[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]
THE FISCAL YEAR 2023 HHS BUDGET
=======================================================================
HYBRID HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON ENERGY AND COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTEENTH CONGRESS
SECOND SESSION
__________
APRIL 27, 2022
__________
Serial No. 117-81
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Published for the use of the Committee on Energy and Commerce
govinfo.gov/committee/house-energy
energycommerce.house.gov
_______
U.S. GOVERNMENT PUBLISHING OFFICE
61-451 PDF WASHINGTON : 2026
COMMITTEE ON ENERGY AND COMMERCE
FRANK PALLONE, Jr., New Jersey
Chairman
BOBBY L. RUSH, Illinois CATHY McMORRIS RODGERS, Washington
ANNA G. ESHOO, California Ranking Member
DIANA DeGETTE, Colorado FRED UPTON, Michigan
MIKE DOYLE, Pennsylvania MICHAEL C. BURGESS, Texas
JAN SCHAKOWSKY, Illinois STEVE SCALISE, Louisiana
G. K. BUTTERFIELD, North Carolina ROBERT E. LATTA, Ohio
DORIS O. MATSUI, California BRETT GUTHRIE, Kentucky
KATHY CASTOR, Florida DAVID B. McKINLEY, West Virginia
JOHN P. SARBANES, Maryland ADAM KINZINGER, Illinois
JERRY McNERNEY, California H. MORGAN GRIFFITH, Virginia
PETER WELCH, Vermont GUS M. BILIRAKIS, Florida
PAUL TONKO, New York BILL JOHNSON, Ohio
YVETTE D. CLARKE, New York BILLY LONG, Missouri
KURT SCHRADER, Oregon LARRY BUCSHON, Indiana
TONY CARDENAS, California MARKWAYNE MULLIN, Oklahoma
RAUL RUIZ, California RICHARD HUDSON, North Carolina
SCOTT H. PETERS, California TIM WALBERG, Michigan
DEBBIE DINGELL, Michigan EARL L. ``BUDDY'' CARTER, Georgia
MARC A. VEASEY, Texas JEFF DUNCAN, South Carolina
ANN M. KUSTER, New Hampshire GARY J. PALMER, Alabama
ROBIN L. KELLY, Illinois, Vice NEAL P. DUNN, Florida
Chair JOHN R. CURTIS, Utah
NANETTE DIAZ BARRAGAN, California DEBBIE LESKO, Arizona
A. DONALD McEACHIN, Virginia GREG PENCE, Indiana
LISA BLUNT ROCHESTER, Delaware DAN CRENSHAW, Texas
DARREN SOTO, Florida JOHN JOYCE, Pennsylvania
TOM O'HALLERAN, Arizona KELLY ARMSTRONG, North Dakota
KATHLEEN M. RICE, New York
ANGIE CRAIG, Minnesota
KIM SCHRIER, Washington
LORI TRAHAN, Massachusetts
LIZZIE FLETCHER, Texas
------
Professional Staff
TIFFANY GUARASCIO, Staff Director
WAVERLY GORDON, Deputy Staff Director
NATE HODSON, Minority Staff Director
Subcommittee on Health
ANNA G. ESHOO, California
Chairwoman
G. K. BUTTERFIELD, North Carolina BRETT GUTHRIE, Kentucky
DORIS O. MATSUI, California Ranking Member
KATHY CASTOR, Florida FRED UPTON, Michigan
JOHN P. SARBANES, Maryland, Vice MICHAEL C. BURGESS, Texas
Chair H. MORGAN GRIFFITH, Virginia
PETER WELCH, Vermont GUS M. BILIRAKIS, Florida
KURT SCHRADER, Oregon BILLY LONG, Missouri
TONY CARDENAS, California LARRY BUCSHON, Indiana
RAUL RUIZ, California MARKWAYNE MULLIN, Oklahoma
DEBBIE DINGELL, Michigan RICHARD HUDSON, North Carolina
ANN M. KUSTER, New Hampshire EARL L. ``BUDDY'' CARTER, Georgia
ROBIN L. KELLY, Illinois NEAL P. DUNN, Florida
NANETTE DIAZ BARRAGAN, California JOHN R. CURTIS, Utah
LISA BLUNT ROCHESTER, Delaware DAN CRENSHAW, Texas
ANGIE CRAIG, Minnesota JOHN JOYCE, Pennsylvania
KIM SCHRIER, Washington CATHY McMORRIS RODGERS, Washington
LORI TRAHAN, Massachusetts (ex officio)
LIZZIE FLETCHER, Texas
FRANK PALLONE, Jr., New Jersey (ex
officio)
C O N T E N T S
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Page
Hon. Anna G. Eshoo, a Representative in Congress from the State
of California, opening statement............................... 2
Prepared statement........................................... 4
Hon. Brett Guthrie, a Representative in Congress from the
Commonwealth of Kentucky, opening statement.................... 6
Prepared statement........................................... 8
Hon. Frank Pallone, Jr., a Representative in Congress from the
State of New Jersey, opening statement......................... 12
Prepared statement........................................... 14
Hon. Cathy McMorris Rodgers, a Representative in Congress from
the State of Washington, opening statement..................... 16
Prepared statement........................................... 18
Witnesses
Xavier Becerra, Secretary, U.S. Department of Health and Human
Services....................................................... 22
Prepared statement........................................... 24
Answer to submitted questions \1\
Submitted Material
Article of June 29, 2021 ``Inside the Risky Bat-Virus Engineering
that Links America to Wuhan,'' by Rowan Jacobsen, MIT
Technology Review.............................................. 92
The March 2022 National COVID-19 Preparedness Plan from the Biden
Administration \2\
----------
\1\ The witness material havs been retained in the committee
files and is available at https://docs.house.gov/meetings/IF/
IF14/20220427/114658/HHRG-117-IF14-Wstate-BecerraX-20220427-
SD001.pdf.
\2\ The submitted material has been retained in the committee
files and is available at https://docs.house.gov/meetings/IF/
IF14/20220427/114658/HHRG-117-IF14-20220427-SD004.pdf.
The Fiscal Year 2023 HHS Budget
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WEDNESDAY, APRIL 27, 2022
House of Representatives,
Subcommittee on Health,
Committee on Energy and Commerce,
Washington, DC.
The subcommittee met, pursuant to notice, at 10:18 a.m. in
the John D. Dingell Room, 2123 of the Rayburn House Office
Building, and remotely via Cisco Webex online video
conferencing, Hon. Anna Eshoo (chairwoman of the subcommittee),
presiding.
Members present: Representatives Eshoo, Butterfield,
Castor, Sarbanes, Welch, Schrader, Cardenas, Ruiz, Kuster,
Kelly, Barragan, Blunt Rochester, Craig, Schrier, Trahan,
Fletcher, Pallone (ex officio); Guthrie (subcommittee ranking
member), Upton, Burgess, Griffith, Bilirakis, Long, Bucshon,
Hudson, Carter, Dunn, Curtis, Crenshaw, Joyce, and Rodgers (ex
officio).
Also present: Representatives Schakowsky, Mr. Palmer
Staff present: Lydia Abma, Fellow; Jacquelyn Bolen, Health
Counsel; Jesseca Boyer, Professional Staff Member; Tania Calle,
Fellow; Hilary Carruthers, Fellow; Waverly Gordon, Deputy Staff
Director and General Counsel; Tiffany Guarascio, Staff
Director; Zach Kahan, Deputy Director Outreach and Member
Service; Una Lee, Chief Health Counsel; Aisling McDonough,
Policy Coordinator; Meghan Mullon, Policy Analyst; Juan
Negrete, Junior Professional Staff Member; Kaitlyn Peel,
Digital Director; Caroline Rinker, Press Assistant; Chloe
Rodriguez, Clerk; Kylea Rogers, Staff Assistant; Andrew
Souvall, Director of Communications, Outreach, and Member
Services; Rick Van Buren, Health Counsel; Charlton Wilson,
Fellow; C.J. Young, Deputy Communications Director; Alec
Aramanda, Minority Professional Staff Member, Health; Kate
Arey, Minority Content Manager and Digital Assistant; Sarah
Burke, Minority Deputy Staff Director; Seth Gold, Minority
Professional Staff Member, Health; Grace Graham, Minority Chief
Counsel, Health; Nate Hodson, Minority Staff Director; Peter
Kielty, Minority General Counsel; Emily King, Minority Member
Services Director; Bijan Koohmaraie, Minority Chief Counsel,
Oversight and Investigation, Chief Counsel; Clare Paoletta,
Minority Policy Analyst, Health; Kristin Seum, Minority
Counsel, Health; Kristen Shatynski, Minority Professional Staff
Member, Health; Olivia Shields, Minority Communications
Director; and Michael Taggart, Minority Policy Director
Ms. Eshoo. The Subcommittee on Health will now come to
order. Good morning, colleagues.
Good morning, Mr. Secretary. Welcome.
Due to COVID-19, today's hearing is being held remotely, as
well as in person. For members taking part remotely,
microphones will be set on mute to eliminate background noise.
Members will need to unmute their microphones when you wish to
speak.
Since members are participating from different locations at
today's hearing, recognition of members for questions will be
in the order of subcommittee seniority.
Documents for the record should be sent to Meghan Mullon at
the email address we have provided to your staff, and all
documents will be entered into the record at the conclusion of
the hearing.
Secretary Becerra has a hard stop at 1:15 p.m. today, so
I--you will find that I will not be my usual generous self in
terms of not lowering the gavel after 5 minutes is consumed. So
we want to have enough time for every member to question.
So the Chair now recognizes herself for 5 minutes for an
opening statement.
OPENING STATEMENT OF HON. ANNA G. ESHOO, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF CALIFORNIA
Mr. Secretary, welcome to your first in-person hearing with
our Health Subcommittee. What a difference a year makes. When
you last testified at our subcommittee in May 2021, our
hearings were virtual, the vaccine rollout was just beginning,
and Congress had just passed the American Rescue Plan a few
weeks before.
Today over 218 million Americans are fully vaccinated.
COVID hospitalizations and ICU admissions are at the lowest
they have been during the pandemic. Premiums under the
Affordable Care Act are at an all-time low, and enrollment is
at an all-time high. Nearly 6 million Americans have newly
gained health insurance coverage over the past year, and
American families have saved an average of $2,400 on their ACA
health insurance premiums last year.
President Biden's fiscal 2023 budget request continues
these achievements by helping American families rebuild from
the COVID-19 crisis healthier and safer than before. The budget
invests $81.7 billion over five years in pandemic preparedness,
including 40 billion for the development and manufacturing of
vaccines, tests, and treatments, and $28 billion to rebuild the
CDC and the public health workforce. These are incredible
figures.
Importantly, the budget provides $11 billion to address the
overdose crisis. And every member of this subcommittee, Mr.
Secretary, is engaged and cares deeply about this issue.
President Biden has called for a whole-of-government
approach to save lives, get people the evidence-based care they
need, and go after drug traffickers to stop overdose deaths.
The President's budget outlines a strategy to use $20.8 billion
to improve our Nation's mental health, including increasing the
availability of crisis care and achieving full parity--this is
so, so important--and achieving full parity between physical
and mental healthcare coverage.
The budget continues to focus on addressing health
disparities. It invests in quality maternal healthcare,
especially for Black and native women, while also increasing
funding for the title 9 Family Planning Program. It takes the
historic step of proposing $142 billion over the next decade in
mandatory funding. This is a first for the Indian Health
Services.
Importantly, the President's request provides $5 billion in
the Advanced Research Projects Agency for Health, ARPA-H, which
holds the potential for transformational advanced biomedical
research to address diseases like Alzheimer's, diabetes,
cancer, and ALS. As the House sponsor of the authorizing
legislation for ARPA-H, I believe your decision to place ARPA-H
within NIH--let's just put it this way: I don't agree. That is
in capital letters, with exclamation points.
There is still more to do. We still need a safe and
effective vaccine for children under the age of five. We need
to make sure that vulnerable Americans' health insurance
coverage is not disrupted when the public health emergency
expires. We have to continue the health insurance subsidies
from the American Rescue Plan. And we must finally allow
Medicare to directly negotiate drug prices, so that
prescription drugs are affordable.
So I look forward to working with you to develop a budget
and policies to improve our Nation's health and well-being. And
we thank you for being here with us today, Mr. Secretary.
[The prepared statement of Ms. Eshoo follows:]
Prepared Statement of Hon. Anna Eshoo
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Ms. Eshoo. The Chair now recognizes Mr. Guthrie, our
distinguished ranking member of our subcommittee, for 5 minutes
for his opening statement.
OPENING STATEMENT OF HON. BRETT GUTHRIE, A REPRESENTATIVE IN
CONGRESS FROM THE COMMONWEALTH STATE OF KENTUCKY
Mr. Guthrie. Thank you. Thank you, Madam Chair.
Thank you, Mr. Secretary, for being here today, and today
we are discussing the U.S. Department of Health and Human
Services's proposed Fiscal Year 2023 budget.
Today also marks the second time that the Secretary has
been before this subcommittee, and when the Biden
Administration has extended the public health emergency five
times, and we should hear more from our leaders of an agency
that controls over $1 trillion in spending. And I call on my
Democratic colleagues to hold more HHS oversight hearings. It
is one of the most important duties that we, as Members of
Congress, have, and our constituents deserve better.
One stark example is the lack of oversight on COVID-19
spending and response. The last time the Administration
testified on COVID-19 before the committee was in March 2021,
over a year ago. I know myself and other members of this
committee have asked Secretary Becerra to provide a detailed
plan for unwinding the COVID-19 public health emergency, and
particularly how agencies intend on ensuring there are no
significant disruptions as we transition from these waivers as
they expire. And we have yet to receive a response, and
hopefully we will do so soon.
Oversight is especially important, given the huge increases
in funding requested by the Biden Administration. The HHS
budget before today calls for a 12 percent increase in
discretionary spending at HHS for Fiscal Year 2023. The budget
specifically gives more than six billion combined boost in
funding to the Centers for Disease Control and National
Institutes of Health, both of which have come under fire
recently over controversial mask guidance and COVID-19 research
funded by NIH using American taxpayer dollars.
We need to hold NIH accountable. We need to also ensure
taxpayer dollars are not going to labs engaging in risky gain-
of-function research, and ensure researchers are transparent
about how they are spending taxpayer dollars from these funded
research grants.
The budget even increases spending for climate change
initiatives at HHS, and through a 174-page budget that we have
here, it mentions climate change more than fentanyl.
I am increasingly concerned that HHS has lost its way since
President Biden took office, and these budget priorities
reflect this changing course. HHS has become increasingly more
politicized, which we saw with CDC's school reopening and
masking guidance, and less transparency with Congress,
especially in the context of the use of COVID-19 relief funding
that a recent STAT news article outlines. The agency has also
taken a punitive, one-size-fits-all approach to combating
COVID-19 through onerous vaccine mandates.
The Biden Administration has always failed the American
people about planning to revoke title 42, which was used to
prohibit migrants from entering the United States illegally to
spread--to prevent the spread of COVID-19. This poor decision
comes despite the Biden Administration extending the public
health emergency for another 90 days in the same month, without
providing a clear plan of action to address what many expect
will be a massive influx of migrants trying to enter the United
States through our southern border.
We have seen an unprecedented level of fentanyl and
fentanyl-related substances entering our country through the
southern border and killing thousands of Americans. Between
2020 and 2021 fiscal years combined, U.S. Customs and Border
Patrol seized over 15,000 pounds of illicit fentanyl at our
southwest border. This coincided with the highest number of
drug overdoses our country has ever experienced, and the
expected number of overdose deaths reaching 106,000 in the 12-
month period ending in November 2021.
We need to secure our borders and work to permanently
schedule fentanyl-related substances to keep these poisons out
of our communities. We can also do this while promoting public
health programing like the bill Mr. Tonko and I partner with--
partnered on together. This legislation offers individuals
seeking help overcoming their addiction with the resources they
need to get back on their feet, like workforce services and
peer support services.
I finally am concerned with--the Department has continued
to restrict access to approving medical advances such as the
first FDA-approved therapy to treat Alzheimer's disease in
almost 20 years. I urge the Biden Administration to swiftly re-
propose a new coverage policy that allows patients, doctors,
and their families to make informed decisions about their
treatment.
HHS must get back on track to using its resources for
solutions that will drive down healthcare costs for Americans,
keep deadly drugs off our streets, and bring new breakthrough
and potentially lifesaving cures to patients.
[The prepared statement of Mr. Guthrie follows:]
Prepared Statement of Hon. Brett Guthrie
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Mr. Guthrie. Thank you, and I yield back.
Ms. Eshoo. The gentleman yields back. The Chair now
recognizes the chairman of the full committee, Mr. Pallone, for
his 5 minutes of opening.
OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF NEW JERSEY
Mr. Pallone Thank you chairwoman Eshoo. And let me thank
our former colleague and Secretary for being here today for
this important hearing.
I am pleased to have you here to talk about the budget,
because the budget is really an expression of our values, and
the annual budget process provides us with an opportunity to
review and consider the priorities of the Administration. That
is why I am pleased this budget proposal puts resources toward
the programs and agencies that help improve lives, prepare us
for the future, and protect the health and well-being of all
Americans.
The funding priorities in this budget provide a roadmap to
continue to get back on track in the wake of the pandemic, to
keep fighting COVID-19, continue making healthcare more
affordable and accessible for all Americans, to improve our
country's response to mental health challenges, and to address
deep and persistent health inequities.
The impact and ongoing response to COVID-19 has helped to
crystallize the importance of adequately funding public health,
and I am pleased the budget makes critical investments in our
public health infrastructure to ensure the Federal Government
has the resources it needs. And the budget increases funding
for each of the agencies within HHS that are involved in
pandemic response. And the work of these agencies has allowed
Americans to return to a semblance of normalcy.
I am immensely proud of the Biden Administration's work to
undertake the largest free vaccine program in our country's
history. And as a result of their efforts, three out of four
Americans have received at least one dose of the vaccine. And
this has reduced hospitalizations and healthcare spending and,
most importantly, saved millions of lives.
We are also in the midst of a mental health and substance
use disorder crisis, and our country continues to be devastated
by overdoses driven by the widespread availability of opioids
and stimulants in the drug supply, such as fentanyl and
methamphetamines. And I am glad to see that the budget
prioritizes funding for programs and services to address this,
and acknowledges the connection between mental health and
substance use. The budget increases access to prevention, harm
reduction, treatment, and recovery services. Each of these are
critical components to effectively address substance use.
Now, without question, the Biden Administration's actions
have dramatically improved access to health insurance coverage.
And I want to commend Secretary Becerra for the tremendous
progress HHS has made in helping people get affordable, high-
quality healthcare. During the 2022 open enrollment period, a
historic 14.5 million people enrolled in healthcare coverage.
Because of the success of the American Rescue Plan, families
have seen lower premiums, and the national uninsured rate is
near historic lows.
Despite these gains, there is still significant gaps in the
healthcare safety net in the states that continue to refuse to
expand Medicaid. Closing the coverage gap for uninsured people
remains a priority, and the House has taken action to ensure
that low-income Americans in every State will have access to
quality, affordable healthcare.
I am most pleased the budget prioritizes investments in
health equity across HHS, including funding for a number of
critical maternal health programs that will reduce inequities
that have long persisted in maternal health occurrences.
And finally, the budget also reiterates the Biden
Administration's commitment to reducing prescription drug
prices, and calls on Congress to pass legislation that aligns
with the principles included in the Administration's
comprehensive plan for addressing high drug prices. Americans
pay, on average, three to four times more for the same drug as
those in other countries. And we continue to watch drug prices
increase year after year as our constituents struggle to afford
the medications they need to stay healthy.
This House has taken action to give the Secretary of HHS
the ability to negotiate for lower drug prices, cap out-of-
pocket costs in Medicare part D, and stop drug price increases
at the rate of inflation. So it is imperative that these
policies become law as soon as possible. And I am pleased that
President Biden shares our commitment to reducing drug costs
and saving American consumers money.
So let me thank you, Xavier, for being here today. I look
forward to hearing from you on the Administration's priorities,
and certainly appreciate your and HHS's ongoing work to ensure
the health and well-being of the American people. Thanks again.
[The prepared statement of TMr. Pallone follows:]
Prepared Statement of Hon. Frank Pallone, Jr.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Pallone. And I yield back, Madam Chair.
Ms. Eshoo. The gentleman yields back.
The Chair is pleased to recognize the ranking member of our
full committee, Congresswoman Cathy McMorris Rodgers, for your
5-minutes opening statement.
OPENING STATEMENT OF HON. CATHY McMORRIS RODGERS, A
REPRESENTATIVE IN CONGRESS FROM THE STATE OF WASHINGTON
Mrs. Rodgers. Thank you, Madam Chair.
And Mr. Secretary, welcome back to the Energy and Commerce
Committee. This is an important day, and we have important
questions that need to be answered.
Health and Human Services has been at the forefront of the
COVID-19 response. You have jurisdiction over CDC, NIH, and
many other agencies. And unfortunately, we have seen too many
examples where Health and Human Services seems to prioritize
what is an extreme political agenda, rather than staying
focused on mission. The mission is to improve the health and
well-being of all Americans.
I am very concerned about a lack of transparency that is
eroding people's trust in public health, and eroding confidence
in Health and Human Services.
First, there is the Administration's confusing response
when it comes to the public health emergency. The
Administration's decisionmaking hasn't been based on science.
What we see more and more is that it is based upon power and
politics. President Biden wants to lift title 42 for a radical,
open-border agenda, despite an overdose crisis that is killing
more than 100,000 people a year, mainly because of illicit
fentanyl coming across the southern border. According to
President Biden, there is no COVID-19 emergency for illegal
immigrants, but there is for toddlers in Head Start, who are
still forced to wear a mask.
Student loans are still being deferred, costing taxpayers
4.3 billion per month and making the inflation crisis worse.
We see the Administration fighting to keep the mask on for
those that are traveling on airplanes. None of this appears to
be rooted in common sense, science, or an awareness of the
crises in America today.
People want their freedom back. This is the land of the
free. They want a secure border, a healthier future for their
children, safer communities, and they want leadership that
reflects these priorities.
We are not in the same place we were two years ago. And
that is why in February I asked for the Administration's plan
to properly unwind the public health emergency. And I have yet
to receive a response.
I also want to discuss the Centers for Medicare and
Medicaid Services' unprecedented decision to restrict coverage
for an FDA-approved Alzheimer's treatment to only 1,300 to
1,500 people fortunate enough to have been in the clinical
trial. Worse yet, this decision applies not only to the
recently approved drug Aduhelm, but an entire class of
Alzheimer's treatments. We should trust doctors and patients to
decide if an FDA-approved drug is right for them. FDA
determined the drug is safe and effective, including for
seniors in the Medicare program. This decision is clear second-
guessing of FDA's authority to determine drug safety.
Democrats may say that the drug would bankrupt Medicare,
but it is hard to take that concern seriously when Democrats
voted for using savings from their government drug price
control proposal to subsidize and inflate health insurance
premiums for people not on Medicare. I urge that this proposal
not be resurrected, and that you rethink the national coverage
decision.
There is also other examples of how the Department is
losing the public's trust. Inflation from out-of-control
government spending is making everything more expensive,
including healthcare and for seniors on fixed income. Seniors
are now paying 15 percent more, the largest dollar increase in
the program's history. Yet bipartisan laws signed by President
Trump to lower costs remain unimplemented and unenforced.
We are still waking for--waiting for the rules to make it
easier for people to know what doctors are in network. And we
haven't seen enforcement against hospitals refusing to post
their prices. Yet we have seen other top priorities: millions
of dollars for a climate change office, forcing healthcare
workers to perform abortions on demand, policing speech with
Big Tech companies, price controls for fewer cures, colluding
with teachers union to keep closed--the schools closed and kids
masked, undermining the rights of parents, avoiding oversight
for how taxpayer dollars are spent on risky research in China.
And again, the open borders, instead of cracking down on
fentanyl trafficking.
This is not inspiring confidence. My message to Health and
Human Services today is to stop digging the hole. Let's build
trust. Let's make sure that we are trusting people to make the
best decisions for themselves and their families. Our mission
is to improve people's well-being.
[The prepared statement of Mrs. Rodgers follows:]
Prepared Statement of Hon. Cathy McMorris Rodgers
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mrs. Rodgers. And with that, Mr. Chairman, I--or Ms.--Madam
Chairman, I yield back.
Ms. Eshoo. The gentlewoman yields back. I will now
introduce our witness.
Secretary Xavier Becerra is the twenty-fifth Secretary of
Health and Human Services in our Nation. Previously, he served
as the attorney general of the great, great, great State of
California. And very importantly, he served 12 terms in the
House of Representatives. And we are classmates; we entered the
Congress together.
So welcome back, Mr. Secretary, to the subcommittee. You
are now recognized for your time to provide your testimony to
us.
STATEMENT OF HON. XAVIER BECERRA
Secretary Becerra. Chairwoman Eshoo, great to see you
again.
Ranking Member Guthrie, good to see you also. And thank you
again for the time you have made available to have
conversations in the past.
To all the members of the committee, thank you for this
opportunity to discuss the President's Fiscal Year 2023 budget
for the Department of Health and Human Services.
Today more than 257 million Americans have received at
least one dose of a COVID-19 vaccine. Two-thirds of adults over
the age of 65 have gotten a booster shot. We have also closed
the glaring gap in vaccine rates we usually see for communities
often left behind.
It has paid dividends to surge resources, including tests
and treatments to our hardest hit and highest risk communities:
340 million free COVID-19 at-home tests shipped across America;
270 million free N95 masks; 100 million booster doses; almost
$186 billion in Provider Relief Funds distributed through more
than 800,000 payments to over 441,000 providers for COVID
losses and expenses. That is 441,000 hospitals, community
health centers, doctors, pharmacies, nursing homes, and so many
other healthcare providers. Real money. Real relief. Real
results.
Beyond COVID-19, today more Americans have insurance for
their healthcare than ever before in the history of our Nation.
That includes a record-breaking 14.5 million Americans who
secured health insurance through the Affordable Care Act. Many
of those insured Americans are paying less than $10 a month in
premiums for that solid insurance coverage and the peace of
mind that comes with it.
In addition, we launched Operation Allies Welcome, an HHS-
led effort that has helped over 68,000 of our Afghan brothers
and sisters resettle as refugees in America. And we have now
begun to extend support to Ukrainian refugees fleeing the
Russian invasion of their homeland.
We are coordinating with our 50 states, tribal governments,
and territories nearly $300 million in nationwide support to
prepare for the launch of the new 3-digit 988 National Suicide
Prevention Lifeline this July. What 911 is for local
emergencies, we are working hard to make 988 for Americans who
experience a mental or behavioral health crisis.
HHS has also made key investments to close holes in our
public health system in areas like maternal health, where we
have extended Medicaid coverage for postpartum care for a new
mother and her baby from two months to 12 months.
The President's 2023 budget lets us build on that record of
investment in Americans' health. It proposes $127 billion in
discretionary budget authority, and $1.7 trillion in mandatory
funding, including a standout and historic investment to
transform the mental health infrastructure in our country, a
priority I know you share.
It also asks for $82 billion for the President's pandemic
preparedness proposal, to get ready for whatever might come
next after COVID-19. Considering that COVID has cost our
country more than $4.5 trillion in direct support from the
Federal Government so far, this is a no-brainer to prepare for
the next pandemic. The funding we are requesting will be end-
to-end, meaning for research, development, approvals,
deployment, and effective response.
Madam Chair and members of the committee, this budget turns
hardship into hope, inclusion into opportunity. I look forward
to working with you to make it a reality, and to continue our
efforts to give Americans real relief, real results, and real
peace of mind.
With that, I am more than willing to answer any questions
you may have.
[The prepared statement of Secretary Becerra follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. Eshoo. Thank you, Mr. Secretary. We will now move to
member questions, and The Chair recognizes herself for 5
minutes to do so.
First, Mr. Secretary, we know that we don't agree with--or
I don't agree with your decision relative to ARPA-H, but here
are my two questions very quickly on it.
You have explained that, by placing it in NIH, it was
necessary to do so, so that the administrative work of standing
up the agency could take place. My question is, precisely how
much time does ARPA-H need NIH's administrative support to get
stood up? Just very quickly.
Secretary Becerra. Madam Chair, we are going to use NIH to
make sure that those ministerial duties----
Ms. Eshoo. I know.
Secretary Becerra. HR----
Ms. Eshoo. How much time?
Secretary Becerra. We will wait to make sure that we get a
director in place to find out exactly how much that director--
--
Ms. Eshoo. So you don't know----
Secretary Becerra [continuing]. Will want to use----
Ms. Eshoo [continuing]. How much time yet.
Secretary Becerra. No, because we have to make sure that
the new director has the ability----
Ms. Eshoo. OK.
Secretary Becerra [continuing]. To make----
Ms. Eshoo. Can ARPA-H, in your view, be an independent,
stand-alone agency, once it is stood up?
Secretary Becerra. It will be an agency that has its own
authorities, and its own direction, and its own director that
will report directly----
Ms. Eshoo. I think I----
Secretary Becerra [continuing]. To me.
Ms. Eshoo. I think I just got the answer.
Politico reports that FDA may wait to receive both Moderna
and Pfizer's vaccine applications for children under five
before beginning the authorization process. But Moderna's
vaccine application may be ready before Pfizer's. Is it true
that FDA plans to wait for both applications?
I mean, obviously, parents across the country are--their
patience is strained.
Secretary Becerra. The FDA is waiting to receive that
information from both of those manufacturers. And as soon as it
has the information, it will move through the process of trying
to find out if it is safe and effective----
Ms. Eshoo. So is FDA waiting for both applications?
Secretary Becerra. It still has not received the full
applications from either one.
Ms. Eshoo. OK. The COVID response--back to the budget, the
COVID response under the Trump Administration, I think, was
really marked by a great deal of chaos. The Strategic National
Stockpile was empty, local public health departments were
overwhelmed, it took far too long to get tests and treatments
to the public.
In May 2020, our subcommittee heard from former BARDA
director, Rick Bright, about how he and his agency were
marginalized and ignored when he pushed to develop critical
COVID treatments and increase production of masks and other
equipment. Under your leadership, BARDA is--it is empowered to
respond to COVID and future pandemics.
My question to you is--BARDA's budget is continually raided
to fund other HHS efforts. If Congress provides the new
pandemic preparedness funding, will you commit that BARDA will
not see its funding transferred to other agencies?
These are very important funds. The Strategic National
Stockpile has its own funding: $975 million, 828 billion with a
$80 million increase to BARDA. But if the figures are only
markings on a sheet of paper, what needs to benefit the
American people is not going to take place.
So I think my overarching question, Mr. Secretary, is the
following: Are you changing course? And if so, how, in terms of
pandemic preparedness?
We have learned many lessons. It is so important for us to
demonstrate that we have learned the lessons of the past, and
not just pile on more money to more programs. So can you just
spend a moment to describe where the changes are, and also your
commitment to BARDA?
Secretary Becerra. Madam Chair, thank you for the question.
I won't speak for previous treatments of BARDA, but what I
will tell you is, as you see in our budget, we call for a ten
percent increase in its budget. BARDA will be one of the chief
proponents of the President's pandemic preparedness plan moving
forward. The work that is being done through H-CORE, which is
the operation that took over from Operation Warp Speed, relies
on BARDA. From my perspective, we can't get out of this
pandemic without BARDA, and we are going to do everything we
can to lift up BARDA, because it is the agency that Congress
created to help us navigate those minefields.
Ms. Eshoo. I like your description of BARDA. It was--I am
very proud that it was my legislation that created it.
So I think at some point, Mr. Secretary, that you give an
overall view--perhaps today, if not in writing--what is going
to change, and the new dollars that--the increases that are
infused in the overall agency.
With that, The Chair now recognizes the ranking member to
question for 5 minutes.
Mr. Guthrie. Thank you.
Welcome back to the House, Mr. Secretary, glad to have you
here today.
I toured the border last--early in the year with Dr.
Burgess, and the border was overwhelmed. My focus was--for this
subject of this committee, is--was the illicit fentanyl coming
across the border. And when we were talking to the Border
Patrol, and Dr. Burgess asked the question, and he said that
if--what if we repealed title 42, revoked it, and he said it
would go from a crisis to a catastrophe.
And so the concern is when CDC, HHS recommended--I know it
is tied up in court now, but did recommend removing this May
23d, did you consider the flow of illicit fentanyl coming into
the country, and what countermeasures--you know this would
create another opportunity for it to come forward. What was the
concern when you made that decision about fentanyl?
Seventy percent of Kentuckians who died of overdose died of
illicit fentanyl. I think that is typical for most of our
State. So how do--in revoking--the decision to revoke title 42,
what factors did you put into place for fentanyl or other drugs
coming across our border?
Secretary Becerra. Congress, first--or Congressman, first,
I think we all recognize that we need to do everything when it
comes to drug enforcement policy to make sure we interdict
drugs that are trying to come into the country. But you are
confusing health policy with migration and drug interdiction
policy, because title 42 would impact those immigrants who are
actually crossing the border and not trying to clandestinely
enter. They are trying to seek asylum. So when they come in,
they present themselves. Therefore, if they were carrying
fentanyl, we would be able to discuss----
Mr. Guthrie. So we asked that question of the Border
Patrol. And what they said was anything that doesn't discourage
people from coming, the volume continues to increase.
And therefore, as a matter of fact, we went through one of
the processing centers and they said, ``Look at every person in
here with a badge, every person in here with a uniform, and
that is somebody that should be on the border.''
So I understand title 42, I am not confusing it. But I do
know that it is a deterrent, that if you are going to remove
that deterrent--I know HHS has a different focus than Homeland
Security, but surely the Administration has some kind of plan
in place to keep--to try to interdict this illicit fentanyl
that is flowing across the border.
Secretary Becerra. And again, title 42 speaks to health
conditions in the country. And what you are speaking to are
either migration challenges or drug interdiction challenges.
And so----
Mr. Guthrie. Right, but it is still a country challenge. I
understand----
Secretary Becerra. That is correct. But you would use
migration laws or drug interdiction laws to try to deal with
those challenges, not healthcare laws.
Mr. Guthrie. So on the illicit fentanyl, currently it is
temporarily scheduled. Do you think it should be permanently
scheduled, illicit fentanyl, and subject to mandatory minimums?
Secretary Becerra. On fentanyl what I can tell you is that
the FDA and the different agencies within HHS will be reviewing
how we treat--whether it is fentanyl or any other drug, whether
we put it on any formularies.
Mr. Guthrie. OK, but you are not going to take a position
on whether it should be scheduled, if it is subject----
Secretary Becerra. I wouldn't want to get ahead of the
agencies that actually do this through the science.
Mr. Guthrie. All right.
And so we talked a little yesterday. I remember last
Thanksgiving trying to go around town in Bowling Green,
Kentucky, trying to find tests for--my kids thought that they
might have brought fentanyl--I mean, excuse me, COVID into
our----
[Laughter.]
Mr. Guthrie. Not fentanyl, thank goodness. COVID into our--
--
Secretary Becerra. Hopefully, they didn't find that.
Mr. Guthrie [continuing]. Into our community. And, you
know, and there was just a shortage.
Kentucky had to ration monoclonal antibodies for Delta. And
the Vice President said, ``We didn't see Delta coming.'' I
think most scientists did not--upon whose advice and direction
we have relief--didn't see Delta coming. And every time we had
Dr. Fauci, it was--mask, we are going to do this. He goes,
``Well, we don't know if a wave is coming.'' It seems like we
didn't know a--we expected a wave to come, and we weren't
prepared for it. Could you talk about why we didn't have--we
are talking about all that--if you remember all the press
conferences in April and May 2020. When the previous
Administration was there, everybody was testing, testing, all
the other things. And within three months--you know, we are a
year-and-a-half into it, and we weren't ready for a wave.
Secretary Becerra. Congressman, thanks for the question.
And as we discussed previously, we had millions of tests
available. What happened is that Americans started to demand
the at-home tests. The tests that we had available were the
tests that would take a week or two to get results, because
they go into laboratories to give you the results. People
wanted immediate results, because they wanted to know if they
could go visit their grandmother.
Mr. Guthrie. Exactly.
Secretary Becerra. So what we did was we really ramped up
the availability of those instantaneous at-home tests, which,
unfortunately, are less reliable than the PCR tests.
Mr. Guthrie. Well, why weren't we ready in May? And--I
mean, excuse me, November 2021?
Secretary Becerra. I am sorry, where----
Mr. Guthrie. I mean I understand what you are saying, and
the President set up the program where people can order these
tests.
Secretary Becerra. Yes.
Mr. Guthrie. But why weren't we ready in November 2021? We
didn't know it was going to come that month, but we knew a wave
was coming, and we just didn't have that at-home tests.
Secretary Becerra. Well, remember, we had hundreds of
millions of tests available for Americans as of the summer. In
fact, it was--we had no tests available for the American public
a year ago, or about February/March of last year. So we ramped
up dramatically.
But the shift came when people wanted to be able to take
the test solely at home, very convenient----
Mr. Guthrie. And then we didn't have enough antibodies. I
know my time has expired, but thank you for your time. I
appreciate----
Secretary Becerra. Thank you.
Mr. Guthrie [continuing]. You being here.
Ms. Eshoo. The gentleman yields back. The Chair is pleased
to recognize the chairman of the full committee, Mr. Pallone,
to question for 5 minutes.
Mr. Pallone Thank you, Chairwoman Eshoo, and thank you,
Secretary Becerra, for your testimony.
I wrote a provision in the Families First Coronavirus
Response Act in March 2020 that provided states with an
increase to their Federal Medicaid funding if they agreed to
keep everyone enrolled in Medicaid during the public health
emergency, and every State took the deal. And it has been a
tremendous success at ensuring that poor and disabled Americans
didn't lose their health insurance during the pandemic.
Now, when the public health emergency ends, states have to
check that everyone on their rolls is still eligible for
Medicaid. But I am worried that people could be wrongly dropped
from Medicaid simply because they make a procedural mistake
during the application process.
Now, the Centers for Medicare and Medicaid Services
recently released guidance that promoted 12 months' continuous
eligibility for children under Medicaid, 12 months' postpartum
eligibility for new moms with Medicaid, and CHIP express lane
eligibility. And these policies could help mitigate coverage
losses after the public emergency ends.
So I was glad to see CMS endorse these policies because, as
I am sure you know, the Build Back Better Act would actually
require every State to put in place the continuous coverage
policies that I just mentioned, and would permanently authorize
express lane eligibility.
So my question after that long intro is it seems critical
that Congress passes into law these policies to ensure that
children and new mothers will keep their coverage when the
public health emergency ends. And I just want you to say
whether you agree. You don't have to just say yes or no,
though, you can expand.
Secretary Becerra. Chairman, the results are there. It is
clear that, by having provided that kind of coverage, extended
coverage, we have kept Americans from falling into the poverty
crack. And I hope that Congress is able to work together to
continue that support, because today, as I mentioned, more
Americans have healthcare coverage, fewer Americans are living
in poverty than before.
Mr. Pallone Well, thanks. Now, the Tri-Caucus chairs has
recently sent a letter to House and Senate leadership asking
for these policies to be included in the final reconciliation
legislation. And I wanted to thank Representative Ruiz and
Representative Kelly for their leadership on these issues, and
their letter. The letter states that Black and Latino
individuals in certain Asian American populations are
disproportionately covered by Medicaid. And it stands to reason
that these individuals would therefore be at greater risk for
coverage losses at the end of the public health emergency.
So my second question, given these concerns, it seems that
the continuous coverage provisions in the Build Back Better
would help prevent disproportionate coverage losses among the
minority groups, and are important for health equity. Do you
agree with that?
Secretary Becerra. Absolutely. And the--we know that there
are some 12 to perhaps 15 million Americans who might lose
their insurance coverage if we don't do the Medicare expansion
and continuous coverage the right way. And so we hope that, in
this process of unwinding from the public health emergency, we
don't lose all those Americans who are currently getting
covered.
Mr. Pallone Well, thank you.
Now, finally, Medicaid covers about half of the children in
the country now, and pays for nearly half of all births. So
these coverage provisions are not only far-reaching, but they
are affordable. And as you know, we paid for them entirely in
the House legislation.
So my question is, given the low cost, given the low cost
of these policies and the huge number of children and new
mothers they would cover, it seems like they give us a
tremendous bang for our buck. And that is my final question,
whether you agree.
Secretary Becerra. As my mother would say, ``Mejor prevenir
que remediar,'' better to prevent than to remediate.
You did a phenomenal job of helping us prevent illness and
disease, which makes it possible for families to have healthier
children who become healthier leaders of our country in the
future.
Mr. Pallone Well, I appreciate that.
You know, I think everyone on this committee knows that
prevention saves money. But as you know, because you were on
the Ways and Means Committee, that is not the way the CBO
works, right? They charge us for everything, whether it
prevents a further cost down the line. But I think we have to
constantly remind everyone that prevention does save money. And
I appreciate what you said.
So I don't know, it just seems obvious to me that, if we
want to ensure that children and new mothers don't lose their
Medicaid when the public health emergency ends, that we should
include these coverage policies in the legislation before the
public health emergency ends. So thank you again.
And I yield back. Thank you, Madam Chair.
Ms. Eshoo. The gentleman yields back.
The Chair is pleased to recognize the ranking member of the
full committee, Representative McMorris Rodgers, for your 5
minutes to question.
Mrs. Rodgers. Thank you, Madam Chair.
Mr. Secretary, in February I asked you and the President
for a plan to end the public health emergency, hoping to get
information about how to transition two vaccines, fully
approved, to commercial distribution, and how states can
quickly and easily incorporate flexibilities from the pandemic
into their Medicaid programs.
We didn't receive a response or your plan, but we have
received more requests for money. These requests have come
without information on how you and the states have spent
pandemic funds to inform needs today.
I will note the reports about COVID-19 funds going to fund
things like a high-end hotel, a ballpark, and ski slopes.
Do you commit to following up on your current budget
request, and also more funding requests to include all
assumptions about operations, cases, and relevant existing
available funds to all Members of Congress and the public?
Secretary Becerra. Congresswoman, we will continue to
provide the information that outlines how we have used the
COVID money that we have received. We have provided volumes of
paper in response to questions. We have done numerous
briefings, bipartisan briefings, on the expenditures for COVID.
We will continue to do that.
The President's plan to move us beyond COVID-19 but stay
prepared for any future pandemic outlines in his budget how we
would use the money. We are more than ready to brief you, as
well, in more detail----
Mrs. Rodgers. OK, OK.
Secretary Becerra [continuing]. Because we know we need to
be ready.
Mrs. Rodgers. Yes. Well, it is pretty basic, and we need to
have those details. And unfortunately, there is a lot of
questions that have not been answered.
Do you anticipate the U.S. Government being the sole
purchaser of COVID-19 vaccines for the rest of 2022?
Secretary Becerra. We know that there are other--whether it
is nations or there are others who are looking to purchase, we
will continue to make sure that we provide the American people
with the supply that we need. And so we will do everything
possible to make sure----
Mrs. Rodgers. Do you have a projected cost?
Secretary Becerra [continuing]. What we need.
I am sorry?
Mrs. Rodgers. Do you have a projected cost to the Federal
Government?
Secretary Becerra. The Pandemic Preparedness Plan does
outline what we think we would need. Remember that, if we are
talking about getting further supplies of existing vaccines,
that would be a different price than if we have to go toward a
vaccine that deals with new variants----
Mrs. Rodgers. OK.
Secretary Becerra [continuing]. Or if we have to go through
a--toward a new vaccine, all together.
Mrs. Rodgers. Do you have a plan to transition to
commercial distribution for vaccines?
Secretary Becerra. That is part of the President's Pandemic
Preparedness Plan.
Mrs. Rodgers. OK, OK. Thank you.
I asked last year if there would be any proposals that
would give you, as Secretary, the ability to implement drug
price controls using quality-adjusted life years, QALYs. QALYs
put a price on a person's life. The National Council of
Disability has recommended against using QUALYs. I am
introducing a bill this week to ban the use of QALYs.
Do any proposals in the budget require your Department to
rely on QALYs to make decisions?
Secretary Becerra. Congresswoman, the best I can tell you
is right now nothing that we are proposing would put any limits
on the ability of an American to be able to get the best
quality care that America can afford to provide.
Mrs. Rodgers. Does your Department use QALYs?
Secretary Becerra. I am not aware of our particular
agencies using anything like that to make final determinations.
Mrs. Rodgers. Well, I--and I am pleased to hear that. I
hope that you will look at my legislation. I think it is very
important that we clarify and ban the use of QALYs.
Finally, because of inflation and surging prices, Americans
are paying more for everything, including healthcare.
Empowering them with information on the actual price of
healthcare is more important than ever. Your budget states that
``enforcement activities are necessary to drive compliance with
price transparency.'' A recent survey found a majority of
hospitals are not compliant with the hospital transparency
rule. When will we start to see these enforcement actions?
Secretary Becerra. Congresswoman, we have begun enforcing
that law as of this year. We have issued numerous challenges to
some of the providers where we have evidence that they are not
following through with the transparency requirements under the
law.
Fortunately, most of those providers are responding in kind
to make adjustments, and we will continue to enforce that law.
Mrs. Rodgers. Well, I appreciate your commitment to this. I
believe it is so important that we are getting this
information. And, really, this is something that has been
supported bipartisan, Republicans and Democrats coming together
and making sure that we do have this transparency around
prices.
Secretary Becerra. I agree.
Mrs. Rodgers. And finally, I just want to say, as it
relates to the budget, it has been disappointing. We have been
a bit frustrated that we haven't seen more details on how funds
have been spent. But I did notice that you had found the
resources to establish an office of climate change and health
equity in August 2021, and I also just saw this past Friday you
released an initiative to lower hospital emissions.
I just hope that you will get back to the priorities that
have been outlined in a bipartisan way.
I yield back, Madam----
Ms. Eshoo. The gentlewoman yields back.
The Chair is pleased to recognize the gentleman from North
Carolina, Mr. Butterfield, for your 5 minutes to question.
Mr. Butterfield. Thank you very much, Madam Chair.
And thank you, Mr. Secretary, for your testimony today. It
is good to see you, Mr. Secretary. I have great memories of our
work when you served here in Congress. I even have great
memories of our travel when you served with us in this body. I
particularly remember when we accompanied President Obama to
Charleston for the funeral of the Charleston nine.
Secretary Becerra. Yes.
Mr. Butterfield. And so I appreciate your friendship and
appreciate your work.
Over the years, Mr. Secretary, I have been really, really
alarmed about the growing mental health and substance abuse
disorder crisis facing our families. I am very grateful that
the Administration has taken action to address the growing
mental health and substance abuse disorders.
In the midst of COVID, Congress provided nearly $9 billion
to states, and to tribes, and communities to respond to
emergency mental health and substance use needs through the
appropriations, through the CARES Act, and the American Rescue
Plan. The 2023 budget would build on those efforts, providing
$2.9 billion for mental health, 6.6 billion for prevention and
treatment efforts within the Substance Abuse and Mental Health
Services Administration.
My question is, what activities in communities does the
Administration intend to target with these increased resources,
and why?
Secretary Becerra. Congressman, first, thank you for the
earlier mention of the friendship, and I hope to continue to
work with you on any number of these subjects, but certainly on
this one, because the President had made it clear he intends to
deploy game-changing resources and investments to make sure we
tackle the mental health and behavioral health crisis.
I mentioned the 988 Lifeline that we hope to launch in mid-
July that will let anyone who is suffering a mental or
behavioral health crisis to be able to reach to someone who
could offer them help.
We are going to do much more when it comes to drug overdose
problems that we see. When over 100,000 Americans are dying in
one year from drug overdose, we know we have to tackle the
opioid and drug overdose crisis.
And we are going to do everything we can to help children,
because we know COVID has exposed the belly of a--of what we
see as a true problem with mental health being experienced by
our youngest Americans. And so we are going to do everything we
can to focus on that.
I am engaged right now in a national tour, visiting states
throughout the country to try to highlight what the President
is hoping to do in his budget.
Mr. Butterfield. Thank you, Mr. Secretary. Let me just ask
you this. Let me ask you about the proposed crisis care set-
aside, and the prevention and early intervention set-aside in
the mental health block grant, as well as the proposed recovery
support services set-aside and the substance abuse block grant.
Why do you believe these programs are important, and can
they have flexibility to meet the needs of our citizens?
Secretary Becerra. Congressman, as I said earlier,
prevention is far better and more effective, and better for the
dollar than is remediation. If you wait until someone has a
real crisis, it costs a lot more money, just like going into an
emergency room, than it does in trying to prevent someone from
getting to the point of suffering a crisis.
So we want to interdict where possible. We want to
intervene where we can. And what we want to do is let families
know that we want to be there, shoulder and--shoulder to
shoulder with them as they try to address these crises,
especially for these children.
Mr. Butterfield. Thank you. I have time for one more, Mr.
Secretary.
Since 2015 I have worked on a bipartisan basis to expand
access to disposable wound therapy for Medicare patients
receiving home healthcare. In 2015 we successfully created a
new Medicare benefit to this effect. Unfortunately, the way
this benefit was implemented makes it extremely difficult for
patients to access this technology. To fix this, Mr. Mullin and
I introduced legislation that would make technical corrections.
Would you be so kind as to commit to work with us on this
proposal, so that it can make it to the President's desk before
the end of this Congress?
Secretary Becerra. You have my commitment, Congressman, to
work with you to see where we can go with the legislation.
Mr. Butterfield. Thank you, Secretary Becerra.
I yield back, Madam.
Ms. Eshoo. The gentleman yields back.
The Chair is pleased to recognize the gentleman from
Michigan, Mr. Upton, for your 5 minutes to question.
Mr. Upton. Thank you, Madam Chair.
And welcome, Mr. Secretary. We are glad to have you in
person today. That is for sure.
And I want to thank you, Chair, for holding this important
hearing, and your leadership on ARPA-H.
I would like to think that we are close to moving
bipartisan authorization--authorizing legislation through this
committee. And I would note that my Cures 2.0 partner, Diana
DeGette, and I look forward to working with you to advance this
important legislation, as well.
We also look forward to working with you and Chairman
Pallone and Ranking Member Cathy McMorris Rodgers on another
important bipartisan piece of legislation. Cures 2.0, we
continue to hear from patients, families, doctors, researchers,
innovators from across the country how important it is to move
forward. When this committee works together we do improve
Americans' lives, and I am thankful to be part of it. Simply
put, patients can't wait, and we have no time to waste.
So, Mr. Secretary, drug-resistant bacteria now kills more
folks than HIV, globally. Sad statistic. CDC is reporting that
both drug-resistant bacteria and fungi are on the rise because
of COVID. The PASTEUR Act, a bipartisan bill that we included
in 21st Century Cures 2.0, is an urgently needed solution to
these growing threats. You agree, I think, with the need to
address the AMR and fungi threats, as well, and I would
appreciate your thoughts on the PASTEUR Act as a solution.
Secretary Becerra. Congressman, I--let me just first say
thank you for tackling this, because too many people are not
aware of how rapidly we are losing the ability to use
antibiotics to treat what are pretty common diseases and
illnesses. And it is not affecting just us, but it is
worldwide.
And unfortunately, as you know, it is tough to get the
manufacturing sector to jump on this, because there is not a
lot of money that they can make anymore. And so we have to work
to provide the incentives. So I am absolutely supportive of the
efforts that you are making in this, because AMR, antimicrobial
resistance, is a problem not just in developing countries, but
here in the U.S.
Mr. Upton. So I am also deeply concerned about--thank you.
And I am also deeply concerned about the State of Federal
health insurance programs like Medicare.
In my view, Medicare's antiquated approaches to coverage
are not well suited for cutting-edge technologies that have the
potential to transform care. Some have pointed to the issue of
improving FDA-CMS communications on innovative technologies
that might help CMS better cover and, more importantly,
reimburse for them. Unfortunately, it seems like the
Administration might be moving in the wrong direction with its
decision to pull the MCIT rule.
So can you tell me or share with me your thoughts on
improving the CMS-FDA communications, and what we might expect
with regards to the MCIT rule?
Secretary Becerra. Once again, you ask a critical question,
because technology has taken this to a new place.
There was a joint statement recently issued by both the
heads of the FDA and CMS to make clear how it is important that
these two distinct agencies work together where they can, but
still fulfill their separate, distinct missions as well as
possible. And we are going to run into these circumstances, as
you mentioned, more and more often, because technology is
taking us farther and farther toward getting new treatments and
therapies.
What I can tell you is that, so long as the mission of FDA
is to make sure that there is a safe and effective treatment or
drug available to the Americans, that is critical. And at the
same time, we have to make sure that CMS's role, which is
different, it is more an issue of whether that particular
therapy or drug is necessary--is the real issue that we have to
confront. But I believe that, with that joint statement of the
two heads of these agencies, they made it very clear they are
going to, where possible, make sure we are working together.
Mr. Upton. Well, thank you.
I yield back.
Ms. Eshoo. The gentleman yields back. And I want to
reiterate once again, as I have previously, my fullest support
for Cures 2.0. I believe that is a must for our subcommittee to
advance, and the full committee, as well as ARPA-H authorizing
language.
And I salute you and Congresswoman DeGette for the work
that you have done. We are all in your debt, because you have
been working on this for three years. And the culmination of
that will be what the subcommittee does with it.
The Chair is pleased to recognize the gentlewoman from
Florida, Ms. Castor, for your 5 minutes to question.
Ms. Castor. Well, thank you, Madam Chair, and welcome,
Secretary Becerra. It is great to see you. And I want to thank
you and President Biden for successfully lowering healthcare
costs and premiums for millions of American families. That is
what Democrats in Congress intended through the American Rescue
Plan.
And now high-quality coverage is more affordable and
available to families at a time when they really needed to put
money back into their pocket: 14.5 million Americans now rely
on the Affordable Care Act, and it has been a particular
godsend in my home State of Florida, where we are the third
largest State in the country, but we have the highest
enrollment of any State, 2.8 million Americans now. That is a
28 percent increase over last year, largely because we were
focused on lowering their costs through those enhanced tax
credits.
Can you briefly discuss the impact of the American Rescue
Plan, and what it has meant--what those enhanced tax credits
has meant for affordable healthcare coverage?
How many new individuals signed up because of those tax
credits, and how many--what is the scope, and what do you
predict the future holds?
Secretary Becerra. Congresswoman, thank you. By the way,
thank you very much for the work you did to make sure that the
Affordable Care Act could be there, and that we could have the
American Rescue Plan to make even better the result of good,
quality healthcare available to so many Americans.
You mentioned it with your--the numbers. Americans are
speaking with their feet and with their voices in applying for
these healthcare plans: the fact that today 14.5 million
Americans can rely on health insurance because of the
Affordable Care Act, six million of them new to the program all
together. And as you mentioned, several million in Florida by
itself, one of 50 states.
The fact that we can offer, as a result of your work on the
American Rescue Plan, Americans a health insurance plan of
quality, not a junk insurance plan, but of quality, for $10 or
less a month in premiums, you can't even go see a movie today
for $10 or less for one movie, let alone a full month of health
insurance coverage. That is real peace of mind.
Ms. Castor. It is. I--in the grocery store, in church,
everywhere I go in my home State, they really are grateful.
I mean, this came at a time we were dealing with a
pandemic, and a time when costs were really hammering our
families. So thank you for everything that you have done. You
must take great pride in the fact you were here when we passed
it, and you are there when you see the expanded coverage of
these high-quality plans.
I also had some sad news from a friend last week, who was
just diagnosed with an HPV-related cancer. And I am so grateful
that President Biden is there to--and you--to help reinvigorate
the Cancer Moonshot. And what you have included in your budget
related to trying to save American lives and lower costs again
by expanding the HPV vaccine really deserves kudos. This is the
first time it showed up explicitly in the budget.
And I would say, you know, when it--that vaccine wasn't
around when we were younger, but it is now for kids and
adolescents. And what I have learned back home is when you ask
parents, if you could prevent your child from ever contracting
cancer, would you, and of course they would. And here we have
this safe and effective vaccine that has been available since
2006. But the uptake rates are not high enough.
So talk to me about--you have committed now to do more on
HPV. How does the Department plan to use what you have
identified as $5 million to expand efforts to improve coverage,
and what can Congress be doing?
We did pass a bipartisan bill out of this committee, by the
way, and a bill through the House of Representatives that will
help. But what is your plan?
Secretary Becerra. Congresswoman, one of the things we
learned with the Affordable Care Act and the enrollment, the
record-breaking enrollment numbers, and with the vaccines and
reaching communities that are often left behind, today you have
Black Americans, Latino Americans who are vaccinated at
essentially the same rate as White Americans. A year ago, there
was a dramatically disparate difference.
And what I will tell you is that what we found is that, if
you go to people, instead of waiting for them to come to you,
they latch on, they take up the effort. And so, when it comes
to HPV vaccine, other treatments that we know are effective, we
are going to go to those communities to let them know about
this. Because if, as you said, if they know, they will make
sure their kids get these vaccines.
Ms. Castor. Thank you very much.
I yield back my time.
Ms. Eshoo. The gentlewoman yields back.
The Chair is pleased to recognize the former chairman of
our subcommittee, and one of our doctors, Dr. Burgess of Texas,
for your 5 minutes to question.
Mr. Burgess. I thank the Chair. And let me just start by
saying I do want to associate myself with the remarks of our
ranking member of the full committee, Ranking Member McMorris
Rodgers. I do feel one of the really severe casualties of this
pandemic has been the credibility in our public trust, the
public trust in our public health institutions. And we really
do need to work to regain that, and when you see it almost
daily.
I guess on the good news front, Dr. Fauci was on Judy
Woodruff last night, and pronounced the pandemic over. So
congratulations. I somehow missed it in the headlines this
morning, but I am glad that that is--at least I hope that that
is true.
I also want to associate myself with the remarks of the
chairwoman of the subcommittee on ARPA-H. It is a critically
important authorization that this committee needs to undertake,
and I share her concern about it being collocated on the campus
of the National Institute of Health.
So, Secretary Becerra, you will remember the last time we
spoke was in our Budget Committee hearing across the way. And I
was concerned about funding for gain of function research,
particularly in adversarial countries. You disagreed with me,
and you said, I think, that question has been answered before,
and you didn't think it would be true. I still remain concerned
about it. I remain unconvinced that NIH did not have some role
in this funding. So I promised you some articles supporting my
position.
I have asked that, Madam Chair, that we make those part of
the record today, and I will, at the conclusion of this
hearing, I will get those to you.
But even if we disagree about NIH funding gain of function
research in adversarial countries, really, the point is made
over and over again in those documents that this was all done
in a BSL2 lab. The biosafety level of the Wuhan lab was not a
biosafety level three or four, as I think it should have been,
but it is almost like it is asking for a lab leak if you are
dealing with a pathogen such as this in a BSL2 lab.
So, I guess the question is, are we at a point now where we
will be very careful about where we fund this type of research?
It bothers me that it was in an adversarial country, and it
really bothers me it was in a BSL2 lab.
Secretary Becerra. Dr. Burgess, first, let me just say that
much of what you said I agree with. We should always be very
cognizant of how any gain of function research is done. We
should be very cognizant of where it is done for all the
reasons you mentioned. And I think that what I can do is assure
you that, at the NIH, at the Department of Health and Human
Services, we take those same concerns and admonitions that you
have just stated very seriously.
And--but I would agree with you that we have to be very,
very careful, because who knows what can surface as a result of
some of this research that is done, especially if it is done in
a place that is not equipped to really handle it.
Mr. Burgess. Well, I really do hope that you will provide
the committee with the official HHS policy directing the NIH in
this regard.
We had a hearing on mental health, and I appreciate your
comments on mental health. A couple of weeks ago I brought up--
are you familiar with what is referred to as the IMD exclusion,
the Institute for Mental Disease exclusion that prevents
Medicaid from paying for coverage, hospital coverage?
So I brought up a concern about that, and I asked the HRSA
administrator if that was a barrier to getting care, and she
wasn't really--she said there is some challenges there, but I
didn't get the impression that, really, she put that as an
obstacle to care. So let me just ask you: do you think the IMD
exclusion is a barrier for patients getting the mental health
treatment that they need?
Secretary Becerra. Congressman, I think we are seeing the
growing need for healthcare. And Medicaid has become a place
that Americans have been able to rely upon to help them pay for
their mental healthcare services. IMD is--doesn't pose a
restriction. I believe it is a statutory restriction that makes
it tough for Medicaid to cover mental health services in many
cases.
We are more than willing to work with you and your
colleagues to try to make sure that Americans are able to
secure the type of healthcare, even if it is for mental health,
not just regular health that we need.
Mr. Burgess. Well, I tried to add that as an amendment when
we were doing one of the reconciliation bills that was defeated
on a party line vote. I hope I can look to your help when
bringing that forward again in legislative language, because I
agree with you, it is a legislative fix that is required.
And it is expensive. I grant that it is. But it is the old
thing about pay me now, pay me later. What is the cost of doing
nothing? And I think we have found it to be extremely high.
Thank you for your testimony today.
I will yield back.
Secretary Becerra. I look forward to working with you on
it.
Ms. Eshoo. The gentleman yields back. The Chair is pleased
to recognize the gentleman from Maryland, Mr. Sarbanes, to
question for 5 minutes.
Mr. Sarbanes. Thank you very much, Madam Chair.
Secretary Becerra, welcome. I appreciate the work that has
gone into this budget proposal. It is very much, for the most
part, I think, a lessons learned budget. It really looks at
what we have been through, and tries to reposition us in a
visionary way for the future. So I thank you for your efforts
and the efforts of your staff.
The pandemic, as we know, has taken a really heavy toll on
healthcare providers, public health workers. That is obvious.
And these frontline heroes have been very stressed, very over-
burdened during the crisis. Many have left the workforce, as we
know.
And we also know that a strong, well-trained workforce in
the health field is critical to supporting a high-quality
delivery system. And we have to make data-driven decisions
about how to prioritize the workforce. To that end, I know the
agency, your agency, is--currently has a number of initiatives
in the health workforce space, including this National Center
for Health Workforce Analysis, and I support that effort.
Could you describe the work of the center just a little
bit, and how you see the Fiscal Year 2023 budget request
responding to this need for collecting, analyzing, and
ultimately acting on workforce shortages and related
challenges?
Secretary Becerra. Congressman, thank you for your
interest, and all of the work that you have done over the years
on these issues. I think a lot of working Americans appreciate
what you are trying to do.
The National Center for Health Workforce Analysis conducts
research. It tries to help us determine if there is a
sufficiency of the workforce throughout the country, the
geographical distribution, what the level of education is for
the workforce. Essentially, it tries to inform you, the
policymakers, about where the gaps are, where the deficiencies
are, so you can better target your resources to make sure that,
if one region of the country lacks a certain type of healthcare
professional--nurses, for example--that we are able to make
sure we target it appropriately. So this way we spend every
dollar that we have most efficiently to make sure we boost up
the workforce.
Mr. Sarbanes. I think it is going to be very important to
do the analysis carefully because, in addition to there being a
lot of competition among healthcare providers for those
workforce positions, there is also going to be competition
between the healthcare industry and other folks that are
looking for workers. There is a lot of teacher vacancies, for
example, across the country, et cetera. So we have got a real
labor workforce potential challenge coming at us. And
navigating that with some good, strong data review and analysis
is going to be important.
I certainly support this center, and I am hoping the--my
colleagues in the House Appropriations Committee will even
double the funding for the center to make sure that we are in a
position to handle this challenge, working together, moving
forward.
Let me turn to another topic real quick. We talked about
this the last time you were here. It is school-based health
centers. I think all the evidence is, when you have these
resources in place with a captive audience, which is a school
full of children that need support and help and healthcare for
themselves, and often times connected to their families and
their communities, it makes a huge, huge difference. And I am
happy to see that HHS has been making strong investments in the
health and well-being of our Nation's children, including
through recently announced joint initiatives between HHS and
the Department of Education to expand health services in
schools.
Can you talk a little bit about the HHS commitment here to
supporting school-based health centers and the students that
they serve in this coming year, including through the
initiative that I just mentioned?
I mean, if I had my way, there would be a full health suite
in every school in America. It seems kind of like a no-brainer,
when you think of all the good that that could do. So I would
love to hear your thoughts about that.
Secretary Becerra. Congressman, maybe you are--you are
younger than me, but I remember when I was going to school in
elementary school, there was a nurse at our school. Today, if
you find a nurse in an elementary school, you are very
fortunate. It is one of the major losses that we have seen over
the years in trying to provide our children with as much access
to healthcare, especially for kids who have parents who can't
afford insurance. It is a big loss that we have seen over the
years.
The President has made a commitment to try to reach out to
communities to provide health services to children, including
at school-based settings. We are providing $40 million for a
new pilot program to integrate behavioral health supports in a
community setting. So whether it is in school community
centers, somewhere where it is accessible to families, where
they don't have to travel a long distance, we would like to
continue to work with you and others to see if we can buildup
programs like Project Aware, which is a program that helps us
focus resources and attention into places like schools, so that
our children do have access to care when often times they don't
have access otherwise.
Mr. Sarbanes. Thanks very much. I look forward to working
with you and others in the Department.
I yield back.
Ms. Eshoo. The gentleman's time has expired.
The Chair is pleased to recognize the gentleman from
Virginia, Mr. Griffith, for your 5 minutes to question.
Mr. Griffith. Thank you very much, Madam Chair.
Secretary Becerra, Ranking Member Rodgers, Subcommittee
Ranking Member Guthrie, and myself have sent numerous questions
on COVID origins to the NIH. Can you please get them to answer?
Yes or no?
Secretary Becerra. I am sorry. What is the question?
Mr. Griffith. Will you get the NIH to answer our questions
in related--relationship to COVID origins?
Secretary Becerra. Congressman, I know that the NIH has
answered----
Mr. Griffith. Yes or no?
Secretary Becerra [continuing]. Many of the questions that
were asked on----
Mr. Griffith. OK. If you can get me a more detailed answer
later, I would appreciate it. I got a lot of questions to ask--
--
Secretary Becerra. OK.
Mr. Griffith [continuing]. In a short period of time, as
you are familiar.
Last June, after visiting the border, I asked Acting
Assistant Secretary of the Administration for Children and
Families whether the Office of Refugee and Resettlement, ORR,
needed additional authority or resources from Congress to
improve the inadequate process of vetting potential sponsors of
unaccompanied children. And what they are telling the American
people is that they are doing background checks. And what they
are doing is they are doing a background check on a computer
that is not part of the criminal background system in our
country. They are just checking, you know, PeopleFinders, or
been verified, that kind of thing. Not adequate.
I got a written response stating, ``ORR is currently in
conversations with our agency partners to determine what
additional authority or resources are needed from Congress in
order to improve the sponsor vetting process,'' but nothing
further. In the meantime, unaccompanied children continue to
arrive in the U.S., ORR continues to place children with
sponsors with no real background check.
If we were doing this in a custody case--and I used to
practice that kind of law--either the attorneys or the judge
would be in front of somebody trying to figure out why they
didn't do a proper background check.
So have you taken any action to improve the vetting process
for unaccompanied minors and their truly unvetted sponsors, yes
or no?
Secretary Becerra. Congressman----
Mr. Griffith. I understand you may have to get back to me.
Can you get back to me with a full written answer on that?
Because I am very concerned about this, because while I don't
think they should be here, if they are going to be here, let's
make sure we are putting them with safe people.
I will continue with another question, and expect a full
answer. Can you get me an answer? I do need something
affirmative.
Secretary Becerra. Well, I can tell you I don't agree with
the way you have posed the question, but I will provide you
with an answer to try to give you as best information I can.
Mr. Griffith. And I appreciate that. And I just--look, most
of that is--I stated the facts. We might disagree on whether
they should be here or not, but the facts are they aren't doing
a proper vetting process. And if our court systems were doing
this, there would be people in trouble with the public.
All right. I want to go back to another question----
Secretary Becerra. On the issue of vetting, that is where I
disagree with you. But we will respond to your questions.
Mr. Griffith. All right. Well, we are going to have to
continue to disagree on that, because it is just plain poor.
All right, last year you and I discussed the fact that
President Biden had instructed agencies to maximize the use of
goods, products, and materials produced in the United States. I
hope you are making plans to refill the Strategic National
Stockpile. American manufacturers stand ready to provide
supplies. Will you commit to ensuring products that your
agencies buy come from manufacturers whose operations are in
the U.S., yes or no?
Secretary Becerra. Three hundred and forty million free at-
home tests shipped, two hundred and seventy million free N95
masks. We have done what we need to do to make sure we have a
stockpile that can----
Mr. Griffith. But are they American manufactured? Because
we got lots of people out here who are saying they are going to
go out of business because we are buying from the Chinese
again.
Secretary Becerra. And we--and by the way, because of the
instruction given by Congress, we have more authorities to make
sure domestically manufactured products are available. And
that----
Mr. Griffith. And we will give you whatever you need on
that, I am sure.
Secretary Becerra. I look forward to working with you.
Mr. Griffith. Last week I joined my colleagues, Cathy
McMorris Rodgers and Brett Guthrie, in sending you a letter
with some questions about troubling increase in deaths
associated with substance use disorder. Will you commit to
getting us a timely response, a complete timely response on
that question, on those questions?
And I know you probably haven't seen it, but if you can
give us a timely response, it would be greatly appreciated.
Say, June 1st, June 15th.
Secretary Becerra. Congressman, we are committed to try to
respond as quickly as we can, and please just be in touch if
you haven't gotten the responses you need.
Mr. Griffith. I appreciate that. We will be.
In its response to a March 8th letter I sent to SAMHSA, it
stated that it is not and has no plans for conducting,
collaborating, or funding studies about the mental health
impact of the pandemic. Do you not agree that the institution
responsible for overseeing our Nation's mental health should be
involved in such work, yes or no?
Secretary Becerra. OK. I am not sure I understood, because
SAMHSA is absolutely engaged in trying to make sure we are
assessing the needs throughout the country for mental health
services.
Mr. Griffith. Well, that is not what they told me. I will
send you a copy of the letter.
Secretary Becerra. Thank you.
Mr. Griffith. All right. Last, but not least, when it comes
to treating patients with substance use disorder, it is
critical that 42 CFR part 2 be revised to better align with
HIPAA regulations. The CARES Act instructed Substance Abuse and
Mental Health Services Administration, SAMHSA, to do so, with a
deadline of March 2021. These regulations have yet to be
published.
Earlier this month I asked your colleague, Dr. Delphin-
Rittmon, for a status update. She was unable to provide it. Can
you?
Secretary Becerra. Congressman, you threw a lot of numbers,
code sections, at me.
Mr. Griffith. OK.
Secretary Becerra. Without further reference, it would be
hard for me to respond.
Mr. Griffith. All right, and I do appreciate that. And that
is why I said I had to move quick, because I had a lot of
questions in a lot of big areas----
Secretary Becerra. I----
Mr. Griffith [continuing]. And these are not simple
questions. I will get you a written question.
Secretary Becerra. I appreciate that.
Mr. Griffith. But I really would like a response on that,
because we are a year behind on what the law says you all were
supposed to do.
Secretary Becerra. I appreciate it.
Mr. Griffith. I yield back.
Secretary Becerra. We will followup.
Ms. Eshoo. The gentleman yields back. The Chair is pleased
to recognize the gentleman from Vermont, Mr. Welch.
Mr. Welch. Thank you very much.
Mr. Secretary, it is so good to see you, and welcome.
It really is. I am going to ask you in three--about three
different topics: DIR fees; drug pricing, which you have been a
long-time champion of; and also a substance abuse treatment
program in Vermont that I think has broad applicability.
First of all, on the DIR fees, it is really brutal, what is
happening to the cost of drugs that gets passed on to seniors
and also to our community pharmacies. And I am someone who
thinks that the community pharmacies are an essential component
in our healthcare system. And I know your agency is looking at
the DIR rule in an effort to change it. It would save about $20
billion in out-of-pocket drug costs for folks who are on the
part D program. My hope is that the rule will be finalized
without delay for the year 2023.
By the way, this has got a lot of bipartisan support here
in this committee. So my question is, where do we stand on
that, Mr. Secretary, and can we have confidence that we will
get this done this year?
Secretary Becerra. Congressman, good to see you. And thank
you for the question, an important question.
We agree with you, it is an important rule. We are working
it as quickly as we can. I can't give you a specific timeline,
as I can't give you too many specifics, but we understand how
important it is because patients--or costs are at stake, and we
want to make sure that no one is paying more than they should
for the drugs and medicines and treatments that they need.
Mr. Welch. Well, let me just emphasize this has been a tug
of war for a number of years. The insurers are pushing back,
pushing hard. And this is about whether it is their profits or
we are going to get fair pricing. And it is also about fairness
to our community pharmacies.
I mean, they really have this bizarre situation, as you
know, where they sell the product at the stated price, and they
get a letter from the pharmacy benefit managers saying, ``Oh,
by the way, that product you sold at the price we agreed on
three months ago, we were just kidding, and you owe us money.''
I mean, can that at all be justified as a business model?
Seriously.
Secretary Becerra. Congressman, we are in the midst of
rulemaking. You know it would be inappropriate for me to
respond to questions that go to the substance.
Mr. Welch. All right. Well, I hope you heard my plea here--
again, bipartisan.
Secretary Becerra. I remember hearing it for many, many
years. And it is a good message.
Mr. Welch. And drug pricing, again, I acknowledge your role
you have played when you served here, and, of course, in your
role as attorney general in California. So I know you are
totally committed to doing everything we can to get price
negotiation. I know the Administration is--that is part of
Build Back Better. Where are we on this?
I mean, folks are paying huge amounts for everything from
insulin to lifesaving medication. And the drug industry is just
unrelenting, and using its pricing power, and they are
increasing prices as we sit here. And it has nothing to do with
supply chains. It has to do with their infinite unrestrained
power to raise prices, to raise profits.
Where are we?
Secretary Becerra. Congressman, we have some authorities,
as you know, to take some action to try to help keep drugs at
the prices that are fair. But we need more authorities.
That question, ``Where are we,'' is a question I know we
are posing to Congress. Where are we? How close can you come to
actually giving us the statutory authority we would need to
actually be able to competitively drive down the price of
prescription medication?
And so we will do what we can with the authority we have.
It certainly would help if Congress passes a measure that
enhances our ability to actually go toe to toe and negotiate
for fair prices for Americans.
Mr. Welch. OK, thank you. And my third topic, Mr.
Secretary, is on substance abuse.
In Vermont, we have this program that is working out
combining telehealth with a system where the medically assisted
medication is in a wheel that can only open every 24 hours, and
a person can go on their app in their home and, in the visual
observation of the provider who may be 100 miles away, take
that pill, and there is assurance that there is no abuse. It is
really a tremendous program. We had one person who said it
saved her life, because she didn't have the ability--she had no
car, and she couldn't get to where she had to be.
So what--can--is there any hope that we could have that
sensible approach, which we have on a pilot basis in Vermont,
institutionalized?
Secretary Becerra. I think we have learned that, as a
result of COVID, quite honestly, how much we can
institutionalize when it comes to telehealth. But we need,
again, statutory authority, because some of the prescriptions
are written into law, and we need Congress to act to give us
more discretion.
Mr. Welch. Right.
Secretary Becerra. But we have certainly learned how
important telehealth can be.
Mr. Welch. OK, I yield back. And thank you to all the
healthcare workers----
Ms. Eshoo. The gentleman----
Mr. Welch [continuing]. That have been sticking through it
for over two years.
Thank you, Madam Chair.
Ms. Eshoo. Sure. The gentleman yields back. The Chair is
pleased to recognize the gentleman from Florida, Mr. Bilirakis,
for 5 minutes to question.
Mr. Bilirakis. Thank you. Thank you very much, Madam Chair.
Welcome, Secretary Becerra. In your budget hearing last
year I asked you a question about partial birth abortion or
late term abortions, which are prohibited under law, in which
you stated there is no--and I quote--``there is no law that
deals specifically with the term `partial birth abortion'.'' We
know, of course, that this is incorrect. Not only is there a
Federal law, but the Biden Administration and your Department
in particular has continually undermined these life protections
in the years since we have seen you.
Mr. Secretary, let's try again. Will you commit to working
with Attorney General Garland to enforce the Partial Birth
Abortion Ban Act of 2003, which is law upheld by the Supreme
Court in Gonzales versus Carhart in 2007? Will you commit to
upholding the law, sir, in this case?
Secretary Becerra. Congressman, thank you for the question.
Good to see you. I will--I can absolutely commit to work with
Attorney General Garland to make sure we are complying with the
law, and enforcing the law that we have when it comes to the
issue of abortion.
Mr. Bilirakis. Thank you. Next question, Mr. Secretary.
Historically, decisions about the safety and efficacy of drugs
have been left to the FDA. Yet in your tenure HHS seems to have
gone the opposite direction by significantly limiting the use
of FDA-approved drugs that could potentially help millions of
Alzheimer's patients and Medicare's national coverage
determination--and again, through repealing the MCIT, or the
Medicare Coverage of Innovation Technology, which further
limits the FDA-approved products.
Why do you seem intent, Mr. Secretary, on adding an
additional layer of red tape around your agencies?
If that is not the case, please tell me. I think it
undermines each other in the eyes of the public, especially
with treatments and devices that may help alleviate suffering
for patients.
And of course, this is a very important issue. I have many
seniors in my district, as most do, that have been inflicted
with this terrible disease, Alzheimer's. So if you could answer
that question, sir, I would appreciate it very much.
Secretary Becerra. Thanks for the question. Let me see if I
can try to clarify, because it is an important question.
There is no doubt that Americans, whether it is because of
Alzheimer's or any other illness or condition, are in search of
anything that can help their loved ones. I have family that has
done the same thing.
But what we have to remember is that FDA and CMS are two
separate agencies with distinct authorities and distinct
missions. The FDA is the agency charged with telling us if a
particular new drug might--will be safe and effective. It is
CMS's responsibility to tell us if that particular medicine is
reasonable and necessary for the diagnosis or treatment of an
illness or an injury. Two different entities, two different
missions, both based on science and data to give results.
And so you--we cannot confuse what FDA's mission and role
is with that of CMS, and that is why you have distinct
decisionmaking. As I have said, the heads of both agencies have
come out with a joint statement talking about how it is
important, where they are allowed to, to collaborate and work
together so that what we can do is give the American people the
best result that we can when it comes to either therapies,
drugs, treatments.
And I think they are going to work as closely as we can
because, as I mentioned, I think, to Mr. Upton----
Mr. Bilirakis. Let's make sure that is the case, because
there are a lot of people with, again, that----
Secretary Becerra. Without a doubt----
Mr. Bilirakis [continuing]. Early onset of Alzheimer's that
can be helped with this particular drug. So I would like to see
it approved, so that, you know, Medicare would cover it for our
seniors.
Mr. Secretary, this Administration continues to pressure
Big Tech to stifle free speech under the guise of health
information, despite your own CDC pushing out misleading and
inconsistent information.
I am sure, from your days as Secretary, of course State
attorney general of the State of California, you understand the
First Amendment prohibits governments from pressing--or
pressuring private companies into censoring free speech, which
has made recent actions by the surgeon general particularly
troubling, in my opinion.
We are in the middle of an opioid and mental health crisis,
as you know, with overdose deaths surging to all-time highs.
And yet the surgeon general has instead prioritized policing
speech online. Did you direct the surgeon general to seek
information about individuals on social media platforms?
And is your aim to silence certain people?
If you can answer that question--maybe if you can't right
now because we are out of time, I would like for you to submit
the answer. Thank you, Mr. Secretary.
Secretary Becerra. Thank you.
Mr. Bilirakis. I appreciate it.
Ms. Eshoo. You are going to submit on the record--for the
record?
Secretary Becerra. We can respond later, for the record.
[The information appears at the conclusion of the hearing.]
Ms. Eshoo. All right, the gentleman yields back.
The Chair is pleased to recognize the gentleman from
California, Mr. Cardenas, for your 5 minutes to question.
Mr. Cardenas. Thank you very much, Chairwoman Eshoo and
Ranking Member Guthrie, for holding this important hearing, and
giving us an opportunity to go through the details of the
Fiscal Year 2023 budget.
Secretary Becerra, it is great to see you. I enjoyed
serving with you in Congress, and you served our State well and
our country. And thank you for dedicating--continuing
dedicating your lifelong service to all the people in this
great country as our Secretary.
I want to start today by focusing on an area of increasing
urgency: the rollout of the 988 mental health crisis line. As
you know, 988 will go live in July of this year, just a few
short months from now. This program has the potential to
revolutionize the way we respond to our neighbors in crisis,
and it will help us shift away from having law enforcement
respond to those people with a mental health crisis moment. I
truly believe that 988 will save lives, but it will only be
successful if we meaningfully fund the program throughout the
continuum of care.
Secretary Becerra, I am curious what the Administration's
vision for 988 is, and my question is this: at its most
effective, how does Health and Human Services see 988
operating?
And why is the 697 million that was requested for 988 so
necessary in order to see that vision become a reality?
Secretary Becerra. Congressman, great to see you. Please
tell everyone back home I say hello when you get there.
Nine-eight-eight is indispensable. We have to do it right.
We have been dispensing some $300 million so far throughout the
country to 50 states, the territories, and tribal governments
to make sure that we are ready.
Remember, we have a patchwork right now of this lifeline
for suicide prevention, but it depends on different phone
numbers, different entities to provide the services. This is
the effort through 988, to combine it all, to put the glue
together to make it work for everyone under the rubric of a 3-
digit phone number, instead of trying to remember a 10-digit
number. That is the first part, making sure that someone, if
they decide to seek help instead of go the wrong direction,
that they get a voice that can support them right away.
But you make a really great point, and that is we have to
make sure the service is follow-through. And that is where we
want to work with the states, territories, and tribal
governments to make sure that that is available, as well.
It is a locally operated system. We are there to help glue
it together. We hope that you will continue to support that.
Mr. Cardenas. Yes, thank you so much, Mr. Secretary, for
reminding us that 911 is a localized system, but it is a
nationwide system. And same thing with 988, it is a localized
system.
And I want to first thank you so much for the 300-plus
million-dollar roll-out that you are already engaged with
already to make sure that we can, as best as possible, hit the
ground running when 988 goes live in the middle of July of this
year.
And also, it is about making sure that, when people make
that phone call, that there are people linguistically and
culturally competent to be able to help those people in the
most effective way possible. So with that, can you talk a
little bit about what effort is underway to ensure that folks,
for example, who speak Spanish and other languages can access
this 988 line effectively?
Secretary Becerra. Absolutely. And that is a fabulous
question, because it doesn't help if you make a call and you
can't really communicate well with the person who is trying to
help you. We are doing everything we can to encourage
localities to have the workforce in place that can provide that
service directly.
We are also helping establish backup centers, so in case a
particular location is getting a lot of calls, that there is
a--another backup center that can take up some of that volume.
We don't want someone to call--when they are making that
decision of whether to do something really drastically bad or
get some help when they call that 988 number, we want them not
to be put on hold, and not to get a busy signal.
And so, first and foremost, making sure there is someone
who can actually provide them with real help. And second, as
you said, making sure we back them up. But all through that
process, it has to be culturally and linguistically sensitive,
so that we are getting someone who can really help that person
that is crying out for some support.
Mr. Cardenas. Well, thank you so much. And once again, I
appreciate your proactive efforts.
I want to go on to my question about HRSA, the uninsured
program. And there are as many as 30 million uninsured
Americans who continue to face unique barriers, especially when
it comes to COVID-19 testing and care. And unfortunately, that
money has run dry. What is the Administration doing to address
these needs, now that this program has run out of money? And
what can Congress do to help?
Secretary Becerra. Congressman, we have requested of
Congress further support for COVID activities, including that
uninsured fund for--that providers can seek relief from. We
hope that you are able to work through the process and get us
some additional resources.
Mr. Cardenas. Thank you.
I yield back, Madam Chair.
And Mr. Secretary, please say hello to Dr.--your better
half, Carolina Reyes. Thank you.
Ms. Eshoo. The gentleman yields back.
Just a comment on 988. I think members will recall that all
of the contracting from HHS to the states went to the State
departments of health, not to OES. And I don't know if that was
the best design, but that is the design. And I just--fingers
crossed that it is going to work the way we all want it to,
because it is really going to be an essential service in our
country.
The Chair now is pleased to recognize the gentleman from
Missouri, Mr. Long, for your 5 minutes to question.
Mr. Long. Thank you, Madam Chair.
And thank you for being here, Secretary Becerra. When you
leave Congress, or when you make parole from Congress, do they
issue you a hyperbolic chamber?
Secretary Becerra. Congressman, forgive me, you lost me.
Can you ask that question----
Mr. Long. Well, I have never met any Congressman that has
made parole around his place, gotten out, a year or two later
that doesn't look a lot younger and a lot better than when they
left here.
[Laughter.]
Mr. Long. And you look really good. So I am just asking.
Secretary Becerra. I am taking you home with me.
Mr. Long [continuing]. Hyperbolic chamber when you leave
here.
Secretary Becerra. I am taking you wherever I go,
Congressman.
Mr. Long. Now I am going to test your history a little bit.
Harry Truman, great Missourian, Harry Truman famously asked to
be sent a one-handed economist, as I am sure you remember,
having tired of the dismal--or exponents of a dismal science
proclaiming, ``on the one hand and on the other hand.'' So that
is why he wanted a one-handed economist.
On the one hand--and I think we need a one-handed CDC
director--on the one hand, the CDC feels that the public health
emergency is still dire enough to want to extend mask mandates
for air travelers and other public transportation, and you are
asking for tens of billions of more dollars for emergency
pandemic spending. But on the other hand, it is lifting title
42 May 23d if this stay doesn't get waived, as if there is no
pandemic at the southern border.
Last month alone, there were more than 220,000 migrant
encounters at the southern border, and half were turned away by
title 42, which I think is still a necessary and common-sense
policy to prevent the spread of COVID. Lifting title 42 sends a
clear message for illegal immigrants that, ``Come on in, olly,
olly, oxen free,'' and go on to lead to a huge migrant surge
that the Administration is not prepared for.
The estimates are, with the Border Patrol--the population
of Springfield, Missouri is 169,176 folks, according to the
2020 census. If this title 42 is lifted, every 9.4 days you
could repopulate the--my hometown, the city of Springfield,
Missouri, with 169,176 people.
As HHS Secretary, you oversee the CDC. How can you square
up the message that the pandemic is essentially over at the
border by lifting title 42, but still bad enough to mandate
mask usage for Americans traveling on planes?
Are we in a public health emergency or not?
Secretary Becerra. Congressman, thank you for the question.
I know a lot of folks are asking the very question you asked.
The public health emergency declaration that I issued is based
on the data we have about where we are in terms of this
pandemic. Title 42 is a separate measure in the statutes that
deals more specifically with things like quarantine. It is not
the same to equate title 42 with the public health emergency,
because, as you and I would probably agree, there are still,
what, 300 or so Americans dying every day of COVID. There are
still more than 1,000 people being hospitalized every day
because of COVID.
So we are still in a condition of pandemic--much better
circumstance than we previously found ourselves. But the
situation at the border has presented a number of migration
challenges. You--it is inappropriate to use a public health
law, title 42, that deals principally with quarantines to try
to deal with a migration challenge that we face, because CDC is
required to look at the facts and the evidence-based on health
conditions, not on immigration or migration challenges that we
face.
Mr. Long. I worry even now, because you lost me on that
one.
Secretary Becerra. I apologize.
[Laughter.]
Mr. Long. It was issued due to a health pandemic, correct?
Secretary Becerra. Title 42 was based on the conditions--
the health conditions that we were in at the time that have
since changed. Yes.
Mr. Long. OK. This issue should not be siloed. Encounters
are up 33 percent since February. And I think that lifting 42
directly affects what happens at the southern border. Its
lifting sends a clear signal to me that illegal immigrants
won't be turned away, and we are seeing a massive surge at the
border because of it. And I find it very concerning.
If the Biden Administration is not taking--is the Biden
Administration not taking into account when looking over our
overwhelmed border?
Secretary Becerra. Congressman, remember that President
Biden presented, his first week in office, a plan to reform a
broken immigration system. And what you are pointing to, I
think, again, verifies that we have a broken immigration
system. We should be using immigration laws to deal with that
border immigration challenge, not healthcare laws to try to
deal with it.
It is a very--it is like using a knife to do work that you
would use a screwdriver to do. You might have some success in
some ways, but it is not the right tool.
Mr. Long. OK, thank you. I appreciate you being here.
I yield back.
Secretary Becerra. Thank you.
Ms. Eshoo. The gentleman yields back.
The Chair is now pleased to recognize the gentleman from
Oregon, Mr. Schrader, for your 5 minutes to question.
Mr. Schrader. Thank you very much, Madam Chair, and I thank
the Secretary for being here. Always good to see a former
colleague, and who has moved up the food chain, and is doing
such great work, frankly.
Well, I would like to talk a little bit about healthcare. I
am very pleased to see that the President's budget includes
policy that I have sort of worked on for the past few years to
end some of the gaming of the generic drug application process
and bring less-costly, effective medications to the market
sooner.
If anything, my understanding is the proposal goes a step
further in the President's budget, and uses commercial
marketing, rather than just filing as a time trigger. The
BLOCKING Act that I have proposed has a slightly different
mechanism.
What concerns does the Administration have right now around
generic drug applications filing, and marketing, and all the
timelines?
Secretary Becerra. Congressman, I think the President would
likely tell you that we want to make sure that generic drugs,
safe and effective generic drugs, are made available as quickly
as possible to the American people.
We know that, within that sphere of the manufacturing
industry for drugs, a lot goes on. I can tell you about this as
the former attorney general in California, how we tried to make
this a more competitive marketplace, and how we tried to stop
the gaming of deals that are done behind closed doors that
limit accessibility to safe and effective generic drugs.
The President has charged us with--to do everything
possible to try to make the drug industry a more competitive
place. That would mean that we would be able to put generic
drugs out into the public's hands more quickly.
Mr. Schrader. I totally agree, totally agree. We have also
been working on our BIOSIM Act to encourage providers to use
more of the biosimilars like they do in Europe, and reduce drug
costs. So we are totally in sync, I think.
Switching gears to mental health, youth mental health in
particular, how are the increases in the critical SAMHSA
programs proposed in the President's budget going to help
address the mental health needs of our kids out there?
Secretary Becerra. Congressman, hopefully, working with you
and folks in your communities, what we will do is we will
concentrate some of those resources that I hope you are able to
get to us to help children, whether it is school, through
community settings so they can access that mental health
coverage or service a lot faster.
We find that still too many families don't have good mental
health coverage in their health insurance plans. We are trying
to change that, as well, to make sure that no one is denied
healthcare simply because it is a mental health condition
versus a more generalized physical health condition.
But we will work with you because, if we get the resources
that the President has asked for, a game-changing level of
resources, we should be able to go into your communities and
communities throughout this country and really make a
difference for the--in the lives of so many young people.
Mr. Schrader. Well, I hear so much, you know, certainly
post-pandemic and even a little pre-pandemic, about, you know,
some of the travails of young America dealing with a lack of
social interaction in the traditional school environment. Some
of the problems that are at home, they became exacerbated as a
result of the COVID epidemic. And, you know, the lack of
counselors and whatever that are out there for these children
to seek like we had when I was a youngster--we actually had
counselors in the schools, every school. It has been very
different.
It kind of leads me into the last question on, you know,
provider workforce. I just got off a call a few moments ago
with our hospital association. I have talked with our nursing
providers. I mean, it is in turmoil. The lack of workforce is
legendary now, post--well, not quite post-COVID yet, we are
still in COVID, I totally agree with that.
Secretary Becerra. That is right.
Mr. Schrader. You know, what is HHS doing to evaluate
current flexibilities and programs during the COVID-19 pandemic
that help get healthcare workers, CNAs, whatever, to the
workforce quicker and on a more permanent basis?
Secretary Becerra. Congressman, you hit it on the--right on
the nail. We are losing nurses, we are having facilities fight
for, you know, health professionals, and they are paying major
dollars to have these traveling health professionals come to
their facilities. It is a difficult situation.
We just recently, a couple of months ago, put out a grant
proposal of about $103 million to help with facilities that are
trying to help their workforce cope. So whether it is facing
burnout, whether it is those who are trying to get trained up
so they can move up a notch, or whether it is simply giving
those--that workforce a little bit more time to rest, that
money we have made available so that providers could actually
reward their workforce for everything they have done during
COVID.
Mr. Schrader. Great.
Secretary Becerra. And it is not enough, obviously, but it
is something to try to help deal with the burnout that we are
seeing in the industry.
Mr. Schrader. Excellent. Very good, very good. I look
forward to working with you. Thank you very much.
Secretary Becerra. Absolutely, thank you.
Mr. Schrader. I yield back, Madam Chair.
Ms. Eshoo. The gentleman yields back. The Chair is pleased
to recognize the gentleman from Indiana, one of our doctors on
our subcommittee, Dr. Bucshon.
Mr. Bucshon. Secretary Becerra, thank you for being here
today. I appreciate it. I wanted to start today talking about
the topic that you and Congress have corresponded frequently on
since you were confirmed, and that is the No Surprises Act, or
the surprise billing legislation.
As you know, the U.S. District Court for the Eastern
District of Texas recently ruled that the rebuttable
presumption of a benchmark rate and the interim dispute
resolution process portion of your rule was not valid. The
judge ruled that this provision conflicts--quote, ``conflicts
with the unambiguous terms of the Act.''
I and the majority of my colleagues on both sides of the
aisle involved in writing the legislation have sent multiple
letters to you, and have been speaking frequently with your
office, both before and after the issuance of the rule, stating
that this provision, in our opinion, violated congressional
intent and the delicate balance we struck in getting a deal
that protects patients and is fair to both providers and plans.
So on behalf of the Administration, can you commit to more
closely following the will of Congress and the--and also the
courts, and finalize a rule that does not include a rebuttable
presumption of a benchmark in the independent dispute
resolution process?
Secretary Becerra. Congressman, thank you for the question.
We are in the midst of trying to issue the final rule. We are
heeding the ruling, the court ruling that came out recently. We
are going to try to stay in communication with those of you who
worked very hard on this legislation.
There is no doubt that the American people want to see this
work well. They should not be blindsided with these medical
bills that we are not expecting. And so we are going to do
everything we can to continue to extract the patient from that
food fight that occurs between the provider and the insurer.
And working with you, we hope we are able to issue, fairly
soon, a final rule that puts into effect in a meaningful way
that new law.
Mr. Bucshon. Great, thank you, because--and to your point--
we all agree that the patient has to be taken out of this. And
we heard testimony of just some crazy cases where people got
these tens of thousands of dollars in bills, and we just can't
have that. And we are in agreement. All right, I look forward
to working together with you.
As you know, the roll-out of the Federal portal for the
payment disputes we have--you know, was delayed by nearly a
month and a half. So there has been--that has continued. It is
my understanding that, due to the delay, there are now hundreds
of payment disputes where the 30-day business day open
negotiation period has already expired. And--that was in the
law. And there are many more disputes where the 30-day business
days will be exhausted soon. This means that there is going to
be a flood of disputes that will inundate the Federal portal,
as well as the Federal arbiters over the next couple of weeks.
I have two questions about that, and--what caused the
delay, and will the Federal portal will be able to handle and
resolve the flood of disputes that were created by the delay?
Secretary Becerra. Yes. And, Congressman, I think lawsuits
have consequences. And when we have to wait for a ruling to
determine how we can move forward, it makes it difficult.
We intend to move as quickly as we can, because we want
folks to believe that this is a law that they can count on. So
I--we look forward to working with you. The sooner we get that
final rule issued, I think the easier it will be to try to
process these cases.
Mr. Bucshon. Great, thank you very much.
On another topic, the Medicare Access and CHIP
Reauthorization Act, or MACRA, and the topic of congressional
intent, I mean, you were in Congress and on the committee of
jurisdiction when we worked to pass MACRA. So you know--so I
know you can appreciate me wanting to make sure the agencies
are continuing to use their authority to help maximize what
Congress intended to do.
I still hear concerns about how physicians find it hard to
enter into and participate in alternative payment models, or
that the incentive just isn't there to do so. I think we need
to have more oversight hearings on MACRA, something I have
called on this committee to do, so that we can see why this is
the case and, in general, look at how we can buildupon what is
successful about MACRA and shifting to a value-based healthcare
system, and not just have a fee for service. You know, base it
on value and alternative payment models.
Congress and HHS must find solutions to the existing
physician shortage, and making sure we better value providers'
work is a great first step. As you know, adjusted for
inflation, in-practice costs physicians pay within Medicare
actually declined 20 percent from 2001 to 2021. Given that the
cost of running a medical practice has increased 39 percent
over the same time--otherwise, reimbursement declined 20
percent, increase in practice costs up 39 percent.
I know I am out of time, so I will submit this for the
record, but I am going to read the question: What is HHS doing
to stop the decline in physician reimbursement in Medicare? And
we will submit that for the record.
[The information appears at the conclusion of the hearing.]
Mr. Bucshon. Thank you, I yield back.
Ms. Eshoo. The gentleman yields back. The Chair is pleased
to recognize another one of the doctors on our subcommittee,
Mr. Ruiz, for his 5 minutes to question.
Mr. Ruiz. Thank you.
Secretary Becerra, it is good to see you, my friend. Thank
you for being here today. I know that the Administration as a
whole, and you personally, hold health equity as a top
priority. I appreciate all the work that you have done on this
front, and I look forward to continuing to work together on
policies that address this critical issue.
As someone who grew up in Coachella, and then later
practiced medicine there in the Coachella Valley in the
district I represent, I saw firsthand the very real effects
that health access disparities like physician shortages have on
the health of under-served populations. I came to Congress to
fight for health equity and to level the playing field so that
people have the same access to affordable healthcare,
regardless of where they live or how much money they make.
A shortage of healthcare providers is one of the biggest
challenges to healthcare access that we face. And the outlook
is not good. According to research by the Association of
American Medical Colleges, by 2034 we will have a shortage of
up to 124,000 physicians. That shortage is most pronounced in
under-served areas, and that is why we need to make sure that
we are increasing provider access in the areas that need it
most.
I recently met with regional leaders from eastern Coachella
Valley and Imperial County, two of the most under-served areas
of California, to discuss healthcare challenges that our areas
face. And we must ensure that these areas do not get left
behind.
That is why I have been a long-time advocate of the
Teaching Health Center program, which gets more providers in
under-served areas. Not only are physicians who train in
community health centers more likely to practice in under-
served areas, it also generates a more diverse workforce in
under-served areas. Because of the program's success, Congress
has allocated increased funding over the years to expand the
program.
However, one of the biggest challenges that the program has
faced is uncertainty over funding, which relies on short-term
reauthorization from Congress. That makes planning difficult,
which in turn makes it harder to expand and recruit residents.
Given the workforce shortages that we are facing across this
country, we need to robustly support this program.
And this committee has shown bipartisan support throughout
the years on this issue. I have worked with Ranking Member
McMorris Rodgers over several years to lead legislation on this
issue, and I was thrilled when Chairman Pallone introduced
legislation last year to permanently fund and expand the
program.
Secretary Becerra, do you support teaching health center
program parity with Medicare GME, which is permanently
authorized and funded, as well as expansion of the program
beyond what was authorized in the American Rescue Plan?
Secretary Becerra. Congressman, you--first, great to see
you, and thank you for all your work.
But on this issue of community health centers, and allowing
them to be the teaching centers as well, you had me at hello.
It is indispensable to allow these health centers, quality
health centers that are providing care to some of the least
able to afford it, with the capacity to build. And providing
them with the workforce, the next generation of doctors through
the GME funding, but doing it specifically for these community
health centers, is not only a smart thing to do, but it is the
right thing to do.
So absolutely, we look forward to working with you and
others. And you will see in the President's budget we make a
commitment, both in the mandatory allocation and in the
discretionary allocation, to continue to grow the workforce
through these communities--through these community health
centers.
Mr. Ruiz. Thank you. I fell in love with patient care at a
community health center when I was a freshman pre-med student
in undergrad.
Now I am going to change gears a little here. I wanted to
ask about an issue that I am hearing about regarding workforce
issues at CMS call centers. Specifically, that workers at two
of the call centers that operate CMS's customer service lines
went on strike last month. We cannot be in a situation where
these crucial services for seniors are disrupted.
Can you commit that CMS will work with me in good faith to
ensure that there are not work stoppages that will lead to
service disruptions?
Secretary Becerra. Congressman, we commit to work with you
to try to address some of these issues.
Mr. Ruiz. Thank you. It is very important for the seniors
in my district. It is very important to the workers that
provide good services. And we want to make sure that they have
a fair shot, and that our seniors get the best service that
they can possibly get.
And so I appreciate your time, I appreciate the work that
you have done, especially during the pandemic. We have seen
access to vaccine disparities dissolve within Hispanic
communities thanks to your excellent work, and I commend you
and the Administration on the work that you are doing on health
equity.
Thank you, I yield back.
Ms. Eshoo. The gentleman's time has expired.
The Chair is pleased to recognize the gentleman from
Florida, Dr. Dunn, for your 5 minutes to question.
Mr. Dunn. Thank you very much, Madam Chair and Ranking
Member Guthrie, for holding this hearing today.
And thank you, Mr. Secretary, for being here. I do have
some serious concerns about the President's 2023 Fiscal Year
budget, which calls for more spending on radical, progressive
priorities that are, frankly, out of touch with what America
really is interested in at this time.
Unfortunately, many of the issues we faced a year ago are
even worse today. Public confidence in our Federal health
agencies is at an all-time low, and that is due to confused
messaging by both the CDC and the President's COVID response
team.
You know, politics and policies that are encouraging school
closures and unnecessary student masking has failed our
children, set them back tremendously. And this failure is
evidenced by CDC's own decision to lower the expected
developmental milestones for children earlier this year. And
that outraged pediatricians, speech pathologists, and parents.
This is nothing new. I think, you know, the Administration
often changes COVID rules on a whim to serve capricious
political goals and interests.
Mr. Secretary, I want to suggest that--to you a commitment
to transparency just to get our public health agencies back on
track. CDC needs to be more forthcoming about their data, and
who influenced that, and who continues to influence their
issued guidance.
NIH, we have found, has actively suppressed information
regarding the genetic sequence of SARS-CoV-2 and the
circumstances of the research conducted in Wuhan, China with
NIH dollars. American people deserve answers about the origin
of COVID. So I sincerely hope that you look into the issue
internally, for ways to improve the public's confidence in
Federal health agencies.
So, a question, recently more than 60 immunology experts
and executives wrote to the FDA to express concerns over the
failure to incorporate cellular immunity into the vaccine
studies. I too am worried about that oversight. Congress
actually included language in the Fiscal Year 2022
appropriations bill encouraging NIH to utilize cellular
immunity data in research on vaccines, and requested an HHS-
wide assessment of your efforts to incorporate that data.
To underscore that, cellular immunity is an extremely
important component of the immune response, and it has been
well recognized for a number of years as the key mediator of
long-term immunity in coronaviruses. It predates the pandemic.
So right now, the Biden Administration is talking about
rolling out another round of booster shots for adults and
booster shots for kids 5 to 11. But yesterday the CDC announced
that three out of four children have already had COVID. So why
aren't we looking at T-cell immune response data to make
vaccine decisions?
Secretary Becerra. Congressman, I think I followed most of
where you were going with your question.
What I can tell you is that the CDC has continued to try to
be as transparent as it can with the information that it has.
And the NIH, in coming up with its decisions on how to do its
research, has also tried to be as transparent as it can.
Mr. Dunn. I am going to have to reclaim my time, just
because it is short.
Everybody has told you that, unfortunately. But I will say,
respectfully, I have not heard yet back my requests for
information from the Fiscal Year 2022 budget hearings. So that
is a year ago. We would really like to--you heard that from
other members, as well. They would like to hear back from your
department when we submit written questions. And NIH and CDC
are notoriously poor about that, just for your information, as
a guy on the other side.
So I am a grandfather. I am really concerned about the
consequences of lockdown on kids. And you are probably aware
that Governor Ron DeSantis had made in-person learning a
priority. I encourage you to review data from the State of
Florida and other states that kept their school doors open to
explore the advantages of that for our children.
I have another question regarding the status of
therapeutics funding, research funding, at BARDA. I know we are
short on time. You will get this question in writing. But the
truth is we only pursued monoclonal antibodies. We did not
pursue the small molecules that we know are so effectively
active against a lot of these pathways. We have really good
science on this. And I think that HHS--certainly NIH, CDC, and
FDA--should be keenly interested in following this data,
because it is outstanding.
So you will get those questions in writing from me. Please,
let's hear back this time.
[The information appears at the conclusion of the hearing.]
Mr. Dunn. Thank you very much, Mr. Secretary.
Madam Chair, I yield back.
Ms. Eshoo. The gentleman yields back. I just want to make a
quick comment, because there is a consistency, I think, in
terms of a theme today at our hearing about the loss of
confidence in public health during the pandemic.
I, for one, could not help but notice over a 2-year period,
where the chipping away in terms of attacks on some of the most
revered people in public health coming out of the Congress, Dr.
Fauci being that person. I mean, here is the man that led the
effort to cure HIV and AIDS. What are we doing to ourselves
when we do that?
So we all want confidence to--the American people to have
confidence, to have confidence in their institutions. But this
institution, I think, can be found guilty on many fronts of
diminishing those institutions. It damages our democracy.
The Chair is now pleased to recognize the gentlewoman from
New Hampshire, Ms. Kuster, for her 5 minutes to question.
Ms. Kuster. Thank you so much, Chairwoman Eshoo, and I want
to welcome our good friend and former colleague, Secretary
Becerra.
I would like to acknowledge at the outset my appreciation
for steps that the Biden Administration is taking to tackle the
addiction and mental health crisis in this country, and the
investments in this budget in adolescent mental health,
especially. As we look to the needs of Granite Staters and
communities across the country after COVID-19, we must build on
the work of this committee, and ensure that Americans
struggling with mental health and addiction are supported
through increased access to treatment and recovery. And I want
to thank you for that.
Secretary Becerra, another constant concern I hear from my
constituents in New Hampshire is the rising cost of
prescription drugs. I myself was surprised to pick up a
medication the other day, and my co-pay was $182. Drug costs in
the United States are, on average, three to four times higher
than in other countries with comparable economies. But in
contrast with many other countries, and I might point out, in
contrast with the Veterans Administration and other payers
within the United States, the Medicare program lacks the
ability to negotiate with drug manufacturers on a volume
discount to lower the price of drugs.
Do you agree that allowing the Secretary to negotiate to
lower the price of certain medication in the Medicare program
is critical to lowering overall drug costs?
And is it fair to say that there are no other as effective
tools to constrain drugs as when a drug lacks competition?
Secretary Becerra. Congresswoman, first, good to see you.
But second, easy answer. Yes, absolutely agree.
Ms. Kuster. So we have heard from opponents to these
reforms who claim that provisions like drug price negotiation
with innovation and delay the discovery of new cures. Do you
agree that it must be one or the other, lower costs or new
cures?
Or instead, can we protect patients while we also protect
innovation?
Secretary Becerra. Congresswoman, we are a society that
relies on competition and the free market. It makes no sense to
not be allowed to negotiate for the best price. You wouldn't
accept going into a car dealership and having to take sticker
price for that vehicle. You wouldn't expect to just take any
price from some mechanic if you have to get that vehicle
repaired. It is a true and tried provision--part of our life in
America to be able to get the best price we can, and negotiate
for that best price.
Ms. Kuster. Well, the President's budget reiterates your
support and the Administration's support for a comprehensive
prescription drug pricing plan. How did the drug pricing
reforms included in our Build Back Better Act, passed by the
House, fulfill the Administration's goal of lowering costs for
consumers and patients?
Secretary Becerra. Congresswoman, one, that provision would
have allowed Americans to have a better insight into how drug
manufacturers price their products. That transparency that the
bill would have provided is wholly overdue. As they say,
sunshine is the best disinfectant. We should get to see the
types of prices that we would be charged.
Second, by being able to actually negotiate on behalf of
Medicare's 65 million or so beneficiaries to get the best price
for all of them, that leverage allows us to get good prices,
not just for those seniors and those under Medicare, but it
would then set a trend for other pricing done in the private
sector through their other private markets, whether it is
through Medicare, Medicaid, the Veterans Administration, or
through health insurers. The more transparency you have, the
more the right price will be negotiated, because people get to
see how--what is really at stake.
And so to hide that ball from the American public, it keeps
prices very high.
Ms. Kuster. And do you agree that these policies, the
transparency combined with negotiating a volume discount for
the medication, work in tandem to effectively lower drug costs
and stop price increases?
Secretary Becerra. Absolutely. And at the same time, I
believe it helps promote innovation, because we get to see
where we need medicines, and manufacturers will go into that
space to provide the medicines where the demand is there.
Ms. Kuster. Terrific. Well, thank you, Secretary Becerra. I
am so pleased the Administration is committed to lowering
prescription drug costs for my constituents and for Americans
across this country. We have the solutions to lower drug costs
we spend in the House. And I look forward to seeing those
enacted into law.
And I yield back.
Ms. Eshoo. The gentlewoman yields back.
The Chair is pleased to recognize the gentleman from Utah,
Mr. Curtis, for your 5 minutes to question.
Mr. Curtis. Thank you, Madam Chair, thank you, Mr. Ranking
Member, Mr. Secretary.
You may not remember, but last year in--this opportunity--I
invited you out to Utah, and I am going to re-extend that
invitation, and----
Secretary Becerra. Let's work out a date, Congressman.
Mr. Curtis. Yes, we would very much enjoy that. I know as
well as anybody how busy you are, and how busy the schedule is.
But you also know the sense that--in middle America that we
have for wanting to be part of the solution and part of the
answers. I think what--we are doing in Utah a lot of things
very well. And we would also love to brainstorm with you what
we could do better. So----
Secretary Becerra. A done deal. We will make it happen.
Mr. Curtis. Excellent, I like that. Maybe the best question
of the hearing, right?
So as we know, the budget, the President's budget, is a
reflection of priorities. And so I want to talk to you about
one of the priorities that is showing up in the budget that
concerns me, not because of what is on face value--and let me
explain what I mean by that--but your budget allocates
funding--it went from ten million to $110 million for studying
the potential impacts of climate.
And for context, the budget has $97 million for nutrition
research. And I am the first here to say what is happening with
the climate is important. We need to pay attention to it. It
has an impacts.
But could you see how that potentially--Madam Chair, I
think we have got somebody----
Voice. Oh, awesome.
Secretary Becerra. It sounds like----
Ms. Eshoo. There is--I think Annie Kuster, you need to shut
your microphone off. I think I recognize your voice. You are
interfering, and I think you don't mean to. OK?
Mr. Curtis. It sounds like she has got it, OK.
Ms. Eshoo. All right, got it?
Mr. Curtis. All right----
Ms. Eshoo. The coast is clear.
Mr. Curtis. Thank you. And let me just emphasize, you know,
on this whole thing, I founded the Conservative Climate Caucus,
I am very aware of the importance of this. But 70 percent of
Americans are overweight. And prioritizing climate over right
nutrition and diabetes and healthcare, you can kind of see the
optics of this. And I would love just to hear from you about
the prioritization of this, and realizing, like, you know that
every dollar people are hoping are--spent is on their issues.
And have we perhaps made a mistake by prioritizing climate in
this budget?
Secretary Becerra. Congressman, first, can I thank you for
the thoughtful way you posed the question?
I hope I could convince you on that trip to Utah that the
investment we are making to deal with climate change is going
to be critical to make sure Americans stay healthy.
You come from a State like me, California, where the warm
temperatures, the high heat, can often times have major
impacts. We are finding that there are communities in
California that are running out of potable water. You cannot
raise a family if you can't access potable water easily, and
you can't afford to pay constantly for bottled water. And so
there are many ways that the climate changes that we are seeing
are affecting families. We want to make sure we are doing
everything we can.
We are going to put it in perspective, because the kind of
investment we are putting into that office, as opposed to, as
you mentioned, food nutrition, obesity, it doesn't compare. We
have absolutely been engaged on nutrition issues of obesity for
a long time. We are very committed. It is not doing one over
the other, but it is recognizing that climate change has become
a major issue when it comes to the health of our country.
Mr. Curtis. Your answer doesn't surprise me. Let me just
re-emphasize from--I think from my district's perspective, the
optics, right, of this, and of saying, look, of all the things
that are out there that are important.
And when you come to my district, you will hear this. There
is a fear that climate will be declared a public health
emergency. Could you comment on that?
And I--do you--are you--I can tell from your look you are
not sure of my question, like----
Secretary Becerra. Right, if you could----
Mr. Curtis. Yes.
Secretary Becerra [continuing]. Question again.
Mr. Curtis. Is--yes or no, do you intend to declare the
climate a public health emergency?
Secretary Becerra. Well, I think most people recognize that
climate change has already become an emergency.
Mr. Curtis. Right, but you understand the official
declaration, right, that I am----
Secretary Becerra. Yes. As you know, there are many
elements that go into any kind of declaration of a public
health emergency.
Mr. Curtis. So to be clear, is--that is something that we
should--that we will see coming?
Secretary Becerra. Well, when it comes to the public health
emergency, we will outline the different criteria that we take
a look at. For example, right now we are in this pandemic, and
we are in a State of a public health emergency. It relies on
the evidence, the science, to guide us on that. And we would do
the same thing any time we are ready to declare any form of
public health emergency.
Mr. Curtis. I want to--I just have a few seconds left, and
I want to----
Ms. Eshoo. No, you have another 20 seconds.
Mr. Curtis. OK, thanks.
Ms. Eshoo. I will add on.
Mr. Curtis. Thanks, Madam Chair.
We know that COVID-19 exasperated existing healthcare
problems. Many in Utah and across the United States are
experiencing isolation. Children's mental health, I think we
could agree, is in a crisis. The more time that goes on, the
more data comes out, you know, about some of the decisions that
we have made.
I think, specifically in my district, you are going to see
an exploding of drug and substance abuse. We actually took a
few minutes the other day and sent out a notice to my district
that said, ``Hey, I am going to have a chance to speak on
this,'' and these are the responses that came in, personal
stories about problems with substance abuse: 250 Americans
every day die to drug overdose. I really want to emphasize
that, realizing the amount of time--when you come to Utah I
would love to talk to you about that, as well.
Secretary Becerra. I look forward to it.
Mr. Curtis. Thanks, Madam Chair. I yield my time.
Ms. Eshoo. The gentleman yields back. That is going to be
quite a visit. Exactly.
The Chair is pleased to recognize the gentlewoman from
Illinois, Ms. Kelly, for your 5 minutes to question.
Ms. Kelly. Good afternoon, Secretary Becerra. Good to see
you so soon again. Thanks for being here today.
Just a few weeks ago, as you know, we observed Black
Maternal Health Week, and we just discussed it last night, the
issues around maternal mortality rates, and especially when it
comes to Black mothers, who are three to four times more likely
to die from a pregnancy-related death than White women. And I
was very, very proud that the American Rescue Plan included a
policy that I pushed for, with strong support from this
committee, that would give states the option to cover new
mothers on Medicaid for 12 months postpartum.
Mr. Secretary, how many states have adopted the option to
provide 12 months of continuous coverage postpartum in Medicaid
and very proud that Illinois was the first?
Secretary Becerra. Yes, Congresswoman, first, thank you for
what you did there, working with your colleagues. Crucial.
We had five states, as you mentioned, Illinois being the
first, to come on board to take us up on the challenge to
increase access to postpartum care for women for up to 12
months instead of just 60 days. We are now talking with another
11 states, 12 states who are--have indicated a deep interest in
moving in this direction, as well.
And so, as a result of the American Rescue Plan, we hope
that what we can do is get some close to 800,000 women in
America under full coverage for a year of postpartum care,
rather than just have it drop off after 60 days.
Ms. Kelly. That is great news. Can you just talk about some
of the benefits of providing 12 months of continuous
eligibility postpartum in Medicaid, and how it will help
address the maternal health crisis?
Secretary Becerra. Congresswoman, I say this not just as
Secretary, but as the spouse of an obstetrician gynecologist
who can tell you about many, many experiences with some of her
patients. Sixty days is helpful, but you don't stop being a
mother with all the stresses. The child doesn't all of a sudden
get healthy after 60 days. There is a lot that happens after 60
days.
We want to continue that care, so that child grows up
healthy and strong. We want that mother to be healthy,
physically and mentally, going through that process of becoming
a parent. And it is important that we continue to provide
access to the different health services that--whether mother or
child--will be needing over that course of time, because you
want to set them on the right track. And so this coverage that
you made possible is indispensable.
Ms. Kelly. Thank you. I am thrilled that so many states
have decided to take this option. But unfortunately, we know
this policy will sunset in five years. And what is worse, you
know, we are not seeing 50 states. So some states have decided
not to implement this policy at all, leaving mothers without
coverage at a very vulnerable time. We need to pass mandatory
and permanent Medicaid postpartum exemption policy that is in
my MOMMA's Act. And that was included also in Build Back
Better.
But also I wanted to talk about how we are closing the
Medicaid coverage gap--help women who are seeking prenatal
care, or care early in their pregnancy.
Secretary Becerra. Yes, we hope that more states will take
up the opportunity to expand Medicaid coverage. We hope that
Congress succeeds to provide several million Americans who are
not in states where the expanded Medicaid has been available.
And what we know is the results are that families get to get
up-front, preventative care early, and it helps American
taxpayers from having to spend more money, whether it is in an
ER visit or whether it is because conditions get so difficult.
And so, whether it is through Congress--and I hope that you
all are able to have success in expanding access to coverage in
Medicaid--or whether it is simply the fact that a state--the 12
states that are--have still not expanded Medicaid coverage to
their citizens will take that on, that one way or the other we
will continue to see more Americans have access to quality
healthcare.
Ms. Kelly. Thank you so much. With the leaders of the Tri-
Caucus, the Democratic leadership and the President, we sent a
letter to outline the key Medicaid policies that should be
included in the final reconciliation bill. Thank you so much
for all the work you do. It is great to see you.
And I yield back.
Secretary Becerra. Thank you.
Ms. Eshoo. The gentlewoman yields back.
Thank you for your extraordinary leadership. This is what
was--is being heralded came from the Congress. And we have an
agency that is implementing, and implementing well.
But really, I think, were it not for Congresswoman Kelly
and the work done of the subcommittee and the support of the
subcommittee going to the full committee, we wouldn't be
hailing what we are hailing today. These are such important--it
is such important progress for our country.
The Chair is now pleased to recognize the gentleman from
Pennsylvania, another one of the doctors on our subcommittee,
Dr. Joyce----
Mr. Joyce. Thank you, Madam Chair----
Ms. Eshoo [continuing]. To question.
Mr. Joyce. Mr. Secretary, I would like to ask about
healthcare access, since your Department says that that is a
priority in the recent RFI on access to care and coverage in
Medicaid and CHIP.
In that RFI, CMS asks for feedback on ensuring access to
timely providers and services. So I would like to know, do you
think it would be in the interest of Medicaid beneficiaries if
a State were to restrict access to providers of mandatory
services so that only hospital in their county or service area
in their region would be able to provide Medicaid services
(sic)?
Secretary Becerra. Dr. Joyce, I want to make sure I
understand the question. You are talking about a program where
Medicaid would compel the restricted access of services?
Mr. Joyce. Compelled only to be with hospitals that had
eligibility requirements by whether or not their hospitals were
unionized.
Secretary Becerra. So if there is a requirement that is
based on a level of care, or if there are criteria that are
imposed before a hospital or other provider can be--can take--
make use of Medicaid services, it may be as a result of an
effort to make sure that the care that will be provided is of
quality.
I would have to have more information to answer your
question more directly. But certainly, Medicaid is in the game
of trying to increase access, not decrease access to care.
Mr. Joyce. And if access was decreased because in rural
areas or throughout the Commonwealth of Pennsylvania hospitals
are not unionized, and thus would not be able to accept
Medicaid patients, and would then sever the services that are
available for those Medicaid patients, would that be
unacceptable?
Secretary Becerra. We certainly want to make sure that
Medicaid is supporting hospitals or providers that offer
quality care. And we want to make sure that we keep Americans
and patients away from facilities, providers that don't offer
that level of care that we would expect, because not only would
it be bad for the patient, but it would be bad for taxpayers to
be providing care in that way.
So again, knowing the particulars would be helpful to be
able to give any specific response to any particular provider.
Mr. Joyce. So earlier you stated that you are committed
that Americans stay healthy. I share that commitment.
Americans who rely on Medicaid for healthcare need to have
access to care. As you know, per the letter that I sent two
weeks ago, my home State of Pennsylvania is preparing to
prohibit MCOs from contracting with hospitals and other
providers that had a work stoppage in the past five years if
the provider doesn't have a collective bargaining agreement or
labor peace agreement in place.
Thus, this provision would not only be inconsistent with
your recently published RFI, but it would also appear to be in
violation of existing Medicaid statutes, including 42 CRF
438.206, availability of services; 42 CFR 48214, provider
selection; 42 CFR 438.12, provider discrimination prohibited;
and a large amount of regulations and guidance that flow from
these laws, notably time and distance standards--network
adequacy, in particular--as well as State Guide to CMS Criteria
for Medicaid Management Career Contract that your agency just
released in January of this year.
With that information, I would ask you, Mr. Secretary,
would you be prepared to reject a contract, a contract
amendment, or eState plan amendment that undermines access to
care by denying Medicaid beneficiaries the access to only
hospitals in their county or in their service area?
Secretary Becerra. Congressman, let me commit to you that
we certainly are willing to work with you if you believe that
there is a State plan for your State of Pennsylvania that is
not working in the best interest of any Medicaid patients.
Certainly, we will take a close look at that.
We are in the process of reviewing any number of requests
from different states on how they implement their Medicaid
program. We always, as I said, try to make sure that we move
toward increasing access to care, quality care, for those
patients who would receive it through Medicaid.
Mr. Joyce. Thank you, Mr. Secretary. I look forward to
working with you on that issue. It is important, and it is
beneficial that Medicaid patients have access to more
facilities, regardless of the presence of qualifying
relationships with organized labor. Thank you for agreeing to
address that with us.
Ms. Eshoo. The gentleman yields back.
The Chair now recognizes the gentlewoman from California,
Ms. Barragan, for your 5 minutes of questions.
Ms. Barragan. Thank you, Madam Chair.
Thank you, Mr. Secretary, for being here today, and for all
your work to make sure that there is a strong vaccination
campaign to get the vaccine across the country and to people
who are most vulnerable, and that we are continuing to fight
COVID as we see new variants come through.
I heard you testify about the difference between the FDA
and CMS, and I just want to comment on the decision that I
disagree with CMS on: finalizing a coverage policy to tighten
and restrict coverage of FDA-approved Alzheimer's treatments
for an entire class of drugs.
I had a chance to speak to the administrator, and I had a
chance to hear your response. There seems to be a disconnect.
We are saying that the FDA can say something is safe, but then
the CMS will decide whether it is reasonably necessary. That,
to me, seems like we are saying the FDA can't judge clinical
data, but CMS can.
It is also telling me and sending me a message--and this is
about access--once the FDA passes it, people who have money and
can pay for it will get it. People who are under a CMS program
won't. And that, to me, is an access issue that continues to
trouble me, and to--something that I continue to have an issue
about.
We talk about access to healthcare. This is access to
healthcare. The decision should be between a patient and their
doctor. And so I will continue to speak out, because I am just
so disappointed, and that--this is the first time we have had a
drug that has been approved under the accelerated approval
process that hasn't been covered by CMS, a drug.
So that is the comment I have. I am going to move on to my
questions, and those are on different topics. The first one is
on the Children's Health Insurance Program.
Secretary Becerra, the Children's Health Insurance Program,
or CHIP, has been a remarkable success, reducing the uninsured
rate for children by 68 percent. And 2021 CHIP enrollment
averaged over seven million individuals per month, making it an
essential source of children's health coverage. And during the
pandemic CHIP helped to ensure that children and pregnant women
had free access to COVID-19 testing and treatment.
Despite its success, CHIP is the only Federal insurance
program that isn't permanently funded. So every few years
Congress scrambles to prevent CHIP from running out of money.
Can you speak to the importance of CHIP, and your thoughts on
having it permanently funded?
Secretary Becerra. Congresswoman, first, thank you for all
the work that you have done on these issues.
There would be many more children living in poverty if we
didn't have the CHIP program. There would be many more children
who we would discover late in their--later in their life that
they were suffering from illnesses that might be life-
threatening, but are able to get the care they need to prevent
that from ever taking a life with the CHIP program.
And it just--as I said earlier, my mom would always tell
me, ``Mejor preventir que remediar,'' better to prevent them to
remediate. CHIP is a program that lets families who are lower
income prevent illness in their children from becoming life-
threatening. And we would be in disastrous shape if we did not
reauthorize CHIP.
Ms. Barragan. Thank you. I want to talk a little bit about
the Cancer Moonshot and multiple myeloma.
Mr. Secretary, an important factor in reducing the
mortality of cancer is research and early detection of rare and
aggressive forms of this disease. For example, multiple myeloma
is a rare fatal cancer of blood plasma cells with disparities
in all ages, all stages of the disease. African Americans
account for 20 percent of patients diagnosed with multiple
myeloma, despite being only 12 percent of the U.S. population.
My own sister, who is only a year older than me, was diagnosed,
and is now battling this, and will have it for the rest of her
life. There is no cure.
Barriers to treatment are also present. Latinos have the
lowest stem cell transplant rate for the treatment of multiple
myeloma.
Given the mortality associated with rare cancers and lack
of treatment options, could you discuss how the reignited
Cancer Moonshot would expedite research to improve the lives of
people with rare, aggressive diseases such as multiple myeloma?
Secretary Becerra. Excellent question. And one of the
things that we are doing to try to help launch the President's
Moonshot proposal is to start by getting people back into the
doctor's offices to get screened. There are estimates that 9 to
10 million Americans failed to make their screening
appointments for cancer because of the pandemic. We are going
to launch an effort to try to encourage Americans to go back
and get checked, because the sooner you get checked, the
quicker you can address some of those cancers that can be
preventable.
I will tell you that we are also making every effort to
make sure that we take equity into account in who participates
in these clinical trials, and the work that is done to make
sure that we have treatments for everyone.
Ms. Barragan. Thank you, Mr. Secretary.
Madam Chair, I yield back.
Ms. Eshoo. The gentlewoman yields back.
The Chair is pleased to recognize the gentleman from Texas,
Mr. Crenshaw, for your 5 minutes to question.
Mr. Crenshaw. Thank you, Madam Chair. I thank you and the
ranking member for holding this important hearing.
Thank you, Mr. Secretary, for joining us in person. I have
got to say it seems like there is some bipartisan agreement on
how CMS does approvals. So that is good to hear, as well. It is
not what I want to talk about, though. I want to talk about
title 42, as you can imagine.
And Mr. Becerra, I want to ask you, why do you want to end
the expulsions at the border currently authorized under title
42? I want to understand this.
Secretary Becerra. Congressman, let me try to explain. We
don't base determinations about title 42, which is a healthcare
law that deals principally with quarantining activities, we
don't base those on what is occurring in terms of the border,
on immigration. It is a healthcare measure, title 42, that is
rarely applied. And when it is applied, it is because the
health conditions are such that CDC has recommended that we use
it to try to keep populations from intermingling in ways that
could lead to worse results when something like COVID-19 hits
us.
Mr. Crenshaw. And I would take that as the answer if you
didn't also support title 42 authority to continue the mask
mandate on airplanes, to mask children in Head Start programs,
to authorize the eviction moratoriums. So you have got to be
consistent. You either believe that title 42 is still a
necessary thing to do because of COVID, or you don't. So which
is it?
Secretary Becerra. Well, in the various instances that you
have raised, you will see that the guidance that CDC has
provided has changed, whether it is for cruise ships, whether
it is for children in school settings. They have all been
adapting to the--what the facts and the medicine and the
science tells us should be the case with regard to those----
Mr. Crenshaw. I find it hard to believe that the science
tells us that there is still COVID on airplanes, even though
that has been debunked wildly. I mean, many, many times, given
the filtration systems on airplanes. You are still pushing for
that mandate. But there is no COVID on the border, with 8,000
people crossing every single day? And with title 42 rescinded,
all estimates--this isn't even a partisan estimate--all
estimates point to about 18,000 a day.
So again, which is it? Is COVID still a problem or is it
not?
Secretary Becerra. Congressman, I--maybe you disagree, but
we are losing more than 300 Americans a day. We still have over
1,000 Americans being hospitalized every day.
Mr. Crenshaw. So it is a problem. So then why not keep
title 42 at the border? Why not allow those expulsions?
Secretary Becerra. Because, as I explained, the law that I
use to declare a public health emergency is different from the
law, title 42, that you are referencing that is used
principally--and only very infrequently--to deal with things
like quarantines.
Mr. Crenshaw. Right, communicable diseases.
Secretary Becerra. We have seen an evolution of this
pandemic.
Mr. Crenshaw. I know, but again, there is clearly no
consistency here, and that is the problem----
Secretary Becerra. There is absolutely----
Mr. Crenshaw [continuing]. Right?
Secretary Becerra [continuing]. Consistency in the--what
CDC has done. CDC has been using the facts and the science to
drive what it does.
Cruise ships are different from schools, which are
different from the border. And you--it is not a cookie cutter
approach to the use of our healthcare--of healthcare
authorities. Title 42 is not the same as the emergency
declaration----
Mr. Crenshaw. I think we have--you have utterly failed to
provide the scientific data and scientific backing for saying
that COVID measures are still required for children over two
years old and on airplanes, when both of those things have been
debunked many, many times, versus the border, with 18,000
people potentially crossing every day. That is--and, by the
way, filling up our hospitals, filling up on busses, moving
into the United States, getting tickets to wherever they want.
This is a problem.
And also, to say that HHS doesn't deal with immigration,
and that you do--that you look at this completely separately,
that is also not true, because you oversee ORR, right, which is
the unaccompanied minors. So how on earth can HHS deal with a
tripling, quadrupling of unaccompanied minors coming through
your system, when you rescind title 42?
Secretary Becerra. Congressman, once again, by law we are
the entity, ORR, the Office of Refugee Resettlement, which
takes custody of a child that is unaccompanied by an adult
found at the border. By law, the Department of Homeland
Security cannot hold that child for more than 72 hours. We then
provide an accommodation.
Mr. Crenshaw. Well, I understand what your job is. I am
saying----
Secretary Becerra. That is not a----
Mr. Crenshaw [continuing]. There is no way you can do it
under these conditions. I don't care how much money we give
you----
Secretary Becerra. We are doing----
Mr. Crenshaw. You are not, though. It is impossible.
Secretary Becerra. Congressman----
Mr. Crenshaw. You are letting people go----
Secretary Becerra [continuing]. You understand that title
42----
Mr. Crenshaw [continuing]. In vast quantities.
Secretary Becerra. Congressman, you understand that title
42----
Mr. Crenshaw. That is a problem.
Secretary Becerra. You understand, Congressman, that title
42 has not applied to those children----
Mr. Crenshaw. No, I understand that. But here is what
happens, right? You have an excessive number of people crossing
the border. And along with that is more people. They come in
large groups. This will happen in--by extraordinary numbers
without title 42.
Ms. Eshoo. The gentleman's time has expired.
Mr. Crenshaw. And everybody agrees with that.
Ms. Eshoo. The gentleman's time has expired.
Mr. Crenshaw. All right, thank you.
Ms. Eshoo. The Chair now recognizes the gentlewoman from
Delaware, Congresswoman Blunt Rochester, for her 5 minutes to
question.
Ms. Blunt Rochester. Thank you, Madam Chairwoman, and thank
you so much, Secretary Becerra, for joining us today to discuss
the President's Fiscal Year 2023 budget for the Department of
Health and Human Services.
I want to start off by saying that I applaud the
Administration's efforts to make sure that Americans get
healthcare coverage, and also to protect us from this historic
pandemic. It is not lost that we have come a long way, and we
still have a ways to go.
But today I would like to focus on an issue that is really
a priority for me and so many others, and the pandemic has
exacerbated it, social challenges have exacerbated this, and I
am extremely pleased to see the Administration's budget request
include several important proposals to strengthen access to
mental health and substance use care and services.
My colleagues on this committee and I have led efforts to
provide your Department and the Departments of Treasury and
Labor with new tools to strengthen the enforcement of existing
mental health parity laws.
The Department's recently released report found that
insurance companies are failing and falling short of providing
parity in mental health and substance use disorder benefits.
And the report documented numerous parity violations. Secretary
Becerra, can you briefly discuss the report's findings, and why
mental health parity is so essential for our constituents?
Secretary Becerra. Congresswoman, thank you for the focus
you have placed on this issue over time, and thank you for the
work that you have done.
We can't say that we are going to really try to treat with
the healthcare needs of Americans if we leave out mental health
services, especially at a time when, because of the pandemic,
we have seen how dramatically we--the increase in need for
mental health services is out there, and especially for our
children.
And so we are going to do everything we can to make it
clear that the President is willing to invest $50 billion over
the next ten years to change the way we deal with mental health
services. And we are going to start doing far more work to
aggressively enforce the law, to make sure there is compliance
with the mental health parity laws that we have in books.
Ms. Blunt Rochester. You know, the fact that some insurance
companies are still failing to deliver parity is unacceptable.
And that is why I am really pleased to see the budget request
includes funding for grants to help states enforce mental
health parity requirements.
Can you briefly discuss the challenges that states face in
the enforcement and oversight of existing parity laws, and why
this funding is critical?
Secretary Becerra. As the former attorney general in the
State of California, I will tell you that it is tough. When you
have a good partner in the Federal Government helping you go
out there and do some of this enforcement, you can do far more
than just the Federal Government by itself.
And so I think many states will appreciate, if Congress
provides us with this funding, the grant help that will provide
states who want to be out there and aggressively enforce these
parity laws.
Ms. Blunt Rochester. For far too long frontline workers
have lacked access to coverage for mental health, and--due to
loopholes in the current law that allows State and local plans
to opt out of mental health parity.
I am also heartened to see that the budget includes a
request to finally close this loophole. Can you discuss the
importance of ensuring that frontline workers are protected by
mental health parity laws?
Secretary Becerra. That is--isn't it tragic when you find
out that you are working real hard, you are doing everything to
keep someone else healthy, and then you don't have access to
the kind of care you need?
We are going to do everything we can, Congresswoman, to
eliminate those kinds of barriers that really don't belong in
the 21st century, not in America.
Ms. Blunt Rochester. And last, Medicaid and CHIP cover 40
million children. Therefore, Medicaid and CHIP investments in
access to needed mental health services are critical to
addressing the national child mental health emergency. What are
you proposing in your budget to specifically address children's
mental health challenges under Medicaid and CHIP?
Secretary Becerra. Congresswoman, we are trying to make
sure that, first, Medicaid is available to all families. And we
still have some states that aren't taking up the Medicaid
opportunity to provide their families with that care.
Second, we are trying to make sure that we expand coverage
into places in the community setting, so it is not just
reimbursement at a hospital, but there is more and more
conversation about the possibility that Medicaid could actually
be there in schools to provide those kinds of services, mental
health services, that many of our children need.
I have been in conversation with Secretary Cardona in the
Department of Education. We are going to continue to work
together to see if we can expand access to healthcare for our
children, including in our schools.
Ms. Blunt Rochester. First of all, I just want to again
thank you so much for this focus. We have experienced
individual trauma, as well as collective trauma as a country
through all of this. And your efforts are going to make a big
difference. And thank you so much for being here.
I yield back, Madam Chair.
Ms. Eshoo. The gentlewoman yields back. The Chair now
recognizes the gentlewoman from Minnesota, Ms. Craig, for her 5
minutes of questions.
Ms. Craig. Thank you so much, Madam Chair.
Secretary Becerra, thank you for being here today to
testify in front of the committee.
As a Member of Congress, I know that you know one of my top
priorities has been to lower the cost of healthcare for my
constituents, a priority that I was so happy to see reflected
in HHS's 2023 budget.
When discussing the high cost of prescription drugs, those
who rely on insulin specifically, we understand why
prescription drug reform is so critical. According to the
research by RAND Corporation, drug companies charge more for
insulin in the United States than in nearly three dozen other
countries, and the average price in America across all types of
insulin was more than ten times higher than the average price
for all the other countries combined. That is why any solution
to reduce drug prices must include solutions to reduce the cost
of insulin.
I am incredibly pleased that the House recently passed my
bill, the Affordable Insulin Now Act, which would cap the out-
of-pocket costs for insulin at $35 for those with private
health insurance coverage or Medicare part D. But we know that
capping the cost--out-of-pocket cost alone is just not enough.
We must continue to work on solutions to effectively lower the
list price of lifesaving medications like insulin, including
through drug price negotiation.
So, Secretary Becerra, insulin has been available for
roughly a century, and yet the costs that patients face are
increasing year after year. In your view, Mr. Secretary, is
there any justification for this?
Secretary Becerra. Congresswoman, first, thank you for the
work you are doing on this subject.
It makes no sense that a drug that has become so readily
available continues to increase in price. It shows how broken
our system is for drug pricing in this country, and why
Americans pay far more than most people around the world for
the same drug, a drug often times manufactured here in the U.S.
I applaud your effort. I hope that you succeed in making it
clear that we have to corral these prices and have something
that makes sense for the American people. I hope you are able
to pass a measure that goes beyond just one particular
medicine, because there are so many drugs that are being
overpriced here in this country.
And so what I can tell you is that no American should not
be able to get the drugs they need. And every American should
be aware of the effort that you are making to make those drugs
much more affordable for them.
Ms. Craig. Thank you. Thank you so much, Mr. Secretary. I
want to just dig in a little bit about your view here.
So how do measures already passed by the House, like the
insulin bill, such as empowering Medicare to negotiate drug
prices, right, inflationary rebates, how do all of those things
work together to lower insulin costs?
And I will just follow that up by saying--any comments you
have on other efforts the Administration is undergoing to
address the high cost of prescription drugs in America.
Secretary Becerra. Congressman, by opening those curtains
to how these drug manufacturers operate, and how they price
their products, that transparency would give everyone sight on
how this is being done--probably not in the best interest of
patients.
Second, we are a country that believes in competition, and
it makes no sense that the biggest purchaser of drugs, the U.S.
Government, whether for Medicare or Medicaid or through the
Veterans Administration program, cannot try to get the best
price for all those patients, for all those Americans who
deserve to have that treatment. And we know that, if we are
able to get the best price, that we will save Americans not
just a lot of money, but we will probably add years to their
life because they will be able to afford their medication.
One of every three Americans right now tells us that they
skimp on their medication because they have to make it last
longer, because they don't have enough money to use it the way
it is supposed to be used. That is not right. We need to tackle
that. And that is where your efforts are going to be
indispensable in making it possible for Americans to get the
drugs they need.
Ms. Craig. Mr. Secretary, I am going to slip in one last
question around your directive to CMS to re-evaluate the
Medicare part B premium increase. Any updates you can share? I
know my constituents really do need the relief.
Secretary Becerra. Congresswoman, that is underway. It is a
complicated process, and CMS is working hard so we can give you
an answer.
Ms. Craig. Thank you so much for being before the committee
today. I appreciate your leadership and partnership.
And with that, Madam Chair, I yield back.
Ms. Eshoo. The gentlewoman yields back. The Chair is
pleased to recognize the gentlewoman from Washington State, Dr.
Schrier, to question for 5 minutes.
Ms. Schrier. Thank you, Madam Chair.
And thank you, Secretary Becerra, for coming before this
committee today to talk about the HHS budget and priorities.
First, let me just say, as a pediatrician, I want to thank
you for prioritizing children in your budget in so many ways.
One thing I am especially pleased to see is the expansion of
the Vaccines for Children program to cover CHIP enrollees. And
this aligns with the provisions in the bipartisan bill that I
sponsored with Dr. Joyce, Representative Butterfield, and
Representative McKinley that strengthens this already excellent
and really important program.
I was also really happy to see the proposal to improve
access for more children by expanding the network of providers
who participate in the Vaccines for Children program. And this
is really important. We are seeing a drop in routine childhood
immunization rates because of COVID. Just last week it was
reported that hundreds of thousands of students are no longer
adequately protected from common diseases--what used to be
common diseases like measles, mumps, and pertussis. And this is
particularly dangerous for the tweens in middle school who are
particularly behind on their vaccines, where we already see
outbreaks of whooping cough.
On the topic of immunization, again, as a pediatrician mom,
I know that the best way to help anxious parents feel
comfortable about vaccinating their children is a conversation
with an empathetic, compassionate, trusted provider. I also
know from experience that these conversations take time, and
that trust is not built overnight. The Medicaid program
acknowledged this last summer, and is now recognizing the
considerable time and effort this can take in a clinic visit,
and implementing programs to make sure that every person who
wants a vaccine can get it.
Secretary Becerra, how will HHS work with CDC to ensure
that children get caught up on routine childhood vaccinations?
And how can we make sure that the pediatricians can take
adequate time to have these thoughtful conversations?
Secretary Becerra. Congresswoman, first, you have really
pointed out how important it is that those trusted voices that
get Americans to take the leap are so essential in this effort.
And pediatricians are among the most trusted individuals when
it comes to encouraging families to take important measures,
safety measures, for their children.
So we are going to be working with those trusted voices,
including folks like you and others, pediatricians, who can
really reach out and connect with families in ways that others
can't. We are going to continue to make every effort to provide
states and local governments with the capacity to do more
screening of our families, so that they can get the type of
information they need. So if we find out they haven't yet
received a vaccination, that those families will take the step
to let those children be vaccinated.
And we are going to try to do everything we can to make
sure that, under the health programs that the Federal
Government helps administer--Medicare, Medicaid, in case of
children, and CHIP--are available to help those families who
have lower incomes be able to include their kids when it comes
to the protections that a vaccine provides.
Ms. Schrier. I appreciate that, and I appreciate having
multiple locations where kids can get those vaccinations. It
also may make sense because those conversations are so long,
and can take away from other important conversations we have
with patients to even have the ability to do a visit just
regarding vaccines.
I also want to highlight your comments about ensuring that
Americans have access to affordable healthcare. And with the
help of the American Rescue Plan, there was a dramatic drop in
insurance premiums last year. In fact, in my State nearly
60,000 Washingtonians enrolled in new coverage, and more than
100,000 Washingtonians paid--pay $100 or less every month,
thanks to these subsidies. And I just want to emphasize how
important it is to keep those cost-cutting subsidies, and to
not let them expire at the end of the year. And also, of
course, to expand Medicaid in states that opted out.
Is there anything, Secretary Becerra, that Congress can do
to work with you to keep healthcare affordable for Americans
with the Affordable Care Act plans?
Secretary Becerra. Congresswoman, I think you mentioned one
of the most important things that you can do, and that is to
continue those subsidies that have made quality healthcare.
These are robust plans. They are not those skinny, junk plans,
insurance plans, that some people have to buy because they
have--they only pay a small amount up front in premiums, but
when they actually end up using the healthcare services they
pay a ton of money out of pocket.
And so these plans, as you mentioned, $100 a month in
premiums for some families, under $10 a month for other
families, it is the way to go. With your help, we can make it
possible for more----
Ms. Eshoo. The gentlewoman's time has expired.
Ms. Schrier. Thank you. I yield back----
Ms. Eshoo. The Chair now recognizes the gentleman from
Georgia, Mr. Carter, for 5 minutes to question.
Mr. Carter. Thank you, Madam Chair.
Mr. Secretary, along with 12 other Members of Congress, I
sent a letter to you and Commissioner Califf on February 16th
about an important issue about blood testing, and about the
policies, and about the American Red Cross. The bacterial
mitigation method in question has been implicated in several
cases of sepsis and two patient deaths. In December the FDA
said that they were investigating more cases. Are you aware of
any results of this investigation?
Secretary Becerra. Congressman, I don't know of any final
results on that, but we can check back in, and--or I can have
the folks, Dr. Califf and the folks from the FDA, get back to
you, as well.
Mr. Carter. I would hope so, because this is very
concerning to me. As you know, there are three different
methods that can be used here. And the one that the American
Red Cross is using--and they are the primary supplier of
blood--is--the one that they are using, not only is it the most
expensive of all of them, but it has a shorter shelf life. And
we have had these instances of sepsis that have been reported,
and have resulted in a loss of life.
And that is of concern for a number of reasons,
particularly in a district like mine, where I have a large
rural area. When you don't have a long shelf life on some of
these things, then rural hospitals suffer because of it. The
longer shelf life, obviously, the better it is for them. And
obviously, the cost is a factor, as well.
And I am really concerned about the choice--the hospitals'
choices being limited, and the customers are only being
provided with one bacterial mitigation methodology.
And can you understand what--my concern here? When the
American Red Cross requires that the most expensive, the
shortest shelf life, and the one that is--has been indicated to
cause sepsis to--that is the only choice they have. Can you
understand my concern there?
Secretary Becerra. Absolutely. I hear what you are saying,
and certainly I can make sure that we followup with you,
whether it is FDA directly or some other folks on our team. We
could try to followup with you.
Mr. Carter. I hope so, and I look forward to that, because
this is extremely important.
Mr. Secretary, as you know, I am a pharmacist and a
healthcare professional, and I have been fighting for years to
get rid of DIR fees. You know what those are.
Secretary Becerra. I do.
Mr. Carter. They are clawback fees. You know, it was put
best, I think, by one of my colleagues, Representative Peter
Welch, you know, that those DIR fees, a pharmacy may get paid
$10, and then six months, a year, two years later the insurance
company comes back and says, ``Well, we should have only paid
you $7, so you owe the $3.'' I mean, that is just not a
sustainable business model. And this is what the PBMs have been
doing with the DIR fees, and it makes it tough on small
businesses and on small pharmacies, as well.
As, you know, pharmacists are the most accessible
healthcare professionals in America: 95 percent of our
population lives within 5 miles of a pharmacy. We need to keep
pharmacies open. It is important to our healthcare delivery
system, accessibility.
I was very encouraged in--that in January your Department
proposed a common-sense policy that would require price
concessions in the Medicare part D program at the point of
sale, where it should be, so that we know it is going to the
patient and not to the third party, not to the middleman, the
PBM that serves--and brings no value whatsoever to the
healthcare system, in my opinion.
I wanted to make sure. Do you agree that your rules--
actuary analysis that seniors would save, on net, $21.3 billion
over the next ten years?
Secretary Becerra. Congressman, as you know, when we are in
rulemaking I have to be very circumspect in what I say. But we
stand by what we have produced so far, and we are hoping to
issue that final rule very soon.
Mr. Carter. And I hope that this will go through, and I
hope that you will implement this rule. I have heard some
chatter, if you will, some noise that it may be delayed. Again,
I hope that is not the case.
This is an actual situation where we can decrease
prescription drug costs for patients without inhibiting
research and development, without discouraging research and
development, but simply by having transparency in the drug
pricing chain, and making certain that the discounts are at the
point of sale, where they are going to the patient.
Secretary Becerra. Congressman, I can say it emphatically
that we are looking forward to working with you on this issue.
And by the way, if you will permit me, I would like to just
salute all those pharmacists who have been real heroes in this
effort to try to tackle COVID.
Mr. Carter. Well, thank you. I am very proud of my
profession, and very proud of the work that they have done,
because, as you mentioned, and as I mentioned earlier, the most
accessible healthcare professionals in America.
Secretary Becerra. They stepped up.
Mr. Carter. And extremely important. That is why this issue
with PBMs----
Ms. Eshoo. The gentleman's time----
Mr. Carter [continuing]. And DIR fees needs to be
addressed.
Ms. Eshoo [continuing]. Has expired.
Mr. Carter. And I thank you, and I yield back.
Ms. Eshoo. The gentleman's time has expired. The Chair
recognizes the gentlewoman from Massachusetts, Representative
Trahan, for 5 minutes to question, followed by the gentlewoman
from Texas, Mrs. Fletcher, followed by--and I understand the
Secretary has agreed to this--the gentleman from Alabama, who
is waiving on. And that will conclude the hearing today. All
right?
So Mrs. Trahan, you are recognized.
Mrs. Trahan. Thank you, Madam Chair.
Mr. Secretary, thank you for being here with us today.
The Fiscal Year 2023 proposed budget indicates that, once
again, this Administration prioritizes expanding affordable,
accessible, high-quality healthcare for all Americans,
including those in our under-served communities.
In my district, in Massachusetts, no one has done more to
deliver quality, affordable care to the under-served, and under
extremely challenging circumstances, than the nurses, doctors,
and administrators at Lawrence General Hospital in Lawrence,
Mass.
As you may recall from your visit to Lawrence last August,
the hospital serves the 80,000 residents of a beautiful,
bustling, diverse, and historic city. And 80 percent of the
city's residents are of Hispanic or Latino descent.
And you may remember that the area was struck by a series
of natural gas explosions in September 2018, which devastated
the community. You know, just as the city was recovering, the
pandemic struck, setting progress back. On a per capita basis,
the city has suffered greater numbers of COVID infections than
nearly any of the other 350 cities and towns in Massachusetts.
And at one point, three-quarters of Lawrence General's
inpatient capacity was dedicated to recovering COVID-19
patients.
Time and again, Lawrence General has come through for the
community, particularly the 20 percent living in poverty.
Indeed, approximately 75 percent of its patient population is
public payer, primarily Medicare and Medicaid. However, by
caring for an under-served and COVID-ravaged community,
Lawrence General has experienced an unprecedented increase in
expenses. And because COVID forced them to pause or postpone
more lucrative services, Lawrence General is struggling
financially.
The proposed budget does not include sufficient targeted
funding for our safety net hospitals like Lawrence General, who
were particularly hard hit by COVID-19, and now financially
unstable. So, Mr. Secretary, I am just curious how you see the
Fiscal Year 2023 budget helping hospitals like Lawrence General
keep their doors open as they continue to provide critical care
to their communities through COVID-19.
Secretary Becerra. Congresswoman, thank you for the
question. And thank you, by the way, for your constant,
consistent advocacy for the people in your district who use
Lawrence General Hospital, for the workforce, the men and
women, healthcare workers at Lawrence, for all the good work
they do, as well.
We are going to continue to do everything we can, whether
it is through the Medicaid program or whether it is through the
Medicare program, to provide the services to those--excuse me,
provide the resources to those providers who are out there
providing services, especially to our less-well-served families
throughout the country.
I will tell you that, as we have had conversations with
regard to the Provider Relief Fund that Lawrence and other
providers throughout the country were utilizing to try to help
cover some of those COVID costs that they had, that we think
that it would be a phenomenal opportunity for Congress to
provide us with additional resources to supplement the Provider
Relief Fund, because it is now essentially out of dollars, so
we could continue to provide services and support to those
providers who stepped up.
And as I have explained to you before, we try to do the
distribution of those dollars in a very transparent way. We
can't speak for what was done before we came to office, but any
time that we distribute a dollar under the Provider Relief
Fund, you will know exactly how it got distributed.
Mrs. Trahan. Well, I appreciate that.
You know, just curious. The HHS didn't request additional
funding for safety net hospitals or provider relief in the
COVID supplemental. Could you just speak to, you know, the
priorities that were reflected in the supplemental, and how we
can go about working together so that we do get the safety net
hospitals the funds that they need to get through?
Secretary Becerra. Congresswoman, and if you will look at
the original request that we made for a supplemental earlier,
much earlier this year, it did include funds that would have
been made available to the Provider Relief Fund. That request
was substantially more than what at this stage is being
discussed in negotiations in Congress for a supplemental
package.
We would love to see dollars included in a supplemental
package that would provide additional resources to the Provider
Relief Fund. We don't have a vote in that process. It is you
and your colleagues here in the House and then in the Senate
who will make a decision. But we hope that, in your wisdom,
that you will include funding for the Provider Relief Fund, so
we can continue to provide those services that those hospitals
and other providers have dispensed to many of our uninsured
population who need that support.
Mrs. Trahan. Thank you. Thank you, Mr. Secretary. I am out
of time.
I yield back.
Ms. Eshoo. The gentlewoman yields back. The Chair
recognizes the gentlewoman from Texas, Mrs. Fletcher, for her 5
minutes to question.
Mrs. Fletcher. Thank you Chairwoman Eshoo, and thank you,
Secretary Becerra, for coming today to discuss the President's
Fiscal Year 2023 budget request for the Department of Health
and Human Services and its agencies. I have three issues I
would like to raise with you in my time today.
First, I am thrilled that Congress authorized the Advanced
Research Projects Agency Health, ARPA-H, this year. And recent
advances in biomedical and health sciences, from immunotherapy
to treat cancer to highly effective COVID-19 vaccines,
demonstrate the strengths and successes of the U.S. biomedical
enterprise. Such advances present an opportunity to
revolutionize how we prevent, treat, and even cure rare
diseases including cancer, Alzheimer's, infectious disease, and
many others that affect a significant number of Americans and
people around the world.
Secretary Becerra, in March you announced that ARPA-H would
be part of NIH, but that the physical location would not be at
the agency's campus in Maryland. And as my colleagues on this
committee have heard many times, I represent many people who
work in the Texas Medical Center in Houston, which is the
largest medical center in the world, and home to some of the
most innovative medical research in the world today.
The Texas Medical Center is uniquely situated to house
ARPA-H with its existing infrastructure, world-leading research
institutions, and incredible people. The people who work there
are willing and eager to ensure this new agency is successful.
So I want to ask you first when you plan on announcing the
location of ARPA-H, and what you are taking into account when
making this decision about its location.
Secretary Becerra. Congresswoman, thank you for your
interest and your support for ARPA-H.
We are right now in the process of making some of those
decisions. We would like to try to work as closely as we can
with the inaugural director of ARPA-H before we launch too far.
But what I can tell you is that we wanted to have as much
independence as possible, untethered from some of the previous
ways that we have done some of the research, because this
research we want to be--have the applicability as quickly as
possible, versus some of the basic research that we see that is
phenomenal research that is done by NIH.
I will tell you that I have duly noted that you have
mentioned that there is a great site there in Texas that could
accommodate ARPA-H. I will tell you that there are a whole
bunch of folks who have reached out to us and told us the same
thing. It is a fabulous opportunity for America to launch. Just
as DARPA for the Department of Defense was able to launch some
real innovation, we hope ARPA-H will do the same on healthcare.
Mrs. Fletcher. Terrific. Thank you so much.
I also want to touch on two other issues affecting Texas.
Unfortunately, a little bit less positive, but I am hoping to
get your insights here and raise these issues with you. I have
raised this first issue directly with CMS: patients who use
Medicaid have been unable to access basic critical reproductive
healthcare services at Planned Parenthood for almost a year,
because of the [inaudible] termination of Planned Parenthood
from the Texas Medicaid program. It has had a disastrous
impact, and has really just decreased access to care and led to
poor health outcomes. It is a violation of the Medicaid free
choice of provider requirement. I saw your exchange with
Representative Chu when you testified in front of the Budget
Committee, and I look forward to swift action from CMS to
enforce this requirement.
The second issue I would love to ask you about, as well, is
a similar topic.
It is really incredibly important component to ensure
reproductive autonomy is access to medication abortion, which
we know is the safe and effective option in early pregnancy.
And now that some of the burdensome risk evaluation mitigation
strategy requirements have been eliminated from mifepristone,
one of the medicines used during medication abortion care.
I want to be sure that HHS is doing everything in its power
to protect and expand access to this care, especially in states
where there are so many restrictions increasing every day.
I really appreciate that you took steps to form the
Reproductive Healthcare Task Force, and was hoping you could
update the committee on the steps that the Department and the
task force are taking to ensure that medication abortion care
continues to be accessible to patients.
You know, what specifically is HHS doing to facilitate
dispensing and provision of care via clinics, mail order,
pharmacies, retail phamacies, mail, and telehealth?
You know, there are just a few seconds left. If you could
share with us and prioritize this issue, we would very much
appreciate it. Thank you.
Secretary Becerra. Congresswoman, respecting the time that
is left, what I can do is followup with you more specifically.
But what I will tell you is when a medication is made
available because FDA has decided that it is safe and
effective--and we have a job to make sure that we provide care
to as many Americans as possible--we are going to do everything
we can to enforce the law to make sure everyone, including
women, including for abortion care, get the services and the
products that the medical products that they need to be able to
exercise their rights.
Mrs. Fletcher. Thank you so much, Mr. Secretary. I have
talked over my time.
Madam Chair, I yield back, and thank you for accommodating
me.
Ms. Eshoo. The gentlewoman yields back.
Mr. Secretary, I want to ask you to do something. I know
that you are ten minutes past where you want to be. Mr. Palmer
is waiving on, Mr. Palmer of Alabama. Would you take his
questions? And then----
Secretary Becerra. Certainly.
Ms. Eshoo. OK. The gentleman from Alabama is recognized for
5 minutes to question.
Mr. Palmer. Well, thank you, Madam Chair.
I truly appreciate your indulgence, Secretary Becerra. I
have expressed this concern in other hearings, and I think we
are facing a crisis of confidence in our Nation, public
confidence in many of our institutions. A lot of it has borne
out of the handling of COVID. We have become even more divided
as a Nation, and it is impacting healthcare and the trust in
healthcare.
And what I want to ask you about--and I hate to do this,
but HHS has just issued a Medicare physician fee schedule final
rule that includes a provision that will provide a financial
incentive for doctors to create and implement an anti-racism
plan. And that is raising a lot of concerns among people. And I
just want to hear from you a little bit about how this is going
to operate.
And I will tell you my concerns. I think it undermines
public confidence in two ways. I think it raises questions in
the minds of minorities that, if they see a physician who is
not of the same race or color, that they are not going to get
quality care. And it undermines the confidence of people who
are White that they are going to be discriminated against. How
would you address that?
Secretary Becerra. Congressman, I want to be as thoughtful
in my answer as you were in the question.
First, we don't have a policy as you have described. Our
policy is to try to tackle the disparities that we see in
healthcare access. There are--I could tell you the number of
stories I have heard from women, mostly Black women, who go in
to get care and they are not believed when they say that they
are in pain. There are people who have experienced, because of
sickle cell, experienced deep, deep pain when they presented in
an emergency room, aren't believed, and don't get immediately
the treatment that really should be provided to someone who is
suffering from sickle cell disease.
We know that this happens. To ignore it is to ignore a
travesty our in our system. We are simply trying to say that no
one should be denied healthcare simply because the disparities
that exist prevent you from getting the care you need.
Mr. Palmer. But we already----
Secretary Becerra. We are going to try to tackle those the
best we can.
Mr. Palmer. Yes, but we already have those rules.
And by the way, one of my best friends, Dr. Tim Townes, was
one of the leading researchers in the world at the University
of Alabama Birmingham on sickle cell research, and he is White,
and he has devoted his entire career to that.
And I just--I want you to understand that there is a divide
that is being created here that is going to further undermine
public confidence. And we have to be extremely, extremely
careful about how we address these. All of us, not just the
Biden Administration, but all of us.
Secretary Becerra. I agree.
Mr. Palmer. And it creates serious concerns that, you know,
if you go into a doctor's office and you think if you put down
you are White, you are not--you are going to be--it----
Secretary Becerra. But Congressman, to that point, if you
will permit me, it is--much of this is driven by the myths and
disinformation. I would challenge you to show me where in our
policies we call anything we are doing anti-racism policies. We
are simply trying to make sure everyone has equal access to
healthcare.
Mr. Palmer. Well, if there are doctors out there that are
discriminating against anybody for any reason, they need to be
dealt with in another manner, because that is totally
unacceptable, totally unacceptable.
Secretary Becerra. I agree with you.
Mr. Palmer. So I just want to raise that point, let you
know that this is an issue. There are people out there that
have raised concerns to me about it, and I intend to address it
further at the appropriate time.
But I do appreciate very much you answering the question,
and your assurances that it is not the intent of HHS to
discriminate against anyone. I will hold you to that.
And also, again, I sincerely appreciate you staying 30
minutes past the original time that you said you would give us.
And with that, Madam Chairman, I will yield the remainder
of my time.
Ms. Eshoo. The gentleman yields back the remainder of his
time.
And, Mr. Secretary, thank you for accommodating the members
and the member that has--that waived on, and that you would
take their questions. It is very generous of you. Thank you for
being here today. We have covered a lot of ground.
I would just quickly raise two points, Mr. Secretary. You
are a former Member of Congress. You know that you wanted your
questions answered when you addressed, you know, those that
were representing the agencies. I think the assistant secretary
of legislation has some work to do, some catch-up work here,
because on both sides of the aisle members have made reference
to writing, but they haven't had their questions answered.
And second, I think that it is important, as Secretary of
HHS, to have a plan if, in fact, title 42 is lifted. You have
responsibility for a plan, a public health plan, so that there
is not any public health disaster relative to those at the
border. So that is your responsibility. I know that 42 is--
seems to be kind of up for grabs right now because of the court
case. But nonetheless, HHS has to have a plan. I don't know
what that plan is, but I expect that you would come out with
one and outline it.
So thank you----
Secretary Becerra. And Madam Chair, on that point----
Ms. Eshoo. Yes?
Secretary Becerra [continuing]. If you are referring to the
situation at the border, we do have a plan to address those--
that situation, post-title 42. If you are speaking more
generally, in terms of what happens to the country without
title 42, we have been working on that, as well, and we can
present that to you and the committee members if you would
like.
Ms. Eshoo. No, it was the former, not the latter.
Secretary Becerra. Yes. And remember, Madam Chair, that
title 42 has not applied to the individuals at the border that
HHS has jurisdiction over, the children. We haven't had title
42 apply to unaccompanied migrant children since December 2020.
Ms. Eshoo. Anyone that comes into the country that is
admitted into the country, there are public health issues
there. And we have had to deal with them before, and we might
be presented with that case, I don't know, given the courts
are--what the Administration is going to do.
But you always have to have a plan, and I don't think we
can walk away from that.
All right, I just have a unanimous consent request to enter
two items to the record. Does the ranking----
Mr. Guthrie. No objection.
Ms. Eshoo. No objections. So without objection, so ordered.
Ms. Eshoo. Members have ten business days to submit
additional questions for the record.
And the witness, we ask that the Secretary respond promptly
to any questions that are received.
And at this time the subcommittee is adjourned.
[Whereupon, at 1:33 p.m., the subcommittee was adjourned.]
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