Test test captions Copyright National cable satellite corp. 2008 as i described in my testimony, we know that Nursing Homes with a higher proportion of black and latin residents have higher death rates, however theres not universal reporting of the race and ethnicity of those individuals within Nursing Homes who have been affected by covid. That presents for us a significant challenge when it comes to targeting resources in order to prevent the transmission of covid. Because, you know, when covid19 enters a nursing home its because someone has brought it in and what its telling us that if those Nursing Homes are following the same safety procedures of restricts visitors, ensuge that providers have clean ppe every time theyre coming in, then we shouldnt see these disparities. However we do. And the likelihood these disparities in rates of covid infections within Nursing Homes are going to occur are going to be even higher in communities with a higher burden of covid19. And so what were seeing in the Nursing Homes is really a snapshot of whats going on in a community. So we really need the data coming out of the Nursing Homes on who, on the socio demographic characteristics of who is contracting covid to stop these disparities. Just to clarify have the disparities in congregate setting outbreaks been similar or different from what youre seeing in the broader population . The disparities in congregate care settings are quite similar to what were seeing in the broader population, however ill offer the caveat that older adults, at the Older Adult Community dwelling, the disparities tend to be smaller than they are younger ages and the disparities that we see at younger ages are likely due to a higher burden of earlier onset cardiovascular diseases, kidney diseases and dibtsz. By the time we have older adults living in communities those rates tend to even out a little bit more, however the intensity of the disparity is still significantly higher in congregate care settings. Two to five times higher for black and latin residents that be for white congregate care residents. Thank you. Thank you. Senator blumenthal. Thank you, chairman collins, thank you senator casey, to both of you for having this hearing on such a critically important topic and it couldnt be more timely. Like many of my colleagues over the last few weeks in connecticut, ive been to a number of demonstrations, peaceful, and passionate, and more than 17 myself all across the state and i have been so inspired and impressed by the cries for justice, not only in policing, but also in housing, education, health care, maternal mortality, addressing the disparities that exist in so many areas of health care. In connecticut, black and latin residents are three times likely to have tested positive for covid19 as white people. And black residents are more than two and a hoof times likely to have died from the disease as white people, latin people are more than one and a half times as likely and just one last statistic, almost 60 to 70 of all our deaths from this insidious disease have occurred in Nursing Homes. If you are older and you are black or latin, this disease has a target on your back. Not one that you have created but one that has resulted from lack of Proper Health care, housing, maybe education. That is a kind of injustice this nation must overcome, so i thank all of the witnesses for your testimony and i want to begin by asking, dr. Carnethon, you mentioned in your testimony the lack of trust and rapport that must be overcome if vaccines are to be effective. What specifically would you recommend doing to overcome lack of trust and rapport . Yes, there is a historic lack of trust in the Health Care System owing back to the days of the tuskegee experiment cited most often and more recently theres evidence to suggest nonwhite minorities are not receiving the same evidencebased care in certain settings as nonhispanic whites. Building trust, what my colleagues wor working most heavily in the space and i believe dr. Mack can likely speak to this as well, Building Trust involves spending time with the community, ensure that we are explaining the why and the how, along with the how, of what we are doing to Community Members and most of all spending time to listen to members of the community so that we are addressing their needs as well as our own. What we really need to do is put ourselves in the shoes of Community Members to try to understand what those barriers are to wanting to engage in Preventative Health behaviors to wanting to accept these vaccines. Thank you. I want to focus, dr. Jones, on an issue that i think is tremendously important, our federally qualified Health Centers. I visited with are 17 federally qualified Health Centers in a call on friday and i have visited physically almost all of them over the last couple years, and i know how critical they are. In fact, you mentioned that 77 of the patients you care for are from racial or ethnic minorities in connecticut we have 17 of those kinds of centers and the numbers are almost the same. Nearly 75 of Connecticut CommunityHealth Center patients are from racial or ethnic minorities. The heros act was passed by the house not that long ago with an additional 7. 6 billion in emergency funding for community Health Centers. Its a month later, but we still have not voted on it. Its a critical bill. Can you tell us how those Additional Resources would be used by your Health Centers and others . Sure. Thank you for the question. I hear people talking about Building Trust and how do we reach people. Im proud to represent over 1400 fqacs across 120,000 sites across the country. Thats who we are and thats what we do. The trust is there. Our focus is a safety net for the uninsured, under insured and under served. I think fqacs need to be more involved getting people into the community. We have relationships with community leaders, churches, businesses, et cetera. The funding should be set up in such a way there are Resources Available so that people can have access to care, theres Resources Available so everyone has ppe, so people can be tested and also Resources Available so that people can find medical homes and get preventative care. So the money that we have received thus far have been used to key our staff employed so that we can treat this vulnerable population. Without that money, a lot of my peers across the country would have had to downsize and the amount of care that we would have been able to deliver would have been significantly less. Thank you. The thing, one last thing, people respond to people that look like them, and the idea of being comfortable with people that look like me and understand me is significant. Thank you. Thank you very much. Thanks. Thank you. Im uncertain whether tim scott has returned yet and it looks like hes been a bit delayed, so well next call on josh holly. Thank you, madam chair, and thank you for holding this hearing today. I also want to thank the Ranking Member for his participation in help in setting this hearing up. Thanks to all of the witnesses here for your testimonies. Like other regions, my home state of missouri that has seen and continues to see disproportionate rates of infection and deaths among our seniors and also among communities of color and this is a tragic reality that Merits Attention by congress and action by congress and so i want to thank, again, madam chairwoman and the Ranking Member for holding this hearing. Mr. Jones, i would like to come back to a question that senator blumenthal was asking you a moment ago about community Health Centers. The cares act provided i believe 127 billion in supplemental funding for Public Health and social services, emergencies, including funding for community Health Centers. In april i asked secretary azar at hhs to prioritize funding for community Health Centers in my home state of missouri and i did this after speaking with a representatives of the health care community, pastors and others who emphasized to me the vitally Important Role community Health Centers can play in meeting the needs of underserved communities being disproportionately affected by the virus. I want to give you the opportunity to expand on the line of answers that you started with senator blumenthal a moment ago. Can you tell us more about why the community Health Centers play such an Important Role and what they can do in helping to address some of the needs that were seeing here, some of the unique needs faced by Older Americans and absolutely. In under served communities. Go ahead. Thank you for the question. It centers around social determinants of health. We have been plagued as a race, as human beings, with this overall arching concept and what it simply means is that people are at a disadvantage based on housing, education, where they live, the environment about which they matriculate. The way the funding has helped is the fact that we have been able to reduce the barriers by which people can seek health care, most of the Health Care Centers across the country run about a 30 to 40 no show is, meaning that people are scheduled for appointments, they dont call, they dont show. More often than not its because of things they cannot control. The other issue that people need to think about, people are focusing on living, on life. Health care is important, but its not important if you dont have a way to put a roof over your head or to feed your family. The thing that has been important for fqacs we have moved from a culture or process of seeing people in our Health Center at telehealth, telehealth has been significant in this way that we are trying to address the disparities in primary health care. Were now able to see people in their own homes, were able to remove the barriers that have been in place that would stop them from seeking health care. The funding not only provides health, allows us to provide health care in an environment by which we werent able to do before. It gives us the funding to get into our mobile vans and get out into the community and provide the care that we need. As i said before, lets not forget the fact that this pandemic has and i said this in my testimony its a flash point on the health and inequities and the inequities of our overall Health Care Systems that there needs to be a way that everyone has access to care and, again, the funding will allow us to broaden our scope and to deepen our resources to provide the care for the people that need it. Thank you very much for that. Let me pick up on the telehealth point that you mentioned just now and that you also mentioned in your written testimony and about how vital that can be, telehealth can be to expanding Health Care Access to the pandemic, this pandemic, and in general. One of the things we know however is many elderly lowincome communities of color, rural communities, have significant barriers to accessing telehealth and this is true in my own state where we have a significant rural population and where all of those things are true. Tell me a little bit about how youve addressed concerns related to Technology Access and what more you think we can do to improve that so we can improve this vital tool . Sure. Back when i was a young child, i used to laugh because our doctor used to carry a little black bag and walk up and down our street and see pem in their homes. We have a division in our Organization Called homebound is outreach. We have nurses that we send into the community and they see people who, for whatever reason, cannot come into our Health Center and also they are the eyes and ears of our providers. One of the things we have done to those people that dont have the technology, we sends the nurse into the home and we use the technology of our laptop to communicate with our providers in the office. We have, i know at our particular Health Center and my peers in western pennsylvania, weve pride for funding so we can get technology into the home of the aged and the feeble so they have the opportunity to turn on the community to see whats going on. Thats only half the battle because the technology is still a challenge. So there needs to be staffing, there needs to be Community Ambassadors that have they dont have to be medical people. They have the ability to get into the community and get into the homes of people that need care. It could be a very inexpensive proposition. Theyre not the highest paid people. They can be the ears and eyes to providers to provide the care, were doing that on a small scale and we plan to expand that as we continue to identify the needs. Thank you very much. Thank you for the tremendous work youre doing and the other witnesses for being here. I will have a few questions for you in the record. Thank you, madam chair. Thank you. Senator warren. Thank you very much, madam chair, and thank you very much for putting together this hearing. Seniors are bearing the brunt of the covid19 pandemic. People over 65 account for just 18 of coronavirus infections, but they make up 80 of the deaths. Nursing homes, where 1. 3 million seniors living, and systemic racism has put seniors of color at even greater risk of catching and dying from covid19. Were nowhere near controlling this pandemic. Public Health Officials are reporting tens of thousands of new cases and hundreds of deaths every day. Congress must act fast, really fast, to protect our seniors and contain this virus. We need to ramp up testing and we need to create a National Contact tracing program and stabilize our supply chain and need better data to ensure communities of color are getting the covid19 resources that they need. Let me start with you, mr. Woods, in your testimony you talk about how Atrium Health developed a covid19 dashboard to track cases and deaths in real time. All of this data was stratified by race and ethnicity as well as additional factors like geography. So, mr. Woods, what did the data reveal about how communities of color were experiencing the covid19 pandemic . Thank you for the question and your leadership in this regard. Some of what the testimony of some of the other panelists is, those social determinants of health, the cracks have been laid bare. The issues of lack of access to food, lack of access to health care, all of those in these communities, we found that they were magnified during the covid pandemic. I think what were realizing is that its years of lack of investment in core communities we invested tens of millions in Affordable Housing because you dont have a warm place and a warm home, youre not going to be healthy. We have fed about 10,000 kids through our kids eat program, because if you dont have food you wont be healthy. Its just magnified the social and economic and Health Care Disparities weve known for a long time and been fortunate to have been part of a coalition to help address that straight on. I really do appreciate your work in this and what im hearing you say is the Demographic Data you collected showed that communities of color face barriers in accessing covid19 resources and in the responses. So let me just follow up with this, mr. Woods. Its one thing to detect disparities, but its another thing to tackle them. Did the data lou you to actually reduce racial inquicktity in your Coronavirus Response . We did. As i mentioned in my testimony because we have the unique ability to run our own internal covid tests we were able to launch quickly when we saw this data and the six different zip codes in the charlotte area, we were able to work with the churches, the hispanic community, and we said rather than you come to us, we have nine fixed testing sites, let us go to you, but we dont want to assume we know where to go, so please tell us where it is so we were in Church Parking lots, ymca parking lots and we also it was mentioned earlier, the one thing i want to focus on as much as anything, we have invested this past year 7 million just on interpretive and language services. We know that, for example, thats a really important part of reaching this community so its not just taking the data, going to where the communities of needs are, but making sure we had the language to be able to speak to people on their terms. Right. So in other words, by collecting detailed Demographic Data, you could develop a targeted data driven response to covid19 and send resources where they were most needed and send the appropriate kind of resources to those places. From the outset of this pandemic, the Trump Administration should have collected Demographic Data to guide its covid19 response. But it didnt. So instead, my colleagues and i have spent months pushing hhs to publicly report race and ethnicity data. In the end we had to force hhs to issue a report on covid19 Racial Disparities. Still only 55 of cases reported to cdc to date include information on race and ethnicity. Let me ask it a different way, without uptodate, comprehensive Demographic Data about covid19, do you believe that the federal government will be able to craft a Pandemic Response that provides communities of color with the resources that they need . What i can do is speak from our experience. Without the data that we had to respond to this community in real time our data is updated every two hours. We know where the incidents of covid, we have a map i look at every single day in terms of how its spreading so from our experience without that Realtime Data it is really difficult to contain and eliminate the covid. Thats really important. Its part of the reason im still fighting for comprehensive coronavirus data. Last week Ranking Member casey and i asked hhs to report Demographic Data on residents and workers in Nursing Homes to better track covid19 infections and deaths among seniors. We need to put the Public Health impacts of systemic racism at the very heart of the cdcs work and im working on legislation to do this. In this pandemic and beyond. If the Trump Administration doesnt start taking this virus seriously, tens of thousands more americans will die and a disproportionate number of those seniors will be people of color. Congress must act. Thank you, madam chair. Thank you. Senator braun. Thank you, madam chair. This is just another topic regarding health care. Ive spent so much time on the issue prior to becoming a senator and social determinants, underlying issues with chronic conditions as well as how minorities are being treated through an epidemic like this, to me still begs the question, of whats wrong with our Health Care System before we got to this junction. In my opinion, im going to ask the question of mr. Woods and mr. Jones, our issue with health care when it comes to access, to covering preexisting conditions, no caps on coverage, all the things, 80 senators weighed in prior to covid coming along, are still there. And to me, the number one issue and been referred to as a tape worm on our economy, is the high cost of health care. 18 to 19 of our gdp here in this country and, of course, its nearly half that in 20 to 25 other countries with results that are as good as ours. So to me in my own business, in trying to tackle this 12 years ago, until i engaged the individual in his or her own well being and tried to provide transparency so you can see what things cost, whatever we sti to do here and whatever we can accomplish through the federal government to look at disparities we still get back to the same old stimp. Its dysfunctional, its run increasingly by large corporations that have no interest in fixing the system. I want to ask you this, transparency, president trump, by the way, has been the most aggressive individual on trying to reform certain dysfunctional parts of our Health Care System. Every time it occurs it ends in the courts because the industry takes him to court. We here as senators tip toe around the industry too often. What about basic reforms to actually not only address issues like were talking about here, like transparency, what value would transparency give us, the hospitals recently took the president to court on a directive he wanted to make the charge masters transparent, now its been overturned by a judge, thank goodness were making headway. The question is directed to mr. Woods, do you believe transparency would be the tool to not only fixing health care in general, but also to help us better navigate through disaster like a microorganism thats confronting us now . Thank you, senator, for the question. I think transparency is certainly one of the solutions and we are like other Health Systems that have provided charges online so i think thats one avenue, but i think fundamentally the issues that we deal with, at least in our communities, as a safety net provider, go back to some of the things that were alluded to earlier. We are the safety net provider for the entire state of North Carolina. We see more medicaid, more compensated than anyone else in the state and so i think we still theres a lot of opportunities to continue to Fix Health Care and on through the Health System lens but also we have to come together to deal with some of these referred to earlier, some of the social determinants of health that are being magnified in this crisis. The lack of Affordable Housing, thats fundamental to dealing with the Health Care Cost and crisis in this community. Ultimately, these patients are showing up in our facilities. I think its a multifactorle equation we have to serve for transparencies, part of it, and the one thing that i would suggest is that these things can only be addressed through private Public Partnerships such as the one that were i just mentioned earlier, for example, for masking where we have big business and Health Systems working together and i think working together with the health department. I think its a complex equation. The president said health care is complicated. Certainly agree with him. Transparency is one of many ways to help address the situation. Imagine the dividend we would get from saving that we could invest in some of the other things you were talking about. Mr. Jones, would you briefly comment on it as well . My time is about up, but please tell me what you think . Sure. Transparency is only part of it. Its under the broad umbrella of socioeconomic status. As i mentioned before, this pandemic has served as a flashpoint, but the Bigger Picture is, we have to get fundamentally into the situation that why is there disparity and it all has to do with education, neighborhood, housing, social reported access to health care. The broader picture is we need to take care of this pandemic, it needs to be a federal global approach. Once we get on the other side of this, we need to peel it all the way back and get to the root of what the issues are. Again, its about people not having equity and equality in accessing jobs, education, and health care. Thank you so much. Thank you, senator. Senator jones. Thank you, madam chairman, and thank you Ranking Member casey for holding this really important hearing. This is especially i think significant in all of our states but i have been acutely aware of the problems in alabama. You know, mr. Woods, i would like to kind of follow up with you initially about some senator casey made some comments about medicaid. You practice, youve got hospitals i think in both North Carolina and georgia and like alabama, those states did not expand medicaid. Youre one of the largest providers of medicaid services. Every study ive seen has indicated that Health Outcomes are raised in states that have expanded medicaid, but we still seem to have a great deal of political pushback on Medicaid Expansion, not only in our states, but also in the congress. We got billions of federal dollars that were putting into every state right now that deal with this pandemic and it only makes sense to me that we try to do that in a way to give states the incentives to expand medicaid. Weve made a lot of strides. The Commonwealth Foundation indicated that black working aged adults across the country have greatly benefited from Medicaid Expansion and there is a huge proportion of those folks that reside in our states. I would like to ask you about Medicaid Expansion and the benefit that the population that you serve, how it would benefit, how it would improve your hospitals, as if we can go forward and try to get something in this next package to give states the incentives to expand medicaid. Thank you for the question, senator jones. You know, one really live example of what were seeing especially during this video is one out of five americans have Behavior Health issues dealing with mental Health Issues, and were seeing our outreach, especially right now with Behavior Health, has magnified significantly. One of the things that Medicaid Expansion would do is provide additional funding for care of mentally ill patients. Thats just one example that were we to have that coverage now, we would be able to expand our efforts significantly. The other thing i would just say, as a safety net provider as i alluded to earlier, if you look at we never turn anyone away, ir representative of ability to pay, right now we probably cover about two cents for every dollar of cost that we have for someone who is uninsured. Medicaid expansion would probably increase that to 11 or 12 cents. What we do with the initial funding as we continue to invest in the community through Skilled Nursing facilities, outreach to minority communities, et cetera. I think its important i think to continue to explore Medicaid Expansion in states like ours because i think it will help the community be healthy. Great. Thank you very much. I completely agree with you about the Mental Health aspect of this. I think folks often forget as we focus so much on this virus right now, that i think a lot of the mental Health Outcomes or mental Health Issues are going to be with us for a long time based on this virus. Dr. Mack, let me ask you a little bit about morehouse. Since coming to the senate ive been a strong advocate for additional funds for hbcus, we got additional funds for the first two years and were able to get some permanent funding. In the cares package we had a billion that went to hbcus. Recently ive joined a letter with my colleagues senator harris and booker, to try to encourage an additional 6. 5 billion to hbcus and particularly graduate institutions like yours. If we could get only a portion of that, i mean how how would that benefit colleges like morehouse . How would you use additional funds in the middle of this pandemic to help us get out and how would it benefit a college and the communities that you serve . Thank you, sir. As i stated earlier, we are on the front lines with these communities, not only from an experience aspect, but what were doing today with the testing, also with the treatment and also the push to get vaccinations. If we would have that additional funding, it could help us to educate and train providers and mds who actually work within these under served communities. At Morehouse School of medicine, over 50 of our graduates actually work in the state of georgia, state of georgia is mostly a rural place, so our graduates actually go into these under served communities, multicultures and actually work in those communities. I think it would benefit from a training perspective, benefits when it comes to scholarships to provide training for the students, but also, the care that we provide on the front line. As you stated quickly, i would like to say about the insurance, around covid today, the lines are longer in those communities that are uninsured and under insured. Also, the testing sites happen not to be in those under served communities. Its affecting us today when it comes to accessing care. It could help us in many ways. Right. Thank you all for being here with us today. Thank you for the work youre doing in all of this. Thank you, madam chair, for this hearing, important hearing today. Thank you. Thank you. Nsenator tim scott. Good morning, chairwoman, thank you for all your hard work and dedication on so many of these issues important to the nation. Frankly you have been the leading voice in our congress and i mean either the house or senate. In our congress, for issues around disparity and around taking care of people who simply need help, you have been the type of chair who looks only at americans, not at parties or color, but at people in need. Thank you for being that kind of chairman. I really appreciate your leadership. Let me just say this, as we looked at the numbers in south carolina, 27 of the population happens to be black, about 43 of the fatalities are africanamerican, 32 of the diagnoses are, so those numbers were alarming to me initially and as i looked around the country i found that 14 of michiganers are africanamerican but 41 of the mortality were black. I started realizing that there seems to be a racial impact and i asked hhs to step up and start giving us more information broken down by racial categories and they did that and i asked my governor to do the same thing and he did that. So we were able to then start target morg targeting more of our energy and focus on the health care incomes and disparities. Number two, as i spoke with nih and dr. Collins we started talking about the importance of the rad x up so we could put more testing in communities. I pushed my governor and our health care apparatus in south carolina, so thankful they responded constructively and positively, that weve had a pop up of sites for testing at churches and schools in minority communities. These are important. Even with all of the new ground that were making up and a whole lot of ground to make up, when you look at the confidence within our communities particularly communities of color as it relates taking a vaccine, 25 of africanamericans say theyre willing to take the vaccine, 37 of hispanics, to the panel, what can we do to increase those numbers . I would like to take a stab at that senator. Thank you. Again, the issue has to do with trust and you dont start during a pandemic. The trust starts way before then. I need to give a shout out to fqac. Thats who we are and what we do. Were in the communities where people trust us, people come see us, theyre treated with dignity and respect. It doesnt matter if they have insurance or they dont have insurance. So the way we can do that is identify agencies, organizations and churches that people trust. Once you get the trust, then you can start the conversation of convincing people the value of getting the things that they need to have. Thank you, mr. Jones. I would like to follow with that. This is dr. Carnethon. We right now are working with through a cross nih Initiative Led by nhlvi and Minority Health in Health Disparities. We understand as dr. Jones stated it would have been ideal to start sooner however we have to start now and we have to get out there, weve got to build these bridges and i think whats going to be critical is to communicate the urgency and also to really empower Community Members to understand that they have to be the ones to step up to help us stop the impact that were having on minority communities. So what i would like to do with our messaging is really promote this partnership that we have to step up in order to help o ourselves. Let me make this comment on the paycheck protection program, one of the things i saw as a Small Business owner or a previous Small Business is owner the importance of having a marketing mechanism in place. I went to the mbda and said im going to put 10 million so we have the marketing that reaches in specifically to communities of color and targets the outcomes were looking for, higher utilization of the ppp. I would say i hear the need for something similar and if that is true, where is that similar organization. Certainly the churches, i know the hbcus and worked with them and our office led the charge to get more resources for the hbcus in the cares act and according to the uncf we have recordbreaking dollars coming in during the last three years. How do we find those one or two organizations that penetrate so deeply that we can have that kind of focus. And senator, this is gene woods. You know, one thing i think we just got to recognize a part of the issue is after 3 million cases of covid and 140,000 deaths, we still have a fundamental general in the country 50 of people dont want to get vaccine nated. Flu season last flu season we had 40 of the population that said were not going to get a flu shot. I think the messaging has to occur on multiple levels and there should be a National Strategy right now, a pr campaign as you mentioned, that touts the benefits of vaccination. I think thats layer one. And then with respect to your suggestion, what weve done here and in the communities we serve is we have partnered with Media Outlets to specifically focus on minority communities. There could be a National Strategy but there has to be a local strategy as well because the different outlets have different insights and into the particular communities. I think its got to be a multi fact torl type of campaign but that begins that vaccinations are important as part of containing covid but also influenza. After this is over if you have time. One day this week i would love to continue this conversation. Absolutely. Yes, sir. Senator, if i could say one thing quickly, i think we have to stop funding the usual suspects all the time. We have to look for new organizations that have deep tentacles within the community. And thats the initiative were doing now. Organizations through the Community Respect as leaders, i think we have to partner with those organizations as weve said earlier, and make sure some of the resources, empower those organizations to do the work and be the lead for that work within the community. Thank you. I look forward to reaching out to some of the panelists if youre interested in engaging in this conversation further when were not limited to five minutes of questions and answers. I read through your backgrounds and frankly im impressed with the group of folks dedicating a lot of your life to making a difference. I would love to partner with those who may be interested in doing so. Thank you. Thank you very much, senator scott. Senator rosen. Well, good morning, everyone. Thank you, senator collins, Ranking Member casey, for holding this important hearing, and, of course, like senator scott said for the Impressive Group of panelists who have spent so much of their life and efforts on health care, in so many areas, particularly this one. I want to address the Racial Health disparities and how we can work through Education Training and resources to make things better because racial and ethnic Health Disparities persist because of longstanding inequities in working, living, health and social conditions. We see the manifestations of such disparities everywhere. For example, during covid19, data from my home state and the Southern NevadaHealth District shows la tinos are dying at a higher rate than any other group in the region. Northern nevada the la tino population has the highest number of covid19 counties even though they only make up a quarter of the countys population. We know too often inadequate access to care, underlying biases, place ethnic and racial minorities and seniors of color at greater risk of complications due to covid19 and other diseases as well. So Research Also suggests that provider actions can be influenced by implicit biases which impact the delivery of overall medical care sometimes without medical providers realizing it. Im glad to see that the university of nevadas Reno University of nevada Reno Sanford Center for aging are taking the steps to combat racial bias by requiring staff to attend trainings on the subject. The center is taking steps to review both internal policies and the gerontology curriculum overall to ensure that they include economic, social and policy content that address the impact of Racial Disparities. So to dr. Mack and dr. Carnethon, as both researchers and educators, how can we best train our medical students and, in fact, all of our medical professionals to identify and understand their own implicit biases so that they can recognize how this contributes to their Decision Making and delivery of care and what types of practices do you think are worth us investing in to be overall success to make the most success . So lets start with dr. Mack and then go to dr. Carnethon, please. Thank you. Well, when we consider the practicing, weve always focused on the importance of primary care and the Behavioral Health component that it actually highlights within primary care. Thats what were talking about. There is a larger aspect to the training which should provide the sensitivity of the student to the total patient and the health care of the patient. We realize that only 20 to 25 of your health is contributing to health care. So its very important that we take in consideration those social, economic determinants. And that includes the bias of physicians, the bias of the Health System when it comes to treating patients. That has to be put in the curriculum, expressed and trained whether its in the ambulatory setting or its in the hospital. Some of that training means we have to train the trainers. Educators have to be aware of the biases and while there, the student is shadowing them, they have to also make sure that theyre addressing that i think we have to make sure its in the curriculum, its taught, but also the academia, including myself, professors, et cetera, are properly trained to train the students properly to be aware of those biases. Thank you. Dr. Carnethon. Thank you for this opportunity. These are discussions that we are actively having right now at our medical school about how best to incorporate these Critical Skills in the ways in which we teach our clinicians to treat patients in how to interis act with them. My experience in the educational field suggests experimental learning is one way to cement the lessons that are out there. I think the ability for medical students in training to actually hear directly from patients, the ability to hold panels or even invite Community Members to share their experiences, providing recordings so that Health Care Providers can hear the very subtle languages that they may use that does seem to imply that the problem lies with the patient. Consider the example of managing somebody with diabetes saying you need to eat more fresh fruits and vegetables. To hear directly from a Community Member how difficult it is to access the fresh fruits and vegetables in the neighborhoods where they live may may help to guide the ways they hold conversations with patients. I think this content should be required and i think experimental learning is an excellent technique to train medical providers on how to best Pay Attention to these factors. Thank you. I appreciate that. I do agree in the way that we listen and respond and the way that we offer advice, all of us can learn from those kinds of conversations. I appreciate that. Thank you, senator collins. Thank you. Senator rick scott. Well, first i want to thank senator collins. [ inaudible ] and the Ranking Member casey for holding the hearing and all the witnesses for being here today. This is an unprecedented time in our country. One of my concern has been all along that we dont have enough testing and ive also heard that Health Insurers are limiting or denying coronavirus testing for some of their enrollees which thats clearly unacceptable and dangerous. So i have i introduced a bill testing act that will make sure everyone american can have access, it will be hard to get back to a normal life, and get a test and i hope we can get Something Like that done to make sure that happens. Mr. Jones, can you talk about how the business of our qualified Health Centers have changed since the coronavirus started back in i guess february, but early march . Absolutely. In a word we went from seeing people in our Health Center to doing telehealth. We were seeing in the middle of march we went to about 85 of the people we saw was through telehealth and as i mentioned in my statement it was because we needed to practice social distancing, we need to protect the patients, we need to protect our staff. So the best way for us to do that was doing it remotely. The other way changes we have included in our scope of practice testing every day. So in addition to treating patients the way we normally do and incidentally when a lot of patients come our Health Center oftentimes theyre coming way beyond the acute stage. Its not unusual for a typical patient to have three to five comorbidities. They come into the hospital for high Blood Pressure and you find other things. In addition to doing that were doing testing and were trying to make sure we get the testing back in a reasonable amount of time so when you start looking at Contact Tracing you can figure something out. So our whole model has changed significantly. And amid all of this we have people that are afraid to come out of the house. We have people afraid to actually get tested and people that are still trying to wonder how do i get back to normalcy. Have your overall volumes gone up or gone down . Theyve gone down. Weve gone possibly 33 on the medical side. The dental side is nonexistent. Because of all the cdc guidelines our dental team is really doing testing. Were only doing emergent case and a little bit of denture. The ppp has enabled to keep going and not lose the level of care that weve had. So without that funding we would have had a very difficult time having a Viable Organization to address this problem. How are you doing on getting your protective gear . We are fortunate in the western part of the state. Our difficulty has come in getting the test results. In some situations its taken 7 to 10 days. So were working feverishly trying to find tests we can get the results a lot quicker so we can actually communicate back to people so theyll know what to do in order to protect themselves. So you havent had access to the rapid tests . I just received an email this morning from my supply department saying were going to be getting those tests next week. So prior to that we did not have them available to us, no. Thank you for what you do. We have a lot of great fairly qualified Health Centers in florida, and i know theyre a safety net for a lot of communities. And so thank you for what you do. Mr. Woods, can you talk about how youre doing with regard to getting protective equipment and gear and how youre doing with regards to testing . Back in march because we were looking at the peak we had canceled our electives and we took that time to really enforce our ppe and for the with isolated challenges we have a predominantly female work force. We need more small n95 masks. Thats something on a weekly basis we make sure that we focus on. On testing i shared earlier we do have our special Lab Equipment so we can run our own tests. We can probably do four times the amount of tests and have close to same day turn around. The challenge is reagents. And so some has been in some extent swabs. So i think we really need to continue to beef up the supplies of reagents so we can expedite the testing. That would be our request. And the other thing and theres been some conversation on testing about a National Registry and how that testing and those reagents are distributed to hot spots. So i think thats something were having some conversation about opportunities to do that as well. What are you going to do differently in the future to make sure you dont have the same problem again. Well, we certainly have significantly expanded our sources of supplies. So, you know, a lot of times youre buying in bulk to get savings or we lesed we needed to get a diversified supply line. Obviously our par levels are where they might have been several months now in some respects extend to a year or beyond. Weve invested probably about 45 million or so just to ensure we have stockpiles of ppe. Is your elective surgery coming pack . It is right now probably about 85 on some of the elective surgeries. Our in patient surgeries are pretty much precovid levels. Where were seeing some challenges is mostly in the emergency room. That concerns us because theres a lot of studies as you know people are having heart attacks at home and are afraid of coming into the emergency room. So were really focused on our campaign, we call it our covid Safe Campaign because were sharing with the community exactly what were doing to keep people safe. And were doing rapid cycle surveys of patients. So far 95 of patients have said they felt safe when they come in. And for the 5 that have questions what we do is take that data and rapid cycle improvements to make sure people feel more comfortable. Now, well see what happens in the fall. Senator mcsally. Thank you, chairman collins. Thank you for your expertise during this very unprecedented time. I first want to echo im a cosponsor of rick scotts bill thats focused on testing and ensuring people can get free testing during this once in a century pandemic and Insurance Companies are not denying that to people or theres a financial burden. Hopefully thats something everybody can agree upon and we need to get that passed. We should just not have finances be a barrier for people getting tested. I want to talk about the impact of the coronavirus on nativeamerican communities. And as youve all mentioned Underlying Health conditions such as diabetes we know is one of the strongest risk factors for covid19. We also know diabetes is far more prevalent in minority communities and we have 22 nativeamerican tribes in arizona. They have a greater chance of having type 2 diabetes than any population. The river Indiana Community has the highest rate of type 2 diabetes in the world. Congress has established the special Diabetes Program for indians. The sdpi 1997 to provide prevention and Treatment Services through the grant program. Tribal communities have been able to develop much needed Diabetes Programs and increased access to quality diabetic care. While this is popular and effective it suffered from shortterm and stagnant funding, which is why i introduced legislation to authorize the special Diabetes Program for indians for an additional five years and increase the funding to 200 million per year. In the midst of the pandemic where theres a multitude of obviously Health Care Funding priorities, can you talk about the importance of maintaining focus and treatment for underlying conditions like diabetes and the importance of programs like the sdpi . Absolutely. Thank you so much for bringing us this important point. Precovid i spent most of my time on diabetes, cardiovascular disease and lung disease. And these conditions are not going way, and these conditions are leading to adverse Health Outcomes from covid19 exposures. One thing thats not going to happen is covid is not going to magically go away. We are going to be living with covid for a long period of time, and theres no indication the Underlying Health conditions are going to become less problematic for people exposed to covid. Using that rationale we need to continue to support research that prevents the development of chronic diseases such as diabetes, hypertension, Heart Disease that are predisposing to worse outcomes. In my testimony i mention the use of telehealth and telemedicine particularly via video. I think this is critical because older adults may find themselves skipping their maintenance visits. And the opportunity to be on a call or better yet a video call with their physicians to make sure theyre managing their chronic conditions is going to be critical throughout this so that we can protect them from developing the worst the work you have done so far to provide support for these resources particularly in these native communities definitely needs to continue. That actually brings up a follow on for me. I have legislation with senator doug jonesulse also on this committee about medical monitoring especially for rural communities. If you have continuous glucase monitoring or things like that you can transmit that information without having to take transportation long distances to get to the doctor. How important is the medical monitoring as well as the telehealth . I think the medical monitoring is critical, and you bring this up at a time when were working to use bluetooth enabled devices so we can have Blood Pressure measurements sent regularly to physicians, gluicose monitors sent regularly to treating physicians and clinicians so that we can monitor. Its always been a wonderful strategy for those in rural areas or far away from Health Care Providers to be able to track more regularly. And these are critical things that need to happen in addition to making the Technology Available if you build it they will come isnt enough. We need to leverage people who can go out and teach our older adults and our adults to use it. Ive had a number of zoom explanations with my family members and i know people need help with these technologies and how to set them up. But all that is really critical to making sure we can keep the population as healthy as possible. Thanks. Before i forget the navaho nation has submitted a statement on the covid19 impact on the navaho elders. With that id like to submit this to the record. Without objection. I want to shift to arizona has a growing hispanic population. According to the American Psychological association and National Survey look at people 70 years or older 44 of latinos receive home based family caregivers compared to 25 of nonhispanic whites and ethnic differences were found among those with regard to the care recipient. Among those age 70 and older who required care whites are more likely to receive help from spouses compared to hispanics more likely to receive help from their Adult Children. The instance of the Adult Children being caregivers more likely for the hispanic population we know anyone who is a caregiver youre also taking time off from your job to care for your loved one. That impacts your livelihood and support for your own family. Doctor, can you talk about just these issues with caregivers specifically . What other challenges do minority caregivers face and preventive measures we can take to ensure both the protection of the caregivers and the elderly . Yes, thank you. Minority caregivers tend to have less resources. Unemployment is usually higher in these communities, less time to take out work. And oftentimes the kids are engaged. Sometimes the children are actually missing school. So i think this goes into more resources to not only care for the populations in a preventative manner to make sure they dont get sick but also to have the telehealth and also those social programs to help support families whether its around meals or whether its around caregivers. As you know today few elderly go into Nursing Homes. I have family who have alzheimers disease. People retire early and theyre looking for resources because the insurance does not pay or we dont have any way to pay to put them in personal care. The Health Care System itself cant take care of everything. We have to put resources in those areas of prevention but that are outside the walloffs the facility to support these from not only Health Care Services but also social services that the kids can continue to be educated and et cetera. Let me just say this, the wifi gap we call it the homework gap is also the telehealth gap. So the same folks who cant get the homework especially during this time are going to fall behind. And education is an indicator of health. Thank you, madam chair, for having this hearing. Thank you. Senat senator sinema. Thank you, madam chair. Arizona is currently experiencing one of the worst outbreaks in the nation. Our state is also home to many communities in high risk groups meaning theyre more likely to become severely ill should they contract the virus. In arizona many of our communities of color have been disproportionately impacted from the virus both in a Public Health perspective and an economic one. Arizona is home to many groups that are considered high risk including seniors in our hispanic and latino communities and amongst our tribal populations. Its clear policy makers must address the different disparities that exist in different communities if were to successfully combat this pandemic. Doctor, i was struck by the part of your testimony that called for increased investment in our health care struckker. Many nativeamericans face increased risk relative to covid19 and other illnesses in part because some communities dont have access to Running Water or sanitation or other basic needs. Tribes in arizona have been particularly hard hit by the pandemic. The navaho nation at one point had the highest number of confirmed coronavirus rates in the country and nearly one of ten residents in the White Mountain country tribe have tested positive for the coronavirus. These Health Care Challenges exist in other underserved communities as well. How Running Water and other resources can impact possible health during a pandemic especially for vulnerable sear yz . Yes, thank you. That is entailed in the conversation about what happens outside of the walls of the house facility. Thats a Significant Impact to health. And thats why prevention is so important and resources for prevention that extend into the homes of nativeamericans and other underserved populations. How much can we save if we provided their water, provide their food assets, and we provided equitable living for those communities . That in and of itself and education and those things improves the health of the population. Its been proven. Its been studied. So that is an extension of the Health System. That is what the Health System is called upon to do. So to your point its not only only testing. Its very important the testing. But the uninsured and those on medicaid are standing in long lines, theyre sleeping overnights to get tested and then their test results are coming delayed. So to sum it up we have to consider to extend health into the home and health care into the home and more around Preventive Services and addressing the social determinants of the health as opposed to waiting until people get sick before we start to take care. Thank you. Any other members of the panel would like to respond . Senator, what i would add is it also because in many of these native communities access to basic Health Services is also a big challenge in having to travel. I think it does speak to continuing to invest and fund teleHealth Services well beyond this pandemic so we can reach those communities with respect so theyre getting the right physicians and caregivers into those communities without them having to travel sometimes for basic care. I think thats another part of the solution to help those in need in many of these tribal communities. Thank you. And actually my next question is for you, mr. Woods. Your testimony mentioned different strategies to help break down barriers to testing care and for information amongst our communities of color. One recommendation was to ensure the availability of language and interpretation services. I could see how this could be important not just for Public Health information but also to help seniors access other services and avoid coronavirus related scams. Thats why ive made it a priority to have my press releases that we share translated into spanish and with work with Community Organizations to reach more people. But when it comes to our aging populations how important is it to design coronavirus information and services that are both culturally relevant and specific to their needs as memb members of a high risk population and second how deaccess to services help combat isolation of any seniors in high risk populations are experiencing when theyre unable to see family and friends due to the pandemic . Yeah, its absolutely essential. And one of the things you mentioned actually what were finding out and im half spanish and half africanamerican, and what were finding out is its actually a problem sometimes to translate from english to spanish. Really when were writing our pr and Public Service communications and speaking were really doing it in the native language, so thats one thing i would just add. The other thing, you know, class of culturally Linguistic Services i mentioned we invested about 7 million this past year just on translation and interpretive services. Then when weve gob out to these minority communities with testing it was very, very important to have on our mobile vans people that can speak in the language. I think one of the panelists mentioned people sometimes are more comfortable with others caring for them that look like them, also speak like them is really important. So i think this is an essential fundamental way of addressing this, and i do think providing funding, medicare and medicaid funding for interpreters and translators could go a long way not just for this pandemic but for dealing with some of the things you brought up including social determinants of health that extend beyond this pandemic in vulnerable communities. Thank you. Thank you, mr. Chairman madam chairman, im sorry. Thank you, senator. We are about to start some votes but im hopeful the Ranking Member and i can ask just a couple more quick questions before we adjourn the hearing. And my first one is for mr. Woods. I have had many Healthcare Providers in maine tell me that theyre very concerned that the delayed and deferred health care screenings and elective procedures which whoil theyre called necessary will produce down stream effects where people will have increased cancers, Heart Disease, strokes, undiagnosed diabetes as a result of the delay of health care during this pandemic. And its interesting because researchers found that after Hurricane Maria hit puerto rico the leading cause of death was due to that interrupted access to health care. Similarly after Hurricane Sandy shutdown the Veterans Affairs hospital in manhattan for six months Blood Pressure control for at least two years compared to veterans in connecticut whose access was uninterrupted. For those who are already struggling with inequitable access to health care in general how can we ensure that the actions taken to defer routine health care dont create a Second Health care crisis down stream . Senator, thanks for that question. And that really is keeping many of the people in my seat awake at night. I mean, the lock down for example weve had in different areas has had a large impact on routine screenings, coalon oss s colonoscopies so i think its a real concern. I think part of the solution comes in inspiring confidence both at the Health System level as i alluded earlier that were doing Everything Possible to really keep a patient safe when they come into our facilities. Were testing staff. Were getting ppe to the patients as theyre coming in, temperature checking and cleaning between rooms that are taking two or three times longer but were sharing with the community were doing everything we can to keep them safe. I think also theres an opportunity for policy makers for some of the conversations weve had today of testing and Contact Tracing and so forth to give a megtser of confidence to the communities that were also doing everything we can to keep them safe so we share that concern. Every day we see the manifestations of delayed care. At one time it might have been called elective, it goes quickly the emergent. Were reaching out to the community in many different forms to say if you think you have elective care needs come to us, we will help guide you. But its that sense of confidence that is important we provide the communities that were doing Everything Possible to keep them and their loved ones safe. Thank you so much. My final question is for the doctor and it has to do with Clinical Trials. Making Clinical Trials more inclusive of women and minority groups has been an issue that senator warren and i worked on and became part of the 21st century cares act. But we know that many older black americans are reticent to participate given past medical exploitations such as miss appropriation of cancer cells belonging to henrietta lacks, for example. So my question to you, doctor, is what recommendations do you have to help ensure that Clinical Trials are more representative of those who face the highest risk of covid19 . Thank you so much for pointing out that significant challenge that we face when it comes to making sure that the therapies that we develop work for everybody. There are cases throughout history where we have shown that not including women in Clinical Trials left us with a gap in understanding about the biological mechanisms of action of a given drug. I think were in a similar we face the risk of being in a similar position here when we talk about vaccine trials for managing and preventing the infection. And the ways that we have worked to try to engage communities to participate in Observational Research are the Partnership Strategies that i described earlier. I think we need to start that now so that we can prime communities to be ready to partner with the medical and Research Establishment so that we can test strategies that will protect us. I think messaging around a shared sense of responsibility to protect ourselves may help to motivate individuals who may be reticent to join. I think putting forth faces that the community trust, the faith based faces that dr. Jones mentioned, engaging federal qualified Health Centers as well as hbcus can help to lend a bit of trust. And finally seeing the investigators behind this work we do have a diverse biomedical work force. Its not as diverse as we would certainly like to have, but there are key individuals out there who represent the very communities who are the hardest hit. I think putting these individuals at the forefront of messaging the shared responsibility that we have to participate in science will help us achieve our goals of developing therapies that work for all. Thank you so much. Senator casey . Thank you, chairman collins. I just have a quick question. I know you just have a question. I just have one more and i know we have to wrap up. Its on home and Community Based services. We know as weve referred to all of the deaths in longterm care settings one of the or part of the answer to getting those deaths down is to have care settings that are not congregate, and one of the ways to do that is home and Community Based services, so i wanted to ask you, doctor, about explaining how additional medicaid dollars for these huge and Community Based benefits would be crit criminal for older adults. Yeah, really appreciate that especially your efforts on behalf of shoring up the Financial Resources for home and Community Based workers. Keeping seniors in their home can be safer providing them with opportunities to receive the care they need and maintain their independence is critical. I think there are two key issues here. One is the need to protect the home care workers. You know, essentially they need to have the same level of protective equipment that we are providing for our Health Care Providers within Health Care Settings. They are going from home to home. The last thing we want is for those individuals to be transmitting disease from home to home. And while many professionals within Health Care Settings have protections about their income if they happen to be sick or unable to work a number of home and Community Based workers dont have those protections, and so their incentive to be conservative about symptoms is lowered when if they dont go to work they dont get the care that they need. So i think, you know, those are critical ways in which money can be used to prec thootect those individuals. Thank you. Thank you, madam chair. Thank you very much senator casey. I want to thank all of our witnesses for joining us today and sharing your extraordinary dedication and expertise. I particularly appreciate it that each of you focus so much on recommendations, on Practical Solutions that we can pursue in order to lessen the disparity, the Racial Disparity in the covid infections and also in general in our Health Care System. This week the overall death toll in the United States from covid19 now stands at more than 140,000 deaths. While more than 3. 7 million have been infected. Nearly 1 in 3 americans knows someone personally who has died from the coronavirus far exceeding their white counter parts. As ive mentioned it is appalling to me that my state of maine has the worst rate of covid Racial Disparities in the nation. And i know that is of concern to the people of maine and to Health Care Providers as well to the governor. We face many challenges and risk factors present throughout the country. How to drive down covid infections amongst populations where many hold jobs as front line or essential workers who may not be able to easily engage in the same level of social distancing as some of their white neighbors do to transportation or housing arrangements and those who may have cultural or linguistic barriers particularly among our immigrant population. I welcome suggestions how federal dollars to ensure or mitigate covid actually reach all members of our communities as we intend. Support for translation and interpreters services, direct engagement of trusted community partners, teleHealth Services which we heard a lot about today can enhance that response. And for seniors who are at the highest risk of severe complications or even death the value of these interventions is even greater. I hope that our committee will continue to Work Together on policies that not only can help change the trajectory of this current pandemic but also solve some of the disparities have have become so evident during the pandemic. Senator casey, id like to turn to you for any closing remarks. Thank you for this important hearing and i want to thank our witnesses for testimony and the ideas they gave us for solution. We know over the next several weeks the senate will go over legislation to provide help to ten of millions of americans suffering from the covid19 disease in the jobs crisis. This legislation is an opportunity to advance justice for Older Americans in communities of color as well as many other americans. This bill should include policies to save the lives of nursing home residents and nursing homeworkers. The bill should also guarantee access to Affordable Quality Health care. The bill should also recognize and pay the heroes on the front lines. I hope well pass this test that our National Challenges have presented to us and well also pass the bill that strives to achieve a measure of justice for our seniors in communities of color. Thank you. Thank you. Again, my thank tuesday all of our witnesses, to the Many Committee members who participated in todays hearing, and to our staff which worked so hard to bring these witnesses to us and to put this hearing together. Committee members have until friday, july 31st, to submit any additional questions for the record. Again, my thanks and this concludes our hearing. We are adjourned. Tonight on American History tv our series landmark cases. Produced in cooperation with the National Constitution center we explore the issues, people and places involved in some of the most Significant Supreme Court cases in our nations history. We begin at 8 00 eastern with katz v. United states, a case that expanded americans right to privacy under the Fourth Amendment and changed the way Law Enforcement officers conduct their investigations. And then at 9 35 brandonburg, v. Ohio, a case in which the Supreme Court overturned the hate speech conviction of an ohio ku klux klan leader. The court issued a decision up holding his right to Free Expression even if offensive. Watch landmark cases tonight on cspan 3 and any time at cspan. Org. American history tv on cspan 3 exploring the people and events that tell the american story every weekend. Coming up this weekend saturday at 8 00 p. M. Eastern on lectures in history we look back to 2012 and here from Phyllis Schlafly about the routes and developments of the modern conservative movement. And sunday four Police Training films from the 19 60s. At 6 00 p. M. Eastern on american artifacts a tour of the ellis island immigration museum. And at 7 00 p. M. Eastern historians talk about recent debates over removing historical monuments. Exploring the american story. Watch American History tv this weekend on cspan 3. Up next on cspan 3 a conversation with the British Ambassador to the United States about russias influence in