conditions covered under this act. could you share with us what those cancers, what types of cancers these were? are? dr. howard: yes. currently covered in the program are every type of cancer, is the short way to approach this every type of cancer except uterine cancer. mr. burgess: are there those that are -- if you were to pick the top three malignancies, what would those be? dr. howard: i think if you looked at our 4,000 or so cases right now, probably the top ones would be thyroid cancer, there are five common cancers that americans get, skin being the one, that's our top cancer there's breast cancer, that's also a top cancer for us there's colon cancer, which is a top cancer for us, thyroid cancer is another cancer for us,

but we've seen a lot of very common cancers like that and we've also seen some very rare type cancers and oftentimes, from an epidemiological basis that can be interesting, about the rare cancers. mr. burgess: sure. and that speaks to the value of having people with the expertise in treating the injuries encountered because an uncommon cancer can be a difficult diagnosis at which to arrive. dr. howard: exactly. and if this were distributed we would not -- this if this group were distributed, it would be hard to find those rare cancers if the patients were not seen in our clinical centers and rather they were seeing their own personal physicians throughout the united states. it would be very difficult to do

that. mr. burgess: it provides a focus that otherwise would not be available. just a brief comment on the observed versus the expected cancer rates of the population that you're following, is this number, i guess i calculate it to be 6% based on the number of patients you're following and the cancers you reported, how does that stack up to the general population? dr. howard: that comparison i'm afraid we can't do at this time. that would be something we would have to wait and see what our researchers would come up with in giving us that kind of number. we're now looking at, and the fire department of new york city is doing some research using as a reference population to compare our world trade centers firefighters to another cohort established by the institute of firefighters not involved in

world trade center so we hope that line of research could answer your question someday. mr. burgess: it would give a better control if you age match for people in similar occupations. dr. howard: yes, sir. mr. burgess: switching gears a little bit you mentioned you're trying to aid not just individual members but help grow the body of evidence and the body of information. so that you can help in other situations. are you going to be able to provide feed fwook -- feedback to municipalities and boroughs as to the type of workers compensation coverage that may be provided to members of the fire fighting community or the type of health insurance that's provided? some of the shortcomings you mentioned were within the workers compensation system. are there lessons you have learned that can be extrapolated to other communities? dr. howard: certainly.

i think new york state itself, its legislator and governor have responded to this issue by providing a mechanism by which responders, survivors, can sign up to a program, they don't have to actually make a claim but they can register and then if they should develop a condition later on that their claim would not be beyond the statute of limitations. so other states have also looked at that and we hope that people will learn, especially from these long duration disasters. mr. burgess: thank you and i yield back. mr. pitts: the chair thanks the gentleman, and yields to ms. schakowsky, five minutes for questions. ms. schakowsky: thank you and i would like to thank the survivors, for the first responders and survivors, i'm sure in addition to some health conditions that may be more

visible, that the trauma of the incident and the loss of friends, co-workers, family is something that lingers on forever, really. in illinois, dr. howard, there are 13 first responders and between one and nine survivor the way the data is capped between one and nine, enrolled in world trade center health program. clearly there's no concentration of those individuals in any kind of program of nationwide providers. so i imagine there's physicians that have one or two, etc. so how do you maintain that, the cohesiveness of that network? dr. howard: i think that's a very good question. i think there's a couple of ways that we do this. first of all, our nationwide provider network is headed by very capable physician who is a

part of our new york-based centers, new york and new jersey-based centers of clinical excellence. so he participates in all of our meetings and is a great educator and teacher for the ka dray of physicians that do monitoring and evaluation of that population, as you point out, a physician may have only one or two. those physicians themselves are occupationally trained so they have the same kind of training to be able to connect exposure and health conditions as similarly situated physicians at our clinical centers. as i mentioned, we're also trying to, we are pleased that medscape is helping us put

together constant training, so to speak, 24-7, you can go to their website and get information about the latest findings from the program that may influence your practice. so even though we have a distribution network and even those physicians in the nationwide provider program may have one or two patients they're see, we want them to be a similarly -- to be similarly situated knowledge wise as the rest of our physicians. ms. schakowsky: thank you. so my understanding of the, data there are a total of 70,000 people enrolled in the program and it says that more than 30,000 responders and survivors have at least one world trade center related health condition. so there are some people in the program, i gather, that are more than -- that are simply, not simply, but that are being monitored? is that the difference in number? dr. howard: we offer monitoring and treatment. if you're in the monitoring program and you do not have a health condition that is included for coverage in our program, then you come on a periodic basis for monitoring.

so you're not in treatment, there's no condition that a world trade center physician has connected to your exposure. so they are continuing to monitor. ms. schakowsky: but the monitoring is done within the network and there's not an additional cost to that individual for the monitoring? dr. howard: no, our members bear no cost. ms. schakowsky: so the population that you serve includes some number of families of, or spouses of firefighters. some are in that program. survivors that may be, workers in the area, residents students, daycare participants etc. i'm wondering what the breakdown is between first responders and then survivors. dr. howard: in terms of enrolled members in our program? currently, total enrollment of

the population, as you say is 71,942. general responders, which would be police, construction workers, firefighters, that came from all over the united states is about 38,953. our firefighter members are 16,169. which leaves 18,301 survivors. ms. schakowsky: does anybody leave the program? aside from the issue of re-enrollment, do they have to re-enroll every year? dr. howard: no, you're enrolled once in our program. ms. schakowsky: does anybody leave? dr. howard: i hope not but i do not know that for a fact. we have members who have passed away but leaving, they may go to

their, as has been said, by representative pallone, they may go to their private physician to obtain health care for other non-related conditions. ms. schakowsky: thank you very much. mr. pitt: thanks the gentlelady and recognizes mr. lance for questions. mr. lance: thank you. i don't have any questions but i want to thank you for what you're doing, dr. howard. i want to thank congressman pallone who has worked on this issue over the course of the last more than a decade and all of the members of the congress who recognize the importance of re-authorization of this legislation. this is a bittersweet hearing for me. new jersey lost more than 700 residents.

my son was playing freshman high school football and he had a teammate whose father didn't come home. i lost a princeton classmate in the south tower. and my story is similar to the stories of many. i think the best speech that the younger president bush ever delivered was on september 14 at the national cathedral, where he said that this world god created is of moral design, grief and tragedy and hatred are only for a time, love and remembrance have no end he concluded by paraphrasing st. paul to the romans, that no evil can separate us from god's love. what you have done is based on goodness, remembrance, and love and that's certainly true of the first responders. i thank all the first responders, and i am sure this legislation will pass unanimously here and on the floor of the house. i yield back.

mr. pitts: the chair thanks the gentleman. the chair recognizes the gentleman from new york, mr. engel, five minutes for questions. mr. engel: thank you, mr. chairman. none of us who represent the new york, new jersey and surrounding area that wasn't deeply affected. there are 1851 people in my district who are program beneficiaries of all you do, dr. howard. we're very appreciative of it. you've answered some of my questions but i want to try to bring out certain other things. many of us in the aftermath, mr. lance just mentioned the friday after the tuesday of the attacks, many of us in the delegation went to the site of the attacks. it was surreal. you just scratched your head and

you couldn't believe you were really, it's like a nightmare you couldn't believe you were living it and then you realized every few seconds, this is real. and so we walked around, other people walked around, we really weren't wearing a mask. they did give us masks but didn't really make it seem as if it was that important. i've heard a lot more people got exposure, i went back several times, i don't have any ill effects, thank god, but people who are now starting to get effects, do we have trouble tracing it back to, is it -- is it difficult for people to prove so many years later that their illnesses are a result of exposure they got at the world trade center site? dr. howard: it is difficult. it's difficult for any of us to recall exact details of what we did a month ago a year ago, let

alone this many years ago. so for new members coming in our program a lot of the questions that we ask about their exposure, they're very difficult to answer. recall is imperfect in all of us. but we take that into consideration. in terms of the questions we ask and the answers they give us. mr. engel: doctor, thank you for the great work you do, really great work. makes me proud to have been an original co-sponsor of this legislation and i think in all the years i have been in congress, i have never seen our delegations more united on one thing particularly the new york delegation. since the program has been continuing, obviously when things continue you see what works, what doesn't work, you make adjustments. what would you change in the program? what are some of the things you found difficulty with that perhaps we should consider modifying or changing to make it more efficient? dr. howard: i don't think that we found anything in the act that has been a show stopper for us in administering the program.

we look at all of the items in the act as helping us and we consider the act to be well a well written document that's given us a road map and as for so many years, for over a decade, we had no authorizing language so we made it up as we went along, together with our clinical centers of excellence so we're extremely happy to have this authorizing outline for us. mr. engel: how much flexibility exists with regard to the world trade center health programs eligibility requirements? for example, if someone meets nine out of 10 benchmarks but is desperately in need of care, can exceptions be made to ensure care gets to those who need it? dr. howard: we look at every case on a case by case basis. as i said, recall is not perfect this many years later and we

take that into consideration. we only decide that somebody is not eligible when we're absolutely certain that they do not fit any of the stated criteria in the act. if we err at all, it's on the side of including someone in the program. mr. engel: in your written testimony, you note the work that's been done through the world trade center health program. work has been done to understand the impact that 9/11 had on children. i understand that the program has funded research projects to specifically examine the effect of 9/11 on the physical and mental health of children and adolescents. can you talk about that? dr. howard: first of all, we're very privileged to have a number of researchers in new york who are interested in this area of pediatric research for 9/11. as i say, we have seven projects that are funded in this area. they have not been completed as

yet. so we're looking forward to those findings. so i can't report today about what those studies are showing. but it's important that they -- that we have them and they continue and we're privileged to have a very -- a couple of very good researchers working on that. mr. engel: thank you doctor and thank you for all you do. we're grateful to you, it affects those of us in the new york area every single day and our constituents are grateful. thank you. mr. pitts: the chair thanks the gentleman. the chair recognizes ms. brooks for five minutes for questions. ms. brooks: i'm a former deputy mayor of indianapolis in the late 1990's, we hosted the world police and fire games in the summer of 2001, before the 9/11 attack. and there were many new york new jersey firefighters and police officers who perished in the attack, new york

firefighters who perished that had participated in those games. but we also had a group called task force one that traveled from indiana to world trade center and we've since learned because of this hearing, that we have 53 people in the state who responded. i have 12 in my particular district and i want to pay particular tribute as other colleagues have done, not only to all of those from new york and new jersey but people like individuals from task force one, engineers and technical experts and their search dogs, traveled immediately that day and continue to operate around the clock with all their brothers and sisters in new york. there was a story several years ago about an indianapolis fireman and member of task force one, charlie gleason, who was deployed.

he said in that tv story he, said, and i quote, he got a little bit of that world trade center cough. from that mix of the fumes. but he said that he would gladly answer the call again and that you understand the risks but we have to take care of the men and women that are going and that continue day in and day out to risk their lives for fellow citizens. i want to thank you and all of the men and women who were here today for their service and all the men and women around the country who did answer that call. i'd like to ask you what you lose sleep about with respect to this program, what are your greatest challenges. you've answered incredibly well so many questions posed to you but what would you say are the greatest challenges facing this program that we must re-authorize? and how do you plan to respond to those programs? those challenges?

dr. howard: the biggest thing that worries me is that i would have to spend any amount of time, waste my time, closing the program. as opposed to growing the program. ms. brooks: and the manner in which you plan to grow the program, how do you plan to do that? dr. howard: one of the issues we faced in the program and i think i can speak for all of our clinical centers of excellence directors and our national nationwide provider network is when the bill passed, the president signed it on january 3, 2011, we had to be up and running, july 2011. it was a very short implementation time. by a lot of work by a lot of people we were able to open our doors on july 1, 2011.

but i think what we've done over the last five years and we hope to continue to do is quality improvement of the services we offer. our pharmacy benefit plan, for instance, and other support for our members. we want to receive their input so we can continue to improve the program. ms. brooks: thank you. thank you for your service, i yield back. mr. pitts: the chair thanks the gentlelady and recognizes the gentleman from new york, mr. collins, for questions. mr. collins: thank you, mr. chairman. i too want to recognize our first responders here. i think any time you come, as you have, it helps members of congress in what we know is going to be bipartisan support as previously stated to unanimously pass this re-authorization. but first of all, mr. chairman i'd like unanimous consent to enter into the record a statement from representative dan donovan who represents staten island and a portion of brooklyn.

mr. pitts: without objection, so ordered. mr. collins: i'd also like to recognize representative peter king who is with me today and thank dr. howard for all you've done. you've pretty much answered, i think, most of our questions. i represent 105 towns in western new york, in the buffalo and finger lakes area. i believe that most of our volunteer fire departments we're mostly volunteer, we have one paid fire department in my district, sent individuals down to ground zero. that's what firefighters do and first responders. it's a community a brotherhood. and i'm just happy to have learned more today about how those individuals are more than likely in your program being monitored and i think again in a bipartisan way we're with you and you're doing great work. i don't believe you're going to have to lose any sleep about shutting this program down. with that, mr. chairman, i'd like to yield the remainder of

my time to representative king if he would have any comment he is would like to add. mr. pitts: the chair recognizes the gentleman. mr. king: i thank you for allowing me to sit in and take part in the hearing, i thank the gentleman from new york, mr. collins, for yielding time. i'd like to say there's probably no more important bill to be passed in the time i've been in congress than the 9/11 zadroga act. i had about 150 fatalities from my district and more than that i see every day, to this day people with rare lung disease, respiratory illnesses, blood cancers. this is something that's absolutely necessary to continue and i know that people may find, this might be wrong or that might be wrong, but the fact is, this is as effective as any program i've seen in all the time i've been in congress. it provides a need, it's essential to go forward. i want to thank all the men and women, the first responders,

fdny, nypd, the construction contractors, i saw mr. nadler come by before. everyone who answered the call that day and those who were suffering these illnesses, people in the prime of life who have again lost their jobs, have these debilitating illnesses which have changed their lives so radically all because they did what had to be done. again, i thank the chairman for holding this hearing. i thank the committee for taking this issue up. i thank all of you for being here and i certainly thank mr. collins for yielding me the time and i yield back. mr. pitts: the chair recognize s the gentlelady from north carolina, mrs. ellmers, five minutes for questions. mrs. ellmers: thank you, mr. chairman, thank you dr. howard for being with us. i too want to thank the first

responders who are here today. a very emotional subcommittee hearing. i'm going to try hard to stick to the information and get into some of these questions. along the lines of where we are today, and i know that you have already stated, dr. howard, that as the number of affected first responders have come forward those who have been determined to have cancer, how many are in existence right now? how many are with us? what number do you have of potentially affected patients who have a diagnosis of cancer? dr. howard: right now we have -- about 400 cases of cancer. some of those cases may represent an individual that may have more than one cancer but generally speaking that's the number of members that we have who we're -- we have certified with cancer. mrs. ellmers: as far as the certification process, i'm just

curious as to how you determine approval or denial? and do you have numbers that play out as far as the possibility of being approved or denied? dr. howard: sure. let me just briefly explain the process. the physician who is seing the -- seeing the patient makes the connection between their exposure and the health condition, in this case, cancer. so they can say that it's caused by, contributed to, or aggravated by their exposure. that's the determination made by the physician. we don't make it in the program. that's an independent view that the physician has. then they submit it to us and we make sure that all of the supporting information is there and then we certify it. if the supporting information isn't there, we have a question, we go back and forth unless -- untlil we're all absolutely

sure, including the determining physician and us, that this is a case to be certified. certification then means that you get your cancer covered for health care. mrs. ellmers: having the concentration on cancer leads me to the next question, which is do you anticipate adding other possible diseases outside of the cancer realm? dr. howard: we have received to date seven petitions for requests adding conditions. two of those were cancer. the original cancer petition chairman pitts referred to, 001, and then soon after that we had a petition with regard to prostate cancer and then five others. with the five others, we did not find sufficient scientific evidence to support their addition. we get quite a few requests for adding conditions. it's hard to estimate whether -- what conditions we would add in the future. but we evaluate each of those requests on their scientific basis. mrs. ellmers: in regard to

autoimmune diseases, i understand that you have made a determination that those would not be identified or a can you expand on that? dr. howard: we received our last petition to add a large number of autoimmune diseases to our statutory list. we reviewed all the information, including the very excellent study that had recently stimulated that petition by fdny and we found it was insufficient at this time. it doesn't mean that, and this is why we're emphasizing so much the importance of research funding in this program, is the additional work that is going on by other c.c.e.'s and our world trade center health registry to look into that issue. it doesn't mean that forever and ever it will not be added but at this time it will not be added. mrs. ellmers: thank you, dr.

howard. i appreciate all the information you have helped us with and i'm glad to know that this is considered to be an ongoing process into the future because we don't know what the future holds for this. again, god bless all the first responders who are here and your families. thank you so much, i yield back. mr. pitts: the chair thanks the gentlelady. now that all the members of the subcommittee have had an opportunity to ask questions, we can -- with unanimous consent i ask that the member of the full committee, ms. clarke, be given five minutes for questioning. the chair recognizes ms. clarke. ms. clarke: thank you, mr. chairman. we have been joined by congressman nadler of new york original sponsor of the zadroga act and i wanted to yield some time to him. mr. nadler: i thank you for yielding. i thank the chairman for holding the hearing and the members. i simply wanted to say as someone who, along with mr. king and mrs. maloney, was one of the three original sponsors of this

bill, we struggled for years and years to pass it, i'm glad, and history has proven the necessity of this bill. i wanted to thank dr. howard for his wonderful service. i'm glad that the chairman has called this hearing and that judging from the comments at the hearing, there seems to be a lot of bipartisan support for extending this bill. we know the necessity of that. i want to urge that that be done and i thank you, chairman of the committee again. the extension of this bill is essential because the diseases won't go away. this is for both the first responders and the survivors in the community. so i urge the extension of the bill. i thank you for yielding and i yield back to her. >> thank you. dr. howard, just following up on a couple of the questions that were asked about the

condition, for the record, what is the process by which you can add new conditions to the program? >> well, first of all, the administrator has the ability to add a condition on his or her own motion. the other very common route that we have seen so far is the public can petition the administrator to add a condition. as i said, we received seven petitions so far. two we have added the condition, the first one being cancer, the second one being a particular type of cancer, prostate cancer. the other five we have found insufficient evidence for. >> i understand the statute outlines specific timing requirements for you to respond to those petitions. could you describe that for us? >> right. the administrator has 60 days to respond to a petition unless the administrator refers the petition to our scientific and technical advisory committee. and then the time frame is 180

days. for instance, in terms of the first petition on cancer, we referred that to our science technical advisory committee. they had 180 days to make their decision. >> do you have any concerns with the statutory time frames under which you would have to respond to such petitions? >> well, unof the things that the g.a.o. report pointed out in their review of our cancer petition and, or addition of cancer, was that there was no external peer review of our science that we used to justify the addition of cancer. we believe in peer review very, very much. we want to do external peer review but the time frame of 60 days was just given the enormity of the task of adding all that, all those numbers of cancers, that was a very short period of time, so we were unable to engage in external peer review. >> very well.

can you briefly tell us about the registry? it is our understanding it was created to follow individuals who were exposed to environmental topics related to the world trade center terrorist attacks. tell us a bit more about the registry and why it is important, important, too, for studying the w.t.c. related health effects. >> the world trade center health registry operated by the new york city department of public health and mental hi jean is a vital participant in the research aspects of the program. they started very soon after 9/11. they have, interestingly enough, about 71,000 members also and, i might add, i was told by director last week, that they have registrants in the registry from every congressional district, all 435. and they have produced almost 60 papers in this area. they follow the same people

over periods of time, so they -- every so many years they study them to figure out what their experience is. so their research is vital to this program. >> we have a sense of any of their findings so far? >> all of their findings are not only on their website but also on ours. and i think some of the things that we've learned already the issues about asthma, mental health persistent post traumatic stress syndrome, etcetera, have come largely from the world trade center health registry studies. >> so you think it is important we continue our work. >> it is absolutely vital. >> thank you very much, dr. howard. i yield back. thank you, mr. chairman. i thank the ranking member. >> chair thanks, gentle lady. that concludes the questions of members here present. i'm sure doctor, we will have followup questions from members. we'll send those to you in writing and we ask that you please respond promptly. >> thank you, mr. chairman.

>> thank you. that concludes our first panel. we'll take a three-minute recess as the staff sets up the witness table for the next panel. stand in recess. >> all right. the time of recess having expired, we will reconvene. i'll ask the guests to please take their seats. [gavel pounding] ladies and gentlemen, ladies and gentlemen, please take your seats. the committee will reconvene. ask the guests to please take their seats and i'll introduce the second panel. we have three witnesses on the second panel.

i'll introduce them in the order which they will present testimony. first, we have dr. iris udosson, medical director, environmental and occupational health sciences institute. robert wood johnson medical school. welcome, doctor. secondly we have mr. david haley retired police officer, new york city police department. finally, we have ms. barbara brunette former detective, new york city police department. thank you very much for your patience, for coming, for your testimony. your written testimony will be made part of the record. you'll each be given five minutes to summarize. there are a series of lights on the table. you'll see green first, then yellow. when red appears, we ask that you please conclude your testimony. so at this time doctor, you

are recognized for five minutes. summarize your testimony. >> he serve as director of director of the rutgers clinical center in new jersey. we are one of six clinics in the new york-new jersey area that provide medical monitoring and treatment for world trade center first responders. i am a physician who is board certified in internal and occupational medicine and am a professor at rutgers and a member of the national toxicology panel, an expert panel that advises the national institute of environmental health sciences concerning the relationship between exposure to toxic chemicals and health. i thank the committee for the opportunity to provide the best quality medical care to the brave responders who suffer from multiple chronic and often

disabling medical illnesss including pup monday arrie fibrosis asthma, gastric reflux, sign usitis and others. we have been monitoring since january, 2003 and began treating patients with federal funding starting in 2007. in addition to the treatment of the aforementioned conditions over the past three years we have been able to use our funding to optimize cancer care. this is critical since as early as 2008 our responders were already showing a cancer rate that was 15% higher than people their age who are not at the disaster site. this rate is only increasing and our patients are much younger than usual cancer patients and are nonsmokers. they were highly exposed to environmental toxins as well as severe mental health trauma from what they witnessed at ground zero from seeing people jumping off tall buildings to their deaths or finding charred

remains. our designation as clinical center of excellence has allowed us to provide quality of care for these responders by centering all their care in a convenient location with staff members sensitive to their needs, coordinating treatment from start to finish. the combination of program wide knowledge gained over 12 years of care delivery in addition to my personal knowledge in new jersey has allowed us to understand this cohort of patients using medical and pharmaceutical resources wisely to accomplish the following objectives which i will illustrate with specific patient examples. coordination of care for complex cases diagnosis, and treatment of patients considering both physical and mental health aspects of disease, use of state-of-the-art diagnostic techniques for early diagnosis and treatment, use of knowledge gained in our treatment of patients to allow for early intervention, enabling our skilled patients to stay at

work. i am proud to share this panel with a retired police officer who performed many months of search and rescue work at the site. david presented with swelling in his neck in 2006, which was eventually diagnosed as an aggressive metastatic cancer of the throat. this is an unusual and rare cancer in healthy, nonsmoking americans. however, in my center we've seen eight other patients with this cancer in new jersey, alone. david's treatment has required a team of doctors including myself as primary care, general oncologist, radiation oncologist, general surgeons, ear, nose, and throat surgeons because of the complicated nature and location of his cancer it has been extremely difficult to treat but at the present time he is tumor free since april of 2014. the second patient i want to tell you about is a retired detective with severe shortness

of breath, chest discomfort, fatigue, and inability to perform his duties as a police officer. he was present a the 9/11 site on the date of disaster, reported being engulfed in the dust cloud and witnessing people jumping out of buildings. he was treated by his personal physician, with five medications for his respiratory issues but no other conditions. his evaluation at our center confirmed the presence of asthma but we were also able to diagnose gastric reflux, sleep apnea, post traumatic stress disorder, and panic attacks. this patient was given treatments for those conditions and received therapy for ptsd and panic disorder. the patient was able to recognize his panic attacks were causing him to use increased amounts of his asthma medication and he learn to control his attacks. at his most recent examination he no longer needs mental health medications and is

enjoying his retirement. the third patient i want to speak about works as a consultant to prevent tax fraud, an abnormality was noted on his tax scan, chest x-ray and he was referred for a ct scan. a small knowledge yule was noted in november of 2014 which grew larger in january. this was evaluated by a radiologist who was an expert in interpreting lung ct scans. she was concerned about the suspicious nature of this nodule and its growth since the original scan. this patient was referred to our university surgeon who removed the stage one lung cancer which does not need chemotherapy or radiation. i want to say this patient is back at work. he's overseas looking for people who cheated the government paying taxes. and finally rutgers university and nyu have combined to do research finding markers for sleep apnea associated with environmental exposure. this expertise has allowed for

early diagnosis and treatment of obstructive sleep apnea enabling us to get people to work safely. my fourth patient is a pilot for a law enforcement agency with a history of gird and sinusitis which are risk factors for sleep apnea. this patient has been successfully treated for his condition and is fully qualified under federal standards to skillfully operate his aircraft. he asked how he could thank me for his treatment and i said he should continue catching terrorists. in summary, all of our patients are honored and treated by skilled clinicians. we believe we are continuing to acquire the knowledge to provide early diagnosis and treatment of emergency responders who were exposed to toxic agents and psycho social stressors. we strive to continue to achieve excellence and cost effectiveness in treating our patients as well as preparation

for providing the best possible medical care for any emergency responders who are exposed to a multitude of unpredictable exposures. thanks very much for your time. >> thanks to the gentle lady and now recognizes mr. haley five minutes for your summary. >> thank you sir. first thing i'd like to do is thank you for having the hearing. it's obviously very important by the amount of people that are here today and it's both an honor and a privilege to be here and address you. there's a lot of things i'd like to say about this. i think the most important is to answer a question that you all basically posed to dr. howard. and that is what happens if? and dr. howard was wonderful in his answers but i think i'm going to be a little more blunt about it. people are going to die.

the men and women that are sick, that are being taken care of now i've only been cancer free a little over a year. i could easily, and if it wasn't for this lady right here, i wouldn't be here at all. so to end this program, people are going to die. it's just a fact. it's unquestionable. that's what's going to happen. i was born and raised in mr. pallone's district and lived in his district once i retired. now i moved a few years ago and i live in another district. i have both sides of the aisle covered here. this is is not something that should have any political fighting. this should be an absolute bipartisan 435-0 type bill. this is a ground ball, no brainer as far as i'm concerned.

and as the other -- and the last point i'd like to make because i'll try to keep this brief is i wouldn't be here, sitting here if it wasn't for the doctors and dr. udasin and her other colleagues' knowledge, skills, abilities research. they have become the absolute experts in what is ailing us and not just me but all the other people that are part of this program. you can't go to your regular doctor. they don't have the knowledge. they just don't. they're not bad doctors. there is nothing wrong with it. but what has happened to us because of the conditions that we were in is -- has become very specific. and i didn't have a normal

cancer and there's a lot of other people that don't have normal cancer or normal blood diseases and because of their absolute dedication, they have come up with plans and outlines and that they can treat and get us through these difficult diseases. and that is the most important thing that we can have of quality of life to go forward. i want to leave it at that. i'll be happy to answer any of your questions. >> now recognize ms. burnett, five minutes for your opening statement. >> subcommittee, ranking member green and members of the subcommittee on health for

inviting me to appear before you today. my name is barbara burnett. i live in bayside, new york. i am 52 years old, a wife, mother, and grandmother. with me here today are my husband and my son. i am a proud former new york city police detective. i retired from the department after 18 1/2 years of service. my career came to a to an end because of an illness i suffered from my service at the world trade center site. i served there about 23 days in total. the morning of september 11, 2001 i was working in brooklyn, new york in the gang intelligence division when my fellow officers and i learned of the terrorist attacks in new york city we rushed to lower manhattan the fastestway i possible which was by boat. when we arrived, the towers had collapsed. the air was thick with dust and smoke. i put my hands over my mouth and nose just to breathe. may fellow officers and i worked all day and well into the night. we evacuated people from around the world trade center site.

we directed them away from the disaster. there was so much dust but i was not given any respirator or protection for my eyes throat, or lungs. i had to wash the debris out of my eyes and throat picking up a hose. my fellow officers and i along with all the rescue workers and first responders could not stop doing what we had to do. the first night i finally left the world trade center around 10:00 p.m. after 12 hours. five hours later, i reported bak to the world trade center site at 4:00 a.m. in the morning on september 12. i removed debris by using buckets and shovels and at no time was i provided respiratory protection. if i was not crying over what i was seeing in a room, tears streamed down my face from burning, irritating dust. i spent weeks at the world trade center site shoveling, clearing away debris searching for survivors, and later assisting sifting for body parts of the dead. we worked side by side and hand in hand with iron workers,

construction workers, firefighters police officers, all of us searching the dust and removing debris together. we were searching and removing the wreckage of the world trade center. we were working right on top of the burning, smokey, hot rubble. the fires never stopped burning. air quality we were toll was not a concern. all of us working 24/7. the work was tough and dirty. we were choking and it was dangerous. there was never a time when i even thought about quitting or leaving. i thought of thousands of poor victims. if our work brought the removal and recovery efforts closer to the end we were glad to contribute. i live with the consequences of 9/11 every day. i have been diagnosed with lung disease more specifically hypersensitivity pnumanitis with fibrosis in my lungs. the inflammation in my lungs interferes with my breathing and destroys the tissues that get oxygen to my blood.

my lungs are permanently scarred. i cannot move around my home or take the stairs without wheezing or gasping for breath. i start each morning inhaling multiple doses of medication. i am told i will eventually need a double lung trans plate. lung steroid use has caused weight gain and the other prescription medications have caused many additional illnesses. i have been diagnosed with diabetes high blood pressure, osteo arthritis and rheumatoid arthritis. i have suffered partially detached retinas in both eyes each requiring surgery. prior to my world trade center service i was in top shape. i had no history of lung disease. i never smoked. i always had a physically demanding lifestyle and career. during my time with nypd i worked for five years in the plain clothes narcotics unit. theas assignments required me to walk four miles per day

making arrests in buy and bust operations and executing search warrants. i have made over 200 arrests in my career and assisted in hundreds more. i have been recognized by the nypd numerous times for excellent police duty. i have also received several medals for meritorious police duty. i was brian peterson and raised in brooklyn, new york. i played college and high school basketball. i played on the women's team which competed across the united states internationally. life has become very different since i became sick. every month i see the doctors at mount sinai to renew my prescriptions. this program saves lives. it is saving my life today. it provides medical structure by coordinating doctors and medication. my family does not have to suffer the financial burden of doctors visits, copayments, deductibles and the terrible cost of prescription medication which would not be available to

me without the program. i would also note the health conditions are worsening. many of the first responders have been diagnosed with cancer. many have died of cancer. the amount of dust to which we were exposed was unprecedented. many of us had cancer and other injuries that arose late after the exposure. more than 50 types of cancer have been identified as being directly related to the toxins at ground zero. cancer arises years and years later. for these reasons i urge the committee to approve the bipartisan legislation before it. thank you. >> the chair thanks the gentle lady and all the witnesses for their testimony. i will begin the questioning by members and recognize myself five minutes for that purpose. dr. udasin, we'll begin with you. in your testimony you talk about the coordination of care that your clinic provides and that you can spend time with your patients.

can your elaborate in more detail about that? >> since david is sitting next to me that's a really good example, david's condition was in such a peculiar location that we had to find different surgeons that were able to get to where his cancer was, so this required speaking to people individually to determine who had the right expertise to actually take care of his cancer. where he could get the right radiation, that was the big issue in david's case also, because there were certain issues with how he was receiving radiation and he could better go to one place and not go to another place. and the good news for david was that he had a supportive family

to take care of his other needs. but we've had other patients not as fortunate as david where, unfortunately, we've had to help coordinate getting them into things like hospice care, so my staff and i would like to acknowledge tracy, my administrator, who is sitting there who helps us arrange a lot of the important things that we do with our patients, getting them from place to place, making sure they get a good appointment, a prompt appointment, so, you know, you go into a doctor's office and you have an abnormal test, and then you have to go and see a specialist. if you go in just by yourself, they say oh, you can have an appointment next november. that's their next available appointment. but i can assure you when i call up, you'll be in by

tuesday, if that answers your question. >> well, just to follow up with the coordination and having time, very important for the level of care that you give, was it possible to provide this level of care before congress established the world trade center health program? >> it was not possible to obtain this degree of care. initially we had, in the end of 2002-2003 we just had the monitoring program, and it was very frustrating because you could find something wrong with a person and we really didn't have the resources to make sure they got to see the correct person. i'm grateful for the funding that we have now so that we can do that. >> thank you. can you talk about your care before and after the creation

of the centers of excellence in the -- because of the compensation act and in your view is it better coordinated? >> i was thinking of a story when you just asked the doc a question. i am probably one of her original patients going back to the monitoring program back in 2003. the first time i went there, my blood pressure was basically somewhere off her chart. my sinuses were completely blown out. i had constant infections. i had gird, which is acid reflux, and she basically refused to let me leave her office unless i went straight to my doctor to get treated for the blood pressure. and i'm 6'3" and she's about 5'1" and i believed her that she wasn't going to let me out of the office. so yeah. there's a big difference.

and she is just wonderful. i'm sure -- i haven't really dealt -- i've only dealt with one other of the doctors at her office and i have never been to any other offices so i can't speak about any of them but the doctors, you know, are just tremendous and they, as she was saying when the cancers kept coming back for me, and it's reoccurred four times for me, you can now -- she can make those phone calls now and get me to the right -- when she says tuesday she's not kidding you. >> thank you. ms. burnett, would you respond to that as a patient in the w.t.c. health program. are you satisfied with your access and the care uff a received and compare before and after. >> yes, i am very satisfied with my care because in 2004 i started blacking out at work

and nobody knew why. and with the regular doctors i was just being sent out for different kinds of tests. in the program they send me to one doctor who sends me to another doctor to make sure everything is covered. they schedule everything for you and i think it's very important that they follow up in what's going on and how they treat us is very well. >> thank you. my time is expired. the chair recognizes the ranking member. >> thank you, mr. chairman. from your testimony i understand you've been seeing dr. udasin since the permanent world trade center health program was established. would you explain what being able to see dr. udasin at the

center. >> when i went to be dr., she would tell me go see doctors asked, why see. her knowledge and skill, what she has been able to put together, she has those tools in her belt that will send me to the right person. >> do you think he would've been in worse condition without being in the center? >> i would not be here. the last surgery i had last year, there were only, i believe for surgeons that were qualified

to do what i needed to get done. >> mrs. burnett, from your testimony, i understand you received services from the mount sinai clinical center. can you explain what that meant to you? collects the care i received had been excellent. they did and open long biopsy which determined which lung disease i had and how i needed to treat it, and what doctors i needed to see. >> could you explain the care you received a mount sinai? >> i have a primary doctor they send me to doctors for the specific diseases i have. one primary coordinate all of that. >> do you think your condition

would be worse if you did not have access to the program? >> i believe it would be terribly worse. i had that world trade center cough. i was not able to hold a conversation without the medication. >> dr., why do the patients need specialized care provided at the clinical centers? dr.: we have people with rare conditions that need specialist help. we have been able to use our best resources to get people that have seen many abnormalities in things like cat scans to get patients like the gentleman i mentioned, to have the cancer removed. i think really the number of conditions and the collocated

cases we see, so you might have one condition and that influences another, and makes a third condition worse. if you have mental health issues and you have reflux, and then you get chest pain, and you have asthma, you end up taking too many medications and then you get side effects. many of the asthma medications if you take too many can precipitate heart disease. i -- i feel like early recognition and treatment of all of the conditions correctly allow for much better outcomes. >> with so many possible illnesses, a misdiagnosis would not be uncommon. >> that is correct.

miss burnett described her sheer number of conditions. yes, that is the issue. you treat one condition effectively, but you kill the patient, or you are doing it because she had some other condition that you ignored. that is why i believe we are able to do. we are a primary gate keeper type person. i can make sure all of the specialists are talking to each other and make sure that the total patient is treated correctly. >> thank you. i think because of the competitions and exposure to no telling what that you need to have someone who looks at the whole person and actually treats all of the illnesses. >> chair thinks the gentleman now recognize the gentleman from new jersey, mr. lance. >> thank you mr. chairman.

dr., can you explain in a little more detail your center of excellence and what that means how many there are any metropolitan region? what qualifies your organization as being a center of elk -- excellence? dr.: we are part of the non-fdny responded program. they have a separate center. we are one of the newer consortium centers which includes those in mount sinai, nyu, stony brook, queens college, and rutgers. >> mount sinai and nyu would be in manhattan.

dr.: there is one in nassau. we serve as the center of excellence in new jersey. our physicians are board certified in primary care specialty, internal medicine and occupational medicine. as i said, rutgers has an environmental center of excellence in the same building. we do extensive work on exposure and help the facts, and that happens besides that, the rest of the faculty that i work with we have a lot of experience with exposure to illness. we have a pulmonary doctor who

comes into our practice and sees patients with us. we have mental health people that come in to our practice and see patients. across the street we have our surgeons, our gastroenterologist and specialists that we need. by the way, we changed our name to rutgers. in any event -- >> that is because our state legislator permitted the combination. dr.: right. in any event, then i have my registered nurses who are there helping us take care of patients, making sure that histories are obtained correctly. aching sure people actually know how to use their medication. this is important that people

make sure that not only the right medications are used, but used correctly. then i have my mental health core, administrative core, and that group of people is performing audits to make sure everyone else is doing a meeting correctly. we are doing the best we can to keep costs down using generics. all of our providers and people that are writing prescriptions everyone is certified. our patients actually get their medications when they get to the farm is. that is part of coordination of care. i can assure you we are performing these audits because i want to make sure we have funding to treat our patients.

presumably you guys are going to get endlessly confirm this bill. i want the money to be there to treat our patients. >> thank you very much, doctor. miss burnett, what position did you play basketball? >> point guard. >> i was five foot eight going ever played. mr. chairman, i have a letter from 38 members of the new york and new jersey delegation to speaker boehner and leader pelosi requesting early passage of this bill. i would request that it would be cemented for the record. >> derailment seeks unanimous. >> thank you. >> we recognize the ranking member of the full committee.

>> thank you mr. chairman. i wanted to get into, try to have you explain the importance of not only be rutgers center but all of the centers that are part of this world trade program. there is an extensive research component, i want to emphasize how yours developing -- how you are developing diagnosis and treatment for disorders that people might not even be aware of, and how that research and the uniqueness of the center makes that possible. can you describe how the rutgers center involved from research to world trade center conditions and how that research helps treat those conditions.

>> answering the rutgers, we have a lot of sleep apnea experts at those two centers. when i am proud to say is that between our laboratory toxicologist and our sleep experts, we have developed certain markers that we are seeing in certain patients. one of our sleep experts presented this of the recent thoracic society meetings. certain people can be predicted possibly to have sleep apnea. this is important because these are inflammatory markers and these people at the 9/11 site or exposed to all kinds of toxins

that can cause inflammation. because of that that association between environmental exposures and inflammation, we have been able to find people sooner, get the treated -- get in -- them treated. traditionally sleep apnea with something that you had to be enormously obese to get. we have patience that are not quite playing point groep -- point guard, but are an awfully good shape and they have sleep apnea. because of our occupants hit -- occupational expertise, it is a serious condition. there was someone who died recently because a buster ever fell asleep.

-- bus driver fell asleep. a lot of our patients have to drop -- drive commercial vehicles, operate subway planes operate all kinds of heavy equipment, it is good that we are able to treat them and keep them safe and awake. that is one thing our research has accomplished. it is not only applicable to our patients, but two other people with environmental exposures. >> the other thing is how we can expect an increase among the population of these 9/11 related conditions. as time goes on we find more cancers, more disorders, as people get older that maybe did not exist before. we are now finding through the

research that are related to 9/11 that we did not know about before. dr.: i want to say that certain kinds of emergencies have short latency periods. you expect to see something like that in just a couple of years. other toxins like asbestos have longer latency. . they may's be seen later on at a different time. you asked a question to dr. howard earlier about mistakes made to providers outside the program, if i could just add that we have found in the program that people have been undertreated by local providers for various cancers, for various

severe lung conditions, i do want to say even though that was not the question you asked, i do want to say we had been able to improve the health care by getting better diagnostic services to our patients than they were able to get. >> thank you very much. thank you mr. chairman. >> chair thinks the gentleman. that concludes the questions of the members. they will have follow questions in writing we will submit those to you asking you to please respond properly. i would remind members they have 10 days to submit questions for the record. they should submit questions by the close of business on thursday, june 25. thank you very much for sharing your personal experience and your testimony. the community will take up this

legislation and act on it. you have performed a public service by being here today. thank you very much and without objection, the subcommittee is can armed. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] announcer: on thursday, the house approved florida rules. on friday, votes on those two trade authority bills. the fast track would grant president obama authority to submit an amendable trade agreements to congress. the trade adjustment assistance taa is a federal program to help workers who lose their job because of free trade.

announcer: a new congressional directory is a handy guide to the 115th congress. it has twitter handles and bio information. there are looks of the print -- president shall him a federal agencies and state governments order your copy today. it is on the c-span online store at c-span.org. announcer: coming up from the u.s. house, numbers considering rules for debate on two trade bills. then more on a trade bills from indiana congressman luke messer. that is followed by a senate hearing on retaliation for federal whistleblowers. on the next washington journal, congressman kevin yoder of kansas discusses the

transportation trade bill. then the president's authorization to use military force against isis. you can join the conversation with your phone calls and comments on facebook and twitter. on friday, and epa ruled that would change national air will any standard for ground-level ozone. before a subcommittee. that is on c-span3. here are some of our featured programs this weekend on book tv on c-span2, saturday night at 10:00 p.m. eastern, that's news contributor chris -- just in powers says that although they were once a champion, liberals are now against tolerance and preached each -- free speech.

and then, michael morel on the agencies were on terror and the current fight against isis. on american history tv on c-span3, saturday night, author kevin mcmahon on the strategy behind president nixon's supreme court appointment and the impact on the court and american politics. sunday night at 6:00, on american artifacts we visit the national museum of history. get our complete schedule at c-span.org. the house debated a role debating to trade promotion bills. one bill deals with customs enforcement and the other would grant president obama fast authority to submit an amendable

trade agreements to congress. the rules were approved by a close vote of 217-212. eight democrats voted yes, 34 republicans voted no. the debate is just over an hour. >> mr. speaker i rise today in defense of ronald reaganwhich is known as t.p.a. since the days of president ronald reagan, republicans have supported free trade because we know that when america competing, america wins. t.p. samplet a vital piece of our free trade agenda because it creates the process that we need to secure trade agreements that grow our economy, create good-paying jobs, and the lowest prices for american consumers. for america to continue to

determine the rules of the economic, the global economic world, we need to lead by crafting free trade agreements and thus the house is here today to provide to the president the parameters under which he should negotiate, or he show she should negotiate a trade promotion authority. free trade means more good-paying american jobs. it means -- free trade means that american workers make american products at american businesses to be sold all across the globe. more than 38 million american jobs are tied to trade and these jobs pay well. in fact, job trade -- trade related jobs on average pay 18% more than jobs that are not trade related. mr. speaker, the republican party is here today with ronald reagan's -- with ronald reagan watching from heaven down on taos say that we are continuing what he really began and that is

a process of american exceptionalism around the world. mr. speaker, i reserve my time. the chair: the gentleman from texas reserves. the chair recognizes the gentlelady from new york. ms. slaughter: thank you very much mr. speaker. i thank the gentleman for yielding me the customary time and yield myself such time as i may consume. the chair: the -- the speaker pro tempore: the gentlelady is recognized. ms. slaughter: shortly after midnight tuesday night the rules committee learned we would consider the senate package of three sweeping trade bills. we convened an hour later and considered hundred of -- hundreds of pages of new text rewriting our trade laws and the rule the house. part of that package includes what is called fast track a procedure that has outlived its purpose and circumvents congressional authority because it does not allow for committee debate or the members to be able to amend it or change it or up and down. at least that's what happens over here in the house.

the -- this silences debate of the members of the chamber and by doing that americans who send us here don't have a voice. we're being asked to push this transpacific partnership through by using fast track and we're being asked to push fast track through with a closed rule. now we've been very concerned about what's in this fast track. as you know, we really aren't allowed to know. only allowed to vote up or down on the trade bill itself. so once the fast track is passed. i realize how awful it was for us here, if we wanted to go see it we had to take someone with us with security clearance and would not be allowed to talk about it. i learned something this morning that's even worse, an article in the "new york times" about the australian government, members of parliament there who say if they go down and read the trade bill they have to sign an oath that they will not speak of it for four years. now if that doesn't ask the

question of who runs these democracies the representatives of the people of the united states or the corporate giants who write the trade bills? we are not -- that we are not able to see. that makes it pretty plain here who runs it here because from what we have heard, that his leaked out through wikileaks it's that the major parts of this bill have been negotiated by big pharma, pharmaceutical industries of america, and the financial district. neither one of those have shown any capacity to put the members of the public first. australia is so concerned ability pharma asking for 12 more years of patents on their inventions that it would ruin their medical system. so far, according to the leaks, nobody much likes it. instead we could have had

transparent debate about the bill we had seen and a bill we know, all we do is know what happened in the rule committees yesterday. yesterday new york member of the rule committees or any member of the house who came before it were allowed to have amendments approved. now, the senate did. and it allowed amendments to change the bill considerably, but not us. amendments were offered in the rules committee to provide for transparency so that we will know what these things are all about. this to the change the investor state what we need to bear down on, and the australians are also aware of is that disputes from any of the 12 countries in this trade agreement, if they do not approve of or believe they are losing money because of our clean air act, or our clean water act they can go to the three-person tribunal of corporate lawyers and act against us. we know that that's a concern in this congress because just

yesterday, they voted away the country or origin labeling because they were concerned that -- about the w.t.o. now, we -- as i pointed out we had those amendments, we also had one on currency manipulation which is of major concern. we lose lots of jobs and lots of money because of currency manipulation and we simply allow it to happen. we will not do anything everybody says that should be in the bill, that the president would veto it. all this american public once again, those of us who are standing here trying to take care of them, are not going to be able to do it because we only know by word of mouth or what we may read in the newspapers what's in there. let me tell you what's in the rule. that's a very important piece. most of the discussion in the house has been around what we call the pay-for, for part of the trade bill which is called trade adjustment allowance.

that is supposed to take care of all the people who are laid off, or lose their jobs. the fact that we have asked for such a large number indicates to me that they expect an awful lot of jobs lost in this country system of what we -- what the t.a.a. was paid for as it came from the senate were the $7 million cut in medicare. nancy pelosi is working along with john bayner to change what the cuts that will be paid for with the t.a.a. but i need to make it very clear and i want everybody to understand that the bill we voted on this morning the african growth bill which contains the new pay-fors other than medicare are not valid until after the senate acts on that bill. so if tomorrow on the floor trade adjustment allowance and the fast track authority pass, they will go to the senate with the pay-fors coming from

medicare. i think it's very important that we make that point because many of the people that served with us here are confused about exactly where that is coming from. let me repeat that. the pay-fors that substitute for the use of medicare to pay for trade adjustment allowance will not be valid until after there is senate action, or when that takes place. we were told that the speaker said over in the senate that we would do this under unanimous consent but we have also been told that unanimous consent will not be given. so anyway mr. speaker, the advocates of the fast track, the t.p.p. are tells us that this is going to be a wonderful trade deal. now we know that it's not going to create jobs because none of them have. those of us in upstate new york after nafta were told that we would get at least 250,000 new jobs. instead, as the speaker probably knows, we lost a great deal. so if we members of congress, as i pointed out wanted to view

the deal, we could not talk about it. and that by itself should be enough to have us not do it. in a seminal sose yo logical discussion of our early american democracy called democracy in america, alexis de tocqueville said of our nation in 1835, and i quote, the surface of american society is covered with a layer of democratic paint, but from time to time one can see the old arest co--- aristocratic colors breaking through, end quote. this is one of those times, mr. speaker, because this bill, this trade bill that affects every person in the united states and will for maybe a generation to come, is not being written by members of the house of representatives or of the senate, but in a closed, back room deal and as we are told by major corporations in the united states to benefit themselves. .

by giving away the role of congress, we give away our ability to safeguard america's jobs. and most importantly again, the american laws meant to protect the citizens, such as the clean water act. i have never seen a bill come out of this congress on trade that benefited either the american manufacturer or american worker. any lawmaker thinking about voting for a job-killing trade agreement should look at nafta and our growing trade deficit with south korea and think about whether they want to be responsible for shipping their constituents' jobs overseas. we know this bill has been modeled after failed policies that shuttered store windows and closed factories all across the nation. that is the legacy, ladies and gentlemen, of free trade. what we are to demand in our

trading bills is fair trade. america should not be the supplier of jobs to the rest of the world to improve their economies at the cost of ours. from food safety to clean air and labor standards, to environmental protections, this trade deal would impact every facet of our daily lives. 90% of the seafood now that is consumed by americans is imported. less than 3% of it is inspected. tons of it has been sent back of that small amount being inspected. we will not be able to investigate them coming in here under this free trade act. i urge my colleagues to vote no on the rule and carefully consider the trade package before us. and i reserve. the speaker pro tempore: the gentlelady reserves. the chair recognizes the gentleman from texas. mr. sessions: you know, the gentlewoman originally is from

kentucky and she would recognize when i tell this awesome story about how important a free trade agreement is. a couple of years ago we did a free trade agreement with the country of korea. within a year, mr. speaker, as a result of that trade agreement, the number one selling car in korea came from georgetown kentucky. and is a toyota camry, made in the united states. the koreans love it, a kentucky-made product. if we didn't have free trade agreement with korea, the people in georgetown, kentucky, couldn't claim to be the number one car in korea. mr. speaker i would like to yield two minutes to the young gentleman from auburn washington dave reichert. the speaker pro tempore: the gentleman is recognized. mr. reichert: i'm rising today

in support of today's rule which will allow us to proceed in consideration of trade promotion authority, trade adjustment assistance and customs legislation. passage of trade promotion authority is absolutely critical to our economic growth and global leadership. without t.p.a., we will not be able to bring home the benefits of a high standard trade agreement. now what are the benefits? job creation, selling american products across this globe to 96% of the market, which exists outside of this country. selling american. that's what we want to do. and we not only create jobs but create jobs that are higher paid wages, which we are struggling with across this country and raising the minimum wage. we can do this in this prayed adjustment. and this is counter to what communities across the nation

need right now. and again, more opportunities more good-paying jobs. and that leads to a promising future to our families, to our children to better paying high tech jobs and manufacturing jobs across this country. i'm proud to be the co-sponsor house sponsor of legislation to renew trade adjustment assistance because i understand the necessity of t.a.a. not only is this a great trade initiative here, but we are also taking into consideration as we move ahead in this global economy that there may be people who do have opportunities to look at other jobs and this t.a.a. bill provides training and education for people to have and gain better jobs higher paying jobs. so i would encourage my colleagues to vote for this rule and in support of the t.p.a. and t.a.a. ap customs legislation

and i yield back. the speaker pro tempore: the georgia a yields and the chair recognizes the gentlelady from new york. ms. slaughter: i appreciate my friend, mr. seeings giving a good kentucky story. that factory has been in three decades and it's toyota, which is japanese. korea has 26 car dealers in the country. and we buy japanese cars that are made here but they don't buy ours in japan. two years ago we sold 8,000 american cars to japan that entire year and i imagine we sell that many cars in the united states on a daily basis. i appreciate the story and georgetown would love to be mentioned, but we got to get it right. now i'm going to yield to the the gentlewoman from ohio, ms.

kaptur the speaker pro tempore: the gentlelady is recognized. ms. kaptur: i thank the ranking member for yielding me. i rise in opposition to this rule because america's middle class and our workers have been under economic attack. and i rise to voice my opposition to the restrictive process being used to shove these job outsourcing trade deals through congress. the republican leadership has denied our house any amendment even on currency manipulation on legislation that is sure to impact every single american turning our oversight role into more than a rubber stamp. this makes a mockery of the house's clear constitutional authority on trade and commerce. this limitation is being sued because republican leaders do not want to go to conference with the senate. this belies every american, every member their right to be represented and have a voice in

this process. hundreds of multinational corporations and lobbyists helped to write and amend and draft the t.p.p., the transpacific partnership line by line. but today years into the process and negotiation and final stages, members of congress were only recently given our first access to read it. you have to go to a secure room deep in the visitors' center and we are supervised and the notes we take are confiscated and we can't discuss it with anyone unless they have top secret clearance. the trade deal is a secret deal and fast track it through congress hoping that congress won't understand what's in it. and i find hard to imagine a more dangerous approach than fast tracking another trade deal through congress. t.p.a. the authority to fast track is the gateway to the transpacific partnership. both will further harm workers

and communities through a faster global rate to the bottom with more outsourcing of jobs, more lowered wages more dropping benefits, more lower standards for compensation and environment. we have seen that in nafta 30 years ago. for years i fought destructive provisions -- might i have additional time? ms. slaughter: i yield another minute. ms. kaptur: over this period of time, every time one of these so-called free trade deals is signed, america moves into deeper and deeper trade deficits, deeper and deeper red ink as more of our jobs get shift jobs. i remember in mexico and looking at a windshield factory. it seemed like a movie set. it was real. last year alone, our trade

deficit cost us 20% of our g.d.p. is anybody here paying attention or are we all apart of the 1% and forget about the 99% who had to bear the brunt of this terrible, terrible outsourcing of jobs. average american wages across my region have dropped by $7,000. this trade deficit didn't happen by accident. some people got filthy rich off of it. this is the time for america to say no more. no more. we are going to do it right and create trade deals that create jobs in our country and create a stronger middle class improves wages and improves the environment no more taking it out of the hide of america's workers. we are here because we stand on their shoulders. i yield back. vote no on this rule and no on t.a.a. and month on t.p.p. the speaker pro tempore: the the gentlewoman from new york reserves.

the gentleman from texas. mr. sessions: i love our colleagues who come down here and argue japan's the problem you can't talk about the trade agreement that we have with korea where it works. japan japan, japan. good gosh this is about getting a trade deal with t.p.p. of which japan would be included. this is a deal where my colleagues come down and don't like where america -- our are our trade deficits. the bottom line is that the united states has a trade surplus with its 20 free trade partners. surplus. we are trying to take people from nontrade agreements where we run a deficit and they close their market, to a trade deal where we run a surplus where people want to buy american-made products. we have a good deal for them today. and one of those good deals is

agriculture so that our men and women in agriculture can sell their products around the world. and i yield three minutes to the chairman of the agriculture committee, michael quay. -- conaway. mr. conaway: i thank the chairman in bringing us the underlying legislation. everyone in the room knows farmers and ranchers are the most productive and meet rapidly growing and ever changing demands here at home and reach stretches well beyond the shores of america. exports account for one-third of total u.s. farm income. in the case of commodities like cotton tree nuts, rice and wheat, over one half is exported. in 2014, u.s. agricultural exports set a record, highlighting the growing demand for quality food and fiber around the world. in a recent hearing, the united states exported as much beef

pork and poultry with the 20 countries as they did to the other 170-plus nations in the world. beyond the other benefits trade supports almost one million -- american jobs like food processing and transportation. as a result, it's crucial not only to american agriculture but to the u.s. economy as a whole to maintain and increase access to the 7 billion consumers. to obtain that access it's imperative we work to reduce and eliminate barriers to trade so farmers and ranchers can compete in the global market. but negotiations in the world trade organization languishing, free trade agreements represent our best opportunity to expand trade opportunities for u.s. agriculture. history has shown that trade promotion authority in one form or another has been vital incompleting and implementing past agreements. congress has granted t.p.a.

since every president since 1974. t.p.a. will provide the correctness to conclude the effective trade agreements as possible by making it clear that congress and this administration are serious about this endeavor. legislation before us today empowers congress to move the aggressive trade aep agendaa and includes the strongest measure to make sure the president sticks to the negotiating objectives laid down by congress with the ability to turn t.p.a. off. congress will decide the fate of each agreement. i'm a strong proponent of free trade and the benefits it provides. however, if we are not going to expand american markets to other countries with lower standards will step up to the plate and fill that demand. markets are not won after they have been lost and billions around the globe want america's food and fiber.

we can boost our economy and meet these demands by showing we are a strong and reliable trading partner and we can make that happen bypassing this rule and the underlying agreement. i yield back. the speaker pro tempore: the gentleman from texas, mr. seeings, reserves. the chair recognizes the gentlewoman from new york. . ms. lee: i rise in strong opposition to this rule. our country has already lost too many good-paying american jobs because of past trade deals and we should be clear about what this rule would do. this rule is really a vote to extend medicare sequestration and provides for no amendments in the fast track bill, trade adjustment assistance and the customs bill. we've seen what happens when bad trade deals are passed without

congressional oversight. american jobs are shipped overseas. many come from communities of color. dangerous food makes its way to our meals. human rights are violated. labor standards are ignored. and the effects of climate change get worse. the american people do deserve better. the american people deserve a trade policy that creates american jobs and an open process for passing trade deals that gives them a strong voice. passing this rule and passing fast track does neither. this is a bad deal for american workers, it's bad for american jobs and it needs to go back to the drawing board. a draw board that's public and that gives the american people a voice in trade policy, not just big corporations and hedge funds -- hedge fund managers. between 2001 and 011, the growing trade deficit with china cost our nation more than 2.7 million jobs. nearly one million of these jobs mind you, came from communities of color. after these workers lost their

job they situation went from bad to worse. these workers saw their wages fall nearly 30% or more than $10,000 a year. the total economic cost of this job loss to these communities is more than $10 billion. that's $10 billion each and every year. we cannot allow another bad trade deal to ship millions more american jobs overseas. we can't allow another bad trade deal to strip billions from struggling communities. we cannot allow this rule or flawed p.a.a. or fast track to pass. make no mistake i support trade. i have the honor of representing the port of oakland and i understand the critical role that trade plays in the economy of my district. in california and also in our country. however, let me just say, trade only grows our economy -- the chair: the gentlelady's time has expired. ms. lee: may i have an additional 30 seconds. ms. slaughter: i'm sorry, we'll be out.

ms. lee: this bill is in the fair, not open, not transparent. the chair: the gentlelady's time has expired. the gentleman from texas. mr. sessions: the bottom line is that where there is trade with other countries, we have a trade deal, america wins. we get more jobs. as an example, three million jobs in lone star state of texas and we have -- we have that are related to trade and jobs are growing nearly twice as fast as nontrade jobs. this is what's happening. it's the vie brancy of america. at this time i'd like to yield five minutes to the gentlewoman, the chairwoman of the -- ok, you can have three minutes to the gentlewoman from -- who is the chairman of our house admin committee, the gentlewoman from harrison township, congresswoman miller. the speaker pro tempore: the gentlewoman is recognized for three minutes.

mrs. miller: thank you very much. i thank the gentleman for yielding. i tnt want to use everybody else's time. i rise in strong support of this rule. i come from southeast michigan which of course is the heart of american manufacturing. michigan manufactures -- manufacturers, especially the big three automaker companies, have all had concerns for years about the unfair competitive disadvantage they face by nations that manipulate their currencies, such as japan or south korea china. so it was very important to me that if congress moved forward with legislation to give trade promotion authority to this president and others, that the package must also include strong new tools allowing north korea fight back against those nations that unfairly manipulate their currency and those that harm american manufactures -- manufacturers. so mr. speaker, i am very, very thankful that chairman ryan and house leadership agreed to work with us to craft an approach which i believe is a strong step forward. for decades, administrations of

both parties have refused to identify foreign currency manipulators to take any action to stop it. the manager's amendment put forward by chairman ryan that we worked with him to develop gets very, very tough on currency manipulators. for the first time ever mr. speaker, it puts in place a three-part test to define currency manipulation with specific guidance requiring nations that manipulate their currency to be named publicly. also for the first time the focus will be shifted from reporting and monitoring to actionable items and to steps that will show the impact of currency manipulation on the american economy as well, mr. speaker, as requires remedial action to be taken. these tough steps will impact every nation that we trade with. not just those that might be included in the t.p.p. but every nation that we trade with. including south korea and china.

as i mentioned. japan. and certainly while these are steps in the right direction more needs to be done. absolutely more needs to be done. and here in congress, every member of congress continues to reserve the right to oppose any t.p.p. agreement that does not meet the needs of the american economy and the american manufacturing industry. and with these changes that i've outlined here that are going to be in the manager's amendment i support and am proud to support this trade package that will provide an opportunity to drive our economy forward. i yield back. the chair: the gentlelady from michigan yields back. the gentleman from texas reserves. the chair recognizes the gentlelady from new york. ms. slaughter spm i'm pleased to yield two minutes to the gentleman from massachusetts, mr. lynch. the speaker pro tempore: the gentleman is recognized for two minutes. mr. lynch: thank you, mr. speaker. i thank the gentlelady for yielding. mr. speaker, prior to coming to congress i worked for a while as an ironworker at the quincy ship

yart in quincy massachusetts. i was a welder. unfortunately, because of bad trade policy that shipyard closed down and thousands of workers were laid off. later on, i also worked at the general motors facility in framingham, massachusetts and the company decided to close that plant down and while they opened three new ones in mexico. so i have seen what lousy trade policy can do. the fundamental problem with our trade policy is that it is negotiated in secret by multinational corporations who basically hiring foreign labor at very low wages move the jobs overseas and then export the products back into the united states. if you look at some of the minimum wagers in countries that we're dealing with in this trade agreement for ma lay shah and vietnam, it's less than $1 an hour for the minimum wage in those countries and thain maintain those low wages so that

they can attract business. it's a race to the bottom. i do want to say that as part of my job with the oversight committee, i have had a chance to go to south korea and japan to see how our trade agreements have been working out there. i was in south korea for several days and just on my own and with my staff, i looked for an american car. for several days. i saw we were in traffic a lot. south korea is a booming industrial country. major highways. i saw hundreds of thousands of cars. i saw two, two, united states cars. one was the one i was driving in from the embassy and the second car was my security detail behind me. those were the only two u.s. cars. only two u.s. cars. our trade with japan. i was in japan as well. you need a detective to find a u.s. car in japan. that's the plain and simple fact.

they import $1 billion worth of u.s. manufactured products in auto and the air industry. we import $25 billion. $1 billion -- may i get another 30 seconds? or are we out of time? ms. slaughter: we are. the chair: the gentlelady from new york reserves. the chair recognizes the gentleman from texas. mr. sessions: i would like to ask one simple question. what was that trade deal that you were talking about. mr. lynch: the korea-u.s. trade agreement two years ago. mr. sessions: i thought you said you lost your job. mr. lynch: what's that? no no, no. the job i lost, you were talking to people, the job i lost, 2,00 workers lost at the g.m. plant those plants were reopened in mexico. mr. lynch: when was that? mr. lynch: right after and a half tafment another bad trade agreement. mr. sessions: we gave you good

job and you came to congress. i think the gentleman makes a point i'd like to make and that is we need a trade deal with japan to level the playing field and that's exactly what we are going to do. at this time i'd like to yield three minutes to the gentleman from north carolina, the gentleman who sits on the ways and means committee, the gentleman, congressman holding. the speaker pro tempore: the gentleman is recognized for three minutes. but i would like to remind everyone that the comments should be directed to the chair. mr. holding: mr. speaker, i'd like to thank chairman ryan sessions tiberi, for their tireless efforts to move us closer to realizing trade deals to unlock new markets and bolster our national security. mr. speaker, i rise in support of both the rule in front of us today and the trade promotion authority legislation we will consider tomorrow. the benefits of increased free and fair trade are well

established and undeniable. for companies in my state, the pending trade deals would remove tariff barriers and unlock doors for businesses such as morris associates who export the world's best poultry chilling equipment. o a company like cummings engines in my state that export u.s. made engines and allow countless farms to export chickens tobacco, and sweet po tai lows across the globe. this means increased productivity, better wages and more jobs. more importantly t.p.a. is about empowering congress, making sure that this body and people's elected representatives keep tight reins on this president. now i'm certainly no supporter of the president's laundry list of unconstitutional actions from immigration to the administration's unilateral attempts to salvage the sinking ship that is obamacare which is

why t.p.a. is needed. the president is going to negotiate trade deals whether or not we pass t.p.a. why wouldn't we want to make this president's negotiators more accountable? the deals themselves more transparent? and make our oversight more effective? here's how it works. president disregards the parameters congress sets out or fails to consult members at every stretch. congress can turn off t.p.a. the president comes back with a bad trade deal, congress can vote it down. but mr. speaker, we need t.p.a. to not only get the best deals possible but also need this authority to check the president. so i urge my colleagues, support the rule, support t.p.a. and i yield back. the speaker pro tempore: the gentleman yields back. the gentleman from texas reserves. the chair recognizes the gentlelady from new york. ms. slaughter: mr. speaker i'm pleased to yield two minutes to the gentlewoman from michigan, land of cars, mrs. dingell.

the speaker pro tempore: the gentlelady is recognized for two minutes. mrs. dingell: thank you, mr. speaker. mr. speaker, the rule we are considering today represents everything for me that's wrong with politics. we're currently debating the most important package of trade legislation in a generation. yet despite how critical this issue is to american jobs, this rule does not allow any amendments. currency manipulation, the mother of all trade barriers has cost this country as many as five million jobs. a bipartisan group of 20 members, 10 republicans, 10 democrats proposed an amendment to address this. and it is vital that congress debate and vote on how to address currency manipulation as we set u.s. trade policy for the next decade. with nothing but the deepest of respect for the care of the rule -- for the chair of the rules committee, i want to give you

the facts about the korean free trade agreement. the reality is before it passed, after it passed, we increased exports to korea from 14,000 to 34,000. by comparison korea imported into this country 800,000 to the u.s. before the trade agreement and now exports 1.3 million. we increase our exports to korea by 20,000 they increased their exports to this country by 461,000. toyota made more money last year in currency manipulation in this country than ford motor company did in its worldwide operation. the american people deserve a full and open debate on trade policy. not procedural gimmicks and political games that shut out amendments and avoid the tough questions. let's defeat this rule and have a real debate on the issues that the working men and women of this country have sent us here

to consider and that our -- and that are so critical to the livelihood and backbone of this american economy. american jobs are at stake. thank you mr. speaker, i yield back. the speaker pro tempore: the gentlelady yields back. the gentlewoman from new york reserves. the chair recognizes the gentleman from texas. . mr. sessions: i would like to yield to the gentleman from washington for three minutes. the speaker pro tempore: the gentleman is recognized for three minutes. mr. newhouse: i would like to thank the chairman for yielding his time. i rise today to support the rule and the underlying trade promotion authority granted by h.r. 1314. i can affirm that the rules committee seriously considered many amendments and concerns from both democratic and republican members late into the night. this rule has been very fair

deliberative and interested parties have been given ample opportunity to weigh in on it and the underlying legislation. mr. speaker, as you just heard, i come from the state of washington, which is the most trade-benefited state in the country. if my colleagues want to see the jobs it creates look at my state. we export coffee aircraft footwear and soft wear. in washington we export apples. more than 85% of the wheat 75% of the hops. consumers around the world are enjoying a brand new crop of frerk washington state cherries. but the trade success story i want to share with you is about potatoes. prior to the u.s. free trade agreement that was si