[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]




 
THE FISCAL YEAR 2021 HEALTH AND HUMAN SERVICES BUDGET AND OVERSIGHT OF 
                        THE CORONAVIRUS OUTBREAK

=======================================================================

                                HEARING

                               BEFORE THE

                         SUBCOMMITTEE ON HEALTH

                                 OF THE

                    COMMITTEE ON ENERGY AND COMMERCE
                        HOUSE OF REPRESENTATIVES

                     ONE HUNDRED SIXTEENTH CONGRESS

                             SECOND SESSION

                               __________

                           FEBRUARY 26, 2020

                               __________

                           Serial No. 116-103
                           
      [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] 


      Printed for the use of the Committee on Energy and Commerce

                   govinfo.gov/committee/house-energy
                        energycommerce.house.gov
                        
                        
                          ______                       


             U.S. GOVERNMENT PUBLISHING OFFICE 
 52-377PDF           WASHINGTON : 2023 
                      
                        
                        
                        

                    COMMITTEE ON ENERGY AND COMMERCE

                     FRANK PALLONE, Jr., New Jersey
                                 Chairman
BOBBY L. RUSH, Illinois              GREG WALDEN, Oregon
ANNA G. ESHOO, California              Ranking Member
ELIOT L. ENGEL, New York             FRED UPTON, Michigan
DIANA DeGETTE, Colorado              JOHN SHIMKUS, Illinois
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          CATHY McMORRIS RODGERS, Washington
KATHY CASTOR, Florida                BRETT GUTHRIE, Kentucky
JOHN P. SARBANES, Maryland           PETE OLSON, Texas
JERRY McNERNEY, California           DAVID B. McKINLEY, West Virginia
PETER WELCH, Vermont                 ADAM KINZINGER, Illinois
BEN RAY LujanN, New Mexico           H. MORGAN GRIFFITH, Virginia
PAUL TONKO, New York                 GUS M. BILIRAKIS, Florida
YVETTE D. CLARKE, New York, Vice     BILL JOHNSON, Ohio
    Chair                            BILLY LONG, Missouri
DAVID LOEBSACK, Iowa                 LARRY BUCSHON, Indiana
KURT SCHRADER, Oregon                BILL FLORES, Texas
JOSEPH P. KENNEDY III,               SUSAN W. BROOKS, Indiana
    Massachusetts                    MARKWAYNE MULLIN, Oklahoma
TONY CARDENAS, California            RICHARD HUDSON, North Carolina
RAUL RUIZ, California                TIM WALBERG, Michigan
SCOTT H. PETERS, California          EARL L. ``BUDDY'' CARTER, Georgia
DEBBIE DINGELL, Michigan             JEFF DUNCAN, South Carolina
MARC A. VEASEY, Texas                GREG GIANFORTE, Montana
ANN M. KUSTER, New Hampshire
ROBIN L. KELLY, Illinois
NANETTE DIAZ BARRAGAN, California
A. DONALD McEACHIN, Virginia
LISA BLUNT ROCHESTER, Delaware
DARREN SOTO, Florida
TOM O'HALLERAN, Arizona
                                 ------                                

                           Professional Staff

                   JEFFREY C. CARROLL, Staff Director
                TIFFANY GUARASCIO, Deputy Staff Director
                MIKE BLOOMQUIST, Minority Staff Director
                         Subcommittee on Health

                       ANNA G. ESHOO, California
                                Chairwoman
ELIOT L. ENGEL, New York             MICHAEL C. BURGESS, Texas
G. K. BUTTERFIELD, North Carolina,     Ranking Member
    Vice Chair                       FRED UPTON, Michigan
DORIS O. MATSUI, California          JOHN SHIMKUS, Illinois
KATHY CASTOR, Florida                BRETT GUTHRIE, Kentucky
JOHN P. SARBANES, Maryland           H. MORGAN GRIFFITH, Virginia
BEN RAY LujanN, New Mexico           GUS M. BILIRAKIS, Florida
KURT SCHRADER, Oregon                BILLY LONG, Missouri
JOSEPH P. KENNEDY III,               LARRY BUCSHON, Indiana
    Massachusetts                    SUSAN W. BROOKS, Indiana
TONY CARDENAS, California            MARKWAYNE MULLIN, Oklahoma
PETER WELCH, Vermont                 RICHARD HUDSON, North Carolina
RAUL RUIZ, California                EARL L. ``BUDDY'' CARTER, Georgia
DEBBIE DINGELL, Michigan             GREG GIANFORTE, Montana
ANN M. KUSTER, New Hampshire         GREG WALDEN, Oregon (ex officio)
ROBIN L. KELLY, Illinois
NANETTE DIAZ BARRAGAN, California
LISA BLUNT ROCHESTER, Delaware
BOBBY L. RUSH, Illinois
FRANK PALLONE, Jr., New Jersey (ex 
    officio)
                             C O N T E N T S

                              ----------                              
                                                                   Page
Hon. Anna G. Eshoo, a Representative in Congress from the State 
  of California, opening statement...............................     2
    Prepared statement...........................................     3
Hon. Michael C. Burgess, a Representative in Congress from the 
  State of Texas, opening statement..............................     4
    Prepared statement...........................................     6
Hon. Frank Pallone, Jr., a Representative in Congress from the 
  State of New Jersey, opening statement.........................     7
    Prepared Statement...........................................     8
Hon. Greg Walden, a Representative in Congress from the State of 
  Oregon, opening statement......................................     9
    Prepared statement...........................................    11

                               Witnesses

Alex Azar, Secretary, U.S. Department of Health and Human 
  Services.......................................................    12
    Prepared statement...........................................    14
Answers to submitted questions \1\
Anthony S. Fauci, Director, National Institute for Allergy and 
  Infectious Diseases, National Institutes of Health \2\
Stephen M. Hahn, M. D., Commissioner, Food and Drugs and Drug 
  Administration \2\
Robert Kadlec, M. D., Assistant Director, US Department of Health 
  and Human Services \2\
Robert R. Redfield, Director, Centers for Disease Control and 
  Prevention \2\

                           Submitted Material

Article of January 2020, ``Lack of new antibiotics threatens 
  global efforts to contain drug-resistant infections'' submitted 
  by Mr. Shimkus.................................................    96
Chart ``FY 2020,'' submitted by Ms. Dingell......................    99
Report of November 2019, ``Ending the Cycle of Crisis and 
  Complacency in U.S. Global Health Security,'' submitted by Ms. 
  Brooks \3\
Letter of June 13, 2018, to Mr. Azar and Ms. Verma, from four 
  House Committees to HHS and CMS regarding the case Texas v. 
  United States, submitted by Mr. Pallone........................   101
Letter of December 7, 2018, to Mr. Azar and Ms. Verma, from four 
  House Committees to HHS and CMS regarding the case Texas v. 
  United States, submitted by Mr. Pallone........................   106
Letter of April 8, 2019, to Mr. Azar and Ms. Verma, from five 
  House Committees to HHS and CMS regarding the case Texas v. 
  United States, submitted by Mr. Pallone........................   108

----------
\1\ Mr. Azar did not answer submitted questions for the record by 
  the time of publication.
\2\ The witnesses did not answer the submitted questions for the 
  record by the time of publication.
\3\ The information has been retained in committee files and also 
  is available at https://docs.house.gov/meetings/IF/IF14/
  20200226/110589/HHRG-116-IF14-20200226-SD003.pdf.
Letter of February 18, 2020, to Mr Pallone, et al., from Sarah 
  Arbes, Acting Assistant Secretary for Legislation, HHS, 
  submitted by Mr. Pallone.......................................   113
Article of October 25, 2019, ``Trump campaign urges White House 
  to soften proposed flavored vape ban,'' by Michael Scherer et 
  al., Washington Post, submitted by Ms. Eshoo...................   116
Letter of October 29, 2019, to Mr. Azar, HHS, from Mr. Pallone 
  and Mr. Wyden, from two Congressional Committees, submitted by 
  Mr. Pallone....................................................   126
Letter of June 27, 2019, letter from the Energy and Commerce 
  Committee examining HHS's administration of the Medicaid 
  program, submitted by Ms. Eshoo................................   129
Letter of February 26, 2020, to Ms. Eshoo and Mr. Burgess, by 
  Jane M. Adams, Vice President, Federal Affairs, Johnson & 
  Johnson, submitted by Ms. Eshoo................................   134
Statement of February 26, 2020, from American Society for 
  Microbiology, submitted by Ms. Eshoo...........................   135
Article of February 20, 2020, BioCentury entitled, ``Biopharma 
  industry, academics push back against demands for price 
  controls on COVID-19 countermeasures,'' by Steve Usdin, 
  submitted by Ms. Eshoo.........................................   137
Article of January 30, 2020, Wall Street Journal entitled, 
  ``Pharma to the Rescue,'' by the Editorial Board, submitted by 
  Ms Eshoo.......................................................   139


THE FISCAL YEAR 2021 HEALTH AND HUMAN SERVICES BUDGET AND OVERSIGHT OF 
                        THE CORONAVIRUS OUTBREAK

                              ----------                              


                      WEDNESDAY, FEBRUARY 26, 2020

                  House of Representatives,
                            Subcommittee on Health,
                          Committee on Energy and Commerce,
                                                    Washington, DC.
    The subcommittee met, pursuant to call, at 1:00 p.m., in 
the John D. Dingell Room 2123, Rayburn House Office Building, 
Hon. Anna G. Eshoo (chairwoman of the subcommittee) presiding.
    Present: Representatives Eshoo, Engel, Matsui, Sarbanes, 
Lujan, Schrader, Kennedy, Cardenas, Welch, Ruiz, Dingell, 
Kuster, Kelly, Barragan, Blunt Rochester, Pallone (ex officio), 
Burgess, Upton, Shimkus, Guthrie, Griffith, Bilirakis, Long, 
Bucshon, Brooks, Hudson, Carter, Gianforte, and Walden (ex 
officio).
    Also present: Representatives DeGette and Schakowsky.
    Staff present: Joe Banez, Professional Staff Member; Kevin 
Barstow, Chief Oversight Counsel; Jacquelyn Bolen, Counsel; 
Jeffrey C. Carroll, Staff Director; Kimberly Espinosa, 
Professional Staff Member; Waverly Gordon, Deputy Chief 
Counsel; Tiffany Guarascio, Deputy Staff Director; Stephen 
Holland, Health Counsel; Zach Kahan, Outreach and Member 
Service Coordinator; Saha Khaterzai, Professional Staff Member; 
Chris Knauer, Oversight Staff Director; Una Lee, Chief Health 
Counsel; Kevin McAloon, Professional Staff Member; Aisling 
McDonough, Policy Coordinator; Meghan Mullon, Policy Analyst; 
Alivia Roberts, Press Assistant; Tim Robinson, Chief Counsel; 
Kimberlee Trzeciak, Chief Health Advisor; Rick Van Buren, 
Health Counsel; C. J. Young, Press Secretary; Nolan Ahern, 
Minority Professional Staff, Health; Jennifer Barblan, Minority 
Chief Counsel, Oversight and Investigations; S. K. Bowen, 
Minority Press Secretary; William Clutterbuck, Minority Staff 
Assistant; Jordan Davis, Minority Senior Advisor; Caleb Graff, 
Minority Professional Staff Member, Health; Tyler Greenberg, 
Minority Staff Assistant; Brittany Havens, Minority 
Professional Staff, Oversight and Investigations; Peter Kielty, 
Minority General Counsel; Ryan Long, Minority Deputy Staff 
Director; Kate O'Connor, Minority Chief Counsel, Communication 
and Technology; James Paluskiewicz, Minority Chief Counsel, 
Health; Kristin Seum, Minority Counsel, Health; Kristen 
Shatynsky, Minority Professional Staff Member, Health; and Alan 
Slobodin, Minority Chief Investigative Counsel, Oversight and 
Investigations.
    Ms. Eshoo. The Subcommittee on Health will now come to 
order.
    I just want all members to know that our witnesses today 
have to leave at 5:00 p.m. So the questions for the first panel 
on the HHS budget with the Secretary and welcome, Mr. 
Secretary--are going to be limited to four minutes. In the 
second panel, on the coronavirus response, those questions will 
be limited to 5 minutes, which is the usual case, but only ten 
members are going to be able to ask questions during that 
round. So I will have to be strict with the gavel since the 
witnesses have a tight timeframe, and I know that you will all 
cooperate with that.
    And so let us begin.
    Welcome, Mr. Secretary. We are glad that you are here. We 
have a lot to take up, and every bit of it is, obviously, 
serious.
    The Chair now recognizes herself for 5 minutes for her 
opening statement.

 OPENING STATEMENT OF HON. ANNA G. ESHOO, A REPRESENTATIVE IN 
             CONGRESS FROM THE STATE OF CALIFORNIA

    And let me begin with this, Mr. Secretary: I think that 
confusion is the enemy of preparedness. Confusion is the enemy 
of preparedness. I believe that the administration's lack of 
coordination for the coronavirus response is on full display. 
We all know that. Markets are reacting, I think, at least in 
some part, to the lack of trusted information, amongst many 
other factors.
    Our government, across the government, has to speak with 
credibility and authority. Instead, it is like a Greek chorus 
chanting on the side of the stage. We have one saying one 
thing, the President saying something else, and that adds to 
the confusion.
    I think that there are key questions that need to be 
addressed for the American people: What is the plan, the 
overall plan; should this virus infect Americans in high 
numbers?
    What is the plan for increasing diagnostic capacity, and 
what is the target number for that? Dysfunctional tests, we all 
know, have limited our ability to diagnose the virus, and the 
small number, it could be said, of U.S. cases may reflect 
limited testing and not the virus's spread. But it is up to our 
professionals to put out with clarity that kind of information.
    What is the plan for protecting our healthcare workers that 
are on the front lines of this? What is the plan to increase 
hospital capacity?
    Now, in my view, the United States of America has the 
premier professional public health professionals in the world--
in the world--our scientists, our doctors, and those that are 
heading up the agencies, those that are part of the agencies. I 
think the problem rests more with administration people, one 
saying one thing, others saying something else.
    I think that the briefings that are done for the Congress, 
if I might suggest, should be open to the public. There is no 
reason to have secrets about this. And I say that because it 
raises the element of fear with people. ``There is something 
going on behind closed doors that they are not telling us.''
    And it is a time for us, if I might use the expression, to 
give them an inoculation of confidence. And certainly the virus 
triggers fear, and I think the antidote for this is truth and 
transparency, including informing the American people of a 
coordinated, fully-funded government plan to keep us safe.
    These are not things they can do for themselves. We are the 
ones. You are certainly in the driver's seat on this. And I 
think that the funding request--and later in my questions, I 
will ask you about that--is wholly inadequate.
    Now, before requesting the emergency funding, the 
President's budget contained dangerous cuts that weaken our 
public health frontline response, gut the healthcare safety 
net, and end programs focusing on increasing our healthcare 
workforce.
    So we are driving in the wrong direction. It is as if there 
is a fire and the fire engine is going down the wrong end of 
the road instead of to the fire. We need these resources in 
order to care for the American people.
    As the author of the Pandemic and All-Hazards Preparedness 
Act, I know that the best way to fight outbreaks is by 
preparing and investing in advance, not by rushing after a 
pandemic hits.
    And while the virus is spreading, the President's budget 
cuts almost $700 million from the CDC, $430 million from the 
national institute focused on infectious diseases, $3 billion 
from the government's global health program. This is a jaw-
dropping $1.6 trillion cut from the very Federal programs that 
cover one in three Americans. This doesn't make any sense.
    And the President's budget virtually ends the workforce 
development programs that trained more than a half a million 
clinicians each year. I see them every week in my congressional 
district at Stanford Medical Center and Lucile Packard 
Children's Hospital.
    So the budget weakens our public health safety net and it 
hurts our country's resiliency. The CDC, NIH--all of these 
agencies cannot run on fumes--cannot run on fumes. And it is 
not even a Tesla if it doesn't have a battery that is going to 
last.
    And if Americans are uninsured or underinsured, they are 
not going to seek care, and that will contribute to the spread 
of the disease.
    So I don't know what is--the President often has promised 
``beautiful'' healthcare. I don't find beauty in what I just 
said, and I am sorry that this is a part of it.
    So, with that, I will have questions, and thank you again 
for being here.
    [The prepared statement of Ms. Eshoo follows:]

                Prepared Statement of Hon. Anna G. Eshoo

    Confusion is the enemy of preparedness.
    The Administration's lack of coordination for the 
coronavirus response is on full display and the markets are 
reacting to the lack of trusted information, amongst many 
factors.
    Our government must speak with credibility and authority.
    That means answering key questions for the American 
public:

    What is the plan should this virus infect Americans 
in high numbers?
    What is the plan for increasing diagnostic capacity and 
what is the target number? Dysfunctional tests have limited our 
ability to diagnosis the virus. The small number of U.S. cases 
may reflect limited testing, not the virus's spread.

    What is the plan for protecting our healthcare 
workers?
    What is the plan to increase hospital capacity?
    The virus triggers fear and I think the antidote for this 
is truth and transparency, including informing the American 
people of a coordinated, fully-funded government plan to keep 
us safe.
    Instead of taking this situation seriously, the President 
has sent Congress a coronavirus funding request that is 
inadequate for this emergency.
    And before requesting the emergency funding, the 
President's budget contain dangerous cuts that weakens our 
public health frontline response, guts the healthcare safety 
net, and ends programs focused on increasing our healthcare 
workforce.
    As the author of the Pandemic and All Hazards Preparedness 
Act, I know that the best way to fight outbreaks is by 
preparing and investing in advance, not by rushing after a 
pandemic hits.
    While the virus is spreading, the President's budget cuts 
almost $700 million from the CDC, $430 million from the 
National Institute focused on infectious diseases, $3 billion 
from the government's global health program . . . and a 
jawdropping $1.6 trillion from the federal programs that cover 
one in three Americans.
    And the President's budget virtually ends the workforce 
development programs that train more than half a million 
clinicians each year.
    The President's budget weakens our public health safety 
net, hurting our country's resiliency. If Americans are 
uninsured or underinsured, then they won't seek care and will 
contribute to the spread of the disease.
    The President has often promised ``beautiful'' healthcare, 
but his HHS budget shows an ugly truth.
    The people of our country need a swift advancement of a 
strong, strategic funding package that addresses the scale and 
seriousness of this public health crisis.

    The Chair now recognizes Mr. Burgess, the ranking member of 
our subcommittee, for his 5 minutes for his opening statement.

OPENING STATEMENT OF HON. MICHAEL C. BURGESS, A REPRESENTATIVE 
              IN CONGRESS FROM THE STATE OF TEXAS

    Mr. Burgess. And I thank the Chair.
    Thank you, Secretary, for being here. Always great to see 
you in our committee. I hope the feeling is mutual; you always 
are grateful to be here at our committee.
    I just have to say, Madam Chair, that two weeks ago I was 
criticized rather severely for even suggesting that we needed a 
coronavirus hearing. The work we were doing that day, which was 
a bill that was never going to become law, was so important 
that we didn't need to do that hearing. We did need to do that 
hearing. I am grateful we are having it today. I am grateful we 
have the Secretary.
    Now, this hearing is also being coincidently run with the 
President's budget proposal for fiscal year 2021. And that is a 
lot of stuff to cover in one hearing, but I guess we will do 
our best, Mr. Secretary.
    So let me just say, I do appreciate the administration's 
commitment to healthcare. I appreciate the commitment to 
lowering healthcare costs and reducing the complexity of the 
system so that patients can more easily access their care.
    One thing the administration and, Mr. Secretary, 
particularly you led on was advancing kidney health for 
Americans. That trend continues in the Health and Human 
Services budget proposal and the support for H.R. 5534, the 
Comprehensive Immunosuppressive Drug Coverage for Kidney 
Transplant Patients Act.
    As you know, Mr. Secretary, this bill would extend Medicare 
coverage of immunosuppressive drugs past the current 36-month 
limit. A patient with a kidney transplant needs to take 
immunosuppressives or their body will ultimately reject the 
graft, causing the patient to return for dialysis treatment.
    A kidney transplant is indeed an investment in the future 
of that recipient patient, and this bill will help protect that 
investment. I have worked on this policy for a decade, and I am 
thankful it has been highlighted as a priority by the 
administration. It is time for Congress to finally pass this 
commonsense legislation.
    The budget also continues the work of the SUPPORT Act, one 
of the major pieces of legislation passed in the last Congress, 
by making clear that the opiate epidemic and programs in the 
oversight investigation--and making sure that the opiate 
epidemic and response programs are indeed a priority.
    In our Oversight and Investigations Subcommittee, we have 
heard from various States about the efforts they are making to 
help those with substance use disorder. Funding for these State 
opiate response grants is imperative to allow States to find 
the innovative ways to combat this crisis.
    I also appreciate the fact that the administration included 
Hyde Amendment pro-life protections in all proposed funding 
language. It is important to ensure that Federal funds are not 
used to perform abortions. And I hope as this subcommittee 
moves forward with reauthorizations and the Appropriations 
Committee puts together the bills for fiscal year 2021, they 
will maintain those protections.
    Other important programs and policies are receiving 
increased funding, including: the Maternal and Child Health 
Block Grant, the Health Resources and Services Administration's 
Maternal Health in America initiative, and the 340B drug 
pricing program. Funding increases for the Centers for Disease 
Control and Prevention's influenza program are particularly 
important as we now face this worldwide coronavirus outbreak.
    Which brings me to the novel coronavirus. And it has 
infected over 80,000 individuals worldwide, and proven to be 
more deadly than SARS. I appreciate the Trump administration's 
vigilance and rapid response efforts.
    Mr. Secretary, let me just say, I was so heartened--I think 
it was four Fridays ago when you came on the air and said there 
was a limit to people being able to come into this country from 
China. And I thought it was important that the administration 
say that.
    And I believe that is one of the central things--my thesis 
is that is one of the central things that has provided us at 
least a little breathing room as this virus erupts around the 
world. We are, fortunately, not as affected as some other 
countries. Now it is incumbent upon us to make sure that we 
utilize that time wisely.
    Certainly, the Pandemic and All-Hazards Preparedness Act, 
which was worked on by this subcommittee in the last Congress 
and finally passed at the beginning of this Congress--important 
piece of legislation. I would have liked for us to have done 
real-time hearings updating, are we doing what was intended 
with that bill? Is the stockpile responding appropriately to 
the authorizations that we made?
    And this is the type of information--rather then the 
political rhetoric back and forth that we have heard, this is 
the type of information that I think would be helpful and, 
indeed, reassuring to the American people.
    You can't ignore the fact of what has happened to the 
markets. Today we are grateful that they have seemed to have 
rebounded a little bit. But, look, we all know China has not 
been forthcoming with information, and it is that uncertainty--
that uncertainty--that I believe it is one of the negative 
forces driving the market.
    Mr. Secretary, I appreciate you being here today. We will 
have multiple questions for you. I certainly look forward to 
your testimony.
    Thank you. I yield back.
    [The prepared statement of Mr. Burgess follows:]

             Prepared Statement of Hon. Michael C. Burgess

    Thank you, Madam Chair. I want to thank Secretary Azar for 
being here today to discuss President Trump's Budget Proposal 
for fiscal year 2021 and the 2019 novel coronavirus, or COVID-
19, outbreak.
    I appreciate the Trump Administration's commitment to 
healthcare, especially lowering healthcare costs and the 
reducing the complexity of the healthcare system so that 
patients can more easily access care. One thing the 
Administration, particularly you, Secretary Azar, has led on is 
advancing kidney health for Americans. That trend continues in 
the Health and Human Services Budget Proposal's support for 
H.R. 5534, the Comprehensive Immunosuppressive Drug Coverage 
for Kidney Transplant Patients Act of 2019.
    This bill would extend Medicare coverage of 
immunosuppressive drugs past the current 36-month limit for 
kidney patients who do not obtain other health coverage.
    A patient with a kidney transplant must take their 
immunosuppressive drugs or their body will ultimately reject 
the kidney causing the patient to return to dialysis treatment. 
A kidney transplant is an investment into the future of the 
recipient patient. This bill will protect that investment. I 
have worked on this policy for nearly a decade, and I am 
thankful that this has been highlighted as a priority by the 
Administration. This Congress is the time to finally pass this 
common-sense legislation.
    This budget also continues the work of the SUPPORT Act, by 
making clear that the opioid epidemic and response programs are 
a priority.
    In the Oversight and Investigations Subcommittee we heard 
from various states about the efforts they are making to help 
those with substance use disorder. Funding for these State 
Opioid Response Grants is imperative to allow states to find 
innovative ways to combat the opioid crisis.
    I also appreciate that the Administration included Hyde 
Amendment and pro-life protections in all proposed funding 
language. It is important to ensure that federal funds are not 
used to perform abortions, and I hope that as this subcommittee 
moves forward with reauthorizations and the Appropriations 
Committee puts together the bills for fiscal year 2021, that 
they will maintain those protections.
    Other important programs and policies receiving increased 
funding including the Maternal and Child Health Block Grant, 
the Health Resources and Services Administration's Maternal 
Health in America Initiative, and the 340B Drug Pricing 
Program. Funding increases for the Centers for Disease Control 
and Preparation's influenza program is particularly important 
now as we face a worldwide coronavirus outbreak.
    This novel coronavirus, named COVID-19, has infected over 
75,000 individuals worldwide and has proven to be more deadly 
than SARS. I appreciate the Trump Administration's vigilance 
and rapid response efforts. The State Department issued a level 
4 travel advisory for China and the Administration has been 
appropriately restrictive in allowing non-citizens who had 
traveled to China within the last 14 days from entering the 
U.S. It is a relief to know that our country is taking this 
outbreak very seriously and has successfully limited the number 
of cases in the United States; however, with increased global 
spread and community spread in countries such as Italy, COVID-
19 will become more difficult to contain.
    Our agencies have worked together to protect the American 
people from this outbreak and have been successful in limiting 
infection of those in the U.S. This is proof that the Pandemic 
and All-Hazards Preparedness and Advancing Innovation Act of 
2019 is working. Thanks to the work of this subcommittee in the 
last Congress and the leadership of Rep. Susan Brooks and 
Chairwoman Eshoo, our public health system is working as 
intended. I believe that our response efforts thus far have 
shown that our public health system has adapted and improved 
since the Zika and Ebola responses. Throughout those responses, 
Chairman Upton ensured that we had robust hearings on those 
responses to ensure proper Congressional oversight and 
understanding of the situations. I hope that we will be able to 
stick to that tradition and hold a standalone hearing on COVID-
19.
    I do appreciate the CDC and other agencies' transparency in 
providing multiple telebriefings for Congressional staff each 
week so that Congress can be as informed with the most up-to-
date information as possible. I look forward to learning more 
about COVID-19 and the challenges and successes of these 
response efforts.
    Thank you for holding this important hearing. I yield back.

    Ms. Eshoo. The gentleman yields back.
    I want the ranking member to know the following. On January 
30, I requested that, the following week, we have a hearing on 
the coronavirus with the heads of the agencies. The Secretary 
leaned in and said, ``I head up the effort, and I want to be 
there with that team.'' And here we are today.
    So this is not something, Dr. Burgess, that we have just 
casually overlooked or ignored. That is far from the fact.
    I now would like to recognize the chairman of the full 
committee, Mr. Pallone, for his 5 minutes.
    Mr. Pallone Thank you, Chairwoman Eshoo.

OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE 
            IN CONGRESS FROM THE STATE OF NEW JERSEY

    Today's hearing serves two critical purposes: first, we 
will examine the Trump administration's proposed budget for the 
Department of Health and Human Services for fiscal year 2021, 
and, second, we will get a crucial update on the 
administration's ongoing response to the coronavirus.
    I am disappointed, though not surprised, that the Trump 
administration budget proposal completely contradicts the 
healthcare promises that the President repeatedly makes to the 
American people.
    When it comes to ensuring the American people have access 
to affordable and quality healthcare, the Trump administration 
has failed them, and this budget proposal continues that 
record.
    Two years after showering the wealthy and large 
corporations with major tax breaks, the President's 2021 budget 
proposal slashes $100 billion from the Affordable Care Act, 
$500 billion from Medicare, and more than $900 billion from 
Medicaid over the course of years. And the President also wants 
to make it easier for States to take away people's coverage, 
undermine their care, and cut critical benefits.
    And this puts the health and well-being of tens of millions 
of children, parents, pregnant women, and people with 
disabilities at risk. Medicaid is a lifeline for millions of 
working-class families, and it is unconscionable that the 
president wants to cut it to pay for tax cuts for millionaires.
    Now, these budget cuts also fly in the face of President 
Trump's own words. He promised that, as President, he would not 
cut Medicare or Medicaid. And he promised in his State of the 
Union Address earlier this year that he would continue to 
protect the more than 130 million Americans with preexisting 
conditions. But, as Secretary Azar knows, this administration 
is now suing in the Federal courts to strike down the ACA and 
all of its consumer protections.
    Overall, President Trump is proposing a 12-percent cut to 
the HHS's budget, one of the largest cuts to any Federal 
agency. The devastating cuts don't end at Medicare, Medicaid, 
and the ACA. The President's proposal cuts the National 
Institutes of Health by $3 billion and the Centers for Disease 
Control and Prevention by $675 million. And keep in mind that 
this is the very agency that is now responding to the 
coronavirus.
    And I am also concerned by the proposal to move tobacco 
regulation out of the FDA's authority altogether. Instead, the 
administration would create a new, untested agency to oversee 
tobacco products while we are in the midst of a youth tobacco 
epidemic.
    After years of regulatory uncertainty, the Tobacco Control 
Act clearly and unambiguously ensured that FDA would regulate 
tobacco products for the protection of public health, and, over 
the last decade, the agency has worked to develop the 
expertise, workforce, and scientific basis to effectively 
regulate these products.
    So I am concerned that this proposal would only serve to 
further politicize tobacco regulation by stripping away FDA's 
sound, scientific, and evidence-based approach and replacing it 
at the whims of political appointees. And it is nothing more 
than a gift, frankly, to big tobacco companies.
    Now, let me just move to the second topic at hand. After we 
discuss the budget, we will ask questions of the Secretary and 
other top public health officials on the administration's 
efforts to address the coronavirus outbreak. It is critical 
that we get an update on the scale of the outbreak, its 
repercussions in the U.S., and how we can work together to 
ensure the safety of all Americans.
    I think we have one of the strongest public health 
infrastructures in the world, and it is more than capable of 
coming to an effective solution. And we should be supporting 
that system with all available resources.
    So, again, Madam Chair, I thank you. And I think--well, 
actually, I have time left, if anybody wants it, but--everybody 
gets time, or should--does anybody want my time? I guess not.
    All right. Thanks a lot. I yield back.

             Prepared Statement of Hon. Frank Pallone, Jr.

    Today's hearing serves two critical purposes. First, we 
will examine the Trump Administration's proposed budget for the 
Department of Health and Human Services for fiscal year 2021. 
And second, we will get a critical update on the 
Administration's ongoing response to the coronavirus.
    I am disappointed, though not surprised, that the 
Administration's budget proposal completely contradicts the 
healthcare promises that President Trump repeatedly makes to 
the American people.
    When it comes to ensuring the American people have access 
to affordable and quality healthcare, the Trump Administration 
has failed them, and this budget proposal continues that sorry 
record.
    Two years after showering the wealthy and large 
corporations with major tax breaks, the President's 2021 budget 
proposal slashes $100 billon from the Affordable Care Act 
(ACA), $500 billion from Medicare and more than $900 billion 
from Medicaid over the course of ten years. The president also 
wants to make it easier for states to take away people's 
coverage, undermine their care, and cut critical benefits. This 
puts the health and well-being of tens of millions of children, 
parents, pregnant women, and people with disabilities at risk. 
Medicaid is a lifeline for millions of working-class families, 
and it's unconscionable that the president wants to cut it to 
pay for tax cuts for millionaires.
    These budget cuts also fly in face of President Trump's own 
words--promising that, as president, he would NOT cut Medicare 
or Medicaid. And promising in his State of the Union Address 
earlier this year that he would continue to protect the more 
than 130 million Americans with pre-existing conditions. As 
Secretary Azar well knows, this Administration is now suing in 
the federal courts to strike down the ACA and all of its 
consumer protections.
    Overall, the President is proposing a 12 percent cut to 
HHS's budget--one of the largest cuts to any federal agency. 
The devastating cuts don't end at Medicare, Medicaid and the 
ACA, the President's proposal, cuts the National Institutes of 
Health (NIH) by $3 billion, and the Centers for Disease Control 
and Prevention (CDC) by $675 million. Keep in mind this is the 
very agency that is now responding to the coronavirus.
    I'm also concerned by the proposal to move tobacco 
regulation out of the Food and Drug Administration's (FDA) 
authority altogether. Instead, the Administration would create 
a new, untested agency to oversee tobacco products while we are 
in the midst of a youth tobacco epidemic. After years of 
regulatory uncertainty, the Tobacco Control Act clearly and 
unambiguously ensured that FDA would regulate tobacco products 
for the protection of public health. Over the last decade, the 
agency has worked to develop the expertise, workforce, and 
scientific basis to effectively regulate these products. I'm 
concerned that this proposal would only serve to further 
politicize tobacco regulation by stripping away FDA's sound 
scientific and evidence-based approach and replacing it at the 
whims of political appointees. This is nothing more than a gift 
to big tobacco companies.
    Now, let me move to the second topic at hand today. After 
we discuss the budget, we will ask questions of the Secretary 
and other top public health officials on the Administration's 
efforts to address the coronavirus outbreak. It is critical 
that we get an update on the scale of the outbreak, its 
repercussions in the United States, and how we can be working 
together to ensure the safety of all Americans. We have one of 
the strongest public health infrastructures in the world, and 
it is more than capable of coming to an effective solution. We 
should be supporting that system with all available resources.
    Thank you, and I yield back.

    Ms. Eshoo. The gentleman yields back.
    Pleasure to recognize the ranking member of the full 
committee, Mr. Walden, for his 5 minutes for his opening 
statement.

   OPENING STATEMENT OF HON. GREG WALDEN A REPRESENTATIVE IN 
               CONGRESS FROM THE STATE OF OREGON

    Mr. Walden. Thank you, Madam Chair. Good afternoon.
    And, Mr. Secretary, thank you for being here today. It is 
not the first time we have seen you here, I think, this year 
probably, but certainly, we appreciate the work you and your 
team have done dealing with the coronavirus.
    I think I have been in every one of the roundtables and 
hearings that you and your team have provided for this 
committee and other committees. Chairman Pallone and I were the 
co-moderators of the first one in the Visitor Center, where 
every Member of Congress was invited, and I was at the last 
one, and I was at the Situation Room at the White House before 
the break. And, you know, I think you all have been very 
forthcoming with the facts.
    And for whatever reason, we haven't had a hearing here. 
Maybe we wanted to wait until this one. But I think it is 
important that we hear from you and the team that you are 
leading.
    And I think it is important to recognize the work that Mrs. 
Brooks did on reauthorizing the Pandemic and All-Hazards 
Preparedness Act in the last Congress. We had big fights about 
that, but thank goodness it is in place, because it is designed 
to do exactly what we are encountering today: have a lead 
person in the administration--that is you--that is designated 
by the President, and a team ready to go.
    And so I guess I have been to enough of those briefings 
that I saw Members kind of yawning at some point in those, 
quote/unquote, ``closed-door briefings'' because we were 
hearing it for the third time.
    Now, we were gone a week, and a lot has changed. And we 
know what is happening in China is probably worse than we are 
being told. And I think the big issues there are the supply 
chain as well as public health.
    We know it is spreading around the world, and we are trying 
to cope. And we know, and you have warned us, and Dr. Fauci has 
warned us, and others, expect it to--you know, this could well 
mutate, but that doesn't mean end of world. It can well expand; 
we should be ready for that. But, as Mr. Pallone said, we have 
a terrific public health system here in the United States.
    A lot of that is driven at the local level. And it is 
important we have those communication links in place so that 
when we identify something, somebody coming in through an 
airport, the local health officials know about it at home and 
we are able to deal with it. And I think it is good to get this 
out in the public.
    I would just point-out that we will hear from you and the 
CDC, FDA, and ASPR and NIAID to give us an update on the 
sidecar hearing. We have had now, what, 80,000 confirmed cases 
worldwide, 2,700 deaths. The outbreak has become a significant 
global health concern. Yesterday, Italy announced 300 
individuals have been affected by the coronavirus; 11 have 
died.
    There is still much we do not know about the outbreak, and 
so we will learn more, I guess, after this budget hearing.
    But it is essential that we do everything we can and 
provide you the assistance. And I know, in the meetings I have 
been in with everybody else on this committee that was there to 
attend, you have made it clear, if you need more money, you 
will ask us, and we have made it clear, if you need more money, 
tell us, and we will work with you.
    Now, we will want to get the specifics, obviously, but I 
know you have sent up a supplemental request for, I think, a 
total of a little over $2 billion, $2.5 billion. Some of that 
is reprogramming; some of it is additional money. No sooner had 
that left your office than some politicians were on the air, 
criticizing you for not asking for enough. And so we will be 
interested to get your response to that.
    I do think it is also essential to look at perspectives in 
terms of what Americans are facing today with the traditional 
flu and that we have probably lost, what, 10,000 or more 
Americans have died from the annual flu. And we have vaccines 
for that and treatments for that. And so we have to think about 
that, as well, and practice good public health.
    I was in Japan with a couple of other of my colleagues on 
the committee, and you can't go anywhere in Japan without the 
hand sanitizer being squirted in your hands. And it was a good 
lesson, I think, for all of us. But we ought to be doing a 
little bit more of that here and we would probably help with 
the traditional seasonal flu and spread of other diseases.
    And so there is a lot we can learn from you; there is a lot 
we can learn from your team. And we will look forward to 
hearing from you directly on that, on the record here in the 
public.
    So, with that, Madam Chair, I yield back.
    [The prepared statement of Mr. Walden follows:]

                 Prepared Statement of Hon. Greg Walden

    Madame Chair, thank you for holding this important hearing. 
Secretary Azar, welcome back. Thank you for taking the time to 
be here today and the work you and your team continue to do.
    Providing funding to essential health programs has been one 
of the priorities of this committee. Last year, we passed 
several important bills that reauthorized research funding for 
autism and the Emergency Medical Services for Children program. 
We also included provisions in the end-of-the-year spending 
bill that provide additional protections for CRT wheelchairs 
provided to Medicare beneficiaries. These provisions--that are 
now law--directly and positively impact the American people and 
show we are a committee that can continue to reach bipartisan 
agreements to help the public.
    The President's budget continues to build on a number of 
proposals that increase health access to rural communities, 
combat the HIV epidemic, and provide states greater flexibility 
to engage in innovative programs--such as implementation of the 
Money Follows the Person demonstration, giving consumers the 
choice of where they live and receive services.
    As the opioid epidemic continues to claim lives and other 
drug epidemics are arising, the budget also keeps vital grants 
in the budget for substance use disorder treatment.
    The budget also integrates proposals that members of this 
committee have previously supported, such as providing lifetime 
coverage for immunosuppressive drugs for kidney transplant 
recipients as well as an extension of the Independence at Home 
demonstration program. These are good, bipartisan proposals 
that continue to build on the work this committee has done.
    The budget also reiterates the President's commitment to 
providing greater price transparency, so patients know the cost 
of their services. Additional provisions remove regulatory 
barriers that hinder the ability to have more value-based care, 
such as modernizing the Stark Law and making site-neutral 
payment changes so that costs can be uniform for all Medicare 
beneficiaries.
    It should also be noted that we are quickly approaching the 
May 22nd deadline to fund community health centers and other 
essential programs for the rest of the year. These are 
important programs and we need to make sure they are fully 
funded; it's also an opportunity to act on legislation to end 
surprise medical bills - a key priority of not only this 
committee, but also President Trump. Of course, the President's 
budget also emphasizes the need to engage in drug pricing 
reform to lower the cost of prescription drugs for consumers. I 
hope that we can work on bipartisan proposals that will do so 
and I continue to believe the Lower Costs, More Cures Act, that 
I introduced, has a path to the President's desk. This would 
provide savings to the American people, place the first out-of-
pocket cap on America's seniors' drug costs, and prioritize 
innovation without sacrificing lifesaving cures--unlike Speaker 
Pelosi's alternative with estimates that up to 15 or even 100 
fewer cures would be developed.
    After we hear from Secretary After we hear from Secretary 
Azar, we're going to hear from representatives of the CDC, FDA, 
NIAID, and ASPR to give us an update on the coronavirus 
outbreak and responses to combat it. I thank Doctors Redfield, 
Hahn, Fauci, and Kadlec for taking the time to appear before us 
today. With over 80,000 confirmed cases and over 2,700 deaths, 
the outbreak has become a significant global health concern. 
Yesterday, Italy announced over 300 individuals had been 
affected by the coronavirus and 11 had died. There is still 
much we do not know about the outbreak given that public health 
authorities have been given limited access to Chinese patients. 
It is important to make sure that the CDC and other agencies 
have the necessary funding to further research and manage this 
outbreak. Earlier this week, the Administration requested 
emergency funds to combat the coronavirus outbreak and I think 
this Committee should do everything it can to assist public 
health officials with this crisis.
    I thank both panels for taking the time to appear and I 
look forward to hearing from each of you.

    Ms. Eshoo. The gentleman yields back.
    I now would like to introduce our witness for today's first 
panel. One person, one person alone: the Nation's Secretary of 
Health and Human Services.
    Welcome to you, Secretary Azar. You certainly are familiar 
with the lighting system around here, so you are now recognized 
for 5 minutes for your statement to the committee. Thank you 
for being here.

                     STATEMENT OF ALEX AZAR

    Secretary Azar. Great. Thank you very much.
    Chairwoman Eshoo, Chairman Pallone, Ranking Members Walden 
and Burgess, thank you for inviting me to discuss the 
President's budget for fiscal year 2021.
    I am honored to appear before the committee for budget 
testimony as the HHS Secretary for the second time, especially 
after the remarkable year of results that the HHS team has 
produced.
    With support from this committee, this past year, we saw 
the number of drug overdose deaths decline for the first time 
in decades, another record year of generic drug approvals from 
FDA, and historic drops in Medicare Advantage, Medicare Part D, 
and Affordable Care Act exchange premiums.
    The President's budget aims to move toward a future where 
HHS's programs work better for the people we serve, where our 
human services programs put people at the center, and where 
America's healthcare system is affordable, personalized, puts 
patients in control, and treats them like a human being and not 
like a number.
    HHS has the largest discretionary budget of any nondefense 
department, which means that difficult decisions must be made 
to put discretionary spending on a sustainable path.
    The President's budget proposes to protect what works in 
our healthcare system and make it better. I will mention two 
ways that we do that: first, facilitating patient-centered 
markets; and, second, tackling key, impactable health 
challenges.
    The budget's healthcare reforms aim to put the patient at 
the center. It would, for instance, eliminate cost-sharing for 
colonoscopies, a lifesaving preventive service. We would reduce 
patients' costs and promote competition by paying the same for 
certain services regardless of the setting.
    The budget endorses bipartisan, bicameral drug pricing 
legislation. And I want to thank this committee for your 
bipartisan work to pass legislation such as the CREATES Act to 
cut patient costs and save taxpayer dollars through lower drug 
prices.
    The budget's reforms will improve Medicare and extend the 
life of the Hospital Insurance Fund for at least 25 years.
    We propose investing $116 million in HHS's initiatives to 
reduce maternal mortality and morbidity. And we propose reforms 
to tackle America's rural healthcare crisis, including 
telehealth expansions and new flexibility for rural hospitals.
    The budget increases investments to combat the opioid 
epidemic, including SAMHSA's State Opioid Response Program. 
This successful grant program grew out of this committee's 
creation of the State Targeted Response grants in the Cures 
Act, and we were pleased to work with Congress to provide 
flexibility on the SOR grants for States to address stimulants 
like methamphetamines.
    We request $716 million for the President's initiative to 
end the HIV epidemic in America by using effective, evidence-
based tools. Thanks to support from Congress, we have already 
begun implementation of the initiative.
    The budget reflects how seriously we take the threat of 
other infectious diseases, such as the novel coronavirus, by 
prioritizing the funding for CDC's infectious disease programs 
and maintaining investments in hospital preparedness.
    As of this morning, we still had only 14 cases of the novel 
coronavirus detected in the United States involving travel to 
or close contacts with travelers. Coming into this hearing, I 
was informed that we have a 15th confirmed case, the 
epidemiology of which we are still discerning. Three cases also 
exist among Americans repatriated from Wuhan, and 42 cases 
exist among American passengers repatriated from the Diamond 
Princess cruise ship in Japan.
    While the immediate risk to the American public remains 
low, there is now community transmission in a number of 
countries, including outside of Asia, which is deeply 
concerning. We are working closely with State, local, and 
private-sector partners to prepare for mitigating the virus's 
potential spread in the United States, as we expect to see more 
cases here.
    On Monday, OMB sent a request to make at least $2.5 billion 
in funding available for preparedness and response, including 
for therapeutics, vaccines, personal protective equipment, 
State and local public health department support, and 
surveillance. I look forward to working closely with Congress 
on that proposal.
    This year's budget aims to protect and enhance Americans' 
well-being and deliver Americans a more affordable, 
personalized healthcare system that works better rather than 
just spends more. I look forward to working with this committee 
to make that commonsense goal a reality.
    Thank you very much.
    [The prepared statement of Secretary Azar follows:]

                     Prepared Statement of Mr. Azar

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] 

    Ms. Eshoo. Thank you, Mr. Secretary.
    And we will now move to member questions. And I will 
recognize myself for 4 minutes, which will be the limit for 
questions to the Secretary.
    Mr. Secretary, we know that on February 24, the Acting 
Director of OMB--what was requested, the appropriation of $1.25 
billion for emergency funding for the virus. Is that what you 
requested of OMB?
    Secretary Azar. So the actual total supplemental 
authorization would be $2.5 billion. We proposed----
    Ms. Eshoo. That I know, but----
    Secretary Azar [continue]. Half of that to be covered----
    Ms. Eshoo [continue]. The new funding is 1.25.
    Secretary Azar. I do want to emphasize, as I have told the 
appropriators, that was meant as a suggestion of a way to fund 
half of it. But if Congress decides there are other approaches, 
we are not wed to that.
    Ms. Eshoo. And what exactly does that cover? And is it 
anticipatory?
    Now, yesterday, the CDC said we need to be prepared--
essentially, we need to be prepared for a much larger spread of 
this virus in the United States. So is what has been requested 
in emergency funding to cover a broader plan, or is it on the 
figures that you just gave us?
    Secretary Azar. So it is to cover expenses that we believe 
are appropriate for 2020. So this would go through the end of 
2020's fiscal year. And then we would work with appropriators 
on any adjustments to 2021 appropriations in the weeks and 
months ahead as we continue to learn on a daily basis about the 
spread of the disease.
    Core investments. First, surveillance, expanding our 
surveillance system for novel----
    Ms. Eshoo. Yes. I have some other questions, so----
    Secretary Azar. Oh, sure. But----
    Ms. Eshoo. All right.
    Secretary Azar [continue]. I am happy to walk you through 
the five key basic----
    Ms. Eshoo. And I read the entirety of your printed 
statement.
    I want to turn to the status of drug pricing policy 
proposals. If you could just say ``yes'' or ``no,'' it would be 
great.
    Have you finalized a policy ending drug rebates to 
middlemen in Medicare?
    Secretary Azar. We did not move finally with that rule.
    Ms. Eshoo. OK.
    Have you finalized a policy tying drug prices to the lower 
costs, the reference pricing?
    Secretary Azar. We had an advance notice of proposed 
rulemaking, so that was not an actual formal proposal yet.
    Ms. Eshoo. All right.
    Have you finalized a proposal to make drug manufacturers 
put list prices in television advertisements?
    Secretary Azar. We did. And much to their shame, the pharma 
industry sued. And Congress has not passed explicit 
authorization for that list price requirement in the statute 
that I wish they would do.
    Ms. Eshoo. Are you planning to finalize or pursue any of 
these policies in the near future?
    Secretary Azar. We plan to finalize as soon as we can the 
importation program implementing section 804 of the Food, Drug, 
and Cosmetic Act to allow low-cost importation from Canada.
    Ms. Eshoo. You know that the House passed H.R. 3. You also 
know that the President said that we are going to ``negotiate, 
negotiate, negotiate so hard,'' or something like that. ``We 
are going to negotiate like crazy.'' Do you support direct 
negotiations?
    Secretary Azar. We do not support H.R. 3 because we don't 
believe the negotiation framework in there is either a 
negotiation or actually practical and implementable. And it 
also just has no chance of passing in the Senate. The 
bipartisan package of Grassley-Wyden is struggling even to get 
to the floor there.
    Ms. Eshoo. Well, H.R. 3 caps out-of-pocket, as you know, 
prescription costs for seniors. Do you support the capping of 
out-of-pocket costs for them?
    Secretary Azar. We have an important opportunity here----
    Ms. Eshoo. Yes or no?
    Secretary Azar [continue]. Bipartisan----
    Ms. Eshoo. Yes or no?
    Secretary Azar [continue]. To cap out-of-pocket spending 
and reduce what seniors----
    Ms. Eshoo. Yes or no?
    Secretary Azar [continue]. Are you paying for Part D. So, 
yes, we do.
    Ms. Eshoo. OK. Good.
    Well, I think that I have asked all--let me just--well, 
H.R. 3 also limits drug price hikes to inflation. Do you 
support the inflation caps?
    Secretary Azar. So that is part of the Grassley-Wyden 
package also in the Senate, and we----
    Ms. Eshoo. Do you support it?
    Secretary Azar [continue]. Have made clear that that is a 
package we can support it. It is not the only bipartisan 
package, but the price inflation penalties in Part D and B are 
acceptable to us as a means of getting list prices under 
control.
    Ms. Eshoo. Thank you.
    My time has expired. I now would like to recognize the 
ranking member of the subcommittee for his 4 minutes of 
questions.
    Mr. Burgess. Thank you.
    Mr. Secretary, in December of 2018, the President signed 
two important bills into law that addressed maternal health and 
maternal mortality. The first bill, Representative Jaime 
Herrera Beutler's Preventing Maternal Deaths Act, established a 
grant program for States to establish or expand maternal 
mortality review committees. The other bill, Improving Access 
to Maternity Care Act, required HRSA to identify maternity care 
health professional target areas.
    So how have you used these bills? How is your agency 
building on the success of those two laws to ensure access to 
quality maternity care and prevent maternal mortality?
    Secretary Azar. First, could I thank you for your 
leadership on immunosuppressive drugs? I hope you saw that we 
put in the budget what you have long advocated for in terms of 
that coverage.
    On this----
    Mr. Burgess. Yes. Yes, you may say thank you. You are 
welcome.
    Secretary Azar. And on maternal mortality also, the work of 
Congress really focusing on this critical issue. Too many women 
are dying either in childbirth, preterm, at childbirth, or 
postpartum. And so we have made this a serious part of the 
President's agenda, with a $116 million initiative, with the 
$74 million increase, that focused on improving prevention, 
quality improvement, postpartum health, and improving the data 
collection on that, so a four-part strategy that we look 
forward to working with Congress on coming out of the budget.
    Mr. Burgess. Well, I thank you for that.
    You know, Republicans on this subcommittee in 2017 sent 
your predecessor, Secretary Price, a letter asking for HHS to 
update and release the Pandemic Flu (Influenza) Plan. And it 
previously had not been updated since 2005.
    Can you describe how you are using the Pandemic Influenza 
Plan as a guide in preparing for your response to this current 
outbreak of the coronavirus?
    Secretary Azar. So, as you know, I was one of the 
architects of the original pandemic plans back in the Bush 
administration. That work is foundational. That is what has set 
up our entire State, local, and Federal preparedness program 
for any type of viral outbreak like this.
    And so it is really the blueprint for how we are operating 
today, including my role, leading through the Emergency Support 
Function 8 under the National Response Plan, which is the 
doctrine that we have had in place now for 15 years.
    Mr. Burgess. Let me just say, this committee did do work on 
H.R. 3 last October. There was concern from many of us that the 
negative effects on innovation and development would really be 
profound. And now we find ourselves confronted with this 
coronavirus outbreak, where we know we need new antivirals, we 
know we need new vaccines, we know we need new monoclonal 
antibodies to help people who become ill.
    Can you just speak to the fact of, is innovation still 
important? Because we have heard several times in this 
subcommittee and in the full committee that maybe innovation 
wasn't so important as getting cheaper drugs into people's 
hands.
    Secretary Azar. Innovation is vitally important, and that 
is why two of the key legs of the supplemental request are to 
develop vaccines and therapeutics for this novel virus.
    One of the challenges with H.R. 3 is the sheer amount of 
money it would pull out of the system. And I am not a believer 
that if you pull any money out of the drug industry----
    Mr. Burgess. Right.
    Secretary Azar [continue]. It is catastrophic or 
impossible. But the sheer amount would materially impact the 
bringing forward of drug therapies for Alzheimer's, for 
arthritis--just go through the list of therapies that you need 
to incent, or you won't get them.
    Mr. Burgess. Yes. And, you know, interestingly enough, the 
Alzheimer's drug that was withdrawn a year ago, I am reading, 
is now getting a new look at different dosing schedules. And, 
again, work like that, that is not going to happen if we don't 
value innovation.
    Mr. Secretary, I thank you for being here and certainly 
look forward to the second part of this hearing.
    I yield back.
    Ms. Eshoo. The BARDA biodefense budget has also been cut.
    Now, glad to recognize the chairman of the full committee 
for his 4 minutes of questions.
    Mr. Pallone. Thank you, Chairwoman Eshoo.
    Mr. Secretary, I thank you for appearing before our 
subcommittee today. But I continue to be upset by the Trump 
administration's decision to ask the court to strike down the 
ACA in the Republican lawsuit that is seeking to declare the 
entire law invalid.
    If the district court ruling is upheld, then the Trump 
administration will be responsible for the largest coverage 
loss in U.S. history. Over 20 million Americans would lose 
their coverage, raising consumer costs and making lifesaving 
healthcare unaffordable for American families. And it would 
eliminate protections for preexisting conditions, adversely 
impact the Medicare program, and end Medicaid expansion.
    So I have sent you three letters now, including one in 
April of last year, requesting any analysis, study, assessment, 
or reports regarding the potential impact if the entire ACA is 
found to be unconstitutional. And for almost two years now, I 
have repeatedly asked for any documents relating to any 
contingency plans in place in the event the ACA is found 
unconstitutional.
    Only last week, I received a 1- and 1.5-page response that 
answers none of my questions, frankly. And the documents 
produced so far to the committee answer none of these 
questions.
    So I would like to submit, Madam Chair, my letters and the 
Department's response in the record. I would ask for unanimous 
consent.
    Ms. Eshoo. So ordered.
    [The information appears at the conclusion of the hearing.]
    Mr. Pallone. So, really--I have 2.5 minutes here, Mr. 
Secretary--I think the American people have the right to know 
what the administration's contingency plans are, given the 
President is asking that this entire law be declared invalid. 
Maybe you just have to answer ``yes'' or ``no.'' We will see. I 
only have two minutes.
    Secretary, has the Department conducted an analysis to 
evaluate the impact on individuals with preexisting conditions 
and their access to affordable health insurance if the ACA is 
found unconstitutional, yes or no?
    Secretary Azar. Well, of course, it is not going to be left 
just like that. We would replace it with something that would 
actually deal with preexisting conditions----
    Mr. Pallone. But have you done any kind of contingency 
plans for what would happen if the court struck down the ACA, 
yes or no?
    Secretary Azar. We are always considering different 
options, but it will depend on the nature of any ultimate court 
decision----
    Mr. Pallone. All right.
    Secretary Azar [continue]. If it even agrees with striking 
down all or part of the ACA.
    Mr. Pallone. All right. Well, it doesn't sound like there 
is such a thing.
    Has the Department conducted an analysis to evaluate the 
impact on premiums and access to coverage in the individual 
market, particularly for individuals with preexisting 
conditions, if the ACA is found unconstitutional, yes or no?
    Secretary Azar. Well, it depends on what would be struck 
down, whether all of it is struck down, part of it, or none of 
it.
    Mr. Pallone. OK.
    Secretary Azar. We are years, possibly, away from a final 
court decision on all of these elements.
    Mr. Pallone. All right. Well, let me ask you this. Are 
there any contingency plans to ensure that the 20 million 
people who are covered under the ACA do not lose coverage? 
Anything at all? Any contingency plans?
    Secretary Azar. Well, first, we have been emphatic that we 
are changing nothing about how we administer this program 
during the pendency of the litigation. And at the time that 
there--if there is a final court decision striking down all or 
part of it, it will depend on the context of that decision and 
the politics, frankly, of who is in Congress and what we can 
work with to ensure the----
    Mr. Pallone. Well, I am trying to----
    Secretary Azar [continue]. Protection of preexisting 
conditions.
    Mr. Pallone. It sounds like the answer is, no; you don't 
have anything yet.
    I would just like a commitment from you, basically, to 
respond to my request to provide any documents to the committee 
that relate to contingency plans in the event that the ACA is 
struck down. Can you give me that commitment?
    Secretary Azar. I am sure you will understand that 
deliberative processes regarding potential legislative 
proposals are some of the core of the internal executive 
departments' functions.
    Mr. Pallone. So it sounds like the answer is no. Well, I 
just think that it is unfortunate because, you know, our 
oversight responsibility is to make sure that, in the event we 
have this terrible situation, that there is some kind of 
contingency plan. And I don't think you have it. So I don't 
believe the administration has any kind of comprehensive plan 
to address the fallout that will occur if this Republican suit 
is successful in court.
    Thank you, Madam Chair.
    Ms. Eshoo. The gentleman yields back.
    The Chair recognizes the ranking member of the full 
committee, Mr. Walden, for his 4 minutes.
    Mr. Walden. Thank you, Madam Chair.
    Mr. Secretary, again, thanks for being here.
    I want to make a couple of points.
    One is, on the opening day of this Congress, I led the 
effort on the House floor, now in the minority, trying to move 
an effort to protect people with preexisting conditions pending 
this lawsuit's decision.
    Congress could act. This House could move legislation to 
put into law certainty to protect people with preexisting 
conditions, in addition to the laws that are already on the 
books dealing with preexisting conditions. But my colleagues 
have chosen not to do that.
    So they could. And we would probably find common ground 
here on a preexisting severability language. There is a lot 
that could be done here.
    Second, it was the Congressional Budget Office--
independent, nonpartisan--that said, I believe 8 to 15 new 
medicines would never be invented because of H.R. 3, Speaker 
Pelosi's partisan drug pricing bill. As you said, that could be 
a cure for Alzheimer's. It could be a cure for the coronavirus. 
We don't know.
    And that is just the first ten years. The further out you 
look, the more future innovation will be lost. California Life 
Sciences said upwards of 85 percent of what they invest in 
would go away. Eighty thousand U.S. jobs, 80,000 is what 
California Life Sciences said. We would lose the R&D. We would 
lose the innovation.
    Now, no President that I have been around, Republican or 
Democrat, has ever leaned in harder on these issues of cost of 
care than President Trump. And I was with you and him when he 
announced the effort to get transparency in the hospital 
system. And before we got from the news conference to the Oval 
Office, I believe the hospitals had sued you. Is that correct?
    Secretary Azar. I believe it is, yes.
    Mr. Walden. Yes.
    And you talked about the drug disclosure in advertising. 
And what happened there?
    Secretary Azar. Rather disgustingly, the pharmaceutical 
industry sued us to conceal their list prices from their 
consumers.
    Mr. Walden. And so then I want to talk about Medicare Part 
D. We were all working together on this committee, which we 
have a great reputation of doing--occasionally we fight, and 
that is all right; we know it. But we were working together to 
cap the out-of-pocket costs for seniors under Medicare Part D 
and modernize Medicare Part D when all that, unfortunately, 
came to an abrupt halt, driven, I am going to say, from the 
Speaker's office. Those discussions ceased.
    But we agreed that we needed to cap out-of-pocket costs. We 
put that in our bill, H.R. 19. They put that in their partisan 
H.R. 3. But we all agree that it is time to cap the out-of-
pocket costs for seniors in Medicare.
    Does the administration support capping the out-of-pocket 
costs for seniors in Medicare?
    Secretary Azar. Absolutely.
    Mr. Walden. Did the administration opposes H.R. 3?
    Secretary Azar. We do oppose H.R. 3.
    Mr. Walden. Did the administration support the concepts of 
H.R. 19, our alternative?
    Secretary Azar. We support the elements of it, absolutely, 
including the notion of capping out-of-pockets and saving 
seniors money.
    Mr. Walden. One of the big issues we have dealt with here, 
or tried to, is the high cost of insulin, not just for seniors 
but for others. But in our alternative, H.R. 19, that was all 
bipartisan legislation, we capped cost of insulin, I believe, 
at $50 a month was the maximum.
    Does the administration support that concept?
    Secretary Azar. I believe so, yes.
    Mr. Walden. So, going forward, are you hopeful that 
Congress and the administration can get together on a plan the 
President can sign, that can become law, that would actually 
reduce the costs of pharmaceutical drugs in America without 
driving innovation away?
    Secretary Azar. Yes. I have said the administration is the 
most flexible party here--Republicans, Democrats, Senate, 
House. Get list prices under control, lower out-of-pockets, and 
give the drug plans the real incentive to get drug prices down.
    Mr. Walden. H.R. 19 contains about 80 or 90 percent of the 
Wyden-Grassley bill. We think we are with you, we think we can 
get there, if we can just put the partisan weapons away.
    Thank you, Mr. Secretary.
    And I yield back.
    Ms. Eshoo. The gentleman yields back.
    Pleasure to recognize the gentleman from New York, Mr. 
Engel, for his 4 minutes of questions.
    Mr. Engel. Thank you, Madam Chair.
    Secretary Azar, the State of New York was extremely 
disappointed to hear that CMS has denied the State's request 
for a renewal of its Delivery System Reform Incentive Payment 
Program, known as DSRIP.
    When the program was first approved, CMS and HHS insisted 
that New York include targets for the State's Medicaid program 
that would incentivize providers to move away from fee-for-
service, toward value-based payments.
    New York's healthcare community has made progress in doing 
just that, receiving double-digit reductions in preventable 
hospital readmissions, while saving the Federal Government 
billions of dollars.
    The request for additional time and continued investment of 
those savings in DSRIP was to move closer to exactly what CMS 
and HHS have been saying the Federal Government wants everyone 
to be doing. So, in light of that, why would CMS and HHS want 
to stop supporting these successful efforts to achieve the very 
goals that the Trump administration has been saying that it has 
for healthcare?
    So will your department commit to meeting with the State of 
New York to discuss how these reforms are sustained into the 
future? And I would like a ``yes'' or ``no'' answer if I could 
get it.
    Secretary Azar. Yes. I am not familiar with that particular 
program, but you are right, we do support value-based 
transformation in our programs. I don't know the particulars of 
why CMS has had difficulty with New York, but, yes, we will be 
happy to sit with New York.
    Mr. Engel. OK. And I would be happy to sit with you as 
well----
    Secretary Azar. Thank you.
    Mr. Engel [continue]. And discuss it.
    Mr. Secretary, we have mentioned it here, other members 
have mentioned it here, and you know it far too well, that 
Americans are suffering from the current epidemic of 
skyrocketing prescription drug prices. My constituents always 
tell me they are having to make unconscionable choices between 
paying for food or filling a lifesaving prescription such as 
insulin.
    The House has taken bold, decisive action to lower drug 
prices through H.R. 3, which provides a commonsense solution to 
this crisis by allowing the government to negotiate drug 
prices. That is a policy that the President supported as a 
candidate in 2016, saying--and I quote--``When it comes time to 
negotiate the cost of drugs, we are going to negotiate like 
crazy,'' unquote. That is from the President.
    The administration has yet to deliver any meaningful 
solutions for the health crisis. In May 2018, your Department 
released a blueprint to lower drug prices, but many of those 
policies failed to materialize or provide minimal relief to 
patients. Other ideas, such as the International Pricing Index, 
have been shelved.
    Despite these failures, President Trump claims to have 
reduced drug prices, when, in fact, a recent report showed 
that, on average, drug prices increased by over five percent at 
the start of this year.
    Mr. Secretary, can you commit to me today that you will 
deliver on the President's promise to negotiate drug prices? I 
would like a ``yes'' or ``no'' also.
    Secretary Azar. So we support bicameral, bipartisan 
legislation that would get through. And there are many 
principles in H.R. 3 the President is supportive of, but it has 
to pass both houses of Congress, and, at the moment, H.R. 3 
doesn't have a chance of seeing the light of day in the Senate. 
And so we need to work together to see if something can get 
through both chambers.
    Mr. Engel. Well, I am sure if the President asked Mitch 
McConnell to put it on the agenda, he would.
    Secretary Azar. I don't think so.
    Mr. Engel. There are plenty of things that we have passed 
in this House that, unfortunately the other body hasn't done, 
and the President seems to be right along with it.
    So I just think it is another example of the 
administration's broken healthcare promises to the American 
people. I just think that we need to get those prices of drugs 
down, and we need to have not empty rhetoric but true facts.
    And I yield back the balance of my time.
    Ms. Eshoo. The gentleman yields back.
    Pleased to recognize the gentleman who was the former 
chairman of the full committee, Mr. Upton of Michigan, for his 
4 minutes.
    Mr. Upton. Thank you, Madam Chair.
    Mr. Secretary, welcome. Big time.
    So, as you know, this committee, on a unanimous vote, 
passed 21st Century Cures--``Cures,'' as we call it. When I was 
chair, we expedited the approval of drugs and devices, and I 
would suspect strongly that your testimony that we had a record 
number of generic approvals is a direct result because of what 
this committee did.
    We also added some $45 billion in health research over a 
10-year span. And, frankly, we asked the question of the 
agencies, as we worked on this legislation, what is it that we 
could do to help you make sure that we hit these targets of 
faster approvals of drugs and devices. And so, whether it was 
the FDA, the CDC, and others, the NIH obviously, they gave us 
an answer, and we delivered.
    And at the end of the day, for this crisis, we are going to 
find a vaccine to solve coronavirus. I know that we are. And I 
would like to think that what we did in this committee and then 
passed on the House floor will be a direct result of that.
    And, frankly, it prompts all of us, I think, to ask the 
questions of what more can we do to get on a faster pace to 
find that vaccine and that cure. And, in fact, as you may know, 
Diana DeGette and I are again working on a 2.0 Cures bill, 
where we can take these three years since President Obama 
signed the bill into law and ask those questions to see what, 
constructively, we can do so that all hands are on deck. And I 
know--I don't have to ask you--I know that you will help us 
with ideas to do that.
    A question that I have is: A containment is the very first 
step in responding to any outbreak of coronavirus. We have seen 
that around the world now. And statements from yesterday 
indicate that the CDC said it really isn't if but when it gets 
to larger numbers here in the United States.
    I have always believed in the adage that if you are going 
to do something, you better do it right the first time because 
you are not going to find a second. And you want to make sure 
that--pay me now or pay me later. So we need to have the right 
numbers as it relates to fighting this terrible disease.
    Is the $2.5 billion, is that a floor? Is that a suggestion, 
the $2.5 billion that you requested?
    Secretary Azar. We have described the request as at least 
$2.5 billion for 2020 money and then work on 2021 money as we 
see the situation develop over the weeks and months ahead.
    Mr. Upton. So I know that we are waiting to see the precise 
details of where it is going. Are any of those dollars 
envisioned to include the contingency of what China has done as 
it relates to regional quarantines?
    Secretary Azar. No, we don't envision that as a, kind of, 
practical step here in the United States. As Dr. Messonnier 
spoke about yesterday, in the event that we had community-level 
outbreaks, which might be small, just a town, a city, if we had 
that, we would take the pandemic playbook, which is community-
based mitigation steps, social distancing.
    It is very rare that those types of--that ``cordon 
sanitaire'' efforts around cities are effective. They usually 
promote more panic and cause people to actually leave and 
spread.
    Now, China is a different government and culture than we 
have here.
    Mr. Upton. Of the 14,000 Americans that have died this flu 
season, do you know what percentage of those were not 
vaccinated?
    Secretary Azar. I do not have the numbers. Historically, 
our youth who die tend to not to have been vaccinated, which is 
a real tragedy.
    Mr. Upton. And last question: Has there been any query of 
those 55 Americans who currently have been diagnosed with the 
coronavirus--did any of them have the flu vaccine, do you know? 
Was that question asked of any of the 55?
    Secretary Azar. I don't know that that would have been 
asked. We don't, of course, have any evidence that the flu 
vaccine would have any properties related to the novel 
coronavirus. But I don't know if that was asked as part of the 
intake for the patients.
    Mr. Upton. OK.
    I yield back.
    Ms. Eshoo. The gentleman yields back.
    It is a pleasure to recognize the gentlewoman from 
California, Ms. Matsui, for her 4 minutes of questions.
    Ms. Matsui. Thank you, Madam Chair, for holding this 
important hearing.
    And welcome, Mr. Secretary.
    Before I get into my line of questioning, I do want to 
express my deepest concerns about the Medicare, Medicaid, and 
other cuts included in the budget. At a time when we are 
dealing with the coronavirus outbreak, an addiction crisis, and 
a lawsuit that threatens ACA protections for preexisting 
conditions, the administration's cuts to critical safety-net 
programs target the most vulnerable in our communities and aim 
to further erode access to vital healthcare services.
    We should be prioritizing primary comprehensive care, 
particularly in the mentally ill and people with addiction. I 
believe mental health is the area where we have an opportunity 
to work together and make progress.
    Mr. Secretary, I appreciate the Department's strong support 
of the Certified Community Behavioral Health Clinic Medicaid 
demonstration. As you know, Representative Markwayne Mullin and 
I are working to further scale the program with our bipartisan 
legislation, the Excellence in Mental Health and Addiction 
Treatment Expansion Act.
    For the eight States currently participating in the 
Excellence demonstration, we have studies showing that quality 
mental health services, outpatient care, and addiction 
treatment provided at these facilities are saving lives and 
money. People are avoiding jails and emergency rooms; instead, 
getting the comprehensive care they need in their communities.
    We have 11 additional States that are ready to participate 
in an expanded Excellence program. Our bill has a bipartisan 
group of 88 cosponsors who support this full expansion, and the 
House has already voted to extend the program longer-term.
    I was very pleased to see that the budget this year 
explicitly endorses extending this Excellence demonstration. 
And I believe we do all agree, Mr. Secretary, that adequate 
Medicaid resources around substance abuse treatment are 
essential to fighting the opioid and addiction epidemic.
    Mr. Secretary, I have a question: Under the leadership of 
Chair DeLauro, $200 million was made available to HHS in fiscal 
year 2020 to help States prepare for eventual participation in 
the Excellence demonstration. How does HHS plan to obligate 
these resources?
    Secretary Azar. First, thank you for your personal 
leadership on the Certified Community Behavioral Health Clinic 
issue. You are right, the data is showing really positive 
results today, so thank you for that.
    In terms of your work with Chairwoman DeLauro, SAMHSA is 
now accepting applications from States for these grants to 
increase access to and improve the quality of community mental 
and substance use disorder treatment services through the 
expansion of CCBHCs, and the deadline for States to apply is 
March 10.
    Ms. Matsui. OK. Thank you. The positive impacts of the 
demonstration make it clear that there is room to improve 
mental health and addiction care in this country by scaling 
this program.
    In California, our county hospitals, public academic 
medical centers, and public children's hospitals rely upon 
financial arrangements that leverage public funds and 
partnerships as essential means of providing healthcare to the 
most underserved communities and patient populations in the 
State.
    I have concerns about the administration's recent proposal 
to eliminate these sources of funding, particularly supplement 
payments. I worry that, if finalized, the Medicaid 
accountability rule would destabilize the whole system of care 
provided under Medi-Cal. Medicaid supplemental payments are an 
integral component of total Medicaid reimbursement that 
providers rely on for adequate reimbursement and financial 
stability.
    Mr. Secretary, have you weighed the restrictions on 
supplemental payments against the adequacy of these base 
payments? Are there plans to make any corresponding adjustments 
to base payments for these providers?
    Secretary Azar. So we are hearing the very important 
feedback from you and others about that regulation, and we want 
to take that in as we look at how and whether to finalize at 
CMS the relationship of these intergovernmental transfers to 
supplemental payments and, also, if there are ways we can work 
with States to restructure payments in a way that would be 
consistent with the law. So we want to work with the States, 
not be adversarial to them, on this.
    Ms. Matsui. OK. Well, thank you, Mr. Secretary.
    And I yield back.
    Ms. Eshoo. The gentlewoman yields back.
    Pleasure to recognize Mr. Shimkus of Illinois for his 4 
minutes of questions.
    Mr. Shimkus. Thank you, Madam Chairman.
    Thank you, Mr. Secretary, for being here.
    Coronavirus is a novel pathogen, as a lot of us know, but 
in your testimony you also mention emerging microbial threats.
    And, Madam Chairman, I ask to submit in the record this 
news release from the World Health Organization on the 17th of 
January 2020.
    Ms. Eshoo. So ordered.
    [The information appears at the conclusion of the hearing.]
    Mr. Shimkus. And in the 114th Congress, I joined with Gene 
Green on what we called the ADAPT Act. Last Congress, it was 
Tony Cardenas and I, with the help of the now-chairman of the 
subcommittee, Anna Eshoo, who joined, and technical assistance 
by HHS, on what we call the REVAMP Act. And it is an attempt to 
address how, if you have this antimicrobial resistance, how 
public funding may not be the only way you can address this.
    Can you talk about that challenge?
    Secretary Azar. Yes, I am very concerned about the drug 
development around antimicrobial resistance in terms of 
creating a sustainable market.
    You know, we have had, actually, tremendous success from 
the efforts you have led and the Congress has led and BARDA at 
my agency have supported. We have supported the development of 
16 novel antibacterial projects. I believe three have actually 
come to market.
    What we are finding, though, is there is a market failure 
question here, where you are basically asking a company to 
develop a drug but then not to have it used much. And that is 
not a usually sustainable business model.
    So I have actually commissioned my team to work on how we 
can possibly solve that; is that more like a bioterrorism 
chemical countermeasure and the approaches that we need there. 
Quite concerned about this.
    Mr. Shimkus. And that is what we have tried to do 
legislatively, and, at sometime, one was the tradeable vouchers 
debate, which I think should have legs, especially in this 
concern of, as you put it, trying to have something on the 
shelf that you don't want to use. That is the key.
    Scott Peters and I are also working on legislation that we 
call Ending the Diagnostic Odyssey. And it is an attempt to 
help DNA sequencing so that when there is a disease or some 
event you don't have to test, test, test; you can go just 
through the sequencing aspect of that.
    Do you have any thoughts on or comments of what you all may 
be doing that we don't know about in trying to push more DNA 
identification?
    Secretary Azar. So I have not studied that particular 
issue. We are happy to get back to you on that. It certainly is 
at the fore right now as we deal with novel coronavirus and 
have the CDC diagnostic, but also hope that commercial 
innovators will develop physician bedside diagnostics for rapid 
insight testing.
    Mr. Shimkus. Yes. And this is timely--well, it obviously is 
timely because of the threat that we are all concerned about 
now, but it is also Rare Disease Week. And a lot of that 
community is, you know, looking for this as a novel way, 
especially on what we call that diagnostic odyssey. And we see 
that with people who are struggling with just types of cancer 
and trying to identify the right treatment early versus what I 
would say sometimes is a trial-and-error method that is very 
damaging to the health of the patient.
    And with 30 seconds left, I wanted to just briefly--and it 
has been asked a little bit before. You all do support Medicare 
D reform; is that correct?
    Secretary Azar. Oh, absolutely. It is a real opportunity 
for seniors.
    Secretary Azar. Well, you would cap catastrophic payment, 
the limit at $3,100. So a patient would never pay more than 
$3,100. And then, at least the Grassley-Wyden plan, the senior 
could actually opt into a program where they would pay no more 
than $258 a month for their drugs, no matter what their 
expenses are.
    Ms. Eshoo. The gentleman yields back.
    The gentleman from Maryland, Mr. Sarbanes, is recognized 
for his four minutes of questions.
    Mr. Sarbanes. Thank you, Madam Chair.
    Secretary Azar, you certainly know that the popularity of 
e-cigarettes has recently led to an unprecedented surge in 
youth tobacco use, and it is bringing back a vengeance the 
tobacco epidemic in this country we have worked so hard to 
curb. It shows why we have to improve the law and something 
this committee has been working on.
    Unfortunately, the Trump administration is now proposing, 
as I understand it from the budget, removing FDA's oversight of 
tobacco products in favor of an untested agency that will take 
years to get off the ground, which threatens to set us back 
even further. I am perplexed that the administration would 
decide to do this, remove FDA's authority, alter the agency's 
public health mission, which includes making, quote, ``tobacco-
related death and disease'' part of America's past, not 
America's future, and by doing so, ensuring a healthier life 
for every family.
    This latest move is kind of breathtaking. It makes no 
sense. It is a crazy thing to do by the administration, which 
unfortunately, hasn't taken significant action against big 
tobacco as more of our Nation's youth are becoming addicted.
    In January, after heavy lobbying from big tobacco, as we 
understand it, and the vaping industry, and listening to 
partisan political consultants like Trump campaign manager Brad 
Parscale, the administration reversed course. We were on a 
trajectory where we thought everybody was on the same page.
    The administration reversed course, and announced a policy 
which failed to ban all flavored e-cigarettes, allowing popular 
menthol cartridges to stay on the market, and allowing all 
flavored disposable e-cigarettes and open tank e-cigarettes to 
proliferate through our Nation's schoolyards, which is exactly 
what they are doing.
    And I am concerned that removing this authority from the 
FDA, which is a part of the proposal, could lead to even more 
loopholes and more industry influence.
    My question is this: When formulating the budget proposal 
to remove the FDA's tobacco oversight authority, did you, your 
agency staff, White House staff, or staff of the Office of 
Management and Budget, speak or meet with any lobbyists or 
other representatives of the tobacco industry, or, for that 
matter, political operatives who work for or are contracted by 
the President's reelection campaign?
    Secretary Azar. Well, I certainly--I can't speak for 
others. I am not aware of any such deliberations. The idea was 
that if we move the tobacco center out from under FDA, first, 
if it were a politically appointed--a presidential-appointed, 
Senate-confirmed leader, they would be more accountable to 
Congress. Second, as a direct report to me, or whoever is 
Secretary, elevating the role of tobacco control there.
    It has always been a little bit of an odd connection. FDA 
is about safe and effective, whereas the tobacco center is 
about regulating a product that is undeniably bad. And so there 
is a----
    Mr. Sarbanes. It doesn't make any sense, does it?
    Secretary Azar. It would be subject to Congress if it was 
something----
    Mr. Sarbanes. I mean, we are at the height of it. We are at 
this tipping point on this epidemic when it comes to vaping.
    I mean, there does reside, however you want to sort of 
carve up what you consider the appropriate mission of the FDA 
to be; there certainly exists, resides within the FDA now 
significant expertise and experience in terms of dealing with 
this issue. Why you would propose, at this moment in time, when 
this epidemic risk in a sense overtaking the dimensions of the 
previous tobacco epidemic we saw in this country, by zeroing 
out that authority and moving it to an untested new agency, 
which, by the way, I think would be more susceptible to 
political influence of the kind I was just recounting than it 
is now. It doesn't make any sense to me. I urge you to 
reconsider that. We are in the midst of this crisis, and we 
have to use every tool available to us here in the government 
to respond to it.
    With that, I yield back.
    Ms. Eshoo. The gentleman yields back.
    There is 5 minutes and 22 seconds left on the clock. Any 
member that would like to leave to vote, when we get to--you 
can leave now. When we--when the clock goes to zero, they will 
hold the vote open for those that have not arrived from our 
subcommittee, and at that point, we will take a 20-minute 
break.
    But now I would like to recognize the gentleman from 
Kentucky, Mr. Guthrie, for his 4 minutes of questions.
    Mr. Guthrie. Thank you, Mr. Secretary.
    I look forward to getting into the coronavirus. I will do 
that in my second rounds of questions. So the SUPPORT Act we 
passed last year included my bill, the Comprehensive Opioid 
Recoveries Act, to establish treatment centers that offer FDA-
approved medications, and assistance treatments, all of them 
comprehensively. Currently, SAMHSA has the grant application 
open for entities to apply and I am glad HHS is moving fast in 
implementing the program. But my question is: How is HHS 
implementing other parts of the SUPPORT Act? And does HHS 
conduct any oversight on how the funds are actually being used?
    Secretary Azar. So, first, thank you for the SUPPORT Act, 
and it is so comprehensive we actually established a SUPPORT 
Act implementation leadership committee to track all of the 
different work streams needed under the SUPPORT Act. It is 
really enhancing our work across all five elements of our 
strategy on opioids, and so, we are just--we are driving 
forward, making progress on the opioid epidemics. We have got--
the overdose deaths are down for the first time in decades as a 
result of our collaborative bipartisan efforts here, and we are 
implementing and using the SUPPORT Act authority. So thank you 
for those.
    Mr. Guthrie. OK. Thank you.
    And also, in 2018, Congress passed my bill, the bipartisan 
BOLD Infrastructure for Alzheimer's Act. Can you please provide 
an update on how this law is being implemented across the 
country?
    Secretary Azar. So, with that Act, I want to, if I could 
get back to you in writing on that, I don't have all the 
details on that particular program. I apologize, but if I could 
get back to you.
    Mr. Guthrie. OK. Thank you.
    And this is kind of technical from my role as ranking 
Republican on the Oversight and Investigations Subcommittee on 
this committee. This committee and Oversight and Investigations 
conducted extensive oversight, cybersecurity at HHS, including 
through technical audits conducted by GAO of cybersecurity 
controls at HHS operational divisions. So, as I said, it is 
very technical.
    Last Congress, the Subcommittee on Oversight and 
Investigations held a closed hearing, in part, because HHS 
failed to properly identify and address certain 
vulnerabilities. We recently received preliminary results from 
the most recent audit of another HHS agency, though I can't go 
into details in this setting.
    So my question is: Does HHS have a point person who 
coordinates corrective actions on cybersecurity among all HHS 
agencies, and, if so, will you direct that person to continue 
to work with the committee on improving enterprise 
cybersecurity at HHS, and ensuring that mitigations applied in 
one setting are consequently applied through all of HHS?
    Secretary Azar. Yes, we do. Our chief information officer, 
Jose Arrieta, who works directly with me, absolutely is in 
charge of those issues. If I could go back to your previous 
question, I had misheard on the BOLD Act.
    Mr. Guthrie. On the BOLD Act, yes.
    Secretary Azar. So I apologize on that.
    For fiscal year 2020, CDC will have two funding 
opportunities to carat ck word. I can't find it as a verb 
actions under the BOLD Act. So first, there will be the public 
health programs to address Alzheimer's disease and related 
dementias; and second, there will be the centers of--the Health 
Centers of Excellence to Address Alzheimer's Disease and 
Related Dementias. We expect both of those funding 
opportunities to be out in the coming month. And for fiscal 
year 2021, the President's budget for CDC includes $3.493 
million to continue to support these Alzheimer's activities.
    Mr. Guthrie. Because by 2050--that is when I will be 86, I 
believe--they believe it is going to be a trillion, estimated 
to be $1 trillion spent on Alzheimer's disease. Not only is it 
devastating to the individual who has it, the family that cares 
for that person, but also it would be devastating to the 
deficit and the budgets of our country. So this is something 
very important. Thanks for your leadership and effort, and I 
appreciate working with my colleagues here to move the BOLD Act 
forward and address it.
    And I yield back.
    Ms. Eshoo. The gentleman yields back.
    A pleasure to recognize the gentleman from New Mexico, Mr. 
Lujan, for his 4 minutes, and I will wait right here with you 
and then we will run over.
    Mr. Lujan. Thank you, Madam Chair.
    Secretary Azar, when Donald Trump was running for office 
four years ago, he famously said that he wouldn't cut Medicaid. 
He didn't say it once or twice, but claimed it at least five 
separate occasions, that he would not cut Medicaid but, in 
reality, no President and no administration in the last 50 
years has done more to undermine Medicaid than Donald Trump.
    In fact, his first major legislative effort to repeal the 
Affordable Care Act would have ended Medicaid as we know it, 
and put the healthcare of 70 million Americans at risk. And if 
my colleagues from the other side of the aisle want to protect 
people with preexisting conditions, they should drop the 
lawsuit. That could happen tomorrow.
    After President Trump failed to cut Medicaid legislatively, 
he decided to try the same thing administratively, even though 
the law clearly does not allow it.
    Secretary Azar, there has been some misreporting that the 
block grant guidance is limited to adults in the expansion 
population, but under the administration's guidance, States 
could block grant Medicaid for more than just expansion adults. 
Isn't that true?
    Secretary Azar. Congressman, I don't--I don't believe that 
is the case. I will ask did CMS administrator to get back to 
you on that, but my understanding was that it would be an 
optional demonstration for adults only, and that it would 
actually not affect coverage for our most vulnerable, our 
pregnant women, children, elderly adults, people on eligible on 
the basis of disability. But I will ask Administrator Verma to 
get back to you on that, because that is not my understanding.
    Mr. Lujan. Let me jump into this. I am glad that you 
pointed that out, because I think that there is a concern here, 
and I hope that you would agree with me that, if that is your 
understanding, that you do something about it, Mr. Secretary, 
because the Center on Budget points out that people that are 
low-income parents, women who are pregnant, and people with 
disabilities who are covered through Medicaid expansion could 
be included in what I will describe as the President's illegal 
block grant guidance.
    Is that something that you would agree with if that is the 
case? Would you stop it if, in fact, the guidance does allow 
for those vulnerable populations to be discriminated against?
    Secretary Azar. So I have been under the view that it does 
not affect coverage for our most vulnerable populations. It 
doesn't allow them to strip benefits, or strip eligibility. 
Essential health benefits have to be covered. You can't change 
eligibility. You can't cap or limit----
    Mr. Lujan. Mr. Secretary, if I may, just for clarification, 
because it sounds like we are on the same page.
    Secretary Azar. What you are saying I am not--the concerns 
you are expressing----
    Mr. Lujan. Mr. Secretary----
    Secretary Azar [continue]. I don't believe we are in the 
HOA, but we will get back to you on that.
    Mr. Lujan. Let me ask you this pointed question.
    Secretary Azar. Yes.
    Mr. Lujann. If, in fact, the President's Medicaid block 
grant program does allow for those folks to be thrown off and 
get caught up in this, will you stop it?
    Secretary Azar. Well, we are not going to approve plans 
that allow people to be thrown off, because it can't change 
eligibility. I can't change eligibility.
    Mr. Lujan. Let me ask it one more time, because it sounds 
like you are getting there.
    Mr. Secretary, if, in fact, vulnerable populations like 
pregnant women, families, and those that are disabled, are 
subject to this rule where they could be block granted, will 
you stop it?
    Secretary Azar. I don't believe we would--I will not 
approve a plan that removes coverage for our most vulnerable 
citizens.
    Mr. Lujan. So that is enough for me. You said you will not 
approve a plan.
    Secretary Azar. I will not approve--with very low-income 
parents, children, pregnant women, elderly adults, or people 
eligible on the basis of disability should not be affected in 
terms of their Medicaid coverage, is what I am informed. I will 
get back to you from Administrator Verma to confirm all of 
those details. I want to make sure that I am right on that, but 
that has been my understanding of the HOA program.
    Mr. Lujan. What I am looking for is assurance that if what 
my comments are associated with being consistent with the 
Center on Budget points out, you, in fact, will not approve 
that plan and you will not allow for Medicaid block grant cuts, 
devastating cuts go into a place that will be subjected to 
pregnant women, families, and those with disabilities?
    Secretary Azar. The categories that I mentioned before are 
ones that I do not believe are subject to it, plans should not 
be approved if they would harm eligibility for those 
individuals.
    Mr. Lujan. So if the Center on Budget's assessment is 
correct, you will not allow that to go into effect?
    Secretary Azar. I do not believe their assessment or 
description of the program is correct, and I have said I don't 
expect that I would approve any plan that would harm our 
vulnerable populations. It is a healthy adult opportunity under 
Medicaid expansion, but we will get you any clarification on 
that afterwards. Thank you for raising that to me.
    Mr. Lujan. There is a reason that most of us in this 
Congress has--have opposed Medicaid block grants. These are 
devastating programs. It is another effort to undermine 
Medicaid, and to continue to cut the program which President 
Trump promised he would not. This is another example of where 
he is.
    And with that, I yield back.
    Ms. Eshoo. The committee will now recess for approximately 
20 minutes. So hold on to your seats while you stand up and 
stretch and we race over and come back.
    It sounded like the Secretary said yes, Ben Ray.
    [Recess.]
    Ms. Eshoo. The subcommittee will come to order. Thank you. 
Thank you, Dr. Azar, for your patience.
    And I now would like to recognize the gentleman from 
Virginia, Mr. Griffith, for his--is it 4 minutes--4 minutes of 
questions.
    Mr. Griffith. Thank you, Madam Chair.
    I appreciate you being here. Thank you so much. The 
President and your agency have expressed concerns with the 
middlemen in the drug supply chain, pharmacy benefit managers, 
PBMs. Over time, PBMs have morphed into under-regulated 
entities with opportunities to exploit their position in the 
middle of the drug transactions in the U.S. For example, 
according to a new report from XIL Consulting, which is run by 
former Express Scripts' executive, PBMs benefit from an obscure 
fee known as direct and indirect remuneration, DIR--I know you 
are familiar with that--at a rate exceeding 500 percent per 
prescription as compared to the average administration fee. 
Last year, the administration proposed a rule to address these 
DIR fees, but later withdrew it.
    Do you still have plans to implement accountability 
measures for PBMs?
    Secretary Azar. No.
    Mr. Griffith. And if so, what does that regulation look 
like?
    Secretary Azar. So I remain very concerned about the DIR 
fees and their impact, especially on America's community 
pharmacists, as well as independent specialty pharmacies.
    So, the reason that we did not finalize that rule--and we 
were very transparent at the time--was the concern that by--if 
we forced the DIR fees to basically go through to the benefit 
of the patient, that that could cause an increase. The 
middlemen would jack up the part D premiums for our seniors, 
and that was the concern and the President just has been 
adamant that he does not want to run the risk of part D 
premiums going up.
    We--so it remains a priority for the administration to deal 
with this issue. If we ever could legislatively, that would be 
useful also.
    Mr. Griffith. And as you know, I would love to have a 
legislative solution, but we thought this might be a good test 
case to do it with that.
    Secretary Azar. Maybe even through, if we could get 
bipartisan, bicameral drug pricing legislation, that might be a 
vehicle to have that in there.
    Mr. Griffith. It might be.
    And let me ask you this: There has been some mention 
earlier today of H.R. 3. I raised the concern, and then later, 
it was raised by the Congressional Research Service that the 
bill, as written, is just blatantly unconstitutional. Have your 
lawyers advised you that that is the case in their opinion as 
well?
    Secretary Azar. I have not had anyone study the 
constitutionality issues on H.R. 3 about the penalty amounts 
and whether that would work. So I haven't seen any analytics on 
that.
    Mr. Griffith. Any time they want a discussion on it, I am 
more than happy to facilitate one.
    Let's talk about opioids, because I only have a little bit 
of time left. Over the past few years, there has been a lot 
talk about how they are prescribed in America, and how pain is 
medically managed in general. And I will tell you, that I 
thought we were on the track of getting our healthcare 
professionals to back off of giving out so many opioids for 
pain, but I have a friend who is currently undergoing some 
procedures, and we were talking yesterday about how they had 
given her opioids, how she took it in the initial day after 
some painful procedures, but that after that, she turned it 
away but they--you know, she has got it sitting in her house. 
What has this administration and HHS done to reduce the 
overprescribing of opioids?
    Secretary Azar. So we have actually, through the CDC, put 
out guidance to professionals on appropriate prescribing. We 
continue to work on even further titrated by different pain 
areas on what the best guidance is to do that.
    It is distressing to hear that. We have seen, though, an 
over-25 percent, I believe, decrease, maybe 30-percent decrease 
in the opioid prescribing of illegal opioids to date since the 
President took office. So we are making progress, but, of 
course, it is disturbing to hear any pockets like that.
    Mr. Griffith. Well, and--look, it is going take time but we 
can't--just because we have started to solve the problem, we 
cannot think it is solved, and we cannot take our foot off the 
gas pedal in trying to make sure that we don't overprescribe, 
and that we deal with this issue. It is very serious in my 
district and many others.
    I thank you very much, and I yield back.
    Ms. Eshoo. The gentleman yields back.
    The Chair is pleased to recognize the gentleman from 
Oregon, Mr. Schrader, for his 4 minutes.
    Mr. Schrader. Thank you very much, Madam Chair.
    Thanks for being here, Secretary Azar. I appreciate it 
very, very much. I am going to leave my coronavirus questions 
to the next panel, but we do want to make sure the CDC is fully 
funded, and a little concerned about the original budget. Glad 
to see some changes coming forward.
    My question, the first question, is on Medicare Advantage. 
It is a huge program in Oregon and many, many States. It 
leverages our Federal tax dollars to maximum advantage. Most 
Oregonians, most seniors get a lot of their prescription drug 
coverage from Medicare Advantage. Very concerned that this 
administration, and frankly, others, have tended to try and cut 
Medicare Advantage programs. I think that is foolhardy. The 
whole goal here is to actually make sure that the savings from 
the Medicare Advantage are plowed back into making sure there 
are more benefits that are covered, better prescription drug 
coverage, and expanding it to a larger universe.
    So could you give me some assurance you are going to 
continue, this administration? You will try and continue to 
improve the Medicare Advantage program and not take away the 
savings that could be plowed into more benefits for folks.
    Secretary Azar. No, absolutely. So I am actually under 
direct orders of the President in his Medicare executive order 
to enhance and protect Medicare Advantage, exactly the things 
you are talking about: Offer more supplemental benefits, make 
sure people--make those plans as attractive as options for 
people as possible.
    Mr. Schrader. Just saw guidelines on reducing caps and that 
sort of thing that made me nervous about what the intent was.
    The second question is on the proposed Medicaid rule. Hear 
a lot about that back home. In many States, I was budget chair 
for my State back in the day, and it seemed like a great 
opportunity for our States to, again, leverage Federal dollars 
with State tax dollars, actually with private hospital dollars 
and long-term care dollars. So it was a really smart use, I 
thought, of taxpayers' limited ability to finance programs they 
want. This really made great use of the dollars.
    I am very concerned with this new MFAR rule that you are 
going to--ostensibly it is, with all due respect, framed in the 
guise of transparency, when, indeed, it is a backdoor attempt 
to take away matching funds, the ability for the provider tax 
to be leveraged in many States, including ours.
    So, I guess, given the fact the executive order requires 
Federal agencies to perform this regulatory impact analysis to 
determine the effect of the impact of the proposed rule, but 
the proposed rule says the fiscal impacts of the Medicaid 
program from the implementation of the proposed rule is 
unknown. Do you consider that to be a comprehensive regulatory 
impact analysis?
    Secretary Azar. I haven't looked at the reg impact analysis 
there. So I just I don't know the specifics on that, but, 
certainly, I do want to assure you we are hearing the feedback 
from you and others and governors about this. We are looking at 
this not to be penal, but, rather, to make sure that those 
intergovernmental transfers are genuine State money that is 
getting matched and not funny money or schemes--that is really 
the intent--and to also be more prospective, not penal, looking 
backwards, as much as we can.
    So we are--I appreciate getting this feedback. We are 
hearing a lot of it, and we are taking that in.
    Mr. Schrader. Well, what some people would call funny money 
schemes, others would call smart financing in using the 
accounting system the way it has been established for decades 
to maximum advantage. It would really put a huge hundreds-of-
million-dollar hole in the Oregon State HHS budget. So I would 
urge you to back down on that a little bit, or at least give it 
some more serious thought.
    I yield back. I thank you, Madam Chair.
    Ms. Eshoo. The gentleman yields back.
    It is a pleasure to recognize the gentleman from Florida, 
Mr. Bilirakis, for his 4 minutes of questions.
    Mr. Bilirakis. Thank you. Thank you, Madam Chair. I 
appreciate it very much.
    Secretary Azar, thank you, first of all, for your 
leadership. I appreciate it very much. And thank you for your 
responsiveness to a lot of my constituents' concerns as well.
    Again, we have begun to make progress, in tackling our 
Nation's opioid crisis, and HHS has played a key role in that 
effort. Thank you for your continued support, of course.
    Do you feel--and this is a budget question; do you feel HHS 
has the necessary resources to continue to implement provisions 
of the 2018 SUPPORT Act and the 2019 HHS Pain Management Task 
Force recommendations?
    Secretary Azar. I do believe so. In fact, we have increased 
funding for opioids in this budget.
    Mr. Bilirakis. OK. Very good.
    Also, next, the community house centers, as you know, do a 
wonderful job. The funding is expiring soon. Now, we 
reauthorized it for an additional seven years, and that is a 
great thing. But, again, how do community health centers serve 
as a gateway to integrated care for individuals with mental 
illness and substance use disorder?
    Secretary Azar. You know, more than 28 million people rely 
on HRSA's community health centers that we fund. They are a 
critical part of our primary care network, of preventive care 
for individuals, and they deliver high-quality service. And we 
are using them also as part of the Ending the HIV Epidemic 
program to reach the underserved and reach people that we need 
to bring into treatment and prevention.
    You know, more than 93 percent of our 1,400 health centers 
provide mental health counseling and treatment. Sixty-seven 
percent of them provide substance abuse services. I believe 
the--I think the number 60 percent of the clients at the 
community health centers, I believe, are ethnic and racial 
minorities. I am always just so impressed when I visit them, 
the quality of care and the quality of service there.
    Mr. Bilirakis. Absolutely. Do you have anything to add? 
Because I wanted to give you an opportunity to add, because 
this is a big issue affecting our constituents, obviously, on 
the insulin pricing. I know that this has been mentioned in the 
committee, but if you could maybe elaborate on that, I would 
appreciate it very much.
    Secretary Azar. I appreciate that. I did want to clarify 
one thing from Mr. Walden's question earlier regarding a piece 
of legislation. I misheard about, I guess, it is a proposal to 
cap out-of-pockets at $50 for insulin. The administration does 
not have a formal statement of administration position on that 
piece of legislation yet. Of course, we want to get out-of-
pockets down. We want to deal with the insulin issue, and get 
insulin pricing down for everybody, but we don't have a formal 
statement yet on that issue.
    The part D reforms the committee has worked on and that has 
a lot of bipartisan support though, that could be such a 
benefit to people, that catastrophic cap at $3,100, spreading 
that cap over 12 months, where no senior would ever pay more 
than 258 bucks a month for their prescriptions if they opted 
into that. What an incredible thing we could deliver for 
America's seniors if we could get bicameral, bipartisan action 
on that.
    Mr. Bilirakis. Absolutely.
    Well, thank you for clarifying that, and, of course, we 
will follow up with you, because, again, this is a big issue 
affecting our constituents.
    How does the budget address school safety? I don't have 
much time, do I? How does the budget address school safety and 
the mental health needs of our students?
    Secretary Azar. So we fund Project AWARE in here, which is 
a really important school-based school safety program for those 
for mental health services. We have Healthy Transitions funded, 
which improves access to mental disorder treatment and related 
support services for youth. We have the Safe Schools Framework 
Implementation Toolkit to help educate teachers and 
administrators to identify kids in crisis who need mental 
health intervention. That is part of it.
    Mr. Bilirakis. OK. Thank you very much.
    I appreciate it, Madam Chair.
    Ms. Eshoo. The gentleman yields back.
    It is a pleasure to recognize the gentleman from 
Massachusetts, Mr. Kennedy, for his 4 minutes of questions.
    Mr. Kennedy. Thank you, Madam Chair.
    Mr. Secretary, thank you for being here.
    This week, DHS implemented their well test for immigrants 
nationwide. The earlier estimates show that the rule could lead 
to 4.7 million people withdrawing--excuse me--from Medicaid and 
CHIP alone, many of whom are legal immigrants, the children of 
immigrants, asylum seekers, and refugees. Yes or no, sir, 
nearly five million people are forced to forego their health 
coverage; is that a success?
    Secretary Azar. We do not believe that individuals who come 
to this country should be dependent on public taxpayers for 
healthcare or other services.
    Mr. Kennedy. So refugees having access to healthcare is a 
success?
    Secretary Azar. We do not believe that individuals who 
should come to this country to be dependent on public welfare 
programs. That is the--that is the--that is the basis for 
that----
    Mr. Kennedy. So, sir, you have frequently told the story of 
your grandfather arriving at Ellis Island from Lebanon as an 
impoverished teenager who spoke no English. You talk about him 
being met by a member of the United States Public Health 
Service. You speak proudly of that story. Under this rule, 
based on your own telling of that story, your grandfather would 
have been turned away. So I ask you, yes or no, are you proud 
of this public charge policy?
    Secretary Azar. So my grandfather came and worked his way 
through his bootstraps.
    Mr. Kennedy. Would he have gone--would he have had access 
to healthcare under this policy?
    Secretary Azar. No, he would not have.
    Mr. Kennedy. And do you----
    Secretary Azar. And he wouldn't have asked for it, because 
he would have wanted to make his own way.
    Mr. Kennedy. And so you are proud of this policy.
    Secretary Azar. I am proud of my grandfather and 100 years 
ago, he came to the United States----
    Mr. Kennedy. That was not the question.
    Secretary Azar [continue]. In Ellis Island.
    Mr. Kennedy. That was not the question. Are you proud----
    Secretary Azar. We supported this policy. It is--we----
    Mr. Kennedy. I am going to take that as a no.
    Secretary Azar. The American people don't support the idea 
that people should be coming to this country to be----
    Mr. Kennedy. Mr. Secretary, next question. Are you aware 
that under your leadership, the number of Americans without 
health insurance has risen for the first time in a decade in 
2018 by roughly two million people?
    Secretary Azar. So actually, the numbers on the uninsured 
require a bit more depth than that. The--what is happening on 
the uninsured is actually the ACA has--most of the growth of 
uninsured is because the ACA priced individuals out of the 
individual markets.
    Mr. Kennedy. Sir, I am almost out of my 4 minutes.
    Are you aware, sir, Mr. Secretary, that the percentage of 
uninsured children rose by .6 percent under your leadership? 
Would you consider fewer children with access to healthcare a 
success?
    Secretary Azar. So actually, in terms of children and 
coverage, we have SCHIP. We have reauthorized that for a long 
period of time. We have got the Medicaid program----
    Mr. Kennedy. So you contest the numbers?
    Secretary Azar. So in terms of the uninsured numbers there, 
the children that are uninsured are likely part of the coverage 
gap left by the ACA, as well as the pricing out of 
nonsubsidized----
    Mr. Kennedy. Sir, do you believe that it is the--so last 
month, we held a hearing here about an opioid epidemic where a 
representative from the Department of Health and Human Services 
of North Carolina stated that if North Carolina had expanded 
Medicaid, 415 more people would be alive in North Carolina 
today. Do you believe that this administration's opposition to 
Medicaid expansion that, according to that individual, has cost 
lives; is that a good policy choice?
    Secretary Azar. I am not going to validate that 
politician's statements. I don't know who it was----
    Mr. Kennedy. It was a representative of the Department of 
Health and Human Services of North Carolina.
    Secretary Azar. I don't know who they are. I don't know the 
basis for that. I haven't seen the evidence.
    Mr. Kennedy. So you are unaware of the fact that Medicaid 
has saved lives in North Carolina?
    Secretary Azar. No----
    Mr. Kennedy. The absence of Medicaid expansion----
    Secretary Azar. That is not what I am saying. I am saying I 
haven't seen the evidence basis for the assertions you are 
making and that he made.
    Mr. Kennedy. One last question for you. You have spoken 
about this administration's efforts to combat coronavirus and 
the so-called increased choice for healthcare. For one man, 
Osmel Martinez Azcue, those two things recently converged when 
he tried to be prepared after developing flu-like symptoms 
following a trip to China. He was left with a bill of well over 
$1,000, and a demand of proof that the flu he was tested for 
wasn't related to any preexisting condition, or else he would 
be forced to pay a few thousand dollars more.
    So, please explain to me as we are staring down a potential 
pandemic, and the CDC is warning about fundamental changes to 
our way of life because of it, do millions of people that have 
signed up for junk insurance plans pushed by this 
administration, do they really have a choice?
    Secretary Azar. So the short-term limited duration plans 
are an option for individuals. We have been very clear that 
they may be the right choice for some, but they may not be the 
right choice for others who have preexisting conditions.
    Mr. Kennedy. Even people with thousands of dollars of 
uninsured claims in the midst of a potential pandemic, that is 
a good choice?
    Secretary Azar. So if an individual, if it is a choice 
between no insurance and some insurance at 60 percent lower 
than what the Affordable Care Act has priced them out of the 
market at, it is at least an option for individuals provided.
    Mr. Kennedy. Unless they expanded Medicaid.
     I yield back.
    Ms. Eshoo. The gentleman yields back.
    It is a pleasure to recognize the gentleman from Indiana, 
Dr. Bucshon, for his 4 minutes of questioning.
    Mr. Bucshon. Thank you very much.
    And thank you, Mr. Secretary, for being here today.
    I am going to switch gears a little bit. 340B is a critical 
program, especially for rural hospitals, and I am just 
interested in what you think should be done, if anything, to 
continue to ensure that the 340B program, given its significant 
growth, is helping more patients get access to care?
    Secretary Azar. You put your finger right on it there when 
you mentioned the growth. It has grown from $7 billion of 
pharmaceutical sales in 2012 to $19.3 billion in 2017, and we 
believe in the 340B program, but we do believe those savings 
need to actually make their way to patients, not just 
subsidizing hospitals, but actually make their way to patients.
    I mean, imagine, for instance, just take the issue of 
insulin. Hospitals often acquire their insulin at an extremely 
low price, but they don't have to necessarily pass those 
savings on to the patient that they are serving as an 
outpatient. That is partly why we would, part B, propose the 
changes and have tried to implement the changes that would 
reduce what seniors have to pay for part B--for--would have to 
pay in the Medicare program for their drugs.
    Mr. Bucshon. Do you think that more transparency in the 
340B program would be part of the solution?
    Secretary Azar. Absolutely. We support transparency in the 
program. We support giving the regulatory authority as part of 
our budget, and also requiring that hospitals that want to get 
the benefit of those savings I just talked about, to retain 
that in the program, would have to dedicate one percent of 
their work towards delivering charity care which seems like a 
pretty low bar.
    Mr. Bucshon. So what you are saying is probably that HRSA 
does need probably more authority and more teeth to address the 
program. Would you agree with that?
    Secretary Azar. We need greater oversight, but we need 
regulatory authority to implement that oversight so that we can 
have--so we can actually do audits in an enforceable way and 
have that type of transparency.
    Mr. Bucshon. Thank you.
    I would also like to thank you for making improvements in 
pain management a key component of the HHS opioid strategy 
plan. I mean, I firmly believe we will never successfully 
address the opioid epidemic unless we also improve pain 
management, and I am a physician, and patient access to non-
opioid therapies, particularly FDA-approved medical devices, 
which have the greatest opioid-sparing potential.
    Can you tell us what HHS is doing to promote pain 
management best practices and the status of various provisions 
in the SUPPORT Act to break down barriers to non-opioid 
therapies for pain?
    Secretary Azar. So one of my top priorities has been to 
leverage the Center for Medicare and Medicaid Innovations 
authorities to fight the opioid epidemic and that is why we 
developed the Maternal Opioid Misuse, or the MOM Model, and we 
recently announced the participants in that model and that is 
going to address the fragmentation of care for pregnant and 
postpartum Medicaid beneficiaries with opioid use disorder by 
supporting care coordination and better integration. So that is 
part of that.
    Mr. Bucshon. Great. And earlier in the hearing, you were 
starting to give some bullet points on, I think, corona, your 
plan, the five-point plan or whatever. In the last 50 seconds, 
can you expand on that?
    Secretary Azar. You bet. First, expand our surveillance 
system so we have novel coronavirus surveillance comparable to 
what we have on the flu, because that is the bedrock of our 
public health response; second, money to support State and 
local public health departments are going to have to do a lot 
of work here; third, vaccine research and development; fourth, 
therapeutic research and development; and fifth, finally, 
strategic national stockpile acquisition, especially of 
personal protective equipment.
    Mr. Bucshon. Thank you for that.
    And do you feel that we have had enough access to--in China 
to get the data that we need to help solve this problem? Has 
that loosened up?
    Secretary Azar. We have struggled. The World Health 
Organization GOARN team has now completed its mission. We are 
waiting for its report. The initial reports I have is that that 
team felt they were getting access to information and evidence, 
but I want to see the final results of that.
    Mr. Bucshon. Thank you, Mr. Secretary. I yield back.
    Ms. Eshoo. The gentleman yields back.
    Just for the record, HHS has existing oversight authority 
of the 340B, and it is my understanding that HRSA has conducted 
1,500 audits of the program. So the question----
    Secretary Azar. The courts actually have said we do not 
have the ability to implement regulations. So that--and that--
--
    Ms. Eshoo. We are not talking about that. We are talking 
about audits, and so that is why I wanted to get this on the 
record. Look at your audits and see what is in them. It is 
under the control of your department.
    I now would like to call on, or recognize, the gentleman 
from California, Mr. Cardenas, for his 4 minutes.
    Mr. Cardenas. Thank you very much, Madam Chair, and I 
appreciate the opportunity for us to have this oversight 
hearing.
    Secretary Azar, thank you so much for being with us. This 
is an opportunity for to us ask you some essential questions in 
fulfilling our oversight duties. And last time you were here 
before us for our budget hearing, I asked you about your 
agency's role in the horrifying practices of separating 
children from their families. Today, I would like to ask you 
about other ways that the administration is impacting families, 
both in my district and throughout the country.
    I would like to ask you about an issue that is frightening 
families in my own district. I am, of course, talking about the 
for-profit company's proposal for a detention center in my 
district, a proposal approved by HHS and that wants to use our 
Federal tax dollars to put a facility there to have children in 
a prison-like setting.
    VisionQuest, the company that received these funds from 
your agency, has a history of alarming reports and stories of 
abuse within their programs right here in this country. These 
stories include descriptions of excessive use of physical 
restraints and isolation, verbal abuse, food deprivation, 
humiliation and intimidation, and even deaths and this is all 
about them having children in their care.
    As part of the due diligence of your organization, would 
officials within the Office of Refugee Resettlement be aware of 
these types of violations before awarding a contract to such a 
company like VisionQuest?
    Secretary Azar. I don't want to endorse the statements that 
you have made regarding that entity, because I do not know the 
particulars of that entity or the allegations that are being 
made there. So I want to be careful I am not endorsing that, 
but----
    Mr. Cardenas. OK. Go ahead.
    Secretary Azar [continue]. I would expect it would be part 
of any grant review of any grantee to examine their past 
history, and treatment of children. I would absolutely expect 
that, yes.
    Mr. Cardenas. OK. If you could please report to this 
committee if any of the grantees, such as the one I was talking 
to, if there is any evidence within the Department of any valid 
situations with an organization such as--an organization that 
would be entrusted with Federal funds to house children.
    Secretary Azar. Sure.
    Mr. Cardenas. OK? Thank you.
    But funds--these funds that you would be providing as of, 
unless you were to have such evidence; you would go ahead and 
contract with an organization?
    Secretary Azar. Well, that is how, as you know, the 
Unaccompanied Alien Children program runs, is we hire grantees 
that run permanent, hopefully, permanent State-licensed 
facilities that care for children until we can place them with 
sponsors. That is really what the system Congress set up. That 
is what we run.
    Mr. Cardenas. Thank you.
    And the city of Los Angeles is in the process of 
solidifying their ordinances to whether or not they are going 
to allow private entities to use Federal funds to house 
children.
    I have another issue I would like to discuss with you. I 
want to turn to the issue of impacting American families, 
especially vulnerable children throughout America. In your 
written testimony, you speak about the importance of promoting 
adoption to give children the stability and love during their 
childhood. You speak about prioritizing adoption, but you 
neglect to mention the fact that right now in America, the 
agencies are turning away qualified potential parents because 
they are either LGBTQ, or they happen to be of a religious 
minority here in America. This is in the--this is in spite of 
the fact that LGBTQ parents are seven times more likely to 
foster or adopt children than non-LGBTQ parents.
    My question is, in your efforts to identify and address 
barriers to adoption, can you tell me how eliminating data 
collection and reporting on sexual orientation over fostering 
adoptive youth and parents is helpful to furthering that goal?
    Secretary Azar. So the AFCAR is what you are referring to, 
I believe, is the AFCAR's reporting system and the original 
regulation contain 270 individual data points, 153 of which 
were new, and the States, there was significant feedback about 
just the sheer volume of data collection and expense to States, 
all of which is money that, if we add more and more questions, 
more and more data collection, that is money the States can't 
use to actually assist with adoption and foster care placement. 
So it is really just an effort to streamline those data 
requests in there.
    Mr. Cardenas. My time has expired.
    I yield back.
    Ms. Eshoo. Is the gentleman yielding back?
    Mr. Cardenas. Yes.
    Ms. Eshoo. I thank the gentleman.
    It is a pleasure to recognize the gentlewoman--and that she 
is--from Indiana, Mrs. Brooks, for 4 minutes.
    Mrs. Brooks. Thank you, Madam Chairwoman.
    And welcome, Secretary Azar. Thank you for being here.
    And thank you for pointing out that just this past June, 
the President signed PAHPA, the reauthorization of PAHPA, of 
which this committee worked very hard on in the last Congress, 
and we finally got it done in this Congress.
    And I worked particularly hard with the chairwoman and the 
ranking member of this committee to try to make sure we 
improved our readiness and our response, and because the 
question of a pandemic is really not a question of if, but 
when, I think most people, and obviously CDC is acknowledging 
that.
    One thing I would like people who are listening to 
understand, the global security--Global Health Security Index 
was recently issued, and the United States of America was first 
in the world out of 195 countries for prevention, detection, 
response, and public health. And I also want to commend the 
administration for the National Health Security Strategy that 
was put in place for 2019 to 2022. I want to commend you for 
leading that work.
    But with respect to PAHPA, I am curious. How are you 
leveraging, how is HHS leveraging all of the new things that we 
put into PAHPA? And then I have one--I would like to also ask 
you to address, because there are so many good things in your 
budget, but I am particularly concerned about a $200 million 
cut to BARDA, because BARDA has brought forth so many 
incredible innovations and the partnership that they have with 
the private sector. Given this proposed cut, what strategies 
are we going to put in place if BARDA is cut?
    Secretary Azar. So on the BARDA question, so that was, of 
course, in the budget before the coronavirus situation, and 
because Congress in the appropriations in December added, I 
think, $535 billion of Ebola funding available in 2020, we are 
pulling forward some of our acquisition strategies for BARDA 
into 2020 around, especially vaccine and therapeutics on Ebola.
    So that created some offset. We may need to relook at that 
now, given some of the offsets proposed in the supplemental 
requests but that was meant to be somewhat because we had 
pulled forward some of those acquisition strategies to 2020.
    Mrs. Brooks. OK. But the private sector companies who are 
our partners in developing the diagnostics, the therapeutics, 
the vaccines, and because the government is the customer for 
those products, is it fair to say then that BARDA, and all of 
the BARDA professionals who are working in BARDA, is it fair to 
say that they should not anticipate, with what is happening 
right now a cut in their funding?
    Secretary Azar. We would--first, we would work with the 
appropriators as to whether the offset we proposed on the 535 
Ebola to be part of the funding of the supplemental, if that 
happens. I can tell you from feedback this morning at the House 
Appropriations Committee, I think that may be unlikely from the 
appropriators.
    Mrs. Brooks. We still have Ebola in Africa. Is that 
correct?
    Secretary Azar. We do, although fortunately, it is on the 
downswing on the Epi Curve at this point but what we would do 
is use that money for acquisitions on Ebola, if that money 
remains there for Ebola in 2020 vaccines and therapeutics that 
we have got. But if not, we would work with appropriators on 
making sure BARDA is adequately funded certainly.
    Mrs. Brooks. And are there any other issues or any other 
strategies or framework that we provided in PAHPA that you are 
using specifically right now to combat the coronavirus?
    Secretary Azar. On the coronavirus, the--I can't trace 
directly to the PAHPA authorities but, for instance, our 
vaccine strategies are very much influenced by that in terms of 
recombinant DNA, the universal vaccine research that we are 
doing in the influenza case, as well as cell-based technology 
to bring domestic manufacturing capabilities here.
    Mrs. Brooks. I yield back my time. I thank you.
    Ms. Eshoo. The gentlewoman yields back.
    Just for the record, the gentlewoman asked about the $200 
million cut to BARDA, and the Secretary responded.
    The administration, Mr. Secretary, put out the budget ten 
days after, after, not before, after declaring a public health 
emergency. So your answer is really not correct on that.
    Secretary Azar. Well, I am sure you understand the budget 
is locked in December. So it is already probably was printed by 
the date of the coronavirus outbreak.
    Ms. Eshoo. Well, you mean the administration doesn't have 
the ability to call it in and cross something out and say, N-O, 
we are the not cutting this, we need it? I mean, that is not--
come on. Come on. All right.
    Now the gentleman from Vermont, Mr. Welch, is recognized 
for 4 minutes.
    Mr. Welch. Thank you.
    Thank you, Mr. Secretary. You have been here a while.
    Drug importation, we are very happy that you are proceeding 
on that and, as you know, we have a Republican Governor in 
Vermont who is extremely interested in getting authority to do 
this. They hope to have everything that is required for you 
sooner than the deadline. So we think it is a great 
opportunity. Our Republican Governor and Democratic legislature 
wants to take advantage of this.
    One of the concerns that the Governor has, in particular, 
but all of us, is including insulin and that is not included, 
and my understanding is that there have been some concerns 
raised as to whether that can be safely done. It really would 
make a huge difference to Vermonters and, as you know, a lot of 
people already drive across the border to get insulin, and even 
some companies do that.
    Our view is that the concerns about safety are always 
legitimate, no matter where the source of drugs, but our real 
request is to accommodate insulin as one of the drugs that 
could be imported as long as it is done safely. I wish you 
could comment on that and tell us what we need to do to give 
some relief to folks that are desperate about the cost 
difference.
    Secretary Azar. So unfortunately, insulins as an injectable 
product are expressly excluded under Section 804 of the Food, 
Drug, and Cosmetic Act which is the provision for the Canadian 
importation regime that we are using. We have no objection to 
it. In fact, the second part of the importation program where a 
drug company could bring a product in with a new drug code and 
actually price it at their--price at a lower list price so that 
they could deal with their PBM, those middlemen contracts, that 
are open for all products, including insulin.
    Mr. Welch. So let me just understand. This is helpful. You 
are saying it is because the statute----
    Secretary Azar. Yes, we have--we did not----
    Mr. Welch [continue]. Not because of a concern that HHS 
has.
    Secretary Azar. It is the statute.
    Mr. Welch. So as far as you are concerned, if you felt 
there was authority under the law for insulin to be included, 
you would see no reason to object to that.
    Secretary Azar. That is correct. We would be supportive if 
the statute provided for that. We believe it can be imported 
appropriately, but the statute does not allow me to approve an 
importation regime under 804 with insulins in it.
    Mr. Welch. So if we did an amendment to the statute to 
allow for insulin to be an exception, you would be supportive 
of that, it sounds like.
    Secretary Azar. I can't formally state an administration 
position, but I can tell you the President wants importation. 
He wants it yesterday, and we are delighted the Governor is 
working, because we want shovel-ready importation programs 
that, when we finalize a rule that we could get to work on 
approving.
    Mr. Welch. All right. So who would I follow up within the 
administration? It probably sounds like you----
    Secretary Azar. Me.
    Mr. Welch [continue]. But if I talk to the President about 
supporting what statutory provision may need to be included in 
order to allow insulin to come in. That would be huge, huge, 
huge for the Governor of Vermont, and for the people of 
Vermont.
    Secretary Azar. Sure. Happy to work with you on that. 
Absolutely. Talk directly to the President with you.
    Mr. Welch. All right. Thank you.
    And I yield back.
    Thank you very much----
    Secretary Azar. You bet.
    Mr. Welch. [continue]. Mr. Secretary.
    Ms. Eshoo. The gentleman yields back.
    The gentleman from Georgia, Mr. Carter, is recognized for 4 
minutes.
    Mr. Carter. Thank you, Mr. Secretary, for being here.
    I want to follow up on Representative Griffith's questions 
about DIR fees by the pharmacy benefit managers and, of course, 
as you know, the PBMs have squeezed out almost $4 billion out 
of pharmacies that have retail pharmacies with these DIR fees. 
In a survey that was done by the National Community Pharmacists 
Association said that 58 percent of the independent retail 
pharmacists in this country don't expect to be in business in 
two years, the result of DIR fees which, of course, should be 
of concern to all of us, but particularly to HHS and delivery 
of healthcare services in our country.
    I just wanted to ask you. I believe you responded to Mr. 
Griffith by saying that the concern was the higher premiums 
with the insurance companies. As you know, three PBMs account 
for almost 80 percent of the market share in this country, and 
all of those PBMs are owned by insurance companies. How can 
we--how can we answer the question of whether those rebates 
that they are getting, the PBMs they are giving, are going back 
to the insurance company that is also owned by the same 
company?
    Secretary Azar. Well, that is one of the real problems we 
have got, is we don't have PBM transparency. Absolutely. So we 
can't actually know where those monies are flowing.
    Mr. Carter. It would appear to me that that is just taking 
money out of one pocket and putting it in the other pocket. I 
mean, it is the same company and then it is extended even more 
than that to include the pharmacies as well. So you know, the 
vertical integration is something that has got to be addressed.
    But what do you think we can do to address the DIR fees? 
Now the DIR fees have been associated with higher out-of-pocket 
costs for recipients, and that is certainly something we have 
to be concerned about, and I know you are concerned about and 
you have said in the past that you are. If we can lower out-of-
pocket costs, would it help to have the rebates at the point of 
sale?
    Secretary Azar. Oh, yes, it would help to have rebates at 
the point of sale. That would lower out-of-pocket costs. And 
pushing through, so folks understand, the DIR is basically a 
penalty provision that the middlemen impose on the community 
pharmacists, but the patient is made to pay off of the full 
price when they buy the drug and the pharmacy later may get 
this callback of this penalty, but the patient doesn't get a 
refund of their out-of-pocket.
    Mr. Carter. Absolutely. And that callback can take place 
almost a year afterward----
    Secretary Azar. Exactly.
    Mr. Carter [continue]. And sometimes two years afterward.
    Secretary Azar. Very unpredictable to the community 
pharmacy. They are struggling from this. Absolutely.
    Mr. Carter. Absolutely.
    Now I want to switch to the coronavirus and these are yes-
or-no questions, if you could answer them for me. At this time, 
at this time, are you and others involved in preparing for a 
potential COVID-19 outbreak, doing everything you can to 
prepare for such an event?
    Secretary Azar. We are indeed.
    Mr. Carter. At this time, if you and others involved in 
preparing for a potential COVID-19 outbreak felt like you 
needed more money, would you have asked for it?
    Secretary Azar. I would have and I have and that request is 
there.
    Mr. Carter. OK. At any time, if you and others involved in 
preparing for a potential COVID-19 outbreak need more money, 
will you ask for it?
    Secretary Azar. I will indeed.
    Mr. Carter. Absolutely. So it is not as to say that the 
amount of money that is asked for is proportional to the effort 
that is going to be put forth to prepare for this?
    Secretary Azar. Right. That is right. And the President has 
made very clear in my own discussions with him, as well as 
publicly, that we want to work with Congress on an appropriate 
supplemental proceedings here and we have said--it quite 
deliberately says at least $2.5 billion. We want to work with 
Congress. We got to get that money and make sure that Congress 
is satisfied with the funding also.
    Mr. Carter. As should be the case.
    And, again, if you find out that you need more, you are 
going to come back to us, and we are going to approve it. We 
want you to have everything that is available that you need to 
prepare for this. And you are going to do that, correct?
    Secretary Azar. That is correct.
    Mr. Carter. Madam Chair, I yield back.
    Thank you, Mr. Secretary.
    Ms. Eshoo. The gentleman yields back.
    The Chair recognizes the gentleman from California, Mr. 
Ruiz, for 4 minutes.
    Mr. Ruiz. Thank you, Secretary Azar, for being here today.
    As a father and a physician, I care very deeply about the 
physical and mental health of children and also children while 
in the custody of the Office of Refugee Resettlement. And I am 
glad my colleague Tony Cardenas brought that up because I am 
also dealing with a similar situation in my district.
    ORR's website says their unaccompanied children program, 
quote, ``takes into consideration the unique nature of each 
child's situation and incorporates child welfare principles 
when making placement, clinical, case management, and release 
decisions that are in the best interest of the child.''
    So let me get this straight, because I definitely want 
answers. When determining appropriate housing for children in 
ORR custody, do you give grants to for-profit organizations 
with a documented history of child abuse?
    Secretary Azar. Again, I can't speak to that particular 
grant that was raised before. We would give grants to for-
profit or nonprofit without discrimination, but----
    Mr. Ruiz. OK. So the caveat is those with a documented 
history of child abuse.
    I recently learned that, in addition to the facility in 
Arleta, California, ORR is providing a grant to VisionQuest to 
open a 130-bed shelter for unaccompanied children in the city 
of Hemet, California, which I represent. VisionQuest is a for-
profit organization whose history suggests that their focus is 
to make money rather than care about the well-being of 
children.
    This is exemplified by VisionQuest's very long history of 
keeping children in abusive and harmful conditions, which my 
colleague touched on. Dating all the way back to 1987, a report 
from the RAND Corporation found that, quote, ``the treatment 
methods used by VisionQuest were unorthodox'' and that 
``activities engaged in by the youths posed unnecessary risks 
to their health and safety.''
    Last year, the Associated Press reported that in 1994 the 
Department of Justice documented episodes of physical and 
mental abuse at a VisionQuest shelter in Franklin, 
Pennsylvania, including staffers pulling children's hair, using 
harsh restraints, choking minors, and even slamming them into 
walls.
    And in 2017 the city of Philadelphia had to end a contract 
with VisionQuest after State inspectors found that staff 
members had choked, slapped, and injured children in the 
facility.
    Secretary, as our providing Federal funding to a for-profit 
organization with a long history of child abuse is definitely 
not in the best interest of children, are you familiar with 
these reports?
    Secretary Azar. I am not familiar with all of those 
reports. Some of the allegations that you raised, I am familiar 
with.
    Mr. Ruiz. Here is the report.
    Secretary Azar. Of course, whether for-profit or nonprofit 
is not the factor----
    Mr. Ruiz. This is the RAND report.
    Secretary Azar [continue]. But we want to ensure that any 
grantee----
    Mr. Ruiz. And this is a----
    Secretary Azar. Thank you.
    Mr. Ruiz [continue]. Letter within the Department of 
Justice documenting
    Secretary Azar. Thank you. I appreciate that.
    Mr. Ruiz. My question now----
    Ms. Eshoo. Would the gentleman be seated and speak from the 
microphone so that what you say can be properly recorded?
    Mr. Ruiz. Sure. Will do.
    So, now----
    Secretary Azar. Of course, one of these is, I just noted, 
from 1994.
    Mr. Ruiz. Of course. So that is why I mention a long 
history of abuse.
    Secretary Azar. But we will make sure any grantee is 
appropriate to the----but we need to make sure that----
    Mr. Ruiz. And so that is why----
    Secretary Azar. Correct, and not----
    Mr. Ruiz. That is why, when you look and review at these 
programs, I want to ask you, what is the process? Is there 
transparency? How do you determine and how do you open this up 
to communities to determine who is going to house children with 
the safety of these children in mind?
    Secretary Azar. So, for these permanent bedded facilities, 
which is our goal at the request of Congress, the grantees 
would actually have to be State-licensed. And so there is a 
State licensure procedure.
    Mr. Ruiz. OK.
    Secretary Azar. That would be the community involvement.
    Mr. Ruiz. Well, the State of Pennsylvania denied them their 
ability to take care of children because of those horrible----
    Secretary Azar. And then they would not be able to be a 
grantee in that case.
    Mr. Ruiz. And they had to close that facility.
    So the question is, when you look at those reports and you 
review the evidence, would you be open to reevaluating these 
grants and your relationship with VisionQuest----
    Secretary Azar. I will ensure----
    Mr. Ruiz [continue]. And their care for ORR?
    Secretary Azar. I will ensure that ORR has looked at these 
and this was part of the evaluation criteria in looking at 
them.
    Of course, just because an entity has--all of the behaviors 
you described are absolutely unacceptable. I just want to be 
very clear about that.
    Mr. Ruiz. And I am glad you said it, because I----
    Secretary Azar. Absolutely unacceptable----
    Ms. Eshoo. The gentleman's time has expired.
    Secretary Azar. Thank you.
    Ms. Eshoo. The Chair recognizes the gentleman from 
Missouri, Mr. Long, for his 4 minutes.
    We really need to move along, because we have another 
panel, and everyone knows it is a very important one. So let's 
stay within our time.
    Mr. Long, 4 minutes.
    Mr. Long. Thank you, Madam Chairwoman.
    And, Secretary Azar, I want to thank you for being here 
today. I know we tried to get together one time, and as soon as 
we sat down, my phone started blowing up that my house was on 
fire in Missouri, which it turns out it wasn't, but the alarm 
company people seemed to think it was and they sent the fire 
department. I am sure you remember that.
    But I want to thank you for working so hard to advance the 
administration's health agenda on behalf of the American 
people.
    As you note in your testimony, rural Americans face many 
unique health challenges. And, under your leadership, HHS 
created the Rural Health Task Force and is proposing a four-
point strategy to transform rural health, which is vitally 
important in my area, as I represent a lot of rural areas.
    Can you first speak to the Rural Health Task Force's role 
in identifying the needs of rural areas and how to meet those 
needs department-wide?
    Secretary Azar. You bet. Yes, absolutely. Thank you.
    The Rural Task Force identified four key priorities for us. 
The first, we have to develop a sustainable model for rural 
healthcare. We can't just patch it over with money if it is not 
underlying economically viable. Second, we have to have 
prevention and health promotion in rural America. Third, we 
have to leverage technology and innovation like telehealth. 
And, fourth, we have to get the next generation of providers 
out into rural America, and we have to allow nurse 
practitioners and P.A.s to practice to the full extent of their 
license in rural communities.
    Mr. Long. OK. Thank you.
    And one area in rural health that has been seriously 
impacted over the last few years is durable medical equipment, 
as you are apprised of. I was pleased that CMS issued the 
interim final rule in May of 2018 that provided payment relief 
for durable medical equipment in rural areas and continued the 
relief in the 2019 end-stage renal disease final rule until the 
end of 2020.
    Can you tell me if CMS plans to continue this relief in 
rural areas after 2020?
    Secretary Azar. So I am not able, obviously, to discuss a 
pending regulatory action, but I do know that that was a major 
priority, to get that payment fix in place through the interim 
final rule to ensure better equity for rural America. So that 
remains very much top of mind for us.
    Mr. Long. OK.
    And in the President's fiscal year 2021 budget, there is a 
provision that would expand the competitive bidding program for 
durable medical equipment into rural areas in 2024. We have 
heard many complaints about the competitive bidding program 
over the years, really since its inception. Can you detail how 
you would like to reform the program and how it would impact 
rural areas?
    Secretary Azar. Yes. What we would like to do in the budget 
is, actually pay for durable medical equipment under the 
competitive bidding program and move that, though, from a 
single payment amount that is based on the maximum winning bid 
to actually paying suppliers on their own bid amounts and then 
expanding the competitive bidding to additional geographic 
areas, including rural areas.
    We think that would actually enhance access to DME in rural 
areas by allowing competition there rather than simply having 
to depend on the payment result secured elsewhere. We think 
that can solve a lot of the access challenges that we saw that 
we had to work to fix with the interim final regulation.
    Mr. Long. OK.
    And has CMS engaged with outside experts, economists, or 
consumer groups on this as it considers expanding the 
competitive bidding program?
    Secretary Azar. We do. We engage with stakeholders and 
experts before we consider any new policy. And, of course, the 
benefit when we do notice-and-comment rulemaking is to get that 
feedback.
    Mr. Long. Would you go forward with the proposal without 
the Congressional approval?
    Secretary Azar. I believe, for some of the regional 
elements on competitive business, I believe that we--I don't 
know if we require statutory authority. I want to get back to 
you on that, as to whether the budget has that as an 
administrative action or a statutory request. If I could get 
back to you, Congressman, on that.
    Mr. Long. If you would, I would appreciate it.
    Secretary Azar. You bet. Thank you.
    Mr. Long. And I yield back.
    Ms. Eshoo. The gentleman yields back.
    The Chair now recognizes the gentlewoman from Michigan, 
Mrs. Dingell, for her 4 minutes of questions.
    Mrs. Dingell. Thank you, Madam Chair.
    Thank you, Mr. Secretary. I know it has been a long 
afternoon.
    It has been nearly a month since you declared a formal 
public health emergency and response to the coronavirus global 
threat. On February 2, you sent a letter to Congress that you 
intend to use or transfer or reprogram authority to reallocate 
approximately $136 million from current programs.
    Yesterday, we got the details of those transfers, and I 
would like to request unanimous consent to enter that into the 
record.
    Ms. Eshoo. So ordered.
    [The information appears at the conclusion of the hearing.]
    Mrs. Dingell. Thank you, Madam Chair.
    These include $62 million transferred out of NIH, $37 
million taken from the Low Income Energy Assistance Program, 
and $7.5 million from the Centers for Medicare and Medicaid.
    Given that you plan to take $37 million from the Low Income 
Energy Program, do we have any estimates of how many people 
that is going to impact and who is going to go without heat 
this winter?
    Secretary Azar. So, for the transferred reallocation 
authority, that works out to a 0.2-percent change. And we did 
that across the Department evenly, but then, within different 
agencies, they selected various programs.
    On LIHEAP, we are now late in the season, almost at the end 
of February. I don't have an analysis for you of----
    Mrs. Dingell. Can we get, for the record, please, what we 
think the impact will be? Because we obviously are worried 
about people who aren't going to have heat.
    You are going to take--and I don't mean to be--I just have 
to go fast. I have 4 minutes. You are going to be taking--you 
took $62 million from NIH. Is that going to harm our ability to 
conduct medical research into new cancer treatments--I am 
happy, with you, that opioid deaths have gone down this year. 
There is no one who feels stronger. Maybe Annie. We are 
together--and meet other public health challenges. What is 
going to happen to those programs?
    Secretary Azar. So the NIH, in doing the reallocation and 
taking their allotment of the 0.2 percent, they firewalled off 
certain priorities, including, I know, opioid research and 
development is one of the primary areas----
    Mrs. Dingell. So it has not been cut?
    Secretary Azar [continue]. Pediatric cancer--right.
    Mrs. Dingell. All right.
    Now, I know you talked about this yesterday, but you stated 
in your Senate testimony yesterday that the U.S. Currently has 
about 30 million stockpiled N95 respirators, which are masks 
that can help stop a person from inhaling infective particles, 
but that it might require 300 million for healthcare workers 
alone. This doesn't include masks, gloves, and personal 
protective equipment.
    That was yesterday. We have heard about nearly 900 more 
cases worldwide, 60 more deaths. I am really worried, as I know 
the Chair is, about the supply chain in this country. Your own 
agency has stated that 65 percent of N95 respirators are 
manufactured outside of the U.S., in China and Mexico. 
Yesterday, The Washington Post told us that a large group-
purchasing organization says we may only have a 2-week supply.
    I don't want to frighten anybody. We shouldn't be rushing 
off. But are we facing an imminent shortage of N95 respirators 
and other personal protective equipment?
    Secretary Azar. So I did want to clarify on the numbers 
that I told the appropriators this morning. After the hearing, 
I learned some additional information about the number of masks 
that we have. We have a higher number, but the mix is 
different. So we have 30 million surgical masks, the gauze 
masks. We have 12 million N95 NIOSH-certified masks, and then 
five that are not NIOSH-certified--5 million N95s. So I just 
wanted to clarify the data on that.
    One of the things we are doing with the transfer money that 
we discussed earlier is contracting to get--get contracts 
started with domestic manufacturers of N95 masks so that we can 
scale up production----
    Mrs. Dingell. But how long is it going to take to scale up 
that production?
    Secretary Azar. It will take time because we do not have as 
much domestic manufacturing----
    Mrs. Dingell. Is it a national security threat that 90 
percent of our generics are coming from China? We have this 
kind of shortage. What are we going to do--and I am out of 
time--to help bring the kind of production of these kinds of 
essentials to this country so we are not dependent on anyone 
else?
    Ms. Eshoo. The gentlewoman's time has expired.
    The Chair recognizes the gentlewoman from Delaware, Ms. 
Blunt Rochester, for 4 minutes.
    Ms. Blunt Rochester. Thank you, Madam Chairwoman.
    And, also, welcome, Mr. Secretary.
    I have to express my deep concern and disappointment in the 
implementation of the Affordable Care Act, which is the law of 
the land. It appears that the Department of Health and Human 
Services has made it harder for Americans to access and afford 
the vital health insurance coverage that they rely on.
    Your department recently proposed a rule that would 
discontinue the ACA subsidies for low-income families who do 
not actively reapply during the ACA's open enrollment period. 
These are low-income Americans who are currently enrolled in 
zero-dollar-premium plans.
    Secretary Azar, your department's analysis acknowledges 
that there are 270,000 Americans who are reenrolled in these 
zero-dollar-premium plans that could lose their coverage. And 
yet you proposed ending auto-enrollment for these individuals, 
thereby endangering their coverage.
    First, a ``yes'' or a ``no'' question: In deciding to 
propose this policy, did you consider the fact that it would 
result in American families losing coverage?
    Secretary Azar. I want to get back to you for the record, 
if I could. I don't know that we actually proposed it, as 
opposed to asking for comment on whether one should allow auto-
reenrollment for people that are 100-percent subsidized in the 
ACA exchange markets. I think we asked just for comment on 
that, as opposed to proposing that as the approach.
    Ms. Blunt Rochester. So I am assuming, if you are asking 
for comment, it is something that you are considering?
    Secretary Azar. It is under consideration, if we should 
require someone to apply who is getting 100 percent of their 
subsidy paid for, their premiums paid for, should they 
affirmatively demonstrate that they continue to qualify on an 
income and wealth basis for that, as opposed to just rolling 
over and then pay and chase later if we find months later, they 
don't qualify.
    Ms. Blunt Rochester. So can you guarantee that no 
individuals would lose coverage as a result of this policy?
    Secretary Azar. Well, if they don't qualify, then they 
wouldn't retain coverage at 100-percent subsidy----
    Ms. Blunt Rochester. Meaning, if you changed the policy, 
then they wouldn't qualify and they could lose----
    Secretary Azar. They shouldn't qualify.
    Ms. Blunt Rochester. I am particularly alarmed that your 
department would propose such a policy given that Congress 
statutorily directed you to establish automatic reenrollment 
for all individuals enrolled in the marketplace. That provision 
was signed into law by the President at the end of the year. 
This proposed policy goes against congressional intent.
    Mr. Secretary, will you commit to the American people that 
you will not take any action that would cause American families 
to lose their health insurance? That is just a ``yes'' or 
``no.''
    Secretary Azar. I believe that rider was with respect to 
2020 moneys, and the request for information was regarding the 
2021 plan year, which is not subject to that rider, is my 
understanding.
    Ms. Blunt Rochester. The deep concern is that the 
Department now has a record of refusing to properly invest in 
robust advertising and outreach. The Department has drastically 
reduced funding for outreach and education activities. It has 
gutted the Navigator program, limited the time for enrollment, 
and is giving consumers less opportunity to make informed 
choices. Now the Department threatens to discontinue American 
families' subsidies who have become accustomed to being 
reenrolled every year.
    Mr. Secretary, would you commit to working with me to 
ensure that Americans wishing to enroll in coverage will be 
well-informed about the opportunities to enroll?
    Secretary Azar. Well, I am always happy to work with you, 
Congresswoman, on any issue.
    Ms. Blunt Rochester. Well, we have talked about working 
together before, so I just want to put it on the record on this 
particular issue.
    Secretary Azar. So, you know, just in terms of open 
enrollment, we put out a billion reminder emails, we had----
    Ms. Blunt Rochester. It is just a ``yes'' or ``no'' 
question, because my time has expired. Yes?
    Secretary Azar. Happy to work with you.
    Ms. Blunt Rochester. OK. We will follow up.
    Thank you, Madam Chair.
    Ms. Eshoo. The gentlewoman's time has expired.
    The Chair recognizes the gentlewoman from California, Ms. 
Barragan, for her 4 minutes of questions.
    Ms. Barragan. Thank you.
    Thank you, Mr. Secretary, for being here today.
    As we have heard from you, our U.S. Government has 
implemented aggressive measures to help prevent the spread of 
the coronavirus. There have been repatriation missions. There 
have been travel bans, airport restrictions, and additional 
travel notices issued. Many of these actions have impacted Los 
Angeles County and, in particular, my district.
    On February 2, the President signed a proclamation banning 
foreign nationals who have traveled to China in the preceding 
14 days and were not the immediate family of U.S. citizens and 
permanent residents. Over the course of a few weeks, 808 U.S. 
citizens were flown back to the United States, where they were 
quarantined for 14 days at military bases.
    As of today, 37 countries have confirmed cases of 
coronavirus. Should we expect travel bans from countries, like 
Italy, who have confirmed cases of transmission but are on a 
different continent than current travel bans?
    Mr. Secretary, how sustainable are quarantines and travel 
restrictions in holding the coronavirus at bay?
    Secretary Azar. It is an excellent question. And that is 
why, when we did the initial 212(f) China ban that you 
mentioned, we were very clear, we can't hermetically seal the 
United States off, and, at some point, there would be 
sufficient spread in other countries that measures like that 
would not be effective.
    With China, of course, with the epicenter being in China 
and with the aggressive measures taken by China, that is what 
we felt was appropriate to do there. We will constantly look at 
other travel advisories, 212(f) restrictions, or surveillance 
and requests for home isolation as we gather more information. 
But it is a very fair point, absolutely.
    Ms. Barragan. And so, following up on that, what resources 
are going to the quarantines that are happening?
    Secretary Azar. So----
    Ms. Barragan. And should these be expanded? Should they be 
extended? You know, what additional resources do you expect are 
going to be necessary?
    Secretary Azar. So I would actually like to get us out of 
the Federal quarantine business. And I do want to commend 
California and the local governments there. They have really 
been a superb partner with us on the repatriation of American 
citizens. But it is quite expensive to maintain institutional 
quarantine.
    We don't envision further repatriation flights that really 
has implicated that need for us to scale up this type of 
facilities-based quarantine. In the future, as I think Dr. 
Schuchat mentioned yesterday, we would envision more self-home-
isolation activities, State- and local-based monitoring and 
quarantine activities.
    Ms. Barragan. OK.
    I want to drill down a little bit on this, because on 
Monday HHS issued a statement that revealed a Naval base in 
Ventura County, Point Mugu, may receive American travelers 
coming through LAX who would be quarantined to be monitored for 
symptoms of coronavirus based solely on their travel history. 
Let me repeat that: based solely on their travel history.
    Mr. Secretary, what are HHS's plans to quarantine Americans 
based on solely their travel history? And would those be 
voluntary or mandatory?
    Secretary Azar. So that would be the Hubei province travel. 
So an individual who within, the previous 14 days, has been in 
Hubei province in China, as an American or a permanent resident 
alien or family member, would be subject to mandatory 
quarantine.
    We are seeing very, very few of those individuals. I think 
we had a family of three and then one individual is really all, 
I believe, that we have right now currently in quarantine.
    So that is more of a backup concept there, the Ventura 
facility you are talking about, to know it is there. But we 
have, again, worked very well with the State and locals in 
California.
    Ms. Barragan. Right. And we certainly know that the CDC has 
said that it is not a matter of if the virus is going to spread 
but a matter of when. You know, Congress wants to work with 
your agency to fund adequate and effective and sustainable 
public health responses. We can't do that without sufficient 
funding going forward to appropriate to State and local 
partners.
    Secretary Azar. Yes.
    Ms. Barragan. I know that you will be seeing out of the 
Congress, especially out of the majority, a proposal on that.
    Thank you, and I yield back.
    Secretary Azar. Thank you.
    Ms. Eshoo. The gentlewoman's time has expired.
    The Chair recognizes the gentlewoman from New Hampshire, 
Ms. Kuster, for her 4 minutes.
    Ms. Kuster. Thank you, Madam Chairman.
    And, Secretary Azar, thank you for appearing before our 
committee. There is a lot going on both in your budget and with 
our concerns about the coronavirus, so I will move through this 
quickly.
    The key to a public health crisis, as you well know, is 
trust and credibility. And my point is, it would be helpful for 
clear, easy-to-understand, credible updates from this 
administration to both us, as policymakers and Members of 
Congress, and to the American people. And it would be even more 
preferable if the statements by the President of the United 
States did not contradict the statements of the scientists and 
physicians at the CDC and in your department.
    My time is limited. I want to jump right in on the 
administration's continuing efforts to undermine the Affordable 
Care Act's consumer protections for people with preexisting 
conditions.
    The administration and your testimony today claims to 
support protections for preexisting conditions, but, with all 
due respect, the facts speak for themselves. This 
administration has repeatedly taken action, including court 
proceedings, to undermine protections for people, including my 
constituents, with preexisting conditions.
    Your department finalized a rule to expand junk plans that 
do not provide protection for people with preexisting 
conditions and issued a 1332 waiver guidance creating new 
standards inconsistent with congressional intent. The guidance 
allows States to increase consumers' costs, reduce coverage, 
and undermine protections.
    Simple ``yes'' or ``no'' question, Secretary Azar: Are you 
aware that the 1332 guidance could substantially raise costs 
for Americans with preexisting conditions?
    Secretary Azar. Actually, our 1332 guidance allowed me to 
approve reinsurance waivers for 11 States, causing 10- to 30-
percent declines in premiums in the exchange market.
    Ms. Kuster. And in the other States, what would the result 
be?
    Secretary Azar. One other State was, I think--I forget if 
it was Hawaii that we approved a waiver allowing them to not 
have the SHOP. I think that was it, if I remember. Yes, in 
Hawaii. So that was at their request, to not have the State--I 
forget the exact terminology of what the SHOP is, but it is a 
technical aspect of the Affordable Care Act.
    We have approved no other ACA 1332 waivers at this point.
    Ms. Kuster. And will you commit not to approve waivers that 
would jeopardize the health and well-being and the financial 
well-being of Americans with preexisting conditions?
    Secretary Azar. You can't waive the protection against 
preexisting conditions, under 1332 or otherwise.
    Ms. Kuster. And this administration is inviting States to 
make changes to the ACA subsidy structure and direct taxpayer 
dollars to junk plans. And those do indeed threaten and 
jeopardize individuals with preexisting conditions.
    Yes or no, do you think it is appropriate to allow States 
to direct taxpayer dollars toward junk plans that do not 
provide protections for preexisting conditions?
    Secretary Azar. We think it is appropriate to allow States 
to support access to these short-term, limited-duration plans, 
which are plans that the Obama administration allowed to 12 
months up until the end of the administration.
    Ms. Kuster. Well, let me dive right into that. Under the 
Obama administration, the short-term, limited-duration plans 
were for just three months.
    Secretary Azar. I----
    Ms. Kuster. You have now extended it to 12 months with 
three renewals. That is not the same condition.
    Secretary Azar. I am afraid that is actually not correct. 
The Obama administration had them for up to 12 months up until 
the very end of the administration, when they passed a midnight 
regulation shortening it to three months.
    Ms. Kuster. To three months. That is my point.
    Secretary Azar. Right at the very end. They were perfectly 
fine with the----
    Ms. Kuster. That is my point, is it was three months, and 
you have allowed for extensions for up to three times. That is 
four years.
    And we had people testify here that they did not even have 
noticed that their preexisting conditions were not covered, and 
even insurers that said to them that if they didn't know they 
had a preexisting that they should have known.
    So this is something we need much more work on. I aim to 
protect consumers with preexisting conditions.
    Thank you. I yield back.
    Secretary Azar. Just one correction. It is 12 reinsurance 
waivers, not 11.
    Ms. Eshoo. The gentlewoman's time has expired.
    The Chair recognizes the gentlewoman from Illinois, Ms. 
Kelly, for 2 minutes.
    And I just want to instruct the members; we have two more 
to question, and they have agreed to limit their time to 2 
minutes each. We will then take a very short break, maybe 5 
minutes, to reset the witness table for the next panel and 
allow the Secretary to take, you know, a few-minute break.
    All right. So now we will recognize the gentlewoman from 
Illinois, Ms. Kelly, for 2 minutes.
    Ms. Kelly. Thank you, Mr. Secretary, for being here.
    I wanted to talk about two issues that I have paid a lot of 
attention to and that have actually ravaged communities of 
color across the Nation. One is maternal mortality, and the 
other is gun violence.
    President Trump has expressed concerns about maternal 
deaths, and, following mass shootings last year, he called for 
bipartisan solutions to reduce gun violence. Well, we in 
Congress have come up with bipartisan solutions for both. I 
have worked with my colleagues on the other side of the aisle 
on a bill to expand Medicaid to provide postpartum coverage for 
a full year. And Congress appropriated and President Trump 
signed into law $12.5 billion in funding for the CDC to study 
gun violence.
    Yet your administration seeks to slash funding to and 
block-grant Medicaid, implement more restrictive eligibility 
criteria for Medicaid recipients, and completely zero out 
funding for gun violence research.
    Secretary, are you aware, yes or no, that the budget 
contains a proposal that would allow States to impose an asset 
test on pregnant women in Medicaid? It is pages 112 to 113 of 
the HHS Budget in Brief.
    Secretary Azar. I would want to look at that and get back 
to you on that. I am not aware of that particular provision.
    Ms. Kelly. OK.
    Secretary Azar. We do have the proposal, similar to what 
you just mentioned for Medicaid, that would allow States an 
option to cover pregnant women for one year after birth if they 
are suffering from substance use disorder. So that is another 
part of the maternal mortality initiative.
    Ms. Kelly. Yes. That proposal will cut Medicaid's funding 
by $2.2 billion. That is because it would cause a lot of 
people, including pregnant women, to lose their Medicaid 
coverage. So maybe you----
    Secretary Azar. That is a spending provision, the one I 
just mentioned. It would actually expand--right now, they can 
only get 60 days' coverage postpartum. This would allow that 
coverage for up to a year as a State option in a non-budget-
neutral way, I believe.
    Ms. Kelly. Well, my time is up.
    Ms. Eshoo. The gentlewoman's time has expired.
    That legislation that we took up here is awaiting floor 
approval. The gentlewoman has been a leader on this for long 
before the rest of the members even knew that we had this 
horrible statistic in our country.
    Last but not least, the gentlewoman from Florida, Ms. 
Castor, for her two minutes.
    Ms. Castor. Thank you, Madam Chair.
    Mr. Secretary, the administration is urging the Federal 
courts to strike down the Affordable Care Act in its entirety, 
including the protections for more than 130 million Americans 
who have a preexisting health condition.
    I think my neighbors back home would want me to relay to 
you how dangerous that is, how angry they are about it. They do 
not want to return to the days when insurance companies could 
discriminate against them if they had asthma, a cancer 
diagnosis, some other preexisting condition. They don't want to 
return to the days where an insurance company can cancel them 
if they get sick.
    And I think the coronavirus now highlights the importance 
of consistent health insurance coverage that has a floor of 
essential health benefits. And it really shines light on these 
junk plans. Your department has finalized a rule to expand the 
short-term, limited-duration junk plans. They are not required 
to cover preexisting conditions. You acknowledged that in your 
last budget hearing in front of this committee.
    And a couple of studies have come out recently, a 
Georgetown Health Policy Institute study, one commissioned by 
Leukemia and Lymphoma Society, that kind of highlight the 
abuses here.
    Is the Department conducting any oversight on the abuses of 
these junk plans, the abuses in marketing, and false promises? 
Are you conducting oversight of these?
    Secretary Azar. So the short-term, limited-duration plans 
are off-exchange, and so we don't actually regulate----
    Ms. Castor. Could you just say ``yes'' or ``no'' quickly? 
Because----
    Secretary Azar. We don't----
    Ms. Castor [continue]. The time is short.
    Secretary Azar. We don't regulate them directly. They are 
subject to State insurance regulation.
    Ms. Castor. You do not--so it is, like, hands-off? You 
said, we are going to promote these junk plans, and you are not 
conducting any oversight? Is that true, yes or no?
    Secretary Azar. They are subject to State insurance 
regulations, as individual markets should be.
    Ms. Castor. And you don't check in with the State and 
monitor the abuses in the junk-plan market that are raising 
costs on everybody and excluding preexisting conditions?
    Secretary Azar. So we----
    Ms. Castor. Thank you.
    Secretary Azar. We do not support--we do not regulate State 
insurance commissioners.
    Ms. Eshoo. The gentlewoman yields back.
    Let's take a 5-minute break, and the staff can reset the 
witness table, and then we will resume. Thank you.
    [Recess.]
    Ms. Eshoo. The Subcommittee on Health will come back to 
order.
    What we are going to do is, we are not going to have our 
witnesses do their formal public statements. We have them all 
in the record.
    [The prepared statements follow:]
    [The information appears at the conclusion of the hearing.]
    Ms. Eshoo. We thank you for them. I have actually read 
them, and I am sure my colleagues have as well.
    What I just want to do quickly, out of respect to each, is 
to just give a quick introduction. And then we will go to 
members with their questions.
    And, first of all, thank you for being here. I think that 
the United States of America is so blessed--is so blessed--to 
have, I think, the finest public health professionals in the 
entire world. There is a reason why the world looks to us: 
Because we have you and your expertise.
    So, Dr. Fauci, thank you to you. America can't live without 
you, really.
    Dr. Hahn, welcome to you. I think this is the first time 
that you are before the committee?
    Dr. Hahn. Yes.
    Ms. Eshoo. And we will make it really pleasant for you.
    Dr. Hahn. Thank you very much.
    Ms. Eshoo. We won't do to you what we did to the Secretary.
    Mr. Secretary, welcome back to the table.
    Dr. Kadlec, welcome to you.
    And to Dr. Redfield from the CDC, thank you for being here.
    And thank you, collectively, for what you have done to help 
to brief the Congress during this.
    Now, is it my turn to ask?
    Staff. Yes.
    Ms. Eshoo. OK. Let me start, obviously, with the 
coronavirus.
    I started out earlier today saying that confusion is the 
enemy of preparedness. I do not put confusion at the doorstep 
of Dr. Fauci, Dr. Hahn, Dr. Kadlec, and Dr. Redfield.
    I think that you have done an excellent job in advising, 
briefing the Congress and for the work that you are doing.
    I think we have some problems with the administration, 
because the professionals say one thing and then there is 
confusion on the other side.
    I hope that something else will happen, too, and that 
briefings be held in public so the American people can hear 
you. I hope, as we move through this challenge, that the 
American people will come to know you the way we do, and that 
we elevate the level of confidence and trust that I know you 
can engender, but I don't think it is there now.
    There is confusion; markets are roiling. It is not only 
because of confusion, but there are many matters at hand. But 
you, the scientists, the doctors--the American people couldn't 
be better served. They just couldn't be better served. So thank 
you to you for your especially important service right now.
    What I want to get to--Dr. Hahn, let me start with you--is 
our drug supply. Are manufacturers being forthcoming with the 
FDA about potential shortages?
    Dr. Hahn. Madam Chairwoman, thank you for the question.
    We are being very proactive in our discussions with 
manufacturers. As you know, drug manufacturers are required to 
report to us when there are potential disruptions----
    Ms. Eshoo. And how far in advance do they let you know that 
there will be a shortage?
    Dr. Hahn. Typically those conversations occur in real-time. 
What we have done is----
    Ms. Eshoo. Well, I know that--I think, usually, all of our 
conversations are in real-time. I am saying, how much--you 
know, in a trajectory of time, if they were talking to you 
today, would they be able to tell when the shortage would 
begin? How much runway do we have?
    Dr. Hahn. We often do not----
    Ms. Eshoo. For example, China and manufacturing. So we have 
a problem with that.
    Dr. Hahn. So, just as an example, I can tell you that drug 
manufacturers are required to tell us when there is a potential 
disruption to the drug supply. When the applicants apply to the 
FDA, they might provide, for example, five different 
manufacturers for the precursors to the drug and then five 
manufacturers for the actual final drug form----
    Ms. Eshoo. OK.
    Let me ask you this. If the coronavirus outbreak is 
continuing three months from now--and I pray that it isn't--
what do you estimate the American drug supply will be? Have you 
done----
    Dr. Hahn. So we have looked at this.
    Ms. Eshoo [continue]. Forward-leaning planning?
    Dr. Hahn. There are 183 prescription drug manufacturers in 
China. Twenty are sole-source from China. That is both 
precursors as well as the final drug form. We have reached out 
to all of these manufacturers, and we have no shortages to 
those sole-source drugs.
    It is the redundancy, Madam Chairwoman, that is most 
important, and if we have redundancy, then we can shift to 
other manufacturing sources.
    Ms. Eshoo. Yesterday, the FDA said that--you mentioned 
this--the 20 drug products that are either solely sourced there 
for their active ingredients or finished drug products from 
China. Can you share that list with us, or is that proprietary?
    Dr. Hahn. That is a proprietary list. We are internally 
compiling lists associated with all the questions that we have 
been asking of manufacturers.
    Ms. Eshoo. Yes.
    Dr. Redfield, how many coronavirus tests can the U.S. 
conduct as of today?
    Dr. Redfield. How many cases?
    Ms. Eshoo. Yes. How many tests----
    Dr. Redfield. Oh, tests.
    Ms. Eshoo [continue]. Can our country conduct as of today?
    Dr. Redfield. I would have to get back to you with the 
exact number.
    Ms. Eshoo. OK.
    I kind of teased, but I was serious, Secretary Azar. We 
have some deep cuts to these agencies, the people that you are 
sitting with. And it was mentioned by, I think, the ranking 
member that the budget was printed and it couldn't be changed 
because of the print and all of that.
    I think, Secretary Azar, the $200 million in cuts at BARDA, 
$700 million in cuts at CDC, and $3 billion out of NIH, are you 
willing to reconsider that, given what our country is facing 
and what the American people need day-in and day-out from these 
agencies? They are the essentials.
    Secretary Azar. The proposals to the budget do not impact 
our ability to do the novel corona response. The CDC budget 
actually has a $135 million increase in the fields of 
infectious disease and global health security preparedness.
    Ms. Eshoo. Do you think that, in other words, they deserve 
these cuts? These are healthy cuts? This is good for them, and 
it is good for our country.
    Secretary Azar. You asked me about impact related to novel 
coronavirus. These will not impact functioning related to that. 
And, of course, we have these emergency supplemental request on 
top of that.
    Ms. Eshoo. Well, but if you wrote it in December, how do 
you know that?
    Secretary Azar. Because the changes that we make in the 
budget are not related to categories that will impact our 
ability to do the novel coronavirus response.
    Ms. Eshoo. So there is nothing to reconsider?
    Secretary Azar. I don't believe there is, in terms of the 
existing budget proposal. We have----
    Ms. Eshoo. Well, you know what?
    Secretary Azar [continue]. The emergency supplemental 
adding to accounts that we think are the relevant ones.
    Ms. Eshoo. Today is February 26, 2020, and I certainly hope 
you are right, but I think that we are shortchanging the 
American people.
    At this time, I recognize Dr. Burgess, the ranking member 
of the subcommittee.
    Mr. Burgess. I thank the Chair.
    I would just point out, we are the United States House of 
Representatives. All spending bills originate in the United 
States House of Representatives. So it is certainly well within 
our power to provide the level of spending that you all 
request.
    The House is just now doing its budget, several months 
after the administration did its budget. I will be testifying 
to the Budget Committee tomorrow. I think if people have 
concerns, they ought to bring them up to the Budget Committee. 
I just hope we will actually have a budget debate and vote on a 
House budget, because we haven't in several previous years.
    But I do want to thank the panel for being here today. This 
is critically important. The Chair is correct that people do 
need to see and this needs to be public. That is why we have 
hearings, because hearings are on the record and are public, 
which is why, several weeks ago, I suggested we have this 
hearing, and I am glad we are having it today.
    Secretary Azar, you were testifying on the budget before. 
You did take some questions on the issue of the Office of 
Refugee Resettlement. Just off the topic of the corona, can I 
say, I have been fortunate enough to visit a number of your 
facilities provided by Office of Refugee Resettlement, and I 
think we are fortunate to have the men and women who are 
working in those facilities. And would you just please convey 
to them my thanks? Because I do think they do a good job, and 
we would be much the worse without them.
    Secretary Azar. I will. And that will mean a great deal to 
them. Thank you.
    Mr. Burgess. Dr. Hahn, you and I had talked a little bit, 
somewhat earlier, about the supply chain and the active 
pharmaceutical ingredients that we import from overseas. And 
the fact was that there was an adequate stockpile as, sort of, 
this story began to evolve several weeks ago.
    To the extent that you can tell us, how are things looking 
now, as far as the stockpile that companies have available, as 
far as the active pharmaceutical ingredient?
    Dr. Hahn. Thank you, Representative Burgess.
    As we discussed before, we have received no reports of 
shortages and found no shortages in prescription drugs coming 
from China. And we have discussed this with manufacturers and 
pharma companies, and adequate supplies currently exist.
    Mr. Burgess. So can I just offer this observation? And I 
have been on this subcommittee for a long time, and we have had 
this discussion in other guises and other times. And if there 
is any silver lining to this cloud, it may be that we recognize 
that we need to bring some of that manufacturing back within 
our own shores so that we are responsible for our--we have the 
responsibility for those active pharmaceutical ingredients.
    And I know this is something the President is focused on 
and part of his rebuilding of America. This is, I think, work 
that this committee, subcommittee, has done in the past. I 
think it is something that we really need to take very 
seriously.
    We had some hearings on continuous manufacturing a few 
weeks ago, and I think that is another aspect of this, where--
perhaps some attention to the continuous manufacturing, but the 
main thing is make it here so we are not dependent on a sole 
source from another country. Whether it be in difficulty from 
an infection or just simply out of sorts with the United States 
at the time, it does jeopardize our people, and I do think we 
need to recognize that.
    And, again, that is not a criticism of this panel. We have 
known about that on this subcommittee for a long time, and it 
is just, we haven't acted. Now, perhaps we will.
    Dr. Redfield, I would like to ask you, we have heard 
several times the World Health Organization was able to finally 
get into China and assist them. And now that report is going to 
be coming back. Are you satisfied with the level of interaction 
that you have had with your Chinese counterparts? Because the 
CDC itself was not allowed to go in. Is that correct? It was 
only as part of the World Health Organization?
    Dr. Redfield. We were able to have a representative on the 
GOARN team that went to China to do the investigation. I have 
had regular conversations with my counterpart, the head of the 
CDC in China. We have had a good exchange of scientific 
information. We do have a CDC office in Beijing, China, that is 
there, and they continue to have good interactions with those 
colleagues.
    Mr. Burgess. So you think there is, working with the State 
and local folks?
    Dr. Redfield. There is good scientific interaction between 
us.
    Mr. Burgess. OK.
    And, Dr. Hahn, let me just come back to you for a moment. 
And thank you for the work you are doing on getting a 
laboratory-developed test. That is critical. They can't all be 
done at the CDC. We are going to have to be able to get those 
tests done rapidly in the field for our people on the front 
lines.
    But is there any evidence if there is any sort of hoarding 
behavior going on with things like personal protective 
equipment or pharmaceuticals? Is that something about which we 
need to become concerned?
    Dr. Hahn. In terms of the supply for----
    Mr. Burgess. Yes.
    Dr. Hahn. We have reached out to manufacturers, and we are 
aware that spot shortages can and have occurred. However, 
currently, we know of no overall shortage related to PPE. 
However, this is a very dynamic situation, as I mentioned at 
yesterday's press conference, that we are likely to see some 
pressure, particularly on the demand side here.
    Mr. Burgess. Is there anything----
    Dr. Hahn. We are working very closely with manufacturers on 
this.
    Mr. Burgess. OK. Is there anything you can do to prohibit 
or prevent--not prohibit, but prevent hoarding activity by 
people who might just be buying up equipment?
    Dr. Hahn. Well, the Department has led an all-Department 
effort to communicate to providers and hospitals regarding this 
issue. And we have recommended following CDC guidelines with 
respect to the use of particularly respirators, where it seems 
to be the most pressure.
    Mr. Burgess. OK. Thank you.
    Ms. Eshoo. The gentleman's time has expired.
    It is a pleasure to recognize the gentlewoman from 
Colorado, Ms. DeGette, for her 5 minutes of questioning.
    Ms. DeGette. I thank the Chair for including some of the 
other subcommittees in this.
    As four of the five of you well know, we have been having 
hearings in the Oversight Subcommittee for years on these 
issues. It is what keeps me up at night. The most recent 
hearing we had was on December 4 about seasonal flu and 
pandemic flu. And lo, here we are. And what I am concerned 
about is, we are still not any more prepared than we were on 
December 4. And so that is what I want to talk about.
    Back in 2005, we had a National Blueprint for Biodefense--
or 2015. Some of you recognize this document. Our now-colleague 
Donna Shalala had your job, Mr. Secretary. And in this 
blueprint for defense, what we they did was, they said, in case 
we have some kind of a pandemic, we need to have a clear line 
of authority to make these decisions.
    Are you aware of that, Mr. Secretary?
    Secretary Azar. I wasn't aware of Secretary Shalala's 
recommendation in----
    Ms. DeGette. But are you aware of this blueprint?
    Secretary Azar. More of the blueprint. I wasn't aware of--
--
    Ms. DeGette. OK.
    Secretary Azar. I wasn't remembering that recommendation.
    Ms. DeGette. Well, so this is what I want to ask you. 
Because I just got back from Japan on Monday, and so we were 
really looking at the Diamond Princess incident. And here is 
what I was concerned about, is, you had all these people 
sitting in this petri dish of a ship for a long time. The CDC 
said that people should not be flown back to the U.S. from that 
ship. And then, apparently, the CDC was overruled by the State 
Department.
    So here is my question. You are the chairman of the 
President's task force on the novel coronavirus. Who is in 
charge? Are you in charge?
    Secretary Azar. I am in charge. But in Japan, the Deputy 
Chief of Mission, who is the Charge d'Affaires----
    Ms. DeGette. Right.
    Secretary Azar [continue]. Who made that decision, has full 
authority of the President of the United States----
    Ms. DeGette. Right.
    Secretary Azar [continue]. When in a foreign country.
    Ms. DeGette. So that is the problem.
    Secretary Azar. No, that----
    Ms. DeGette. Well, yes, it is, and I will tell you why that 
is the problem. Because you are the head of the panel, the 
health experts are saying you shouldn't be flying these people 
back in, and then there is another agency that basically 
overruled what you said.
    If we have an outbreak in the United States, there are a 
number of other agencies that are going to have other 
interests. And I will just give you a couple of examples: the 
State Department, which we just dealt with; HHS is you; the 
State public health departments; various other agencies.
    Who is in charge of the final verdict? Is it you?
    Secretary Azar. It depends on the circumstances. If it is--
--
    Ms. DeGette. That is not going to work if we have a 
pandemic.
    Secretary Azar. No. If it is in a foreign country, the 
ambassador of the President is the final word on representing 
the United States' interests in that country.
    Ms. DeGette. So what happened is, they flew back in 14 
Americans, maybe more, who were infected with the coronavirus. 
That is why someone needs to be in charge. And you know what? I 
think it should be you.
    Secretary Azar. I just, with respect, I want to--the Deputy 
Chief of Mission had a very difficult decision to make there. 
They----
    Ms. DeGette. I understand that. I don't need you to explain 
that to me. What I am saying, as this goes along, there needs 
to be someone who can overrule Homeland Security and State, who 
can make these decisions for the American public based on 
public health. And I am hoping we can have some more hearings 
to talk about that.
    Secretary Azar. I appreciate that.
    Dr. Redfield, I want to ask you--because the Chair, 
Chairwoman Eshoo, asked you the question about the lab tests, 
and you said you didn't know how many lab tests are available--
do we have lab tests that will accurately test for the 
coronavirus?
    Dr. Redfield. Yes. I----
    Ms. DeGette. OK. Now, what I heard was they are limited, 
and people have to send their tests to the CDC to be tested. Is 
that right?
    Dr. Redfield. Presently, there are 12 jurisdictions that 
have the test up and running. Nine of----
    Ms. DeGette. Twelve jurisdictions throughout the United 
States?
    Dr. Redfield. Throughout the United States.
    Ms. DeGette. And so people can send their tests there?
    Dr. Redfield. They send their tests there.
    Ms. DeGette. And when are we going to be able to put that 
everywhere?
    Dr. Redfield. Well, we are working cooperatively with----
    Ms. DeGette. I am asking you, when are you going to be able 
to put that everywhere?
    Dr. Redfield. I was trying to say----
    Ms. DeGette. Do you know?
    Dr. Redfield [continue]. We are working with the FDA now. 
We are hoping that later this week----
    Ms. DeGette. OK.
    Dr. Redfield [continue]. Our tests will be such that the 
first one can go--all the laboratories that got it can execute 
the current test on the modification that we did with the FDA.
    Ms. DeGette. OK.
    Dr. Fauci, I know you are working on developing a vaccine. 
If we gave you more money, could we develop a vaccine more 
quickly?
    Dr. Fauci. We would need more money to take it for the next 
step. We are in a Phase 1 right now, and we are OK. When we get 
to----
    Ms. DeGette. How much more money? How much more money?
    Dr. Fauci. For?
    Ms. DeGette. I think you could probably get bipartisan 
consensus that we would give you the money.
    Dr. Fauci. Yes. How much would you need for it to get it 
over the hill?
    Ms. DeGette. Yes. Yes.
    Dr. Fauci. About $140 million.
    Ms. DeGette. $140 million. I think----
    Secretary Azar. And, Congresswoman----
    Ms. DeGette. Yes?
    Secretary Azar [continue]. If you wouldn't mind, the 
emergency supplemental would actually dedicate a billion 
dollars for vaccines. That is part of the detail we will be 
working with the committee on.
    Ms. DeGette. OK.
    I just want to say one more thing, because my time is up, 
and I know that Congresswoman Schakowsky is going to ask you 
some questions about the supplemental. I just want to say that 
even Minority Leader McCarthy today said we need at least $4 
billion. And we shouldn't be shifting money away from Ebola and 
other diseases into trying to deal with this coronavirus. We 
need to work on all fronts at once.
    And I thank you for your comment.
    And I yield back.
    Ms. Eshoo. The gentlewoman's time has expired.
    The gentleman from Kentucky, Mr. Guthrie, is recognized for 
his time.
    Mr. Guthrie. Thank you, Madam Chair.
    And thank you for all being here.
    And just so everybody knows, we have been having these 
meetings, if they have not been formal hearings, bipartisan, 
with several of you over time. And I remember, when we first 
started meeting about this, it might have been Dr. Fauci said--
I don't want to put words in your mouth, but we were going to 
prepare for a pandemic. That is what the American people expect 
us to do. We are going to prepare for a pandemic. We are going 
to put things in place for a pandemic and hope and pray that it 
never comes. We are going to get ready. And as we prepare for 
it, people are going to see things, hear things, and maybe 
react that this pandemic is imminent, when it may not be, 
because we are doing what we are supposed to do.
    The other thing is, I know the White House and the 
administration needs to reassure markets and marketplaces where 
we are and where we stand. And for everything that I have heard 
previously and what Larry Kudlow has said, it is not 
inconsistent with where we are.
    But I know that the CDC came out and talking about the 
pandemic, to be ready for it. And, Secretary Azar, if you would 
like to explain this. I know the CDC warned that Americans 
should--and I will quote--``prepare for community spread'' in 
the United States and should be ready for, quote, ``significant 
disruption.''
    And would you explain what that means and what it means to 
the average person, what that means? And what is the most 
important message you would like for the American people to 
know about the current state of America and the coronavirus?
    Secretary Azar. Our messaging, from the President through 
to the career officials at the CDC, has been consistent, but it 
is striking a balance: America's risk is low at the moment. 
That could change quickly. We are working to keep that risk 
low, but we have always been transparent that we expect more 
cases in the United States with a rapidly spreading virus, 
especially with what we have seen.
    For the average American, there is no change in their 
behaviors except what we always would advise, which is: to 
practice good public hygiene--washing your hands appropriately, 
coughing into your arm, not touching your face with unwashed 
hands--and appropriate preparedness activities at home. And you 
can go to CDC.gov for normal advice for flu seasons, 
hurricanes, and others. Good preparedness, and good 
thoughtfulness at home.
    We are trying to be very transparent to people of the risks 
we face, even if we are at a low-risk situation now, so people 
aren't surprised, so that they know what we are dealing with 
and what uncertainties we are dealing with.
    Mr. Guthrie. Thank you.
    And so, Dr. Fauci and Dr. Redfield, for 50 days, we have 
learned much about the coronavirus, but much is still unknown. 
What is the current--this is what I know people want to know at 
home. What is the current scientific consensus about the 
transmissibility, infectiousness of the virus? And how long, 
once you are infected, if you are infected, how long can you 
pass it on?
    And what are the other remaining known unknowns? What are 
the things you know that you would like to know the answer to?
    With Dr. Fauci and Dr. Redfield and Dr. Kadlec, if that is 
in your world.
    Dr. Fauci. Well, first of all, we know it is a very 
transmissible virus. There are some viruses that are not 
efficient in going from human to human. What we learned early 
on and we are convinced now, given what we have seen in China 
and other countries, that it is a highly transmissible virus. 
That is the first thing.
    The second thing, when you say how long a person is 
infected after they get infected, that is something that is 
still up in the air. And the way you get the answer to that is 
you try and isolate the virus, what we call, shedding for a 
period of time.
    And we know that there are individuals who are actually 
able to transmit when they are without symptoms, before they 
get symptoms. What we don't know yet--and I think we are going 
to get information from the group, including the CDC individual 
and one of my people who was in China with the WHO group--what 
the extent of that transmissibility is from an asymptomatic 
person. Is it minor, part of the driving of the outbreak, or is 
it significant? That is going to be a very important thing that 
is currently an unknown.
    And, Bob, do you want to take over?
    Mr. Guthrie. Dr. Redfield?
    Dr. Redfield. I concur with Dr. Fauci. I think the biggest 
challenge we have right now is, what is the relative 
infectivity, whether before you get sick--are you more 
infectious before you get sick, or are you more infectious 
after you get sick?
    We are tracking these patients that we do have in this 
country to see how long they actually have a virus that can be 
isolated from their respiratory secretions. It is probably 
going to be longer than many of us originally anticipated. I 
think, at this stage, we have an individual who is out about 18 
days from the time they initially actually got sick.
    So I think these are key questions, and we continue to try 
to get the data to answer them.
    Mr. Guthrie. So are there other things that you are looking 
to know that you don't--that you know that you don't know that 
you are trying to find the answers to?
    Dr. Redfield. Well, I think one of the other areas from the 
CDC's point of view is trying to understand the methods of 
transmission. Is it all respiratory transmission through 
droplets? Is there fomite transmission? For example, can this 
virus survive on certain surfaces long enough for somebody else 
to come down, put their hand down, and then touch their face? 
You know, it is not clear right now what the relative 
components of, say, droplet transmission is to fomite 
transmission.
    Mr. Guthrie. Thank you.
    My time has expired. I will yield back.
    Ms. Eshoo. The gentleman yields back.
    The gentlewoman from Illinois, Ms. Schakowsky, is 
recognized.
    Ms. Schakowsky. Thank you.
    As all of you know, the World Health Organization has 
declared the coronavirus outbreak is a global health emergency, 
and our administration now has declared it a public health 
emergency. Yet, Secretary Azar--we have talked about this, you 
have heard about it--the Trump administration asked Congress 
for just $2.5 billion to combat the disease that the CDC's 
Director, Nancy Messonnier, warned could severely disrupt daily 
life and could cause severe illness in the United States.
    So, in that request, you did not, as I understand, 
include--were not specific about surveillance for testing kits 
that actually work--because not all of them have--and for 
treatment. Instead, you suggested robbing $500 million from the 
United States response to the Ebola epidemic, which actually 
still is raging in places. So I find it incomprehensible that 
you are asking for a molehill when what we really need is a 
mountain of support here.
    Secretary Azar, yes or no, do you agree with the President 
of the United States that the coronavirus is ``very much under 
control'' in the United States, unquote, and will, quote, ``go 
away,'' unquote, by spring?
    Secretary Azar. He did not say the last part that you just 
said. He said we hope it will go away with warmer weather. I 
hope everybody here would hope it would go away with warmer 
weather.
    The virus in the United States has been in a contained 
situation to date, but that can change. As Dr. Messonnier said, 
we expect more cases, and we expect that we will see at least 
limited community transmission of the virus in the United 
States.
    Ms. Schakowsky. Let me ask you another question. My 
hometown of Chicago reported the first human-to-human 
transmission of the coronavirus in the United States. And 
though the Illinois and Cook County and Chicago Departments of 
Public Health have expertly, I would say, handled our two 
coronavirus cases; they have not received any reimbursement or 
financial assistance for the work they have done. I just met 
with the director of public health in Chicago, who said they 
are spending $150,000 per week to respond to this.
    Will the United States be able, in the $2.5 billion, to 
help local and State health officials who have already spent 
lots and lots of money trying to deal with this?
    Secretary Azar. So, yes, that is actually part of the 
supplemental request, is to fund State and locals. In addition 
to the $675 million FEP money they already have received for 
many years, Illinois, of course, received each year $16.3 
million for exactly these activities. But we want to give 
additional funding through the supplemental request for those 
activities.
    Ms. Schakowsky. Well, that is really good news. Thank you.
    Secretary Azar, will your $2.5 billion be enough to help 
healthcare workers in hospitals and nursing homes or the home-
care workers who have to care for quarantined individuals?
    Secretary Azar. In what respect are you asking?
    Ms. Schakowsky. Well, I mean----
    Secretary Azar. The salaries? Because they are already 
paid. I am just curious. I want to----
    Ms. Schakowsky. No, I mean, I think----
    Secretary Azar. If there are elements we need to add to our 
request, we will be glad to----
    Ms. Schakowsky. There may be a lot of additional costs 
that--people that work in hospitals, and they may have to hire 
more people. Is there any help that is going to be for 
staffing?
    Secretary Azar. Would you mind if Dr. Kadlec responds, 
Congresswoman?
    Dr. Kadlec. I can address part of your question, ma'am, and 
that is, $350 million is dedicated for personal protective 
equipment that could be used by healthcare workers in many 
different settings. So we are stockpiling that to make it 
available should communities need that in addition to what they 
have on hand.
    Ms. Schakowsky. OK.
    Let me just finally say this. Last week, 45 of my 
colleagues and I sent a letter to President Trump, and what we 
were talking about is, are we going to be guaranteed affordable 
treatments or vaccines that are developed?
    We are concerned that private pharmaceutical companies may 
end up having a role in this and raising the cost beyond the 
point that people could well afford it.
    Secretary Azar. We absolutely share your passion around 
ensuring affordable access to medicines, but the private sector 
must have a role in this. We will not have a vaccine; we will 
not have therapeutics without the private-sector candidates 
that they and we will have to invest in.
    Ms. Schakowsky. But we have paid for all the R&D so far, 
right?
    Secretary Azar. No, that is not accurate. For instance, 
Gilead has a product, Remdesivir, that was originally NIH-
funded basic research, I think, out of the University of 
Alabama, but they have carried forward with development. 
Moderna is using Dr. Fauci's----
    Ms. Schakowsky. My time has expired, but if I could just 
reaffirm then, you are saying it will for sure be affordable 
for anyone who needs it?
    Secretary Azar. I am saying we would want to ensure that we 
work to make it affordable, but we can't control that price, 
because we need the private sector to invest. The priority is--
--
    Ms. Eshoo. The gentlewoman's time has----
    Secretary Azar [continue]. To get vaccines and 
therapeutics. Price control won't get us there.
    Ms. Eshoo [continue]. Expired, Mr. Secretary. Thank you.
    I now recognize the gentleman from Michigan, the former 
chairman of the full committee, Mr. Upton.
    Mr. Upton. Thank you, Madam Chair.
    I have a couple of questions that I hope to run through. 
And I guess the first question ought to be directed to--first 
of all, thank you all, 24/7, and for the briefings that we have 
had over the last couple of weeks as well.
    I guess this ought to be directed first to Dr. Redfield. 
There is a report just published now in the last hour or two of 
apparently there is a daily newspaper in Korea called the 
JoongAng Daily, and they reported that there is a Korean 
Airlines flight attendant who serviced a number of flights 
between LAX and Seoul, and she was confirmed to have 
coronavirus. They are not sure where she got it. There is some 
suspicion that she had also worked a flight to Israel with that 
apparent tourist group that came from Korea there in the 
previous week.
    What do you know about this? Is there some communication? I 
hope you know something, but I know that it is recent news. But 
it was published Tuesday in Korea; it is Thursday now. So just 
wondering what you might know about this.
    Dr. Redfield. I can say that I haven't been briefed on 
that, sir. Normally what we would do, if we had confirmed 
cases, obviously----
    Mr. Upton. Now, this is a Korean woman, 24 years old.
    Dr. Redfield. Yes. So that would be--we are interacting--we 
actually sent someone yesterday to embed in the Korean CDC to 
help facilitate communications between Korea's CDC and our CDC. 
But I can tell you I haven't been briefed on that specific 
situation. But I will look into it and get back to you.
    Mr. Upton. OK.
    And, second--and does anyone else know anything more?
    Dr. Fauci, I know that China did publish, thank goodness, 
the genetic sequence, which has allowed the rest of the world 
to try and pierce the bubble here. Moderna Therapeutics is one 
of the companies--I think they are out of Massachusetts--that 
is actually working on, I want to say, a Phase 1, but I may be 
wrong.
    Dr. Fauci. Yes.
    Mr. Upton. If it is successful, how long? What can you tell 
us?
    Dr. Fauci. We are working with the company Moderna on a 
vaccine platform called messenger RNA. We are working at our 
Vaccine Research Center.
    And we did exactly as you said. As soon as the sequence was 
put on a public database, we pulled the gene out for the spiked 
protein, which is the protein that you want to make an immune 
response against.
    There are several steps in that that determine the success 
or failure of what you are doing. And we have been able to 
successfully express it in this particular platform that we are 
going to use for a vaccine. We have shown that it is 
immunogenic in mice. And very soon, within the next month and a 
half to two, it is going go into humans in a Phase 1 study.
    But I think people need to appreciate--because there is 
often misunderstanding--a Phase 1 study, we will say, was three 
months from the go, which was about a month and a half ago. It 
will take about three months or four to determine if it is safe 
and induces the kind of response that you would predict would 
be protective.
    Once you get there--it relates to the question that I was 
asked before--then you go to a Phase 2 study. The Phase 1 study 
has 45 people. A Phase 2 study has hundreds or maybe even low 
thousands of people. That would take at least six or eight 
months to show that it works. So, from the time you push the 
button to go to the time you even know it works, it is about a 
year to a year and a half.
    Then, as the Secretary said, you have to partner with 
pharmaceutical companies to make millions and millions and 
millions of doses, which could also extend the time.
    Mr. Upton. And that would be a vaccine or a remedy?
    Dr. Fauci. That would be a vaccine----
    Mr. Upton. OK.
    Dr. Fauci [continue]. To prevent infection.
    Mr. Upton. OK.
    The last question that I have, and I will save this for 
Secretary Azar. A couple of weeks ago, my colleague Debbie 
Dingell and I sent a letter to the administration--you were 
copied on it--as it relates to the supply chain of companies 
with operations in China, specifically Wuhan province.
    A lot of us are concerned about products that are made 
there. Auto State, Michigan, we have a lot of different things 
that are there. I know Apple, as an example; they fessed up; 
their stock price collapsed and led to the market trouble that 
we had this week.
    What type of outreach are--have you initiated outreach to 
companies large and small, particularly on the shortage 
questions as well? Because they may not want to tell you what 
they might know. Where are you all on that?
    Secretary Azar. So, as chair of the task force, we have 
directed a whole-of-government outreach to manufacturers and 
suppliers across not just healthcare but everywhere. And Dr. 
Hahn and Dr. Kadlec have led the effort with regard to 
pharmaceutical, generic and biologic, and device manufacturers 
in China.
    And that is what Dr. Hahn was reporting on earlier, the 
results of that outreach. Very proactive. As you know, with 
drugs, they have to report to us potential shortages. Device, 
we don't yet have legislation on that, so we are proactively 
probing that system. As he reported, we don't yet know of any 
potential shortages, but we are on that because we share your 
concern about the risks there.
    Mr. Upton. Just to follow up, is the Secretary of 
Commerce--are they working on other things----
    Secretary Azar. Yes.
    Mr. Upton [continue]. Beyond just drugs and devices?
    Secretary Azar. Yes. With their regulated entities and 
their major manufacturing entities, they are working to gather 
information about potential shortages, as they might impact the 
economy. The National Security Council and the National 
Economic Council are leading those efforts.
    Mr. Upton. Thank you.
    I yield back.
    Ms. Eshoo. I appreciate what Mr. Upton raised overall but 
certainly the last part of it, the whole issue of our 
dependence on China and that 90 percent of the American people 
take generics and that those generic drugs are manufactured in 
China and, to a lesser degree, in India, but China controls the 
global market on the API, the active pharmaceutical 
ingredients.
    But I met with Dr. Kadlec after--I think it was the 
classified briefing. He came to my office. What I wanted to 
know was, do we have an inventory? Do we have an inventory of 
who the manufacturers are? Are any of these plants shut down? I 
know we asked questions about how long they can manufacture 
until they can't, because drug shortages are a part of this 
whole problem with the supply chain.
    But when I met with Dr. Kadlec, we don't have that 
inventory. Is that in place now Mr. Secretary?
    Secretary Azar. Actually, I believe----I believe that is 
what Dr. Hahn briefed you on earlier.
    Ms. Eshoo. We do have an inventory?
    Dr. Hahn. We have reached out to the manufacturers. We have 
to do that proactively because there are not requirements, for 
example, state of operations that are required to report to us.
    Ms. Eshoo. But if we inspect manufacturing plants, don't we 
know who they are?
    Dr. Hahn. Yes, we do.
    Ms. Eshoo. Don't we have a list of them?
    Dr. Hahn. Yes, we do.
    Ms. Eshoo. We do.
    Dr. Hahn. Yes, we do.
    Ms. Eshoo. What is the difference between that and the 
question I asked then?
    Dr. Hahn. So we have a list of manufacturers that have been 
given to us by pharmaceutical companies who manufacture both 
precursor products and final drugs in China. But there may be 
five or six for each of these drugs, and they might be in 
different countries.
    Ms. Eshoo. I see. All right.
    The gentleman from Massachusetts, Mr. Kennedy, is 
recognized for his 5 minutes.
    Mr. Kennedy. Thank you.
    I want to thank you all for being here. Thank you for being 
willing to be before this committee. I have some differences 
with some of you up there on our healthcare policy, but I am 
grateful for your presence here, and I wish you all success. So 
good luck to you, and good luck to us all.
    First off, a bit of--just rapidly, sir, Dr. Redfield, if 
you can. I have a 2-year-old and a 4-year-old, and a lot of 
other parents of young children are nervous about this. Can you 
just give me a real quick answer, as to parents of young kids, 
is there anything people should be doing at this point or 
should be concerned about?
    Dr. Redfield. I want to echo what the Secretary said. Right 
now, the risk to the American public is low, and we would argue 
that they go on with their life. Our containment strategy has 
been quite successful.
    But that said, what was said also is that, in light of what 
has happened in the Republic of Korea and Italy and Iran and 
Japan and we have seen how fast this virus can move, we are 
encouraging people, again, to just think about being prepared.
    Mr. Kennedy. OK.
    Part of being prepared is trying to make sure that there is 
as much and as clear communication as to what we are 
confronting and how the government is structured to be ready 
for this and to meet this challenge.
    I do think, obviously, as some of my colleagues have noted, 
that, despite calls to strengthen our country's pandemic 
preparedness, this administration did dismantle the Federal 
Government's pandemic response chain of command, including 
leadership structure at the White House through the National 
Security Council's global health security unit.
    So when you flash-forward to this year and the coronavirus 
starts spreading throughout the world, there have been reports 
of this task force--and, Mr. Secretary, you indicated that you 
are, in fact, the head of it. I would ask just, if you can, to 
the greatest extent possible, communicate what that structure 
looks like so that people can have some understanding as to 
what is backing that up. You don't have to do it now, but just 
as you can. Just to get that information out would be helpful 
to all of us.
    So, moving on a bit, though, to try to make sure that there 
is not just a structure put in place but that communication is, 
in fact, clear, Mr. Secretary, I would take a bit of an issue 
with the fact that the message is consistent. I think the 
message from you all up here on this panel, so far has been 
pretty consistent. I do have an ABC News story here that I am 
going to enter for the record which quotes the President as 
saying that it is, quote, ``a problem that's going to go 
away,'' end quote.
    The President is also quoted as saying, quote, ``The virus 
we're talking about having to do, you know, a lot of people 
think it goes away in April with the heat, as the heat comes 
in. Typically that will go away in April. We are in great shape 
though,'' end quote.
    Dr. Fauci, does this go away in April with the heat?
    Dr. Fauci. The history of respiratory viruses such as 
influenza and other coronavirus viruses tends to diminish and 
almost disappear as you get into the summer. That is just 
something that happens. Every year, we see that with influenza.
    However--underline ``however''--this is a new virus, so we 
don't know what this virus is going to do. If it acts like 
influenza, the heat will actually make it diminish in its 
impact. But we have no way of knowing how it is going to act.
    Mr. Kennedy. And I would say that there are different 
temperature gradients across this country by April. Fair 
enough?
    Dr. Fauci. Correct. And also in different hemispheres, 
because when we are having cold weather, others are having 
warm, and vice versa.
    Mr. Kennedy. Thank you.
    He has also stated that we are, quote, ``very close to a 
vaccine,'' end quote. But, Doctor, you just laid out that, 
best-case scenario, we are still 12 to 18 months away roughly. 
Is that right?
    Dr. Fauci. Correct.
    Mr. Kennedy. He said--congressional staff briefed folks 
yesterday in a press conference. Said, quote, ``It's not a 
question of if but rather a question of when and how many 
people in this country will have severe illness.'' Almost at 
the exact same time, the President was saying that, quote, 
``it's going work out fine,'' end quote, ``a problem that's 
going to go away.''
    Dr. Redfield, does the CDC agree that this is a problem 
that is going to go away without intervention?
    Dr. Redfield. I think it is important to recognize that, 
from time to time, new pathogens come from animals and get into 
the human species. Clearly, this is one of those times when we 
have a new respiratory pathogen that has come into the human 
species. And I think it is prudent to assume that this pathogen 
will be with us for some time to come.
    Mr. Kennedy. Dr. Kadlec?
    Dr. Redfield. And as----
    Mr. Kennedy. Dr. Kadlec?
    Dr. Redfield. [continue]. Tony said, we don't know the 
cycle of it. We don't know how it is going to--if it is going 
to be impacted by humidity and heat. But I think we should 
assume that this virus is going to be a virus that we are going 
to be challenged with, similar to the other viruses that we 
have that are respiratory.
    Mr. Kennedy. Doctor, thank you.
    I have ten seconds left. For the rest of the panel, ``yes'' 
or ``no,'' agree with Dr. Redfield?
    Mr. Kadlec?
    Dr. Kadlec. I support Dr. Redfield's view.
    Mr. Kennedy. Mr. Secretary?
    Secretary Azar. The President is expressing confidence that 
this team, the public health infrastructure in this country, 
State and local, that we can deal with this. We will prepare 
for this. We will work together on this. He is trying to calm 
the public.
    We see in China that panic can be as big of an enemy as the 
virus in these situations. And so there is always that 
balance----
    Mr. Kennedy. Mr. Secretary, I don't want to panic over this 
either. The stock market is crashing. He is trying to stop the 
stock market. He is not trying--he is outright contradicting 
everything that you all have just said. Outright contradiction.
    Secretary Azar. I think he is expressing confidence in----
    Mr. Kennedy. With no medical basis for it. That is what you 
have just expressed to us. Come on, sir.
    Secretary Azar. Well, no. He is expressing that the 
American people need to take a breath here, that there is no 
change to anyone's daily life from this, that the country has a 
plan, we have pandemic plans, there is a playbook for this, and 
we are executing against that. But we have to be realistic, 
also, and transparent that we will have more cases----
    Mr. Kennedy. And, sir, as head of HHS, do you agree with 
the President's statement, as I quoted, ``The virus that we're 
talking about having to do, you know, that it will go away with 
the heat''?
    Ms. Eshoo. The gentleman's time has expired.
    Do you want to answer that quickly?
    Secretary Azar. No.
    Ms. Eshoo. No. I didn't think so. You are doing a great job 
for the President, Mr. Secretary.
    It is a pleasure to recognize the gentlewoman from Indiana, 
Mrs. Brooks, for her time.
    Mrs. Brooks. Thank you, Madam Chairwoman.
    And thank you all so very, very much for being here and for 
your work day-in and day-out on behalf of not only our country 
but on behalf of the world.
    And I would like to remind my colleagues that in November 
of 2019 the United States of America was ranked number one in 
global health security. The Global Health Security Index, 
conducted by Johns Hopkins, of 195 countries, we are leading 
the world.
    Now, that doesn't mean that we can't always continue to 
improve. And that is what PAHPA, which was passed, signed into 
law in June, did. It actually took care--it focused on 
vulnerable populations, like children, like the elderly. We 
added a lot of new things to that.
    One of the things, though, that I am concerned about is the 
flexibility of the funding and whether or not--we introduced an 
Infectious Disease Rapid Response Reserve Fund. Eighty-five 
million was put into that fund. We have $705 million in a 
Strategic National Stockpile fund. We have all of these.
    How much flexibility is there? Or do we need to give you 
more authority, Mr. Secretary, very quickly, to have more 
flexibility to be able to not focus on Congress having to do 
supplementals all the time? How much more flexibility do you 
need?
    Secretary Azar. Well, the Infectious Disease Rapid Response 
Fund has been critical for us. The flexibilities in the 
Strategic National Stockpile, is critical to us. The emergency 
supplemental, is the most flexibility that you could give us 
there; as we deal with the situation as it evolves, we would 
appreciate that also.
    The challenge with setting up long-term funding mechanisms 
that are indefinite is they can become slush funds for any 
other priority, as opposed to concrete, real public health 
emergencies. I think that has always been the challenge.
    Mrs. Brooks. And if you find that you need more funding for 
any of these funds, will you come back and ask for more 
funding?
    Secretary Azar. Absolutely. And I want to emphasize, the 
2.5 is at least 2.5. It is for 2020 only. And we will come back 
if we need more. And we will work with Congress if Congress 
wishes to give more.
    Mrs. Brooks. Dr. Kadlec, with respect to the Strategic 
National Stockpile, which I believe you oversee in conjunction 
with the CDC--is that correct?
    Dr. Kadlec. Yes, ma'am.
    Mrs. Brooks. What is the status of our Strategic National 
Stockpile?
    Dr. Kadlec. Well----
    Mrs. Brooks. Can you quickly say what those are?
    Dr. Kadlec. Sure. It is a variety of countermeasures that 
deal with chemical, biological, radio, and nuclear 
capabilities, as well as for pandemic influenza. We have a 
supply of personal protective equipment that we have on hand. 
We have sent out a solicitation to get more, but the answer is, 
we have a whole range of things that----
    Mrs. Brooks. And these are at undisclosed locations----
    Dr. Kadlec. Yes, ma'am.
    Mrs. Brooks [continue]. Throughout the country, are they 
not?
    Dr. Kadlec. That is correct.
    Mrs. Brooks. And, at this point, is the Strategic National 
Stockpile sufficiently funded?
    Dr. Kadlec. Ma'am, I think the thing is, at this point in 
time, in light of what the requirements are, we have been 
given, at least in terms of what is in the supplemental 
request, another $400 million, that would be a great benefit to 
help us address any kind of shortfalls for this event.
    Mrs. Brooks. Last week, when I was home, I learned from a 
local public health official in Indiana that an individual from 
this county had traveled from China and, interestingly enough, 
had come through the Chicago airport. And the Chicago airport 
officials notified this public health official, said this 
person is coming home to quarantine, and she appeared at this 
individual's home within 24 hours of that person coming through 
the Chicago airport.
    I thought that was awesome. It was excellent that that kind 
of coordination happened. How did that happen? And is that 
happening all across the country?
    And this individual is going to cooperate with the local 
health official, and provide their temperatures for a couple of 
weeks. Is this happening all across the country?
    Dr. Redfield. Yes.
    Mrs. Brooks. And who at the airports is notifying local 
health officials?
    Dr. Redfield. So what happened, when the original travel 
restrictions were put in for China and Hubei, if you were 
coming into the United States, an American citizen or a family 
member or a permanent resident, on Hubei, you were required to 
go into 14 days of quarantine. That quarantine could either 
have been institutional or that quarantine could have been in 
your home, working with the health departments. And that is 
really how we have operationalized.
    But if you had been from China, the requirement was that, 
when you came through; you were screened. You were given an 
education card, provided that you had no symptoms, telling you 
about the risk and what the symptoms are and the contact 
information with your local health department. And you, in 
conjunction with your local health department, were going into 
what we called voluntary monitoring and isolation.
    And that woman that you gave the example of did exactly as 
we instructed and they were instructed as they went through 
Chicago O'Hare Airport.
    Mrs. Brooks. And so, actually, it was my local public 
health official that was incredibly impressed that she had 
received this information. The young man and his family are 
monitoring.
    Madam Chairwoman, I would like to enter into the record--
CSIS produced a report in November of 2019 about U.S. global 
health security, making sure we are ending the cycle, with a 
number of recommendations. You and I serve on that commission. 
I would ask that that be entered into the record.
    Ms. Eshoo. So ordered.
    [The information appears at the conclusion of the hearing.]
    Mrs. Brooks. With that, I yield back.
    Ms. Eshoo. The gentlewoman yields back.
    The gentleman from California, Mr. Ruiz, is recognized for 
4 minutes.
    And for those that are left, there is an agreement that it 
is 4 minutes because the panel is getting nervous about time. 
So let's honor that, OK? Thank you.
    Mr. Ruiz. Thank you for being here today.
    I want to discuss a very important issue for local agencies 
and that I know many other members are hearing as well, and 
that is funding and reimbursement for moneys that our counties 
and public health departments have spent up front to help fight 
the spread of the coronavirus.
    I am a disaster-trained emergency physician, and public 
health expert. And in disaster or epidemic preparedness, rapid 
reimbursement is a matter of readiness capacity.
    I think we can all agree that a lot is being asked from the 
public health infrastructure in our States. They are stepping 
up. They are coordinating. They are doing the right thing.
    On January 29, a flight carrying 195 Americans from Wuhan, 
China, was diverted to March Air Reserve Base in Riverside 
County, the county that my district is in. Riverside County 
responded efficiently and was effective in monitoring and 
quarantining all of these passengers for 14 days.
    Over 40 county officials worked on this project. In 
addition, the county supplied food, transportation, quarantine 
supplies, screening, housing, a mobile health clinic, emergency 
management standby, and support services for ambulances. All 
told, these efforts are estimated at a little over $1.3 
million.
    And while that flight quarantine is over, the broader 
response continues in Riverside and in communities across the 
country. So receiving rapid reimbursement is critical to 
capacity readiness in the future. If you drain resources 
without replenishing them, you won't have necessary resources 
to fight this public health crisis, such as bedside 
diagnostics, personnel, and masks, just to name a few, and also 
having the resources to create preparedness plans, quarantine 
plans, et cetera, in the case of rapid transmission of this 
virus in the future.
    So I want to ask a question. Dr. Redfield, what are the 
funds that are available to reimburse State and local officials 
for their efforts in responding to coronavirus?
    Dr. Redfield. I will defer some of this to the Secretary, 
but I think he said, in the supplemental, a substantial 
portion----
    Mr. Ruiz. OK. So you are telling me--the last time we 
spoke, you identified--somebody in your staff mentioned a few. 
Now you are saying those funds don't exist; we need to pass the 
supplemental to reimburse counties. Is that what I am hearing 
from you?
    Secretary Azar. So we have the FEP, which funds California 
at $41 million a year, but the supplemental has requested $757 
million from CDC----
    Mr. Ruiz. OK. So which funds----
    Secretary Azar [continue]. Which would have in that the 
State and local funding----
    Mr. Ruiz. OK. Are there funds right now that counties can 
apply for?
    Secretary Azar. No, there are not. That is what the 
emergency----
    Mr. Ruiz. There are no funds?
    Secretary Azar. No additional to the emergency----
    Mr. Ruiz. OK.
    Secretary Azar [continue]. Funds that they get each year 
for these activities.
    Mr. Ruiz. All right.
    Secretary Azar. That is what the supp is for.
    Mr. Ruiz. Well, we are definitely----
    Secretary Azar. We agree.
    Mr. Ruiz [continue]. Going to work on that. And that is an 
issue, right? Because we were under the impression that there 
were. And rapid reimbursement is a matter of readiness 
capacity. If we don't rapidly reimburse, our local agencies 
will not be ready to deal with a potential rapid spread of the 
virus.
    Dr. Kadlec and Dr. Redfield, yes or no, can we get a 
commitment from you both here today that you will reimburse 
these expenses by local municipalities for the costs associated 
with containing the spread of the coronavirus?
    Dr. Redfield. Well, we are clearly going to work to see how 
to get that done.
    Mr. Ruiz. OK. So that is not a commitment.
    Dr. Kadlec?
    Mr. Kadlec. I think the thing is, we are committed to 
basically work with you to do that.
    Mr. Ruiz. OK. Well, we need to reimburse because, 
especially in rural areas, where they don't have the resources, 
they don't have the hospitals, the quarantine spaces, the 
ability to get the supplies over to those areas, you are 
putting them in vulnerable situations if you don't respond.
    Dr. Redfield, since 2008, local and State health 
departments have lost nearly a quarter of their workforce. Does 
this affect our Nation's ability to mount and sustain a 
response?
    Dr. Redfield. I think it is one of the key core 
capabilities that we need to continue to improve for our public 
health ability--that is, the data modernization, which you all 
have helped with last year; the laboratory capacity, to build 
it and keep it fluid, as you see with the current diagnostic 
test; and the third, most important one----
    Mr. Ruiz. Yes. Listen.
    Dr. Redfield [continue]. Is the workforce.
    Mr. Ruiz. Work within a team.
    Dr. Redfield. We need to build that workforce.
    Mr. Ruiz. Be consistent. No discrepancy. Discrepancy breeds 
anxiety. That brings panic. OK?
    All right.
    Ms. Eshoo. The gentleman's time has expired.
    I wanted to get a commitment so that these agencies don't 
lose the money that they are losing. You are asking them to 
promise you even beyond where the cuts are. So I would be happy 
if that could happen, but the Congress has a job to do to 
restore the money in these agencies.
    These cuts are really shameful. They really are. And when 
we have such premier agencies, people at the top that know what 
they are doing, and they are being cut, and the Secretary is 
telling us, ``Well, we did $1.5 billion; everything is going to 
be fine,'' I don't think so.
    Dr. Bucshon from Indiana.
    Mr. Bucshon. Yes, thanks for the 5 minutes. I appreciate 
it. No, 4 minutes. I am just kidding.
    Ms. Eshoo. Four minutes.
    Mr. Bucshon. I mean, in reference to the funding, I just 
want to--I mean, the Congress provides funding for the 
agencies, and a the budget proposal is a budget proposal, no 
matter which President it comes from. So I am not too worried 
that this Congress won't provide the appropriate level of 
funding.
    And I understand also that additional funding--if we could 
quickly bring up the supplemental and pass that, that clearly, 
in my opinion, it would help if Secretary Azar and all the 
people at this table do their job and get money to everybody.
    The other thing is I just want to comment briefly on the 
criticism of the President and what he has said. If the 
President of the United States comes out and incites a panic in 
the United States; it incites a worldwide panic. And I see the 
role of the President as different than mine or Secretary 
Azar's or others. And even though, you know, the President says 
what he says, I do think having a calming effect in a situation 
like this is appropriate, and allow the professionals behind 
the scenes to do their jobs.
    I just wanted to say that. And----
    Secretary Azar. And if I could, I agree entirely. I think 
the President's role has been actually critical in keeping the 
country calm in this situation. He has expressed the levels of 
doubt and uncertainty with his words that we have but also 
tried to be reassuring to the American public as we also try to 
be transparent about what the risks are coming forward.
    We all have different roles to play here, as you said, and 
the President is a very important one, guiding towards balance, 
maturity, and calm in addressing a public health emergency.
    Mr. Bucshon. I would agree. I mean, if the President came 
out and incited a panic; he would be criticized for that.
    So I guess, you know, we had this unprecedented containment 
strategy when things were in China. Now that we know we have 
had problems with person-to-person transmission in Italy and 
South Korea and maybe other places, does that change our 
current containment strategy?
    And, Dr. Redfield, maybe you can address that.
    Dr. Redfield. Yes. I would say first that we are 
maintaining aggressive containment. I want to say that, of all 
the strategies we have used in this multilayer strategy, the 
most important one we have is an astute medical and public 
health community in the United States. Of those 14 cases 
originally that were diagnosed, only one was picked up by the 
screening.
    So we are now moving, obviously, to educate the American 
Medical and public health community that it is not just China; 
we have to worry about now; we have to worry about certain 
places of Italy and Iran and whether it is the Republic of 
Korea. So we are continuing with that.
    And we are continuing to look at our travel alerts. You 
know, we have put the travel alert to Level 3 now for Korea and 
Level 2 now for Italy, Iran, and Japan, trying to let the 
American public know this may not be the time to go to those 
areas.
    Mr. Bucshon. OK. Great.
    And, again, for you, Secretary Azar, do you have anything 
to add to that? OK.
    Again, Dr. Redfield, as far as the testing goes, the CDC, 
12 other public health laboratories have the testing, but I 
guess they had some difficulty with the third reagent in the 
test. And can you further explain the problems with the test? 
And have those problems been resolved?
    Dr. Redfield. So, first, the test really measured three 
different--let's just say, three different nucleic acid pieces. 
And one of them had a control; the third one had a control. 
And, in that control, there was low-level contamination.
    There was never any question about whether the test could 
tell positive----
    Mr. Bucshon. OK.
    Dr. Redfield [continue]. Or negative. It just had a group 
of individuals that we had to say we didn't know.
    Mr. Bucshon. OK.
    Dr. Redfield. Those samples, again, were at CDC. CDC has 
continued, we have doubled--I found out we are at 350 to 500 
samples a day, when the question was asked earlier, that we are 
running right now.
    Mr. Bucshon. OK. So the problem has been resolved, 
basically?
    Dr. Redfield. The problem is being resolved. We work with--
--
    Mr. Bucshon. OK.
    Dr. Redfield [continue]. The FDA. And we have a fix that is 
supposed to be operationalized this week.
    Mr. Bucshon. One other quick thing. Have you guys conducted 
disease modeling for a potential COVID-19 outbreak in the U.S.?
    Dr. Redfield. We do have modeling groups. It is a global 
modeling group that is looking at a variety of different 
models. And that is in process. As Tony said earlier, there is 
still a number of things we don't quite know about this virus 
to make those models available for prime time, but we are 
working it.
    Mr. Bucshon. You are working on it. OK. Thank you very 
much.
    I yield back.
    Ms. Eshoo. The gentleman yields back.
    I think that concludes the questions that we have for you 
today. Thank you to each one of you.
    Mr. Secretary, you have been here for many hours, and, you 
know, throw a punch, take a punch, right? But we are all here 
for our fellow Americans--for our fellow Americans.
    And I think if there is anything that has come out of this 
today, we want facts. We want to bring the temperature down. We 
want to bring the fear factor down. And anything and everything 
that you can do in order to achieve that, as we move on with 
Dr. Fauci's work, with larger distribution of the diagnostics 
through the CDC in partnership with what we have across our 
country, is going to go a long way.
    So thank you to each one of you.
    I am not going to adjourn. You can get up and leave while I 
read a very long record of items that need to be placed into--
--
    Secretary Azar. Thank you, Chairwoman.
    Ms. Eshoo [continue]. The record.
    Thank you. God bless you and your work on behalf of the 
American people. Thank you.
    All right. I am going to request--I have a unanimous 
consent request to enter the following documents into the 
record:a June 28 letter from four House committees to HHS and 
CMS regarding the case Texas v. The United States; a December 
2018 letter from four House committees to HHS and CMS regarding 
the case Texas v. The United States; an April 2019 letter from 
five House committees to HHS and CMS regarding the case Texas 
v. The United States; a February 2020 letter from HHS in 
response to the April 2019 joint letter from five House 
committees regarding the case Texas v. The United States.
    The committee actually is still in order. I wanted the 
witnesses to be able to leave, but if anyone wants to gab, take 
it into the side room so that I can read these into the record, 
please.
    A February 2020 letter from HHS in response to the April 
2019 joint letter from five House committees regarding the case 
Texas v. The United States; an October 2019 Washington Post 
article entitled ``Trump Campaign Urges White House to Soften 
Proposed Flavored Vape Ban,'' unquote; an October 2019 
bicameral letter to HHS from two congressional committees 
regarding the increased number of uninsured children in the 
United States; June 2019 letter from the Energy and Commerce 
Committee examining HHS's administration of the Medicaid 
program; a statement from Johnson & Johnson regarding the 
company's response to the coronavirus outbreak; a statement 
from the American Society for Microbiology regarding the 
coronavirus outbreak; a February 2020 article from BioCentury 
entitled, quote, ``Biopharma Industry, Academics Push Back 
Against Demands for Price Controls on COVID-19 
Countermeasures,'' unquote; a January 2020 Wall Street Journal 
opinion piece entitled, quote, ``Pharma to the Rescue,'' 
unquote.
    Are there any objections?
    Without objection, so ordered.
    [The information appears at the conclusion of the hearing.]
    Ms. Eshoo. And the subcommittee will now adjourn. Thank 
you, everyone.
    [Whereupon, at 5:19 p.m., the subcommittee was adjourned.]
    
    
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