From Social Security. Nothing else stayed put. Their mortgage payments, their rent, their food, their cost of living all increased, but for them they were stuck. These are the people that have worked all of their lives. I think we have a moral obligation to do so. Id love to hear from our witnesses what they think about that. Nd start with dr. Vindini. It dr. Candy . Dr. Candy i completely agree. I think specifically we talked earlier about many people who people of color in particular, who are in Nursing Homes and black and latino people there in Nursing Homes in which they are. Larger part of the population Nursing Homes are hit harder. Not only are they not receiving the Economic Resource that is they can to maintain their livelihood, they are also facing this epidemic. They are also harming as a result of covid19. For many of these people its a perfect storm. At least they can be economically during this crisis and i think we should be focused on elderly people in so many different ways. These are not throw away people. The agism in our country is just rampant. Even as a young person, i recognize the value of older people. They certainly have worked all their lives. I want my parents when they collect Social Security to be able to maintain their livelihood. Chair larsen i think its going to become a civil rights issue of the time. May i make a comment . I think youre right we have to have a change in light of the pandemic. One of the things that we have wee can do is change the nature of health care for minority communities across the country for sometime to come. The infrastructure we would create would have that lasting impact. Again i think this would be something that would be very, very beneficial. For the whole country, actually, give them what we have in all these areas. I agree with you any transformative change and thats what we are proposing. Mr. Neal let me recognize the gentleman from North Carolina, mr. Holding, to inquire. Mr. Holding thank you, mr. Chairman. One of the compounding problems many minority communities face throughout the crisis is the lack of access to proper nutrition and care services. Not only are minorities more likelytoto have underlying conditions making them more vulnerable to coronavirus, but they are also more likely to work in Service Industry jobs that cannot be performed from home. As a result child assistance and nutrition programs are essential to minority communities during this crisis. From the beginning nonprofits like the ymca in raleigh where i live, and charlotte, the other end of North Carolina, and all in between have been on the frontlines of efforts to support underrepresented communities in this national emergency. And over the past few weeks the ymca of the triangle, which is where i live, has served almost 50,000 meals to families across the region and provided childcare programs for over 1,700 workers. In garner, North Carolina, just about 30 minutes from my house, has the pool ymca and it last set up day cameps for children and runs blood drives to assist the health care community. These programs not only support our essential personnel, but also provide food and care and stability for our hardhit communities. Despite the tremendous work that the ymcas have done in minority communities, they have been left out of the federal assistance programs they desperately need. Under the paycheck protection program, which congress enacted specifically to help groups like this, in my opinion, affiliated organizations like the ymca cannot access funds if they collectively employ over 500 people. As a result, these two big ymcas in North Carolina furloughed over 95 of their staff. They are continuing to operate at a loss. So without the mmingcy federal assistance ymcas across the United States will no longer be able to provide these invaluable community services. I strongly urge all my colleagues support an adjustment to affiliation rules for the paycheck reduction programs to ensure nonprofits like the ymca can continue to serve those communities in need. My question is for the doctor, in your testimony you talk about ongoing Food Security issues even with the Additional Meal Service funding from the Families First act. So my question is, how can we best work with nonprofits in the private sector to bridge this Food Security gap in underserved communities . First, congressman, i want to echo your call to modify the paycheck protection program. Its a fantastic initiative. I applaud the congress for passing it, but there are some eligibility and other aspects of the program that could be improved to reach a broader swath of american businesses and american people. As far as Food Security, in this emergency the agencies have a lot of authority to waive regulations. We have a lot of Food Labeling requirements that identify food as going from restaurants, those restaurants around opened right now, or going for wholesale use, they cannot as a result they are sent to these not for profits to distribution to american families. The f. D. A. Has done some things to relax those regulation, but i think there should be every every effort to waive as many of those. You want the food to be safe, but you want it to get to people and not stopped by regulation. Id look into that. Mr. Holding thank you very much. Mr. Chairman, i yield back. The chair neal i thank the gentleman. Before i recognize mr. Blumenauer, without i will include in the record an article from the Financial Times of may 22 titles ethnic minorities in america suffer the most of unemployment. I now recognize the gentleman from oregon, mr. Blumenauer, to inquire. Mr. Blumenauer thank you very much, mr. Chairman. Let me just say how impressed i historic smoothly this earing has gone. It is done through a lot of hard work on behalf of the staff and members trying to become conversant with it, but i think its worked out well and its going to be a tool that we may be able to use beyond the current virus. Appreciate the efforts. It this had been a troubling hearing as we have reemphasized time and again the grotesque disparities that we see in terms of africanamerican communities, certainly here in oregon. A problem that we face. In fact the disparity in oregon for the community will be even greater because of some definitional issues. I want to focus for a moment if i could on native people. Dr. Seacrest i appreciate your referencing your tribal roots. And pointing out the horrendous problems faced particularly with the Navajo Nation with a third of the people, i believe you testified, lacked access to safe drinking water. Basic sanitation. Of course access to food. These social determine nantz that help loom large as we deal with these disparities. Native people, however, in particular are challenged. I note that theres been 8 billion that we setaside in our earlier legislation, but until recently less than half of that had been distributed to native people. And in the Pacific Northwest the treaty obligations that go back 165 years have largely been ignored. They have been fighting to have recognition of basic tribal rights in terms of historic fisheries. Deeply troubling. Compounding the problems that hey face they face in this coronavirus. I want to assure that native people are given their due in terms of the response to the the investments investments osed that are supposed to be made on their behalf. Thank you very much for your question. Them is there is the approach today and the emergency that is going on in many of these communities, and then there is our longterm approach. I think the approach today we need to recognize any delay in the funding that youre referring to impacts what is going on right now today during a curfew or lockdown thats happening in these communities. This infection is not them is t the waiting. It is spreading day to day. On the Navajo Nation the rates of infection are still climbing. We do need to get the funding to these communities as soon as possible so that they can enact not only policy programs that actually improve access to personal protective equipment, but that actually improve access to testing. But also that improve access to food. That improve access, as youre saying, to water. These are basic right necessities that these populations are lacking. And in the time of a pandemic, it only heightens or further that need. In the longer term i think the real solution here is that we in these communities need to create, as has been referenced, longterm Economic Sustainability. We need to be able to support and prop up programs that allow for Economic Opportunity in these communities, that allow for the poverty rate to not be 42 . That allow for the employment rate to Unemployment Rate to not be north of 40 in these communities. When you have that kind of scenario you cannot promote health and wellness to the degree that we would otherwise do. Mr. Blumenauer thank you very much, doctor. I appreciate that. Mr. Chairman, i hope there can be special attention given to the challenges faced by native people. They have been disadvantaged because the federal government has not met its obligations in terms of treaty rights. Its unfair. It is inequitable, and it pose as problem not just to native people but all they come in contact with. Thank you. I yield back. Chair neal thank you, mr. Blumenauer. I agree with the point you have made. With that let me recognize the gentleman from South Carolina, mr. Rice, to inquire. Rice thank you, mr. Chairman. Id like to go back to dr. Sea crest what he was just talking about with the longTerm Solution. Doctor, can you talk about what you were just can you expand on what you were just talking about about how to solve these Health Issues for native americans in the long term . Dr. Seacrest if i started with a couple of background facts. Its important we talk about education as the key to everything in terms of Economic Prosperity here. More than 50 of the about 50 of the population in the navajo reservation does not have that education that is needed, is not able to achieve that high school degree. Mr. Rice you said they had 40 unemployment . Dr. Seacrest correct. Mr. Rice you said the longTerm Solution to that is to promote Economic Sustainability . Dr. Seacrest correct. Mr. Rice you said you can promote health and wellness without economic stability. Dr. Seacrest it is pardon hard to address the social risk factors we are talking about today unless you have a plan where the Unemployment Rate isnt so high, where the education rate isnt so low, because then you will not be able to have a pipeline of people who can act in the Health Care Capacity mr. Rice let me ask you this. What was the Unemployment Rate before the coronavirus . Dr. Seacrest that is not a covid related Unemployment Rate. Mr. Rice it was 40 before the covid hit . Dr. Seacrest i dont know what the Unemployment Rate is right now. Mr. Rice i just wanted to talk about i wanted to relate that back to my district. Speaking about the disproportionate effect this disease on minorities. I certainly see that in South Carolina. I have reviewed the demographics. And africanamericans make up about a fourth of the population, over 50 of covid related deaths. I do think that is a huge problem that we have to address. I also believe that it doesnt have that much to do with covid itself, because we have done so much with respect to providing access to health care with these relief packages that we passed, we provided extra money to hospitals to treat covid patients. We increased medicare reimbursement. We specifically that any testing is free whether you have insurance. Whether you have a. C. A. Insurance. Whether you have medicaid. Whether you have any kind of insurance, the testing is free. We have expanded telehealth and all these things i have worked on and others. We have done so much to expand access with respect to covid. I agree that these problems are endemic. They are not new. They result from, in my opinion, lack of huenttunte and lack of Economic Sustainability, which is what you just said, dr. Seacrest, would you agree with that, dr. Aiken . Dr. Aiken i think thats right. Mr. Rice i have three counties, you heard me speak about some of the ones in South Carolina that are majority africanamerican. They havent seen a higher level of covid than the National Average or the average of the state. I havent seen a demographic for those three counties specifically, but what they have had is lack of opportunity for a long time. The thing that crushes me about all this is that we had made so much progress. Along that line in terms of creating opportunity. When i came into office in 2012, the Unemployment Rate in marion county, South Carolina, was almost 20 . Three months ago it was under 4 . Which is an amazing an fascinating thing. We had made so much progress in providing opportunity that would eventually lift these disparities in health care and education and other things. I just cant wait we are on the downside. If you look at the slopes, the numbers are Getting Better every day nationally. We have absolutely bent the curve. I cant wait until we get past that so we can again focus on policies that give everybody of every race and every age more opportunities so that some of these disparities have been eliminated. Im absolutely opened to hearing about any other solutions in the short term, but in my opinion, and i think in the opinion of dr. Aiken, the only, the only longTerm Solution for this is to grow Economic Opportunity for everybody of every demographic, age, race, and otherwise. I yield back. Chair neal i thank the gentleman. Let me recognize the gentleman from wisconsin, mr. Kind, to inquire. Mr. Kind thank you, mr. Chairman. I want to thank all of our panelists for their testimony here today. This has been very, very helpful and illuminating. Dr. Seacrest, let me start wufment i represent a large rural western wisconsin district. I have been working with my Community Back home. They are expressing high levels of frustration with the lack of comprehensive testing for their staff, their members, their employees. And also shortages of personal protection equipment. Is this something thats unique in native country, or is this something consistent with shortages, shortfalls that we are seeing throughout the country right now . Dr. Seacrest we have shortages of personal protective equipment and covid testing in boston in the system i am working in. What i observed in the Navajo Nation the shortage of testing there and lack of personal protective equipment there far exceeds what we are seeing in boston. What happens when you have this shortage, you turn to reuse policies. You start reusing equipment that was meant for one time use. Once you start doing that, it limits the we get into an unclear area of how effective it is anymore. When you are cleaning and sort of homemade sterilizing your personal protective equipment so you can use it again, you are in a whole different range of shortage compared to what we see in some of the other urban environments. Mr. Kind dr. Sea crest let me stay with you and anyone else who want to offer their opinion. The Census Bureau came out with studies showing about 1 3 of americans are displaying signs of clinical depression and clinical anxiety. Is this something thats acute in the minority communities, minority household throughout the country . Is it consistent with the population at large . Dr. Seacrest we already know that Mental Health impacts these communities to larger degree than other communities prior to covid. We also know that these communities have large history of historical trauma, that the source of the trauma is different depending on community we are talking about. We fully expect there will be a wave of Mental Health need coming this summer. Thats going to follow this wave of infections. When you think about the tragedy, there are families the multigeneration at housing that occurs in these communities, there are entire families that have either been infected with it or had multiple deaths in the family all at once. That is going to create a trauma thats going to be long lasting and need for Mental Health services. Its going to far outstrip what are already stressed Mental Health system is able to provide unless we come up with more Innovative Solutions and increase the supply of providers and ways to give Mental Health in these communities. I think telehealth is a wonderful opportunity for us to explore in that space. That will allow us to expand our capacity, but we have to be careful about how we implement telehealth. Is it multilingual . Is it done in a culturally competent way that it addresses the needs these communities have. Mr. Kind finally, will he me just ask, dr. Sea crest, if you want or anyone else, the longterm answer is a vaccine and inoculating people. That can prove challenging depending object the form of the vaccine, the Antivax Movement that exists out there. Do you see any particular challenges trying to get minority communities households inoculated once a vaccine is developed . If i might address that. Its imperative that people understand the vaccine might be available in the short term. But thats not likely. One of my biggest concerns is that the vaccine be fefted tested across all populations to make sure whatever vaccine was developed is effective in our communities. As you know historically, minorities have been left out of some of the most important drug studies that we have had. So from my perspective not only should we make sure that its effective in those communities, we need to develop a Distribution System that is fair and equitable, otherwise its going to create some challenges beyond the vie suss itself. The vaccine virus itself. It will come but not as quickly as we think. We have to make sure people who look like me are part of the studies. Thats very important. Mr. Kind thank you. Dr. Seacrest, anything you want to add . Dr. Seacrest i think thats right. I would also add that when we developed a solution, we have to open up access to the clinics in the other venues where these vaccines would be distributed. We have to break down any trust barriers that have been exacerbated during this pandemic to make sure people people understand this is an approach thats eventually going to allow our communities to heal. I think those will be important essages. Chair neal let me recognize the gentleman from arizona, mr. Shikert. Mr. Schweikert thank you, mr. Chairman. I want to do two separate points. Dr. Seacrest thank you for focusing on the Navajo Nation. Being from arizona and having as a younger man spent lots of time in the nation, you understand its geographic distances is difficult. But as we sort of walkthrough what we are doing well and where we are failing, i would love us to have a better understanding in the phoenix area i have a couple suburban tribal communities. But their numbers are also different. Yet they are right against one of the largest metroplexes in the country. Is that an access issue . Is it a failing of Indian Health services and the way that model works . Is it some other Health Disparity . I provide this to you so that its something we have been thinking about, im very close to calm of these communities, having lived next to them almost all my life, and its something we talk about a lot of their ustration of being sort of caught in the government box of Indian Health services and how they believe they could be dramatically more responsive to Community Members if they were functioning in some ways, given the money and allowed to run their own system. Any sort of comment on both disparities in our native american population, but also the variance between my suburban ibes, my rural tribes, my what should i be looking at to understand . Dr. Sea crest thank you for your question. Illed ill take a moment to highlight for americans. Its important to note that American Indians that a 5 1 2 year shorter Life Expectancy than the rest of the population. To your specific question what i would say is i do not believe that the extent of the pandemic is related to anything that the Indian HealthService Hospital facility did or did not do. I think the spread of this pandemic has been largely Community Based and related to the social factors. The clinical response to the pandemic is a different question. To be a little bit more specific for the Indian Health service, i think we should think of it always think of it not as a Hospital System but as a Public Health agency. As a Public Health agency, if we can enable it to move beyond not just the clinic walls and hospitals and physicians and nurse, but what is the way that the Indian Health service can facilitate Public Health work out in the communities and partnership with the Navajo Nation. I think thats where the power of the Indian Health service can really take root for this pandemic. The majority of the American Indian population is not what is hat will be defined in rural environments. What youre observing is less a factor. Factor of race being the specific thing thats causing the spread of covid among the American Indians but i think youre going to find its still going to be related to the crowding. Nditions and of these families located outside of the reservations, the social ave capital and resources that may surround them in other families. Thank you for that. Thats actually very close. Holtzeakin, dr. Holtzeakin. Yearcame to you and said a from now, what have we learned, will an we do better that give congressman thompson, blumenauer, and some others who this,ly sort of mentioned expansion of things like, what is telemedicine . Is telemedicine facetime on my or e, talking to something, is it the wearables i may have on my body . Thehe Navajo Nation we have Broadband Satellite that are starting to be launched. House may have access to broadband if we would just be willing to be creative, whatre are we learning our failings are . Can we do better . Dr. Holtzeakin i think one of the things we learned is that approach to the internet, specifically which is in general, and ow some restraint regulatory moderation is going in our re successful capacity to hold this hearing, our capacity to do telehealth, away from y to work offices is much, much better than other places. Thing. A tremendous in terms of things i think we need to do better, i think one is thathings we learned the American Health care Delivery System there is no one but we have many, any, many, on the whole, too inflexible to respond to simultaneously the needs of the the population and remainder of the Health Care Needs of americans. Hat weve done is essentially stopped doing a lot of medicine a lot of health care. Its been described as discretionary. Much can simply be postponed. Happen. Have to you like numbers. 5 . P. Fell by mr. Neal the time of the gentleman has expired. Mr. Schweikert thank you, mr. Speaker. Neal thank you, mr. A eakin. Let me yield to the gentleman jersey, mr. Pascrell. Mr. Pascrell thank you for a distinguished panel. Great people. People. I wish i was there with you but this will have to do for now. E knew about the cracks in our Health Care System. Ach one of us on this committee. We knew that an individuals by a wide nfluenced range of factors. This pandemic has turned chasm. Racks into a the burdens of the virus have allen like a ton of bricks on minority groups and the populations. I introduced the researching and nding disparities by understanding and creating the equi equity act, the reduce act, h. R. 5246, the reduce act will improve our data on vulnerable giving states and localities more resources to impacts on Public Health. Y goal is to reduce health disparities. I hope everybody on this committee has the same goal. Need to look beyond the in emic and closing the gap our knowledge, research, and translation is very essential to achieving Health Equity for all communities. You can draw a direct line from structure, the structural and social factors that have ade communities of color more risk, infection, death, poor policy decisions that put these risk. Ommunities at this casual relationship is crystal clear. N my district and in the state of new jersey, 13 of the states population is africanamerican. 20 of those have died of ovid19 in new jersey are black. And to simply dismiss this or structural as a problem rather than coincidence enough. John Hopkins University study the covid19 de infection rate is predominantly counties in black counties is three times that of predominantly white counties and the death rate is six times higher. Lets take one of those communities and i have a for you, dr. Is he kwis sequist, more than 60 of Nursing Homes, lets take vulnerable population, at latino lf are black or and reported at least one coronavirus case. Homes double the rate of were black and latino people make up less than 5 of the population. This dough expect a similarly impact onate disproportionate impact on of color in the 536 longterm care facilities in new at least one case . That . Expect dr. Sequist are you asking, am finding . Ed about that mr. Pascrell i am sure you are surprised. Can we expect this impact in all facilities incare new jersey . Thats my question . Dr. Sequist i think you are tracking one of the tragic aspects aspects of covid. We have failed to take proper our elder population. People who are frailty and in these assisted living and facilities with the pandemic. Say when these facilities are not receiving enough funding and are not able the Infection Control policies and practices that we really need to control do expect that e will continue to see a widespread surge of this pandemic across that particular nvironment in Skilled Nursing facilities. Mr. Pascrell one more question holtzeakin. R. Ouve done a great job in all the times you have appeared before our committee. And your testimony is very interesting. And the to specifics charts. About the you talked g. D. P. You talked about the perspective will happen years from now because of whats going on right now. I have a question. Only have a few seconds left. You can pause on it and maybe write to me, call me. Ask you a question. You use the word structure too. Change. Al very interesting term. Mean, were part of the structure. He congress of the United States. And were part and parcel of the inequities that exist in our society. Were part of it. Not the we are part of it. Want to know what you mean by tructure and how do you change structurally . Because if one is making plans for everybody else and how were to get through equity, it dont work. You really think about t and id like to know about it. Dr. Holtzeakin ill get back to you in writing. Recognize the e gentlelady from indiana, mrs. I believe has in a car. Mrs. Walorski i am on my way to d. C. , mr. Chairman. Thank you very much, mr. Chairman. See all my colleagues today. I want to say thank you to all the witnesses who are with the well. Ses as i want to thank our frontline workers that are across the country. We are a grateful nation for heroic efforts to heal the sick, keep us safe, manufacture the eliver supplies, feed country and help those in needs. In my district in northern we remain committed to doing our part to combat the coronavirus pandemic, but to rstand that we need reasonably open the economy and the country. Ecause getting folks back to maximizes safely our well beings. We know those with diabetes, at thension, obesity are most risk of complication or death from coronavirus. Preventing these conditions has always been important, but this pandemic has made that all the more apparent. Medium to long term, it will be important to find ways issues iate some of the of Health Conditions in which someones social and economic shapes their health. For instance, i am the osponsors of the social determinans accelerator act will elp communities to better leverage existing programs and authorities to improve the health and wellbeing of participants. It would also supply grants and echnical assistance to help state, local, tribal governments ake innovative, evidencebased approaches and improve outcomes and costeffectiveness. We would also pass we could the Affordable Housing credit improvement act of 2019, my h i introduced with colleague, susan delbene, ffordable housing for lowincome americans is a vital part of improving Overall Health outcomings. The legislation would modernize streamline Affordable Housing credits to make it more effective and useful for country. Es across the dr. Holtzeakin, when were looking at the entire picture of health disparities, do you think that should include social determinants of health . And then also, what other policy changes do you think we could be the socialto address determinants of health that would help address chronic disease . R. Holtzeakin so thank you for the question. A lot of federal Health Policy entertainment policy. So we have to be careful about having the policy limit the way practice. Simple example is, in medicare, ften the best thing you can reimburse is a ride to and from the Doctors Office to make sure treatments, get the stay on their medicines, and are ppropriately seen on a timely basis. You can only pay for things of ur health care you limit that. That is the social determinant of health which is an important of the health phenomenon and require cutting across these payment silos that we have for ousing, that we have for health, that we have for nutrition and thinking about how cohesively for better outcomes. Some of the Biggest Challenges i think that face policymakers in area because it requires thinking more comprehensively health care and Health Outcomes and breaking down payment silos. Would focus on. Mrs. Walorski thank you, mr. Chairman. I yield back. Kneale i hope for a safe travel. So before i recognize mr. Davis, consistent with community move to a e will now 21 questioning ratio. Mr. Davis is now recognized for five minutes. Davis mr. Chairman. Mr. Davis. Mr. Davis thank you, very much. I ask unanimous consent to the record upplemental questions that i have. All right. Chairman. , mr. Thank you. Et me thank our distinguished witnesses whose testimonies have been profound. As a matter of fact, i have been astonished. Dr. Hill breath, since you grew arkansas and went to harvard and i grew up in parkdale, arkansas, and went to university of arkansas at pine bluff, just a camden, and had lived in your town and i wanted to know us are camdens are extremely proud of the work that have done and the work that you continue to do. S a matter of fact, we always fondly say that arkansas is a wellknown state. Ts the only state in the bible. And looked over his arc saw. Let me ask you you talked a about contract contact racing, and we know that to be one of the effective ways of reventing and treating diseases. Weve also had many discussions about it and we saw some agreements and of us ements and some believe that there are some individuals who probably might be in position to better job at doing the actual work than others. That you concept subscribe to and if so, why . Hildreth thank you, congressman. And happy to know there is a ellow arkansan sitting in that seat. In order to protect the lives of people in lnerable our population, without a without a drug, the nly thing we can do is protect the population from protection and thats why Contact Tracing is so important. Tracing, as you know, is to identify all the persons who come into contact with someone is positive and there is an element of trust, as you heard before, involved in contact because you are going to be calling individuals and sking them to divulge some personal information. So contact tracer is not someone trusted in those communities, there may be a challenge there. So youre absolutely right, its likely that cultural competence and cultural sensitivity will be as important it is in tracing as offering medical care. That the i believe four black medical schools as a ideally m will be suited to be the ones leading the fight against covid19 in inority and disadvantaged communities. Mr. Davis we talked a great africanamericans, americans, native americans, Asian Americans, americans, those that live in inner cities, barrios, have that are often low income. Have a ere to rescription that could help remedy the problems for many of same time s at the and you could write an order, be for america . Dr. Hildreth well, i will go i said previously. There is a shortTerm Solution and a longer Term Solution is needed. He urgency of the moment is knowing there are certain groups in our population who are more severity of the disease. Why dont we focus on solving that problem . Of the een said by some other panelists, surely having people have a more stable future is very important because thats the factor in determining our health. But we have to focus on the here and now and the here and now, people, many thousands of people, hundreds of thousands of people are going to disease ando severe possibly death. If we dont intervene at this moment. Urgency here that i cannot overstate. We need to be doing these things now. To what i said earlier, before historically are reallyal schools well positioned to do this. We already partner with churches. E partner with local organizations like ywcas. We partner with local schools. Businesses. Ith we can do this. So the shortTerm Solution has alive lets keep people by testing, Contact Tracing, doing those things that need to be done. But clearly an economic overall nd equality and equity is necessary. To me thats going to require a longer conversation. Ven in that, the black medical School Consortium will play an important role. Very much. Thank you mr. Chairman, i yield back. An neal i want to include article from the new york 31, covid19 may Nursing Homes, a striking racial divide. The that, let me recognize gentlelady from california, ms. Sanchez, to inquire. S. Sanchez thank you, mr. Chairman, for calling this critically important hearing today. Also want to thank our witnesses for their testimony that highlight the historical that ities and inequities this pandemic has further exacerbated. Our communities faced heartbreak and economic distress during the pandemic. Of us have lost friends, families, neighbors. While we may all be experiencing same storm, we are not all in the same boat. Los angeles n county show when cases are broken down by race and Latin X Community is disproportionately impacted by covid19. Week, uesday of this there were three times as many latinin the country among x members compared to white counterparts. That in shows particular latino workers have the especially hard hit by pandemic. One in five latino workers are out of work. Hey also have one of the highest uninsurance rates for health care, which makes it to access them Critical Care when they get sick. Any latino families live in multigenerational households which can create exposure risks for those who are deemed cant work from home. And their elderly family members more susceptible. A disproportionately number of workers re essential deemed by our nation to be in a critical infrastructure, but theyre not getting the that ment assistance others are receiving. This is happening to millions of families. Latinos and other minority essential workers on the front pandemic. E yet, they dont get half their hazard pay, they dont dont have ve, they access to Health Insurance. So naturally, they are the first fall. We need to ensure workers on the ront lines are adequately detected to keep our communities safe and our economy running. Proper federal response, its going to take years for the community to recover. Our nation is t stronger and safer when everyone, especially communities that are hardest hit, have their specific needs addressed. Fernandez, i want to go to you first. You touched on this briefly in your testimony. And mistrust ear in the government, particularly n the immigration system, impact the spread and the containment of the virus and or you seen misinformation access to information that that . Ted dr. Fernandez thank you, congresswoman. Fear is an issue. Pandemics, out the pandemic pandemic, the fear. [indiscernible] u. S. Immigration services did made a statement which was very helpful saying that seeking testing would not subject to public charge or consideration. Extended t has not that to either getting treatment refusing Services Related to covid. I think it will be if all inarily helpful contract workers could stay. Their information would not be i. C. E. And it would be extraordinarily helpful if protection extend from public charge allegations treatment and to for tial services isolation ms. Sanchez i am hearing this community. They are not giving the Small Business loans that other businesses are getting. Not getting the unemployme unemployment benefits. Many dont have access to health care or theyre losing their Health Insurance because theyre being laid off. So the disparities are just getting worse. Why a ant understand federal response would not take into account everybodys health. Everybodys health in a pandemic impacts everybody elses health. Are on the lks that front lines, in the food supply terms of health care, workers. Tore and this pandemic has just inequities. Ese and we cant afford to leave any community behind. To ask dr. Hildreth getting everybody back to work, hat will be the best thing to help these poor immigrant and minority communities. I mean, do you think thats to help take away exist . Nequities that dr. Hildreth well, certainly Everyone Needs to get back to work but we need to do that safely. Theres bias in a lot of the things weve been talking about. Goal is to not only save lives but to make sure we can safely. He economy thats why the things ive been peaking about are so very important. To me we are the economy, all of us. Their people have lost ives and according to economists, we value them at 1 trillion right there that we lost. Careful, that number could double easily. So its about doing what we can protect all of us. We protect all of us by protecting the most vulnerable. Im proposing. Because all of us are in this together. Does not respect boundaries, county boundaries. S long as were living together, we have to protect each other by protecting ourselves. Thats what i think we need to be focused on right now. Mr. Neal i thank the gentlelady. Ms. Sanchez i yield back. Mr. Neal thank you. With that i recognize the entleman from ohio, dr. Wenstrup. Mr. Wenstrup brad . Al are you on mute, there you go. Mr. Wenstrup thank you, mr. Chairman. Appreciate the opportunity. Conversation [indiscernible] my district is unique. Ohio. Nati, rural ohio. Northeast ohio. See a lot of the same poor in both in the underserved areas, urban areas, areas. Al nd a lot of times the same higher incidents of certain ailments. Putting together ur Bipartisan Task force to take a look at these issues. E lunge right into that situation. A ohio [indiscernible] strike force, and this is beyond the coronavirus. At. Es so much to look the administration put some emphasis on hot spots. Weve done a lot. Heal telehealth. [indiscernible] if we really want to address, in my mind, the issues, we need to put care, and health area g all into one because people have to go all get the place to try to their needs fulfilled. When it comes to telehealth, i want to st [indiscernible] i said, theres valuable than to themscernible] and letting know [indiscernible] and trust. G that so thats one of the things i think is very important it comes tole] when health care. [indiscernible] i think its a little bit better have a licensed doctor you are talking to. That. E expanded [indiscernible] situation ack to the that concerns [indiscernible] underserved areas look [indiscernible] lead to similar Health Outcomes . Could you repeat that . A very hard time hearing you. Wenstrup rural and underserved areas, while theyre different, they lead to similar outcomes or indiscernible] so the basic issue, i think, get access to issues. O we have the same issues of insurance coverage. And conditional insurance coverage. Facilities and insufficient access. Dr. Holtzeakin and i think, critical access hospital as the key component of of what determines outcomes. In terms of telehealth, i may not be understanding the me thats t seems to an additional tool, a valuable tool, but not a substitute for of the Health Care Delivery mr. Wenstrup but heal health is how th, the question do the environment have some of he same problems, both underserved areas, rural areas, is the [indiscernible] dr. Holtzeakin these are weak economies. They have difficulty supporting a vibrant health care sector. Is, you know, associated also with less insurance and the ability to support that. All run together. Improving the foundation for all would also help provide better care. See dr. Hildreth has left. There you are. I know, one of the things [indiscernible] we gotten ple that have covid19 and recovered. I tried to take the opportunity Public Service announcement, donate plasma, you could help save the life of another. We have a story in cincinnati, the patient was africanamerican who was saved convolessent plasma. How do you think that correlates factors and caring for people and also the opportunity [indiscernible] that . On on the ildreth so i think convolessent plasma is a great lives. Try to save we are not quite certain yet. The antibodies in the plasma will be neutralizing and slowing the virus. Conceptually it should do so. To the extent we can get doing that consider that recovers, thats going to help us all out. Hundreds of had thousands of people whove recovered. For e opportunity onvolessent plasma or a serum treatment and we want to make that part of our efforts in the Minority Community to do just that. Think you raised an important point. Thats one of the things wed be focused on as a consortium is make sure that actually happens, among other things. R. Wenstrup i have a feeling you might be [indiscernible] gentleman. Thank the i thank the gentleman. Let me recognize the gentleman from new york, mr. Higgins, to inquire. R. Higgins thank you, mr. Chairman. Appreciate it very much. Covid19 hasrus and fragility in the American Health care system. Health disparities generally preexistinglot of conditions. With those preexisting conditions, the most vulnerable the worst and most lethal of exposed. Are 100,000 americans are dead. 1,500 more will die today. We have no treatment for covid19. The richest country in the world Expensive Health care can do to those who are fflicted with this is offer them tylenol. People whose lungs are infected, whose hearts are infected, whose livers are infected, this is a tragedy that has, again, revealed the exposed, the fragility of the American Health care system. R. Hildreth, the National Institutes of health is the largest funder of medical world. H in the get o we build trust and greater minority participation forlinical trials, not only drugs that will emerge for the moving forward to test both the safety and forcacy of Drug Development covid19 but also generally speaking . Dr. Hildreth thank you for that question. Youre absolutely right. Theres no organization on the to the hat compares n. I. H. When it comes to biomidcal research. Research. Medical one of the problems is getting minorities in the clinical studies. Be aware of the cohort of americans that was put pool er through a genetic algorithms, predict disease. The American Medical College [indiscernible] part of that cohort. We like to do the same for the algorithms, covid19 drugs and predict disease. The american vaccines. The United States is trying really hard to make sure there diversity in both the researchers and in the research. But its really challenging. All the other aspects of american life, theres bias in how grants are reviewed and trying to address that. So i think thats all the more reason why its really important have the four africanamerican, black medical schools involved in all this. Is what were trying to do. Were trying to make sure that the whole population, no matter like, where you come from, that youre both part and that the problems will be addressed across the board evenly. A great i. H. Is doing job. Even there, i think we have a role to play to make sure diversity both in the researchers doing the work, the clinicians who are doing the treatments, and the participants in the studies. Mr. Higgins let me also ask you this. Not new. Avirus is the World Health Organization the coronavirus was esponsible for severe, acute respiratory syndrome, otherwise later mers s and covid19 is a coronavirus. Going back two decades. Nd the federal government invested in the National Institutes of health to develop vaccine, which would have avoided all of this in all likelihood. They invested two decades having this be conversation today . Dr. Hildreth i think there were opportunities to be better the covid19 virus. In all honesty, you cant make a that youve virus not discovered yet. And there are sufficient the covid19etween virus and the sars virus to make me believe that a vaccine sars would not necessarily protect us against this coronavirus. Belong the same family of the viruses but they are distinct and its not very likely, possible, but not likely that a sars vaccine have protected against a covid19 virus. Now, mind you, we hope, and i of us believe that it might be possible to develop that will us vaccine be crossprotected. But there really is no way for anticipated that this particular virus at this particular time was going to be a challenge. That we could have done more to be prepared in erms of having a Pandemic Response team that could have shut the virus down before it spread around the globe. Given all that weve learned about it, i think were doing pretty well on the front. Fic im more concerned what were doing in the Public Health front. Again, the , consortium comes in. Mr. Higgins i yield back. Gentleman. Thank the i thank the gentleman. Let me recognize the gentlelady rom alabama, ms. Sewell, to inquire. Sewell mr. Neal ms. Sewell, would you yourself . Would you unmute yourself . Ok. Why dont we do this . Ms. Delbene go to and well come back to ms. Sewell . Delbene is recognized to inquire. Ms. Delbene thank you, mr. Chairman. Witnesses for he joining us. I really appreciate your time. And wem Washington State have a we were hit early with region. Navirus in our we also have a large Asian American and Pacific Islanders in our region and researchers at the university of ashington looked at state numbers and found that primary language could be could play big role in poor outcomes for Asian Americans. They collected of covid19 patients, this is cross our state of covid19 patients that specified english at their as their primary 15. 8 were hospitalized. And 7. 4 died. Whose patients that primary language was vietnamese, hospitalized. And 15. 4 died. Who spoke at that tagalog, 17 hospitalized, 48 died. A. P. I. Ook at the broader community, what can we do to address the information and weguage barriers that really see in passing these Broader Health disparities and, do you think how we should address this in the Asian American community where languagesso many more that are spoken and fewer health rofessionals who speak those languages . Thank you for your question, delbene. Ative so we we like to think king washington, attle, they were one of the first people that reported that this data, along with the department of Public Health, they were the two reports that at the rest a look of the country to see how theushing the disturbing numbers were. He data pointed to Pacific Islanders in this. Two r number one number in most disease confirmed cases. And so this is very a lot of to us because the approaches that have been far, like hus increased testing and contact racing are being discussed around our community. And we have not seen them. Not seen it immigrated obstacles of all the you talked about, one of them being language. The issue regarding language and reasons why l people dont engage in these Public Health initiatives has decades. Nd for generations of us researchers and Public Health officials and to deal with ad them and weve only gone around hem by partnering with the community. Theyve had always had access, because of the trust that a lot advocates already have, were able to identify areas testing but we utilize the trust equity within its mmunity to say that afe, that this is this will help you develop a Family Safety plan. Someone hen you ask from the Pacific Community about those sensitive questions such you been in contact with, who you know, whos in house, very personal information questions. Its very unlikely that theyre to release them. And they are going to need of being the t face of trust so they can that information and put it into a frame a reference thatallows them to realize youre not there just to pick on them and keep them in their homes. Them safe, to keep their families safe, and their community safe. Language barriers, a lot f the information are being translated and so i would strongly recommend a local ublic Health Department to reach out to these Community Groups that have access to materials already. But more needs to be done and funded. Ds to be ms. Delbene and for Contact Tracing, too, i think youd say terms of the cultural and the language aspects for it to work. Correct. Contact Tracing is a foreign concept in the Pacific Community. Unless you link it to, what are going to do . Are there Wraparound Services . These questions, will you do something to me if i home . Rouble staying in my will do you something if i dont have enough food to feed my family . These questions lead to . Ms. Delbene thank you. I yield back to the chairman. Recognize now e the gentleman from missouri, mr. Smith. Mr. Smith thank you, chairman neal, and Ranking Member brady. Trying timestainly that were living in. Unfortunate reality that the crisisure nation is crisis our nation is facing that have resulted in communities experiencing disproportionate from of illness and death covid19. These problems are not and we le to overcome must work to address them. Many of the problems that owincome communities of color face are the same problems that folks back home in rural with every uggle day higher rates of unemployment, lack of access to care, and lth increased rates of comorbidity diabetes, hypertension, and obesity. Lowincome americans, especially those living in disadvantaged communities, are feeling the and we this pandemic, cannot continue to ignore the fallout on nomic worsen9 is only going to in inequities. Holtzeakin said in his testimony in april alone, our 20. 35 million 20. 35 million 20. 5 million jobs. Unemployment rate kyrocketed to 14. 7 , the largest rate since the bureau of labor and statistics began recording in 1948. Much of this job loss is coming occupations. Ge americans have heeded the advice f federal, state, and local officials and have and have done their part to slow the spread of coronavirus. But now it is time to allow them lives. Rn to their normal the government cannot and should for its e the risk citizens. We the people have to do that for ourselves. Health care, we must build upon the actions of ongress and president Trumps Administration to increase ccess to care in underserved communities. Telehealth policies has advanced pandemic. Ng this and we must work to ensure rural nd underserved communities are able to access it. I advocated to c. M. S. That expanded tohould be allow some visits to be i was ed audio only, and pleased they listened. This policy has helped mitigate of the key problems with access to telehealth, which is to technology and broadband in rural areas and underserved communities. Ongress must look to making some of these new telehealth policies permanent to encourage stakeholders to make the investments necessary o utilize this flexibility and increase access to care. More concerning, for health care the u. S. Health care 1. 4 m lost over 1. Million jobs in the month of april alone. While many are optimistics these jobs will return once elected procedures begin again, there is about longterm damage system. Ealth care mr. Holtzeakin, in your that ony, you mentioned you did not expect our g. D. P. To levels untilcrisis 2022. The Health Care System to bounce back quicker than that . What are the longterm negative the ts you see hitting Health Care Industry . Think the akin i Health Care Industry will look like the economy as a whole. Again, if you use the ongressional Budget Office forecast as a typical forecast very uncertain times, it shows a sharp decline, 40 in the second quarter. Of about 28 , 27 in the third quarter. And then much slower progress by 2021, back to f the levels we had at the beginning of this year. He Health Care System will probably do the same thing to some extent. Congress has done a remarkable provideoving quickly to Financial Support for hospitals and other providers in the make sure that they flow suffer such a cash crisis that they have to close their doors. That was imperative. I congratulate them. Now a substitution of care. For covid i sure i would call them nonessential [indiscernible] enormous scale. First part was health care. And people stopped doing. Longer term, what well have to deal with the undamental issues [indiscernible] which is access providers, coverage [indiscernible] mr. Smith thank you, mr. Chairman. I yield back. Mr. Neal i thank the gentleman. With that let me recognize the gentlelady from california, ms. Inquire. Ms. Chu thank you, chairman neal. Holding this absolutely critical hearing illustrating the grave that communities of color are facing as a result of covid19. Of incredible importance to the Asian American, Pacific Islander community. I appreciate the opportunity to discuss the impact that is having on these communities. In fact, mr. Chairman, id like for the record a written statement from the health cific islander forum which details the impact to our community. Mr. Neal so ordered. So chu dr. Samoa, im sorry you contracted covid19 yourself. Am so thankful that you recovered, especially since you worker. Ssential and let me say that in my home california, i am so alarmed because native hawaiians and Pacific Islanders have a thats nearly triple their population portion utah, the on and in mortality rate for nhpis has oubled their representative population. This is a critical disparity these only know because states have elected to race and ible] ethnicity but we know thats not the case everywhere. I just in , fact, i just looked at the on c. Website hospitalizations and guess where they put them and native americans, d native even, under the category of other. Ere all just lumped in as others. So dr. Samoa, can you discuss disaggregatingof data by race and ethnicities at ll levels during a pandemic like covid19 . How does identifying the impacts of covid19 by race and help us fight the virus from a Public Health perspective . C. D. C. Be the required to disaggregate states data the way like california, utah, and washington do . Thank you for the question, representative chu. Absolutely feel its necessary to disaggregate data. Communities are disproportionately impacted and its almost as if we pick up a new state every time we look. Preliminary results in egards to illinois show that native americans and Pacific Islanders are high there. Well. Th carolina as o although these were there were rumblings in the Community Way before these reports came ut because we knew that our founding members were dying in those areas. There was a recent article that published talking highrisk communities in rural areas such as the south and the midwest. Because our these recent wave of Pacific Islanders who moved into those areas to in meatpacking and feed Packing Industries were dying. Their numbers werent being reported until community ctivists urged these Public Health departments to disaggregate data. So you can see how hiding that for any e it difficult group trying to reach a very Small Community to get to. Dont have much information in regards to testing so we if the en know vulnerable groups are being tested more. Very Little Information breakdown of the specific asian Pacific Islander a big because that has play if you have the linguistic intervening. So this is relying on information, information that needs to be disaggregated for us reach into those areas. If not, these high numbers that seeing, because i understand everyones being mpacted, but these pacific alarming. Bers are and like i said, there are places where we have a high in texas and oklahoma where the data is not disaggregated yet. We can only guess. And theres no attention being brought to those communities. I think for that reason, its really, really important. Ms. Chu so clearly, we need to a national for isaggregating data from the c. D. C. Let me just also mention that we eally need to make sure that those individuals compact association truly need access to medicaid which is indeed in the heroes act. Are people here because of the treaties in the military islands. Ions on their so thank you for that. I yield back. Mr. Neal i thank the gentlewoman. Yield to the gentlelady from alabama, ms. Sewell, to inquire. Mr. Ewell thank you, chairman. I am hoping you can see me now and hear you. Mr. Neal i can always hear you, dear. [laughter] ms. Sewell first, i want to thank all the panelists and i chairman,ank you, mr. For having this very important hearing. Committees f this rural and Underserved Health that orce, i am grateful the full committee [indiscernible] had a virtual earing on such an important topic thats so dearly personal to me and my constituents. District i represent and have the honor of representing is my home district of alabama. A majorityminority district. S my home state of alabama is relieving restrictions, our ases cases are number of confirmed has by skyrocketing. Are [indiscernible] 1 of the states cases and 43 of deaths. Es make no mistake, this recent spike will have a disproportionate imact on the i represent and the most vulnerable communities. These raising numbers of cases and deaths [indiscernible] rural people. Are our neighbors, our church members, our coworkers and even our family. The covid19 has been indiscriminate, but it has had a disproportiona affect on onate africanamericans. As so many of the panelists have aid, it shines a spotlight on systemic disinvestment that we has made in communities of color throughout. To dr. Ion first is kendi, i want to commend you on thoughtful article and your writings in the atlantic. By the rticularly moved piece that you wrote about our olleague, elijah cummings, in which you said, the more i about the gentleman, the more my chest burned for his family and for many families, of the black families worrying about the mortality of the black ones, for amilies burying their loved ones in caskets [indiscernible] they had more to give. If you had a magic wand, an unlimited checkbook, how these racial ess disparities in health care that by the ghlighted covid19 pandemic . Were going to leave this here on cspan to honor our 4 1year commitment to house. Verage of the u. S. Theyre gaveling back in momentarily to take up the rule reauthorization of the foreign Intelligence Surveillance act. The rule has just been cleared the rules committee an 84 arty line vote and we expect that the house will take that up immediately when they return. Historic day in the house as we well. For the first time in house history, they will allow members beginning this afternoon, beginning today to vote by proxy it count towards achieving a quorum of members for floor proceedings. This 2 50 eastern fternoon, 73 of the 233 House Democrats plan to vote by proxy this week. Again, the house coming in to for the fisa le bill. The rule provides for an hour of general debate. We expect the final vote on the fisa bill coming up this evening as well. Our capitol hill producer tweets debating ouse will be the Senate Passed bill without elements including the lofgrendavidson amendment, which was a late add and caused democrats and others not support the measure. The president tweeting against measure, but not issuing a veto threat quite yet. Li