immigrants from the 2020 census count and at the same time house armed services subcommittee holds a hearing on sexual harassment and retaliation issues at the fort hood military base in texas, live wednesday, c-span.org. >> up next the senate committee holds a hearing to examine the coronavirus and racial health disparities. we will hear how the virus disproportionately affect minority communities and what can be done to address those disparities and racism. this is 2 and a half hours. >> committee come to order. we are having some technical problems, there we go, thank you. before i begin my opening

statements, i want to acknowledge the loss over the weekend of congressman john lewis, a civil rights icon who changed history at great personal sacrifice. in 2015 i was honored to be among those who joined him in selma to commemorate the fiftieth anniversary of the blood sunday march which he led. i send my deepest condolences to his family and loved ones. today's hearing comes at a time when our nation is experiencing the confluence of a health crisis, economic depression and a series of killing is that laid bare the racial injustice that still paints the country. our focus is on covid-19's

disproportionate impact on black and latino seniors. as well as seniors from other racial and ethnic minority communities, black and latino residents are infected with a virus, nearly twice as likely to die from covid-19. the state of maine has the worst racial disparity in covid-19 cases in the country, also comprise less then 2% of maine's population, they account for approximately 23% of all cases, like many other states, many outbreaks have

occurred in nursing homes and congregate care settings. nationwide, 43% of black and latino workers are employed in the service or production jobs that for the most part cannot be done remotely. only one in four white employees hold such jobs. and that includes long-term care where that is according to the kaiser family foundation. at this committee's may hearing, doctor tamara recommended routine history of long-term care. a suggestion that was echoed at the senate health committee hearing last month with former cdc director julie gerberding describes long-term care

facilities as, quote, intrinsic hotspots and suggests we need to test often and test everyone who comes and goes. there is still a great deal we do not yet know about covid-19. with chronic kidney disease, obesity, sickle-cell disease and type ii diabetes are at increased risk of severe illness from covid-19 and black americans experience these conditions at disproportionate rates. diabetes provides a clear example. patients hospitalized, with 20% of individuals submitted to intensive care units.

according to the journal of clinical and root chronology -- endocrinology and metabolism. according to a survey by the centers for medicare and medicaid, although black medicare beneficiaries were as likely as white beneficiaries to perform diabetes self-management activities, they were less likely to have their blood sugar well-controlled. as the founder and cochair of the senate diabetes caucus i worked with my cochair senator jeanne shaheen on legislation to expand medicare diabetes sub management training as well as the pilot program to test the impact of virtual training services. we introduced legislation to create a special task force to eliminate medicare coverage

barriers and accessing the latest diabetes treatment. we have also worked hard for extension of the special diabetes programs that benefit native americans and children and adults with type i diabetes. another factor in the disproportionate impact of the virus on black americans appears to be a distrust of the healthcare system. a study from a california health system observed black patients were more likely to have been tested at a hospital than an ambulatory environment and patient's prior negative experiences with the healthcare system can lead to distrust and a decision to seek care only in the most extreme circumstances.

historical injustices with medical experimentation have also left a legacy of mistrust and skepticism among many african-americans we need to work to resolve. community partnerships and greater healthcare workforce diversity. blacks make up 30% of the us population, only 5% of physicians in the united states according to a recent report from the association of american medical colleges, we are so fortunate today to have such a distinguished panel of experts with us to help us better understand the challenges, and more important to identify meaningful solutions.

i will introduce our witnesses momentarily but let me turn to the committee's ranking member for his opening remarks. as i indicated he is joining us by webex. >> thank you very much for this hearing. as you noted as we begin this work. go we mourn the passing of representative john lewis. congressman lewis was a brave freedom rider, a giant in the civil rights movement who literally shed blood, we know he served in the united states house of representatives over 33 years. his life is a testament to the cause of justice. as members of congress in the wake of his passing we must ask

ourselves at least one major question. what must we do in the senate to fulfill our obligation to further the cause of justice especially as it relates to the challenges we face right now. our witnesses will help us answer that basic question. they will offer solutions amid the pandemic and for the future about health equity for older americans of color. older americans of color as the chairman outlined have spent a lifetime in during the structural inequities and racism that has plagued our country since its inception. we must own up to that simple and shameful truth and we must not only acknowledge these injustices but we are summoned by the example of john lewis to

take action to do something about it as he so often urged us to do throughout his life. what are those injustices? let me name a few but they are searing in their impact. the injustice of the lack of affordable housing based on data from 2015, 46% of black households than one third of their income on rent compared to 30% of white house holds. the injustice of food insecurity, black and hispanic households, twice as unlikely, twice as likely to struggle with food insecurity as white house holds. the injustice of the education gap according to the census 40% of white individuals have college degrees or higher compared to 26% of blacks and 18% of hispanics.

and the unemployment rate for americans, 15.4% compared to 10% for whites, a gap that is not unique. when we have been reminded so horrifically lately the injustice of police misconduct, black americans, it is no wonder that older adults of color are diagnosed with covid-19 at higher rates than whites and are dying, dying of covid-19 at higher rates than whites. the new york times reported on data for the centers for disease control - centers for disease control and prevention that black individuals are 3 times as likely to become infected with the virus and twice as likely to die, twice as likely to die. as whites was a gap that only

widens with age. the new york times analysis of nursing home data found facilities serving significant numbers of black or hispanic residents are twice as likely to have covid-19 infections even accounting for facility size, locations and quality rates. we have a chance right now in the next 3 weeks to address these injustices. and we hope to put ourselves on the road to correctly advance the cause of justice for communities of color all across america as we focus on older americans in this hearing. we have been told that the senate will consider additional legislation to respond to the

ongoing threat of covid-19. is what we need to do in the near term for the near term, the next couple weeks and months. we need a national testing strategy. we need funding for personal protective equipment. we need a specific plan to keep nursing home residents and workers safe and the dollars to make it work so we don't have another 56,000 americans dead in nursing homes. before we get an expansion of long-term services and support from the community, pandemic premium pay for heroes on the front lines helping to care for our aged loved ones, number 6, guarantee of access to quality affordable healthcare. all of these and more to protect older americans of color from the worst public health crisis in a century. the acts to be taken shortly

are not a substitute for enacting policies to address the injustices that have plagued communities of color for generations. taking action on these racial health disparities, a cause of justice demands of us in the united states senate. thank you again, chairman collins for convening the hearing. i look forward to hearing from our witnesses. >> thank you. our first witness is doctor dominic mack, director of the morehouse school of medicine national center for primary care, the nation's first congressionally sanctioned center to develop programs that strengthen the primary care system for health equity and sustainability. last month the us department of health and human services

announced a partnership with the school of medicine to fight covid-19 in racial and ethnic minority, rural and socially vulnerable communities. we look forward to learning more about this partnership and how this works will translate into better data and best practices to better serve seniors in those communities. our next witness will be doctor mercedes carnethon, professor of epidemiology and vice chair of the defense of preventive medicine at the feinberg school of medicine at northwestern university. her research focuses on the epidemiology of cardiovascular disease, obesity, diabetes,

lung health, and subgroups defined by race and ethnicity, geography, socioeconomic status, gender and sexual orientation and gender identity. i am going to turn from introducing the witnesses myself to calling on senator burr to introduce a witness from his state. thank you for joining us. >> thank you for holding this hearing today and to all of our witnesses, welcome. it is a distinct honor to introduce mister jean would from north carolina. in his current role mister woods is responsible for one of north carolina's major health systems that manages 14 million patient interactions encompassing 26 hospitals, 900

care locations and employs 70,000 people. he spent much of his career focused on the committee before today, decreasing healthcare disparities in providing high-quality care for all members of the communitys. he has gained 30 years of experience in healthcare administration, prior to that, the ceo of st. joseph's health system and held a leadership role in the hospital in washington serving as ceo washington center this morning. and a masters of health administration for a bachelors degree from the university of pennsylvania. thank you for the work you've done on tireless efforts during this pandemic. i look forward to hearing your perspective on coronavirus

response, what is next to stop the spread of covid-19? >> you have been a real leader in this area for many years and appreciate your being with us. i turn to senator casey to introduce our reports. >> i would like to introduce mister rodney jones from pittsburgh, pennsylvania, who serves as ceo of east liberty health center, prepares underserved populations in the area. mister jones will share the work the east liberty health center is doing, patients stay safe, and also discussed the threat the pandemic has to the overall health and well-being served by the health center.

stay at home orders and social distancing requirements caused many older adults, people with underlying health conditions to fear leaving their home for the care they need. mister jones has been working at various health centers and hospitals in pennsylvania and ohio for his entire professional life. thank you for testifying today -- >> thank you, senator casey. dominic mack, we will start with you. >> chairman collins, ranking member casey and members of the special committee of aging, thank you for convening. the testimony on behalf of one of four historically black medical schools in the nation. i bring greetings to you. i serve as professor of family

medicine at the national center for primary care for the innovative partnership for minority health entitled national covid-19 resiliency network mitigating the impact of covid-19 for vulnerable populations, the daunting news that black americans are disproportionately suffering is not a surprise to those of us. we serve on the front lines to serve the communities, health disparities and overall health stats. according to the centers for disease control and prevention as of late june, impacted by the coronavirus, with nonminority americans. in my state of georgia, 50% of coronavirus deaths throughout

the nation, seniors experienced disproportionate therapy across all racial and ethnic groups. a glaring lack of healthcare distraction in medically underserved community. to partner with omh, to address a disproportionate impact of covid-19 on communities of color. this will mitigate the impact of covid-19 on racial and ethnic minorities and other vulnerable populations related to covid-19, to engage local and state, to establish dissemination to disseminate culturally appropriate

messaging to use technology, and monitor and evaluate services and measure quality outcomes. states use broad and comprehensive dissemination from the lessons learned in communities. it is a significant step in the right direction. there is a great need in underserved community. the pope fundamental health needs specify what address the breadth of health disparities. without significant action, covid-19 will continue to impact vulnerable populations after the pandemic is gone. with your leadership we realize in equitable results for the crisis we are facing. we are calling on congress and

the administration for measures for legislation. the funding the disparity, short front of the historically black graduate institutions, with real and substantial financial shortfall. provide robust funding for improvement antigovernment of healthcare, and double funding for title vii health protection training programs for resources to increase diversity in the healthcare workforce. 4, invest $100 million, the research funding for national institute for minority health and health disparities specifically targeted at minority service institutions. we stand ready to work with you. to meaningfully address racial

ethnic health disparities in the united states. thank you for this opportunity and i am pleased to have any questions. >> our next witness is doctor carson - great. >> good morning, chairman collins, ranking member casey and other distinguished senators on the committee on aging. thank you for the opportunity to share observations and recommendations for disparities on covid-19 among older adults in my capacity as a research expert. the department of preventive medicine at northwestern university for feinberg school of medicine, study the risk factors for chronic disease for

the previous 18 years. my research which is funded by the national institutes of health and the american heart association and american lung association has described an earlier onset, more severe force of hypertension, diabetes, heart and lung disease among black, native americans and some asian subgroups compared with non-hispanic whites. in my personal experience, never met my maternal grandmother because when she was 63 years old she suffered a stroke followed by a fatal heart attack. i knew and loved my maternal grandmother, she did not know me for the last 10 years of her life because she battled dementia. the relevance of my story is vascular disease that affected by grandparents are the same that are associated with the worst outcomes of covid-19. early scientific reports from countries that preceded us in the pandemic described the

characteristics of individuals with covid-19 were more likely to be hospitalized and die. immediately we realize nonwhite minorities in the us are disproportionately affected. states and municipalities begin collecting demographics for those diagnosed by covid-19 racial and ethnic disparities emerge and for the most acute in the younger ages although these disparities are in community dwelling older adults, a greater proportion of black and latin residents double the rate of covid-19 infections, predominately non-hispanic white californians. against the backdrop of the pandemic i understand the urgency for the country to return to normal. in our research we describe the link between economic factors and health, a strong economy, stable housing, access to healthy foods and healthcare access to manage chronic conditions is likely to be a

greater benefit to elderly, vulnerable populations but we cannot return to normal by prioritizing the economy without offering strategies to get the attacks of covid-19. and first is to expand additional infrastructure and training available to older adults. .. with video capability, and ownership is similar by race and ethnicity. ssa building is one step but in my experience technology

requires trained to maximize these technologies. when a patient and provider can see one another patients can maximize the social connection with their providers and providers of more information in the form of visual to engage whether in person, or other home-based support are needed. second, the nih needs additional financial support to address the short and long-term manifestations. the majority of the $1 billion infusion of support to the nih through the cares act went to the niaid took silver studies of virus and vaccine development. we have learned on that time the sars coast to damage his multiple organs including the heart, , lungs, blood, kidneys d the brain. we know adults who are obese and diabetes have the worst outcome. and underrepresented minorities in older adults are overrepresented in those populations.

as additional financial support is considered other institutes need to be on equal footing would it comes to the allocation of resources. third and final minute engage the communities have been hardest hit by covid-19 as we develop strategies for prevention and treatment. progress is encouraging however the annual flu vaccine, nonwhite and ethnic minorities are less likely to get vaccinated than non-hispanic whites. without building rapport and trust in these committees there's no guarantee highest risk population would get the vaccine or that the even want the vaccine. thank you for allowing me the opportunity to offer the suggestions today and hope we can offer our most vulnerable older adults are very best sites and medical care. >> thank you very much. mr. woods. >> yes, good morning. senator brown, thank you for the current introduction and being afraid of atrium at a shipping for the communities we serve in

north carolina both rural and urban. chairman collins, ranking member casey and members of the senate special committee on aging i named his eugene woods and a presidency of atrium health. while i've had the privilege of meeting senator collins during my time as chair, it is an honor to represent my testimony on behalf of atrium health. as senator brown shared, headquartered in short north carolina, one of the largest non-for profit organizations information about the probe to serving our community for more than 80 years over the largest provider of medicaid for example, in north carolina and for the we provide more than $2 billion in community benefit and yearly to those that were privileged to serve. as i i reflect back on the past few months combating covid we've had to really rethink everything that we do in the health system. i remember the faces of my leadership team the first time we convene to recognize that dimensions of the skies,

resolute faces but if so proud of the team and up front can link it was keeping our patients and communities safe. our mission to care for all has never shined brighter. we realize the road ahead is long and as many challenges that remain. we can do 4000 covid test at atrium everyday because we are one of the few systems of the nation the special in-house lab equipment that can process our own testing. due to a national supply shortage and reagents were only doing one-fifth of our capacity. opportunities remain significantly expand testing supplies so we can care for more people especially elderly and we stand ready to be part of that solution. in many other ways with taken healthcare to a new impact level and accessibility that will outlast this pendant. safeguard covid virtual hospital for example, which has led us to

care for patients in the comfort of their own home while preserving critical capacity inside of our hospitals. today are virtual hospital has cared for more than 11,000 patients at home. i believe this this is a glimpf the future of healthcare. using technology to increase access including for the most vulnerable among us closest to where they live. as another example to help our minority communities we use analytical capabilities to pin point geographic hotspots where there were disparities in covid testing and treatment. partnering with local churches and community organizations we deployed our roving health units to the most vulnerable underserved areas. i'm proud to share in a matter of weeks we were able to completely eliminate any racial testing disparity that existed through the charlotte region. we continue to be deeply troubled by the statistic that even been mentioned and percentage of positive cases and deaths among our hispanic and african-american neighbors. we recently launched a

public-private partnership to collect and distribute 2 million face masks in north carolina. we have atrium parted with business of like bank of america, the carolina panthers, honeywell, lowe's and wells fargo and others including the health department, , at the bred to say in the past three weeks alone we have distributed nearly 500,000 masks to the elderly and when richmond is big business example of a health prevention professional work with business and endeavor help us open up our economy as safe as possible. we have focused on another very important vulnerable population, our seniors and especially those in nursing homes. atrium health was on the first in the nation to cohort elderly covid infective patients to a single designated site for advanced treatment and care with half of our patients, from other nursing homes who were not part of a larger system like ours

and, therefore, lacked the capacity to provide the support needed including with respect to infection prevention resources, respiratory care service nppd. and to date while the national mortality rate for covid in long-term facilities is nearly 40%, our skilled nursing facility has mortality rate of 8%. with regard to racial demographic mix, we care for more than 35% of minority patients with most being latinx. i would also like to acknowledge and thank senator casey for his leadership in helping secure more funding. that a step to save lives. whether through virtual technological hospital at home, roving or through our skilled nursing facilities, that a focus on the vulnerable elderly, i am especially proud we've worked tirelessly to care for the most vulnerable among us during these times. we can't do it alone and that is

why we appreciate forums like this they continue to explore real solutions. on behalf of atrium health, thank you for the opportunity to share our experiences and insights regarding how to mitigate the impact of this pandemic and one day hopefully soon look to eradicate. thank you. >> thank you very much, mr. woods. and i will now call on mr. jones. >> chairman collins, ranking member casey and members of the committee thank you for this opportunity to testify before you today. i am ceo of east liberty family health center center which is a federally qualified health center located in the east end of pittsburgh, pennsylvania. federally qualified health center us or fqhc argument health centers in which the mission is to enhance primary care services as underserved urban and rural communities. they provide services to all persons regardless of the ability to pay and charter

services on a sliding ski feel that is based on family size and income. they service a safety net for patients who are uninsured, underinsured and underserved. health centers are safely come inspect their newly 1400 across the country that approximate 120,000 services every site and underserved communities across the country. each of them health consider -- encompasses 69 zip codes it has has a population of over 11,000 patients which you'll approximate 40,000 -- of the patients we see come one through over the age of 50, 1300 are are over the age of 55, approximately 18% have no insurance, 57% are at a below 100% of poverty guidelines and 86% are at or below 200% of poverty guidelines. 35% are insured through medicaid. 13% have medicare. the remainder are insured

through managed care. 77% of the patients we treat our part of a racial or ethnic minority. 66% of the total population reserve are black, 10% latino or hispanic. our data shows half the patients we treat our over the age of 50 have hypertension, over 800 patients we treat in this age group have diabetes, and nearly 650 patients are overweight or obese. research shows underlying health conditions by conditions i mentioned are more prevalent and minorities due to social determinants of health which are conditions which people are born, grow, live, work and age. include such factors as socioeconomic status, education, neighborhood and physical and five, employment, social support and access to healthcare. the social determinants of health or medical conditions the

brink about our major factors contributing to the disport number of low income individuals of people of color testing positive and dying from covid-19's along with age. the virus has become a flashpoint on racial inequity come financial inequities and social determinants of health. covid-19 has exposed our healthcare system vulnerabilities and our inability to respond effectively to a pandemic. it is also highlighted the fact that low income older adults and older adults of color have suffered significantly greater proportion than the white counterpart. as a result of the pandemic, providers has seen a significant decrease in the patients who are receiving critical primary and preventive care as well as treatment for acute illnesses. in response to this concern we have initiate a comprehensive telehealth program. since march 2020, approximately 85% of all the patients that been treated through telehealth but we also started performing

covid-19 testing in march. in addition to the testing we use this as an opportunity to educate patients regarding the important of having a medical home and preventive care. cows of the aca, we have reached a large if i push including adults of color and deliver the care they need. as of july 2020 more than 780,000 individuals have covered for healthcare service because of medicaid expansion. pennsylvania's uninsured rate was 2.2% 2010, the 5.5% in 2018, the .5% in 2018, the lowest rate on record. medicaid expansion is a lifeline for people otherwise would not be able to access quality healthcare. it is critical that health centers continue to receive funding to continue to serve our patients. thank you for recognizing the role of health centers and making this investment. however, a strong public health system requires a strong

commitment of community health centers which include long-term stable funding for those community health centers, humid health centers will be critical in recovering from covid-19's pandemic or other 40 answering any questions from the committee about how to further the goals of health equity including older adults which is a major goal to achieve it everyday. thank you. >> thank you, mr. jones. we were now turn to questions i want to explain to those who are watching this hearing that we have many members who have joined us via webex, in addition to the members who are here physically. senator braun, nor blumenthal, barely if your name begins with be you, personally to the hearing. we will be recognizing members to ask the questions in order of

seniority. i will turn alternated between the majority and the minority. if a senator is not present or logged into webex when it is his or her turn to ask questions, then that person will go to the end of the queue and will go to the next person. senators will be given five minutes each on this first round. so i'm going to start with my questions. my first one is for dr. mack. dr. mack, i mentioned in my opening statement that name has the largest racial disparity in the nation in terms of covid-19 infections. many in our states black community are immigrants from somalia, congo and other african countries, as well as from haiti.

expanding our states over all testing capacity and reaching these individuals are critically important to staying ahead of this virus here and it's imperative that those who are most at risk for contracting the coronavirus are able to access training. i know that your school of medicine has been tapped by the u.s. department of health and human services to start collecting and presenting data that will lead to best practices for minority populations. my question for you is, are you taking a look at recent immigrant populations such as those in maine, as well as african americans or black americans who have lived in this country their entire lives?

>> thank you, thank you, chairme question. yes, we are. likewise, in georgia i think there was an article in one of the major publications earlier this week that the migrant population within georgia face series of first-inning tested and leaving hospital, those who could access door leaving hospital with these major bills. we are suffering some of those same issues among vulnerable populations outside of the african-american population. it's happening all across the country. for not only insurance is a barrier, education, training, and as you stated in your opening statement, this trust of the system. some of this mistrust plays on historical past of issues that's happen within these communities that have led to this mistrust.

so were looking at that. the importance of education, overcoming the statement of vaccinations. we know there's a lot of misinformation out there, and this has no boundaries. so yes, with all population. one part of the program, and i will end with this, is to make sure that everything is culturally and linguistically appropriate for the audience. a major part of the effort is to a focus groups but also community partners who have we call boots on the ground ability within those populations and within those communities to actually work with that population. people who live in the population by community health workers to actually understand the barriers to testing, take care, to vaccinations, et cetera. so we're looking at a diverse approach to diverse community.

>> thank you, and that's a great segue to my next question which i'm going to ask the remainder of the panel to respond to. we just heard dr. mack mention the importance of having culturally and acoustically appropriate services to reach people, particularly in immigrant communities. and this is particularly important for contact tracing. in maine, organizations serving our immigrant communities suggest that contact tracing will be most successful if it is accomplished in a culturally and linguistically appropriate way by people who are leaders of that community. and we talked with one such leader just last evening. how do we better activate

recruits and tap into the expertise of these community partners who may not have established relationships with traditional public health agencies so that we can better reach and target testing and follow-up services to these at-risk communities? and we will start with dr. carnethon. >> then need to engage communities is one of the recommendations that i highlighted in my statement, and the reasons for engaging communities are exactly what you described. it so that when it comes time for contact tracing, what a critical strategies to prevent the spread of covid-19, it so that we can use individuals on

that community who are trusted to go around asking questions. as you can imagine, in the current climate suggesting that someone from the government is calling to ask questions about where you have been, that can create a lot of anxiety and concern take her in immigrant communities. so that if we can actually find ways to build partnerships through our academic come between academic institution and community leaders, between our healthcare organizations and community leaders, we can bridge that gap and be able to reach people in order to promote prevention. and reaching people in their language is critical. one of the most challenging features of this is that we have got to try to build trust in an urgent situation where they very individuals who are experiencing the worst outcomes are the most

concerned about trust within healthcare system. so i think this can best be done through community partnership. >> thank you very much. my time has expired someone ask the other two witnesses to respond in writing with their suggestions, and call on senator casey. >> chairman collins, thanks very much. i wanted to start with the issue of health insurance, health coverage. we can't talk about the health disparities among seniors and communities of color without talking about health insurance coverage. we know from many services come when defending the commonwealth fund that indicate that quote the aca coverage expansion unquote has led to a stuart redactions in health disparities since 2013. 2013. just a couple of examples. the gap between black and white adults uninsured rates dropped by 4.1%. the difference between hispanic and white uninsured rates fell

by 9.4%, and third, black adults living in space that expanded medicaid report coverage rates and access to care as good as or better than what white adults experienced. unfortunately, the pandemic is wiping away some of these hard-won gains. with job loss that so many americans are experiencing right now, millions endings of people that have lost their job, wilson of that has impact on healthcare. 5.4 million americans have lost their health insurance just from february to may. on top of that we know the administration is not only opposed or supported by should say of the case in the supreme court to repeal them and i would argue distro, the affordable care act, but it just filed the administration did and 82 page

brief indicating support for repealing the aca. i think at a time like this that's unconscionable and i think -- there are more words used to describe it. i have two bills i think it's to this one is a bill that would automatically increase the matching dollars the federal government pays for health care states medicaid and it would match, it would connect i should say, those dollars to states unemployment level so that federal aid would be adjusted based upon the states economic condition and protect coverage. and it has wide support. mr. jones, i'll start with you not only because you're from pittsburgh but that certainly helps. and you explain, mr. jones, in your experience the work you have done in pittsburgh and in ohio, can you explain the role of medicaid and the affordable care act has played and ensuring

that people including older adults of color that the epic care that they need to ask that question number one, number two is, what would be the implications for communities of color if these programs were in jeopardy? >> first of all, thank you for the question, senator casey. medicaid is critical. before covid, 20% of pennsylvania pennsylvania received coverage through medicaid. however, that is not also benefit from medicaid. one in three children and our state also benefit, , two-thirds on nursing home residents in pennsylvania benefit from medicaid and two in five people with this will depend on medicaid in our state. i mentioned in my testimony that at my own organization, 57% of our patients are at or below 100% of poverty, poverty, and 86% of our patients are at or below 200% below poverty.

nearly every patient we treat, 77% of whom are people of color, is eligible for medicaid or subsidies to the marketplace to help with coverage. back during the recession are people lost their coverage to their employer. medicaid was -- that's reason we have it. in 2008-2009, what we saw been is going to be with little of what we see now if things don't change. i do not think it should take an act of congress to make sure that states can respond to the knee. i do not think state should be allowed to cut medicaid just when we need it. i would like to thank you for introducing legislation that would protect medicaid covers individuals and families and assure pensive and by extension to me health centers like east liberty family health center tentative resources to meet the need. as far as affordable care act is concerned, that expanded medicare, medicaid is given people the opportunity to seek

health care as a preventative measure, not when there's acute condition. people forget about the fact an ounce of prevention is worth a pound of cure and we don't focus as much of prevention as we should. the group of people that are overrepresented in this area are blacks and hispanics. expanded -- economic benefits individuals they cover society as a whole. what are the implications if this were to go away? you know, let me just say human lives matter. implications are human beings will not be able to get affordable health care and from a business perspective or economic perspective that's going to be a significant cost so the significant human cost and significant financial cost. thank you. >> thank you, chairman collins. >> thank you. senator burr. >> thank you, madam chair. this first question is for eugene woods.

your success in charlotte is in large part of your health systs relied on the data helping in real-time to direct the care provided both the patients into the broader charlotte community. what are some of the key metrics that provide early warning signs impact of the pandemic on minority populations in charlotte? >> thank you, senator for the question. we have come because of the nature of our organization whenever own internal site does in data specialists, and early on we are trying to make sense of where exactly this disease was growing. what we have, geospatial hotspot in analytics that allowed us to refocus on mostly the six zip codes in charlotte that we would find out had disproportionate incidence of covid and also we realized early on they didn't

have adequate testing. so to my opening statement, we in the matter of three days we saw that data because it's about action not just about data, we had to make roving bands. we went directly to those communities. to the earlier comments, the reason where we knew where to go is really working with the faith community and working with community leaders, we worked engage with hispanic community on initiative called -- for your help and so engage people in their community to help us with that. we were able, some of the data early on was a bit -- were targeted for all kinds of sources nation and we realized we have to do integrally. we refine our ability not just to pin point what committees need our care also this date was important to analyze our staffing needs, our ppe needs and so forth.

so this analytical capability also we provided to the public health department here in charlotte. so one of the recommendations we would have is theirs organizations like ours that have the capability and expertise to do this by ourselves. as many committees throughout the country that don't have that, so we would encourage an investment in public health with respect to analytical capabilities. as i said we were provided that versus the other way round but it is critical to be able to manage this going forward to have that type of capability to really respond to communities in need. >> thank you get my second question is to dr. carnethon. north carolina has been reporting facility level covid-xix data for nursing homes and other congregate living facilities throughout the whole coronavirus responses. what information or metric would be most useful for researchers to study the impact of the outbreak in nursing homes and

other congregate settings? >> thank you for that question. the burden of covid-19 in nursing homes emerged very early on as a significant problem that we are facing. as i described in my testimony, we know that nursing homes with higher proportion of black and latin ex-residents have higher death rates. however, there's not universal reporting of the race and ethnicity of those individuals within nursing homes who have been affected by covid. that person for significant challenge when it comes i to targeting resources in order to prevent the transmission of covid. because when covid-19 enters a nursing home it'sns because somebody has brought it in, i care provider, a loved one, and really what it's telling us that if the nursing homes are following the same safety procedures of restricting

visitors, of ensuring that providers have clean ppe every time they're coming in, and we should 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 covid-19. and so what we are seeing in the nursing homes is really a snapshot of what's going on in a community, and so we really need the data come out of the nursing home on who, on the sociodemographic characteristics of who wason contracting covid o stop these disparities. >> just to clarify it have the disparities in congregate setting outbreaks been similar or different from what you youe seeing in the broader population? >> that the spirits in congregate care settings are quite similar to what wee are seeing in the broader population. however, i will offer the caveat

thatti at older adult community dwelling, community dwelling older adults the disparities tend to be smaller than they are younger ages, and the disparities that we see a younger ages are likely due to a higher burden of the a early ont cardiovascular diseases, kidney diseases and diabetes. i the time with older adults living in communities, those rates tend to even out a little bit more. however, the intensity of the disparity is stillll significany higher in congregate care setting. two to five times higher for black latinx residence than for white congregate residents. >> thank you. thank you, madam chair. >> 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 couldn't

be more timely. like many of my colleagues over the last few weeks in connecticut i been to a number of demonstrations, peaceful and passionate, and more than 17 myself all across the state and i've been so inspired and depressed by the cries for justice, not only in policing but also in housing, education, healthcare, maternal mortality, addressing the disparities that exist in so many areas of healthcare. in connecticut blacken latin ex-residents are more than three times as likely to have tested positive for covid-19 as white people. and black residents are more than 2.5 times as likely to have

died from the disease as white people, latinx people more than 1.5 times as likely. just one last statistic, almost 60 60-30% of all our deaths from this insidious disease have occurred in nursing homes. so if you are older and you are black or latinx, , this disease has a target on your back. not one that you have created but when that is resulted from lack of proper healthcare, housing, maybe education. and that is a kind of injustice that this nation must overcome your so i think all of the witnesses forju your testimony, and i want to begin by asking dr.

carnethon, , you making in your testimony the lack of trust and rapport that must be overcome if vaccines are to be affected. what specifically would you recommend doing to overcome the lack of trustst and rapport? >> yes, there is a historic lack of trust in the health care system owing back to the days of the tuskegee experiment which assent aside most often. even more recently, there's evidence to suggest that nonwhite minorities are not receiving the same evidence-based care in certain settings as non-hispanic whites. evidence-based 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 community health 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. it's a month later, but we still have not voted on it. it's 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. i'm proud to represent over 1400 fqacs across 120,000 sites across the country. that's who we are and that's 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, there's 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. i'm uncertain whether tim scott has returned yet and it looks like he's been a bit delayed, so we'll 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 we're 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 don't call, they don't show. more often than not it's 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 it's not important if you don't have a way to put a roof over your head or to feed your family. the thing that has been important for seeing people in her health center that telehealth, telehealth has been significant in this way that we're trying to address, the disparities and healthcare. we are now able to see people in their own homes, we are able to the barriers that have been in place that would stop them from

seeking healthcare. so the funding not only provides ways to break down the berries associate with our soldier determines of health, allows us to break bite healthcare in an environment by which we were not able to do before. it also gives us a funding to get into your mobile vans and get out inab the community and provide the care thatbe we need. as i said before, let's not forget the fact that this pandemic has come at a said this, testimony, it's a flashpoint on health inequity and also the inequities of our overall healthcare systems, data needs to be a way that everyone has access to care. and again, thell funding will allow us to broaden our scope and to deepen our resources to provide security people get. >> thank you very much for that. let me pick up on that telehealth that you mentioned just out and that you also mention in your written testimony and about how vital that can be, telehealth can be to expanding healthcare access

during the pandemic, this pandemic, and in general. one of the things we know is many elderly low-income communities of color, rural communities have significant barriers to accessing telehealth. this is true to my own state will have a significant world population andte where all of those things are true. tell me about a bit about how you have addressed concerns related to technology access and what more you think we can do to improve that so we can approve this vital tool. >> sure. when i was young child i used to laugh because our doctor used to get a little black bag and walk up and down our street and see people in their home. we have a division in our organization called homebound outreach. we have nurses that we sent into the community and they see people who, fors whatever reaso, cannot come into her health center and also they are the eyes and ears of our providers. one of the things we have done

to those people that don't have the technology, we send sent te nurse into the home and we use that technology of our laptop to communicate with our providers in the office. we have, i know at our protective health center, and i know my peers in western pennsylvania, we have pride for funding so we can get technology into the home of the aged and the people where they where the opportunity to turn on a computer to be able to see what's going on. that's one half the battle because the technology is still a challenge. there needs to be staffing, community ambassadors. it would have to be medical people. they have the ability to get into the community and into the homes of people that need care. it could be a very expensive proposition. they are not the highest paid people and they can be the eyes and ears of providers to provide the care whichch again were doig that on a small scale out our health center that we b plan to expand about as we continue to identify the need.

>> thank you veryin much. thank you for the tremendous worker doing. thanks to the other witnesses for being here and i will have a few records for you in the record. >> senator warren. >> thank you very much, madam chair and thank you very much for putting together this hearing. seniors are bearinge the brunt f the covid-19 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 live have emerged as hotspots of infection and systemic racism has put seniors of color at even greater risk of catching and i from covid-19. we c are nowhere near controllig 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 create a national contact tracing program. we need to stabilize ourvi suppy chain and we need better data to ensure communities of color are getting the covid-19 resources that they need. let me start with you, mr. woodbury in your testimony to talk rachel atrium health developed covid-19 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 gina godfrey. judgment geography. what the data reveal how communities of color were experiencing the covid-19 pandemic? >> thank you for the question and for your leadership in this regard. i think quickly we realized some of what the testimony of some of the other panelists is the 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 this covid pandemic. i think what we are realizing is that it's years of lack of investment in poor communities, things were talked about,, affordable housing. we invested $10 million in affordable housing before this pandemic because we knew if you don't have one place and a warm home, you areli not going to be healthy. we have said about 10,000 kids to our kids eat free program because we realize if you don't have food, you can't be healthy. i think it's just magnified the social and economic and health care disparities that we've known for a long time and we've been fortunate to have been part of a coalition to help address that straight up. >> i appreciate your work in this and what i'm hearing you say is the demographic data you

collect it shows that communities of color face barriers and accessing covid-19 resources and then the responses. let me just follow up with that, mr. woods. it's one thing to detect disparities that is another to tackle them. did the data i live you to act to reduce racial inequity -- allow you? >> it did. as i mentioned, because we have the unique ability to run our own internal covid tests, we were able to launch very quickly when we saw this data in these six different zip codes in the charlotteco area, we were able o work with the churches, what with hispanic community and we said rather than you come to us, we have nine fixed testing sites, let us go to you, but we don't want to so we know where to go so please tell us where does so we were in church parking lots, ymca parking lots, and we also, it was mentioned earlier one thing i want to

focus on as much as anything, we've invested this past year $7 billion just on interpretive and language services. we know that for example, that's a really important part o of reachingi disk unity so it's not just taking therv data, going to wear the communities needs are, but making sure we have the language to be able to speak to people on their terms. >> right. so in other words, i collecting detailed demographic data, you could develop a a targeted data-driven response to covid-19 and send resources whether most needed and sent the appropriate kind to those places. from the outset of this pandemic the trump administration should've collected demographic data to guide its covid-19 response, but it didn't. so instead my colleagues and i spent months pushing hhs to publicly report race and ethnicity data. in the end we had to force hhs to issue a report on covid-19

racial disparities. still only 55% of cases reported to cdc to date include information on race and ethnicity. so let me ask it a different way, mr. woods. without up-to-date comprehensive demographic data about covid-19, do you believe 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, so we know exactly where test disparities are, where the incidence of covid, we have a map that a look at every single day in terms of how it is spreading. so from our experience without the data, without the real-time data it is really difficult to contain andnd hopefully illumine the covid. >> that's really important.

it's part of the reason why i am still fighting for comprehensive coronavirus data. just last week ranking member casey and i asked hhs to report demographic data on residence in workers in nursing homes to better track covid-19 infections and better track deaths among seniors. we need to put the public health impacts of systemic racism at the very heart of the cdc's work, and i'me working on legislation to do this. in this pandemic and beyond. if the trump administration doesn't start taking this virus seriously, tens of thousands more americans will die, and a disproportionate number of those seniors will be people of color. that outcome is unacceptable. congress mustdi act. thank you, madam chair. >> thank you. senator braun. >> thank you, madam chair. this is just another topic regarding healthcare.

i 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 what's wrong with our healthcare system before we got to this junction? and in my opinion, i'm going to ask the question of mr. woods and mr. jones, our issue with healthcare when it comes to access, covering pre-existing 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 the tapeworm on our economy, is the high cost of healthcare.

18-90% of our gdp in this country and, of course, it's nearly half that in 20-25 other countriese 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 try to provide transparency so you could see what things cost, whatever we decide to do here, whatever we can accomplish through the federal, to maybe look at disparities we still get back to the same old system. it'sre dysfunctional. it's runac increasingly by large corporations that have no interest in fixing the system. want to ask you this. transparency, president trump by the way has been the most aggressive individual in trying

to reform certain dysfunctional parts of our healthcare system. every time it occurs, it lands up ina the course because the industry takes him to court. we hear as senators i think tiptoe around the industry too often. what about basic reforms to actually not only address issues like we're talking about here, like transparency, what value would transparency give us, the hospitals recently took the president to court on a directive to where he wanted to make the charge master transparent. now it's been overturned by a judge, thank goodness were making headway. the question is directed to mr. woods. do youou believe transparency would be the tool to not only fixing healthcare in general but us better navigate through a disaster like a microorganism that's confronting us now? >> thank you, senator, for the question. i thinksm transparency is one of

the solutions, and we are like other health systems data provided charges online so i think that's one avenue. but i think fundamentally the issues that we deal with, at least in our communities, as a safety net providers, come back to some of the things that were looted too early. we are seeking a provider for the entire state of north carolina. we have seen more medicaid, more compensated than anyone else in the state. i think we still, there's lot of opportunities to continue to fix healthcare through the health system a lens but also we've got to come together toe deal with some of these was referred to earlier, some of the social determinants of health that are being magnified in this crisis. thefe lack of affordable housin, that's fundamental to dealing with the healthcare cost and crisis in this community.

ultimately, these patients are showing up in our facilities. i think it's a multifactorial equation that we have to solve, part of it, but there's lot of other pieces i think they need to be addressed. the one thing i would suggest is that these things can only be addressed through private-public partnerships such as the one i just mentioned earlier, for example, masking where we're big business and health systems working together and working together with the health department. i think it's a complex equation. the the president said healthcas complicated. certainly agree with them. transparency is one of many ways to help address the situation. >> imagine the debited we would get from saving that we could invest in some of the other things you are talking about. mr. jones, which are briefly comment on it as well quit my time is about but please tell me what you think. >> short. transparency is only part of it.

it under the broad umbrella of socioeconomic status. thismentioned before, pandemic has served as a flashpoint but the bigger picture is, we have to get fundamentally into the situation that why isn't there disparity and it all has to do with education, neighborhood, housing, social reported access to healthcare. but a broader picture is we need to take care of this pandemic. it needs to be a federal mobile 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. and again, it's about people not having equity and equality in accessing jobs, education and healthcare. >> thank you so much. >> thank you, senator. senator jones. >> thank you, madam chair, and thank you, ranking member casey, for holding this really important here.

this is especially i think significant in all of our states but i've been acutely aware of the problems in alabama. you know, mr. woods, i would like to follow-up with you initially about, senator casey made some comments about medicaid. you practice come here hospitals ii think about north carolina ad georgia, and like alabama the states did not expand medicaid. you are one of the largest providers of medicaid services. every study that i've seen has indicated that health outcomes are raised in states that expanded medicaid, but yet we still seem too have a great deal of political pushback on medicaid expansion. not only in our states but also in the congress. we've got billions ofn federal dollars we're putting into every state right now to 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. we made a lot of strides.

the commonwealth foundation indicated that black working age adults across the country have greatly benefited from medicaid expansion, and it was a huge proportion of those folks that reside in our states. so i would like to ask you about medicaid expansion and the benefit of the population that you serve, how will 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. a ..ac expand medicaid. >> thank you for the question, senator jones. you know, one really live example of what we're seeing especially during this video is one out of five americans have behavior health issues dealing with mental health issues, and we're 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. that's just one example that were we to have that coverage the other thing i would say as a safety net provider, if you look at, we never turn anyone away irrespective of ability to pay. right now we cover about two cents for every dollar of costs that we have for someone uninsured. medicaid expansion would probably increase that to 11, 12 cents. what do we do with the additional funding as we reinvest in the community through nursing facilities, outreach to minority communities, et cetera. so i think it's -- it's 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 that folks often forget as we focus so much on this virus right now, 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 virusment dr. mack, let me ask you a little about morehouse. since coming to the senate i've been a pretty strong advocate for hbcu's. we got additional fund for the first two years and then some permanent funding. in the cares package we had a billion dollars that went to hvcu and recently i've joined a letter with my colleagues senator harris and senator booker to encourage 6.5 billion dollars to hbcu's and graduate institutions like yours. if we could get a portion of that, how would that benefit colleges like morehouse?

how would you use additional fund in the middle of a pandemic, how would it help us get out and help the colleges that you serve? ments thank you, sir. as i started earlier, we're on the front lines with these communities not only from experien experience, what we're doing with the treatment and the push to get vaccinations. if we would have that additional funding, it could help us educate and train providers and md's who actually work within these underserved communities. at the morehouse school of medicine over 50% of our graduates actually work in the state of georgia. the state of georgia is mostly a rural place. so our graduates actually go into the underserved communities of multi-cultures and actually work in those communities.

so 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'd like to say the insurance around covid today, the lines are longer in those communities that are uninsured or underinsured. and also, the testing sites happen not to be in those underserved communities. so, it's really affecting us today when it comes to access to care so it can help us in many ways. >> all right, well, thank you all for being here with us today. thank you for the work you're doing in all of this. thank you, madam chair, for this hearing. thank you. thank you. senator tim scott. >> thank you, good morning, chairwoman and thank you for your hard work and dedication on the issues important to the

nation. frankly, you have been the leading voice in our congress and either the house or the senate so in our congress for issues around disparity and around taking care of people who simply need help. you have been the type of chair that looks only at americans, not at parties, not at color, but people in need. thank you for being that kind of chairman and i really appreciate your leadership. so let me just say that as we've looked at the numbers, 27% of the population happens to be black, 43% of fatalities are african-american and 30% of the diagnosis are. those numbers were alarming to me initially and as i looked around the country, i found that 14% of michiganders are african-american, but 41% of the mortality were black. so 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 start targeting our energy and focus on these health care outcomes and disparities, number one. number two, nih ap d-- and dr. collins and i frankly pushed our governor and health care in south carolina and seeing that they responded and we have pop-up sites for testing churches and schools and that's important. and one of the things i see as headwind, the new ground that we're making up -- and there's a whole lot of ground to make up -- when you look at the confidence within our communities, particularly the communities of color as relates to taking of vaccine. 25% of african-americans say

they're 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. >> it starts with trust and you don't start trust during a pandemic. the trust starts way before then, and i need to give a shoutout to sqhc. that's what we are and what we do. we're in the community and people trust us and people see us treated with dignity and respect whether they have insurance or don't have insurance. the way we can do that is identify agencies, organizations and churches that people trust. once we get the trust, these 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. we right now are working with--

through across nih initiatives, led by nihd, minority health and health disparities because we understand as dr. jones stated would have been ideal to start sooner however, we have to start now. we've got to get out here and build bridges. i think what is 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 we're having on minority communities. and so, what i'd really like to do with our messaging is really promote this partnership that we have to step up in order to help ourselves. >> well, let me just save this comment for another panelists. on the paycheck protection program, one of the things that i saw as a small business owners and the previous small

business owners was the importance of having a marketing mechanism into place and i went to the development agency, and i want to put $10 in the mbda so we have the type of marketing that reaches specifically into communities of color and targets the outcomes that we're looking for, which was higher utilization of the ppp. what i hear is i would say that i hear that the need for something similar, and if that is true, where is that similar organization? certainly the churches, i know hbcu's i've worked with them and to get further resources for them in the cares act. and we have record breaking dollars coming in the last three years. so, 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. we've got to recognize a part of the issue, after three million cases of covid and the deaths, we have a general in the country, 50% of people still don't want to get vaccinated. if you look at even during-- this sort of thing we have 47% population said we're not going to get a. you shot. the messages has to be and the levels, a strategy right now, a pr campaign, as you mentioned that touts the benefits of vaccination. i think that's layer one. and then, with respect to your suggestion, what we've done here, and in the communities we serve, we have partnered with media outlets to specifically focus on the community. there can be a national strategy, but there has to be a strategy with different insights into the particular

community. so, i think it's got to be a multi-factorial type of campaign, but it 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'd love to continue this conversation. yes, sir. >> if i could say one thing quickly, i think we have to stop funding the usual suspects all the time. we have to look at new organizations that have deep tentacles within the community and that's the initiative we're doing now. their organizations through the community, respect and leaders, i think we have to partner with those organizations as we've said earlier, and make sure that some of the resources, empower those organizations to do the work and be the lead for that work within the community. >> thank you, sir. i look forward to reaching out to some of the panelists if you all are interested in engaging

in this further when we're not limited to five minutes of questions and answers. and i read through your backgrounds and frankly, an incredibly impressive group of folks and i'd love to partner with those who are interested in doing so. thank you. >> thank you so 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 skt said for the impressive group of panelists who have spent so much of their lives in efforts on health care in so many areas, but particular will i this one. but 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 et disparities persist because of

longstanding equities, living and health and conditions. we see the manifestations of such disparities everywhere. from covid-19, from my home state, shows that latinos are dying at a higher rate than any other group in the region. in northern nevada the latino population has the most number of covid-19 cases even though they make up only a quarter of the counties' total population. we know too often inadequate care, and biases place racial minorities at greater complications for covid-19 and other diseases as well. so research also suggests that providers actions can be influenced by implicit biases that impacts the delivery of overall medical care. sometimes without medical providers even realizing it. i'm glad to see that the university of nevada's reno's

sanford center for aging is taking the steps to combat the impact of implicit racial bias by acquiring staff to training on the subject. they're taking steps to review both the internal policies and the economic program curriculum overall to ensure that they include economic, policy and social content that address the impact of racial disparate. to doctors mack and carethon. how can we best train our medical students, 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? and so let's start with dr. mack and then we can go to

doctor carethon, please. >> thank you, when we consider practice, we've focused on the importance of primary care in and the behavioral health component that it actually highlights within primary care and that's what we're talking about. there's a larger aspect to the training which should provide the sensitivity of the students to the total patient and the health care of the patient. we realize that only 20 to 25% of your health is contributed to health care. so it's very important that we take in consideration those socioeconomic determineants and that comes to putting that in

the curriculum, expressed and trained, whether it's in the ambulatory setting or it's in the hospital and some of that training means we have to train the trainer. educators have to be aware of the biases and while there, the student is shadowing them, they have to also make sure that they're addressing that. so, i think we have to make sure it's in the curriculum, it's taught on the ward, but also, that the academians including myself are aware and properly trained and the student is properly aware of those biases. >> thank you. doctor? >> thank you for this opportunity. these are discussions that we're actively having right now at our medical school about how best to incorporate these critical skills and the ways if which we teach our clinicians

to treat patients and how to interact with them. my experience in the educational field suggests that experien experiential learning is a way to cement the lessons out there. i think that 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 language that they may use that does seem to imply that the problem lies with the patient, consider the example of managing somebody with diabetes to say, you need to eat more fresh fruits and vegetables. to hear directly from a community member about mou difficult it is for them to access those fresh fruits and vegetables in the neighborhoods where they live may help to guide the ways in which they

hold conversations. so i think this content should be required and i think that experimental learning is an excellent technique in order to train medical providers how best to pay attention to these factors. >> well, thank you. i appreciate that. i do agree. 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 and thank you, senator collins. >> thank you. senator rick scott. >> well, first, he want to thank senator collins, and the ranking member for holding the hearing and thank the witnesses for being here today. this is unprecedented time in our country. one of my concerns has been all along that we don't have enough testing and i've also heard that health insurers are

limiting or denying coronavirus testing coverage for some of their enrollees which that's clearly unacceptable and dangerous. so, i have introduced a bill, the coronavirus testing act for every american, and it will be hard to get back to normal life if each can't get a test. we need to get something like that done to make sure that that happens. you talked about the how the business of our qualified health care centers have changed since the coronavirus started back in, really, i guess february, early march? >> absolutely. in a word, we went from seeing people in our health center to doing telehealth. in my own health center, we were seeing in the middle of march, we went to about 85% of the people we saw was through telehealth. as i mentioned in my statement, it was because we needed to

practice social distancing, we need to protect the patient. we need to protect our staff. so the best way for us to do that was to do it remotely. the other way that it changes, is that we have included the practice, testing every day. so, in addition to treating patients the way we normally do and incidentally, when a patient -- when a lot of patients come to our health center, often times they're coming way beyond the acute stage. it's not unusual for a typical patient to have three to five comorbidities. they come into the health center for high blood pressure and you find other things. that being said, in addition to doing that, we're doing our testing and trying to make sure that we get the test back in a reasonable amount of time and you look at contact tracing, you can figure something out. our whole model changed significantly. and when our staff is working, a lot is remotely. so, we've gone into a space that we're not comfortable with, but we've adapted very

quickly and amidst all of this, we have people that are afraid to come out of the house. we have people that are 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 down or-- >> they've gone down. okay. there was more in my presentation i had to take out because it's five minutes, but we haveway gone down approximately 33% on the medical side. the dental side is nonexistent. because of the c.d.c. guidelines, our dental team is doing testing. they're not seeing patients, only emergent cases and a little bit, and our volume has gone significantly. the ppp has enabled us to keep going and not lose the level of care that we've had, so without that funding, we would have had a very difficult time having a

viable organization to address this problem. >> thank you. and i'm getting the protective gear? >> we're fortunate in the western part of the state. we partner with various vendors. we collaborate as sqac in the western part. we haven't had a lot of difficulty getting ppe. we really haven't had difficulty getting the testing. our difficulty has come in getting the results. in some cases taking seven to 10 days, so we're working feverishly trying to get the tests, we can get the results a lot quicker to communicate to people so they'll know what to do to protect themselves. you haven't had access to the-- any of the rapid tests that-- >> it's interesting. i just received an e-mail this morning from my supply department saying we're going to be getting the tests in like the next week. so prior to this, we did not

have available to us, no. >> all right, well, thank you for what you do. you know, we have a lot of great qualified health care centers in florida and i know they're a safety net for a lot of communities. so thank you for what you do. mr. woodford, can you talk about how you're doing with regard to getting protective equipment and gear and how you're doing with regard to testing at your facilities? >> thank you for your question, senator. you know, back in march, because we were looking at-- we cancel all of our electives. we did it before there was any requirement to do so, so actually we took that time to reinforce our ppe. for the most part, we're in wooder situation we were in months ago. with isolated challenges, you know, we have a predominantly female work force. we need more small n95 masks.

there are some comply items we have months of supply for, but we make sure we have testing on. we have the special lab equipment so we can run our own tests and we could probably do four times the amount of tests and have close to the same day turnaround. the challenge is reagents. so some of the-- and still, in some respects, swabs. so, i think, we really need to continue to be beef up the supplies of reagents so we can expedite the testing. that would be our request and the other thing, there's been some conversation on testing, a national registry and how that testing and those reagents are to distribute the hot spots. so i think that's something that we're having some conversation about opportunities to do that as well. >> we this will pass, right? and what do we do differently in the standpoint making sure you have, whether it's, you know, the issues you're dealing with now, the protective, you

know, equipment, the reagents, the swabs, what are you going to do different in the future to make sure you don't have the same problem again? >> yeah, well, we certainly are significantly expanded our sources of supplies. a lot of times you're buying in bulk to get saving, organizations like ours, do you that and you get a lot of savings, but we realized we need a diversified supply line and we have vendors we not have had. and it would have been several months, but to some extent, to a year or beyond. so we've invested probably 45 million or so just to make sure we have stock pyles of ppe and these are things we've been focused on. >> is your elective surgery coming back? >> it is. probably right now it's at 85%. in some of the elective

surgeries, they're pretty much pre-covid levels. we're seeing them on the nursery and that concerns us because a lot of people are in their homes, there's a lot of studies, as you know, that people are having heart attacks at home and they are an avoid are coming into the emergency room. we focus on our campaign, our covid safe campaign, we call it, we're sharing what we do to keep people safe. the other thing, we're 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, we take that data in rapid cycle improvements to make sure that people feel more comfortable. right now we'll see what happens in the fall when influenza comes and how the trend continue then, but right now, our focus, our main concern is emergency room. >> well, thank you for being here and thank you for what you're doing and taking care of

patients and thank you, chairman collins for putting this together. >> thank you. senator mcsally. >> thank you, chairwoman collins. thanks to all of you for your expertise during this very unprecedented time. i first want to echo, a co-sponsor of rick scott's bill focused on testing and ensuring that people can get protesting in this once in a century pandemic. that insurance companies are not, and that this is not a financial bir den. hopefully we can agree about and that will get passed. and it shouldn't be a barrier for people getting tested. i want to talk about the impact of the coronavirus on native american communities. you've all mentioned underlying health conditions, such as diabetes. we know as one of the strongest risk factors for covid-19. we also know that diabetes is far more prevalent in minority

communities and we have 22 native american tribes in arizona, they have a greater chance of having type ii diabetes than any other population. in fact, in arizona, the gila river indian community has the highest rate of type ii diabetes in the world. so we've established, congress has established the special diabetes program for indians, sbpi, for diabetes prevention and treatment services, through the grant program, travel communities have been able to develop diabetes programs and access to quality diabetic care. while this is popular and effective, it's suffered from short-term reauthorizations and stagnant funding which is why i introduced legislation along with my colleague in arizona, senator sinema. for an additional five years and increase funding to $200 million per year.

dr. carnethon, can you talk about the importance of maintaining, focus and treatment for underlying conditions like diabetes and the importance of programs? >> absolutely, thank you so much for bringing up this important point. pre covid, i spent my time on this, and these adverse health outcomes from covid-19 exposure. one thing that's not going to happen. covid is not going to magically go away. we are going to be living with covid for a long period of time and there's no indication that the problems are less problematic for people who are exposed to covid. using that rational, we need to continue to support research that prevents the development

of chronic diseases, such as diabetes, hypertension, chronic kidney disease, heart disease, that are predisposing to worse outcomes. we need to provide strategies for managing those conditions. in my testimony i mentioned 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 for better yet, a video call with their physician to make sure that they are managing their chronic condition, it's going to be critical throughout this and protect them from developing the worst outcomes. and the work that you've done for these resources, particularly in native communities that are suffering mightily definitely needs to continue. >> thanks, doctor. that brings on a follow-up for me. i have legislation also with senator doug jones on this

committee about medical monitoring especially for rural communities. it's not just the telehealth, it's monitoring, if you have glucose man toring and things like that, you can do that instead of long distances. how is the monitoring as well as the telehealth? >> i think the medical modeling is critical. you bring this up at a time when we're trying to adapt to enable youtube devices so we can have these regularly to physicians. glucose monitors for clinicians so we could monitor. it's 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. and, but you know in addition to making the technology available, if you build it they will come isn't enough. we need to leverage people who

can go out and teach our older adults and adults to use it, and a number of zoom explanation with my family members and i know that people need help with these technologies and even how to set them up. this is critical in making sure we can keep the population as healthy as possible. >> thanks. madam chair, before i forget, the navajo nation has an impact statement for navajo elders in particular. i'd like to submit that for the record. >> without objection, thank you. >> and the growing hispanic population, 70 years or older, latinos receive home base family care givers compared to 25% of nonhurricane irma whites and ethic differences with regard to the carry for those

who need to receive care, and they're more likely to receive help from the adult children. the idea of health children, especially for the lippe population, you're taking time off from your job to care for your loved ones. that includes livelihood and support for your own family. so dr. mack, can you talk about issues with caregivers specifically and what other measures could caregivers make to the elderly? >> yes, thank you. minority caregivers tend to, of course, have less resources, as you know. unemployment is usually higher in those communities, less time to take off work. and often times, the kids are

engaged and sometimes the kids are actually missing school. so, i think this goes into more resources to not only care for the population in a preventative manner to make sure they don't get sick, but also to those with telehealth, et cetera. and also to the social programs to help support families, whether it's around meals or caregivers. as you know, today if you're elderly and your ability to actually go into the nursing home. i have people in my family that harems disease. people had to retire earlier and looking for resources because the insurance does not -- we have no way to put them in a personal care home. and i think, again, we've talked about those social determinants that the health care system itself can't take care of everything. we have to put resources and

barriers of pre vens outside of the balls of the facility to support the palm list from not only health care services, but also, social services, the key is to be educated. and we call it the homework gap is the telehealth gap. those who can't get to homework especially did youring this time they're going to fall behind. and education is an indicator of health. >> thank you. thank you, madam chair, for having the hearing. >> thank you, senator sinema. >> thank you, madam chair and ranking member and thank our witnesses for joining us today for this critical coronavirus hearing. arizona is currently experiencing one of the worst outbreaks in the nation and those in high risk great news we think would become severely ill.

and many people of color with the virus and arizona is home to many groups of high risk, seniors and our hispanic and latino communities. it's clear that policy makers must address the disparities that exist if we are to battle the pandemic. my first question is for. dr. mack, but i welcome each's thoughts. dr. mack, i looked at calling for new infrastructure. many native americans are at risk from covid and other illnesses, in part because some of the communities don't have access to running water. and navajo nation at one point had the high eest numbers of kroeps in the country ap nearly one in 10 have tested positive

for the virus. the health care challenge exists in other jumped served communities as well. could you elaborate how a lack of basics services like running water and resources can impact health during a pandemic particularly seniors. >> thank you, this is what happens outside of walls of the health facility. that's a significant impact to health and that's why prevention is so important and resources, and prevention, into the homes of the native americans and underserved populationings. how much can we save if we provided that water, provided that food, if we provided quitab quitable living for those communities. that in and of itself and education and those things,

improves the health of the population. it's been proven. it's been studied. so that is an extension of the health system. that's what the health system is called upon to do. so to your point, it's not only testing, it's very important to do testing, but you know, the uninsured and those who are on medicaid are standing in longer lines. they're sleeping overnight to get tested and then the 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 this conversation around addressing the social determinants of the health as opposed to waiting for people to get sick before we start to take care. >> thank you. any other members of the panel would like to respond? >> senator, what i would have,

also because in many of the native communities, access to basic health care services is also a big challenge and having to travel. i think it speaks to investing in fund well community this pandemic so we can reach the communities with respect to having the right care givers into the communities sometimes travelling for basic care. that's another part of the solution to help those in need in many of these communities. >> thank you, my next question is for you, mr. woods. your testimony mentioned different strategies to break down barriers and amongst our community. one was to ensure culturally relevant information and access to language interpretation services. i can see it would be not om help for information, but help

or senior services have the latest coronavirus here the. >> and that's why i had a priority from my office translated into spanish and to more people. when it comes to our aging population, how important is it to provide crohn's information and services that are both relevant to a high risk population. and second, how can cultural help to ballot isolation in seniors when they're unable to see family and friends due to the pandemic. >> yeah, it's absolutely tension. one of the things you mentioned, we're finding out-- i'm half spanish and half african-american, what we're finding out, it's a problem sometimes to translate from english to spanish. so really when we're writing our pr and our rubble ser visions communications and

speaking, we're really doing it in the native language. that's one i think i would just add. the other thing, if your glass or where there are appropriate services has been a requirement for 10 yearsment only 10 states that provide medicaid support for that. medicare does not. we've invested $7 million this past years on translation and interpretive services and when we've gone out to these minority communities, with testing, it was important to have on our mobile van people that can speak the language. people are sometimes more comfortable with people who speak like them and this is a fundamental way of addressing this. providing funding, medicare and medicaid funding for interpreters and translators could go a long way, not just

feeling with the pandemic, but some things that are brought up thaws it's not in vulnerable communities. >> yes. thank you, mr. chairman. >> thank you. >> madam chairman, i'm sorry. [laughter] >> sorry. >> thank you, senator. we are about to start some votes, but i'm hopeful that the ranking member and i can ask just a couple of more quick questions before we adjourn the hearing and my first one is for mr. woods. i have had many health care providers in maine tell me they're very concerned that the delayed and deferred health care screenings and elective procedures, which while they're called elective, are so necessary, will produce downstream where people will

have increased cancers, hard disease, strokes, undiagnosed diabetes, as a result of the delay of health care during this pandemic. and it's 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 shut down the veterans affairs hospital in manhattan for six months, veterans had words like blood pressure control compared to those whose access was uninterrupted. for those already struggling with inquitable access to

health care in general, how can we ensure that the actions taken to defer routine health care don't create a second health care crisis downstream? >> senator, thanks for that question and that really is keeping many of the people in my seat awake at night. i mean, the lockdown, for example, that we had in different areas had a large impact on routine screening, mammographies, colonoscopies. >> there was a story of a patient who needed surgery, put it off for four months and just that the pain that she experienced until she was able to get it in and taken care of. i think it's a really corp. concerned. and some is showing confidence and we're doing everything to

keep a patient safe when they come into our facilities. we're testing staff. we're giving ppe to the patient as they come in, we're temperature checking and doing all things. cleaning in between rooms that are taking two and three times longer than it should do. but it's a same with the community we're doing everything we can to keep them safe and i think there's an opportunity for policy makers and some conversations we've had today in testing and contact tracing, to give a measure of confidence to the community that we're also doing everything we can to keep them safe. so, we share that concern every day, we see the manifestations of delayed care. as you select it, as it indicated at one time it might haven about called elective because quickly to urgent and then to emergent. we're reaching out. if you think you have elective

care needs we will help guide you. it's the sense of competence that it's important for the community that we are doing everything to keep themselves and their loved ones safe. >> thank you so much. my final question is for dr. carnethon. it's for clinical trials, making clinical trials more inclusive for women and minority groups has been an issue that senator warren and i worked on and became part of the 21st century act. we know that many older black americans are reticent to participate, given past medical exploitations such as the misappropriation of cancer cells belonging to henrietta lax, for example. so my question to you, doctor, what recommendations do you

have to help ensure that clinical trials are more representative of those who face the highest risk of covid-19? >> thank you so much for pointing out that significant challenge that we face when it comes to making sure that the fair piece that we developed worked for everybody. there are cases throughout history where we were shown that not including women in clinical trials left us with a gap in understanding about the biological mechanism of action of a given drug. i think we're 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 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 at that putting forth spaces that the community trusts, faith based that dr. jones mentioned, qualified health centers as well as hbcu's with trust. ap finally seeing the investigators behind this worse. we have a diverse biomedical work force. it's not as diverse as we'd like to have, but there are key individuals out there who represent the very communities that are hardest hit. i think putting these individuals at the forefront,

messaging the science, will help our goal of achieving therapies that work for all. >> thank you so much. senator casey. >> thank you, chairman collins, just a quick question for dr. carnetho carnethon. >> i know you had a question and then we'll wrap up. on as we've referred to the death in long-term care settings, 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 the services. i want to explain how the additional medicaid dollars for the home and community based, the message would be critical for older adults? >> yeah, i really appreciate na. actually the efforts on behalf

of shoring up the financial resources or these home and community-based workers. because as you point out, keeping seniors in their homes can be safer providing them with communities to receive the care that they need and maintain their independence is critical. i think there are two key issues here, one is the need to protect the homes 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 don't have those protections so their incentive to be conservative about symptoms is lowered when if they don't go to work, they

don't get the care that they need. so, i think, you know, those are critical ways in which money can be used to protect 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 appreciated that each of you focus so much on recommendations, on practical solutions that we can pursue in order to lessen the disparate, the racial disparity and the covid infections and also in general in our health care system. this week, overall death toll in the united states from covid-19 now stands at more

than 140,000 deaths, well more than 3.7 million have been infected. nearly one in three black americans knows someone personally who has died from the coronavirus, for exceeding their white counterparts. as 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 as to the governor. we faced many of the same court challenges and risk factors that are present throughout the country. how to drive down covid infections among 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, due to transportation, or housing arrangements. and those who may have the cultural or linguistic barriers, particularly among our immigrant population. i particularly appreciate the suggestions for how to ensure that federal dollars committed to prevent or mitigate covid actually reach all members of our communities as we intend. support for translation and interpreter services, direct engagement of trusted community partners, telehealth services which we've 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 that have become so evident during the covid pandemic. senator casey, i'd like to turn to you for any closing remarks. >> chairman collins, thank you for this important hearing and i want to thank, of course, our witnesses for their testimony and the ideas they gave us for solutions. we know that over the next several weeks, the senate will negotiate legislation to provide health, a measure of health to tens of millions of americans who are suffering from the covid-19 disease and the jobs crisis. this legislation is an opportunity to advance the cause 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 home workers. the bill should also guarantee access to quality affordable health care. the bill should also recognize and pay the heroes on the front lines. i hope that we'll pass this test that our national challenges have presented to us, and that we'll 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 thanks to all of our witnesses, to the many committee members who participated in to today's 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. [inaudible conversations]

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