TICK Act

Mr. Chair, I have an amendment at the desk.

Mr. Chair, just a few weeks ago, I had a roundtable discussion with health professionals and those who are suffering from diabetes. I heard the stories of how much insulin costs and how difficult it was to be able to access healthcare, in many instances. This discussion was held at the University of Houston medical school.

The Jackson Lee amendment makes a good bill even better by providing $10 million more to help ensure that the national goals of finding and bringing

more and better treatments for diabetes is aided by an expanded pool of diverse and talented medical researchers and clinical trial participants.

Many racial health disparities, including diabetes, stem from a lack of access to quality healthcare and proper health awareness. Unfortunately, this means that the incidence of kidney disease has not always matched trial populations. African Americans represent 12 percent of the U.S. population but only 5 percent of clinical trial participants.

Hispanics make up 16 percent, but only 1 percent of clinical trial participants.

Sex distribution in cardiovascular device trials is 67 percent male.

Other significant barriers to diversified clinical trials, which are key to sound medical research and the foundation for medical cures and breakthroughs, as reported by investigators and coordinators, are insurance status, patient inconvenience, cost, availability of transportation, distance to the study site, and patient and family concerns about risk.

My amendment, in particular, focuses on ensuring the outreach for researchers and, as well, those who would be participants in clinical trials. Physicians are the gateway to the patient as well, and the lack of access to physicians also diminishes the rights or the ability for people to be in trials.

My amendment is intended to aid in the necessary effort to diversify the pool of doctors and medical researchers conducting clinical trials and, thereby, helping to diversify the participants in the clinical trials.

I would ask my colleagues to support this amendment.

Mr. Chairman, it is important to take note of this particular chart; proportion of volunteers in clinical research by race and ethnicity. And you will see, as it relates to minorities, at every step of the way, dealing with total U.S. population, only 33 percent participate. NIH-funded clinical research only 36 percent participate; and industry- funded clinical trials, a paltry 16.7 percent.

It indicates as well, and I include in the Record ``Clinical Trials Shed Light on Minority Health.''

[From FDA Consumer Health Information]

Clinical Trials Shed Light on Minority Health

The Food and Drug Administration (FDA) is working to

increase the participation of people in racial, ethnic and

other minority groups in the clinical trials that test new

medical products.

The Food and Drug Administration (FDA) is working to

increase the participation of people in racial, ethnic and

other minority groups in the clinical trials that test new

medical products.

Why is this important?

Ensuring meaningful representation of minorities in

clinical trials for regulated medical products is fundamental

to FDA's regulatory mission and public health, says Jonca

Bull, M.D., director of the agency's Office of Minority

Health (OMH). Racial and ethnic minorities include African

American, American Indian, Alaska Native, Asian American,

Hispanic American, Native Hawaiian and Pacific Islander

communities.

OMH project manager Christine Merenda, M.P.H., R.N.

explains that clinical trials are the proving ground for new

drugs, vaccines and devices. They provide the data that will

determine whether FDA approves a manufacturer's application

for marketing approval.

``Potential racial, ethnic and other differences in

response to drugs are important to FDA's efforts to help

ensure that the safety and effectiveness of drugs are studied

in all people who will use the products once they are

approved,'' she says.

Considering Genetic Differences

Bull explains that there are biological differences in how

people process drugs. For example, variations in genetic

coding can make a cancer treatment more toxic in one ethnic

group than it would be in another. These variations can make

also make drugs like antidepressants and blood-pressure

medications less effective in one group than another.

Getting more data on these differences is essential for FDA

to truly know that a medical product will truly work and be

safe for all patients, Bull says.

Members of minority groups may be more vulnerable to

certain diseases. ``We know, for example, that African-

Americans and Hispanics have higher rates of diabetes, HIV/

AIDS, obesity and cardiovascular disease,'' says Bull. Native

Americans and Asians have been shown to have higher rates of

hepatitis, while Hispanics are disproportionately affected by

diabetes.

But historically, both women and minorities have been

under-represented in clinical trails. For example, according

to a 2011 report from the conference ``Dialogues on

Diversifying Clinical Trails,'' sponsored by FDA's Office of

Women's Health and the Society for Women's Health Research

and supported by OMH:

African Americans represent 12% of the U.S.

population but only 5% of clinical trial participants;

Hispanics make up 16% of the population but only

1% of clinical trial participants; and

``Men make up more than two-thirds of the

participants in clinical tests of cardiovascular (heart and

blood vessel) devices?''

At the conference, more than 200 representatives from

government and industry came together with patient advocates

and the scientific community to discuss strategies for

increasing the participation of women and minorities in

clinical trials.

Why the Disparity?

Bull says there are different reasons why minorities have

been under-represented in clinical trials.

One reason may be a lack of trust because of past abuses,

Bull says. One notorious example was the Tuskegee Syphilis

Study, experiments conducted between 1932 and 1972 by the

U.S. Public Health Service. Health officials recruited poor

black share-croppers in Alabama to study the natural progress

of syphilis. However, while the study was in progress,

penicillin was discovered to treat syphilis. The study was

not stopped and the men were not treated with penicillin that

could have cured them.

According to a recent university study, however, this

attitude seems to be changing. The study was designed to

learn the health concerns and research perceptions among

under-represented groups. When asked about their over-all

interest in medical research, 91 percent of African-Americans

expressed interest in participating.

Nonetheless, recruiting people to participate in clinical

trials--no matter what race or ethnicity--is difficult in

general, Bull notes. FDA works to protect participants in

clinical trials and to ensure that people have reliable

information as they decide whether to join a clinical trial.

There are many benefits to minority participation for

researchers that extend, in larger sense, to society.

Minority participation helps researchers find better

treatments and better ways to fight such diseases as cancer,

diabetes, heart disease and HIV/ AIDS. In addition, it

uncovers differences by gender, race, and ethnicity that may

be important for safe and effective use of therapies.

Safeguards and Resources

Safeguards for clinical trial participants include

oversight by institutional review boards (IRBs), composed of

at least five members, including scientists, doctors, and lay

people. IRBs ensure that appropriate steps are taken to

protect the rights and welfare of participants as subjects of

research.

Though it's too soon to tell, Bull says that the FDA Safety

and Innovation Act (FDASIA) signed into law by President

Obama in July 2012 could have a helpful effect in supporting

efforts to enhance minority participation in clinical trials.

FDASIA requires that FDA report to Congress by July 9, 2013

on the diversity of participants in clinical trials and the

extent to which safety and effectiveness data based on such

factors as sex, age, race and ethnicity are included in

applications submitted to FDA.

Based on these findings, FDA and others involved in

clinical research will be able to identify needs and

opportunties to increase minority representation, says Bull.

In the meantime, Bull encourages consumers to take a more

proactive approach. If you're undergoing treatment and your

condition is not improving, she says, you may want to talk to

your health care professional about the availability of

clinical trials that address our condition.

FDA also has information at fda.gov (http://www.fda.gov)

with information about participating in clinical trials

(http://www.fda.gov/ForConsumers/ByAudience/ ForPatientAdvocates/ParticipatinginClinicalTrials/ default.htm) and links to an array of resources. And

clinicaltrails.gov (http://www.clinicaltrials.gov) is another

resource from the National Insitiutes of Health.

Mr. Chairman, the Food and Drug Administration is working to increase the participation of people in racial, ethnic, and other minority groups in the clinical trials that test new medical products.

So I would indicate that this particular amendment is to give greater focus to ensure that we have access to these individuals. Again, diabetes in minority communities is surging. The difficulty of getting access to insulin is also a conspicuous medical concern. But certain medical illnesses have been known to have a higher prevalence in certain demographic groups, including Type 2 diabetes, lupus, sickle cell anemia, and triple-negative breast cancer.

This particular amendment is, of course, helping to end, or to work on improving the access at this time.

Mr. Chairman, I yield 1 minute to the gentlewoman from Connecticut (Ms. DeLauro).

Mr. Chairman, I urge support of this amendment.

Mr. Chair, I wish to thank Chairman McGovern and Ranking Member Cole of the Rules Committee for making this Jackson Lee Amendment in order.

I thank Chairwoman DeLauro and Ranking Member Cole for their hard work in bringing Division A, the Labor-HHS portion of this omnibus appropriations legislative package, to the floor.

I thank them all for this opportunity to explain the Jackson Lee Amendment, which makes a good bill even better by providing $10 million more to help ensure that the national goals of finding and bringing more and better treatments for diabetes is aided by an expanding pool of diverse and talented medical researchers and clinical trial participants.

Many racial health disparities, including diabetes, stem from lack of access to quality healthcare and proper health awareness.

Unfortunately, this means that incidence of kidney disease does not always match trial populations.

For example, consider that:

1. African-Americans represent 12 percent of the U.S. population but only 5 percent of clinical trial participants.

2. Hispanics make up 16 percent of the population but only 1 percent of clinical trial participants.

3. Sex distribution in cardiovascular device trials is 67 percent male.

Other significant barriers to diversified clinical trials, which are the key to sound medical research and the foundation for medical cures and breakthroughs, as reported by investigators and coordinators are insurance status, patient inconvenience costs, availability of transportation, distance to the study site, and patient and family concerns about risk.

But the most significant barriers limiting clinical participation are race, age, and sex of participants:

1. Women and minority patients are more difficult to recruit.

2. Women and minority physicians have less experience and are relatively costlier to engage.

3. Minority patients with limited English proficiency can require costly translation services.

The first step in engaging women and minorities in clinical trials is finding them.

Research has shown that minority patients seek physicians of their own race, so bringing these doctors into trials is critical.

Physicians are the gateway to the patient.

There are disturbing statistics on the number of African Americans, Hispanics and Native Americans pursuing academic qualification and participating in scientific research.

Many barriers exist that account for the low rate of participation among diverse communities, including patient fear of experimentation and lack of understanding or education with regard to the importance of clinical trials in creating new treatments and cures.

The Jackson Lee Amendment is intended to aid in the necessary effort to diversify the pool of doctors and medical researchers conducting clinical trials, and thereby helping to diversify the participants in the clinical trials.

In short, the Jackson Lee Amendment seeks to open the ``physician gateway'' to the patient.

The Journal on STEM Education reported in 2011 that only 8.34 percent of the STEM doctorates awarded in 2006 were given to underrepresented minorities (URMs), despite making up approximately 28 percent of the U.S. population.

Additionally, GAO found that while the percentage of underrepresented minorities nationwide increased from 13 percent to 19 percent from 1994 to 2003, the total number of STEM doctorates awarded to the same group dropped during this period from 8,335 to 7,310.

In response, the National Institute of General Medical Sciences (NIGMS) created the Minority Opportunities in Research (MORE) Division and similar academic intervention programs.

The MORE programs are comprised of four primary components: research experience, mentoring and advisement, supplemental instruction and workshops, and financial support.

This includes the Minority Biomedical Research Support-Research Initiative for Scientific Enhancement (MBRS-RISE) program, the Minority Access to Research Careers (MARC), Post-baccalaureate Research Education Program (PREP), and the Bridges to the Baccalaureate and Bridges to the Ph.D. programs.

The amount of funds dedicated to these programs reflects the commitment by the science and research community to the goals of the MORE Division in addressing this problem.

Certain medical illnesses have been known to have higher prevalence in certain demographic groups, including type II diabetes, lupus, sickle cell anemia, and Triple Negative Breast Cancer for which African Americans are more than twice as likely to be diagnosed on average.

Race and ethnicity have also been shown to affect the effectiveness of and response to certain drugs, such as antihypertensive therapies in the treatment of hypertension in African Americans and anti-depressants in Hispanics.

Increased diversity in research trials could help researchers find better, more precise ways to fight diseases that disproportionately impact certain populations and may be important for the safe and effective use of new therapies.

But before we can engage more women and minorities to participate in clinical trials, we must be able to find them.

And the key to finding minority patients is find more physicians from their racial and ethnic groups because research has shown that physicians are the gateway to the patient.

The Jackson Lee Amendment opens that gateway.

I urge support for the Jackson Lee Amendment.

Mr. Chairman, I yield back the balance of my time.

Mr. Chairman, I have an amendment at the desk.

Mr. Chairman, let me take this opportunity to thank Congresswoman DeLauro and her leadership as the chairwoman of this subcommittee, and her ranking member, Mr. Cole. I had the privilege of appearing before them in making my request, and so I want to thank them for many of the requests. I don't want to be too celebratory and say all of my requests, but I am very pleased that the investment in healthcare, education, many of the issues that I was concerned about, are well-invested, and it will be the kind of announcements that I will be able to make in my district for the great needs that are needed.

My amendment is to emphasize the importance of a program that, when I went to graduations, I saw students wearing banners, if you will, that said the word ``TRIO;'' that they were graduating with the help of TRIO. They were going on to college with the help of TRIO. And I was very excited about

the opportunity of seeing, in living proof, the proud symbols of those who had had a greater opportunity.

My amendment makes, again, a good bill even better by providing $10 million more to help ensure that TRIO students at the greatest risk of not completing their degree program get additional assistance to finish their education. I was excited when these students walked across the stage going on to college with TRIO support.

TRIO is a set of seven federally-funded education opportunity outreach programs that help low-income, first-generation students, and students with disabilities, to pursue higher education.

There are many opportunities for individuals to go into the trades and other disciplines, but many want to go to college.

The Upward Bound Program, the first Federal TRIO Program, was created in 1964. Later, Talent Search was created. The TRIO name itself was born four years later, when the Higher Education Act of 1965 was amended to include Special Services for Disadvantaged Students.

So today, there are nine TRIO programs that I am excited about; and my emphasis is to ensure that these programs are well-funded.

Even in my own community, I can tell you that TRIO is well-needed and well-utilized.

Mr. Chairman, I ask my colleagues to support the Jackson Lee amendment.

Mr. Chairman, could you tell me how much time is remaining?

Mr. Chairman, I yield 1 minute to the distinguished gentlewoman from Connecticut (Ms. DeLauro).

Mr. Chairman, I am excited that, in 1986, we added the Ronald E. McNair Postbaccalaureate Achievement Program--we all remember him as a great astronaut who died in a horrific astronaut calamity--to foster doctoral degree attainment by students from underrepresented segments of society.

But, Mr. Chair, a young man went to the Upward Bound program at the historically Black Texas Southern University. He graduated from Sterling High School, but he grew up in extreme poverty, stricken with food insecurities and difficult living conditions.

Poverty is not only a state of being, but a state of mind.

However, with the help of TRIO, he went on to acquire life skills, strategies, and the support he needed to follow the dream of attending the University of Texas at San Antonio, majoring in Construction Science Management.

Not only did he graduate from UTSA, but he graduated with honors, and he plans to attend graduate school in the fall. He is one of many students that are impacted; and the more we focus on the at-risk students, the more America continues to ascend to her greatest level.

We helped Terrance, who is a 40-year-old student that began working on his GED at Houston Community College in 2005. He ultimately achieved it 5 years later.

My amendment, again, is to emphasize the doors of opportunity, from Ronald E. McNair, Student Support Services, Talent Search, the Training Program for Federal TRIO Programs, Upward Bound, Upward Bound Math and Science, and Veterans Upward Bound. It is encompassing of many aspects of young people and those returning to school.

I ask my colleagues to support the Jackson Lee amendment, which focuses on those at risk, and turns that at risk into success.

Mr. Chair, I wish to thank Chairman McGovern and Ranking Member Cole of the Rules Committee for making this Jackson Lee Amendment in order.

I thank Chairwoman DeLauro and Ranking Member Cole for their hard work in bringing Division A, the Labor-HHS portion of this omnibus appropriations legislative package, to the floor.

I thank them all for this opportunity to explain the Jackson Lee Amendment, which makes a good bill even better by providing $10 million more to help ensure that TRIO students at the greatest risk of not completing their degree program get additional assistance to finish their education.

TRIO is a set of seven federally-funded educational opportunity outreach programs that help low-income, first-generation students and students with disabilities to pursue higher education.

The Upward Bound Program, the first Federal TRIO Program, was created under the authority of the Economic Opportunity Act of 1964, as amended.

A year later, Talent Search was created as part of the Higher Education Act of 1965 to assist students applying for newly authorized federal financial aid for postsecondary education.

The TRIO name itself was born four years later when the Higher Education Act of 1965 was amended in 1968 to include the Special Services for Disadvantaged Students program--what is now called Student Support Services (SSS).

Since 1968, TRIO programs have been expanded to provide a wider range of services.

Today, nine TRIO programs are included under the TRIO umbrella, seven of which provide direct services to students.

The 1972 amendments to the Higher Education Act created Educational Opportunity Centers (EOCs) to help adults select a postsecondary education program and obtain financial aid.

Veterans Upward Bound (VUB) was also initiated in the 1972 as part of the Upward Bound program to serve returning Vietnam veterans.

Amendments in 1986 added the Ronald E. McNair Postbaccalaureate Achievement Program (McNair) to foster doctoral degree attainment by students from underrepresented segments of society.

In 1990 the Upward Bound Math and Science (UBMS) program was initiated as part of the Upward Bound program to address the need for specific instruction in the fields of mathematics and science.

TRIO also includes a training program for project directors and other staff of TRIO projects (Training Program for Federal TRIO Programs, which was authorized in 1976).

The TRIO programs are administered by the Student Service area of the Department's Office of Postsecondary Education.

TRIO includes: Educational Opportunity Centers; Ronald E. McNair Postbaccalaureate Achievement; Student Support Services; Talent Search; Training Program for Federal TRIO Programs Staff; Upward Bound; Upward Bound Math-Science; and Veterans Upward Bound.

Currently serving nearly 790,000 students across America, TRIO provides academic tutoring, personal counseling, mentoring, financial guidance, and other supports necessary for educational access and retention.

TRIO programs serve students from middle school and high school (Talent Search, Upward Bound, Upward Bound Math-Science) to college and postgraduate study (Student Support Services, Ronald E. McNair Postbaccalaureate Achievement).

TRIO also provides services to adult learners (Educational Opportunity Centers, Veterans Upward Bound).

Jackson Lee Amendment No. 15, adds $10 million in funding to assist students at the greatest risk of not completing their degree program.

TRIO students can include teens to older adults trying make a career move or complete a life goal of a GED or college degree.

I ask my colleagues to support this Jackson Lee Amendment.

LiTroy

TRIO/Upward Bound program at Texas Southern University

Story: Litroy Lambert graduated from Sterling High School in Houston Texas in 2014.

He grew up in extreme poverty stricken with food insecurities and difficult living conditions.

Poverty is not only a state of being it can too often become a state of mind where dreams fester and die.

However, with the help of the TRIO/Upward Bound program at Texas Southern University LiTroy was able to acquire the life skills, strategies and the support he needed to follow his dreams of attending the University of Texas at San Antonio (UTSA) majoring in Construction Science Management.

Not only did LiTroy attend UTSA, but he also graduated with honors and plans to attend graduate school in the fall.

LiTroy is one of many students whose lives have been dramatically changed by the efforts of TRIO/Upward Bound programming and staff.

Stories from Houston Community College's (HCC) TRIO Educational Opportunity Center:

Terrance, age 40

Terrance is a 40-year-old student that began working on his GED at Houston Community College in 2005.

Upon meeting Terrance in his GED class, he explained that he had been working on his GED off and on and was unsuccessful at completing his GED because of the cost of the exam and his inability to pass certain portions of the exam.

He is a father and has also worked odd jobs while attempting to complete his GED.

TRIO offered Terrance an alternative to the GED exam, the HiSet, which is an approved high school equivalency certification recognized by the Texas Education Agency.

In addition to offering him an alternative exam, HCC provided him with vouchers to cover the cost of the exam and within his first attempt of taking the HiSet exam, he successfully earned his high school equivalent certificate.

We assisted Terrance with applying for college and financial aid and he is currently enrolled at and set to begin college classes this fall to earn a Communications degree.

Stories from Houston Community College's TRIO Educational Opportunity Center.

Eric, age 44

Eric is a 44-year-old student that began working on his GED in 1995, stopped attending and then returned to complete his GED in 2017 when he was unable to receive a promotion on his job because he did not have a high school diploma.

After several attempts at the GED, Eric was unable to pass portions of the GED exam because of his work schedule that prevented him from attending class regularly.

Eric struggled with portions of the exam and TRIO offered him tutorial services and the alternative HiSet exam.

Eric successfully passed the HiSet exam and earned his High School Equivalent certificate.

TRIO also assisted Eric with applying for financial aid and college admissions.

Eric will begin working on his pre-nursing courses in the fall so that he can eventually apply to nursing school and receive a promotion at his job.

Christina, age 65

Christina is a 65-year-old disabled student that contacted TRIO because she had problems finding a program that would lead to a job.

She wants to get off disability and work in an office job so that she can take care of herself without the limited income that disability provides.

TRIO was able to advocate for Christina to get financial aid reinstated because she was on probation when she attended previously, due to the demands on her time because of having to care of her sick husband, who died when she was in school.

The TRIO Educational Opportunity Center was also able to connect her with free tuition that is offered by Houston Community College so that she can maximize her financial aid.

We assisted Christina with finding a program that will give her the technology/computer skills she needs that will lead to a job.

Christina is currently enrolled in summer classes and pursuing a degree in Business Technology.

Mr. Chairman, I yield back the balance of my time.

Mr. Chair, I rise to speak about the fiscal year 2020 appropriations bill for the Labor, Health and Human Services, Education, and Related Agencies.

To start, let me recognize the ranking member, Tom Cole, for his work on this bill. We have worked closely together over the years inasmuch as we have developed a mutual respect for one another. While we may have differences of opinions, we have the same values about the scope of these programs and whom they ought to be benefiting.

I want to say thank you to the ranking member of the full committee, Congresswoman Granger. I believe we have put together very strong and serious resources in the Labor-H bill.

I want to say a particular thank you to the chair of the full committee, Congresswoman Nita Lowey, for making the Labor-H bill a high priority.

The Labor-HHS-Education bill supports some of the Nation's most critical programs. They touch individuals and families throughout their lifespan, from Early Head Start to the Social Security Administration.

For 2020, the subcommittee is providing a total of $189.9 billion in discretionary funding. It is an increase of nearly $12 billion over last year's enacted levels.

Our mission has been to advance a positive agenda, to look at issues where programs have been starved, and to reflect the oversight we have been conducting. I believe we have done so.

To arrive at these figures, we hosted 12 hearings on the budget, predatory for-profit colleges, Federal student loan servicing, the unaccompanied children program, wage theft, and the administration's cost-increasing changes to the Affordable Care Act.

We collected nearly 15,000 requests from Members, and we fulfilled, in part or in whole, more than 90 percent of them.

With this input, we produced what I believe to be historic investments in working people, in students, in parents, in children, in families, and in our future.

We make a historic $4 billion increase over last year for early childhood programs: $2.4 billion for the childcare and development block grant, equal to 300,000 new slots for childcare; $1.5 billion for Head Start; and $100 million for preschool development grants.

We also increased funding for K-12 education by $3.4 billion, $1 billion more for title I, and $1 billion more for IDEA, State grants for special education. In post-secondary education, we make an additional investment of $928 million. We increase the maximum Pell grant award by $150.

In health, we make a net increase of $2 billion in the National Institutes of Health, enabling a 5 percent increase for all institutes and centers. We also increased the Centers for Disease Control and Prevention's budget by $938 million.

We held the first appropriations hearing on gun violence prevention research in 20 years. Experts told us that the CDC and the NIH can do and must do this research, so we provide $50 million for gun violence prevention research.

We are investing in women's health. That includes a $114 million increase for Title X. Title X provides annually more than 4 million low-income women and men with contraception counseling services and health screenings. These investments transform lives.

We know this President is highly invested in continuing what we call a tax on women's health. We know the power of the White House and that the President will reject a repeal of the Hyde amendment. That is why this bill maintains current law with regard to the Hyde amendment.

The Hyde amendment is a discriminatory policy that makes access to basic reproductive healthcare contingent on your income. That is simply wrong, and I oppose it, as do others. We will continue the long fight, and we will win that fight in the near term to ensure that women of color, low-income women, and all women are on equal footing with regard to reproductive rights.

Finally, we invest in working people whose pay does not keep up with their rising costs. They struggle to deal with healthcare, prescription drugs, and childcare.

We invest an additional $1.2 billion to help working people find good-paying jobs and to protect and empower them in the workplace. That includes $69 million more for at least 500 new investigators at the Wage and Hour Division to combat wage theft and to help working people receive their full pay.

I am also proud of the new initiatives we are introducing. We provide $150 million for community colleges and other 4-year institutions to train working people for in-demand industries. For too long, working people and middle-class families have been shortchanged, and we are moving ambitiously to make sure that we provide every individual with a better chance at a better life.

We are moving ambitiously to make sure that we provide every individual with a better chance at a better life because we believe that that is our obligation as Members of Congress.

Once again, I want to say thank you to the ranking member, Mr. Cole; to the chair, Mrs. Lowey; to the ranking member of the full committee, Ms. Granger; and to all the subcommittee members who worked so hard in putting this effort together.

And a thank you to the staff who have worked so hard: for the majority, Brad Allen, Jared Bass, Jennifer Cama, Robin Juliano, Jaclyn Kilroy, Laurie Mignone, Stephen Steigleder, and Philip Tizzani; and for the minority, Susan Ross and Kathryn Salmon.

Will the gentleman yield?

Mr. Chairman, the gentleman and I have had these conversations, and I appreciate being able to speak with him.

Mr. Chairman, I thank the gentleman from North Carolina (Mr. Hudson) for bringing attention to this critical issue. I proudly support increased access to Head Start for all children, which is why this bill provides an increase of $1.5 billion for this important program.

Mr. Chairman, let me commit to working with the gentleman and the agency to get to the bottom of this issue that has impacted the children in his district and prevented access to high-quality early childhood education.

Mr. Chairman, I claim time in opposition to the amendment.

Mr. Chair, I strongly oppose my colleague's amendment that would allow the Department of Health and Human Services to use funding in this bill to implement the Trump-Pence refusal of care rule.

Personal beliefs should never determine the type of healthcare an individual receives. However, the administration's rule would completely undermine patient protections by allowing hospitals, doctors, nurses, and other individuals and institutions to deny a patient standard medical care based on personal beliefs, not based on what is best for the patient.

Current law already provides protections for hospitals and healthcare workers to refuse to perform abortions, but the administration's rule would expand Federal law to allow certain individuals and entities to refuse care for any reason at all. That is why we added a provision to the Labor-HHS-Education bill to block this unacceptable rule.

Let's be clear: Freedom of religion is important. It is already protected by the First Amendment. However, this freedom does not give anyone the right to impose their religious beliefs on others, to hurt others, or to discriminate.

This rule has never been about religious liberty. It has been about discriminating, shaming, and denying individuals the healthcare they need.

Under this rule, we know women will be denied access to standard medical care. We know hospitals have refused to treat or refer an individual who needs an abortion.

Under this rule, we know a transgender individual can be denied medical care. For women in rural communities, small towns, or in an emergency situation, the hospital or pharmacy that says ``no'' means these women will not get the care they need.

In this bill, we have made investments to right these wrongs, yet this rule would completely undermine those efforts instead of addressing real areas of concern.

The Trump-Pence administration is completely obsessed with allowing institutions and providers the license to put their religious doctrine before an individual's health.

As stewards of taxpayer dollars, we cannot allow these dollars to be used to deny medical care because of religious beliefs, nor can we allow an individual to impose their religious beliefs on another individual. That could lead to tremendous harm, including deaths.

Mr. Chair, I strongly oppose this amendment, and I reserve the balance of my time.

Mr. Chair, may I inquire how much time is remaining?

Mr. Chair, I yield 1\1/2\ minutes to the gentlewoman from California (Ms. Lee), a member of the Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies.

Mr. Chair, I yield the balance of my time to the gentlewoman from Florida (Ms. Frankel).

Mr. Chair, I yield back the balance of my time.

Mr. Chair, I thank the gentleman for his amendment.

Researchers on the campuses of the National Institutes of Health conduct groundbreaking, lifesaving research on diseases and disorders that affect individuals and families across the Nation. These researchers need state-of-the-art facilities and equipment to conduct this research, which is why I was proud to provide an increase in funding for NIH facility maintenance and construction in fiscal year 2019 in the appropriations bill.

This year's bill maintains that level of support and allows NIH to make progress in reducing its backlog of facilities projects. I share the gentleman's concern about this issue. I look forward to working with him in the future to address NIH's facility construction and maintenance needs.

Mr. Chair, I claim the time in opposition.

Mr. Chair, this bill includes a provision prohibiting the implementation of the administration's damaging new rule for the Title X Family Planning program. It is often referred to as the domestic gag rule. The administration's domestic gag rule is an ideological assault on family planning services.

The Title X Family Planning program is the only Federal program that provides quality, affordable, comprehensive, preventive, and reproductive healthcare services in every single State. Title X clinics serve more than 4 million women and men each year at 4,000 health clinics across every State.

Over two-thirds of the patients who seek care at Title X clinics are in a household that is at or below the poverty level. Many of these patients are uninsured or underinsured.

To be clear, the Title X program does not provide funding for abortions, despite what the others may be saying. However, the proposed rule would make clinics that use non-Federal funding to provide abortions or even referrals for abortions ineligible for funding.

The proposed rule also eliminates the requirement that grantees provide nondirective pregnancy options counseling. That means grantees can simply refuse to offer complete and accurate information to patients.

The rule also allows grantees to refuse to give referrals to patients or even give misleading information to patients when they request a referral.

When patients can no longer rely on their healthcare provider to share full and accurate information with them or to refer them to other care when necessary or when they request it, then the provider-patient relationship has been broken.

We need to trust women. We need to respect women to make choices that are best for themselves and for their families, and we must support providers to offer medically accurate information to patients.

This bill's provision to block the domestic gag rule is critical to maintaining support for healthcare providers offering evidence-based preventive and reproductive healthcare across the country.

Mr. Chair, I urge my colleagues to oppose this amendment, and I reserve the balance of my time.

Mr. Chair, may I inquire as to how much time I have remaining.

Mr. Chair, I yield 1\1/2\ minutes to the gentlewoman from Florida (Ms. Frankel).

Mr. Chair, let me just repeat: Over two-thirds of the patients who seek care at Title X clinics are in a household that is at or below the poverty level. Many of these patients are uninsured and underinsured.

We are looking at the opportunity for healthcare screenings in 4,000 clinics around this country, which is what we want to do. That is not happening because of some ideological assault on family planning, again, someone's personal beliefs being foisted on millions of people around the country. That is not the job we came here to do.

Our job is to be able to have people get the kinds of services that they need, to be told where they can go to get those services, to make the referrals on healthcare that they need. This is not one's own personal view of what someone else's healthcare needs are.

Fundamentally, at the root of all of this is a distrust and a lack of respect for the decisions that women make on behalf of themselves and their families.

Let's trust women. They know what is good for themselves and their families, not 435 people who sit in this body who have their own personal religious beliefs.

Mr. Chair, I yield back the balance of my time.

Mr. Chair, I thank my friend for yielding. She is a loyal champion for her constituents, for the children who benefit from the high-quality early childhood education and services that Head Start offers, and for the business owners in her district.

We want to hold these facilities to high standards. The recompete process needs to be sensitive to the needs of the communities that rely on these services.

I promise to work closely with Representative Waters and ACF to conduct the proper oversight that this issue deserves.

Mr. Chairman, I claim the time in opposition, although I do not oppose the amendment.

I support this amendment, Mr. Chairman. I know the gentleman is a longtime supporter of increased funding for the CDC's Lyme disease program. I commend him for his continued efforts to address this issue, and I thank him for appearing before this subcommittee on Member Day to talk about the importance of this issue.

I have a particular interest in this effort as well as the Lyme disease was discovered in Lyme, Connecticut, so I know all about the illness.

The underlying bill does include a $1 million increase. It is a total funding level of $13 million for the CDC to intensify efforts to develop better diagnostics and to bolster critical prevention and surveillance networks, which are critically important as Lyme disease is being reported in every single State. This amendment would increase the program by an additional $1 million. And I do know from reviewing the amendments that are coming up in the next several hours that there, in fact, is another Lyme disease amendment.

So, Mr. Chairman, I urge my colleagues to vote ``yes'' on this amendment, and I yield back the balance of my time.

Mr. Chairman, I rise in support of this amendment. This is about protecting existing beryllium standards established by the Occupational Safety and Health Administration for construction and maritime workers.

Any effort to weaken or revoke the 2017 rule limiting exposure to beryllium would reflect the first time that OSHA has proposed to weaken a standard protecting workers against a known human carcinogen. It leaves construction and shipyard workers vulnerable to life-threatening beryllium-related diseases and increases their risk of developing lung cancer.

I appreciate that the amendment is drawing attention to the importance of strengthening--not weakening--worker health and safety standards. This is about saving people's lives.

Mr. Chairman, how can you be opposed and support bureaucracy versus saving people's lives?

I am so happy to support this amendment.

Mr. Chair, I rise in support of this amendment, which rejects the administration's plan to terminate the joint partnership between the Department of Agriculture and the Department of Labor that governs the operation of the Job Corps Civilian Conservation Centers.

The Trump administration wants to turn its back on disconnected and vulnerable youth, especially those who depend on Job Corps programs in rural communities. These centers give disadvantaged young people valuable, on-the-job experience and training, putting them on a path to a good job while learning about how to conserve and protect our natural resources.

As a matter of fact, of the top-performing 15 centers, 6 were Civilian Conservation Centers.

Mr. Chair, I urge my colleagues to vote in favor of this bipartisan amendment.

Mr. Chairman, I rise in support of this amendment.

African American adults are almost twice as likely to suffer from diabetes as White adults and are also more likely to suffer from serious complications, such as limb amputations.

I agree with the gentlewoman that increasing the representation of African Americans among biomedical researchers, as well as participants in clinical trials, is essential to addressing disparities in health outcomes for African Americans suffering from this disease.

I would tell the gentlewoman that I was part of a bipartisan effort in the early nineties where we changed the rules of the NIH, including minorities and women in clinical trials, but it would appear that we have more to do. And we have increased funding for research centers in minority institutions by $11 million to support the next generation of researchers and enhance the research infrastructure in minority-serving institutions.

I thank the gentlewoman for offering this amendment. I urge my colleagues to vote ``yes,'' and I look forward to working with her to see if we can turn this around.

Mr. Chairman, I rise in support of this amendment.

The TRIO programs provide student support services to students in helping them to pursue and to complete a college education. These students may be the first in their families to attend college or face other challenges. The student support services provided under the TRIO programs include tutoring, academic advice, financial aid counseling, college preparation, and so much more.

To help our most vulnerable youth access and succeed in college, the Labor-HHS bill increases funding for TRIO by $100 million, for a total of $1.16 billion. And I can tell you, there is bipartisan support for this effort because I know that Ranking Member Cole is a strong supporter of the TRIO program. He recognizes its ability to help youngsters be able to realize their dreams and their aspirations.

So I appreciate that the amendment is highlighting the importance of providing services to encourage individuals from disadvantaged backgrounds to enter, to complete college, and postgraduate education, and I am happy to support it.

Mr. Chair, I rise in support of this amendment.

The National Institute for Occupational Safety and Health, NIOSH, is leading the effort to track the link between the workplace exposures of firefighters and cancer. This registry will provide something that is a more complete, broader representation of our firefighters in our country compared to previous studies.

The underlying bill that we are considering includes an increase of $600,000 to the National Firefighter Registry, and this amendment would provide an additional increase of $900,000.

Mr. Chair, I thank the gentleman for offering this amendment to highlight the importance of the health of our firefighters, first responders who never say no. They were going up in the building on 9/11 while others were coming down in order to be able to survive, and so many lost their lives on that day.

Mr. Chair, I urge my colleagues to vote ``yes.''

Mr. Chair, I thank my colleague for yielding, and I rise in support of this amendment.

Sickle cell disease is a major public health concern. It affects an estimated 100,000 Americans, with a disproportionate effect on African Americans.

People living with sickle cell disease experience significant pain and life-threatening complications.

The Centers for Disease Control and Prevention is working to better identify affected individuals, to understand their health outcomes, and to evaluate strategies to prevent complications and factors that affect individuals living with sickle cell disease.

We may be close to a cure for sickle cell disease because of gene editing, making it all the more important for us to work with people who live day after day with sickle cell.

Mr. Chair, I commend the gentleman for raising attention about this important program, and I urge my colleagues to support this amendment.

Madam Chair, I claim the time in opposition, although I do not oppose the amendment.

Madam Chair, I rise in support of the amendment.

I share the gentleman's concerns about the potential health impacts of red tide and harmful algal blooms and recognize the opportunity for NIH research to contribute to the body of knowledge on this topic.

I would note that the underlying bill under consideration today provides an additional $1 million for the Centers for Disease Control and Prevention to expand its efforts related to surveillance and reporting of health concerns related to harmful algal blooms.

Madam Chair, I thank the gentleman for his amendment and urge my colleagues to vote ``yes,'' and I yield back the balance of my time.

Mr. Chair, I thank the gentleman very much for his amendment and for yielding.

Mr. Chair, in 2009, Nurse Cathy DeCarlo was ordered at Mt. Sinai Hospital in New York, to assist in the abortion of a 22-week-old unborn child.

Under threat of being fired, she said the hospital ordered her to assist in the ``bloody dismemberment of a baby,'' her words, ``and accounting for the body parts afterward,'' which must be done during these abortions.

She said this coercion caused her intense emotional pain and she has had ``nightmares about babies crying in the dark . . .'' ever since.

She appealed to the HHS Office for Civil Rights, but her pleas to enforce her civil rights fell on deaf ears.

No one, Mr. Chair, should ever be pressured or threatened or coerced to perform or facilitate in the killing of a baby.

Abortion is not healthcare.

HHS recently promulgated an essential new regulation to enforce 25 congressionally-enacted conscience laws and provisions to protect individuals, healthcare entities, and providers from discrimination.

H.R. 2740 stops this regulation by not allowing funds to be used to implement it.

Let me point out that HHS points out that the rule will robustly enforce investigations, supervising compliance, making enforcement referrals when necessary to Justice, and remediate

the effects of discrimination in coordination with other funding components in HHS, which may include withholding Federal funds as appropriate.

We need to be serious about conscience rights.

We cannot coerce and tell someone like Cathy DeCarlo or nurses in my State of New Jersey who are told, under condition of losing their jobs, they had to assist in abortions.

Abortion takes the life of a baby. It includes dismemberment and chemical poisoning.

And just think about this: my friends on the other side of the aisle just simply refuse to acknowledge that there is a baby. And that baby deserves respect and protection.

Mr. Chair, I urge my colleagues to vote for the Cole amendment.

Mr. Chair, I have an amendment at the desk.

Mr. Chair, Lyme disease is the most prevalent vector-borne disease in the United States today.

If not diagnosed and treated properly, Lyme can lead to disseminated infection that can affect every system in the body, including the central nervous system. Later symptoms of Lyme include neurological problems, memory loss, brain fog, and heart systems such as heart block and inflammation of the heart muscle.

Lyme has been reported in every State in the United States. My State, for example, has a particularly high incidence of new cases and old, about 50,000 new infections each year.

While grossly undercounted for decades, new scientific evidence shows that the number of new cases of Lyme is now estimated to be between 291,000 to 437,000. Remember, these are new cases of Lyme disease.

Since 1998, Mr. Chair, I have introduced comprehensive legislation on tick-borne diseases, including Lyme. At the core of it was the creation of a working group or a blue-ribbon commission to try to figure out what is going on and to have Lyme-literate participants because there has been a culture of denial about Lyme disease, particularly chronic Lyme, for decades.

With the support and strategic help of Republican Leader Kevin McCarthy, we succeeded in our goal and added the Tick-Borne Disease Working Group to the 21st Century Cures Act. I am thankful to Fred Upton, as well, for his leadership on this important initiative.

I would point out that that Working Group was dead over in the Senate, and again, it was Kevin McCarthy who said the 21st Century Cures Act doesn't come back unless that is in it. That made it happen.

The Working Group is charged with reviewing current research efforts and identifying the gaps in the study, education, prevention, and access to care for patients with Lyme and other tick-borne diseases.

In their inaugural report to Congress, the Working Group said, ``Americans need help, yet progress has been hampered by a lack of attention at the Federal level and by divisions within the field.'' I include the executive summary of the Working Group's report in the Record.

[Tick-Borne Disease Working Group, 2018 Report to Congress]

Executive Summary

Tick-Borne Diseases have rapidly become a serious and

growing threat to public health in the United States. Despite

many scientific unknowns, experts agree that the incidence

and distribution of tick-borne diseases are increasing. Over

the past 25 years, reports of Lyme disease have increased

steadily with estimated annual cases approximating 300,000

(Hinckley et al., 2014; Nelson et al., 2015 ). The number of

U.S. counties now considered to be of high incidence for Lyme

disease has increased by more than 300% in the Northeastern

states and by approximately 250% in the North-Central states.

The Centers for Disease Control and Prevention (CDC)

currently recognizes 18 tick-borne pathogens in the United

States. However, researchers and health care practitioners

continue to discover emerging disease agents and new medical

conditions associated with tick bites.

While most Lyme disease patients who are diagnosed and

treated early can fully recover, 10 to 20% of patients suffer

from persistent symptoms, which for some are chronic and

disabling. Studies indicate that Lyme disease costs

approximately $1.3 billion each year in direct medical costs

alone in the United States. A comprehensive understanding of

the full economic and societal cost remains unknown. It is

likely orders of magnitude higher and potentially a $50- to

$100-billion-dollar problem for the United States, although

more research is needed (Vanderhoof & Vanderhoof-Forschner,

1993; Zhang et al., 2006).

Prompt diagnosis and treatment of tick-borne diseases are

crucial to prevent long-term complications. Today, available

diagnostic tests can be inaccurate and complex to interpret,

especially during the earliest stage of infection when

treatment is most effective. Unlike in other infectious

disease settings, tests to directly measure the presence of

the infecting organism, such as cultures or tissue biopsies,

are not available for some tick-borne diseases such as Lyme

disease. This leaves physicians without the tools needed to

diagnose; and without an accurate diagnosis, it is

challenging for physicians to provide early treatment.

Persistent symptoms after treatment of Lyme disease can be

severe, yet their cause(s) remains unknown and debated. There

are currently no uniformly accepted or validated treatment

options for patients with these chronic symptoms. As a

result, uncertainty surrounding appropriate clinical care has

led to polarization within the medical community, and

patients are often left suffering in limbo without a clear

path to illness resolution or even symptom management (Rebman

et al., 2017). The lack of a clear path for treatment of

persistent symptoms in some patients with Lyme disease

and other tick-borne diseases not only amplifies patient

suffering but also significantly increases health care costs.

This report outlines an integrated, multipronged approach

to the growing public health challenges posed by tick-borne

diseases in the United States. It contains nine main

chapters, including Background; Methods; Epidemiology and

Ecology; Prevention; Diagnosis; Treatment; Access to Care,

Patient Outcomes; Looking Forward; and Conclusion. The

Background and Methods chapters explain how the report was

developed. The other chapters present the main challenges,

key issues, and recommendations specific to the broader

topics.

To understand tick-borne diseases, we need to first

understand tick ecology and how ticks transmit diseases. Due

to the lack of a coordinated national surveillance program,

currently there are significant gaps in information on local

distribution of infection-causing ticks, especially in

regions beyond the Northeast and Upper Midwest. Nationwide,

standardized approaches for tick, animal, and human

surveillance are needed to understand the geographic

distribution of infectious ticks in order to understand the

spread of disease and predict where people are at risk.

Advanced technologies and systematic studies are also needed

to rapidly identify new disease agents that pose emergent

risks to public health, including to the blood supply. Given

that seven new tick-borne pathogens have been shown to infect

people in the United States since 2004,this is a priority.

Effective prevention relies on multi-pronged strategies. To

reduce exposure to ticks, we need a comprehensive

understanding of the biological drivers behind the continued

spread of tick-borne diseases, so that effective tick- and

infection control methods can be identified and validated.

Need also exists for the transparent development of a safe,

effective human vaccine to prevent Lyme disease, the most

common of these illnesses. In the absence of effective

strategies for controlling ticks and blocking the

transmission of tick-borne pathogens, it is crucial to

educate health care leadership are needed to reverse the

alarming professionals and the public about tick-borne

disease prevention, especially best practices for protection

from tick bites. Outreach efforts to promote prevention and

raise awareness among physicians and the public must be

expanded at both the Federal and state level to ensure

accurate, effective, and consistent messaging.

Clinical research priorities must include the development

of new technologies and approaches to improve diagnosis of

tick-borne diseases and monitor response to treatment. There

is a critical need for sensitive and specific direct-pathogen

detection strategies that are broad enough to cover multiple

potential tickborne pathogens. Understanding the etiology and

pathogenesis of ongoing symptoms after initial treatment

should be a clinical research priority. Investigations are

also needed into the potential roles of immunologic

responses, bacterial persistence, and coinfecting pathogens

in order to design and test new therapies and, ultimately,

improve outcomes and care for patients with ongoing symptoms.

Americans need help, yet progress has been hampered by a

lack of attention at the Federal level and by divisions

within the field. The recommendations in this 2018 report of

the TickBorne Disease Working Group represent a longterm

investment in tackling the rise of tick-borne diseases in

this country. However, immediate changes are also required to

help patients already suffering from tick-borne diseases; to

protect them from discrimination; and to address the

inflexible, inconsistent, and often unaffordable care that

patients frequently encounter in the current health care

system.

Increaseed Federal funding, prioritzation, and leadership

are needed to reverse the alarming trends associated with

tick-borne diseases. Despite several decades of research,

prevention, and educational activities, Federal funding for

tick-borne diseases is less per new surveillance case than

that of other diseases. The U.S. National Institutes of

Health (NIH) and CDC spend $77,355 and $20,293, respectively,

per new surveillance case of HIV/AIDS, and $36,063 and

$11,459 per new case of hepatitis C virus, yet only $768 and

$302 for each new case of Lyme disease. Federal funding for

tick-borne diseases today is orders of magnitude lower,

compared to other public health threats, and it has failed to

increase as the problem has grown.

It is also essential that funding and resources be

allocated to support a comprehensive, interagency program to

address the mounting challenges identified in this report.

All research, prevention, and education initiatives should be

inclusive of special populations such as children, who suffer

disproportionately from tick-borne diseases. Patients whose

lives continue to be disrupted by the lasting effects of

these illnesses are counting on emerging scientific research,

evidence-based policy, and the health care establishment--

including the Federal Government with Congressional and

Executive leadership--to provide solutions. We must act now.'

Mr. Chair, much of what we have argued about for a quarter of a century has now been scientifically validated by the Working Group, including the fact that massive numbers of people are getting seriously ill from ticks and that the Federal response has been woefully inadequate.

Let me point out to my colleagues that this amendment very simply boosts the amount of money that CDC will have to spend. Again, it was the Working Group that pointed out that in terms of prevalence, the number of diseases that are charted, no other disease, no other disability gets less funding for CDC or for NIH. I would say that is because there has been such a culture of denial by certain organizations about the prevalence of Lyme over the years, and that has really prevented the necessary work from happening.

We are talking about, in 2017, $11 million for CDC and $28 million for the National Institutes of Health. That is a drop in the bucket for this infectious disease.

CDC has recognized that there are 18 tick-borne pathogens in the U.S., and researchers and healthcare practitioners continue to discover emerging agents.

The Working Group's report was able to underscore a fact many of us have believed to be true, and now it is further validated, that 10 to 20 percent of patients suffer from persistent symptoms, which are chronic and disabling--in other words, chronic Lyme.

The diagnostic tests--and this is, again, where the research dollars can make a difference--are also often inaccurate. The report points out that in about 50 percent or more of the cases, when people do blood tests they are told they don't have it. Those are false negatives. They do have it.

There are other tests that go deeper into the bands to discover this. It is very expensive. We need a world-class diagnostic tool.

Mr. Chair, I would point out to my colleagues that the disproportionate number of people who are infected--mal infected, to be more accurate--are children who are out in the backyard. This report points out that most people get Lyme in their own backyards. Of course, if people play sports, are hikers, or are out in the wilderness, they are also further at risk.

So this amendment increases CDC's funding it by $1 million for Lyme. It is a modest amount but a step in the right direction.

I have also introduced legislation with Collin Peterson, and I would ask my colleagues to take a look at it. It is called the TICK Act, H.R. 3073, and it would create a national strategy like we have done with Alzheimer's and like we have done with other diseases to bring the needed Federal resources to the fight against Lyme.

Mr. Chairman, I do ask Members to support the amendment and take a look at the TICK Act.

Mr. Chairman, I yield back the balance of my time.

Mr. Chair, I have an amendment at the desk.

Mr. Chair, our economy and our Nation's workforce are at a critical juncture. The introduction of new technology and easier flow of people and information from one location to another have transformed our economy and our workforce in ways that were unpredictable and have created both benefits and risks. We need to be careful, however, that we are not leaving Americans behind.

Several years ago, I worked with a number of colleagues to go across the country to ask researchers and have townhalls in communities, from California to New Jersey, what the effect on technology, in particular, and what the future of work wages in the labor movement would be as our work transforms.

One common theme that we heard over and over again across the country--whether it was California, Wisconsin, Michigan, New Jersey, or Massachusetts--was the impact that technology is having on jobs, both good and bad, and potentially having both enormous benefit and risk.

Technology can be a huge benefit to workers and communities alike, but it also has the potential to displace or eliminate jobs. California labor unions have an impressive past of partnering with industry to ensure that any disruption to the workforce, like technology, is done in coordination with and in consultation with workers.

One major problem we face when trying to assess whether automation will be good or bad for our workforce is a lack of data. This amendment simply encourages the Bureau of Labor Statistics to start collecting this important data on the impact that technology is having on our workforce. We can use this data to inform policymaking to fight for workers and the U.S. economy and create programs and policies that will support job creation, retention, and the continued growth to our economy, but for everyone to benefit.

Similarly, this amendment would allow for data collection on mass layoffs. We often hear arguments that blame major job losses on regulations, trade decisions, and other unsubstantiated claims.

With this data that we are asking for, we will be able to collect and be able to clearly and honestly evaluate the effects of mass layoffs and how we can avoid them, or at least how we can help the workers who are affected.

The common theme for this amendment is workforce protection. It is something we agree about on both sides, I believe. We want to create and promote good-paying jobs for Americans and protect those jobs that can be and should be protected.

U.S. workers deserve our best efforts to create policy that is in their best interest. This amendment would help give us the data to do just that, and at no extra cost.

Mr. Chairman, I yield 1 minute to the gentlewoman from California (Ms. Lee), my friend and colleague.

Mr. Chairman, I ask for the House's support. I think it has been said over and over again that information is power. In this instance, this gives us the power to protect and anticipate challenges to the American workforce.

Mr. Chairman, I respectfully ask for support for this amendment, and I yield back the balance of my time.

Mr. Chairman, I have an amendment at the desk.

Mr. Chairman, the bill before us today goes a long way to improving the health of our country. I thank the chairwoman for her leadership and dedication to the health and well-being of all Americans.

I am particularly pleased to see over $6 billion in funding for the National Cancer Institute. As we all know, probably too well, cancer affects all of us in some way. All of us have a family member, a friend, or a neighbor who has had to go through the challenge of being told they have cancer.

Nearly 1.8 million Americans will be diagnosed with cancer in 2019. With recent advancements, however, there has never been a better time in history to go through treatment if one has to be diagnosed with cancer.

New treatments with ever-greater outcomes are being developed constantly, many of them at NCI. The research done at NCI contributes to saving countless lives each year and helps keep millions more healthy, including myself as a cancer survivor of a form of leukemia that, while not curable, is manageable.

Because of the groundbreaking research done at and funded by NCI, by 2016 there were over 15.5 million cancer survivors in the United States alone. By 2026, this number will go over 20 million survivors. However, despite the high quality of care, many patients lack the information they need to understand their treatment and be full participants in their care.

As a cancer survivor, I am all too familiar with the uncertainty that follows the words, ``you have cancer.'' Doctors and health professionals start talking at you, using terms you have never heard, all of which matter, but little of which you understand. Research tells us that when someone is told, and family members are told that a family member has cancer, they only retain one in four words.

While more than two-thirds of patients surveyed are satisfied with the care they receive, the vast majority lack knowledge about treatment, options, and details. In fact, a recent study by NIH states that only 45 percent of patients reported being adequately informed about their diagnoses when told they have cancer by their physicians.

In a study in 2016, the Journal of Clinical Oncology stated that 38 percent of patients could never even remember talking with their doctor about life expectancy.

Cancer treatment is complicated, and I can tell you it is emotional for the people who are being treated, for their family, and for their loved ones. Yet 73 percent of patients do not search for additional information about their diagnoses. That is why it is so important that cancer care providers communicate clearly and often with patients and survivors.

This amendment will set aside $1 million for NCI to perform a study on how to use best practices to improve communications between cancer care providers and patients and survivors. When people have the information they need, they can more successfully navigate treatment and life as a survivor.

A cancer diagnosis will always come with uncertainty, but providers can and must do more to communicate clearly to help patients, their families and friends, and survivors to fully understand their diagnosis, their treatment, and their lifelong care expectations. It will allow patients to do what patients should do: fight cancer.

I thank the cosponsors of my amendment, Congressman Buddy Carter from Georgia, who is also the co-chair of the Cancer Survivors Caucus with myself, and Congressman Jamie Raskin, who is a member, for coauthoring this amendment.

Mr. Chairman, I yield 1 minute to the gentlewoman from California (Ms. Lee), my friend and my neighbor.

Mr. Chairman, I urge the passage of this amendment, and I yield back the balance of my time.

Mr. Chairman, I am grateful for the support in this bill for the Statewide Family Engagement Center Program, and I also thank the chair of this subcommittee for supporting the program.

This is an extremely valuable program that facilitates meaningful family engagement for States, school districts, schools, and parents to foster positive school environments and improved academic achievement.

Specifically, grantees are nonprofits that carry out parent education and provide comprehensive training and technical assistance to schools to support family-school partnerships.

Research is clear that the more involved families are in a student's education, the better the student performs. If a parent understands the value of the curriculum, develops relationships with teachers and administrators at their child's school, and feels involved in the local community as a result, the student reaps the benefits.

I was proud that a bipartisan provision I authored with Congressman G.T. Thompson led to the creation of Statewide Family Engagement Centers.

Unfortunately, due to an administrative oversight at the Department of Education, a $1 million shortfall for financial year 2019 has been created in this program. If it is not fixed, current grantees will have to cut their budgets by 9 percent.

This shortfall will mean the 11 centers will have to cut staff or reduce services. This will reduce the number of families, States, schools, and school districts that these centers can serve in the 12 States across the country that have grantees.

My amendment would make these deserving grantees whole and ensure that students and their families continue to receive the services they deserve to help students thrive in and out of school.

This amendment truly is an easy fix to an unintended problem created by a simple oversight. It is a commonsense amendment.

I thank my friend, Mr. Thompson, for working with us on this, and for his support for this amendment and the program.

Mr. Chairman, I urge my colleagues to support the amendment, and I reserve the balance of my time.

Mr. Chairman, I yield 1 minute to the gentlewoman from California (Ms. Lee).

Mr. Chair, I just want to thank my colleague from northern California, and I want to thank my colleague from Pennsylvania. It has been a pleasure working with them when I was in the minority, and it is a pleasure working with them in the majority.

This really should be nonpartisan, bipartisan. It creates a real vehicle to improve the quality of life for children and families and schools, and I would urge support for the amendment.

Mr. Chair, I yield back the balance of my time.

Mr. Chair, the bill before us today goes a long way toward improving the health of our country. I commend the distinguished chairwoman, once again, for her tireless leadership for the health and well-being of all Americans.

One particular area where increased investments have been made in this bill is mental health. I could not agree more on the importance of addressing this vital component to a person's well-being.

Mr. Chairman, at a time in our history where we are having transformative interventions and innovation in discoveries when it comes to mental health, we have a challenge to provide more infrastructure and more resources. I have been told that we have 75 percent more requests for services in behavioral health since the ACA was passed with parity in it, but a 25 percent decrease in the number of young people going into professions.

So we clearly need to do more when it comes to mental health, and there is no place better to do more than with young people, to get them involved in understanding that there isn't a stigma, that, like cancer, behavioral health and mental health should be addressed with evidence- based research, and if people seek that kind of treatment, they will be able to live full and successful lives and will get away from generations of stigma against people who have legitimate behavioral health issues that can be treated just as medical treatments can.

According to the National Alliance on Mental Illness, approximately one in five adults in the United States--almost 50 million Americans-- experience mental illness in a given year. Millions of children also suffer every year from traumatic experience and mental illness.

Mr. Chair, approximately one in five young people age 13 to 18--more than 21 percent--experience a severe mental disorder; 13 percent of children age 8 to 15 experience a severe mental disorder at some point in that timeframe; yet only about 50 percent of children with mental health conditions receive the services they need.

Children who get the treatment and support they need can learn to successfully control their symptoms, perform better in school, and have better social and emotional outcomes throughout their lives.

When children go without treatment and support, their symptoms can become harder to control as they grow older. In fact, adults who do not get proper treatment as children face an increased risk of having other chronic conditions and die, on average, 25 years earlier than others from preventable causes--25 years because they are not getting the treatment they need.

That is why it is so important that we address mental illness at a young age. Children and their families must know that it is okay to ask for help and should be taught where to look.

My amendment would improve access to mental health support for children in a school-based environment to meet students' needs onsite. This funding will help children who might not otherwise get mental healthcare get the support they need in a setting they know and trust.

NIH research shows that children promoted to the next grade increases by almost 13 percent and the average number of days children are suspended decreases significantly as children participate in mental health services offered at their schools.

Our teachers are already underpaid and overworked, and many teachers report that they are the first and only support children receive for their mental and behavioral health problems. By increasing services to students directly in schools, we can help reduce the mental healthcare crisis and decrease the stigma at the same time.

I urge passage of this amendment.

Mr. Chair, I yield 1 minute to the gentlewoman from California (Ms. Lee), my friend and colleague.

Mr. Chair, I would like to begin by expressing my appreciation, as I discuss the defense portion of this bill, to my ranking member, Mr. Calvert. He has made it easy to continue the collegiality, transparency, and bipartisanship that is a hallmark of the Defense Subcommittee. He is a wonderful partner.

I also do want to express my gratitude to Chairwoman Lowey, Ranking Member Granger, and the other members of the subcommittee and full committee for their efforts. I want to also thank the staff. This legislation would not be possible without their outstanding effort.

At this time, I would like to highlight some of the elements of this legislation that deal with the well-being and morale of those in uniform.

The bill provides a 3.1 percent pay raise for our women and men in uniform. This is the largest increase in basic pay since 2010. The report expresses, however, support for a 3.1 percent pay increase for DOD civilian employees as well.

We rely on DOD civilians to work side by side with military personnel. The administration's refusal to request an increase in pay for Federal employees devalues the important work done by these public servants. Congress must rectify this failure.

I believe that access to affordable and quality childcare is vital to retention for All-Volunteer Forces, particularly for mid-career personnel. Thousands of military children are waitlisted for childcare development centers, and I am disappointed that the services have failed to meaningfully address this serious problem. To get at the backlog, the bill provides an additional $70.7 million for upgrades to military childcare facilities.

The pervasiveness of sexual assault amongst servicemembers is deeply abhorrent. It is disheartening that the most recent report on this subject shows that sexual assaults across the U.S. military increased by a rate of 38 percent last year, with over two-thirds of assaults going unreported.

The bill provides $297.2 million for Sexual Assault Prevention and Response programs at the service level, $13.5 million above the fiscal year 2019-enacted level. It also provides an additional $35 million for the Special Victims Counsel and $3 million for the Sexual Trauma Response and Treatment pilot program.

The bill provides $1.26 billion for environmental restoration activities, which is $188 million above the current request.

There are also several actions taken in the bill that I believe are important to highlight as an appropriator and as a member of the legislative branch.

In recent years, the Department has viewed report language as suggestive and, on several occasions, has taken action in contravention of it or simply ignored congressional direction in the report. It is unacceptable, and it must stop. Report language is directive; it is not permissive.

I would also point out that the budget justifications should be complete in detail. In many instances, they continue to be lacking.

For example, there was a $72 million request to establish a Space Force, but the Department was unable to answer basic questions about the structure of the force, nor could they provide detailed long-term costs.

Another example would be the proposed reorganization of the Military Health System. In its 2020 request, the Department requested a significant amount of money for the reorganization and proposed major reductions in healthcare billets. Yet, it could not answer basic questions about how the reorganization would affect servicemembers and beneficiaries.

This legislation also takes steps to return to balance the relationship between the executive and legislative branches in response to the administration's unconstitutional use of dollars appropriated for the military to fund the construction of a wall on our southern border. If Congress appropriates funds for a designated and authorized purpose, it is not lawful for those funds to be used in contravention of the law.

In closing, I reiterate my thanks to Mr. Calvert and the members of our subcommittee, as well as our wonderful staff for their exceptional work, dedication, and long hours.

I look forward to the debate on our amendments.

Mr. Chair, I would like to begin by expressing appreciation to Ranking Member Calvert. He has made it easy to continue the collegiality, transparency, and bipartisanship that is the hallmark of the Defense Subcommittee.

I also would like to express my gratitude to Chairwoman Lowey, Ranking Member Granger, and the other Members of the Subcommittee for their efforts. And thank you to the Subcommittee staff, particularly the clerks, Becky Leggieri and Leslie Albright, as well as Walter Hearne, Brooke Boyer, Ariana Sarar, Jackie Ripke, David Bortnick, Matt Bower, Bill Adkins, Jennifer Chartrand, Hayden Milberg, Paul Kilbride, Shannon Richter, Sherry Young, Kyle McFarland, Johnnie Kaberle, Kiya Batmanglidj, and Jamie McCormick. I would also like to acknowledge the personal office staff, Joe DeVooght, Preston Rackauskas, Rebecca Keightley, and Christopher Romero. This legislation would not be possible without their outstanding effort.

The bill would provide $690.2 billion for the Department of Defense, which is $15.8 billion above the fiscal year 2019 enacted level and $8 billion below the request. The base funding recommendation is $622.1 billion, which is $15.6 billion above the fiscal year 2019 enacted level and $88.2 billion above the request. The overseas contingency operations recommendation is $68.1 billion, which is $165 million above the fiscal year 2019 enacted level and $96.2 billion below the request.

This bill supports the Department of Defense's effort to align its resources with the National Defense Strategy. This strategy redirects the Department's primary focus toward the challenges posed by great powers such as

China and Russia, and their efforts to counter and challenge the technological and operational superiority long enjoyed by the United States military. This technological overmatch can no longer be assumed, and this bill provides funding to develop and field new weapon systems and capabilities to address these new challenges. To support this forward-looking posture, the bill makes major investments in procurement and research and development.

Rather than focus my remarks on those investments, which have been detailed in several documents released by the Committee to the public, I am instead going to run through some of the efforts in this legislation that deal with the well-being and morale of those in uniform, their families, DoD civilians, and defense communities.

The bill provides a 3.1 percent pay raise for our women and men in uniform. This is the largest increase in basic pay since 2010 and maintains the Committee's commitment to ensuring our all-volunteer force is compensated for their sacrifices.

The report expresses support for a 3.1 percent pay increase for DoD civilian employees. We rely on DoD civilians to work side-by-side with military personnel to provide medical care for our troops, to perform vital logistics, maintenance, acquisition, and other essential services. The Administration's refusal to request an increase in pay for federal employees devalues the important work done by these public servants and I hope this Congress will ultimately rectify that in this year's appropriations measures.

I believe that access to affordable and quality childcare is vital to retention in the all-volunteer force, particularly for mid-career enlisted and officers. Thousands of military children, including over 9,000 whose parents serve in the Navy, are waitlisted for Childcare Development Centers. I am disappointed that with such demonstrated need the military services' requests for childcare facilities were relatively unchanged from prior years. To get at this backlog, the bill provides an additional $70. 7 million for upgrades to military childcare facilities, which is complementary to an effort included in the FY20 Military Construction Appropriation measure to accelerate the construction of new Childcare Development Centers.

The pervasiveness of sexual assault amongst service members is deeply abhorrent and it is disheartening that the most recent report on the subject shows that sexual assaults across the U.S. military increased by a rate of nearly 38 percent in 2018, with over two-thirds of assaults going unreported, The bill provides $297.2 million for Sexual Assault Prevention and Response programs at the Service level, $13.5 million above the FY19 enacted level and equal to the request. It also provides an additional $35 million for Special Victims Counsel for victims of sexual assault and $3 million for a Sexual Trauma Treatment Pilot Program for treatment of members of the Armed Forces for PTSD Related to Military Sexual Trauma.

The bill provides $1.26 billion for environmental restoration activities, which is $188 million above the request. This includes $13 million for a nationwide health study on the implications of PFOS/PFOA at former and current domestic military installations. Further, the report directs the Department to achieve a drinking water cleanup standard equal to or better than the EPA health advisory level for federally controlled sites and surrounding communities whose water sources were contaminated because of Department activities.

I believe these efforts and several others within the bill will have an immediate positive impact on people's quality of life.

There are also several actions taken in the bill that I believe are important to highlight as an Appropriator and a Member of the Legislative Branch.

In recent years, the Department has viewed report language as suggestive, and on several occasions has taken actions in direct contravention or simply ignored Congressional direction in the report. That is unacceptable and must stop. Report language is directive, not permissive.

For example, in FY19 the Committee Report expressed significant displeasure with the inadequate budget justification by the Department of Defense. There have been improvements in certain areas, but a number of major proposals put forth by the DoD in the FY20 budget were incredibly lacking in detail. For example, there was a $72 million request to establish a Space Force, but the Department was unable to answer basic questions about the structure of the force, nor could the detail long-term costs. Because of that uncertainty, the Committee only provides $15 million for Space Force.

Another example would be the proposed reorganization of the Military Health System. This reorganization was mandated in the 2017 Defense Authorization Act. In its FY20 request the Department requested a significant amount of money for the reorganization and proposed a major reduction in healthcare billets. Yet it could not answer basic questions about how the reorganization would affect service members and beneficiaries. Of particular concern to the Committee were impacts to pediatrics, maternity care, and mental health. The legislation halts the reorganization until those questions can be answered.

Further, this legislation takes several steps to return to balance the relationship between the Executive and Legislative Branch, in response to the Administration's unconstitutional use of dollars appropriated for the military to fund the construction of the wall on the southern border. The Constitution gives the Congress the power of the purse. And if Congress appropriates funds for a designated and authorized purpose, it is not lawful for those funds to be used in contravention of that direction.

Specifically, the bill reduces the amount of money the Department can move between accounts by 75 percent from the FY 2019 levels. This reduction leaves the Department with $1.5 billion in general transfer authority, which allows for the meeting of urgent and emergent military requirements. The legislation also increases the notification requirements and requires additional detail be provided to Congress in order for the Department to reprogram funding or start a new program. These are not actions that were taken lightly, but are absolutely necessary in order to allow Congress to carry out its Article I responsibilities.

Finally, I feel compelled to spend a moment discussing the issue that has been an albatross around this Committee's neck since August 2, 2011, the Budget Control Act (BCA). In past years, I have bemoaned the sheer lunacy of the BCA and how it has made this Committee's work that much more difficult. Unfortunately, that dynamic remains until Congress and the President come together and find a solution to the BCA caps for FY20 and FY21. I understand that this is not a simple matter. However, I fail to see the benefit from delaying the conversation any longer.

In closing, I would like to again reiterate my thanks to Members and staff that logged the long hard hours required to put this product together and I look forward to debate on the amendments.