    [House Hearing, 117 Congress]
    [From the U.S. Government Publishing Office]

                           EXAMINING THE POLICIES AND
                       PRIORITIES OF THE U.S. DEPARTMENT
                          OF HEALTH AND HUMAN SERVICES

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

                                    HEARING

                                   before the

                        COMMITTEE ON EDUCATION AND LABOR
                         U.S. HOUSE OF REPRESENTATIVES

                        ONE HUNDRED SEVENTEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                 HEARING HELD IN WASHINGTON, DC, JUNE 16, 2021

                                   __________

                               Serial No. 117-20

                                   __________

          Printed for the use of the Committee on Education and Labor

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

             Available via: edlabor.house.gov or www.govinfo.gov

                            __________

                 U.S. GOVERNMENT PUBLISHING OFFICE
    44-857PDF            WASHINGTON : 2022

                        Committee ON EDUCATION AND LABOR

                 ROBERT C. ``BOBBY'' SCOTT, Virginia, Chairman

    RAUL M. GRIJALVA, Arizona            VIRGINIA FOXX, North Carolina,
    JOE COURTNEY, Connecticut              Ranking Member
    GREGORIO KILILI CAMACHO SABLAN,      JOE WILSON, South Carolina
      Northern Mariana Islands           GLENN THOMPSON, Pennsylvania
    FREDERICA S. WILSON, Florida         TIM WALBERG, Michigan
    SUZANNE BONAMICI, Oregon             GLENN GROTHMAN, Wisconsin
    MARK TAKANO, California              ELISE M. STEFANIK, New York
    ALMA S. ADAMS, North Carolina        RICK W. ALLEN, Georgia
    MARK DeSAULNIER, California          JIM BANKS, Indiana
    DONALD NORCROSS, New Jersey          JAMES COMER, Kentucky
    PRAMILA JAYAPAL, Washington          RUSS FULCHER, Idaho
    JOSEPH D. MORELLE, New York          FRED KELLER, Pennsylvania
    SUSAN WILD, Pennsylvania             GREGORY F. MURPHY, North Carolina
    LUCY McBATH, Georgia                 MARIANNETTE MILLER-MEEKS, Iowa
    JAHANA HAYES, Connecticut            BURGESS OWENS, Utah
    ANDY LEVIN, Michigan                 BOB GOOD, Virginia
    ILHAN OMAR, Minnesota                LISA C. McCLAIN, Michigan
    HALEY M. STEVENS, Michigan           DIANA HARSHBARGER, Tennessee
    TERESA LEGER FERNANDEZ, New Mexico   MARY E. MILLER, Illinois
    MONDAIRE JONES, New York             VICTORIA SPARTZ, Indiana
    KATHY E. MANNING, North Carolina     SCOTT FITZGERALD, Wisconsin
    FRANK J. MRVAN, Indiana              MADISON CAWTHORN, North Carolina
    JAMAAL BOWMAN, New York, Vice-Chair  MICHELLE STEEL, California
    MARK POCAN, Wisconsin                JULIA LETLOW, Louisiana
    JOAQUIN CASTRO, Texas                Vacancy
    MIKIE SHERRILL, New Jersey
    JOHN A. YARMUTH, Kentucky
    ADRIANO ESPAILLAT, New York
    KWEISI MFUME, Maryland

                       Veronique Pluviose, Staff Director
                      Cyrus Artz, Minority Staff Director
                                     ------

                                C O N T E N T S

                                  ----------
                                                                       Page

    Hearing held on June 9, 2021.....................................     1

    Statement of Members:
        Scott, Hon. Robert C. ``Bobby'', Chairman, Committee on
          Education and Labor........................................     1
            Prepared statement of....................................     3
        Foxx, Hon. Virginia, Ranking Member, Committee on Education
          and Labor..................................................     3
            Prepared statement of....................................     4

    Statement of Witnesses:
        Becerra, Hon. Xavier, Secretary, U.S. Department of Health
          and Human Services.........................................     5
            Prepared statement of....................................     8

    Additional Submissions:
        Comer, Hon. James, a Representative in Congress from the
          State of Kentucky:
            ``Biden admin reroutes billions in emergency stockpile,
              Covid funds to border crunch,'' Politico, May 15, 2021.    93
        Good, Hon. Bob, a Representative in Congress from the State
          of Virginia:
            ``Becerra's cautious border play rankles White House,''
              Politico, May 10, 2021.................................   102
        Harshbarger, Hon. Diana, a Representative in Congress from
          the State of Tennessee:
            ``Xavier Becerra is wrong that no law addresses partial-
              birth abortion," PolitiFact, May 19, 2021..............   109
        Questions submitted for the record by:
            Chairman Scott...........................................   113
            Ranking Member Foxx......................................   117
            Sablan, Hon. Gregorio Kilili Camacho, a Delegate in
              Congress from the Commonwealth of the Northern Mariana
              Islands................................................   114
            Bonamici, Hon. Suzanne, a Representative in Congress from
              the State of Oregon....................................   115
            Castro, Hon. Joaquin, a Representative in Congress from
              the State of Texas.....................................   116
            Espillat, Hon. Adriano, a Representative in Congress from
              the State of New York..................................   117
            .........................................................
        Comer, Hon. James, a Representative in Congress from the
          State of Kentucky                                             123
            Owens, Hon. Burgess, a Representative in Congress from
              the State of Utah......................................   124
            Miller-Meeks, Hon. Mariannette, a Representative in
              Congress from the State of Iowa........................   124
        Responses to questions submitted for the record by:
            Secretary Becerra........................................   126

                           EXAMINING THE POLICIES AND

                       PRIORITIES OF THE U.S. DEPARTMENT

                          OF HEALTH AND HUMAN SERVICES

                                  ----------

                            Wednesday, June 16, 2021

                      House of Representatives,
                              Committee on Education and Labor,
                                                        Washington, DC.
        The Committee met, pursuant to notice, at 9:01 a.m. via
    Zoom, Hon. Robert C. ``Bobby'' Scott (Chairman of the
    Committee) presiding.
        Present: Representatives Scott, Grijalva, Courtney, Sablan,
    Wilson of Florida, Bonamici, Takano, Adams, DeSaulnier,
    Norcross, Jayapal, Morelle, Wild, McBath, Hayes, Levin, Omar,
    Stevens, Leger Fernandez, Jones, Manning, Mrvan, Bowman, Pocan,
    Yarmuth, Mfume, Foxx, Wilson of South Carolina, Thompson,
    Walberg, Grothman, Stefanik, Allen, Banks, Comer, Fulcher,
    Keller, Murphy, Miller-Meeks, Owens, Good, McClain,
    Harshbarger, Miller, Spartz, Fitzgerald, Cawthorn, Steel, and
    Letlow.
        Staff present: Ilana Brunner, General Counsel; Ijeoma
    Egekeze, Professional Staff; Daniel Foster, Health and Labor
    Counsel; Rashage Green, Director of Education Policy; Christian
    Haines, General Counsel; Alison Hard, Professional Staff;
    Rasheedah Hasan, Chief Clerk; Sheila Havenner, Director of
    Information Technology; Eli Hovland, Policy Associate; Carrie
    Hughes, Director of Health and Human Services; Ariel Jona,
    Policy Associate; Andre Lindsay, Policy Associate; Yonatan
    Moskowitz, Oversight Counsel--Labor; Mariah Mowbray, Clerk/
    Special Assistant to the Staff Director; Kayla Pennebecker,
    Veronique Pluviose, Staff Director; Theresa Thompson,
    Professional Staff; Banyon Vassar, Deputy Director of
    Information Technology; Cyrus Artz, Minority Staff Director;
    Rob Green, Minority Director of Workforce Policy; Taylor
    Hittle, Minority Professional Staff Member; Amy Raaf Jones,
    Minority Director of Education and Human Resources, Dean
    Johnson, Minority Legislative Assistant; Georgie Littlefair,
    Minority Legislative Assistant; John Martin, Minority Workforce
    Policy Counsel, Hannah Matesic, Minority Director of
    Operations; Maureen O'Toole, Minority Press Assistant; Alex
    Ricci, Minority Professional Staff Member; and Mandy
    Schaumburg, Minority Chief Counsel and Deputy Director of
    Education Policy.
        Chairman Scott. The Committee on Education and Labor will
    come to order. Welcome to everyone and I note that a quorum is
    present. The Committee is meeting today to hear testimony on
    ``Examining the Policies and Priorities of the U.S. Department
    of Health and Human Services.''
        This is an entirely remote hearing and as such the
    Committee's hearing room is officially closed. All microphones
    will be kept muted as a general rule to avoid unnecessary
    background noise, and Members and witnesses will be responsible
    for unmuting themselves when they're recognized to speak, or
    when they wish to seek to be recognized.
        If a Member or witness experiences technical difficulties
    during the hearing please stay connected to the platform, make
    sure that you're muted and use your phone to immediately call
    the Committee's IT director whose number was provided for you
    in advance.
        Should the Chair experience technical difficulties and need
    to step away, Mr. Morelle or any other Majority Member, is
    hereby authorized to assume the gavel in the Chair's absence.
        In order to ensure that the Committee's five-minute rule is
    adhered to, the staff will be keeping track of time using the
    Committee's field timer which is designated in its own
    thumbnail picture designated 001_timer and will show a blinking
    light when the time is up.
        As a courtesy to our witness and to get to our questions as
    soon as possible, we will forego the customer roll call.
    Pursuant to Committee Rule 8(c) opening statements are limited
    to the Chair and the Ranking Member, and now I'll recognize
    myself for the purpose of making an opening statement.
        Today we are meeting to discuss the Department of Health
    and Human Services Budget Request for Fiscal Year 2022, and to
    examine the Department's policies and priorities. Secretary
    Becerra, thank you for coming today and thank you for your
    time. I fondly remember a time when we both served on this
    Committee, as well as the judiciary Committee, and I'm pleased
    to welcome you back.
        We look forward to discussing your vision to ensure all
    Americans access to high-quality healthcare. The importance of
    maintaining a strong public health system has never been more
    apparent. Regretfully, we are mourning the grim milestone of
    600,000 COVID-19 deaths in the United States. Many of these
    deaths could have been prevented by a coherent response to the
    pandemic.
        For example, last night I attended an event at the
    Philippine Embassy, and I was informed that they had suffered
    20,000 deaths. The United States is three times bigger than the
    Philippines, so at their rate we would have suffered 60,000
    deaths, not 600,000 deaths.
        Fortunately, the Biden/Harris Administration is taking an
    evidence-based approach to reinvesting in the well-being of our
    families and communities, most notably the Administration has
    worked with Congress to enact The American Rescue Plan which
    helped more than half of our Nation's adults get fully
    vaccinated, protected children from abuse and neglect, and
    expanded access to child nutrition and put us on track to
    cutting the child poverty rate about in half.
        We addressed rising rates of domestic and gender-based
    violence, strengthened support for older Americans, and
    expanded access to affordable healthcare. These investments
    have saved lives and reaffirmed that when we invest in the
    health of our communities, we provide people with the tools to
    care for themselves and their loved ones.
        However, severe challenges are still ahead. Secretary
    Becerra you inherited a department that consistently sabotaged
    the Affordable Care Act, and jeopardized access to healthcare
    for millions of Americans.
        Today we look forward to hearing how the Department's
    budget request, the American Jobs Plan, and the American
    Families Plan will finally help defeat the pandemic and extend
    access to high-quality healthcare for people across the Nation.
    Again, thank you for being with us today.
        [The statement of Chairman Scott follows:]

            Statement of Hon. Robert C. ``Bobby'' Scott, Chairman,
                        Committee on Education and Labor

        Today, we are meeting to discuss the Department of Health and Human
    Services budget request for Fiscal Year 2022 and examine the
    Department's policies and priorities.
        Secretary Becerra, thank you for coming today and thank you for
    your time. I fondly remember our time when we both served on this
    Committee, as well as the Judiciary Committee, and I am pleased to
    welcome you back. We look forward to discussing your vision for
    ensuring all American access to high-quality health care.
        The importance of maintaining a strong public health system has
    never been more apparent. Regretfully, we are mourning the grim
    milestone of 600,000 COVID-19 deaths in the United States. Many of
    these deaths could have been prevented by a coherent response to the
    pandemic.
        For example, last night I attended an event at the Philippine
    Embassy, and I was informed that they had suffered 20,000 deaths. The
    United States is three times bigger than the Philippines, so at their
    rate, we would have suffered 60,000 deaths--not 600,000 deaths.
        Fortunately, the Biden-Harris Administration is taking an evidence-
    based approach to reinvesting in the well-being of our families and
    communities.
        Most notably, the Administration has worked with Congress to enact
    the American Rescue Plan, which:

       Helped more than half of our Nation's adults get fully
            vaccinated,

       Protected children from abuse and neglect and expanded
            access to child nutrition,

       Put us on track to cutting the child poverty about in half,

       Addressed rising rates of domestic and gender-based
            violence,

       Strengthened support for older Americans, and

       Expanded access to affordable health care.

        These investments have saved lives and reaffirmed that, when we
    invest in the health of our communities, we provide people with the
    tools to care for themselves and their loves ones.
        However, severe challenges are still ahead. Secretary Becerra, you
    inherited a Department that consistently sabotaged the Affordable Care
    Act and jeopardized access to health care for millions of Americans.
        Today, we look forward to hearing how the Department's budget
    request, the American Jobs Plan, and the American Families Plan would
    finally help defeat the pandemic and expand access to high-quality
    health care for people across the country.
        Again, thank you, for being with us today. I will now recognize the
    Ranking Member of the Committee, the gentlelady from North Carolina,
    Dr. Foxx.
                                     ______

        Chairman Scott. I will now recognize the Ranking Member of
    the Committee, the gentlelady from North Carolina Dr. Foxx.
        Ms. Foxx. Thank you, Mr. Chairman. There's absolutely no
    reason why this event should not be conducted in person in the
    Committee hearing room. Vaccines were taken, mask guidance was
    changed, yet Democrats are pursuing permanent pandemic policies
    to exert more control over people's lives.
        And there's absolutely no reason why we should not treat
    every witness we have with respect and not do the roll call and
    waste everybody's time. The Biden administration inherited a
    pandemic that was winding down, but the Administration now
    creating several new crises all on its own.
        There's a crisis at the border. Human traffickers and drug
    smugglers are ubiquitous and rampant. The Secretary of the
    Department recklessly packed children in the holding cells well
    beyond capacity limits. There's a crisis in our school system,
    students are most likely from 6 months to a year behind in
    their studies because the Biden administration insists on doing
    the bidding of teachers' union's leadership.
        There's a mental health crisis caused by Democrats'
    mandated, isolation policies. Our children, particularly our
    young girls, are attempting suicide at staggering and
    mortifying rates. There's an inflationary economic crisis,
    prices on consumer goods are skyrocketing because of the
    Democrats' failed stimulus policies and energy policies.
        And what did this Administration do with these self-imposed
    catastrophes it thrust upon the American people? The Biden
    administration proposed the most outrageous budget proposal in
    the history of our Nation. The Democrats' bloated budget
    panders to the Democrats' most extreme socialist allies and
    leaves working class Americans to fend for themselves.
        Furthermore, the President's radical healthcare proposals
    shatter the bedrock of America's healthcare system, employer-
    sponsored health insurance, cheered on by socialist supporters
    in Congress. Obamacare 2.0 will be a disaster.
        The President's morally repugnant budget also forces the
    public to fund abortions. Secretary Becerra has much to explain
    and unpack at today's hearing, and Committee Republicans look
    forward to getting answers. With that Mr. Chairman I yield
    back.
        [The statement of Ranking Member Foxx follows:]

               Statement of Hon. Virginia Foxx, Ranking Member,
                        Committee on Education and Labor

        There is absolutely no reason why this event should not be
    conducted in person in the Committee hearing room. Vaccines were taken,
    mask guidance has changed, yet Democrats are pursuing permanent
    pandemic policies to exert more control over people's lives.
        The Biden administration inherited a pandemic that was winding
    down, but the administration is now creating several new crises all on
    its own.
        There is a crisis at the border. Human traffickers and drug
    smugglers are ubiquitous and rampant. The Secretary's Department
    recklessly packed children into holding cells well beyond capacity
    limits.
        There is a crisis in our school systems. Students are most likely
    from 6 months to a year behind in their studies because the Biden
    administration insists on doing the bidding of teachers' union
    leadership.
        There is a mental health crisis caused by Democrats' mandated
    isolation policies. Our children, particularly our young girls, are
    attempting suicide at staggering and mortifying rates.
        There is an inflationary economic crisis. Prices on consumer goods
    are skyrocketing because of the Democrats' failed stimulus policies.
        And what does this administration do with these self-imposed
    catastrophes it thrust upon the American people? The Biden
    administration proposes the most outrageous budget proposal in the
    history of our Nation. The Democrats' bloated budget panders to the
    Democrats' most extreme socialist allies and leaves working class
    Americans to fend for themselves.
        Furthermore, the President's radical health care proposals shatter
    the bedrock of America's health care system--employer-sponsored health
    insurance--cheered on by socialist supporters in Congress. Obamacare
    2.0 will be a disaster.
        The President's morally repugnant budget also forces the public to
    fund abortions.
        Secretary Becerra has much to explain and unpack at today's hearing
    and Committee Republicans look forward to getting answers.
                                     ______

        Chairman Scott. Thank you. Without objection all other
    Members who wish to insert written statements into the record
    may do so by submitting them to the Committee Clerk
    electronically in Microsoft Word format by 5:00 p.m. on June
    23, 2021. I'll now introduce our witness.
        The Honorable Xavier Becerra is the 25th Secretary of the
    Department of Health and Human Services, and the first Latino
    to hold office in the history of that office in the history of
    the United States. Previously he served 12 terms in Congress,
    so welcome back as well as serving as Attorney General for the
    sake of California.
        We appreciate the Secretary for participating today and
    look forward to your testimony. Your written statement will
    appear in full in the hearing record. You are asked to limit
    your own presentation to about a five-minute summary. After
    your presentation as you know we'll move to Member questions.
        The witness is aware of the responsibility to provide
    accurate information to the Committee, and therefore will
    proceed directly with his testimony. Secretary Becerra, it's
    good to see you today, you're now recognized for five minutes.

    STATEMENT OF HON. XAVIER BECERRA, SECRETARY, U.S. DEPARTMENT OF
                       HEALTH AND HUMAN SERVICES

        Secretary Becerra. Chairman Scott, Ranking Member Foxx, and
    Members, thank you for the opportunity to be before you, and
    great to be with so many friends and colleagues from the past.
    The Department of Health and Human Services is at the center of
    many challenges facing our country today.
        The COVID-19 pandemic has shed light on how health
    inequities and inefficient Federal funding can leave
    communities vulnerable to crises. So, now more than ever, we
    must ensure that the Department has the resources to achieve
    its mission and build a healthier America.
        For HHS, the budget proposed $131 billion in discretionary
    budget authority, and $1.5 trillion in mandatory funding. This
    budget underscores the Administration's commitment to prepare
    the Nation for the next public health crisis, to expand access
    to affordable healthcare, to address health disparities, to
    tackle the opioid and other drug crises, and to invest in other
    priority areas like maternal health, tribal health, and early
    childhood education.
        Of course, the fight against COVID-19 is not yet over, but
    even as HHS works to beat this pandemic, we must prepare for
    the next public health crisis. To start, this budget makes
    significant investments in our preparedness and response
    capabilities, including investing in strategic national
    stockpile, and our public health workforce. It provides a new
    mandatory funding stream for the manufacturers of medical
    countermeasures here at home to protect America from future
    pandemics, and to create U.S. jobs.
        The budget also includes the largest Fiscal Year investment
    in the CDC in almost two decades. The budget reflects the
    President's commitment to expand access to quality affordable
    healthcare for all Americans, it builds on the groundbreaking
    reforms introduced in the American Rescue Plan by permanently
    extending the enhanced premium subsidies that put affordable
    healthcare coverage within reach for millions more Americans.
        The budget also expands access to home and--community-based
    services under Medicaid, critical services that allow older
    Americans and our loved ones with disabilities to live
    independently in their homes and communities.
        And the budget calls on Congress to take additional steps
    this year to lower the costs of prescription drugs, and further
    expand and improve health coverage through additional benefits
    and public coverage options. Healthcare must be a right, not a
    privilege, and we will work to ensure that families across the
    Nation are able to secure the healthcare they need.
        As we work to expand access to affordable healthcare and
    address the challenges of COVID-19 and future pandemics, we
    need to address public health crises that are already here,
    like violence in our communities, and climate change. The
    President's budget increases funding to support domestic
    violence survivors.
        It addresses gun violence by doubling funding for firearm
    violence prevention research, and it allows HHS to play a major
    role in the Administration's government-wide efforts to tackle
    the climate crisis by supporting research and programs
    identifying the human health impacts of climate change and
    establishing an office of climate change and health equity.
        To ensure that HHS is equitably serving all Americans, the
    budget invests in reducing maternal mortality and morbidity
    that disproportionately impacts women of color. It builds on
    the American Rescue Plan's State option to extend Medicaid
    postpartum coverage.
        It funds a range of rural healthcare programs and expands
    the pipeline for rural health providers. It includes a dramatic
    funding increase, and advance appropriations for the Indian
    Health Service, and it invests in improving access to vital
    reproductive and preventative care services through Title X. To
    support families and build the best possible future for our
    children, the budget makes major investments to ensure high-
    quality childcare is affordable to low-and middle-income
    families, and it provides high-quality pre-K for all three- and
    four-year olds.
        I think we all know that our experiences as children shape
    the adults we've become, supported childhood leads to success
    in the future. To address COVID-19's unprecedented acceleration
    of substance use and mental health disorders, the budget makes
    historic investments in SAMSA to support research prevention,
    treatment, and recovery services.
        To support innovation and research, the budget increases
    funding for NIH by 9 billion, 6 and a half billion of which
    will go to establish the Advance Research Projects Agency for
    Health, or ARPAH with an additional focus on cancer and other
    diseases such as diabetes and Alzheimer's.
        This major investment in Federal research and development
    will leverage ambitious ideas to build transformational
    innovation through health research and the application and
    implementation of health breakthroughs.
        Finally, to ensure our funds are used appropriately, the
    budget invests in program integrity, including efforts to
    combat fraud, waste, and abuse in Medicare, Medicaid, and
    private insurance. Mr. Chairman, I'd like to close by
    recognizing the women and men at HHS for their outstanding and
    tireless work fighting COVID-19 to protect the health of their
    fellow Americans.
        To build back a prosperous America we need a healthy
    America. We've taken important steps over the past few months
    to beat back this pandemic, to expand access to quality
    affordable healthcare, to lower health insurance premiums, and
    to protect women's health at home and abroad.
        President Biden's budget requests build on that progress.
    Thank you.
        [The prepared statement of Secretary Becerra follows:]

                   Prepared Statement of Hon. Xavier Becerra

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Chairman Scott. Thank you. Thank you very much. We'll now
    get to Member questions beginning with the gentleman from
    Arizona Mr. Grijalva.
        Mr. Grijalva. Thank you very much Mr. Chairman and thank
    you for being here Secretary Becerra. It's good to see you
    again my friend, and glad to have you in this very important
    and vital role and leadership that you've earned as Secretary
    of Health and Human Services.
        As you have heard already today, and the drumbeat will
    continue that it is your fault, and by extension the fault of
    the Biden administration for any perceived or real ills that
    are affecting the American people. The attack on January 6 on
    our democracy forgotten; just a mere walk in the park.
        Four years under the previous Administration of concerted
    efforts to dismantle healthcare, aggravate the disparity that
    already exists, undercut and sabotage Obamacare, that didn't
    occur. The tax cuts to the super wealthy that have skewed and
    affected the services that the American people need and demand
    from their government, and the punitive refugee and immigration
    policies that were the hallmark of the previous administration.
        So yes, recovering from those is difficult, and it's going
    to continue to be difficult, but I'm glad to have you in that
    role Secretary to lend some leadership, some rationality and
    some empathy and compassion to those issues that the American
    people need addressed, and need addressed quickly.
        I think the efforts in your budget reflect that, and I'm
    proud to support it. Two questions that we saw during the
    pandemic responses. First, the lack of the response, but as a
    response undertook itself and certainly under the leadership of
    the Biden administration even more so, the role of public
    health departments, county based public health departments, how
    important they became in the vaccination process and the
    outreach process, in the testing process, and what role do you
    see for public health going forward in those departments in
    particular, and what in the budget do you see as reflecting
    that?
        The other issue is childcare. That is a glaring need in
    this country for working parents, and particularly for working
    moms, how do you see that in the budget being reflected, and
    with that I'll turn that back over you to Secretary, for your
    response to that thank you.
        Secretary Becerra. Congressman, great to see you, thank you
    for the question. Public health one of the most important
    lessons we've learned is how ill-prepared this country was to
    reach everyone in America who needed help when it came to
    COVID. And part of the problem was we didn't have a good
    partnership and a clear safety net where we were interconnected
    with our public health colleagues at the State and local level.
        And what we should learn from that is that we should never
    again allow those gaping holes to exist in our national public
    health safety network. We are working closely with our
    partners. We are providing guidance and support, not just
    simply mandates, and so we allow on the groundwork to be done
    by those closest to that work, but we will be there to support.
    We will not ever again I hope return to the day when we tell
    people you're on your own.
        It is time for us to work together, public health must be
    addressed. We don't want to see another pandemic, and that's
    why we're preparing with our State and local partners to be
    ready to provide everyone in America with the healthcare that
    they need, and for that you need a strong, safety net of public
    health.
        The second question was childcare.
        Mr. Grijalva. Childcare.
        Secretary Becerra. Yes. I hope that you all succeed in
    passing the American Family Plans that the President has
    introduced, because it will be a generational type of
    investment in our kids. We know that barely one in seven
    children who qualify, who is eligible to receive childcare has
    a chance to get it, and we want toto change that.
        We saw again with COVID what happens when you don't have
    adequate childcare, when you don't pay people who provide
    childcare services enough, and we can't experience that again.
    It's not just important for the health of our families, it's
    important for the health of our economy.
        Mr. Grijalva. Mr. Chairman thank you so much and I yield
    back.
        Chairman Scott. Thank you. Next will be the gentleman from
    South Carolina, Mr. Wilson.
        Mr. Wilson. Thank you, Mr. Chairman and thank you Ranking
    Member Virginia Foxx. Mr. Secretary, I agree very much with
    Ranking Member Virginia Foxx that we should be in-person. I
    think it's actually insulting that we're not in person for you
    to be able to speak to the American people, for us to be
    present with you to speak to the American people.
        We can always remember that the architect of Obamacare,
    Jonathan Gruber, said that it was built on the stupidity of the
    American people, and that means that we need to be open and
    transparent and somehow be working together in a bipartisan
    manner, but it can't be done with the level of isolation that I
    see here today.
        Mr. Secretary in light of the recent cybersecurity threats
    I was grateful to represent a Savannah River site in South
    Carolina and George to see that the HHS is taking initiative to
    increase cybersecurity for the radiation dose reconstruction
    program affecting claimants under the Energy Employees
    Occupational Illness Compensation Program Act.
        Unfortunately, as a result the National Institute for
    Occupational Safety and Health established a temporary
    moratorium of completing dose reconstructions. A key process
    for many claimants with cancer, meaning that workers from sites
    like the Savannah River site that I represent, will not be able
    to proceed with their claims.
        What if any immediate alternatives could be done to by
    NIOSH to implement, to ensure these claimants can proceed with
    their claims during the period, especially for those that are
    terminally ill?
        Secretary Becerra. NIOSH plays a very important role along
    with the Department of Labor trying to make sure we're
    protecting the health and safety of our workers. The research
    that we do is indispensable. We will continue to do that work.
    We understand that COVID has disrupted many things, and what I
    can commit to you is that if you believe that there's more that
    we can be doing, we can work with you.
        Please inform your team to reach out to my team, and we
    will work with you if you believe there's something more that
    we should be doing at NIOSH.
        Mr. Wilson. Well, thank you and in fact I've got a really
    talented young lady Emily Saleeby who will be in touch with
    your staff right away.
        Secretary Becerra. We'll be waiting for her call.
        Mr. Wilson. Well, hey, she's available 24 hours a day, 7
    days a week. It's really good. Mr. Secretary the policies
    contained in H.R. 3, Speaker Pelosi's partisan drug pricing
    scheme, will stifle the very innovation that contributed to the
    America's Wuhan virus vaccine success.
        I'm grateful to cosponsor H.R. 19, the Lower Cost More
    Cures Act, which is produced by Ranking Members Kathy Morris
    Rogers, Kevin Brady, and especially Congresswoman Virginia
    Foxx. Every provision in H.R. 19 is a bipartisan solution to
    drug pricing issues. Just last Congress we sent 15 bipartisan
    provisions of the Lower Cost More Cures Act to President Trump
    that he signed into law.
        The last thing I believe is that we need for government to
    hinder private sector investments to the ability of drug
    companies to develop treatments and vaccines, especially during
    a pandemic. With the White House Council of Economic Advisers,
    and even the Congressional Budget Office in agreement that H.R.
    3 would lead to fewer new drugs being produced over the next
    decade, do you agree that H.R. 3 will have a negative impact on
    the private sector's ability to development treatment and cures
    for patients which we encounter when we do encounter another
    pandemic?
        Secretary Becerra. I think you and I and everyone agrees
    regardless of what the legislation is that we have to reduce
    the cost of prescription medication. We have to make vaccines
    available to all, and that requires us to continue to have the
    infrastructure in this country, both public, but also
    importantly private; the private research and manufacturing
    capabilities to put out the vaccines as we've seen occur with
    COVID.
        And what I will tell you is the President has been very
    committed and he's been very public about this that he wants to
    see the price of drugs go down, and he is willing to work with
    anyone. H.R. 3 is a proposal that not only reduces the price of
    prescription medication, but it also saves the government quite
    a bit of money. But there are other proposals as you mentioned,
    and we are open to considering any proposal that reduces the
    price of prescription medication and protects the American
    people.
        Mr. Wilson. Well, thank you and indeed, I'm so grateful for
    the leadership of the Congresswoman Virginia Foxx, and I know
    she'd be happy to meet with you and explain the benefits and
    the superior status of H.R. 19 to3, and with that I yield back.
    Thank you.
        Chairman Scott. I thank both of our questioners for staying
    within time. I forgot to ask people to maintain their time
    because if everybody goes 1 minute over, we'll be almost an
    extra hour in the hearing, so we're going to try to keep
    exactly to five minutes, and I appreciate the first two who are
    complying before I gave the warning.
        And next will be the gentleman from Connecticut, Mr.
    Courtney.
        Mr. Courtney. Thank you, Mr. Chairman and Mr. Secretary
    it's very exciting to see you here today as one of our former
    colleagues. Congratulations on your confirmation, and also
    congratulations on your great work as Attorney General in
    California.
        You again, were one of the AG's that stepped forward to
    defend the Affordable Care Act, and with passage of the
    American Rescue Plan which we have now already seen in the very
    short space and time that well over a million new Americans
    have now enrolled in qualified health plans as well as there's
    an expansion on the Medicaid side, so your work was not in
    vain. It was really critical to stand up in the ACA's hour of
    need.
        I also want to thank you for your great work in terms of
    protecting defrauded student borrowers. The news yesterday that
    Secretary Cardona who hails from the State of Connecticut was
    finally going to discharge the debt of defrauded student
    borrowers from ITT Tech that's about 72,000 borrowers across
    the county who got totally ripped off by that institution in
    the last administration.
        I mean just disgracefully was refusing to provide relief
    for those students. Again, as Congresswoman Hayes can attest
    there's well over about 1,000--2,000 kids in Connecticut that
    are going to get relief from that order, so again your work as
    AG was not in vain.
        Mr. Secretary I wanted to focus for a minute on a COVID
    policy which HHS adopted, which I support, which is they
    basically suspended the 3-day hospitalization rule for Medicare
    patients to get coverage upon discharge from hospital. This has
    been a persistent problem over the years in terms of the way
    hospitals were coding patients as outpatient as opposed to
    inpatient, and we just have horror stories over the years of
    elderly patients with broken hips, ribs, who in some instances
    were in hospital for 5, 6, 7, sometimes 12 days, and then found
    out that they did not qualify for follow-on rehab care for
    their injuries because of the way they were coded as
    observation status, not inpatient.
        Again, HHS suspended that rule during the pandemic, which I
    think was a smart move. And I would like to at least flag this
    issue. There is a bipartisan bill H.R. 3650. It is supported by
    over 30 geriatric groups including ARP, the Committee to save
    social security and Medicare, and many provider groups like the
    ER docs and other to really get rid of this surprise billing on
    steroids, because that really is what happens to patients when
    they again find out that they were coded in the wrong bucket
    and lose this coverage.
        Again, it's a very specific issue. I don't want to put you
    on the stop this minute, but I want to flag it for you that you
    know as the emergency order sunsets that the system is going to
    snap back to where it was before, and we want to work with the
    Department to either enact 3650, or get some policy, and I
    don't know whether you just want to react and comment. I do
    have one other question.
        Secretary Becerra. Congressman first, great to see you
    again, and actually I'm aware of this. I look forward to
    working with you. You understand that this is a statute we have
    some constraints in what we can do, but we are absolutely
    willing to work with you. President Biden is committed to
    expand access to care, not reduce it, so definitely look
    forward to working with you.
        Mr. Courtney. Well, thank you, and you're right, we do need
    to move forward by law, but the good news is we now have some
    data during the pandemic to show that maybe some of the cost
    issues that have raised concerns in the past really in some
    ways allowing people to get the care that's medically
    prescribed that actually reduces hospital readmissions.
        And again, just really quickly on H.R. 3, I just would not
    that that bill, the savings that accumulates which you
    mentioned, a big portion of that is actually getting invested
    in the National Institute of Health. The bill also totally
    protects and preserves the R&D tax credit which pharmaceutical
    companies like Pfizer, you know, utilize and Moderna utilize.
        So, you know we are leaving a framework that still
    encourages investment in R&D, and I think frankly, the
    collaboration of Congress in the CARES Act, other COVID bills
    and the Rescue Plan working with the private sector is a great
    success story, but frankly the taxpayers and patients should
    not have to bear the brunt of unacceptable prices for
    medications like insulin that have been off patent for decades.
        Secretary Becerra. I agree with you Congressman, and we're
    definitely looking forward to working with you and your
    colleagues to get something done to reduce the cost of
    prescription medication.
        Mr. Courtney. Thank you. I look forward to it again.
    Congratulations, it's great to see you.
        Secretary Becerra. Thank you. It's great to see you as
    well.
        Chairman Scott. Thank you, the gentlemen for the minority
    side is the gentleman from Michigan, Mr. Walberg.
        Mr. Walberg. Thank you, Mr. Chairman and Secretary Becerra,
    welcome back to the people's house. I wanted to followup on a
    question that I know you've received in previous hearings, but
    now that you have had some time to talk with your team perhaps
    you have had time to learn more about the rationale.
        In reference to efforts to reduce maternal mortality in the
    Centers for Disease Control and prevent some budget
    justification the budget uses the term on page 14 of that
    document, uses the term of ``birthing people.'' Secretary
    Becerra is there a reason the agency is using the term
    ``birthing people,'' and that's the only spot I've seen in the
    budget, but the term was used birthing people, rather than
    mother in this context. Is there a reason?
        Secretary Becerra. Congressman, thank you for the question
    and let me try to explain as I did the last time that use of
    the word birthing people is an effort to try to be not only
    inclusive, but accurate in the way we describe the individuals
    involved in this particular matter.
        And that would include mothers, that would income women of
    whatever walk of life, but we want to make sure we're
    inclusive, and we want to make sure we're using words that are
    accurate to convey what is going on.
        Mr. Walberg. Well, let me followup with that. At a previous
    hearing you said the goal was to be precise in the language you
    choose. Why is mother not a precise term that's totally
    inclusive in every way, shape, and form? In fact, when we've
    first began hearing that term ``birthing person'' or ``birthing
    people'', mothers and women in general all across my district
    expressed great concern that that was not a precise term, it
    was more given to agriculture, and it was pejorative in their
    mind.
        Mother is a term that is special, it's unique, it speaks
    specifically to the uniqueness of birth itself and who is
    capable of doing that thankfully. Can you provide this
    Committee with a definition of birthing person specifically?
        Secretary Becerra. And thank you for asking the question in
    a thoughtful way, as it does require a thoughtful response.
    Congressman, as you and I know, there are individuals take for
    example a surrogate who will not be the mother of that child.
    There are individuals who do not categorize themselves as being
    male or female, and what we want to make sure is that we are
    not excluding anyone when we use particular terms.
        Certainly, birthing person would include a woman who
    considers herself to be a future mother.
        Mr. Walberg. Well, again, as we see all across the course
    of your budget mother is used but one spot, birthing people is
    put in. There's a concern that there's a camel's nose under the
    tent for social change, and social engineering that goes
    against precise X and XY chromosomes and science itself.
        I express strong opposition to that on behalf of mothers
    and women all across my district, and I believe across this
    country. There's a time when we say what we really mean, and a
    mother is a mother, surrogate or otherwise. The term is
    understood Secretary, I'd encourage you to remove that term.
        Perhaps you could also clarify another issue that has come
    up regarding the Federal law on partial birth abortion. In
    response to several Members of Congress you said you will
    follow that law under Roe v. Wade however, it has not been
    clear if you recognize the law as defined in Section 1531 of
    Title 18 U.S. Code which bans specifically partial birth
    abortion.
        In your response to Representative Joyce at your May 12th
    hearing, you stated that partial birth abortion is not a
    medically recognized term. With all due respect Secretary
    Becerra were you suggesting that doctors would not have to
    follow the law because they used different terms?
        Secretary Becerra. Congressman, thank you again for the
    question and the thoughtful way it was presented. Just as I am
    required to follow the law and do, and will, every physician in
    America must follow the law, and I will repeat what I've said
    before. In this country the law of the land is Roe versus Wade.
        A woman has a right to exercise her choice when it comes to
    reproductive health. We will defend that right, and we will
    protect that right, and we recognize that we must do that
    according to the law that exists in America.
        Mr. Walberg. Well, I encourage you, even though you voted
    against the law that banned partial birth abortion, it is the
    law. Section 1531 of Title 18, Title 18 U.S. Code, with that I
    appreciate your response and I yield back.
        Chairman Scott. The gentleman yields back. Next the
    gentleman from the Northern Mariana Islands, Mr. Sablan.
        Mr. Sablan. Thank you very much Mr. Chairman for this.
    Secretary Becerra, thank you for joining us. Congratulations on
    your new job. You have to make up your mind whether you're
    going to live in the east coast or the west coast. You're
    always welcome here in Congress.
        Mr. Secretary the question
        [inaudible] address the barriers indicated in the
    territories caused by a Medicaid funding gap and an incidental
    local matching rate. Are you familiar with that section of the
    bargain; and if so, can you elaborate on the Administration's
    position on that addressing the disparities in the insular
    areas and territories please?
        Secretary Becerra. First, great to see you again, always
    wonderful to have a chance to work with you and I guess I'm
    familiar with this issue. You and I have worked on these issues
    in the past on behalf of the territories, and the President has
    also been clear where he stands on this issue.
        In his budget he makes it very clear that he supports
    eliminating the Medicaid funding caps for U.S. territories, and
    in aligning Medicaid financing for the territories with that of
    the states.
        Mr. Sablan. Thank you. And I'm going to jump to another
    issue. I have several that I will submit for the record, but
    Mr. Secretary starting in Fiscal Year 2021, HHS is required to
    set aside 75 million for the territories from the full amount
    appropriated in the childcare entitlement states program.
        We find that the 75 million is going to be allotted among
    the territories in proportion to their respective needs. What
    data or formula does HHS use to determine their respective
    needs of each territory? You can answer now or come back with
    me later.
        Secretary Becerra. Congressman let me get back to you on
    the precise data, or the formulation that was used, and I'm
    pretty sure you were asking about childcare, but it's a little
    difficult to understand your question because at least for me
    you were coming in and out, but I think it was regard to
    childcare, and how that funding would work for the territories.
    We can get back to you on that.
        Mr. Sablan. All right. And I will submit this question for
    you to review and give us some answers Mr. Secretary. Let me
    also say before I forget and get to my next question. Mr.
    Secretary I want to thank the men and women in your department,
    the men, and women in various public health agencies throughout
    the Nation, and of course to the American people sir. Just
    today my district in Northern Mariana Islands moved to the
    community vulnerability developing.
        This is great news and since we started this pandemic, I
    think 180-something infections, and of that we have had two
    deaths. In the very, very, beginning from individuals who are
    coming in and were sick before they got here. But of course, we
    couldn't have done any of this sir people say if it weren't for
    the generosity of the American people, and I thank you for all
    the help.
        But my final question Mr. Secretary, Northern Mariana has
    never been eligible for especially in our country, for 5
    percent of the funding from pandemic emergency assistance, or
    set aside for tribal pilot programs. We distributed it in the
    manner deemed appropriate by the HHS Secretary.
        [Inaudible]----funding for the Northern Marianas?
        Secretary Becerra. Congressman absolutely. Let me first say
    that I know the President believes this, and I feel it as well
    that when it comes to pandemics, or any types of crises we all
    reach out to everyone in the American family, and certainly our
    brothers and sisters from the Mariana Islands and the territory
    are part of the American family.
        And so, when it comes to something like a crisis, or where
    it comes to the distribution of funding, we will do at HHS what
    we can to make sure that those funds first go to those in need,
    and we try to do it in a way that lets us show a transparent
    allocation. And so, what we're willing to do is work with your
    office if you'd like your team, to give you a more precise
    answer as to what the Mariana Islands can expect.
        Mr. Sablan. Yes sir, thank you. It is good seeing you again
    Mr. Secretary. Mr. Chairman I yield back.
        Chairman Scott. Thank you. The next I see on the screen is
    the gentlelady from New York Ms. Stefanik.
        Ms. Stefanik. Thank you, Mr. Chairman. Secretary Becerra
    you talked about in your testimony the importance of focusing
    on access to healthcare in rural communities, and I represent a
    very rural district in northern New York.
        One of the challenges we've faced is there was a CMS
    redefinition of the term primary road, this significantly
    narrowed the eligibility criteria, and it's putting many of our
    rural hospitals at risk of losing their critical access
    hospital status. I am working with my colleague, Representative
    Delgado, across the aisle on addressing this issue which is
    particularly challenging because it pulls the rug out from
    under these hospitals, amidst a very challenging once in a
    century pandemic.
        Can you commit to working with both of us on a bipartisan
    basis to address this misguided redefinition because this is
    going to impact rural districts across America?
        Secretary Becerra. Congresswoman, thank you for the
    question. I'll make sure that the team at CMS is aware that
    you're asking this question, and absolutely would commit to
    working with you and your colleagues to see where we can head
    on this.
        Ms. Stefanik. My next question is regarding during the
    Trump administration, President Trump created the Conscious and
    Religious Freedom Division within HHS's Office of Civil Rights
    to review complaints of discrimination against healthcare
    entities that exercise their rights under the law to choose not
    to provide or pay for abortions or other healthcare procedures.
        It is unclear based upon the language in President Biden's
    budget, but do you plan on eliminating the Conscious and
    Religious Freedom Division yes or no?
        Secretary Becerra. Congresswoman, we are going to continue
    the work that it takes to protect the rights of all Americans,
    including religious freedom rights. We're going to do
    everything we can to be as aggressive as possible. My history,
    if you'll take a look at it, is one about defending
    Constitutional and civil rights of all Americans, and as a
    person of faith I can guarantee you that we will do everything
    we can to make sure people are able to exercise their rights
    under the Constitution when it comes to religion, their faith,
    and so forth.
        Ms. Stefanik. So that's a no, that you won't eliminate that
    division?
        Secretary Becerra. We're going to continue to move forward
    in protecting people's rights and having an Office of Civil
    Rights that will continue to protect those. We have a number of
    cases that are coming before us. All of those, if they deal
    with Constitutional civil rights, we under the Office of Civil
    Rights, we'll be protecting those rights.
        Ms. Stefanik. Great. It's a simple question, is it a yes or
    no that you plan on eliminating the Conscious and Religious
    Freedom Division?
        Secretary Becerra. We will do nothing that's against the
    law.
        Ms. Stefanik. So, you won't eliminate it, great. I'll take
    that. You'll do nothing to eliminate thank you. And I am
    familiar with your record while you were Attorney General of
    California, HHS found the State of California to be in
    violation of Federal law by imposing universal abortion
    coverage mandates.
        I just want to reiterate on the record do you commit to
    upholding the enforcement of Federal conscious protections and
    religious freedom laws, including the Weldon Amendment?
        Secretary Becerra. Congresswoman we will continue to
    respect and not only follow the law, but enforce the law when
    it's under our jurisdiction, including the religious rights of
    Americans.
        Ms. Stefanik. Great. So, the answers I've gotten today are
    thank you for being willing to work with us on a bipartisan
    basis on the rural healthcare issue. No, there will not be an
    elimination of the Conscious and Religious Freedom Division,
    and commitment to upholding Federal law when it comes to
    conscious protections, thank you I yield back.,
        Chairman Scott. Thank you. Next will be the gentlelady from
    Florida Ms. Wilson.
        Ms. Wilson. Good morning. I could hear you.
        Chairman Scott. I could hear you.
        Ms. Wilson. Good morning, everyone, and Secretary Becerra
    welcome home. We are so proud of you, and everything that you
    have accomplished, and you've earned it all, so God bless you
    as you assume this high position, we are so proud of you. I
    just want everyone to remember why we are holding this hearing
    remotely. Our country lost over 600,000 people in a pandemic,
    they died.
        And my district is an epicenter. And people are still
    dying, and they will continue to die until we can vaccinate
    everyone and get rid of all these conspiracy theories and
    misinformation. And Members of Congress are going to continue
    to get sick and to die until all Members of Congress are
    vaccinated.
        Now with that said I just have a couple of questions for
    the Secretary, and I think it would be best if I asked my
    questions in threes, and then you answer them. No. 1, school
    nurses. We have a police officer in every school. We tried to
    do that across the country, and I'm just wondering with what
    has happened during this pandemic do you agree that instead of
    having police officers in every school, we should focus on
    having a healthcare professional at every school?
        I have a bill that I have been filing for years, it's one
    nurse one school, and I filed it through the legislature,
    through the Senate and in Congress, and I want to know how you
    feel about that. Also, the American Rescue Plan includes a
    temporary 5 percent Federal medical assistance percentage
    increase for states to expand Medicaid.
        I'm from Florida. I wrote my Governor a letter asking him
    to expand Medicaid, and I want to know what you would say to
    Governor DeSantis to make him expand Medicaid, because I'm not
    having any luck with it. And then sickle cell anemia, what does
    HHS do to ensure that patients who are Medicaid and Medicare
    beneficiaries have equal access to all of the innovative
    therapeutics that are now available? Those are the first three.
        Secretary Becerra. Congresswoman great questions and great
    to see you. You look the same, I love those hats. First, nurses
    in school. You and I probably remember the days when we were in
    elementary school and we knew that there would be a nurse there
    for us, and what a sin that we don't do that for our children
    today right?
        Especially in our schools most in need to have access to a
    nurse. If you help us pass the American Families Plan, I
    guarantee you we will see far more nurses in our schools
    providing care to our children who really need it, because
    we'll give the resources to our local school districts to do
    that, so I hope we're able to work with you to pass the
    American Families Plan.
        Medicaid expansion, what would I tell any Governor? You got
    elected to care for all the people in your State, not just
    some. We're offering you a deal that is hard to beat. We're
    going to actually help pay for virtually almost 100 percent of
    that cost of that care for that individual who doesn't have
    access to care right now, and hopefully then you'll buy into it
    and find that it makes sense to cover someone, because they
    won't be getting their healthcare at the emergency room, the
    most expensive way to get it now.
        And so, it's a savings not just for you as Governor, it's a
    savings for us as a Federal Government when we get people good
    care, and they start getting the preventative care that keeps
    them from getting really ill and suffering from those chronic
    illnesses in the future that cost so much.
        Finally, sickle cell anemia. Congresswoman I've got to tell
    you, I think there's some bright news on the horizon when it
    comes to sickle cell. Finally, we're beginning to see far more
    investment, but this is where a program like ARPA H is so
    critical, because it lets us zero in on these really difficult
    and devastating diseases and conditions that sometimes because
    they don't hit everyone, are far more expensive to focus on.
        This lets us target some of those like sickle cell, certain
    cancers, Alzheimer's, and actually come up with a solution, so
    I hope you'll be supportive of our efforts to start ARPA H
    which will let us go and save lives.
        Ms. Wilson. Thank you. Quickly, I Chair Higher Ed, so I'd
    like to know how will the HHS budget support CDC engagement and
    technical assistance for colleges and universities in the event
    of an outbreak now that we're opening colleges and
    universities?
        Chairman Scott. If you can be very quick because the time
    has expired.
        Secretary Becerra. Congresswoman I'll simply say that as I
    said before, we can't have holes in our public health network,
    certainly our schools, whether college or K through 12 has to
    be part of that network to protect everyone in the case of a
    pandemic.
        Ms. Wilson. Thank you and I yield back.
        Chairman Scott. Thank you. The gentleman from Georgia Mr.
    Allen.
        Mr. Allen. OK can you hear me, OK?
        Secretary Becerra. Yes sir.
        Mr. Allen. Good. Mr. Secretary thank you for joining us
    this morning and obviously my constituents are concerned with
    the cost of healthcare and certainly, some of the issues
    surrounding you know surprise medical billing and that sort of
    thing. My first question, and again, I don't you know I can't
    tell you where these numbers are coming from, but I'd like to
    know what your agency can give me that will tell me because Mr.
    Scott, Chairman Scott brought up the Philippines this morning
    versus the United States.
        And I understand we pay about 10 times per capita for
    healthcare in the United States versus other nations. Is that
    correct?
        Secretary Becerra. Congressman I can't say that it's 10
    times, but I know compared to the rest of the industrialized
    world America has the most expensive per person cost of
    healthcare. Other countries that provide quality healthcare to
    all their people whether it's Canada, France, Germany, Great
    Britain, they all do it for far less than we do.
        Mr. Allen. Yes, and that might explain why they're coming
    here for healthcare. Mr. Secretary, for each premium dollar in
    taxpayer dollars that is paid into Obamacare, what percent of a
    dollar gets back to take care of a patient?
        Secretary Becerra. All right so I'll get back to you on a
    precise number. If I recall correctly at least close to 80
    percent of any dollar that's spent must be, must go into actual
    care. I know I'm probably off on that number. I remember from
    my days in helping craft the Affordable Care Act back in 2009
    and 10 that we wanted to make sure that the lion's share of any
    dollar that an American consumer puts into healthcare would be
    spent on healthcare, not on marketing, not on profits, and so
    the lion's share of that dollar in the Affordable Care Act must
    be spent on care for that patient.
        Mr. Allen. Right and exactly right now it has to run
    through Washington to get back to take care of a patient, and
    that's what I want to know is exactly what Washington is taking
    out of that dollar. We have about 8 million jobs open in this
    country 10 million people are not working. Of those 10 million
    about 3 and a half million are on enhanced unemployment because
    of the American Rescue Plan.
        Mr. Secretary strong economic growth allows more workers to
    enjoy the benefit of health insurance provided by their
    employers. Do you agree that getting people back to work would
    help decrease the number of uninsured individuals in the United
    States?
        Secretary Becerra. Any time you have a job Congressman, as
    you know, if you're far more capable of affording the
    healthcare that your family needs, but to have a healthy
    economy we need a healthy America, and that's why it's so
    important that we continue to expand healthcare and get people
    back to work.
        If they can get everyone vaccinated, get everyone to be
    safe. I think what we're going to do is see a prosperous
    America moving forward.
        Mr. Allen. We've you know gotten about as I said, about 25
    million work capable Americans trapped on welfare and why does
    the Biden administration budget propose to continue COBRA
    subsidies and expand ACA subsidies which make it more appealing
    not to seek employment?
        Secretary Becerra. Congressman COBRA is a program that's
    been a lifeline for a lot of Americans who lose their job and
    as a result their health insurance attained with the job.
        Mr. Allen. I understand the purpose.
        Secretary Becerra. Well, it gives people a bridge until
    they're able to find other insurance, whether through their new
    employer, or through some other means, whether it's on the
    Affordable Care Act or elsewhere, and what you want to do is
    make sure that you don't have these gaps.
        COVID exposed the gaps that we have in our healthcare
    system. The result of this pandemic is that because of these
    gaps many Americans not only got sick but died. And what we
    want to do is keep Americans alive, and the best way to do that
    is to make sure they have access to good care from the start.
        Mr. Allen. Right. And we want to give those folks an
    incentive to go to work, and then I got two more quick
    questions because I'm about out of time. Do you agree or
    disagree that Americans staying out of the workforce is bad for
    their mental, physical, and economic health?
        Secretary Becerra. Well, certainly we want to make sure
    everyone is ready to go back to work mentally, physically, and
    we want to make sure it's safe, that they've been vaccinated,
    they're not going to infect others, and I don't know many
    Americans. My dad, I don't remember a day when my dad didn't
    work, even though often times he wouldn't be able to do the
    construction job he did because the rain, he always found work.
        And so, I think many Americans are out there looking for
    every good job they can, but let's make sure they're safe, and
    they're vaccinated, and ready to go back to work.,
        Mr. Allen. Well, I'm out of time, but the other question I
    had is surprise medical billing and where we are with that
    rule, and if you could cover that at some point in time in this
    hearing that would be much appreciated. Thank you very much and
    I yield back.,
        Chairman Scott. Thank you. The gentleman's time has
    expired, and I'm sure the surprise billing will come up. I'll
    make sure of that. The gentlelady from Oregon Ms. Bonamici?
        Ms. Bonamici. Thank you, Mr. Chairman. Secretary Becerra
    it's so great to see you, and I'm very grateful that President
    Biden selected you. Congratulations on your confirmation as our
    Secretary of Health and Human Services.
        There are so many important issues within HHS, but I want
    to focus on two because of time limits. The Older Americans Act
    of PBD Services block grant program. The last years have been
    particularly difficult for seniors as they disproportionately
    faced threats to their health and well-being.
        The President's budget proposes 1.1 billion dollars to
    strengthen critical programs for older adults under the Older
    Americans Act and the Elder Justice Act, and this includes
    significant fund for nutrition assistance, vaccination efforts,
    caregivers, so I proud to see the reauthorization of the Older
    Americans Act of 2016 and again in the last Congress, and I
    hope to make similar progress with the Elder Justice issues.
        So, these programs are extremely important to not only my
    constituents in northwest Oregon, but to everyone. In the early
    parts of the pandemic CMS issued guidance on visitation in
    long-term care facilities, and unfortunately there was some
    confusion about the ability of the State long-term care on this
    to maintain access to residents in a pandemic.
        So, in response when Congress passed the CARES Act, which
    included a provision I offered to clarify that the continued
    direct access of other access through the use of technology to
    residents of long-term care facilities for health emergencies.
    Now CMS eventually clarified your guidance, but I'm concerned
    with the early confusion they have denied resident's critical
    protections and oversight.
        So, I am hoping that CMS makes access to this vital
    program, these services for long-term care residents a priority
    going forward. So, what can your department do to make sure
    that these mostly voluntary but very important advocates have
    access to the support that they need to carry out their
    important work.
        Secretary Becerra. Congresswoman, thank you for the
    question, and thanks for pointing out how critical it is that
    we have accurate data, and that we're communicating it well
    because in a pandemic a minute could make the difference
    between someone getting too ill or surviving or not.
        And so, I think at CMS what we're going to try to do is
    recognize that we are the possessors of very valuable data. We
    try to work with our local communities as best we can. Please
    let us know if you think that we're not doing that, but we are
    learning as well. I think CMS learned many important lessons as
    a result of COVID, and how we can try to get information out
    faster.
        But I look forward to working with your team.
        Ms. Bonamici. Thank you, thank you, Mr. Secretary. The
    long-term care Ombudsman program is so important because it
    really provides a voice for residents of long-term care
    facilities. So, I Chair the Civil Rights and Human Services
    Subcommittee, and one of my top priorities this year is to
    advance the long overdue reauthorization of the community
    services block grant program. So, I'm working with Congressman
    G.T. Thompson toward a comprehensive update of CSBG.
        And I know others on the Committee, the public working with
    us to strengthen these vital anti-poverty programs, so I
    particularly just want to thank you for the support for CSBG,
    especially the Administration's budget, I understand since one
    of the few Presidential budgets to propose an increase in
    funding since the program began.
        The nation's community action agencies (or CAAs) are funded
    by the community service block grants, and they have served an
    essential role during the pandemic. So, the CARES Act invested
    a billion dollars to help CAA's standard services, and the
    legislation also raised the CSBG eligibility criteria 200
    percent above poverty line, which provided greater flexibility,
    and I support that increase.
        But what is your view on the role of community service
    block grants as an anti-poverty? Would you commit to working
    with us to provide communities with the flexibilities to
    provide updates to the program that can strengthen the
    abilities of the action agencies to better serve those in need?
        Secretary Becerra. Congresswoman, indispensable. You've
    described why these services are indispensable. Thank you for
    the support and the CARES Act to give us that extra funding.
    The President makes commitment to continue that forward, and if
    you are able to pass the American Families Plan, we can make
    truly generational changing investments in making sure we're
    taking care of our folks.
        Ms. Bonamici. Thank you. And again, the community service
    block grant program has been an essential anti-poverty program,
    and I look forward to working with you and the Administration
    and again committed to this bipartisan approach to make sure
    that we can continue the great work of our community action
    agencies, so thank you, Mr. Secretary, again it's wonderful to
    see you. Thank you for your work and I yield back. Thank you,
    Mr. Chairman.
        Chairman Scott. Thank you. Next is the gentleman from
    Kentucky, Mr. Comer.
        Mr. Comer. Thank you, Mr. Chairman, Secretary Becerra. I
    was able to lead a group of our colleagues on the House
    Oversight Committee down to our southern border in April, this
    to New Mexico and Texas. We spoke to border patrol agents in
    DHS facilities housing unaccompanied children.
        Since then, Vice President Harris is yet to see this crisis
    in person and is honestly blatantly avoiding the realities of
    the crisis situation we have at the southern border. Mr.
    Secretary, isn't it correct that under current law
    unaccompanied minor children who cross the border from
    countries other than Canada and Mexico, are turned over to the
    custody of HHS?
        Secretary Becerra. That's correct Congressman.
        Mr. Comer. Given the sheer number of children who have been
    coming in recent months, isn't it true that HHS stood up a
    dozen emergency intake sites to be able to care for the influx
    of children who were arriving?
        Secretary Becerra. Congressman, we did what we were
    obligated by law to do, and that is to care for these kids, and
    so if we couldn't find a State license facility where you
    typically would send a child for such care, we did what we
    needed to do, establishing, standing up as you said, some of
    these sites to be able to provide those care and the basic
    services that we expect for any child.
        Mr. Comer. And isn't it true as Politico was reporting that
    HHS reallocated 850 million dollars that Congress originally
    allocated to rebuild the Nation's strategic national stockpile
    of medical equipment?
        Secretary Becerra. Congressman we did use the dollars that
    are available to us within our budget to try to pay for these
    services. We could, you know we have a choice, either find the
    money to pay for these, or don't provide the services. By law
    we have to provide the services, and I think our moral
    conscious would tell us that we have to provide the services
    for these children as well.
        Mr. Comer. I know it's a crisis situation. Given the surges
    we've seen do you believe it was prudent for President Biden to
    reverse many Trump policies that were deterring minors from
    making the dangerous journey at the hands of smugglers into our
    country without any plans to replace those policies?
        Secretary Becerra. Congressman I won't weigh into the
    discussion of immigration policy other than to say the
    President made it very clear, whether it's your child, my
    child, or any other child is not going to face harm in this
    country.
        We can't decide the fate of that child. That child may end
    up having to return to the home country. That's an immigration
    process, but what I can tell you at HHS our obligations to make
    sure that while they're here, even if only temporarily, we're
    going to make sure they're cared for.
        Mr. Comer. I don't want any child in harm's way either but
    with all due respect Mr. Secretary, the Biden lack of border
    policy is inviting more and more unaccompanied migrants to make
    that dangerous journey, and I strongly encourage you to
    encourage the President, or the Vice President, if she's still
    in charge of border security, to come up with a plan and take
    this seriously so we can deter the record numbers of
    unaccompanied minors and illegals who will cross that border
    every day.
        Mr. Chairman I'd ask that the political article I
    referenced be entered into the record.
        Chairman Scott. Without objection.
        Mr. Comer. Switching gears Mr. Secretary, I'm also
    concerned with the Administration's waiver of patent
    protections for successful COVID vaccines. I'm afraid that as
    our country begins recovering, we are learning more about the
    lingering effects of COVID on public health. These waivers
    would mean this outlook for the development of boosters and set
    a dangerous precedent for future vaccine developments.
        Mr. Secretary, can you provide some insight into how we
    should prepare for future pandemics if we cannot ensure the
    Federal Government is not devaluing the R and D they worked so
    hard to recover?
        Secretary Becerra. All right, so thanks for the question.
    And as I mentioned in my opening statement, we are already in
    the works preparing for the next pandemic, or next healthcare
    crisis. We don't want to wait.
        We can take the lessons learned from COVID to help protect
    the American people, but I do want to caution that what the
    President said with regard to the TRIPS treaty that we have
    that deals with pharmaceuticals and how those can be
    distributed across the world, he made a commitment to work with
    the WTO to see if there was a way to make those vaccines
    available to the rest of the world quicker.
        He did not waive any authorities. Those are all part of any
    negotiation with regard to those treaties and the treatment of
    the patents and protections that those medications have.
        Mr. Comer. Thank you. Mr. Chair I just want to close with
    this one concern. I'm concerned regarding the inequities and
    the distribution of the provider relief fund. In my
    congressional district of Kentucky, assisted living providers
    who care for over 2,000 elderly individuals across 37
    communities.
        The population that was most vulnerable to COVID were
    allocated less than 1 percent of the provider relief fund,
    that's about 3 billion dollars, and have only received about a
    third of that. The average age of a resident in assisted living
    is 85. These vulnerable individuals need assistance with daily
    activities such as eating, using the restroom, taking
    medication, dressing, et cetera.
        Over 40 percent of assisted living.
        Chairman Scott. The gentleman's time has expired.
        Mr. Comer. Residents have Alzheimer's or some form of
    dementia due to PPE needs, workforce needs, and occupancy
    declines, assisted living, caregivers have suffered over 15
    billion dollars in losses in 2020.
        Chairman Scott. The gentleman's time has expired.
        Mr. Comer. And 230 million in Kentucky alone. I just wanted
    to throw that in there Mr. Chairman. Thank you for Mr.
    Secretary for being here, and I yield back.
        Chairman Scott. Thank you. The gentleman from California
    Mr. Takano.
        Mr. Takano. Thank you, Mr. Chairman. Good to see you Mr.
    Secretary. Congratulations. I'm going to go right into it. Mr.
    Secretary, I want to give you a moment to maybe share with the
    American people, how the President's budget included in the
    American Families Plan calls for an investment of 250 billion
    dollars for childcare expansion. And 200 billion dollars to
    provide high quality universal pre-care over 10 years. How that
    would provide relief to parents and ensure that children are
    cared for in environments that support their learning and
    development.
        Secretary Becerra. Congressman great to see you and thank
    you for the question. I think it's pretty obvious after COVID
    what happened in America when we found parents unable to find
    quality safe childcare for their kids. It disrupts the work
    efforts. It disrupts the child's education.
        I don't think any of us want to experience that again.
    We're still seeing the effects of COVID on families as they try
    to get back to normal. We have to start paying our caregivers
    decent salaries so that we can attract good people to care for
    our kids. It's kind of strange that we are willing to pay a
    scientist or a merchant a great deal of money, but the people
    who train these children to become that successful scientist or
    merchant, we're not willing to pay them good money.
        And so, I think we've learned the investment that the
    President wants to make is so that every child has access to
    decent childcare. We want to make sure every three-and 4-year-
    old has access to pre-K. Those are the kinds of things that are
    good for America, not just for that family or that child.
        So, we look forward to working with you to passing the
    American Families Plan.
        Mr. Takano. I'll work with you. I commit to that sir.
    Secretary Professor Taryn Morrissey of American University has
    said that on average the early care and education settings
    attended by many young children, particularly low-income
    children, or children of color, provide quality at levels too
    low to adequately promote children's learning and development.
        How would the Administration proposals ensure that low-
    income children of color are not left to low quality childcare
    options?
        Secretary Becerra. Well, as you know President Biden has
    made it a commitment. One of the principals of this
    Administration will be equity. And you cannot have equity if
    you're not giving kids access to good quality care regardless
    of where they live.
        Your zip code should not determine the quality of your
    care, and this Administration is committed, and I can tell you
    that not just as Secretary, but as who I am as a person and
    what I have fought for all my life, that, at HHS, we're going
    to make sure that if someone is going to get funding for
    childcare, we're going to make sure that they're held
    accountable to make sure it's good quality care for that child
    and that family.
        Mr. Takano. Thank you for that Mr. Secretary. Secretary, as
    you know, I Chair the Veteran Affairs Committee, and I'm happy
    to report that during the pandemic we had very low infection
    rates, and very low death rates due to the pandemic at our
    community living centers which are a long-term care facilities.
        Similarly, in California Secretary Imbasciani at Cal Vets
    saw that we had veterans homes in California that have
    virtually no infections compared to other settings across the
    country. And as you know 40 percent of our COVID facilities are
    attributed to congregate living centers.
        And I note that under the Trump administration there was a
    relaxation of regulation and oversight through CMS of the for-
    profit facilities across our country. Do you intend to revisit
    the regulatory environment and the oversight environment of
    these facilities? And you know, most importantly the Trump
    administration amazingly you know relieved these facilities of
    their climate to retain infection control expertise. Do you
    have a comment on that?
        Secretary Becerra. Congressman, I may no longer be the
    Attorney General for the State of California, but I take with
    me much of the work that I did to the oversight and
    accountability to make sure that those who receive taxpayer
    dollars to provide services to the American people fulfill
    their commitment, and I can guarantee you, and I mentioned it
    in my opening statement, that program integrity is going to be
    one of the hallmarks of the work that we do to make sure that
    no one is taking advantage of taxpayer dollars, and that people
    receive the care that they're entitled to.
        Mr. Takano. Well, Mr. Secretary, I believe we need to
    really learn the lessons of the pandemic, and just how these
    facilities across the country long-term care facilities could
    see such devastating death rates and infection rates. I'll try
    and talk very quickly. I note that in the territories that
    there's a lack of portability for Medicaid benefits. Is that
    something that we can count on your help to address?
        Secretary Becerra. Congressman absolutely. I addressed that
    earlier, absolutely.
        Mr. Takano. All right. I yield back Mr. Chairman, I kept
    within my five minutes.
        Secretary Becerra. Thank you. Exactly. The gentleman from
    Idaho Mr. Fulcher?
        Mr. Fulcher. Thank you, Mr. Chairman. Mr. Secretary, thank
    you for spending some time with us today. I represent the great
    State of Idaho, and I would like to talk to you about enhanced
    short-term plans (or ESTPs), for a moment. Idaho's ESTPs have
    been a critical option for people in my State who may be
    changing jobs, in temporary employment, or starting a new job
    and awaiting health insurance.
        These plans are comprehensive covering the essential health
    benefits required under the Affordable Care Act. In many cases
    Idaho's ESTPs have higher actuarial values than those offered
    by the Affordable Care Act. Unlike the ACA plans, they can be
    offered anytime throughout the year and have up to a 3-year
    renewal.
        Finally, our State insurance codes consumer protections
    apply to all of our ESTPs. These plans are needed for people
    who don't qualify for an ACAAC subsidy. As people get back to
    work, they will need that kind of flexibility and health
    insurance. The alternative for them is to wait for coverage
    having none if something happens.
        Mr. Secretary, will you commit to working with our State
    officials to ensure there is a workable option with the ESTPs,
    given their success, and given the need to encourage people how
    to have formal access to health insurance as you view short-
    term health plans?
        Secretary Becerra. Congressman, thank you for the question.
    This one's important because we want everyone to be able to
    afford their health insurance coverage. We want everyone to
    have comprehensive plans. You all passed legislation on
    surprise billing because often times people thought they had
    certain levels of coverage and found out when the bill came
    that they didn't.
        We don't want Americans to be duped. And so, what we want
    to make sure is that they get strong affordable coverage that
    they can afford, and I'm sorry that they know they can count
    on. And the ACA provides protections against junk plans that
    don't really provide real services that leave people in the
    lurch holding on to a very expensive bill.
        And so, any plan that can provide quality care guaranteed
    at a good price. we'll be supportive of.
        Mr. Fulcher. Including the enhanced short-term plans?
        Secretary Becerra. Well, if they provide those levels of
    coverage at a good price and don't shock people with bills that
    won't be covered by the insurance company, we are willing to
    look at that. So, what we don't want is for these junk plans to
    proliferate.
        Mr. Fulcher. So, then you will consider ESTPs as an option
    for those people who can't qualify for the subsidy?
        Secretary Becerra. We certainly will take a look at any
    plan that offers high standards for all Americans at affordable
    prices.
        Mr. Fulcher. We as families, certainly in my State. I'm
    sure this applies elsewhere. Many family Members, whether
    schoolteachers or other public servants face what we call the
    family glitch problem, where employees are covered for health
    insurance, but not their spouse or their family. And does HHS
    have a plan to address the cost of coverage for those families,
    and if they make too much to qualify for an ACA subsidy?
        Secretary Becerra. Congressman we are willing to work with
    you. As you know we're going to need Congress to come up with a
    solution for some of these issues because it's in statute, and
    so we are absolutely willing to work with you to make sure that
    everyone has access to that affordable coverage.
        Mr. Fulcher. OK. All right Thank you, Mr. Secretary. I'm
    going to shift gears to a different top really quick before my
    time is up. Secretary on April 15 of 2021, HHS proposed a rule
    change to Title 10 of the Public Health Service Act that would
    revise the family program regulations and require all
    recipients and Title 10 funds to counsel and refer women for
    abortions.
        Not only would this rule violate the conscious right of
    healthcare providers but will also undermine Title 10 which
    protects taxpayers from being forced to fund abortions. Mr.
    Secretary, what will your department do to ensure that it does
    not exceed its constitutional power by implementing broad and
    coercive mandates such as that?
        Secretary Becerra. Congressman, thank you for the question.
    This one's important because we want all our families to know
    they have access to good quality care, and Title 10 has been so
    important for families who need family planning services. We
    will, as I've always said, make sure that we give everyone,
    including women access to the kind of coverage they need. We
    will protect their rights for that, and we'll make sure that we
    follow the law as we do so.
        We believe that in the program that we have on Title 10,
    not only are we expanding access to care for mostly women, but
    families all together, we're going to do it in a way that
    conforms with the law.
        Mr. Fulcher. Mr. Secretary thank you for the answer. I'm
    just about out of time. But that rule change does violate the
    conscious right of our healthcare providers, and so, please
    consider that as you move forward. Mr. Chairman I yield back.
        Chairman Scott. Thank you. The next one I see is the
    gentleman from New Jersey, are you still on the screen Mr.
    Norcross? The gentlelady from Washington Ms. Jayapal?
        Ms. Jayapal. Thank you, Mr. Chairman and Secretary Becerra,
    it is so wonderful to see you here today, and to say that
    shortly after your visit to Seattle, we were so proud to become
    the first city, major city in the country to reach a 70 percent
    vaccination rate that's fully vaccinated.
        We're actually I think at 78 percent for first-round
    vaccinations, so, we're proud to lead the country, Mr.
    Secretary, it's because of the Administration, because of the
    American Rescue Plan, and we thank you. You know, I think that
    we are still seeing so many of the catastrophic effects of the
    COVID-19 pandemic, and I wanted to ask you about three specific
    things.
        One is about the global pandemic. In the American Rescue
    Plan, 6 billion dollars was allocated to Health and Human
    Services for COVID-19 vaccine development, manufacturing,
    distribution, and supply chains. Could you provide an account
    of how much of that money has been spent, and how much is left
    that we can immediately put toward really improving our
    domestic production investing 25 billion into production of
    vaccines that we can send to places around the world so we
    could combat this pandemic globally?
        Secretary Becerra. Congresswoman, first congratulations on
    the work that your city has done. It is phenomenal, and it was
    a great visit that we had, and I could see why you got to 70
    percent so quickly because I could see how well everyone was
    working together as a team.
        On the question of the dollars, and if I get these wrong,
    my team will make sure that we correct them, and so, let me
    just break down the 6 billion. 2 billion of the funding has
    been going to operations. Another 3 billion is being used for
    antivirals. Thanks as well to the American Rescue Plan.
        The President is working on the 10 billion dollars that
    were approved for domestic manufacture capabilities for PPE and
    pharmaceuticals, and we're going to be investing in this budget
    that we present 21 and a half million or so, in new funding for
    the resilient supply chain and shortages program.
        So, we're doing what we can to prepare. We're doing what we
    can to make sure that we recoup what we have to use, and we're
    going to try to be ready for anything coming at us in the
    future.
        Ms. Jayapal. Thank you, Mr. Secretary. So, you're saying
    there's nothing left of the 16 billion, is that correct?
        Secretary Becerra. Well, I don't know; and a lot of it has
    been earmarked. We probably still have some there and we could
    try to give you the precise numbers when we followup with
    everything if you'd like.
        Ms. Jayapal. Great. Well, you know I think we're trying to
    work very hard to make sure that we invest 25 billion into
    addressing and getting vaccines to countries around the world
    because as you know low-income countries have received just .4
    percent of vaccines, and we're not going to defeat this crisis
    unless we defeat it globally.
        In addition to the need for greater global vaccine access,
    COVID-19 has shown us why insuring healthcare for all is
    critical. Right now, there are critical improvements to
    Medicare that President Biden has committed to.
        Can you speak to the importance of lowering the Medicare
    eligibility age to 60, so that we include 23 million additional
    Americans, including nearly 2 million uninsured individuals,
    and improving Medicare benefits to include dental, vision and
    hearing, and will you work with us Mr. Secretary to make that a
    reality for Americans?
        Secretary Becerra. And before I give the answer to that,
    can I just add that the 580 million vaccines that President
    Biden has committed to the world, to the co-vac program, but
    globally to make sure they're out there. Those surplus vaccines
    that we can make available will help tremendously in our
    commitment to be a partner in trying to help the world get
    vaccinated, and that's part of our ongoing work.
        And we've been able to do that because we've been able to
    get so far along as you've mentioned with your city in
    vaccinating Americans. So those surplus vaccines will be made
    available to the world. In regard to the benefits of lowering
    the age of eligibility for Medicare, or expanding services like
    hearing, vision, dental to seniors on Medicare, let me tell you
    it's due. We need to move forward. The President is supportive.
    He'd like to support anything that you all do in Congress.
        There is a number of ways to get there. But what we're
    hoping to do is to continue the work that has increased the
    number of Americans who have affordable care, whether it's
    through the ACA, or its through Medicare, we want to see more
    Americans get covered until every American has that right to
    say I have access to healthcare.
        Ms. Jayapal. Fantastic. And I have just a few seconds left,
    but I do want to give you a chance to address the consequences
    of Donald Trump's zero humanity policy to separate children
    from their parents, which has a conspicuous silence from many
    of my Republican colleagues.
        3,900 children were separated by this policy, and we cannot
    yet reconfirm re-unification for 2,100 families. Secretary
    Becerra, just tell us how your Administration has been tackling
    this terrible problem created by the former Administration.
        Secretary Becerra. Congressman, I know the time is expired
    so I will be very brief and simply say I have three daughters.
    Don't let anyone try to separate me from my daughters. I think
    every parent thinks the same way. We must think of that just
    with our own personal children, but with all the children that
    we have in this country.
        And we're going to do everything we can at least under this
    Administration to keep families together, not to break them
    apart.
        Ms. Jayapal. Thank you, Secretary. I wish we could hear
    more from you because you've done so much, but I'm respecting
    that my time has expired Mr. Chairman thank you.
        Chairman Scott. Thank you. The gentleman from Indiana Mr.
    Banks.
        Mr. Banks. Thank you, Mr. Chairman. Mr. Secretary I'm
    deeply concerned. I can't hear, can you hear me now. OK. I
    don't know what I'm doing wrong. Mr. Chairman I'll have to
    pass.
        Chairman Scott. We'll come back to you. The gentleman from
    Pennsylvania Mr. Keller.
        Mr. Keller. Thank you, Mr. Chairman, and I would like to
    thank the Secretary for being here today. Retroactive and
    direct, and indirect renumeration or DR fees are a huge problem
    for community pharmacies across north center and northeastern
    Pennsylvania.
        These fees are applied by pharmacy benefit managers on
    community pharmacies after the point of sale, sometimes months
    afterwards. It's hard to think of another industry that deals
    with such unfair treatment. According to the Fiscal Year 2022
    budget justification, DR fees increased by more than 91,500
    percent between 2010 and 2019.
        Earlier data showed that DR fees grew by 45,000 percent
    between 2010 and 2017, meaning this increase more than doubled
    between 2017 and 2019. According to the National Community
    Pharmacy Association the average community pharmacy pays more
    than 80,000 per year in DR fees. This is simply unsustainable
    and unacceptable.
        Mr. Secretary, DR fees are clearly creating problems,
    driving pharmacies out of business, and increasing drug costs
    for those who rely on prescription drugs, particularly seniors.
    Do you support action to prevent pharmacy benefit managers from
    imposing such crippling retroactive fees on community
    pharmacies?
        Secretary Becerra. Congressman you've touched on something
    that is part of this dilemma that we have with pharmaceutical
    costs, the costs of prescription medication. And the reason why
    I think so many of us, and I know you probably as well, want to
    get to a solution that reduces the cost.
        I am willing to work with you to try to see what we can
    address in these areas, but I will tell you that I think some
    of the solutions are going to have to come from Congress
    because much of the dilemma that you're raising is a statutory
    problem that you face.
        But we're willing to work with you, provide the technical
    assistance because what we cannot do is find that the person
    who loses at the end of the day because of those difficulties,
    bureaucratic or otherwise, are consumers who need those drugs.
        Mr. Keller. And a long time our senior citizens with their
    Medicare. In 2018, HHS and CMS included DIR reform language in
    a proposed rule, but ultimately it was not included in the
    final rule. Would you support reviving that proposed rule?
        Secretary Becerra. Congressman I commit to work with you
    and our team at CMS to review that again and see where we can
    go.
        Mr. Keller. Yes, but the rule we're talking about was HHS
    and CMS, so if this is rulemaking, and we can do something that
    is quicker in Congress, would you willing to take a look at
    that and do that?
        Secretary Becerra. Absolutely committed to taking a look at
    that, and we could stay in touch and your team could followup
    with our folks at CMS and here at HHS.
        Mr. Keller. We'll most definitely do that. The DIR Reform
    to Reduce Senior Drug Costs Act will require that price
    concessions be included in the negotiated price at the point of
    sale to a Medicare beneficiary. This would obviously require
    HHS involvement to be implemented.
        How do you feel the implementation of ideas like this might
    be at the agency level?
        Secretary Becerra. So, there we will do what we do with all
    of these proposals where we have to do regulation. We'll take a
    thorough look, a deep dive into them. What we'll do is input
    out any proposed regulation out for comment by you, by
    stakeholders, by the public, get the feedback, and then if we
    think we have something that's been pretty well baked, then
    we'll put it out there and roll it out and hopefully it can
    take effect, but we'd have to first work with you and
    stakeholders in the community to make sure that this is an idea
    that actually has good legs.
        Mr. Keller. We need to make sure that we look at the cost
    of prescriptions drugs because the increases are negatively
    impacting not just the pharmacies that have to pay these DIR
    fees, but also the constituents with access to them.
        Secretary Becerra. Absolutely agree.
        Mr. Keller. As you see it how can Congress and the
    Department of Health and Human Services work together to find
    additional solutions to this issue?
        Secretary Becerra. We're ready to provide whatever
    technical assistance you might have if you all propose
    legislation to deal with this. We are prepared to work with you
    if there's some regs that you all think we should be proposing.
    We'll work with you as we get ready to promulgate them.
        So, what we could do is put them on the ground as quickly
    as possible and let them go live.
        Mr. Keller. I appreciate the willingness to be able to work
    with the department on finding solutions to these problems that
    are affecting so many of all of our constituents, and really
    get at the root cause. We need to get at the root cause why
    these costs are happening and help our constituents with access
    because we want to make sure that our pharmacies succeed, so
    that our constituents can have the choice and the access to the
    necessary drugs, so I do appreciate this, you know, the
    prescription medicines are so important to many people's well-
    being. So, thank you and I yield back.
        Secretary Becerra. Thank you.
        Chairman Scott. Thank you. The gentlelady from North
    Carolina, Ms. Adams.
        Ms. Adams. Thank you, Mr. Chairman. Thank you, Ranking
    Member, Secretary Becerra, thank you for your time today,
    particularly given since you've testified thrice last week. You
    explained various priorities in your opening highlighting all
    America's workforce continuing to face challenging
    circumstances.
        For instance, the pandemic has brought severe impacts on
    essential workers, particularly women of color in America. The
    COVID-19 vaccine workforce, vaccination workforce, has been
    expanded through the PREP Act, and efforts across North
    Carolina to donate freezers for the storage of vaccines.
        Let me ask you although the CDC's budget was increased by
    21 percent, the National Institute of Occupational Safety and
    Health was level funding for 2022, and NIOSH is the only agency
    in government with occupational health and safety research. And
    during a prior Workforce Protection Subcommittee, we learned
    that there was literally no workplace tracking of the COVID
    outbreaks during the pandemic.
        So, what does this suggest about the priority that the
    Administration is placing on the worker's health and safety
    inside CDC?
        Secretary Becerra. Congresswoman, first great to see you
    again and looking forward to working with you closely on this
    and other issues, but I can tell you, if you want to help us
    with this budget, getting it the largest increase in funding in
    two decades, we will make sure that we're investing in all the
    research that has to happen.
        NIOSH remember, does the research side of this. We don't do
    OSHA's side which is the actual enforcement side that's done
    through the Department of Labor, but I commit to you that we're
    not going to let any research lapse or go undone that helps us
    understand how we better protect our workforce because we saw
    what happens when we don't protect those essential workers,
    many of whom are people of color.
        Ms. Adams. Absolutely. Expectant mothers who experience
    discrimination in medical settings, have limited awareness
    about other maternal healthcare providers included in their
    health plans provider network. So how can HHS increase patient
    access to appropriate in-network providers?
        Secretary Becerra. Congresswoman, thank you for asking
    this, and my wife thanks you as a high-risk OB-GYN thanks you
    for not just asking it, but for being a fighter on this issue.
    Listen it is incredible to believe that in this country the
    richest nation, the democracy in the world, we have some of the
    worst outcomes for women when it comes to being pregnant. And
    the maternal mortality rate for some in our country, especially
    for women of color it's devastating.
        And so, President Biden made a commitment, and we're going
    to have resources here that tackle this to provide women with
    better care to avoid that mortality that might occur, the bad
    morbidity results, and by the way we're challenging states to
    accept an increase in Medicaid funding so that we can keep a
    woman receiving postpartum care, not just for 60 days, but for
    a full year.
        And what we hope is that the states will take us up on that
    job, while we're paying for most of it, so that women can
    continue to receive the care they need after delivery.
        Ms. Adams. Well, increasing workforce diversity in the
    field of maternal health requires additional support for
    allies, health professionals which includes lactation
    consultants, nutritionists, dieticians, laboratory sciences,
    mental health counselors, and speech language pathologists.
        So how will the Fiscal Year 202022 budget expand job
    opportunities for these critical healthcare providers who are
    underrepresented in the maternal health sector?
        Secretary Becerra. Congresswoman if you all help us with
    our budget and passing the American Families Plan, we will have
    an additional 3 billion dollars that we'll be able to make
    available to improve maternal health. We have a 200-million-
    dollar program called the Maternal Mortality Review Committee's
    program where we help those at the local level know where they
    have to put the resources to help women have good outcomes and
    stay healthy.
        And so, there are a number of ideas that we're working on,
    but we're going to need your help to make sure this budget gets
    through.
        Ms. Adams. Great, great, thank you so much. You have my
    support. Thank you for all the great work that you're doing.
    Mr. Chairman I yield back.
        Chairman Scott. Thank you. It looks like Mr. Banks is
    available now, the gentleman from Indiana Mr. Banks.
        Mr. Banks. Yes Mr. Chairman we'll try this again.
        Chairman Scott. Good, very well, very well.
        Mr. Banks. Mr. Secretary your budget proposal is the first
    budget proposal in 45 years that doesn't include the Hyde
    Amendment and Hyde Amendment protections preventing taxpayer
    funds to go toward paying for abortions. If that's true, if
    that is the case as it appears to be, that would make your and
    the Biden administration the most pro-abortion Administration
    in the history of this country.
        So, what I want to know right now, and I wonder if you
    would commit to is if you will commit to never directing
    taxpayer funds to go toward funding partial birth abortion.
        Secretary Becerra. Congressman what I can try to make sure
    I do is guarantee to you that we're going to follow the law,
    and as I just finished saying to Congresswoman Adams, we want
    to make sure we're helping women be healthy and stay healthy if
    they're going through pregnancy.
        Mr. Banks. Mr. Secretary can we expect you to commit to not
    funneling money toward paying for partial birth abortions, it's
    a simple question.
        Secretary Becerra. We will not send money anywhere we're
    not allowed to by law Congressman. We will make sure that we
    enforce the law and provide the health protections and services
    that Americans are entitled to, including women.
        Mr. Banks. Mr. Secretary I'll ask you again, will you
    commit to not sending our taxpayer dollars to go toward funding
    partial birth abortion?
        Secretary Becerra. Congressman, you're asking a question
    and what I must say to you is that there are scores of low-
    income women in America who are not receiving the care that
    they need and are entitled to. We're going to make sure that we
    leave no one behind, but we're going to do that by following
    the law, and so if you're a woman in America we want to make
    sure you have access to reproductive services that you're
    entitled to under the law.
        Mr. Banks. Mr. Secretary, the HHS Office for Civil Rights
    contains a conscience and religious freedom division that
    enforces nearly two dozen Federal laws protecting conscience in
    healthcare and human services, including protections against
    coerced participation in abortion and assisted suicide. That
    division is currently being overseen by a political appointee
    named Laura Durso, with a long history of--left-wing activism.
    Here is a sampling of some of the outrageous things that Laura
    Durso has publicly said about the conscience and religious
    freedom division.
        In a tweet she said the division, `Sends shivers down my
    spine.' And that, `Any policies that come from it will only
    enable discrimination and pain.' In an interview she called for
    a nation of the division, `Insulting at best.' And falsely said
    that the division only represents, `Christian beliefs,' and is
    `Trying to impose them on the country, and that they don't care
    about the vulnerable, and shield people who object to
    transgender people even existing.'
        In the same interview she enthusiastically agreed with the
    host who said that the division was, `An office that makes
    people feel like crap, and is the most immoral thing that we
    can think of.'
        Finally, in another tweet she said that the work of the
    division was like those who `stood with rapists over
    survivors.' Mr. Secretary, do you disavow any of these
    outrageous statements and attacks on career professionals of
    the division made by Ms. Durso?
        Secretary Becerra. Congressman, you're presenting me
    something that I've never seen, and I can certainly take a look
    at that, but what I will tell you is that each and every person
    in the Department of Health and Human Services, especially in
    the Office of Civil Rights has an obligation to protect the
    constitutional civil rights of all Americans, and we're going
    to do that.
        We're going to make sure.
        Mr. Banks. Mr. Secretary will you commit to removing a
    biased ideologue like Ms. Durso from any decisionmaking
    relating to the conscious and religious freedom division since
    she obviously has a bias against what the division does?
        Secretary Becerra. So, Congressman, I look forward to
    working with you to take a look at some of these issues. You're
    presenting me something I have not heard of and having been an
    Attorney General for the State of California, I don't proceed
    based on something that I'm not aware of.
        We're going to make sure everyone in our department does
    the work that's required, and I guarantee you that the people
    that are right now at the Office of Civil Rights understand
    their obligations to protect the people's civil and
    constitutional rights, including their conscience rights,
    religious freedom rights, and I think that everybody in our
    division at civil rights, and within our department does
    exactly that.
        And if there isn't someone who does that, we'll get to the
    bottom of it.
        Mr. Banks. Thank you. I yield back.
        Chairman Scott. Thank you. Next is the gentleman from New
    York, Mr. Morelle.
        Mr. Morelle. Thank you very much Mr. Chairman for holding
    this important hearing, and Mr. Secretary thank you for your
    service and for being here this morning. Mr. Secretary I do
    want to come back to the question of surprise billing. I was
    one of a number of Members very active in congressional efforts
    to pass the surprise medical billing legislation.
        And as the Administration proceeds with implementing the
    law, I believe it's paramount that public comment be under
    consideration during the rulemaking process. And I understand
    the first rule, as I understand OMB is looking at their own
    review of the No Surprise Act, as your department works on
    implementing.
        I urge you first of all to remember congressional intent.
    I'm sure that's something you're going to do. I want to make
    sure that we have an independent dispute resolution process
    that captures the unique circumstance of each billing dispute,
    and not honing in on a single piece of information or use that
    as a default which the law did not foresee.
        But in addition, there has been some concern that the rules
    pertaining to the law will proceed through an expedited
    rulemaking process as opposed to a standard rulemaking process
    which allows ample public comment. Can you give us some
    assurance that you will actually work on the standard
    rulemaking that includes public comment?
        Secretary Becerra. All right, so we're committed to
    transparency when we do these rules. That's something that I
    said during my confirmation hearings. I've said it during this
    testimony on our budget, that transparency is critical as we
    try to move through some of these rules, but we're going to
    work as quickly as we can because we understand how important
    the surprise billing law is, not just to you all, but to
    Americans, so we'll be there to work on it, and we're going to
    make sure at the end of the day regardless of where the regs
    come down, that a patient is no longer on the hook for that
    surprise bill.
        Mr. Morelle. Yes. So just to be clear does that mean that
    you intend to use a standard rulemaking with public comment?
        Secretary Becerra. I'll have to make sure I go back to CMS
    to find out exactly where they are, and I know we've already
    moved some of the proposal rules through the process here, and
    I'll get back to you on that.
        Mr. Morelle. OK. That would be great I'd appreciate it. I
    just wanted to shift for a moment to a question about long-term
    sustainability of Medicare. I grow increasingly concerned about
    the number of people particularly my age who are part of the
    baby boomer generation aging into the Medicare program.
        Early years when people enter Medicare, they tend to be
    lower in utilization, health relatively good. As they begin to
    age utilization goes up, costs go up. And it seems to be 10-15
    years from now baby boomers will not only represent a
    significant number of people in the company on Medicare,
    probably the greatest number that we've ever had, that will
    also be at the point where utilization is higher.
        At the same time if you pair that with some of the labor
    shortages, and some of the demographics, there will be fewer
    people in the workforce paying into the Medicare through their
    participation in the Medicare rates as it relates to being paid
    through wages.
        So, I wonder if you could just share with me what HHS is
    looking at or thinking about relative to the long-term
    sustainability of Medicare?
        Secretary Becerra. Congressman, great question, and I'll
    look forward to working with you all because the long-term
    sustainability of Medicare will be dependent on Congress
    passing something with the support of the Administration. And
    there are a number of long-term solutions.
        What I will tell you is this: No one wants to see us damage
    what Medicare has meant for tens of millions of seniors who
    paid into the system as you just mentioned. It has a been a
    lifesaving program for so many Americans before 1965-67, when
    Lyndon Baines Johnson helped pass Medicare.
        There were too many seniors who were living in poverty, so
    we're going to make sure that we work with you toward solvency.
    That will be something we can tackle. There are any number of
    great ideas, and what we can do is also make sure we expand
    coverage under Medicare for more Americans who are reaching
    their senior years.
        Mr. Morelle. Well, I do appreciate it, and I would love to
    work with your team on some innovative ideas around that.
    Quickly, and I know I'm running out of time, and I don't want
    to impose. The 340B Drug Pricing Program allows hospitals,
    including the 100 hospitals in my State of New York, that
    allows them to purchase outpatient pharmaceuticals from drug
    companies at a discounted rate.
        And they use those to provide greater access to needed
    drugs and more comprehensive services. Last year I led a letter
    signed by the entire New York delegation, bipartisan based,
    asking for flexibility for these hospitals during the pandemic.
        I don't know that that issue has been resolved, and I don't
    believe it's too late, and so can we have your commitment to
    work with HHS to leverage its authority to protect the 340B
    program, including using the 1135 waiver authority to
    temporarily waive the Medicare disproportionate share?
        Secretary Becerra. We look forward to working with you
    Congressman.
        Mr. Morelle. Terrific. Thank you so much. Mr. Chairman I
    yield back.
        Chairman Scott. Thank you. The gentleman from Wisconsin,
    Mr. Grothman.
        Mr. Grothman. Thank you. Just a few questions. In your
    testimony you talked about how it would be a priority, or at
    least you wanted to do something to stop sexual abuse, gun
    violence, racial inequities, drug abuse. I know we recently hit
    a point in which 90,000 people in a 12-month period died of
    illegal drug overdose.
        When I read about all these topics, and of course we've had
    hearings here for this when I was in the State legislature on
    all of these topics, whenever we deal with these topics, I
    think part of the issue in the background is value structure.
    There are absolutely wonderful children raised by families and
    wonderful people in all family structure.
        Nevertheless, there's sometimes are correlations. Would you
    in addressing these issues, be willing to look at family
    structure, or see if there are correlations there that ought to
    be publicized.
        Secretary Becerra. Congressman, we have too many of our
    kids dying of these substance use disorders. I'm willing to
    look at anything with you and others that we think helps us get
    to a solution to keep our families alive.
        Mr. Grothman. If we gather information and we find out that
    some family structures are more beneficial than others, would
    you be willing to publicize that?
        Secretary Becerra. We're willing to look into anything
    Congressman that helps keep our families alive.
        Mr. Grothman. OK. Next question. I have a bill out there in
    which we're trying to legalize by assemblers as insulin
    substitutes. Obviously, I'm being fought by the drug companies
    that gets me to the hundreds of thousands of families who are
    right now having to pay for insulin. Depending upon the quality
    of their insurance some get off relatively cheaper, but some
    are paying you know $800.00 or $900.00 a month. Would you be
    willing to champion the legalization by assemblers in order to
    result in a cheaper substitute to insulin products?
        Secretary Becerra. Congressman, I think everyone agrees
    that the price of insulin is just outrageous the way it's gone
    up, and we have to do something.
        Mr. Grothman. No. The question for you is because I know
    some companies are making money on the current system, and I'm
    going to need a champion to get this thing through, would you
    be willing to meet with me, or other representatives of the
    bio's similar group, and if it can be shown it would probably
    reduce costs for these families, would you be willing to take
    on Congress and push a bill like that through?
        Secretary Becerra. I've got my team here. They've taken
    notes. So, we'll look forward to hearing from, or we'll be in
    touch with you to followup.
        Mr. Grothman. OK. Well, I hope you have the guts to stand
    up to the special interests. Next question I have for you, you
    know inflation is just out of control. We see it on so many
    different commodities right now, and you're proposing a 23.5
    percent increase in discretionary spending for HHS.
        Even apart from the pandemic, Congress has not exactly been
    frugal over the last 3 years, right? But you're proposing a
    massive increase one more time. Could you comment on that, and
    does it ever concern you when you propose these big increases?
    And your department is one of the biggest of the bunch, that it
    can lead to inflation and permanently damage America
    economically?
        Secretary Becerra. Thanks Congressman, and a very important
    question, something that the President is also having to
    tackle. And that is what we hope we can do is make sure that
    we're making investments through this budget, not just spending
    dollars because they have to be wise allocations.
        We are seeing now, the recovery from COVID because we made
    the right investments. We are beginning to see more Americans
    get health insurance coverage because we made the right
    investments in the Affordable Care Act.
        And we're going to continue to try and do that, whether
    it's on childcare because we see how many families are in
    desperate need of good childcare, or whether it's trying to
    protect the life of a woman as she's getting ready to deliver a
    baby by providing better maternal healthcare.
        These are all good in investments that will ultimately save
    us money versus just being an expenditure that goes without
    notice.
        Mr. Grothman. Well, I think there are a lot of lines in the
    budget when you go for 24 percent of good RBI investments, and
    I would argue that during the entire massive increase in the
    Federal Government, most people claim Federal Government is
    spending this really because investments in our approaching the
    30 trillion-dollar deficit. Is there anywhere in that budget
    that you feel 23.5 percent was a tight budget? That's the
    lowest increase you can get away with?
        Secretary Becerra. Congressman, we're trying to get out of
    this hole created by COVID. It's not done free. And but I'm
    willing to work with you if you think as I mentioned in my
    opening testimony, we're going to be very aggressive when it
    comes to program integrity, making sure we root out any
    misspending, any fraud, and so look forward to working with
    you.
        You can point out a program to me that you believe is not
    being well run or is making a good investment. I'm more than
    willing to look at it.
        Mr. Grothman. Thank you very much.
        Chairman Scott. Thank you. The gentlelady from Pennsylvania
    Ms. Wild.
        Ms. Wild. Thank you, Mr. Chairman, and Thank you, Mr.
    Secretary for being with us today. I want to personally thank
    you, in addition to all of the ways you've served this country,
    to thank you for your commitment to mental health matters which
    dates back to the very earliest days of your career I know.
        And before I get to my question, I just want to take an
    opportunity to remind folks out there who are watching, that
    there are many resources available for people who are in
    distress, or contemplating suicide. The National Suicide
    Prevention Hotline is currently always available at 800-273-
    8255.
        And I really look forward to the implementation of 9-8-8 as
    the new suicide prevention hotline in July 2022. I know it's
    been an indescribably difficult year for people in my community
    and across the country this past year. And our kids are
    hurting, people are hurting.
        A new study just confirmed that suicide attempts among
    girls have increased dramatically with emergency rooms now
    reporting 39 percent more suicide attempts for girls aged 12 to
    17 in the winter of 2021, compared to 2019. Your department is
    a very important piece of the suicide prevention safety net,
    but it's only one piece.
        Some partners who we would expect to be helping are our
    large companies, including YouTube. You will see behind me this
    rather large poster of a YouTube that is a screenshot from
    YouTube that we took that represents believe it or not, in the
    beginning of a video on how to tie a noose.
        And we've been in contact with YouTube. I've been pushing
    them for months to step up their suicide prevention work and
    finally remove instructional videos on how to tie a noose. I
    hope you can see it; it says how to tie a noose. These affects
    to the perfect hangman's noose. It's got 3.1 million views and
    then it goes on multiple pages of how to perfect a noose
    imagine that.
        We need to meet and find people where they are, and all too
    often our young people are for better or worse, looking for
    answers on places like YouTube. Secretary Becerra, my question
    to you is are you willing to work with me to convene a meeting
    with YouTube and experts in suicide prevention to get this
    addressed?
        Secretary Becerra. Congressman, first thank you for the
    work that you're doing on this crucial subject because I mean
    it's tough to lose any life, but a young life worse. And so, I
    would look forward to working with you and your staff any ways
    that you think we can try to address this suicide issue with
    teems, and just with the mental health issues that we know are
    cropping up as a result of COVID-19, so please count us in any
    of the efforts you're looking to undertake to help address
    this.
        We have resources. Thank you by the way for what you did
    with the American Rescue Plan. We're going to do what we can,
    and we look forward to working with you.
        Ms. Wild. Thank you so much and believe me, we will be
    reaching out. We've made some progress with YouTube, but not
    nearly enough, and I think it's going to take the weight of
    your office to get us to where we need to be with them.
        Now I want to just take a step back in my remaining time
    and ask you do you believe that your department has sufficient
    resources to prioritize suicide prevention? What's been
    promising? What needs scaling up? And how can we help here in
    Congress?
        Secretary Becerra. Well, that's a mouthful of a question
    Congressman because we actually have more resources now than we
    have had in quite some time because of the work you did on the
    American Rescue Plan. If you help us get that American Families
    Plan that the President has proposed through, we'll have more
    resources as well.
        But as you know, we've been so far behind. Even on 9-8-8,
    the resources that we have that we're putting into it. This has
    to be a nationwide effort, and it's going to be tough to scale
    up to make sure that 9-8-8 is available to anyone who needs to
    call. And so, it's great that we have more resources.
        Going back to the previous conversation I had with the
    Congressman about how we're investing our money, and can we do
    with less? You know we don't have enough right now, and you
    know this, to deal with the mental health issues that we're
    confronting, the substance abuse disorder issues that we're
    confronting.
        We need those dollars, and the budget reflects the
    President's commitment to invest to keep Americans safe and
    healthy.
        Ms. Wild. Thank you so much Mr. Secretary. I look forward
    to working with you on this very important issue, and I do
    believe it should be a bipartisan priority, so thank you.
        Chairman Scott. Thank you. Next Mr. Secretary our next
    questioner is a surgeon from North Carolina, Dr. Murphy.
        Mr. Murphy. Thank you, Mr. Chairman, and Thank you, Mr.
    Secretary for appearing before the Committee. I'm going to
    start a theme that others have spoken about. I'm a physician,
    we've done a great job of vaccinating. We're now meeting in the
    chambers without masks. This particular venue on how to conduct
    Committee business, and I know it's going on in other
    Committees too is simply ridiculous, and it's not doing the
    work of the people appropriately.
        So, I am hopeful that we'll actually get back to seeing
    people in person and doing the work in the manner that we
    should do that's most effective. Mr. Secretary, the use of
    telehealth I will tell you, I worked on telehealth for quite a
    while when I was working in our state's general assembly, and
    unfortunately got blocked by a lot of insurance companies.
        And one of the great things that the Trump administration
    did was release the regulations on telehealth. It makes a
    difference to practice. I actually still practice in a very
    rural part of eastern North Carolina, and telehealth has made a
    game changing difference of people being able to access
    healthcare.
        I'd just like to ask for your support in making the
    telehealth accepted by benefit permanent, so I'd like you to
    comment just on that, that you'll continue what was a silver
    lining in this pandemic and allow the American people to be
    able to access telehealth.
        Secretary Becerra. Congressman thanks for the question.
    Crucial. We learned a lot from COVID. Telehealth has been
    indispensable. Look forward to working with you. We'll do what
    we can through regulations with the discretion we have, but
    we'll probably need your help to make sure we can fully
    implement moving forward, the new opportunities that telehealth
    is making available.
        We have to make sure as well that we provide broadband to
    all communities so that no one is left out but look forward to
    working with you because Congress and the Administration can
    make a great deal of moving forward on telehealth.
        Mr. Murphy. Great, great. Also, Bobby noted that I'm a
    surgeon. I'm a urologist. I deal with diseases in the male and
    female genital urinary tract, so I've done a lot with fertility
    and those types of things.
        And so, I still to be very honest with you, I have to
    scratch my head, and I'm losing more hair as we go about this
    mother/father thing. Can you give me an instance where I should
    call someone a birthing person who is not a mother? In other
    words, should I now call my mom my birthing person? What is
    this nonsense?
        Give me an instance where this is appropriate.
        Secretary Becerra. Congressman, thanks for letting me
    respond. And you know I'm not going to make a mountain out of a
    mole hill. What we're talking about is making sure we use
    language that's inclusive, that is accurate, and if you wish to
    call your mom, mom as I call my mom, mom, go right to it.
        But for some people they like to make sure that they are
    accurately represented when we refer to them. And we just want
    to be inclusive, that's all it is. People can make more of it,
    but there's nothing more. You can send your Mother's Day card
    to your mother as I send to my mother, nothing changes
        Mr. Murphy. Yes, I just don't get it. I know a lot of
    genealogy. I work with X and Y chromosomes and all these other
    things. I just don't understand that. I mean what should I call
    my dad?
        Secretary Becerra. Well, let me put it to you this way.
    There was a time when my dad saw language that said, ``No dogs
    or Mexicans allowed.'' And so, he couldn't walk into an
    establishment when he was a young man, even though he was a
    U.S. citizen.
        Words have meaning and we try to be accurate, and we want
    to be sure just as we allow anyone to walk into an
    establishment, we want people to understand that when we talk
    about a program, it refers to everybody, and if you prefer to
    be referred to as a birthing individual, so be it. We're not
    harming anybody.
        Mr. Murphy. Yes, well, all right thank you. That baffles
    me. It just makes no sense to me. It's been 84 days since Vice
    President Kamala Harris was appointed as the border czar. 84
    days and she's not visited the border. Do you brief her on
    what's going on at the border, or have you asked her to visit
    the border?
        Secretary Becerra. We are fortunate to have an opportunity
    to brief the Administration, the White House, the President,
    and the Vice President periodically. Certainly, on the affairs
    that deal with Health and Human Services. And we know that the
    President and the Vice President are very engaged on this.
        The Vice President just came back from a trip to Central
    America and Mexico where she was trying to help us address
    these immigration challenges, and I know that they are on a
    day-to-day basis receiving briefings, not just from us, but
    from the Department of Homeland Security and others when it
    comes to these issues involving immigration.
        Mr. Murphy. All right. Let me just throw one other thing.
    We were just talking about overdoses and drugs as subjects that
    are very dear to my heart. I worked a lot on the opioid
    epidemic. Because of the crisis that the Biden and Harris
    Administration has created with the flood of drugs, illicit
    drugs are now coming into our border, how do you see us being
    able to push that backward, since we're going to see a massive
    increase in the number of overdoses?
        Secretary Becerra. Congressman, first it's not going to
    surprise you that I don't agree with either characterization,
    and two, I think this Administration is doing more to keep
    drugs out of the hands of individuals, and for those who
    already are drug addicted, to try to help them recover.
        And so, I hope that we're able to with your support
    continue in that course.
        Mr. Murphy. Thank you, Mr. Chairman I'll yield back.
        Chairman Scott. Thank you. The gentlelady from Georgia Mrs.
    McBath.
        Mrs. McBath. Thank you, Mr. Chairman for convening this
    hearing today, and thank you so much Secretary Becerra for your
    continued service to our country, and just your commitment is
    just definitely without reason. We definitely know that you
    truly care about the health and welfare of Americans.
        But during this pandemic you know with many families
    sheltering at home, you know we've seen an unfortunate rise in
    cases of domestic and family violence. It's now time more than
    ever I believe to really work on securing the funding for
    protecting these survivors and their children.
        I've seen too many families in my own home State of Georgia
    which I represent. They're suffering at the hands of domestic
    and family violence. And I just know we've got to protect these
    families and families all across the Nation. That's why I'm
    proud to have reintroduced the bipartisan legislation that
    reauthorizes and expands the necessary funding of programs
    focused on helping survivors of domestic and family violence,
    FIPSA, and this legislation we know would provide survivors the
    resources that they need to rebuild again, and to keep their
    children safe, and mind you this was legislation that was even
    before I came to Congress in 2018.
        But as you know the Committee recently held a hearing on
    FIPSA and is currently working on tweaking the reauthorizing of
    this legislation. And we're also providing, you know we've also
    provided 450 million in the emergency supplemental fund and in
    the American Rescue Plan to support the survivors of intimate
    partner violence, especially under COVID-19.
        But Secretary Becerra, can you provide an update for us on
    the distribution of these American Rescue Plan Act funds to
    communities, and also are people getting the help that's been
    mandated by this legislation that we passed?
        Secretary Becerra. Congresswoman, thank you for the
    question. Can I just say thank you Congresswoman McBath for
    your commitment to this, and you're just tenacious dogged
    persistence on this because it is worse than people think. We
    just don't see it because it's taking place at home, right?
        And so, thank you for protecting those family Members who
    are victims of some of the worst violence we can ever
    experience, and having it done by someone you thought you
    loved, or loves you. We are making a commitment to try to spend
    that money locally the way the locals believe it could best be
    spent, and so the more than 200 million dollars that we put
    into FIPSA in this budget would help locals make those
    decisions building on what we've learned since COVID.
        At the same time, you're probably familiar with the program
    that we're calling for under CDC, the community-based violence
    intervention initiative. That's to help prevent these things
    from ever occurring. And so, working with champions like you
    and folks back home who understand this issue, what we hope is
    that we can make a dent in this and make a big difference in
    the lives of some of these family Members, and get them the
    help they need to prevent it from occurring.
        The most important thing is to keep family units together
    as possible, one way or the other, protect Members in a family.
        Mrs. McBath. Right. Well, thank you for that. You know as
    we're moving forward with this reauthorization, and as you said
    absolutely, I am doggedly pursuing this because I've been
    watching under COVID just the percentages and the statistics go
    up with women that have been abused by their domestic partners
    through the use of guns.
        You know what are your top priorities for this legislation?
        Secretary Becerra. Well, we'd like to do our part on gun
    violence prevention. The research that we can do because this
    is a health crisis, it's not just a gun violence crisis, it's a
    health crisis. And if we can add the data that helps us
    understand how to address this, how to prevent it, that will
    take us a long ways.
        We're going to continue to work with those who want to try
    to help those family units, whatever shape they take to protect
    those domestic partners as best we can, but we understand that
    there are a lot of professionals who have been doing this for a
    while in those communities, and we should try to work with them
    because they know how to do it best to tailor programs for that
    community.
        What may work in California may not work in another State.
        Mrs. McBath. You're absolutely right, and I'm just really
    glad about the, you know, reauthorization and appropriated you
    know additional funding it's really going to reach different
    demographics of individuals that were not included in this
    appropriated funding before such as our Native American
    populations, so I'm really looking forward to being able to
    really continue to champion.
        And anything that you need from me, my staff, anything that
    you need from us please don't hesitate to call on us because
    we're really going to continue to doggedly pursue this for the
    sake of making sure that our families are safe and healthy
    thank you.
        Secretary Becerra. Georgia's got a great champion and be
    proud of yourself thank you.
        Mrs. McBath. Thank you very much I yield back the balance
    of my time.
        Chairman Scott. Thank you. The gentlelady from Iowa, Ms.
    Miller-Meeks.
        Mrs. Miller-Meeks. Thank you, Chairman Scott, and Secretary
    Becerra. Before I begin my questions, I want to thank you for
    the guidance that HHS recently issued granting more flexibility
    for the provider relief funds. I wrote a letter to you with my
    colleague representative asking the Department to issue this
    type of guidance and this much needed flexibility will allow
    providers to fully use the provider relief funds as they
    continue to recover from the impact of the COVID-19 pandemic.
    So, thank you and the Department for the guidance update.
        Also, Secretary Becerra, on May 6, also my colleague, Dr.
    Murphy who you recently heard from any myself, wrote to the CDC
    Director Walensky, asking questions about the troubling
    information that had come to light with respect to the role the
    teachers unions had played in altering the CDC's school
    reopening guidance.
        A response to that letter was requested by May 20, but we
    have still not received a response a month later. Mr.
    Secretary, can you tell me what the Biden administration is
    worried about revealing, and will you commit to us to get us a
    response to that letter within the next week?
        Secretary Becerra. Congresswoman we absolutely commit to
    get you a response as quickly as we can. We'll keep your team
    updated on where we are. A critical question all of us, whether
    it's our teachers or whether it's our children in school, and
    certainly the families who will see these kids come back home
    after being in school, we all want to make sure we're protected
    and don't see COVID flare up again.
        So, we'll try to get back to you as quickly as we can. By
    the way thank you for your work on the provider relief fund
    because we listened to a lot of your all comments in making
    sure we came out with the guidance that would be helpful in
    regulations.
        Mrs. Miller-Meeks. Thank you again for that and given the
    number of children that have committed suicide while schools
    are closed, I think it's extraordinarily important that we
    actually are listening to the science rather than the teacher's
    union, and that's particularly troubling in light of the public
    testimony Dr. Walensky gave subsequent to our letter.
        She testified that teacher's union input one guidance was
    limited to ``what happens if you have immunocompromised
    teachers?'' However, the emails I've covered showed that the
    unions influence worked well beyond that issue, and so if you
    can explain you know if necessary and correct the
    inconsistencies between the testimony of your CDC Director and
    the CDC emails.
        Secretary Becerra. Congressman I can tell you that knowing
    Dr. Walensky that she and her team at CDC used the agency as
    critical, and they make sure that they use all the science they
    have before them to make the decisions for the CDC. That's one
    of the reasons why I think we're able to come out of COVID
    because CDC has based its actions on the facts and science
    before it to guide America in how we move forward.
        Mrs. Miller-Meeks. And given how critical the CDC is, of
    the additional 1.6 billion budget increase for the CDC, can you
    commit that a significant portion of that will be directed
    directly to non-competitive, local public healthcare grants, so
    our local public health officials get the assistance they need
    after having worked 24/7 through a pandemic?
        Secretary Becerra. I commit to work with you. I don't want
    to commit anything in terms of CDC's allocations because I
    obviously would want to talk to Dr. Walensky about that and her
    team, but we can commit to you that we'll do it in a
    transparent way so that you and others can see exactly how we
    are allocating those resources.
        Mrs. Miller-Meeks. Thank you. There are also troubling
    reports earlier this year that the HHS was placing
    unaccompanied alien children with sponsors in the U.S. before
    background checks were completed. Today are all sponsors of
    unaccompanied minors, unaccompanied children receiving
    background checks prior to placing a child?
        Secretary Becerra. Congresswoman, I want to guarantee you
    that under my watch, and certainly under President Biden's
    watch every child who is discharged to a custodian, a
    responsible sponsor, has had that background check done before
    we release that child.
        Mrs. Miller-Meeks. Thank you. The AP reported in March that
    the Biden administration was waiving FBI fingerprint and
    background checks for staff and volunteers at temporary influx
    facilities who directly care for children. Today are all care
    givers at temporary influx facilities being fingerprinted and
    getting background checks prior to working with children?
        Secretary Becerra. Congresswoman, here I can assure you
    again. Anyone who works for the Department of Health and Human
    Services, and especially with regard to the care of the
    unaccompanied migrant children goes through all the appropriate
    and legally required checks before we allow them to work with
    us.
        We have different categories of workers, obviously some who
    have direct care services, some of provide the oversight of the
    discharge process and the review of files, but we make sure
    that anyone at HHS, or who is employed by HHS has gone through
    the corporate checks before they can be employed.
        Mrs. Miller-Meeks. So, you would agree that a lack of
    background checks on caregivers and a lack of fingerprinting
    increases the risk of physical and sexual abuse on children at
    the border, and having unaccompanied minors dropped off at the
    border does increase their risk of human and sexual
    trafficking.
        Secretary Becerra. We are not going to do anything that
    imperils the safety of a child, and I think at least in the few
    months that I've been secretary, I think we've proven that we
    are doing this in a way that not only protects the rights of
    these kids but respects the rights as well.
        Mrs. Miller-Meeks. Well thank you so much for answering my
    questions, and I would also encourage you to visit the border
    and I yield back my time.
        Chairman Scott. Thank you. We will have a 5-minute break
    after the next questioner, and then come right back to either
    Mr. Owens or Mr. Good, if Mr. Owens is not available. The
    gentlelady from Connecticut Ms. Hayes and then we'll take a
    break.
        Mrs. Hayes. Thank you, Mr. Chair and Thank you, Mr.
    Secretary for being here today. Before I start my statement,
    I've heard a lot of concerns about the input of teachers unions
    and school reopening. We had a conversation with the leaders of
    both of the largest teacher unions in the country, and they are
    both committed to doing everything that they can to have full-
    time in-person reopening in September, so that is what they are
    looking for as well.
        So just something to note here. Secretary, Mr. Secretary,
    yesterday I introduced a bill, H.R. 3904 Reducing COVID-19
    Disparities by Investing in Public Health Act, which responds
    to the disparities that have emerged in COVID-19
    hospitalizations and deaths by tackling the underlying chronic
    problems, disparities in public health and chronic disease
    prevention and treatment.
        I want to first thank you for the over 261 million dollar
    increase to the National Institute of Minority Health and
    Health Disparities in the proposed budget. The COVID-19
    pandemic has revealed that we need to do more to combat
    systemic inequities that have left communities of color more
    vulnerable in our healthcare system.
        There are significant racial disparities in the race by
    which Americans suffer from chronic diseases like heart
    disease, diabetes, and asthma. African-American children are 12
    percent more likely to suffer from childhood asthma. African-
    Americans are 30 percent more likely to die of heart disease
    and twice as likely to have a stroke. Additionally, African-
    Americans made up 22 percent of COVID-19 deaths.
        So, I was a little disappointed to see that this budget
    included just a negligible increase for the chronic disease
    prevention and health promotion fund at CDC. The American Heart
    Association and the American Lung Association recommended that
    this fund be increased threefold, so having seen the impacts of
    these chronic underlying conditions, and the need for increased
    funding, when I saw that the Office of Minority Health was flat
    funded in Fiscal Year 2022, I was to say the least,
    disappointed.
        Can you talk a little bit about how important funding for
    these areas are, and what efforts your department will make to
    increase funding to combat chronic diseases and the
    corresponding disparities that accompany them?
        Secretary Becerra. Congresswoman, thank you for the
    question, and thank you for being a champion of eliminating
    those health disparities. One of the pillars, at least under my
    Administration at HHS will be equity. I've made that clear to
    all of those lieutenants within this agency, and it's a large
    agency as you know.
        I am reflecting the commitment that President Biden has
    made to move forward on equity, and what I can tell you is in
    the investments we're making whether it's on minority health
    where we are investing a quarter of a billion dollars in the
    National Institute of Minority Health and Health Disparities,
    or whether it's the issue of maternal health that we were
    investing several millions dollars to try to address the
    disparities that we see in outcomes for women in maternal
    health.
        That's all to make sure, excuse me, that's all to make sure
    that we address these disparities that have existed for far too
    long. And so, what I can tell you is that we're committed. You
    may not see it in the line item on the budget, but we are
    absolutely committed to making progress in addressing these
    disparities.
        I wouldn't be in this position if that weren't the case.
        Mrs. Hayes. Well, thank you. I appreciate that. And I just
    I'm glad to hear that because this isn't about feelings of a
    particular community, but data has shown us, and the
    disparities that were revealed during COVID has shown us that
    there are huge equity gaps that need to be addressed in our
    systems, in our processes, and our functions.
        What can we in Congress to do help support your department
    in securing funding, or even in promoting these efforts? Did I
    lose you?
        Chairman Scott. Mr. Secretary I think inadvertently muted.
        Secretary Becerra. Yes, I did, I did, but I was drinking
    water. Congresswoman what I would say is first the most
    important thing you can do is keep tenaciously testing the
    Secretary of Health and Human Services to make sure that we do
    address these disparities. I hope you will keep coming at me
    and saying, `Secretary, show me what you've done,' and I
    guarantee you that if I'm worth my weight in salt, I will have
    done what you would like to see, and that is to address these
    things.
        And the fibers in my being, my DNA, is all about making
    sure we address these disparities, so keep me in the task.
        Mrs. Hayes. I can absolutely commit to doing that. Thank
    you, Mr. Secretary. With that Mr. Chair I yield back.
        Chairman Scott. Thank you. And now we'll take a 5-minute
    break and as soon as the Secretary comes back, we'll reconvene
    with either Mr. Owens if he's available, or Mr. Good would be
    next if he's not available. A 5-minute break.
        [Whereupon a brief recess was taken to reconvene this same
    day.]
        Chairman Scott. Back to order. And the next person is Mr.
    Owens on screen I don't see him. My distinguished colleague
    from Virginia, Mr. Good.
        Mr. Good. Good afternoon, sir. Thank you, Chairman, and
    Thank you, Secretary Becerra for being with us today. And I
    appreciate the opportunity to talk with you. Secretary I would
    like to discuss how your department is handling the thousands
    of unaccompanied migrant children who are illegally entering
    our country.
        It's been disheartening to see President Biden reverse
    policies that would mitigate the crisis at the border, such as
    the MPP, or Migrant Protection Protocols commonly referred to
    as remain in Mexico, and that Vice President Harris has yet to
    visit the border as others have noted, even though the
    President has named her as our border tsar with responsibility
    of thousands of children falling under your jurisdiction.
        I'm sure you're extremely disappointed in frustrated with
    the refusal of your superiors to control the situation at our
    southern border, as you struggle to deal with and try to clean
    up the mess they're making of our border and our immigration
    policies. Secretary Becerra do you think it would be helpful if
    the President were to visit the border to see first-hand the
    crisis he has exacerbated and continues to create there at the
    border.
        Secretary Becerra. Congressman, thank you for the question.
    It's crucial. This is an important one. I think the President
    and the Vice President are committed to making sure that we
    take on this challenge that immigration presents.
        He did present early on a proposal to Congress to try to
    reform a broken immigration system. This is what happens when
    you have a broken immigration system right? For our purposes,
    we have to take care of quite a number of kids who have come
    across without any adult with them, and it's a tough issue.
        But I guarantee you that the President's committed, along
    with the Vice President to tackle this as best we can, and
    hopefully Congress will take up immigration reform.
        Mr. Good. But you don't think it would be helpful for him
    to actually visit and to send a message that he's engaged, or
    for him to even know what you're dealing with first-hand by
    going to the border, you don't think it would be helpful for
    the President to come?
        Secretary Becerra. Well, he and his team, and that includes
    me, have been very engaged.
        Mr. Good. I just want to know that you don't think it would
    be helpful for him to come?
        Secretary Becerra. I think the President has to be on top
    of all of these issues.
        Mr. Good. Let me move on please because I want to know if
    you think it would be helpful for him to be there himself. How
    about the border tsar? Do you think it would be helpful to you
    if she were to visit to get a better sense of what needs to be
    done?
        Secretary Becerra. Well, the Vice President has already
    shown her commitment to this issue. She just recently returned
    from a trip to Mexico, returned to America.
        Mr. Good. I'm referring to the border, I think she's a
    little confused. We don't need her to go to Europe's borders,
    but to go to our border. Do you think it would be helpful for
    her to come to our border?
        Secretary Becerra. I think it's important to have the top
    two leaders of our Nation engaged, and they are both engaged
    with their team.
        Mr. Good. I agree with that. How about yourself. Have you
    yet since you've become Secretary, or do you plan to visit the
    border?
        Secretary Becerra. Congressman, I've been to the border so
    many times over the course of my life, and in my career and I
    certainly have been there as Secretary of Health and Human
    Services.
        Mr. Good. So, I'm sorry, when were you last at the border?
        Secretary Becerra. I was there about two or 3 weeks ago
    when I visited one of our sites there in the El Paso area.
        Mr. Good. Well, and I'm sure that you would say that it's
    been helpful to see how much worse it has become during this
    Administration, to see it up firsthand. The world is watching
    and observing the utter chaos and the lawlessness that's become
    the disaster on our border, yet it doesn't seem to be
    sufficient urgency from this Administration to address the
    problem.
        Do you have any sense of when, if ever, this Administration
    might gain operational control of our border?
        Secretary Becerra. Congressman, look we are not separating
    kids from their parents. We are not seeing people die in the
    hands of Federal Government officials. I will tell you that
    what the Biden administration has done is handled this in a
    lawful manner.
        It is a challenge, but I respect that we have a President
    who's willing to treat people as human beings and is respecting
    of the law.
        Mr. Good. Well, I think we are facilitating the separation
    of children from their parents the way that we are encouraging
    illegals to stream across the border, that we're allowing
    unaccompanied children to come across, and we're trying to help
    and facilitate that versus preventing it.
        In previously Administration were to secure the border, it
    looks more impressive with each passing day as we see the crime
    and the drugs and the suffering of victims, including the
    children, that are streaming across the border.
        It does seem to be that there's been disagreement within
    even this Administration though on how to handle it, and if I
    run short on time, I'm going to reference the article which
    Chairman, Mr. Chairman I'd like to submit for the record
    please, this article from Politico article from last month that
    was titled, ``Becerra's cautious border play rankles the White
    House.''
        It seems as if you were in favor of the refugee camps of
    the 15,000 before the Administration reversed it to 62,000. Do
    you see any operational reason, or any benefit to go to the
    62,000 instead of 15,000?
        Secretary Becerra. First Congressman, that article is
    inaccurate. And second, I believe we're going to handle the
    influx of refugees as they come. The President is Committee to
    make sure that we do our part as a world partner to make sure
    that people who are seeking to escape persecution and death
    have a place that they can go, and America has always been a
    shiny light in that regard.
        Mr. Good. Thank you, sir my time is expired, so Mr.
    Chairman I yield back. Thank you.
        Chairman Scott. Okay, without objection the article will be
    submitted to the record.
        Mr. Good. Thank you, sir.
        Chairman Scott. Is Mr. DeSaulnier ready to respond, to ask
    questions? The gentleman from California, Mr. DeSaulnier.
        Mr. DeSaulnier. Thank you, Mr. Chairman. Mr. Secretary it's
    such a pleasure to see you. Always proud to see a graduate of
    McClatchy High School. Usually, those graduates go to really
    good schools like the University of California Davis Berkeley,
    but you know, really glad to see you.
        I have two questions. COVID has really accelerated the
    demonstration I think for all of us for behavioral health,
    particularly for young people. We had a terrific hearing at a
    Subcommittee on health with Ranking Member Allen. Really
    encouraging bipartisan acknowledgment that this is an important
    area from my perspective.
        And I appreciate Ranking Member Allen's contribution, and
    all the Members contribution. We know that ACA and with parity
    that was really a good thing.
        Chairman Scott. If the gentleman from California wants to
    suspend briefly, I think the recorded studio is having a
    problem with the livestream. If you can just suspend for a
    moment.
        Mr. DeSaulnier. Probably a Stanford grad.
        Chairman Scott. Yes. We're back live, the gentleman from
    California.
        Mr. DeSaulnier. Well, let me finish that thought. So
    behavioral health, particular emphasis on kids. We've got I
    think in a lot of ways the good thing in this stigma is it's
    falling apart dramatically, so Americans are seeking out
    behavioral health services. But we don't have as many people
    going in to the professional, so we've got this supply and
    demand problem.
        I wonder if you could tell me, and I'd love to work with
    you on this, is how do we address this? We've got this great
    policy in the ACA that allows for parity. We've gone some
    challenges around that that the Committee and Subcommittee are
    working on, but we need to get more infrastructure.
        We need to get more providers. And of course, the expertise
    and the knowledge on neuroscience and how the brain works to
    stress is growing exponentially, and with a particular emphasis
    on kids. We know that there's a lot of emerging research in
    COVID on the impact on kids.
        So how do we work together with you and your department to
    meet the needs for people, particularly young people, around
    behavioral health as we come out of COVID?
        Secretary Becerra. Congressman, thanks for the question and
    the sincere way in which you posed it. But at the end of the
    day, we got to put our money where our mouth is, and we've
    always talked about making mental health at parity with the way
    we treat physical health.
        And we've never done that. And fortunately, you all did us
    a great service in the CARES Act, and of course in the American
    Rescue Plan, and actually provided real dollars to try to
    tackle this. We just put out about a month ago a three billion
    dollar let of money, half of it for mental health, half of it
    for substance use disorders. That's real money that hits the
    ground in these communities where you are, where I am.
        We have to do more of that. This budget that the President
    presents provides over a billion and a half dollars for the
    community mental health services block grant to go even
    further. We hope that you'll help us with the American Family
    Plan to make these investments.
        But at the end of the day as you and I know, it's whether
    we're willing to put our money where our mouth is to make this
    happen, and fortunately today more and more were willing to say
    that there's a family Member who needs mental health services.
        Mr. DeSaulnier. Great. We'll look forward to working with
    you. The plaque that is gun violence in the United States, very
    difficult issues for the Congress, very partisan. I wonder if
    there's a possibility in the department, and I really feel
    strongly and have for a long time that this is a public health
    issue.
        And if we look at it analytically, respect the second
    amendment, respect that we have differences of opinion, and my
    comments won't de-emphasize the importance of urgency as every
    day goes by.
        But maybe a little longer view is now that we've got CDC
    with some funding at least for research, but couldn't we look
    at a longer view and hopefully address the urgency of this, but
    just gun safety. And surely, we can all agree that evidence-
    based research on gun safety with recommendations to Congress
    and the Administration to enact gun safety policies could be
    something we could all focus on an agree to.
        I wonder if you could comment on that, how much discretion
    you might have to actually pursue that within the department.
        Secretary Becerra. Congressman, you, and I come from a
    State where treating gun violence as a healthcare problem, as a
    public health crisis is not new. And fortunately, President
    Biden has recognized that we have to do more. We are going to
    expand research. If you help us with our budget request, we
    will be able to expand our research to help other states beyond
    California.
        But at the end of the day, we have to recognize that this
    is a crisis. It's a healthcare crisis, not just a gun violence
    crisis, and the quicker we do that the more lives, especially
    young lives that we'll save, so look forward to working with
    you on that.
        Mr. DeSaulnier. And just because it's personal to me I
    always remind people that over 100 people who die of gun
    violence every day in the country, two-thirds of them are
    suicide, and that far outstrips the second causes of suicide in
    the United States. We know the proximity of the guns
    accelerates the success of people committing suicide.
        I really look forward to working with you Mr. Secretary on
    both subjects, and really important work that we have to do,
    and again I'm so proud of you.
        Chairman Scott. The gentleman's time is expired.
        Mr. DeSaulnier. I yield back thank you.
        Chairman Scott. The gentleman from Utah, Mr. Owens.
        Mr. Owens. Secretary, we have had a series of hearings in
    recent months looking over the impact of COVID-19 on different
    student populations. Republicans have invited parents to those
    hearings to talk about the negative impact on school closures
    on their children and families.
        Two of those parents have explicitly said that one of the
    lessons are nation should learn from this pandemic is that
    schools are essential services and should never, ever be closed
    for an extended period of time. Do you agree that we should
    resolve as a nation to never close our schools indefinitely as
    so many school districts have done this year?
        Secretary Becerra. Congressman, thank you for the question.
    Would I agree that we should never have to close our schools?
    We should always do what we can to prevent the need to keep a
    child from going to a school, and that's why we're trying to
    prepare for any pandemic in the future, and COVID is going to
    teach us a whole lot.
        Mr. Owens. OK. President Biden's 2022 budget requests
    enormous increases of early childhood care and educational
    programs, both new and existing programs. For early education
    that includes about 200 billion to impose a universal preschool
    program for all third, and fourth grade children. I'm sorry,
    three-and 4-year-old children, as well as an 11.9 billion
    dollars for Head Start program which has increased to 1.2
    billion since 2021.
        The proposed universal preschool and existing Head Start
    program are largely duplicative in early education programs.
    How do you see these two competing programs co-existing, and
    what studies have you done to understand how this proposal will
    impact the existing small businesses already serving these
    children?
        Secretary Becerra. Congressman first there is no conflict.
    They will work in concert to make sure that families have the
    resources they need to make sure that they not only have
    childcare services available, but it's quality childcare
    services.
        We are so far behind in making that available. We are the
    greatest democracy, richest democracy in the world, but we seem
    to be the only industrialized nation that doesn't realize or
    figure out a way to actually make sure that parents can go to
    work and not fear what's going to happen to their kids during
    their work hours.
        We can make these investments and make it work for
    everyone. And I guarantee you this is not a dollar wasted when
    you help a family provide quality childcare for their kids.
        Mr. Owens. Since the outbreak of the pandemic an astounding
    amount of Federal funding has been put into early care and
    educational system, including a 40 day and American Rescue Plan
    Act alone. This act excluded all Republican input, and reflects
    poor policymaking, especially with respect to accountability.
        On April 14, the Committee sent a letter to you asking
    important information about the oversight of this unprecedented
    influx of new Federal childcare funds. Sadly, we have not
    received a response. With respect to the 50 billion in the ARP
    for childcare, how are you working to ensure the funds are
    spent responsibly, and to avoid a funding cliff for childcare
    providers and to support long-term solutions for family's
    childcare needs?
        Secretary Becerra. Congressman, let me invite you and your
    team if you'd like to work with us as we implement some of the
    programs under the American Rescue Plan. As I mentioned to you,
    and I said in my opening statement, transparency is going to be
    a big deal for us. We want to make sure that we demonstrate the
    program integrity so that we make the right use of these
    dollars that you've made available to us.
        We thank you for making those dollars available to us so we
    could actually help families provide the childcare that they
    need for their kids. And when we do a program if you have any
    questions, we're going to make ourselves available, so please
    feel free anytime early, before we start implementing, or
    during its implementation to ask us any questions you have.
        Mr. Owens. Thank you, Secretary. I yield back.
        Chairman Scott. Thank you. The gentleman from Michigan, Mr.
    Levin.
        Mr. Levin. Thank you so much Mr. Chairman, and it's so
    great to see you, an honor to call you Secretary Becerra.
    Thanks for appearing before us today. I'm going to try to
    shoehorn in two questions, or two sets of questions, one about
    the ACA and one about care workers, so let's see if we can do
    it.
        As you know there's a lawsuit brought by Republicans,
    California versus Texas, which threatens the future of the
    Affordable Care Act. In fact, I think you rallied states in
    defense of the ACA in your former role of California's Attorney
    General.
        I applaud the Biden administration for reversing the
    position taken by the previous Administration which supported
    partisan Attorney's General who argued that the law should be
    struck down. But the threat of this lawsuit is still there, a
    decision by the Supreme Court could be handed down any day.
        So, would you explain what this means for my constituents?
    Which parts of the ACA are at risk if this Republican lawsuit
    were to prevail, what kind of chaos could result of the
    republic Attorney's General succeed, and what would happen to
    the existing insurance market?
        How many people do you think might be harmed as a result?
    Give us your sense?
        Secretary Becerra. Congressman, first great to see you, and
    please pass along my best regards to former Congressman Levin
    as well.
        Mr. Levin. You know I will.
        Secretary Becerra. Absolutely, please give him a big hug
    for me.
        Mr. Levin. He's so proud of you sir.
        Secretary Becerra. Oh, he's an important mentor in my life,
    and someone who really taught me some real values in how you
    can exercise those in Congress. We're going to find out real
    soon. It's in the hands of nine individuals, nine Americans.
        And if they choose to find it constitutional as they have
    in the past, then we're going to be able to grow that number
    from 31 million Americans who have good health insurance
    coverage as a result of the Act to even more. If they somehow
    for some reason decide that it is not constitutional, well then
    you all have some really important work to do and so do we, to
    somehow protect all those Americans who don't have to worry
    about having a pre-existing condition.
        And all of a sudden now they're going to suffer and face
    the consequences they had in the past where you could be
    discriminated against you getting insurance coverage simply
    because you have asthma, or you have some other type of pre-
    existing condition.
        All those kids were under the age of 26 who have health
    coverage through their parents policy will all of a sudden find
    that if you're 18 to 26 you're out of luck, and those parents
    will no longer be able to provide them coverage.
        Those seniors who have preventive healthcare services and
    help paying for their prescription medication, will find
    they're out of luck if the Affordable Care Act goes away. All
    of those things disappear if somehow a majority of those nine
    justices believe that the Affordable Care Act is
    unconstitutional.
        But Congressman, having been the Attorney General who got
    to have his team argue that case before the Supreme Court, I
    can't tell you I'm totally confident, but I actually have a
    great deal of confidence that the Supreme Court, those justices
    will find a way to do the right thing for America, and protect
    the Constitution and its values by protecting the affordable
    care act. That's my hope, we'll see.
        Mr. Levin. Thanks. I hope you're right for sure. And you
    know I'm a former union organizer. My first job in that space
    was helping nursing home workers organize with SCIU I think
    almost 40 years ago, but we won't dwell on the passage of time.
    Making sure the direct care workforce has a safe workplace, a
    living wage, and great benefits is a cause near and dear to my
    own heart, and I know it is to yours.
        And I know from my--first-hand experience that this
    critical workforce is made up largely of women of color and
    immigrants who are paid on average about $12.00 an hour. So,
    Mr. Secretary how will HHS partner with the Department of Labor
    and us to invest in the direct care workforce, and how will you
    do it in a way that improves worker recruitment, retention,
    development and make sure that they're paid well and protected
    in their workplaces?
        Secretary Becerra. Congressman, critical because it's hard
    to believe that we don't want to pay people who care for our
    dearest loved ones in the right way, and that's why the
    President's budget places true value in supporting those
    caregivers. We're requesting 73 million dollars in increase for
    a total of 280 billion dollars, to provide support for the
    National Family Caregivers and Native American Caregivers
    support programs that are out there, helping caregivers.
        We want to continue to see those Americans who take on the
    tough task of caring for our family Members receive the wages
    they deserve, and we are looking forward to working with you to
    pass the American Families Plan that gives an opportunity to
    invest further in caregiving for whether it's our grandmother,
    or our child making sure that we do it the right way, paying
    real wages.
        Mr. Levin. Thank you so much sir. We're here to work with
    you and Mr. Chairman I yield back.
        Chairman Scott. Thank you. The gentlelady from Michigan Ms.
    McClain?
        Mrs. McClain. Great thank you very much Mr. Secretary. I
    want to thank you for being here today. I just have a few
    questions. First would you agree that obviously the health and
    safety of our citizens remains the utmost priority?
        Secretary Becerra. Absolutely.
        Mrs. McClain. OK. And I've listened to the testimony. You
    stand behind the Fiscal Year 2022 budget request of 131 billion
    for HHS, even though it's a 23 percent increase, correct?
        Secretary Becerra. That budget we have put forward and
    having gone through all the elements of it and hope that you'll
    support it.
        Mrs. McClain. OK. And do you commit to ensuring a
    transparent and responsible use of taxpayer dollars?
        Secretary Becerra. Of course.
        Mrs. McClain. Thank you. So, I'm glad that you agree with
    me on the basics. And I believe that there is a crisis. You
    testified that you agreed with me there's a crisis, a pandemic
    crisis. Do you feel that we're coming out of the COVID pandemic
    crisis?
        Secretary Becerra. The President, his efforts to get so
    many millions of Americans vaccinated is an ambitious goal to
    get 70 percent of adults with at least one shot in arm by July
    4. All of those efforts is investments in the American Rescue
    Plan and support of Congress to pass it. All of those efforts
    have led us to the point, well, you're now beginning to see
    some states open up, and so we're not out of the woods, but we
    are certainly in a far better place than we were a year ago.
        Mrs. McClain. Do you believe we have a crisis at the
    border?
        Secretary Becerra. We are certainly facing the challenges
    that come from having a broken immigration system, and I have
    to deal with those in one aspect when it comes to those
    unaccompanied migrant children. But without a doubt for decades
    having an immigration system that's broken, creates these kinds
    of challenges.
        Mrs. McClain. So that's a yes, we do have a crisis at the
    border? I'm confused with the answer, sorry.
        Secretary Becerra. Well, we have a broken immigration
    system that is creating all of these challenges that we must
    face. It's not just this Administration. Previous
    Administrations. I remember when I was a Member of Congress.
        Mrs. McClain. I agree as we sit here today, I think we have
    a crisis on the border. We have a broken immigration system as
    well. So, I'm just, are we in agreement, or do you think we
    don't have an issue with the border?
        Secretary Becerra. Well, I'm glad you agree that we have a
    broken immigration system. It definitely creates these
    challenges that while we're taking them on, it makes it tough,
    and I hope that you all will take on the President's proposal
    for immigration reform.
        Mrs. McClain. I don't know why it's a struggle to answer
    the question about a crisis at the border, but I'll take it as
    a not answer, I guess. Where my confusion comes in is you've
    diverted 2 billion dollars of funding to deal with the crisis,
    non-crisis, pick whatever word you want.
        You know 850 million from the stockpile money, as well as
    $850 million of COVID testing money, so can you see my
    confusion is if we don't have a crisis at the border why are
    you diverting funds from COVID and from our stockpile that
    would help us deal with the COVID crisis we have now, or a
    future pandemic?
        So, I'm very confused if we have a non-border crisis why
    are we diverting 2 billion dollars.
        Secretary Becerra. Congresswoman, thank you for the
    question, and I've tried to explain this in the past. We have
    an obligation under the law to provide care for these
    unaccompanied minor children regardless of what their ultimate
    outcome will be if they have to return back to their home
    country or not.
        While they're here temporarily it's our obligation to make
    sure they are safe and healthy.
        Mrs. McClain. And that obligation comes at a cost.
        Secretary Becerra. Absolutely.
        Mrs. McClain. Because for every action there's a cost,
    right?
        Secretary Becerra. Well, there's certainly a financial
    cost, no doubt. But we're going to do it right because we
    should not pick corners simply because the child may not be
    someone we know or have had in this country for a long time.
        Mrs. McClain. But it's coming at a cost to our non-crisis
    at the border, so if we don't have a crisis at the border why
    would we need to divert two billion dollars to take care of
    that non-crisis?
        Secretary Becerra. So, Congresswoman we are handling the
    challenge that the unaccompanied children present. At the same
    time, we're making sure that we're making use of those dollars
    to pay for those services in the ways that you all in Congress
    have provided to us.
        So, all the moneys that we've used, we used transparently,
    that's why you're able to cite certain figures.
        Mrs. McClain. OK. So, we are going to continue. Do you see
    more money being diverted to this issue in the future?
        Secretary Becerra. Congresswoman until you all fix this
    broken immigration system, we're going to continue to face
    challenges like this, and I have under law the obligation to
    make sure to care for these kids. Until you all deal with the
    crisis, the critical aspects of immigration the way that they
    should be dealt with, this broken immigration system is going
    to continue creating these challenges.
        Mrs. McClain. Right. And we can start by limiting the
    number that come in, but with that I'm out of time. Thank you,
    sir, for your time. I appreciate it and I yield back.
        Secretary Becerra. Thank you.
        Chairman Scott. Thank you. The gentlelady from Michigan.
        Ms. Stevens. Thank you, Mr. Chair, can you hear me all
    right?
        Chairman Scott. We can.
        Ms. Stevens. OK great. The other gentlelady from Michigan
    representing from Troy down over to Canton and Thank you, Mr.
    Secretary, for your testimony today which was very well-written
    and put together and your answers to today's questions have
    been tremendous.
        I've been seeing that there's a lot of emphasis on
    immigration and we've got a large Committee here today, but
    it's interesting because our jurisdiction and Ed and Labor's is
    pretty specific for why you are here.
        And the last time I checked there's certainly a lot that we
    should be discussing within our jurisdiction, and that's
    exactly what I wanted to talk to you about Mr. Secretary, which
    is you know our older Americans who have been so hard hit by
    this pandemic.
        While the need has been growing for years, the pandemic has
    caused an unprecedented increase in demand from older Americans
    for meals and other critical older American Needs Act services
    that help them stay safe and well in their homes. You know I
    frequently participate in the Meals on Wheels program that
    operates in Waterford, Michigan.
        But we see ourselves defeating this virus and making lots
    of progress in the pandemic. The needs for programs like these
    are likely to remain, so just wanted to hear from you Mr.
    Secretary about your plans to continue to serve older adults
    who now rely on OAA services as Federal COVID stimulus program
    began to wind down, thank you.
        Secretary Becerra. Congresswoman, thank you for the
    question, critical. You may be aware that in May, early May the
    Administration for community living within the Healthy Human
    Services Department released about a billion and a half dollars
    in funding to states and territories, and that was money that
    we thank you for because it came from the American Rescue Plan,
    and that was for our older American Act programs.
        Those dollars are going to help fund vaccine outreach and
    coordination to help address social isolation to too many of
    our seniors are experiencing to provide family caregiver
    support, and to offer nutrition support for our seniors.
        Ms. Stevens. Great. And Secretary Becerra, we know that the
    pandemic has also had a severe impact on the mental health of
    young Americans that's come up in today's hearing. And
    according to the American Academy of Pediatrics over 40,000
    children have lost a parent to COVID 19.
        Has HHS begun to collect data on children and teens
    affected by COVID-19 related loss, and how those efforts are
    going to inform the department's mental health awareness and
    treatment programs? And is there any way that Congress might be
    able to be of an assistance to you in those efforts?
        Secretary Becerra. Excellent question, and I hope that you
    and some of your colleagues would followup because we are
    collecting a great amount of data, and it will be very useful,
    not just for our programming of resources, but for you all
    making policy that will take us in an even better direction.
        So please be in touch with my team because that data can
    help drive good decisions on where we go next.
        Ms. Stevens. Yes. And it certainly begins almost as
    empirical right, so one of the things obviously not related to
    your jurisdiction that we're starting to see in Michigan is a
    major demand for guidance counselors in our schools.
        I've heard some reports that guidance counselors used to
    see in some of our schools on average, 17 to 20 students, and
    now that's upwards of 100. And so, this isn't within your
    jurisdiction, but just thinking about that support network that
    goes into our school system.
        And so with that I'm going to cede back my time to the next
    question Mr. Chair partly because our Secretary has just been
    doing such a phenomenal job, and it's obviously no question why
    he is in this role, and you know was able to answer things that
    might have been better for you know the Homeland Security
    Subcommittee, but obviously you know we are going to keep
    pushing on what we need to do to continue to keep all Americans
    healthy in a strong HHS Department.
        So, with that, thank you, Mr. Chair, thank you, Mr.
    Secretary, and I yield back.
        Chairman Scott. Thank you. The gentlelady from Tennessee,
    Ms. Harshbarger?
        Ms. Harshbarger. Thank you, Chairman and Ranking Member
    Foxx, and welcome Secretary Becerra. We appreciate your time to
    discuss the 2022 budget for HHS. As a pharmacist, I look
    forward to opportunities to work with you and your department
    in areas where we should hopefully have bipartisan agreement,
    improving our healthcare delivery system and addressing
    problems and I really thank Representative Keller for
    mentioning the PBM issues with the DIR fees.
        And because of that, because of being a pharmacist I have
    introduced legislation, it's H.R. 1829, the PBM accountability
    study that would address why some of the drug pricing is so
    exorbitant. And everybody on this Committee has independent
    pharmacies in their district who's struggling with this, and
    I'm glad the Administration's budget also proposes to focus on
    things like substance abuse and mental health disorders.
        That's going to be big in my district, because I do have a
    couple of questions for you sir. First one does deal with drug
    pricing. When the Part D program, the Medicare Part D program
    was created in the bipartisan Medicare prescription during the
    modernization act of 2003, the law included an important
    provision known as the non-interference clause, and that
    inhibits the HHS Secretary No. 1, from interfering in private
    cross-negotiations under the part D program.
        And No. 2, establishing single national formulary for the
    Part D program. And because of that it's my understanding that
    this was put in the law expressly to keep the government from
    interfering in the American health system in determining which
    medications are covered, which are not covered as is commonly
    the case in many foreign countries that are single payer
    systems.
        And honestly, the evidence has been very clear that this
    approach establishing a competitive marked based system in Part
    D has been successful in balancing cost containment with robust
    beneficiary access. But nevertheless sir, the political talk is
    all about the need for negotiation, Medicare Part D, and in
    particular it talks about government.
        The talk is government negotiation. And some have proposed
    eliminating the non-interference provision of the law. And my
    question Secretary Becerra is you know that's very confusing,
    and can you clarify for me whether or not there is negotiation
    happening today in Medicare Part D? And if so, who's doing this
    negotiation?
        Secretary Becerra. Congresswoman, thank you for the
    question, and I know something that we'll have an opportunity
    to discuss further. By the way can I just say thank you to you
    and if you'll convey the thank you to one of your colleagues in
    the pharmacist world for all the work that they have done to
    make vaccines available locally to the community, especially
    those independent pharmacists who really are the ones that know
    their community.
        It's been indispensable to have them step up to the plate,
    and can you please convey on behalf of HHS our thanks for what
    they've done?
        Mrs. Harshbarger. Absolutely sir. They are an integral part
    of the healthcare system, and we need more authority and things
    like that. Start with us first.
        Secretary Becerra. At a time when we're losing that
    personal contact with all those service providers it is sure
    nice to have some of those pharmacists who we have known for
    decades right, to be, and we trust. And so, it's been great, so
    please convey our thanks to them.
        Mrs. Harshbarger. I will do that.
        Secretary Becerra. On the question?
        Mrs. Harshbarger. Yes, go ahead. No, I want you to answer
    the question.
        Secretary Becerra. Yes, yes. We're working, and as you know
    this has been an issue that not just this Administration, but
    previously Administrations have tried to tackle. And in fact,
    we're now in court on a number of these matters. But what I
    will tell you is this, President Biden has made a commitment to
    reduce the prices of prescription drugs.
        We're looking for the best way to do that. We know that
    there are a number of proposals that are out there, different
    ways that other countries have found to do it. What I could
    commit to you is this: We will do everything we can within our
    current power, but we're hoping you all, working with you we
    can get more power to actually bring down the prices of
    prescription drugs.
        Mrs. Harshbarger. That's the goal, and that's where my
    expertise lies. I want to change topics and ask you one other
    thing. I understand from your previous recent hearing
    appearances in the House Energy and Commerce Committee and the
    Senate Finance Committee you have been asked on a number of
    different occasions to affirm that you'll stay the commitment
    to uphold all laws, including the enforcement of the partial
    birth abortion act.
        And your response to Representative Gus Bilirakis was,
    ``There is no law that deals specifically with the term partial
    birth abortion.'' Do you still maintain this position that
    there's no Federal law that deals specifically with that term?
    And that's just a simple yes or no sir.
        Secretary Becerra. Congresswoman I wish life were just a
    simple yes or no. What I can say to you is what I tried to say
    to the Congressman and to others who have asked this question.
    We're going to make sure we uphold the law we follow the law as
    we protect women's rights to healthcare.
        Mrs. Harshbarger. It's simple. If you can read this, and if
    you can't read it, I'll read it for you. It's 18 U.S. Code 1531
    Partial Birth Abortions Prohibited. And you know there's a
    couple things I want to enter into the record. It was a
    PolitiFact article Chairman, it is ``Becerra's wrong that no
    law addresses partial birth abortion,'' so if I could enter
    that, that would be fantastic. OK.
        Chairman Scott. The gentlelady's time has expired. She has
    asked unanimous consent without objection the document will be
    entered.
        Mrs. Harshbarger. Thank you.
        Chairman Scott. The gentlelady's time is expired.
        Chairman Scott. The gentlelady from Minnesota Ms. Omar.
        Ms. Omar. Thank you, Chairman. I know my colleagues on the
    other side of the aisle have a reawakened interest in deficit.
    I agree with them that taxpayer dollars must be well-spent, but
    part of running a government is making sure that revenue comes
    in so that we can pay for all of the good work your department
    is doing Mr. Secretary.
        The Republican party pushed through tax cuts in 2017 that
    were nothing more than massive trillion-dollar corporate
    giveaways, serving essentially only to help the rich get
    richer. One of the things that they promised would happen was
    that companies would reinvest their tax windfalls in research
    and development.
        And how did that work out? According to campaign for
    sustainable prescription drug pricing between 2017 and 2018
    pharmaceutical companies more than doubled shareholder
    dividends while investing only 6 percent more in research and
    development which brings me to my question.
        President Biden support negotiating with drug companies.
    Critics of policies such as H.R. 3 claim that this would
    prevent companies from competing. Mr. Secretary, do you believe
    pharmaceutical industries, stock buybacks and dividend
    constitute innovation, and will those help develop any new
    drugs?
        Secretary Becerra. Congresswoman, thank you for the
    question. I think the President has been very clear that we
    wanted to have a vibrant domestic source of medicine, but we
    also want to make sure that we're getting a fair price for
    those medicines for the people whether it's under Medicare or
    Medicaid, or any other program. And so, the President has made
    a commitment and I'm going to try to follow through on that to
    make sure that as we try to lower the prices of those drugs, we
    look at every type of proposal, including H.R. 3 to get us
    there.
        Ms. Omar. Thank you, Mr. Secretary. I would also like to
    ask you about the future of our healthcare workers. Throughout
    the COVID-19 pandemic contact tracing and translators with
    experience in hospitality, community engagement and other
    fields have used their transferrable skills to streamline
    access to COVID-19 testing, vaccinations and treatment for
    communities heavily impacted by COVID-19.
        What plans does HHS have to ensure that contract tracers
    without prior public health experience can find employment and
    fully transition into the healthcare field?
        Secretary Becerra. Congresswoman, you're probably aware
    that this Administration, by the way with your help in passing
    the American Rescue Plan, is going to be dedicating a number of
    funds and resources to try to help us with the healthcare
    workforce. We understand COVID-19 taught us that were not
    prepared for primetime when it came to dealing with something
    like this pandemic.
        All those gaps in coverage, all those places in America
    that get missed, it's a lot of it because we don't have the
    workforce that we need. We also have to make sure we're paying
    that workforce properly so that people will want to go into
    those fields. So, we believe with some of the resources that
    you've made available through the American Rescue Plan that we
    can actually improve the condition of our public health system
    by improving the conditions of our workforce.
        Ms. Omar. Thank you. Recently I had the opportunity to
    visit an influx care facility in Texas. One thing we heard
    consistently from operators and the HHS staff working there,
    was that the importance of uniting and accompanied minors with
    these sponsors in the U.S. as quickly as possible.
        They outlined to us what some of the barriers were in
    unification, including many core specific issues like delayed
    and processing of background checks and the inability for
    fingerprinting to take place during the quarantine and COVID
    closures. Can you share with us what steps HHS is taking to
    unit children with their sponsors as quickly and safely as
    possible, while still taking COVID precautions into
    consideration?
        Secretary Becerra. First, thank you for your visit to the
    city and for the oversight that you and others are performing.
    We're doing everything we can to try to make sure we find a
    responsible custodian. And I want to emphasize responsible
    because we're not going to let a child go until we feel
    confident that that child will be cared for because we've seen
    other instances where that hasn't been the case.
        We continue to increase the number of personnel that we
    have that can help us do that intake process to be able to
    discharge that child, but it's a difficult process, and as
    you've mentioned COVID has made it more difficult. Let's put it
    this way, we can no longer rely on those licensed care
    facilities that typically would take these children and provide
    them the full set of services and then do the discharge the way
    we used to because those facilities have had to pare down the
    number of kids they accept.
        And so, these emergency intake sites that you visited are
    the ones that are doing some of this work. It is tough, but
    we're going to do it right.
        Ms. Omar. I appreciate you. I yield back my time Chairman.
        Chairman Scott. Thank you. The gentlelady from Illinois,
    Ms. Miller?
        Mrs. Miller. Yes, Thank you, Mr. Chairman, Ranking Member
    Foxx, and Mr. Secretary. The Trump administration was the most
    pro-life Administration in this Nation's history, working hard
    to defend unborn human lives. I'm sad to say that the Biden
    administration is shaping up to be the most pro-abortion
    Administration in history.
        It's truly sad to see our Nation which was founded on the
    idea of natural rights that belong to all humans, dehumanize,
    and attack the most vulnerable among us, the unborn. Secretary
    Becerra, under your leadership of the Department of Health and
    Human Services, the Department has decided to disband the Human
    Fetal Tissue Ethics Advisory Board created by the Trump
    administration to evaluate grant research conducted by the FDA
    and the NIH and ensure that the U.S. Government was not funding
    or participating in unethical research.
        Fetal tissue may sound like an abstract term, but there's
    nothing abstract when researchers are ordering skulls, bones,
    hearts, eyes, and livers from the bodies of unborn babies who
    are too vulnerable to defend themselves.
        Human beings have inherent dignity and should never be used
    as a means to an end. Using fetal tissue from babies killed in
    elective abortions to further research priorities is using
    human lives as a means, rather than treating them with the
    dignity that all human beings deserve.
        So, my question is why did you decide to disband the Human
    Fetal Tissue Research Ethics Advisory Board? Shouldn't we do
    all we can to ensure that taxpayer funded research is done in
    an ethical manner? And then will you commit to investing in the
    creation of ethical alternatives to the use of aborted fetal
    cells in research, drug, and vaccine development?
        Secretary Becerra. Congresswoman, thank you for the very
    important question. I want to make sure we're very clear on
    something. The work that we do at HHS and that NIH and the
    research, is done completely according to the law. There are
    well-established and rigorous regulatory frameworks for the use
    of fetal tissue in research. Any research funded by the NIH
    using fetal tissue goes through all of the appropriate
    guidelines and oversight.
        There is no doubt that we have had some scientific
    breakthroughs and life-saving treatments that have become
    available to Americans as a result of the work that's been done
    according to the law. And the legal and ethical oversight that
    has been in place by decades by the way, not just recently, but
    for decades, and has been supported by democratic and
    Republican Administrations has allowed us to move forward
    because at the end of the day this is a President, and this is
    an Administration that is pro-care and making sure that we
    offer our families the care that they deserve.
        Mrs. Miller. So, do you commit to rigorously enforcing a
    prohibition against the sale of aborted fetal baby parts for
    profit?
        Secretary Becerra. I can absolutely commit that we will
    make sure we follow the rigorous regulatory framework for the
    use of fetal tissue research.
        Mrs. Miller. To enforce the prohibition against the sale of
    aborted fetal baby parts, skulls, bones, hearts, eyes, and
    livers from the bodies of unborn babies?
        Secretary Becerra. Congresswoman I think I'm being as fair
    as I can be. We're going to make sure that we not only abide by
    the law but enforce the law when it comes to fetal tissue
    research.
        Mrs. Miller. It's also come to my attention that your
    department will be resuming intramural research using aborted
    fetal tissue. President Trump suspended the use of fetal tissue
    from elective abortions for NIH conducted research to protect
    the sanctity of human life. Can you justify this decision to
    the Committee please?
        Secretary Becerra. The previous Administration did a lot of
    things that we're not going to do. What I will tell you is that
    what we will do is make sure that as we move forward, whether
    it's on research or any other items that are under the HHS
    agenda, we will do them according to the law and in a
    transparent accountable fashion.
        Mrs. Miller. Thank you. We want transparency with
    accountability. And another question in light of vaccines in
    children, an FDA advisory panel recently met to discuss the use
    of COVID-19 vaccines in children as young as 6 months old. The
    meeting took place on the same day Moderna asked FDA to expand
    the emergency use of the COVID-19 vaccine to children as young
    as 12.
        Pfizer's vaccine has already been authorized for children.
        Chairman Scott. The gentlelady's time is expired. If you
    could very quickly State your question so that he could give a
    brief answer.
        Mrs. Miller. OK sure. Do you believe we should be treating
    children differently than adults when it comes to vaccinating
    children with a product that has not been fully approved? And
    do you believe that schools should require authorized COVID-19
    vaccinations for their children before attending classes this
    fall?
        Secretary Becerra. Congresswoman we can followup because I
    know the time is expired. I'll simply say this. We always
    looked at children differently than we do adults, and let the
    science drive where we go, and CDC has made that, and NIH and
    FDA have all made that very clear it that before we move on
    vaccines, we do it with the science behind us.
        Chairman Scott. The time has expired. Thank you.
        Mrs. Miller. Thank you and I yield back.
        Chairman Scott. Thank you. The gentlelady from New Mexico,
    we're running short on time, but usually we will tolerate it,
    so I apologize. Ms. Leger Fernandez from New Mexico.
        Ms. Leger Fernandez. Thank you, Chairman Scott, and Thank
    you, Secretary Becerra, boy what a difference 6 months makes.
    Because of President Biden's leadership, Congress's passage of
    the American Rescue Plan, and in particular your department's
    work, there's a sense of optimism. I feel it. I think everybody
    feels it as vaccinated people are gathering in public again.
        They're visiting our small businesses, and we're all
    looking forward to a more prosperous future. So, you're opening
    statement correctly noted that the pandemic hit the most
    vulnerable the hardest. I want to focus on a few of those most
    vulnerable that we might not talk about enough.
        And as I talk about it, I'm really going to also focus on
    the need for facilities. So, one is our woefully underfunded
    Indian house service facilities, two with the survivors of
    domestic violence, and three, those suffering from substance
    abuse who need in-patient treatment.
        So, as we are opening up, we know that our domestic
    violence shelters are overcrowded. They've had to turn away
    women and children because they don't have the rooms and beds,
    they need given COVID's distancing requirement. I really do
    appreciate your answers to my friend, Representative McBath on
    providing services for the prevention of family violence.
        And as I've visited the shelters in my district, they truly
    appreciated the American Rescue Plan's funding, but they kept
    going to the fact that they need help to build and keep
    facilities operating. They need access to affordable housing
    for victims as they leave shelters.
        So, Secretary, could you briefly discuss what measures are
    included in the IG's budget and proposals to address the
    facility needs, the facility and housing needs?
        Secretary Becerra. Congressman, great to have you onboard
    and I look forward to working with you. You have big shoes to
    fill, but I suspect you're more than ready for it, so I look
    forward to working with you. I will simply say this. President
    Biden made it very clear where his values are when it comes to
    Indian country.
        He has made a historic investment in the Indian Health
    Service agency that we operate here at HHS. And we're going to
    make sure that we are on the ground working. And I probably met
    with tribes from throughout the country already more than I
    think people would have expected. You know the work we have to
    do because for far too long HIS was underfunded, and we're
    going to try to do everything we can.
        If you help us pass this budget to try to really get on the
    ground and provide some of the infrastructure and the services
    that are needed back home. You will also notice that this
    budget calls for a 2-year cycle for appropriations so that back
    home in Indian country folks have a better sense of the type of
    funding they can expect to come out of the Congress and the
    Federal Government because it is difficult to budget and plan
    your healthcare needs for your communities if you can only rely
    on 1-year funding.
        So, we're trying to do the things that tribes throughout
    the country have said to us they'd like to see us do.
        Ms. Leger Fernandez. I truly appreciate it because you know
    it's amazing. I think the public doesn't know that we really
    only fund 36 percent of what's spent per capital nationally.
    For healthcare, only 36 percent for tribal care, and I think
    there's a 39-billion-dollar shortfall. I think we have a little
    disagreement on the shortfall between what some of the
    advocates are looking at, and what IHS is looking at.
        The other place where we have a really big need for bed is
    with regards to substance abuse. As I travel, I just read you
    know New Mexico has been very hard hit with substance abuse,
    mental health issues that lead to that. And you've talked a bit
    about the operational funding, but what I hear over and over
    again, and this is in Indian country, this is in rural New
    Mexico, this is rural America.
        It's affecting Latinos. It's affecting Native Americans.
    It's affecting all Americans, is we don't have the beds that
    are often needed for in-patient, which means sometimes people
    are dying in jails because they get picked up. They're dying
    alone, and they need in-patient treatment often times, so tell
    me what IHS is proposing regarding that aspect.
        Secretary Becerra. As you know more than 2 billion dollars
    that the President calls for in his budget will try to address
    a number of those concerns, but it's going to be difficult to
    make up for years of underfunding in one budget, and I would
    look forward to working with you, and this is what I said to
    tribes as I've visited these last several months that I've been
    Secretary.
        We look forward to working with folks on the best ideas in
    how we move forward both in terms of facilities and in
    services, because we know in both cases there is a dire need to
    be ready and go and making it better.
        Ms. Leger Fernandez. Well, thank you so much Secretary
    Becerra. I will followup with you also with regarding the
    issues around the beds that are needed in domestic violence
    shelters as well, and my time is up, and I yield back. Thank
    you, Chairman Scott.
        Chairman Scott. Thank you. The gentlelady from Indiana, Ms.
    Spartz.
        Mrs. Spartz. Thank you, Mr. Chairman and Mr. Secretary for
    testifying in front of us. As a Member of the Judiciary
    Committee, I visited the border several times, and I was
    surprised to learn of the change in the policies that your
    agency did from the Trump policy related to the unaccompanied
    minors, so to release unaccompanied minors to potential
    sponsors, Trump administration required all sponsors and adult
    household Members to undergo background checks.
        I was told that you changed your policy which I will look
    at the press release from your agency on May 5th, and you
    confirmed that you did change your policy. So, my questions for
    you, by cutting corners, and eliminating this proper background
    check, why would you change this policy, and don't you put life
    of these kids at risk?
        Secretary Becerra. Congresswoman, thank you for the
    question, and a critical question because we want to make sure
    kids are safe. What we did was we took into account where there
    was a parent, not just an adult, but the actual parent of the
    child that while we did do a check, and we do a thorough
    analysis to make sure that this is the parent of the child, we
    feel far more confident if this is the actual parent of the
    child that we can try to make sure that the discharge occurs as
    quickly as possible.
        Mrs. Spartz. I get it but your policy does not say that you
    don't do it just for parents. It just says for any sponsor,
    maybe not a parent, you don't have to do check household
    Members, regardless of who they are. Isn't it by creating this
    policy you potentially don't know where the kids go? How are
    you even tracking the child welfare?
        Now you have created a situation where this life can be at
    risk, regardless, and then you don't even know where the
    parents, what kind of household they live, so you now aren't
    checking anyone in that household. Isn't it potentially cutting
    corners and putting their life in danger? Or do you believe
    that is not?
        Secretary Becerra. Congresswoman, I urge you to reread the
    guidance that we put out and the instructions, because I think
    you have misread it, but I'm more than willing to sit down with
    you to go through and explain it later on with my team. We do
    not put any child in danger.
        We make sure that we place them in the hands of a
    responsible custodian.
        Mrs. Spartz. But is it correct that you are not requiring
    to do the adult household Members of sponsored background check
    unless there is a reason to, but as a policy it was a change of
    policy? Do you agree with that? Because that's what it says in
    your press release.
        Secretary Becerra. Congresswoman, we don't release any
    child into the hands of any person, including their parent
    until we can confirm that they are not only the parent or a
    responsible adult, but that we have the confidence that the
    children will be safely cared for. So, no child, regardless of
    who the custodian might be, parent, adult family Member, or
    not.
        Mrs. Spartz. But you don't check background checks. You
    don't do background checks.
        Secretary Becerra. Yes, we do, do background checks.
        Mrs. Spartz. You're actually doing and required to do
    background checks on all household Members of that sponsor?
        Secretary Becerra. Congresswoman, as I said, I urge you to
    read our policy.
        Mrs. Spartz. I just read it, so maybe you communicated, or
    that's what I was told by people on the ground in the shelters.
    That's what your press release says, so maybe you need to
    communicate that policy better, but we'll try to clarify that
    and full office view, and I yield the balance of my time to
    Congresswoman Foxx.
        Ms. Foxx. Thank you, gentlewoman, for yielding. Secretary
    Becerra you recently testified before the Senate Finance
    Committee that you'd be open to revisiting the ACA definition
    of affordability for employer-sponsored coverage. Currently
    employers must offer plans that cost 9.83 percent or less of
    the employee's household income.
        But you talk about revisiting this definition, do you mean
    lowering the affordability threshold which will either move
    more employees onto the ACA strain, or increase costs for
    employers? According to 2020 coverage data from the Treasury
    Department, the cost per family to taxpayers on the ACA
    marketplace is $5,722.00, while the cost per family for
    employer-sponsored insurance is $3,974.00.
        How would this proposed change to the definition of
    affordability be affordable to taxpayers?
        Secretary Becerra. Congresswoman, I'm more than willing to
    followup with you and your team if you'd like to explore this.
    What we're going to do is if we're going to make any changes,
    it's to make sure that the care, the healthcare coverage is
    more affordable. We're not about to make any changes that would
    cost an American more money to access the quality of healthcare
    that would be available through the ACA.
        Ms. Foxx. Well, when taxpayers subsidize healthcare for
    those who are on the ACA, that is costing taxpayers money. And
    by the way in your recent testimony every time before the
    Committee you've been in-person, with that Mr. Chairman I yield
    back.
        Chairman Scott. Thank you. The gentleman from New York Mr.
    Jones.
        Mr. Jones. Thank you, Mr. Chairman. A few minutes ago, the
    Secretary was lectured on the importance and the sanctity of
    human life by a Member who just yesterday voted against
    awarding the congressional Gold Medal to our brave police
    officers who risked their lives, and in some instances even
    died to save us in that violent insurrection on January 6.
        And I think it's important to call out the hypocrisy of
    that. Secretary Becerra today I would like to ask you a few
    questions regarding Head Start. As you know Head Start programs
    across the country provide vital early education to children
    from low-income households ensuring that they are well-prepared
    to enter primary school.
        These facilities work to develop social skills and
    emotional well-being in young children as well as offer them
    nutritious meals, health screenings and mental health supports.
    As we build back better from the COVID-19 pandemic, we must
    recognize that the public health crisis has presented unique
    challenges for low-income communities, the same communities
    served by Head Start programs, and many families lost sources
    of income and daily childcare services.
        Despite most Head Start facilities closing their doors in
    order to protect public health, many still work tirelessly, to
    provide resources and support to children and families facing
    new challenges as a result of the pandemic. So, Mr. Secretary,
    we know that the Head Start Act has not been reauthorized since
    2007, and in that time, Head Start programs in many parts of
    the country have found the disconnect between the income
    eligibility thresholds of 100 percent, and even 130 percent of
    the Federal poverty line to be inconsistent with how expensive
    it actually is to live in this country, and what it actually
    means to be in poverty.
        This is especially true in high-cost areas like the one I
    represent in New York, and of course the one that you
    represented when you are a Member of Congress. What actions
    will you take to ensure that Head Start is available for young
    children in need, but who currently might not be eligible due
    to outdated eligibility requirements?
        Secretary Becerra. Congressman, I could not agree with you
    more in the way you've articulated this. We have too many
    families who are modest income, working really hard, but are
    losing their opportunity to qualify for Head Start, and even
    for families that do qualify we just don't have the resources
    to help the way we should.
        And so, the investment that this Administration has made of
    over a billion dollars in Head Start will take us a little
    farther in making sure families have that opportunity. You and
    I would probably agree how tremendously important it is to give
    that child a chance to start on the right track as they get
    ready for kindergarten, and Head Start is crucial.
        But what we can't do is let hard-working low-income
    families miss out simply because the rates have you know become
    unbalanced so that they don't qualify, even though they really
    don't have the resources to pay for something like that on
    their own.
        Mr. Jones. Thank you. I want to keep our focus on Head
    Start. You know that in Fiscal Year 2020 Congress deliberately
    allocated resources for Head Start programs to address the
    concerning rise of childhood trauma throughout our Nation, gun
    and domestic violence, prescription drug abuse, disaster
    related displacement, loss of a parent and other traumatic
    events can leave a child further behind emotionally,
    physically, and educationally.
        With those critical funds Head Start programs pursue
    trauma-informed care training and increased access to mental
    health counselors. They have also developed unique strategies
    to support Head Start families. But nevertheless, these Head
    Start programs are already reporting a significant uptick in
    pandemic related trauma with children and families, and while
    there is a desire for the Administration to expand Head Start
    and move forward, many programs are still grappling with COVID-
    19.
        Would you support increased and specified funding in Fiscal
    Year 2022 to help Head Start programs and address the mental
    health and childhood trauma issues for existing families?
        Secretary Becerra. Congressman I would love to be able to
    say that that's what we will do. I will work with you to make
    sure we have the funding for that. The only hesitation I have
    is that I don't want to lock out sources of funding for other
    valuable vital services within Head Start, but you are
    absolutely right. If we don't tackle this, we're letting the
    child become really a time bomb as they grow older, so we
    absolutely have to do something to provide that mental health
    service.
        Mr. Jones. Thank you. And finally, can you speak to the
    role that Head Start will play moving forward as you seek to
    expand early learning opportunities through your proposals?
        Secretary Becerra. If I had my way Congressman, we would
    make sure every child, your child, my child, who cares whose
    child it is, have a chance to have that start. And we want them
    to be ready to learn, and you've got to give them that chance
    at a Head Start.
        Mr. Jones. Thank you, Mr. Secretary. I yield back Mr.
    Chairman.
        Chairman Scott. Thank you. The gentleman from Wisconsin,
    Mr. Fitzgerald.
        Mr. Fitzgerald. Thank you, Mr. Chair, and Thank you, Mr.
    Secretary for being here. I probably have a unique perspective
    as one of the Members of the Committee today having worked in
    Wisconsin legislature during the pandemic, and as you probably
    are aware, the Deputy Secretary Andrea Palm was part of the
    Evers Administration.
        You know there's a patchwork of local ordinances, both at
    the municipal level and at the county level. Many of them are
    antiquated, as well as State statute. And when the pandemic
    hit, I quickly identified I think many of my colleagues
    identified that there were significant issues that hadn't been
    addressed. And it became kind of a push and pull, often times
    amongst the different levels of government as to what was an
    adequate response, or a response that would make sense.
        And I disagreed with Governor Evers in Wisconsin as the
    Senate Majority Leader, and I also disagreed with Secretary
    Palm on their approach in that how long they held kind of
    things close to the vest on what their approach would be. Let
    me ask you a couple questions.
        If there's a resurgence in COVID, or a variant, what's the
    Administration's position on lockdowns and mask mandates? I
    know that candidate Biden, President Biden now, had absolutely
    said that he would support some type of national mandates on
    those fronts. Where are you guys at on that right now?
        Secretary Becerra. Congressman, thanks first for the
    question, and your question while maybe hypothetical, could
    appropriately happen. And so, what I would say to you is that
    what the President has always said is that we're going to have
    science guide our best practices, and we're going to try to
    make sure that we are right there with our State and local
    partners, never abandoning those partners.
        And what we're going to do is work with them because the
    ultimate decision is up to the states and local government
    leaders how to proceed. The Federal Government does not mandate
    to a local community how to do things, but we do have the
    jurisdiction. The President has been great in asking the states
    if it involved transportation and goes beyond states to those
    kinds of things where he does have authority.
        We're going to do everything we can to protect America.
    We're going to do everything we can to beat back the COVID.
    We're going to do everything we can to give people what they
    need as quickly and as early.
        Mr. Fitzgerald. Would you go as far as to say that you
    would call for a mandate on that?
        Secretary Becerra. Well as you've heard the President say
    before those decisions are really State decisions. They're not
    for the Federal Government, and so right now we've been working
    pretty closely with the Governors and our State partners to
    make sure that you provide them with every type of support that
    we can, so as they move forward for their states, they do this
    in a safe a manner as possible to promote their health and the
    return to normality for all these people.
        Mr. Fitzgerald. Let me ask you a further question on
    vaccinations then. It seems that with certain segments, age
    groups, we've kind of hit the wall on vaccinations. There's
    just a number of people that are saying I'm not going to take
    the vaccination. I'm not going to force any of my children to
    take the shot. What is your approach on that, and what are you
    going to do about that?
        Secretary Becerra. We continue to reach out. We think that
    there are still millions of Americans who want to have a
    vaccination, who are willing to come forward. We want to find
    them. We're going to go to them. We're not going to wait for
    them to come to us, so we want to make it available.
        You no longer have to wait in line. You don't have to worry
    about your age, as long as you're 12 and over, and we're going
    to do everything we can to work with trusted partners in the
    community to reach those folks. We are continuing our efforts.
    We just established for example a youth forum to help us reach
    out to young Americans who haven't yet been vaccinated.
        And so, we're going to continue to do all the work, whether
    it's establishing a tollfree number, a website, a way to get
    information on where the closest vaccination site is to you,
    and of course mobile clinics and all the rest.
        Mr. Fitzgerald. No mandates though? No mandates on
    vaccination?
        Secretary Becerra. As I said before, we leave that to the
    states to decide how they go about doing that. We're going to
    be their good partner and not abandon it.
        Mr. Fitzgerald. Let me just ask one more question on the
    COVID topic.
        Chairman Scott. The gentleman's time has expired. Ask a
    quick question, and a quick answer.
        Mr. Fitzgerald. Yes. Well, hospitals and healthcare
    workers, I mean huge issues still exist, and I'm wondering what
    the Administration is doing to shore up hospitals and the
    shortage of healthcare workers.
        Secretary Becerra. We're going to do everything Congressman
    we can to make sure that we have the PPE and all the supplies
    that we need. Healthcare workers should be the last people who
    could run out of those kinds of supplies. We're working with
    hospitals. We've got to provide a relief fund. Congressman, we
    can give you a more detailed response, but we're going to be
    there every way we can.
        Mr. Fitzgerald. I yield back. Thank you.
        Chairman Scott. Thank you.
        Ms. Foxx. Mr. Chairman there's interference when the
    Secretary is speaking.
        Chairman Scott. I think that was on Mr. Fitzgerald's part.
    Well, let's see how it goes with the gentlelady from North
    Carolina Ms. Manning.
        Ms. Foxx. OK.
        Ms. Manning. Thank you, Mr. Chairman, and Thank you, Mr.
    Secretary for being with us today. I want to talk about the
    kind of health insurance plans that the Trump administration
    took steps to increase. They increased enrollment in junk
    health plans, consumer protections, under the Affordable Care
    Act, and these include in products like short-term limited
    duration insurance policies which do not cover essential health
    benefits.
        They charge higher premiums for people based on illness,
    and they discriminate against people with pre-existing
    conditions. Could you talk to me about what steps the Biden
    administration plans to take to reduce the harmful impact of
    these kinds of plans on consumers?
        Secretary Becerra. Congresswoman, thank you for the
    question. And we intend to enforce the Affordable Care Act. The
    Affordable Care Act was all about providing consumers with real
    coverage and at an affordable price, not duping people into
    thinking they've got health insurance, and the day they use it
    find they've got this massive bill they can't afford.
        We are interested in making sure that if an insurer wants a
    plan out there that it is not junk. And so, we're going to work
    really hard with the powers that we have, and any you decide to
    give us, to make sure that no insurer goes out there and sells
    a faulty product that's nothing but junk to the American people
    when it comes to healthcare.
        Ms. Manning. Thank you, Mr. Secretary. And like many
    Americans, I am deeply concerned about rising prescription drug
    costs. This became an issue with my family. I have personal
    experience with a daughter who was diagnosed with a chronic
    illness, and I was stunned by the cost of the medications that
    she needed to live a normal life.
        So, what is the Biden administration going to do to help us
    bring down the cost, the really outrageous costs, of so many
    kinds of prescription drugs?
        Secretary Becerra. And Congresswoman, here's where I hope
    you all will decide to help us with some changes in statutory
    law, and that is the President said, ``You let me negotiate
    drug prices I will do it.'' To the degree that we have the
    power to do that, we'll try to do it. As you know some of those
    issues are tied up in court.
        He has said we're going to look at every way that has been
    devised, including in other countries, to figure out how we can
    lower the cost of prices of drugs. The President is very
    focused on this. Prescription drug prices are just too high,
    and there's no reason for it, and we're going to do everything
    we can. We hope we can work with you so that we have even more
    authority to bring down the cost of those drugs.
        Ms. Manning. Thank you, Mr. Secretary. The people in my
    district need the relief, and the people all over the country
    need the relief, so we look forward to working with you on this
    issue. I'd like to turn to a different issue, and that's the
    impact that COVID has had on women with postpartum depression
    and other mental health issues.
        Certainly, the isolation forced on people by the pandemic
    has exacerbated these kinds of issues. Can you talk to us a
    little bit about the funding in the budget to address maternal
    mental health issues?
        Secretary Becerra. Congresswoman, thank you. This one is
    really important because in a country as sophisticated and as
    talented and as wealthy as America, we should not have women
    who are actually dying postpartum. And so, one of the things
    that we have done is not only invested some additional funds in
    providing maternal health services to women, but we've now put
    out a program that so far, a couple of states are looking at.
        Michigan has signed on to a program that actually provides
    a woman with postpartum care beyond 60 days, which is what
    currently is provided under Medicaid. We're willing to help
    that State extend postpartum care for that woman for up to a
    full year and we will be great partners in helping finance
    that. And we hope that there will be states who take that up.
        Ms. Manning. Thank you so much. This is a huge issue. There
    are many of us here who look forward to working with you on
    addressing maternal health issues, so thank you for that, for
    all your dedication. Mr. Chairman, I yield back.
        Chairman Scott. Thank you. Thank you. Your colleague from
    North Carolina Mr. Cawthorn.
        Mr. Cawthorn. Excellent Mr. Chairman thank you very much.
    Dr. Foxx thank you for your leadership. Secretary Becerra,
    congratulations on being appointed as Secretary. What we have
    seen out of the Department of Health, and Human Services I
    believe is nothing short of rank hypocrisy.
        I'm confused when the health of the American people and
    their best interest has become a political tool. Quite frankly,
    I find it disgusting. And now sir as head of the Health and
    Human Services, I assume you are aware that CDC policy it
    states that children two or over must wear a mask in public,
    correct?
        Secretary Becerra. Congressman, the guidance we provide is
    based on science, and its guidance to the states, and they can
    decide how to implement it.
        Mr. Cawthorn. Correct. But your guidance is that children
    two and older must wear a mask?
        Secretary Becerra. We want everyone to be safe Congressman,
    affirmative.
        Mr. Cawthorn. So, children two and older must wear a mask.
    Now I also know that science has indicated that young people,
    especially our young children, are less likely to have serious
    symptoms from COVID 19, is that what your findings have told
    you?
        Secretary Becerra. Less serious doesn't mean they don't
    become serious. We want to make sure every American is
    protected if that's possible, and we leave that to the states
    to decide exactly how.
        Mr. Cawthorn. Of course, but according to you the science
    that has been released by CDC, children that are very young are
    less likely to have serious symptoms, much less likely than
    older people and people with diabetes. Now Secretary Becerra,
    you are aware that the youngest age recommended for a vaccine
    currently is 12 years old. Is that also, correct?
        Secretary Becerra. Right now, the CDC guidance says 12
    years and older.
        Mr. Cawthorn. Understood. So now let me get this straight,
    and please forgive me if I'm reiterating some things. But the
    CDC recommends that a child two or older has to wear a mask in
    public, yet they also advocate for children not to get a
    vaccine until 12 years old, is that what you understand?
        Secretary Becerra. CDC is trying to make sure we protect
    all of our loved ones.
        Mr. Cawthorn. I understand we're trying to protect everyone
    sir, but you understand that you have to wear a mask at 2 years
    old until you're fully vaccinated, but you can't get vaccinated
    until you're 12 years old, correct?
        Secretary Becerra. Do you understand the science behind
    saying a mask helps protect a child, and the science behind
    saying when a child can get vaccinated? You're mixing apples
    and oranges, I think.
        Mr. Cawthorn. Well, I disagree with you their Secretary,
    but so putting us all together essentially, a 2-year-old is not
    recommended for the vaccine, but the only way that you can take
    a mask off in public is to be vaccinated. So essentially CDC's
    policy is to keep masks on children for up to 10 years, what is
    your defense for that?
        Secretary Becerra. First, I think you have described it
    improperly. What I will again repeat is that we are trying to
    make sure that no one, including a child, contracts COVID
    because it can be dangerous for everyone including a child. The
    safer we all are means the sooner we can return back to normal.
        Mr. Cawthorn. I understand sir, but the current CDC
    guidelines which have no sunsetting period are saying that they
    have to have a mask on after 2 years old. They can't get a
    vaccine until they're 12.
        And now I don't expect you to get into the weeds of our
    psychology, although you are the Secretary of Health and Human
    Services, but are you aware that studies have shown that masks
    on children impact social integration? It disadvantages our
    young children from developing the necessary skills to discern
    emotions.
        You know it creates a depression, even delayed speech. Now
    I assume you're aware of these studies?
        Secretary Becerra. Congressman, again I hope you'll
    recognize as you've said, CDC is offering guidance. It is not
    mandating. It is offering guidance based on the science.
        Mr. Cawthorn. Now I never said you were mandating, but
    you're offering guidance with a significant amount of blue
    tape.
        Secretary Becerra. But you did say that kids have to wear,
    and what we do is provide guidance. If the child is wearing a
    mask it's probably because the parents have made the decision
    to have that child wear a mask, not the CDC.
        Mr. Cawthorn. And I believe it has been well-founded that
    almost every single blue State in this country follows the
    guidance that the CDC is putting out.
        Secretary Becerra. I hope every State would follow the
    guidance.
        Mr. Cawthorn. I assume Mr. Secretary I have limited time.
    What kind of emotional damage do you think keeping these
    children masked will do to our next generation?
        Secretary Becerra. We're going to try to make sure that no
    child goes through any emotional trauma. Losing your parent
    could be as traumatic as anything I can think of, and if you're
    not safe from COVID, there's a good chance that you might lose
    a loved one, so we want to make sure everyone is as safe as
    possible.
        Mr. Cawthorn. Well, Mr. Secretary I too want everyone to be
    protected, but Mr. Secretary I've got to say sir I'm disgusted.
    Studies clearly indicate that the primary time for social and
    emotional development among our children begins and ends
    precisely in the same timeframe you would muzzle America's
    youth.
        Now I know you say it's just a recommendation, but many,
    many, many people are following it. You know that young
    children are unlikely to be severely impacted by COVID, but you
    don't care. You know that COVID is statistically a medical
    afterthought for children between ages 2 and 12, 2 to 12, but
    you don't care.
        I know it's not a mandate, but CDC's guidelines with strict
    access to vaccinations for individuals under 12 currently, but
    you just don't care. You know that study after study have shown
    that mask wearing at a young age can impact social, emotional
    and a range of capabilities, but sir you simply don't care.
        And if you want me to send you those studies, I'm more than
    happy to have my staff have those sent to you. And Secretary
    Becerra, let me tell you what you do care about sir, from my
    evaluation you care about power. You care about muzzling
    America's future, our children, and forcing them to wear a mask
    from ages 2 to 10, 10 years before they can breathe the air of
    freedom in this Nation.
        Sir I will remind you that we are not descended from
    fearful men. I believe we can beat this virus. I believe that
    our young children are absolutely very close to being immune,
    and sir with that I yield back.
        Chairman Scott. Thank you. The gentleman from Indiana, Mr.
    Mrvan.
        Mr. Mrvan. Thank you, Mr. Chairman. Secretary Becerra, the
    Child Abuse Prevention and Treatment Act supports the
    community-based services for primary Federal program to provide
    funding for child abuse and neglect. It also requires that
    every State has a system in place to identify and provide an
    initial response to child abuse and neglect.
        Earlier this year my colleagues and I, including Ms.
    Stevens, and Ms. Stefanik of this Committee, wrote a bipartisan
    letter to the Appropriations Committee that requested a
    meaningful funding increase for CAPTA. I'm glad that the
    President's budget called for 235 million for CAPTA programs,
    an increase of 49 million above last year's enacted level.
        We know that CAPTA has been underfunded for many years, and
    not enough families have access to prevention services. Why do
    you think, and why is it important now is the time for greater
    investment in CAPTA?
        Secretary Becerra. Congressman, thank you for the question.
    I think you'll agree that for far too long we have underfunded
    these services and I think we're interested in trying to move
    forward as quickly as we can, do a better job. I hope that you
    all, and many of your colleagues are interested in helping us
    move forward because I mean the consequences of not acting are
    severe, and so I thank you for the work that you're doing on
    this, and I hope that you'll find that my team is ready to work
    with you to not only increase the funding, but really implement
    it in a way that works for each local community wherever they
    may be.
        Mr. Mrvan. Thank you, Mr. Secretary. In my district I
    attended an open house for Ashley's House, a transitional
    residency offering background services for survivors of human
    trafficking. It is operated by Dr. Calioni Gopel, a
    psychiatrist specializing in sexual trauma of, and victims of
    human trafficking who shared with me the challenges and grant
    opportunities for residency services.
        My question is will you consider opportunities for
    residence services, providers for survivors of human
    trafficking, and can you share HHS's approach toward human
    trafficking?
        Secretary Becerra. Thank you, Congressman. I look forward
    to working with you on that because we know that human
    trafficking occurs here in the United States more often than
    people want to believe and having the responsibility to care
    for these unaccompanied migrant children who are coming across
    the border so often times we see in the past where at least
    reported to be used for trafficking purposes, whether labor or
    sex, that's a very important issue.
        So definitely we look forward to working with anyone, you,
    or others, who are interested in trying to deal with this issue
    and making sure that we're extending more services to those who
    might be trafficked.
        Mr. Mrvan. Thank you, Mr. Secretary. With that Mr. Chairman
    I yield back my time.
        Chairman Scott. Thank you. I understand the gentlelady from
    California, Ms. Steel.
        Mrs. Steel. Thank you very much.
        Chairman Scott. You're recognized for five minutes, thank
    you.
        Mrs. Steel. Thank you. Thank you, Chairman Scott, and
    Ranking Member Dr. Foxx, and thank you for joining us today,
    Secretary Becerra. I have heard directly from many families in
    southern California that a first-rate State officials who
    advocate to keep our schools shut down. These actions put
    students' futures, and in many instances, their lives in
    danger.
        Many families feel officials failed to provide federally
    mandated accommodations. The Director of School Mental Health
    for Los Angeles Unified District recently stated he was worried
    about those that fell through the cracks due to students being
    kept from school.
        As of March 2021, 80 percent of students in Florida were
    attending schools in person, full or part-time without turning
    schools into super spreaders. At the same time almost 6 million
    California children were unable to attend their classes because
    nearly all California public schools remained closed.
        According to Gallup nearly 3 in 10 parents say their child
    is experiencing harm to their emotional or mental health
    because of social distancing and closures. So, my question is
    you mentioned during your confirmation hearing that the
    ultimate decision on school reopening is a local one, yet State
    officials forced schools to stay closed longer.
        I have heard from parents and have seen many heartbreaking
    stories about children who suffered mental health damage
    because they were not allowed back in the classroom. Do you
    agree that the dangers of keeping these children out of the
    class this year far outweigh the risk of bringing them back?
        Secretary Becerra. Congresswoman, thank you for the
    question. Well, first I should mention how President Biden has
    made it very clear he'd like to see children back in school. I
    think we all would like to see them back in school, and we want
    to make sure that we're doing the reopening of our country as
    safely as possible.
        We've saw, you know we've had to go back just a few months
    to see how bad things can be, and how many Americans, more than
    600,000 American lives we've lost. And so, when it comes to the
    reopening of school, we have offered guidance to our local
    school district partners so they can make the best decisions
    possible, as safely as possible, but there's no doubt that
    we're hoping, and the President made it very clear we'd like to
    see kids back in school and do so safely.
        And when it comes to opening every part of our country, not
    just our schools, we're working with our State and local
    partners to make sure it's done with the science driving our
    decisions.
        Mrs. Steel. Thank you very much. I yield back.
        Chairman Scott. Thank you. The gentleman from New York Mr.
    Bowman.
        Mr. Bowman. Thank you, Mr. Chairman and Thank you, Mr.
    Secretary for being here today, and thank you for your lifetime
    of care and service to our country. I have great respect for
    all that you've done and all that you're going to do. Prior to
    coming to Congress, I worked in public education. I worked as a
    teacher, a school counselor, and a middle school principal for
    10 years. Actually, I had the privilege of opening up my own
    community public middle school in Northeast Bronx.
        And you know as I've spent a career serving my students, I
    learned throughout that time that it's really important for
    social services and healthcare to be connected to the work that
    we try to do in schools, both for children and families.
    They're not just spaces for academic support, obviously they
    are, but children come with so many social and emotional needs
    that the interagency collaboration between schools and social
    services need to be sort of centered as we go forward.
        Can you just comment on that and also speak about what
    collaboration looks like on the Federal level between HHS and
    the Department of Education?
        Secretary Becerra. Absolutely Congressman, and can I just
    say thank you for your service. I know that some of those years
    were probably very tough, but at the end of the day it can't be
    more enriched than watching children become leaders of this
    country for tomorrow, so thank you for what you've done, your
    service here today, but perhaps even more so, your service
    educating America.
        And you're absolutely right. Schools are more than just
    educational institutions, they are hubs of a community, and we
    should make use of them. In some communities, especially in
    intercity communities sometimes it's the only green space that
    people have. And so, we should know that we should be using
    that school as an asset, not just to teach our kids, but to
    bring the community together, to have gatherings of neighbors,
    to provide health resources to children and families.
        Our schools are precious, and you know this because you
    were there for so many years, and we should make true
    investments in our schools, not just in providing instruction
    to our children.
        Mr. Bowman. Are you familiar with the community school
    model, the model there you know there are several different
    models? One is the full-service community school where you know
    a family can come, a parent can come drop their child off at
    school, and then go to the nurse, go to the doctor themselves
    within that school facility, even receive dental supports in
    some cases, and also additional mental health supports for
    parent and child.
        Are you familiar with it? Have you seen it work, and how
    can you do more of that and provide a pathway at the Federal
    level to make sure that happens?
        Secretary Becerra. Having served 24 years in Congress and
    represented a modest income district with a lot of working
    families who have to in some cases, have two jobs, and
    therefore need support for their kids who I myself grew up as a
    latch key child. We understand what it takes, and this concept
    is not new, it's just having the resources.
        You can't put it all on the school district, but in some
    places the cities are actually working with the school
    districts, so they're combining city resources for recreational
    services and so forth with the district, and in many cases,
    you've got non-profits who are coming in.
        But quite honestly, it's the parents, it's the community
    that step forward to make that possible and I mean why would
    you not want to have one stop shop at a school where you can
    provide all these services principally for families who really
    don't have that much.
        Mr. Bowman. Another thing I wanted to ask about was the
    early childhood stage of a child's life which is so important
    right, when we think about the first 1,000 days of a child's
    life, and I know we talked a little bit today about Head Start,
    and pre-Head Start programs.
        So, I wanted to highlight, I don't know if you're familiar
    with the term ``ACES, Adverse Childhood Experiences.'' I'm sure
    you probably are. And ACES when they become compounded lead to
    toxic stress, chronic trauma and long-term negative health and
    education outcomes.
        What's your vision for you know doing more in early
    childhood space to ensure we combat ACES, so that children are
    ready to enter kindergarten, you know, hitting the ground
    running because they grew up in a more nurturing space starting
    the first 1,000 days of life.
        Secretary Becerra. Congressman, Frederick Douglas once
    said, ``It is easier to build a strong child, than to prepare a
    broken man.'' And ACES, and what we learned from that is if you
    reach a child even though they've suffered through a trauma,
    you can actually repair that child and let them grow up and be
    healthy, but if you wait too long you're going to have a broken
    man or woman to deal with, and it is far more expensive, and so
    better to invest early in a child than to wait to try to repair
    them when they're men and women.
        Secretary Becerra. Thank you so much and I yield back. I
    look forward to work with you, you're such a breath of fresh
    air, thank you so much.
        Mr. Bowman. Thank you.
        Chairman Scott. Thank you. The gentlelady from Louisiana
    Ms. Letlow.
        Ms. Letlow. Secretary Becerra, I appreciate you coming to
    our Committee today to discuss Administration's Department of
    Health and Human Services policies and priorities. I was
    encouraged to hear during your testimony that the Department
    will look to continue focusing on rural communities.
        Much of the Fifth District of Louisiana is rural. My
    constituents and I see daily the unique challenges that rural
    America faces in healthcare. Many of which have been
    exasperated by the COVID-19 pandemic. Our rural hospitals and
    providers in the Fifth District are an extremely important
    lifeline that provides hearing services of critical importance
    to our rural communities.
        During the COVID-19 pandemic many were in danger of
    physical disaster, but thanks to the Provider Relief Fund, most
    were able to survive the pandemic and have been able to
    continue providing a central care to their communities today. I
    hope that this department will do everything in its power to
    ensure our rural hospitals and providers have the necessary
    tools and resources to continue serving their communities.
        I was also pleased that you mentioned the importance of
    training for health professionals. There is a considerable
    shortage of health professionals in the workforce today, and as
    we look toward the future specifically, I would like to bring
    up our nurses. During the pandemic, the demand for nurses has
    skyrocketed, and in Louisiana we have seen this demand create
    staffing shortages.
        The Louisiana State Board of Nursing estimated that the
    nursing shortage in our State would nearly quadruple from 2019
    to 2025. Nurses are an integral part of our healthcare system,
    and we need to ensure that we have a healthy and vibrant
    nursing workforce. The care and comfort nurses provide the
    patients, and their families is reassuring, and it helps many
    individuals get through some of their most difficult times.
        I hope that we can work to address the nursing shortage
    that is increasing not only in my State of Louisiana, but
    across the Nation. We are headed toward a true crisis if we
    cannot address the shortage of staffing for health
    professionals.
        According to the American Association of College and
    Nursing, U.S. nursing schools turned away over 80,000 qualified
    applicants in 2019. This includes around 1,400 just in my State
    of Louisiana. Secretary Becerra, what do you believe needs to
    be done to address the critical issues of nursing education and
    curbing staff shortages now and into the future?
        Secretary Becerra. Congresswoman, wow great questions
    because you're thinking ahead, and especially for nurses, we
    all talk about doctors and my wife is a doctor. But she talks
    about nurses more than she talks about doctors because she
    understands that there's nothing a doctor can do very well
    without the nurse.
        And I hope that you work really hard on this, and you know
    you have a partner here because we need to increase the
    attraction to nursing by our young people who are talented and
    want to serve, and I hope that what we can do is make sure that
    these young people are willing to go anywhere, including rural
    America because that's where it's toughest to recruit some of
    these folks.
        And so, we could come up with programs that will give that
    incentive to that young person to go into a nursing program,
    and we could provide a program to give incentive to providers
    to have a better policy when it comes to how they recruit those
    future nurses of America.
        We're making an investment in rural America, close to half
    a billion dollars to try to reach out to those healthcare
    providers in rural America. We have a fund of close to 8 or 10
    billion dollars to try to help rural America go through this
    pandemic with a provider relief fund, and so we look forward to
    working with you, hopefully you'll agree that we do this
    transparently to get moneys out to every community but
    including our rural communities.
        Ms. Letlow. Thank you, Secretary. I have one followup
    question. As a mother of two beautiful children, I believe in
    the sanctity of life. I'm deeply concerned the department's
    budget did not include the Hyde Amendment, this long-standing
    policy to prevent taxpayer dollars from funding abortions must
    be retained.
        I am further concerned about the department's decision to
    resend the previous Administration's protect life goal, and now
    allow abortion providers to receive Title 10 funding. The
    majority of Americans do not want their tax dollars funding
    abortion procedures.
        Secretary Becerra, as a former Member of Congress who has
    voted on bills that included the Hyde Amendment, can you
    explain to the Committee why the Administration has decided to
    abandon this 40-year old precedent?
        Secretary Becerra. Congressman, thank you for the question.
    And I do very much look forward to working with you even on
    these tougher issues. I respect that sometimes we have very
    deep seeded beliefs and values in the way we look at some of
    these issues even though we may look at them differently.
        What I can tell you is we're going to make sure that we
    provide access to good healthcare to all people, we're going to
    respect the law, and ultimately, it's Congress's decision what
    will be included when it comes to the issues of the Hyde
    Amendment.
        Ms. Letlow. Thank you, Mr. Secretary. I yield back my
    remaining time.
        Chairman Scott. Thank you. The gentleman from Wisconsin Mr.
    Pocan.
        Mr. Pocan. Thank you very much Mr. Chairman, and Mr.
    Secretary it's great to see you again as always. You recently
    added to your staff someone from my staff, and she had been
    there all eight and a half years, plus earlier she's amazing,
    so take care of her all right. She's very, very talented.
        Secretary Becerra. She's listening to you Congressman, so
    be careful.
        Mr. Pocan. OK. Well, I just want to let you know we miss
    her, but you have a great add to your office. Let me ask you a
    question about ACA ensured denial of claims. There was a report
    recently from Kaiser Family Foundation that said one out of
    every six in-network claims in 2019 was denied under the ACA,
    and it was a 17 percent denial rate, but that rate is higher
    than the 14 percent rate in 2018, double the 8 percent denial
    of claims experienced by Medicare advantage plans.
        You know obviously, besides certainly those high rates,
    those plans have ranged from 1 percent to over 50 percent
    depending on the insurer. I'm just wondering a little bit about
    that because I know that you know CMS does not currently
    require healthcare.gov insurers to report all the transparency
    data required by the Affordable Care Act. Additionally, data
    reported by issuers are not audited by CMS, and the Federal
    Government has not made the data publicly available in a format
    that's easily useable.
        Should I be concerned? What are we doing around this? I
    just want to make sure that you know again we've got healthcare
    coverage as extensive as possible for everyone.
        Secretary Becerra. Congressman, first great to see you and
    thank you for letting us steal some of your talent. I will say
    this. I want you to stay on top of these things. I want you to
    be a bulldog on this stuff, and I want you to keep us
    accountable as well because I intend to do that also.
        We're going to do the auditing, we're going to do the
    accountability to make sure that if you're going to get money
    from the Federal Government to administer a plan, if you're
    doing it right, you're not shortchanging Americans who deserve
    to have a policy covered.
        Mr. Pocan. Great, and I appreciate hearing that and I
    assumed nothing less to be perfectly honest, but I did want to
    raise the issue because you know I think as much as I so
    strongly support the ACA, we want to make it really live up to
    its promise that when you all created it before I got to
    Congress.
        An issue I had mentioned one other time briefly to you
    about Kratom is that I know we haven't put a new head of the
    FDA in yet. But you know we have had some issues, this is a
    drug, a natural substance I should say, not a drug, that has
    helped many people get off of the addictions like heroin, and
    it's been something where the FDA has previously had a pretty
    Neanderthalic response to helping people get off of things like
    heroin, or people with chronic pain conditions, and not have
    addiction properties.
        We found out recently there was a 2018 HHS letter that
    rescinded a recommendation to the DEA, or to the FDA by the
    U.S. Drug Enforcement Agency to classify some of the Kratom
    alkaloids are schedule one substances which would have made it
    even harder for people to get help or for us to do the research
    we wanted to.
        This letter was kind of kept from the public view for a
    couple of years, and only through a request we found it. I
    guess my question is given some of the past mishandling we've
    had, and the lack of transparency, it would be great if you
    could work with the FDA to issue a comprehensive public report
    about it, and you know especially without the FDA head.
        Yet they recently took an action on a company seizing their
    product. Again, this is a legal product that's helping a lot of
    people. I'd like to try to make sure of that, and any efforts
    you could do to help us would be much appreciated.
        Secretary Becerra. Congressman, it appears what I can tell
    you is that the Acting Commissioner Woodcock, she is working
    hard on all of these subjects. I know that we are looking at
    the subject that you mentioned with regard to Kratom. We can
    try to keep you abreast as best as possible.
        But what I could tell you I think what Doctor Woodcock
    would tell you is FDA operates based on the science, and the
    scientific independence that FDA has enjoyed for a long time is
    something we're going to respect. We will work with Dr.
    Woodcock and the FDA here at HHS, as part of HHS, but we
    respect the fact that the FDA has had this independence to make
    scientific decisions, so that way folks don't have to fear that
    politics entered into those final decisions that they're
    making.
        But something you mentioned, we're going to probably have
    about 90,000 people who died over the past 12 months from
    opioids, and so we absolutely have to do something, I look
    forward to working with you on it.
        Mr. Pocan. Yes, and NYDA, when they were up for a hearing
    recently, they also said the research is very promising. So, I
    just wanted to make sure that we don't have the wrong actions
    happening at a time that we're really getting some good
    research right now to help us. Thank you very much. It was
    great to see you again Mr. Secretary. Thank you, Mr. Chairman,
    I yield back.
        Chairman Scott. Thank you. I don't see any other
    Republicans, Dr. Foxx do you want to be recognized now?
        Ms. Foxx. Yes sir.
        Chairman Scott. We have a couple of other Democrats that
    will be seeking recognition. Ranking Member is recognized for
    her questions for five minutes.
        Ms. Foxx. Thank you, Mr. Chairman and I think my question
    comes very, very timely after what the Secretary just said, and
    thank you, Mr. Secretary for being here. Your emphasis on
    scientific decisions. Excuse me, when President Biden was
    elected, he pledged to ``follow the science,'' and you have
    done that many times today and said you're going to enforce the
    law.
        I'm very concerned though by the erupt departures from the
    CDC shortly after President Biden's inauguration of Dr. Nancy
    Messonnier and Anne Schuchat, two knowledgeable, well-respected
    and experience professionals. News reports say they were
    pressured for their positions which disagreed with your
    Administration.
        So please tell me why these two scientific, well-known,
    experienced professionals left the Biden administration? Were
    their departures related to policy and scientific
    disagreements, with incoming Biden political appointees?
        Secretary Becerra. Congresswoman, you've asked something
    really important because I'm not aware of those reports, and I
    know the two individuals, both of them immensely talented,
    dedicated career employees who've done tremendous things, and I
    have nothing but great things to say about their service to our
    government and to the public.
        What they've done to help us through COVID, and all the
    rest is just astounding, but I know of nothing of the sort in
    terms of their decisions being based on what you described. But
    I can guarantee you that I believe in the independence of the
    FDA to make decisions based on science.
        I visited FDA and the entire time. I mentioned that today.
        Ms. Foxx. OK. This is with the CDC, so you might want to
    talk to your CDC Director about that.
        Secretary Becerra. I'm sorry. I apologize. I mean CDC.
        Ms. Foxx. Yes, yes.
        Secretary Becerra. They are being applied; I apologize
    forgive me.
        Ms. Foxx. OK. Well, Mr. Secretary the Biden administration
    did not start from scratch with COVID-19 vaccine development
    procurement and distribution efforts. Operation Warp Speed is
    one of the greatest technical and logistical accomplishments in
    U.S. history.
        As a result of President Trump's leadership and unwavering
    support for OWS, incredible American scientists and private
    sector innovators partnering with the Federal Government,
    produced, and delivered hundreds of millions of effective and
    safe vaccines. The Biden administration inherited a well-oiled
    machine.
        In fact, by January 2021, OWS had already purchased 400
    million doses of vaccine, and delivery around the country was
    underway. What are you doing to ensure that the tools and the
    structure created by Operation Warp Speed are not lost in the
    lessons learned from this historic endeavor are applied to
    programs managed by your department in the future?
        Secretary Becerra. Congresswoman, I think what we've seen
    accomplished under the leadership of Mr. Perna has been
    tremendously important, and I hope that what we continue to see
    is the building from all those lessons that we've learned
    moving forward because what we can't do is face the situation
    where we lose 600,000 lives in this country again, and I think
    that everyone working together, it makes no difference what
    your political background is, your partisan affiliation.
        If you want to do good work, we want you to serve and we're
    looking forward to having people continuing to work on behalf
    of the American people. And my apologies again for having
    slipped up on CDC/FDA, we've just been talking about FDA, I
    meant CDC throughout that, although again both agencies I think
    we recognized base their actions on science to my knowledge.
        Ms. Foxx. Well, we hope, but we keep hearing that said over
    and over again, but what we see happening is not necessarily
    consistent with what you say. I'd also like to point out that
    in recent comments that have been made where you talked about
    women with postpartum depression. Women dying postpartum, a
    woman with postpartum care.
        You know I'm glad you dropped the silly use of the word
    people from that. You know when we see the first man have a
    baby, we'll know we've had a scientific breakthrough, or maybe
    the Lord at work changing his grand scheme for the way we
    should be operating. With that Mr. Chairman I yield back.
        Chairman Scott. Thank you. Our next questioner will come
    from the Chair of the Budget Committee since we're talking
    about the budget, the gentleman from Kentucky, Mr. Yarmuth.
        Mr. Yarmuth. Thank you, Mr. Chairman, and hello Mr.
    Secretary. It's great to see you. And I'm so pleased that so
    many of my colleagues are, that you're sitting where you're
    sitting. You know we've spoken a lot about immigration today,
    and I just had to make the comment that after spending
    virtually every day with you for 7 months back in 2013 as part
    of the gang of eight in the house.
        I can't think of anyone I would trust more with the welfare
    lives of your children at the border than I would you because
    you've shown during that whole time, and through your actual
    career, how much you do care about the people regardless of
    where they're from. And I deeply respect that.
        And some of the comments that question your motivation and
    your caring from Mr. Cawthorn, just were way above the bay, and
    you're owed an apology for that. But I do want to reference
    what Mr. Cawthorn talked about because it seems to me that we
    don't really know everything about COVID-19 right now.
        That when you say following the science, sometimes the
    science is incomplete, and sometimes the science is unknown.
    And so just wouldn't you say that it's true that we still have
    no idea as to what long-term affects might burden young people
    who contract the disease even though they may not have a
    difficult time with it when they get it, is that not the case?
        Secretary Becerra. That's absolutely correct.
        Mr. Yarmuth. And as a matter of fact, there's some evidence
    that young people do have long-term consequences from having
    contracted the disease. We've got a lot more observation to do
    before we conclude that it would be safe for a three-or 4-year-
    old to contract the disease, and that we should probably do
    everything we can to keep those kids from contracting the
    disease.
        Secretary Becerra. Precisely.
        Mr. Yarmuth. The one thing I wanted to ask you about, there
    are so many things in the American Families Plan, the American
    Jobs Plan, I think that are crucial, and I applaud the
    President and the Administration for including them.
        I think the 2-years of early childhood education probably
    next to doing something about climate change are the one thing
    that we can do to guarantee a vibrant future for our country
    and our society because those kids need every bit of foundation
    that they can get.
        And the whole issue of childcare and elder care and free
    community college, those things are things that you know I
    think an advanced society should make available to its
    citizens. The one thing I'm concerned about is capacity. And
    but I know we talk about for instance adding long-term care as
    a Medicare benefit. It would be great to do that, you know, if
    we could find the money to do that, but just making it
    available, giving them the benefit doesn't guarantee they have
    access because there's not capacity.
        So, my question is, and I know that these things have to be
    worked out still, is the Administration making plans? For
    instance, in childcare, to make sure that 225 or 250 billion
    dollars for childcare that some of that goes to capacity
    building, so that we aren't just giving people an empty promise
    when we say will you have this benefit now.
        Secretary Becerra. Congressman, absolutely. We'd like to
    make sure that the progress can't be retracted or dismantled,
    and so we need to make sure that we're creating that
    architecture that lets us always know that we're going to be
    able to deal with childcare the right way.
        Mr. Yarmuth. Great. And that's why it's probably very
    appropriate to call it infrastructure.
        Secretary Becerra. Absolutely. As I said as Frederick
    Douglas said more than 160 years ago it's easier to build
    strong children than to repair broken men. Building kids, and
    building the future of America, and that's infrastructure.
        Mr. Yarmuth. Absolutely. Well, I look forward to working
    with you to get the Americans Family Plan, the American Jobs
    Plan passed, and on other matters as well. Thank you for being
    with us and I yield back.
        Chairman Scott. Thank you. I don't see any Members who have
    not been recognized. If not, I recognize myself for questions.
    Thank you, Mr. Secretary for being with us. I have a couple of
    quick questions, and a couple that probably deserve a longer
    answer. First, you are preparing for the next pandemic. Will
    part of that preparation include Buying America, so that we
    have an industrial based making masks and things like that?
        We've heard from a lot of domestic mask manufacturers that
    said they can't compete with masks being subsidized from other
    countries. Can we count on you to consider the industrial base
    and purchasing in America to the extent feasible?
        Secretary Becerra. Absolutely and thank you to you and your
    colleagues who voted for the American Rescue Plan because you
    made moneys available for us to make those investments in
    domestic manufacturing.
        Chairman Scott. Thank you. I talked to an ophthalmologist
    earlier this week who said that he was volunteering to help do
    vaccinations and man the phones for questions. Are the Medical
    Corps of Retired Physicians part of that preparation?
        Secretary Becerra. Absolutely. And we just started up a
    youth corps as well to help get youth vaccinated. We're now
    turning to their peers.
        Chairman Scott. Good. We have we mentioned CAPTA, the Child
    Abuse Prevention and Treatment Act. The House with bipartisan
    support of this Committee and the full House passed stronger
    CAPTA, much more money and prevention and other improvements.
        As you're aware that's over at the Senate, any help you
    could provide would be helpful. The other question is on the
    prescriptive drug negotiation, it will save the Federal
    Government a lot of money. One of the criticisms of the bill is
    that corporations who with making less money might do less
    research.
        Isn't it true that a lot of the savings will be put to the
    Federal Government, will be spent on research?
        Secretary Becerra. That's absolutely correct. In fact,
    we're going to be providing them even more incentives to do
    more production because of the research possibilities.
        Chairman Scott. Thank you. You were in Congress when the
    Religious Freedom Restoration Act passed, and it has been I
    believe abused in many ways, including allowing discrimination
    in Federal contracts which I don't think was ever anticipated.
    There are some groups that have been granted waivers, and are
    discriminating not only on employment, but also in services.
        Would you give a second look at contracts that allow a
    Federal contractor with Federal money to say we don't hire
    Catholics, and we're not going to provide services to those of
    the Jewish faith?
        Secretary Becerra. Congressman, we're against any form of
    discrimination. We want to protect people's rights, including
    religious freedom rights, but we also want to make sure folks
    aren't discriminating, so we will take a close look. If there's
    anything that you know in particular, please let us know. But
    we're going to do everything we can to make sure we enforce the
    law.
        Chairman Scott. Thank you. The American Rescue Plan
    improved the affordability and eliminated the cliff on
    subsidies for those getting healthcare through the marketplace.
    Can you briefly describe why it was important to eliminate the
    cliff and to improve the subsidies?
        Secretary Becerra. Congressman, that's one's a no brainer
    in so many ways. You have families in the middle of American
    who are working hard, they've got protection under the
    Affordable Care Act, all of a sudden if they're fortunate to
    get a slight increase in their salary as a raise, all of a
    sudden that triggers their loss of all their subsidies, and
    from 1 day to the next they've got coverage that they can
    afford.
        All of a sudden it becomes really difficult. No one should
    have to go through that kind of experience where they fall off
    the cliff. Thank you for what you did in the American Rescue
    Plan to save millions of American families. And today we've got
    not only families who can afford to continue their care, but
    we've got a lot of individuals who are signing up under the
    Affordable Care Act and getting plans for less than $10.00 a
    month in premiums.
        More than 31 million Americans today have coverage,
    healthcare coverage, good quality healthcare coverage because
    of the Affordable Care Act.
        Chairman Scott. And that cliff can be very expensive
    because you can be paying 9 and 1/2 percent of your income,
    $9,500.00 if you go a couple of dollars further and lose your
    subsidies, you may be looking at a sticker price of $15,000.00.
    And we got rid of that cliff so that people don't have to
    suffer that shock.
        On the No Surprises Act, one of the provisions in there was
    a requirement that the Health and Human Services work with the
    Department of Labor, and we provided funding. Can we count on
    you to work with the Department of Labor to make sure that the
    funding is equitably distributed so that both agencies can get
    their work done?
        Secretary Becerra. We're meeting regularly with the DOL
    team, and I can commit that to you.
        Chairman Scott. Thank you. And my time has expired, so I
    will remind the Committee that pursuant to Committee practice
    materials for submission to the hearing record must be
    submitted to the Committee Clerk in 14 days following the last
    day of the hearing, so that's close of business June 23,
    preferably in Microsoft Word.
        Only a Member of the Committee or an invited witness may
    submit materials for inclusion into the record, and materials
    must address the subject of the hearing. Please submit
    materials to the Clerk electronically by emailing submissions
    to edandlabor.hearings@mail.house.gov.
        Again Mr. Secretary, I want to thank you for participating
    today. The Committee may have some additional questions as you
    know, we'll submit them for a response in writing. The hearing
    record will be held open for 14 days in order to receive those
    responses.
        I remind my colleagues that pursuant to Committee practice,
    witnesses questions for the hearing must be submitted by the
    Majority Committee Staff, or the Committee Clerk within 7 days,
    and questions submitted must address the subject matter of the
    hearing.
        I now recognize the distinguished Ranking Member for any
    closing statement that she may have.
        Ms. Foxx. Thank you, Mr. Chairman, and Thank you, Mr.
    Secretary for being here today. Committee Republicans remember
    well how vicious Committee Democrats were to the previous
    Administration secretary. I'll make the same commitment to you
    that I made to Secretary Walsh last week.
        We'll keep our disagreements professional, and we will
    continue to treat you and other Administration officials with
    the respect your office deserves, no matter how unwise we
    believe your actions appear to us.
        I'm disappointed though, that Democrats no longer demand
    the Cabinet Secretary clear their calendars. Chairman Scott was
    uncompromising with Secretary DeVos on this very point, but I
    noticed that dictate is non-existent for Secretary Becerra.
        A pandemic response in June 2021 is much different from the
    crisis we were combatting in June 2020. The American people are
    following the science and returning to their normal lives. And
    it's past time for Democrats here in the people's house to get
    back to business in person.
        Our families are grappling with many challenges, some of
    their obstacles cannot be solved through public policy and
    should be addressed with a renewed sense of social solidarity.
    But some of their troubles are the result of irresponsible
    action from the Department of Health and Human Services.
        Forced isolation is intensifying a mental health crisis.
    Crowded, unsafe conditions for unaccompanied alien children at
    HHS facilities put these children's health in jeopardy, and a
    rushed vetting process leaves them vulnerable to human
    trafficking.
        Healthcare and consumer good prices are soaring. The
    Medicare trust fund is on the brink of insolvency. China is too
    closely intertwined with our biopharmaceutical manufacturing
    and research initiatives. The Democrats don't seem to care.
        President Biden's bloated budget proposal is as insulting
    as it is morally bankrupt. It seeks to strip Americans of their
    employer provided health insurance, impose a socialist
    healthcare system, coerce Americans to fund abortions, and
    mortgage our children's future.
        I reject the Democrats radical and unpopular agenda, and I
    know very well that the American people do also. Mr. Chairman I
    yield back.
        Chairman Scott. Thank you. And I'll now recognize myself
    for a closing statement, and I want to remind the Ranking
    Member that during the previous Administration the Secretary of
    Health and Human Services appeared before this Committee just
    once, and we appreciate Secretary Becerra as making himself
    available for four and a half hours today.
        Every Member was able to ask five minutes' worth of
    questions, some regrettably went a little over, but we know
    this is not the last time that we're going to see the
    Secretary, so I appreciate his being with us today. And I want
    to thank you for discussing the department's budget request,
    and your vision for transforming our public health system.
        Today we reflected on the critical progress we've made
    under this Administration to confront COVID-19, and to recover
    from the pandemic. However, this hearing has made clear that
    our work is far from over, particularly as people across the
    country continue to lose their lives to the virus.
        We know that stronger investments in public health lead to
    healthier communities, and to that end, I'm pleased that we
    discussed how the department's budget request, the American
    Jobs Plan, and the American Families Plan will finally defeat
    COVID-19 and help people care for themselves and their loved
    ones as we build back a better economy.
        So, thank you very much Secretary Becerra. I look forward
    to continuing our work together as we end this pandemic and
    ensure that people across the country will have access to
    quality healthcare. And if there's no further business to come
    before the Committee without object the Committee stands
    adjourned. And thank you, Mr. Secretary for being with us
    today.
        Secretary Becerra. Thank you.
        [Additional submission by Hon. James Comer, a
    Representative in Congress from the State of Kentucky follows:]

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        [Additional submission by Hon. Bob Good, a Representative
    in Congress from the State of Virginia follows:]

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        [Additional submission by Hon. Diana Harshbarger, a
    Representative in Congress from the State of Tennessee
    follows:]

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        [Questions submitted for the record follow:]

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        [Whereupon, the Committee adjourned at 1:27 p.m.]