths. Sadly, theyre part of the family guam is very compassionate. Even if its just five deaths, it affects a lot of people, including one death from the Aircraft Carrier theodore roosevelt. So that has hit guam pretty hard. The total right now is about 154 positives. Weve tested about 1200 thus far. The u. S. Navy positive is approximately 1000, and they i commend the navy to being able to test 5000 sailors within just a twoweek timeframe. I wrote to them, congratulating them on that task. Its not an easy task. And we ask that as the sailors return to their ships, perhaps the time has come for the u. S. Navy to actually help them get capacity, supplies, and personnel. And im hoping that i get a positive response. The community of guam has always been good with the military, and that cannot be forgotten as you take our voice to congress and to the president. To be transparent to projections coming from the Governors Office here have been way off course. The projected 3000 is over 6000 deaths, and over 400 hospitalized patients or more by now is just not happening. Luckily, the hospitalization rate has remained flat, so thats 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, such as new york city. That being said, though, we cant 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, its like building a restaurant with 2000 sitting capacity, but you only have 100 waiters and 10 cooks. Theres just enough staff for doctors and nurses to staff 2000 additional beds. And this is just to show you the lack of medical staff is part of it Big Health Care disparity our island is experiencing. So with that said, im glad guam has received so much aid. And i really 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. And 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 during this time. But the people really want to get back to work. Just to give you a example, i had a patient who was pregnant. And she had four children. Her and her husband both work, but right now they were 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 they had 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. And this is just one case, and i m sure there are thousands of them out there. The stimulus checks will help, but its not enough. Our people cant continue to be 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. You know, guam is small, and we could not, 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 and he will affect the health care of people, as well. So, 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 youre welcome, sir. Let me introduce you to the next panelist, someone i know and have worked with. Federico de jesus, Senior Advisor for puerto rico. Working on the issues affecting the island. And again, i think well speak to that cumulative effect as we go forward, as the other panelists have spoken, as well. Mr. De jesus, the time is yours. Mr. De jesus good afternoon. I am senior policy advisor for power for puerto rico. Its an honor to be here with you today. Thank you for inviting me to share thoughts and concerns about the covid19 pandemic that affects the commonwealth of puerto rico, and obviously 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 to understand that the u. S. Territories come to this global territory with two hands behind their back. 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 an economic depression from puerto rico in the last 15 years, the pandemic has reared its head. 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. Effective, we are holding this hearing the Natural Resources committee where people were akin to a natural park or gas line is denigrating for puerto rico and the United States. The u. S. General promised to quote, the greatest amount of liberty compatible with its military operation. 120 years later, those words ring as hollow 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. But first of all, whats the situation on the ground . Today, 1433 people have tested positive for covid19. 86 have unfortunately died. And approximately 35 tests have been conducted. So, what explains the lack of testing . First off, the trump administration, as much of you know, has refused to implement a National Testing strategy and is not properly invoked the defense production act. There is a hunger games type of situation competing against each other and the federal government and Global Markets for test. Also, the government of puerto rico entered into a questionable contract for one million koba tests that never arrived. Puerto rico since has had three Health Secretaries resign, and the current secretary, though very forthcoming and professional, 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 to the island. People haveican also barely begun addressing the earthquakes in january that 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 . Well, because as has been widely reported, 20 billion that Congress Approved to rebuild puerto rico, they only sent 1. 5 billion. This committee in congress as a whole has a responsibility to investigate and shine a really 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. And that would be paid for 100 by the federal government. Unfortunately, puerto ricos governor instead has sent some food, many of it expired, to nonprofits that serve the population at large, not necessarily needy children. They have 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 ill be brief, we need to restore federal tax incentives for u. S. Manufacturing. Section 936 and congress eliminating it put us into a now. Sion that were in this is also an national problem. Puerto rico could be another gateway for the u. S. Manufacturer, and boost National Security manufacturing, pharmaceutical, and medical materials, 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. And thankfully, this committee has supported the federal relief act. We also need congress to mandate the fiscal board set aside 9 billion to pay 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. It costs us 1. 5 billion every year. Theres several technical fixes. Basically, 501 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. So, we need the state and federal government need to also get the benefits. The family paid sick leave act, we obviously got paid sick leave for our workers. But unfortunately, the u. S. Department of labor is saying that will only start april 1. But in the case of the island, puerto rico locked down march 15. This was the first and the strictest lockdown. In fact, it also included a curfew to prohibit people from leaving their house at all and at night. While that was commendable, unfortunately there is much more to do. I really want to close by saying we need to lift the medicaid cap. Puerto rico, as other places here, face an arbitrary 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 will really never recover from colonial restrictions. The amendments bill which addresses our concerns is such an important first step. We look forward to the discussion so that the harmful effects can be reduced, and the law is eventually repealed, and for congress to finally uphold its obligation to the colonized territories and puerto rico. Thank you. Chair grijalva our next panelist is justa encarnacion, commissioner for the virgin islands. Thank you for joining us today. Im sure youre extremely busy during this crisis and appreciate your valuable time. Please, the time is yours. Ms. Encarnacion thank you very much. Good evening to you. Ranking member rob bishop and other members of the community. I would also like to acknowledge congresswoman stacy. Towelcome the opportunity inform the Community Desk committee and the congress to respond to covid19 pandemic. As of today, we have tested 872 persons, 732 negative, 62 being positive, with 78 pending test results. 51 have recovered, leaving only seven active cases. Sadly, we have experienced four deaths. 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 tabletop exercise that over 65 agencies attended. We identified gaps for goals and strategies that served as a Building Block in the department. Our interagency meetings continue dearly under fatima, which was sparked by the governors declaration of the state of emergency on march 13. The day of our 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 strong team and 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 of needing respiratory care. The bed capacity is incapable of meeting the projected surge. In addition to the limited bed capacity, the company said a lack of staff and supplies. 14 ventilators. Epidemiology has established that due to our mitigation efforts, they are below are expect peak. There thing for for that. Recognizing this, our efforts have been focused on providing and preparing the facility, beds, recruiting staff, and ordering needed supplies and equipment through fema, hhs, and commercial entities. Due to the efforts, unfortunately, on the region, our request was either denied or placed on hold. As we meet the army corps of engineers and contractors to become an inpatient facility on st. Croix has been repaired, renovated, and equipped. To provide overflow capacity. The work will yield a total of hundred additional beds. Our first Public Health lab was crated by clea and we began cobit testing in midmarch. With most of our cases being travel related, we have worked with the National Guard to establish passenger screenings at the airport. And with other agencies, additional ports of entry. The department of health joins the governor three times a week in press conferences that provide insight on data, trends, mitigation efforts. Covid19 in our community, from the youngest to andoldest, the tips resources for staying mentally healthy during this time. Virtual programs are 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, privateice of interior, donors, and many 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. She was included. Every funding system to reprise provide that department of health. Thank you. Were also thankful to our staff for the dedication to ensure the community receives the Healthcare Services needed and their flexibility. Like other fellow offshore areas, our particular vulnerabilities and distance from the mainland United States present unique challenges that we ask you to always keep in mind as you advocate and legislate on behalf of the entire nation. With gods blessing, covid19s roar will become a whimper. Even so, we know that 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 that you help us to strengthen Public Health and other Critical Infrastructure with which it depends. That includes 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. As i and other programs the residents actually need. We have given a lot in every sector of american life. We are proud americans. We ask for the tools that would allow us to continue to serve and enhance our service. Thank you for the invitation to testify, and im willing to answer any questions you may have. Thank you. Chair grijalva thank you for the insight, the information, and some of your pointed and necessary advice. Let me now introduce you to our final panelist, ms. Sandra king young. You may begin. The time is yours. Ms. Young thank you. Hello to you enter the Community Desk committee and to my fellow 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. Joining me here today are two of a Recovery Task force team members. Our epidemiologist, and Deputy Director for the department of Human Resources overseeing our first responders. Our government are, 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. Weve tested 64 people 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 the local match. If theres anything that can be done to provide the territories 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. Our territory all businesses have to compete with Small Businesses across the country on a firstcome, firstserved basis. Canhe time the businesses find sba assistance, all the funding was finished by the big states. Many of our Small Business owners do not have professional Business Plan writers to submit these applications. Although there is new funding for the coronavirus, the sba portal 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. And thank you 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. Before i turn to my two colleagues, let me take a couple of brief questions. Ms. Young, you talked about the obstacles. One of the things and the 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. But the issue of capacity, and i wanted to ask you, in terms of capacity, where 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. Can you reflect on those obstacles and how you see them all interconnected . Ms. Young i am so sorry, i just got disconnected 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. The Health Response, how are these other issues interrelated in terms of the overall recovery . Ms. Young the 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, serve 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 their peak, American Samoa we 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 sustain prevention efforts when we decide to discuss probably the protocol for us to consider opening up our borders. And we 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. I want to ask just a yes or no answer to each one of you. This is not a new issue, but i want you to know that the delegates have gotten together, and we have taken the lead and we have sent letters to not just leadership, the chairman joined us as well, we sent it took apap, chc, committee chairs. Were trying to not just remove the map to the end of 2020, 2021, and remove the cap permanently. The fmap cap. The issue, i have since my first year here i have sponsored bills. Its really unfair. Im so thrilled with the Court Decision on the puerto rico case. Because 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 rico, they lost their ssi. They are sending ssi 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. Let me also ask, esther, can you you alluded to this, but has your experience been working and communicating with federal agencies such as fema, cdc, how has that been . Ms. Muna thank you, congressman. The experience we had with fema has been actually very supportive. Theres always an ask of how to strategize our laboratory capacity. As i mentioned, we have been testing already using the advet i. D. Platform. And its been basically barry very supportive. One of the things we have been asking for is, because as you mentioned, without a strong Health Care System with fmap. Matching you need it to 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. And im hoping it can continue 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. As you alluded to earlier, we have a sick population already. We need to be able to protect everyone. And medicaid 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 states, a little over 700 applied to territories. Even among that 700 mix, there 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. The doctor next to me and the 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. Yesterday i had a call from the ambassador to the United States, actually, just updating me about how most of the federal states, the citizens who work in the processing plants, meat factories, animal farms, are actually doing ok. Not as bad as those plants are reported to be. So, i was happy to hear that. Dr. Shieh, let me admit my own guilt. My guilt of actually publicizing and representing what fema has given to me, in terms of the peak, the peak for the marianas will be the end of may, early june. And they will be 3000 to 6000 people who are going to be infected. I dont know if Johns Hopkins is just completely wrong, or those models do not work in the islands, or actually maybe because we are able to control and close our borders and so. 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. Dr. Shieh yeah. 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. Just to let you know, almost every single one of our Community Doctors actually reached out to the people, to our patients. We took out psas. 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. Vice chair sablan just one more thing, if i may. I have a senior moment here. So, i will yield for now. Chair grijalva before i ask mr. San nicolas, which begs the 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 then what level 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. Chair grijalva what is the 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. Theres 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 in two weeks, why cant guam or the navy help us test in the community . If the rate 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. For guam, you have to look at local data and make your own projections moving forward. Chair grijalva ok. 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. And at this time, mr. Chairman, 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 missed spending could impact us reputationally 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 the way the local government is administering the funds. 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 answer to local lawmakers with respect to how she is spending these federal dollars. They are at a point now where even the media needs to do a freedom of information act to get answers. Foranswers are putting off the request for an extension or even the statement that comes out from the freedom of information act being very contrary to what has been publicly known. I need to beg the indulgence of the committee to help us find a without on how we can responsibility in congress and the territories ensure that these federal dollars going into our territories are going to be administered away they need to be. I to yield to my colleague from puerto rico. To elaborate on his transparency concerns and then followed up with dr. Shay if he would like to elaborate. Thank you. Am i on . Thank you. You are totally correct. Puerto rico has basically been revolting because of the lack of transparency. Unfortunately, the Current Governor basically is not being transparent. We also have issues with our fiscal control board which was made by the previous leadership of the committee. Because of our unique status, the 1200 checks need to be enda and thenaci submit a plan. The 1200 checks have not arrived. The local government created the local stimulus and the physical board is big the governor she cannot send over the checks until the 1200 checks gets the puerto rico. 15 andted on march people are waiting too long. We are still waiting for 20 billion to get here get there ofm the hurricane and all those dollars required transparency. We need congress to oversight and to compel the government to act according to the law. Dr. Shea, if you wanted to add thank you, thank you, congressman. Transparency is very important. For example, our and nurses over the last month, we had to ask for donations for supplies for face masks, ppe. Doctors and nurses, we should be focused, not asking for donations. The supplies should be provided by the government. For example, fema. We have asked fema to let us know what supplies do you have . What do you have . Let us know the amount so that if we do 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 shared with the public, etc. Those are not transparent. Make that public because we need to know what is in their. Dont tell us with the hospitals come if you have zero supplies, ask us. That is not right. If the supplies are down to 30 days, supply us with what youve got but dont hide that information from the public. As far as the Governors Office goes, i think she has told the senators she does not need to improve inform how the money is spent. I think a transparent government is what we want and without transparency, there is no trust in leadership. As the federal money comes in, every dollar of the 128 million or more come every dollar should be accounted for and it should be made public so we know who exactly how this government is spending money. That is all i have to add as far as transparent goes. Absolutely. Generally, folks that just spoke one of the frustrations with what we are doing now, the online and theual, is the fact that very important function of the house of representatives, which is oversight and accountability, cannot fully happen. You hear about what happened to the Small Business and the paycheck protection plan. Who got the money, who didnt. And mom and pops and independents are still waiting. The dissolution of mass. Countiesabout indian are needing what they need to fight the pandemic. I think accountability is something we need to stress in the areas of jurisdiction which we have. The response ability pointed out, we should and we need to. That is the only way. Trillions of dollars are being spent. The intention of the legislation is a good one. I dont trust this administration to do it equitably and fairly. Im being blunt about that. The role of accountability by this house of representatives is paramount. Other areas of the jurisdiction is obviously the territory, the discussion today. I think we need to take them seriously. Whether the format is online or whether at some point we are able to do that collectively as a committee, we need to. If it ends up being online, and needs to. We need to hold people accountable. It is for the public good the intention of this money was. It was not meant as a supplement to supply what 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 to build up capacity and if it is not being used test the maximum amount of people that is possible in order to get a good reading on when and how we reintroduce stability and normality, whatever that might be, into our communities, then it is not being used correctly, it is not being used right. That will be a response ability i take seriously and i know this committee and subcommittees think as well. Yeah, we need to pursue that. The mechanism now, do we do online or or in person . I think it will end up being online pretty soon. Thank you. May i add something to that . Please. In onee was an article of the newspapers about the thence of attention to federal government. Opede out in todays saying, no, all the government needs are being met. It is untrue, period. Never has been true. Chairman, those, mr. You know me very well. Advocacy foraid it should not be a badge of honor for the department of interior. Absolutely. Nobody asked the assistant secretary to do an update. I guess he has to because he has Nothing Better to do. It is never sufficient. Number one, we very much appreciate it. But, it is not like everything is hunkydory. Its not. Its just my two cents. Ourow much time is left on time . We have 20 minutes left. Let me thank the panels. Becauseo remove myself 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 if i may turn over the meeting to my colleagues to continue. On schedule, prior to the pandemic, were some things. One of them was the whole discussion we are going to have for puerto rico. The whole discussion was necessary, some of the sovereignty questions around territories. The the pandemic hit. It everything was suspended. Those valuable oversight discussions and change of direction in terms of policy hadnt occurred. Thats part of what we are facing. We need to address it. We need to address it quickly. Now, the relief in the response to the capacity, we need to redefine recovery for all of us. Likeare we going to look when we say we have recovered . The are going to be policies that are in place to change the relationship . We look at equity . One of the things learned is the lack of fairness. Preparedness. The inability to act. The lack of resources to Public Health, the lack of resources in terms of stockpiling medical equipment. The lack of planning and strategy to deal with the pandemic. The virus didnt care. It has transformed the way we look at things. I think it applies to the territories as well. I look forward to the conference of steps we will take to make the recovery going forward. I want to thank all of you on the panel. For your valuable information. Nd input and to my colleagues im looking forward to working with them. It involves education. It did involves job training. It involves all of those things. Knows, good health involves many factors. The economicis factors as well. Continue to put a search of sense of urgency into it going forward. Thank you so much. Whats beingor applied to the territories at this point. Ofwill press on the issues medicare and medicaid. I some relief to people. Thank you. I appreciate it. Panelists, i appreciate it. Thank you. Thank you, mr. Chairman. You have Something Else . Youve got 10 minutes. I think this has been shared in other territories. The irs needs more support. They only have one team that is working five different territories in three different time zones in eight different languages that have three different tax codes. If we want to make sure the territories are going to be able to receive resources from this first round and future resources, the irs is going to ind more than one team there. I think that is something i wanted to bring up. Because we are more health care minded. Is there anything that is not touched down that you dont . Oresee coming inquiry i would like to answer that question. Before, i want to make a correction. Category 5 then 2018. One of the things were looking forward to right now is some of our testing supplies. We are waiting for some of those increments to come in. They are asking us some more questions. We can actually begin our mass testing as we are beginning and approached opening. We want to make sure that everyone gets consideration. At covid. Look have to take that into consideration. It would be detrimental to our health care. Our funding is based on population size. Like everyone who is negotiating one of the things i want to mention, we received some ventilators. That is one of the items weve been requesting. The number of ventilators we are usingumber on a daytoday basis. We do not the day after it is needed, it takes time. Going to take 72 hours. Thats why im asking. Its not just for covid. 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 much time. Sure that we are focused on all the territories. I wanted to have an opportunity to say that. We have an opportunity. I know youve done this before in the past. Me to dopportunity for this. Thank you. I look forward to working with each and every one of you. I appreciate the effort youve given. Before come on this broadcast, i was listening to the radio online. They were saying only 22 people in puerto rico are going Contact Tracing. 22 people are not enough. It before coming here. There is federal support the higher more. Without testing and tracing, we cant do it. Cases. Traces for 1400 thats really laughable. That is supposed to go toward covid19 related costs. The congress and listened the transparency issue. Mentioned the transparency issue. Thats more than some the states. You bought four times more than the district of columbia. There has been some Speaker Pelosi had to step up and defend the territories. She had to step up. Some members were asking why the territories were getting 700 per capita. Did standted that she up for the us. She was getting phone calls on that. Got 2 billion for covid19 expenses. We got 120. Transparency is so important. If i can leave you with a final message, its the tip of the spear. We are very near asia. China is right next to us. Never forget qualm. Costs dayere america begins. I feel for you. We have 160,000 people here. Youve got 2 billion. Thats pretty good. I just want to say once provided to the territories. We need to look at the health system. It needs to be a holistic approach of looking at it from prevention, from hospital and responding to Public Health emergencies. Those things need to be there all the time. It should not just be there when a pandemic happens. We need to be prepared all the time. Whatever funding is given to the territories, keep in mind its not because we only have hospitalized. , we are not very populated on the island. Childreno protect our and everybody here. Do toer you can strengthen us, that will be really appreciated. Thats how i want to close. Our time on this call is at an end. If everyone could please wrap up now. I agree. We cant always be crisis managing. See everybody. We will see what we can do. Im not making promises, but we will try. Mitch mcconnell announced the senate will return from legislative work. They will vote on an executive nomination. Steny hoyer said after consulting with members and the attending physician, the house will not return from legislative work. 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