health. the bottom line is no more mental health business as usual, because business as usual is failing too many young people at every single point. from the first time of symptoms to the most critical moments of crisis. that's a lot for the committee to discuss today on these key issues. we're going to have a great panel and i'm going to introduce shortly, i want to thanks senators carper and cassidy for heading up the mental healthcare and senator stavanaugh for years of work on behavioral health issues that are so important. now we'll turn to the senator for opening remarks, and introductions, and where is my friend senator krikmoe, there he is. >> thank you mr. chairman and thank you to our witnesses for joining us today as we discuss ways to respond to mental health challenges impacting children and adolescences across the country, according to recent reports from the cdc the number of young people dealing with depression, anxiety and suicidal thoughts has unfortunate naelt risen during

health is separated from our mental health. so we see often that people get lost because they go from one provider to another trying to get the treatment they need and deserve and they can't -- they can't find one provider to do all of those things. the second thing i'll say is that just in general, getting access to care is very hard for our patients. there are a lot of barriers when we start thinking about what substance use treatment programs only want to give medication versus thinking about other psychotherapeutic interventions. how people get into treatment is very difficult. sometimes, unfortunately, providers will say, well, you need to go to the emergency room intoxicated to get a detox bed, if not they're not going to accept you. this is the reality of how patients get treatment in the system. because of bed availability, because of the way reimbursement happens, because of the way insurers operate. and last but not least, you know, i do want to think about how do we think about substance use in general, the inequity

health care. senator hassan: been navigating -- health care has been navarro gaying through health care challenges -- senator hassan: been navigating -- has been navigating health care challenges. it really shows a system where its weaknesses are. i can't talk about it today but i think beyond what we're going try to focus on today, health care has got to be a priority for the health care consumer. i changed my plan 15 years ago, most individuals weren't interested in prevention in wellness. they were interested in remediation and whatever the cost was. i flipped the paradigm upside down and i think the industry has catered mostly to remediation and it needs to focus, as we get through shortages in work force, in offering the health care consumer more information about how you avoid the system by staying healthy, and prevention, it's the underpinning of what i did, in addition to making my employees' health care consumers. let's look at where we are now. in december of 2021 10.9 million job openin

as physical health care. special passion of mine particularly because we launched our investigations after a debacle at the oregon health sciences center where they couldn't get their claims paid early on in the pandemic because the insurance companies were stalling. senators cardin and food will team up on making it easier to get mental health care via telehealth. and finally, i want to just mention what the direction here is, really the lone star for what the committee has talked about in the past. everybody in america must be able to get the mental health care they need when they need it. that is the northstar here. so featuring mental health experts and advocates because they put a special focus on our young people and before wrapping up i would like to say here today i want to thank the senator from south carolina, senator scott who's talked with me at considerable length about the coots bill that i mentioned and we were able to secure a billion dollars in medicaid for he has been instrumental in this al

, mental health, mental health. that is more true now because of the pandemic. so with that preface, dr. murthy, i've got two questions i'd like to ask you. a few weeks ago i spent time with some leaders from summit county in colorado to listen to local mental and behavioral -- listen to to them discuss local mental and behavioral health needs and potential solutions. one striking theme was the pitiful reimbursement rates for mental and behavioral services, plus wrap-around services from both public and private insurance. one organization called building hope which provides scholarships to receive care said over 50% of their clients have private health insurance. the sheriff of the county was also on and he mentioned that establishing a mobile crisis unit which pairs a clinician and nonuniformed deputy to respond to crises costs $1.5 million for the community but saves the county $17 million. there wasn't a person on this call that disputed this. i'm particularly grateful to senator cortez-mastiff who's led. what i'

i think physical health and mental health braid together. when our mental health is not doing well we will see poor sleep, poor diet, isolating from others, not engaging in physical activities that can provide good mental wellness. >> well, thank you. is there anything you would prioritize in the improvements of that program if we had more dollars for the certified program? >> i think as i spoke in my verbal statement it's around the reimbursement rates. and we sustain the workforce to deliver the crucial care. >> thank you, mr. chairman. >> thank you, senator cantwell. the northwest is going to be very united in this effort. i believe senator menendez will be next. senator menendez, are you out there on line? we may have lost senator menendez. senator menendez? senator portman is next then. >> thank you, mr. chairman. i appreciate it. i appreciate the testimony and the fact you are in the trenches every day doing great work with our young people. dr. hoover, you talked about telehealth. i want to be sure we are focused on the broader behavi

mental health. mental health and now true even more.i have two questions a few weeks ago i spent time with leaders in colorado to listen to discuss local mental behavioral health needs and solutions and one striking team lines the pitiful reimbursement rates for services plus wraparound services for both public and private insurance and one organization called building help and over 50 percent of the clients and private health insurance this year if one is also on and he mentioned establishing a mobile crisis unit which pairs a clinician and nonuniform deputy cost one.$5 million to the community but saves the county $17 million there wasn't a person on the call that disputed this and i have grateful to senator cortez masto who has but reimbursement on the committee. and then to be a cornerstone here in the finance committee. so can you speak to the importance of higher reinforcement and private insurance also medicaid and medicare quick. >> thank you senator for that. and i appreciate your perspective as an educator yourself when it com

physical health. the bottom line is no more mental-health business as usual because business as usual is failing too many young people at every single point from the first sign of symptoms to the most critical momentnt of the crisis. that's what we'll discuss today onat these key issues could we have a great panel and i will introduce themca shortly. i want to thank senators carper andbe cassidy for heading up our efforts on mental-health care and i also want to commend senator stabenow for her years and years of work in behavioral health issues that are so important. now we will turn to senator crapo for hisha opening remarks and then we'll go to introductions and where is my friend senator crapo? there he is, senator crapo. sammy thank you mr. chairman thank you tour witnesses for joining us today as we discuss ways to respond to mental health challenges impacting children and adolescents across the country. according to recent reports from the cdc that number can people dealing with depression anxi

-- electronic health record. so that wouldn't be, it probably would have to track along with their ultimate buildout? >> that's my understanding. enter okay. tell me a little bit about dod-funded research on taking the information that we have about potentially toxic exposure s and making certain presumptions about how that exposure could have caused a bad outcome for a service member. >> sure. >> so-called presumptions. >> sure. with regard to human studies, most of the human studies, human research that we sponsor and continue to sponsor really compares a group of deployers to a group of, a control group of non-deployers to take a look at location, environmental health assessments, what were the threats over there and then look at the differences in terms of the incidents of health outcomes between the deployed force in that area and the control that were non-deployers. in addition to that, we also have experiments. we have animal experiments at the air force up at the 7/eleven which are looking at exposure to

we also know that universal health care coverage can reduce health inequities and disparities in health. when we expanded the children's health insurance program, which was of course expanded for low-income families who did not qualify for medicaid, it was associated with increased access to care and reduced racial disparities. similar instances of diabetes and cardiovascular disease, outcomes by race, ethnicity and socioeconomic status declined once they became eligible for medicare coverage. we also know that as we think about these disparities, universal access to care does -- goes a long way to improving health, but the social determinants of health is actually a bigger determinant in many ways, particularly around health care disparity. but access is an essential component of that. we know also that health insurance coverage can improve the economic well-being of communities, it can create jobs as well. if there's anything that we've not missed, the covid outbreak has demonstrated the importance of universal health care coverage more than anything else. as you know, we've got over

the public health service of the united states whose duty it is to protect the health of the nation. it's a core of positions. scientist and other professional health workers. it is served us with integrity. in 1798 i have asked the surgeon general of the public health service. to talk with us tonight about vaccines. and the soak vaccine in particular? he has served as an officer in the service since 1930. and as your surgeon general since 1948 it is my privilege. to present a distinguished public servant dr. leonard a shealy many questions have been raised and recent weeks about the new vaccine against poliomyelitis. people are asking is it absolutely safe. does it really protect against polio? will there be enough vaccine for large-scale use this summer? i will give you the facts about the vaccine as i know them. and i want to give you some idea of the outlook for the future. first something about the disease itself polio occurs everywhere in this country and throughout the world it is caused by a virus. so small that its presence cannot be known except by its effect on living anim

health.senate.gov and if you are in need of accommodations, including closed captioning, you can reach out to the committee or the office of congressional accessibility services. we continue to see a high number of new covid cases so we are having this hearing in a larger hearing room where we can be socially distanced, limiting the number of people who are in the hearing room, accommodating both some of our committee members and our witnesses through video as we have done previously, and taking additional fissures such as wearing masks. as always i appreciate the work from the staff of the sergeant at arms, the architect of the cow capitol and our committee clerk and staff to make this hearing us safe as possible. thank you to all of you. even before the covid-19 pandemic, our nation was facing mental health and substance use disorder challenges on multiple fronts. millions of people experienced depression, anxiety and other mental health disorders. drug overdoses were on the rise, and our h

health and health equity, speech and language pathology and pharmaceutical sciences. three upcoming programs are the m.s. in health and genetic counseling and the doctor of physical therapy. while we are proud of the work we do at xavier, we as a nation are challenged to address the numbers of black doctors and scientists nationally, much more must be done to develop a representative community of health care providers and scientists, positioned to reduce and eliminate health disparities. to fully address this need, the pipeline sending undergraduate students into schools such as xavier must be fastly expanded. this will be required pathways to all. including information to families on pathways to college, the application financial aid processes, make the journey achievable without the burden of lifelong debt. america cannot afford to develop only a subset of its talent fore saking many whose contributions are needed. with this being said, i would like to firmly thank congress for recent investments in funding to hbcus, tribal colleges and universities. minority served

so when the leading voices on public health issues can you explain how having stable universal healthage such as medicare improves health outcomes? >> it matters. that makes a big difference. the number of times and it is a whole lot of things. and then to reduce healthcare costs. >> i want to talk about the tie in between healthcare and insurance. what harm does a system that tethers health insurance to employment even with the presence of a public option prevent? research at the economic policy institute and then labor union struggle to bargain for increased wages while they also have to for adequate health insurance. can you but those that are bargained quick. >> yes. first of all by tying medical insurance to employment as we now do we find ourselves that people are tied to employment at a time when not only have event or a pandemic how that relationship can be but also more and more people who are working part-time who are contract workers and self-employed. and those that are not tied to individual employers. and then those that are shut out of the healthcare system that is empl

not only is there a mental health component, but there is physical health being delivered in your home where you are accountable and where you know things are. it cannot be overstated, to be honest with you. i think that very often that providing home health care is actually better overall in a system that has limited resources. and it does not seem that way to you, but when we are spending over $550 billion or so for medicare and nearly $400 billion for medicaid and over $400 billion for veterans benefits as well, we run into the challenge of limited resources. i think we can take our resources further by focusing on a delivery system that is so often at home. the final comment i would make is that as we think through the unbelievable challenges of the pandemic, one of the more important points is delivery system a virtual health care. to have patience, as we spoke about today, being able to see their doctors from their homes when possible, really helpful. and i hope we continue as a nation to move in the direction of providing virtual health care as a priority, and as a priority deli

care, in access to health care, if you had a health care, then the days parities in the quality of caret you were able to get. and then covid hit, and those disparities are now too big to ignore, because of who is being impacted. i would love for you to talk about how those disparities manifested themselves in santa ana during the pandemic and what steps you've taken to try to address them as a result of covid. >> look, i'll give you some really specific examples. when the vaccine was, you know, being delivered, you know, the state sent the vaccine inventory to the counties so the county could deliver them to the cities. here in santa ana, we knew that the epicenter of the, you know, the pandemic was here in our city. and unfortunately, vaccines were going to other parts of the county. more affluent communities, you know, more white communities, and that's when, you know, i think the tide turned when everybody, you know, especially me, started shouting at the top of my lungs, you know, we have to get the vaccine delivered to where the problem is. and so, you know, as i said, many of our

behavioral health services under mental health san francisco. we are going to talk about our overview bed expansion. what we do with beds, current status, challenges and barriers and next steps. this answers some of supervisor ronan's questions. we can address more in questions and answers. i apologize going fast. we were told we have seven or 10 minutes. i want to respect your time. this is our mental health san francisco. we are divided into four components. office coordinated care which is a central call center. i think of it as the hotel. com. they help you get people connected, make reservations, get people from hospitals, one stop place people can come in. street crisis response team addresses crisis on the street as an alternative to police actions. mental health service center around the clock drop in service center. new bed facilities which is what we are talking about today. adding new resources to the city. residential care beds we divided into our current system of care which is we have 2200 pre-existing beds. we have a lot of servic

health issues to her role. welcome. we are delighted to have you. >> thank you. >> next, we have dr. gracia, where she works to promote sound public health policy, advanced health equity, address the social determinants of health, and she brings awareness of disease prevention. she has extensive leadership in federal government, professional associations, academia, and clinical practice. welcome. we are glad to have you with us as well. next, we have the reverend douglas greenaway. he retired earlier this year after having served as the association's president and ceo for more than three decades so clearly, he has a long history in dealing with these issues. as many of you are aware, it is the nonprofit education arm of the 6.3 million mothers and young children participating. the supplemental nutrition program and the more than 12,000 service provider agencies and clinics. thank you -- welcome. delighted to have you as well. last but not least, we have someone that i have come to admire and learned so much fro

health. it had a big ceremony invited people from all over the country who interested in mental health the leaders in the field. and i was really excited had great people the best people in the country. the next day i picked up the washington post and not one word. not one word. i was really distressed new york times had a good order. there was not one word. and so then i fussed about it. and people depressed some of the press we would come to came to maybe one or two meetings, but we worked. on those and that task force and that commission and we met long hours and we were and finally one of the press people said doing. well mrs. carter mental health is just not a sexy issue. well that made me mad. i was really made me mad. so it's frustrated sometimes because they would cover the things that i didn't think was important. and they didn't cover in i didn't want mental health cover, but because it was my project. but the stigma is so bad. and that if people are in the country know that it's an

public health. dr. figueroa's research focus is on understanding the drivers of health care spending and poor clinical outcomes among older at-risk populations with complex medical needs. he's also a practicing hospital medicine physician at brigham and women's hospital in boston, where he provides care to many americans with medicare and medicaid. i want to thank dr. figueroa for being with us today to share his expertise with the committee. for a second witness, i'll turn to ranking member scott. >> thank you, mr. chairman. i am pleased to welcome eunice medina. eunice is a new south carolinian but somebody who has a deep background and understanding of this critical issue. eunice serves as the chief of staff and deputy director of programs for the south carolina health and human services. the state department of hhs is the agency responsible for running our state's medicaid program which provides health coverage to more than 1 million south carolinians. it also coordinates care for south carolini

health care providers.art and of the va continues to share education training and outreach to improve exposure related clinical care. airborne hazards and those potential acute and chronic health effects during deployment and post-deployment. as such the department has enhanced its. and post deployment related health assessments and the separation of health investment to include more specific occupational and environmental exposure questions including questions on burn pits and other airborne hazards. the department and the pa are currently collaborating in moldable efforts including the development of the worst ever individual longitudinaldi expose her. we call it i lar are fighting exposures summaries by leveraging personnel locations, environmental monitoring and health assessment data. the department is conduct in a comprehensive exposure monitoring capability assessment aimed at improving individual area exposure monitoring and recordkeeping across thehe installation, training and deploying environment

. >> next, health and human services javier becerra spoke about overcoming health disparities in latinomunity and the current response to the covid-19 pandemic. it's 40 minutes. >> been among the communities hit hardest by the coronavirus pandemic which revealed long health disparities in the united states. today we're going to focus on the impact of those health disparities on latinos. javier becerra from health and human services, thank you for joining me live. >> thank you for having me and thank you for all that you've done. >> thank you very much for whatever i've done, i thank you. let's dig into the health disparities, mr. secretary, experienced by latino communities. first, how have barriers such as hospital, transportation, affected outcomes before and during the pandemic? >> well, jonathan, as you know, if you live in a food desert or if you live in a medical service desert, it makes it far more difficult for you and your family to get the type of services and have the type of health that would be possible if all of those things were within your reach. some cases you could liv

the captives regularly raped the health -- helpless women.ement sales. -- cells. small, pitch black prisoners. once they step foot in the castle, they could spend up to three months in captivity. imagine living in these dungeons. defecating on themselves, standing near corpses. under these dreadful conditions until they were shifted into the new world. and then for them to cross the atlantic, from being thrown off the ship's, to come to places like the united states, africans were then hunted like animals, captures, sold, tortured and raped. they experienced the worst kind of physical, emotional, sake will -- psychological abuse. you can imagine how traumatizing the slavery was. emancipation was followed by 100 more years of institutionalized racism through the enactment of black coals, convict lease -- convict leasing, lynching, these violations continue. and when combined with the crimes of the past as dr. joyce states, it results in unmeasured injuries. so to understand where we have come helps to delay the necessary foundation to ensure t

can you pinpoint when this mental health crisis among doctors and other health care workers actually began? and i don't know if i can speak specific enough time. certainly they meet chess is always run hot for the 20 years. the are going to win. and we've always been busy revolt enough against that. i think the difference then was it felt like leadership was where you and would be responsive to those demands at the moment. and i'd say probably for the last 10 years. and it's been, we raised those concerns as too dangerous as to, to too much and demands and know enough of us to be able to do that. and this is the time when you have not been responding to that, probably the last 10 years. and we have been the funded a lot of our money has went away from the frontline and to private providers. so yeah, i mean, i think that as a sense the government does one to change that we health care is delivered and, and the u. k. and that's fine, we can have an open to be, we can discuss that. but it seems like a law of law has been done. perhaps no, very upfront about that, really would you, would

our big mental health facility hospital, there had been a big expose and the mental health systems act had been passed in 19, you know, this was '63 and this was 1966 when jimmy first ran for governor, but we got in late because our lean-in democratic candidate had a hard attack. but they were moving people out of the hospital because like 12,000 people when they had room for 3,000, it was awful, it was happening all over the country and they're rolling them out before they had new facilities for them. had no services in the communities and everybody started talking to me about what will your husband do if elected governor of georgia? i just learned so much of what was going on and after realizing the election i worked four years to learn about mental health and after the first office, appointed government commission to improve services for the emotional and mentally hand kaep. i got a bit upset too, they covered my mental health work the first few meetings i had and then never showed up anymore and what i wanted to do was bring attention to the issue and how terrible it was and how fe

mental health treatment services. the challenges spoke of earlier is beyond the services there does need to w be a narrative shift how we look at behavior consider a child with trauma sitting in math class having double concentrating on a lesson. if they have a history of abuse perhaps they are focused on is the teachers mood rather than the words because that is what they have to do at home in the community to alert them to danger they w witnessed violence perhaps they are listening carefully but they're so anxious there brain literally has trouble processing language. the story about the child is they are spacey or that they are disrespectful. of the response is corrective action rather than support then that becomes a source of harmon trauma rather than on —- rather than the lifeline. >> i apologize i must do this is against my nature. but i have to call time. sometimes i can'tes help myself and i get in trouble it was an income public education. but we must stay focused on our role and to ensure that teachers can

for the health of the populace? when there is a risk benefit judgment to be made, who makes it? people often care about factors that science ignores. such as whether treatment is affordable, whether it's in line with their understanding of their wealth, and their attitude toward outside authority and systems of power. this is clear in the diverse public attitudes towards masks and vaccines and the coronavirus pandemic, which is an evolving story, and this book is being written. these questions may be cerebral, but health care is inherently visceral. think of the core feel of [inaudible] love, the kobe [inaudible] strep throat mechanisms medicine utica child, or the closeness of must. in any moment of the past, the physicality of health care might be the soft, one inches of the toys the visiting nurse brought with her, the grasp of the metric metal caliber measuring your head, or the tar stink of carbonic acid, a precursor to today's much gentler antisemitic hospital smell. the physical stuff of health care makes abs

i do think there c is a big argument for child health, teen health, getting rid of the transition back and forth. now, the reason i think permanent time is a healthy choice, to get ourselves going, the kids need to be alert to go to school and learn. they are also often times on the road driving in the dark and there've been multiple studies crashes are more common when kids are driving to school in the early morning hours like 7:00 versus 8:00. that's one area kids are really affected in the permanent standard time would make a huge difference. then we also seere the impact of depression, adhd, self-harm, obesity. so there's a lot of health aspects where getting more sleep, wake you up, get you going makes it easier to go to sleep at night and having lots of that would be promoted by having permanent standards adopted. >> thank you. let me just to say we know the economy is hurt by changing the productivity workplace injuries arise, so let me just ask i only have a minute. in your testimony you mentioned the stock market averages a negative return when we switch our clocks. what other

i do think there's a big argument for child health, teen health, by getting rid of the transition back and forth. the reason i think permanent standard time is the healthy choice is because we need light in the morning to become alert to, get ourselves going. the kids need to be alert to go to school to learn. they are also often times on the road driving in the dark, and there have been multiple studies that have shown that motor vehicle crashes are more common when kids are driving to school in really early-morning hours, like the 7:00 hour versus the 8:00 hour. so that's one area where kids really are affected and the permanent standard time would make a huge difference. we see depression, adhd, self-harm, and obesity is huge right now in our kids. there's a lot of health asterisks where getting more sleep, and then the light when you wake up and get you going, and having less of the late evening life that can mess up our sleep patterns. all of that, the early morning light plus light in the evening would be promoted by having permanent standard time adopted. >> thank you. let me ju

the second is to identify health outcomes or health issues of personal concern that need evaluated and further either by primary care provider or specialist in further care but as a function, additional opportunity to ascertain any personal concerns the individuat may have about exposures within the environment in which they operate soldier worked deployed to so essentially there are three main points of care in my view in which the individuals are evaluated is downrange if they experienced symptoms and when they return home as a function of post deployment process it also annually on a periodicin basis when they apper on the health assessment. [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] >> thank you, ih agree with my colleagues, the eiler does report specific questions we ask about airborne hazards so not only are we looking at the occupation environmental risk assessment of a when the member wasle on in reviewing exposures, it's taking questions the member has answered regarding airborne hazards post appointm