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

                         DEPARTMENT OF HEALTH AND HUMAN

                        SERVICES FISCAL YEAR 2023 BUDGET

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

                                    HEARING

                                   before the

                            COMMITTEE ON THE BUDGET
                            HOUSE OF REPRESENTATIVES

                        ONE HUNDRED SEVENTEENTH CONGRESS

                                 SECOND SESSION

                                   __________

                HEARING HELD IN WASHINGTON, D.C., APRIL 6, 2022

                                   __________

                                Serial No. 117-9

                                   __________

               Printed for the use of the Committee on the Budget

       [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                           Available on the Internet:
                                www.govinfo.gov

                                 ______

                 U.S. GOVERNMENT PUBLISHING OFFICE
    47-953               WASHINGTON : 2022

                            COMMITTEE ON THE BUDGET

                      JOHN A. YARMUTH, Kentucky, Chairman
    HAKEEM S. JEFFRIES, New York         JASON SMITH, Missouri,
    BRIAN HIGGINS, New York                Ranking Member
    BRENDAN F. BOYLE, Pennsylvania,      TRENT KELLY, Mississippi
      Vice Chairman                      TOM McCLINTOCK, California
    LLOYD DOGGETT, Texas                 GLENN GROTHMAN, Wisconsin
    DAVID E. PRICE, North Carolina       LLOYD SMUCKER, Pennsylvania
    JANICE D. SCHAKOWSKY, Illinois       CHRIS JACOBS, New York
    DANIEL T. KILDEE, Michigan           MICHAEL BURGESS, Texas
    JOSEPH D. MORELLE, New York          BUDDY CARTER, Georgia
    STEVEN HORSFORD, Nevada              BEN CLINE, Virginia
    BARBARA LEE, California              LAUREN BOEBERT, Colorado
    JUDY CHU, California                 BYRON DONALDS, Florida
    STACEY E. PLASKETT, Virgin Islands   RANDY FEENSTRA, Iowa
    JENNIFER WEXTON, Virginia            BOB GOOD, Virginia
    ROBERT C. ``BOBBY'' SCOTT, Virginia  ASHLEY HINSON, Iowa
    SHEILA JACKSON LEE, Texas            JAY OBERNOLTE, California
    JIM COOPER, Tennessee                MIKE CAREY, Ohio
    ALBIO SIRES, New Jersey
    SCOTT H. PETERS, California
    SETH MOULTON, Massachusetts
    PRAMILA JAYAPAL, Washington

                               Professional Staff

                         Diana Meredith, Staff Director
                      Mark Roman, Minority Staff Director

                                    CONTENTS

                                                                       Page
    Hearing held in Washington, D.C., April 6, 2022..................     1

        Hon. John A. Yarmuth, Chairman, Committee on the Budget......     1
            Prepared statement of....................................     4
        Hon. Jason Smith, Ranking Member, Committee on the Budget....     6
            Prepared statement of....................................     8
            Articles submitted for the record........................    30
        Hon. Xavier Becerra, Secretary,U.S. Department of Housing and
          Urban Development..........................................    11
            Prepared statement of....................................    13
        Hon. Lauren Boebert, Member, Committee on the Budget, letter
          and documents submitted for the record.....................   109
        Hon. Ben Cline, Member, Committee on the Budget, letter
          submitted for the record...................................   140
        Hon. Buddy Carter, Member, Committee on the Budget, letter
          submitted for the record...................................   145
        Hon. Sheila Jackson Lee, Member, Committee on the Budget,
          articles submitted for the record..........................   153
            Report submitted for the record..........................   161
        Questions submitted for the record...........................   164
        Answers submitted for the record.............................   173

                         DEPARTMENT OF HEALTH AND HUMAN

                        SERVICES FISCAL YEAR 2023 BUDGET

                                  ----------

                            WEDNESDAY, APRIL 6, 2022

                               House of Representatives
                                        Committee on the Budget
                                                        Washington, DC.
        The Committee met, pursuant to notice, at 2:06 p.m., at 210
    Cannon Building, Hon. John A. Yarmuth [Chairman of the
    Committee] presiding.
        Present: Representatives Yarmuth, Jeffries, Higgins, Boyle,
    Doggett, Schakowsky, Kildee, Horsford, Lee, Chu, Plaskett,
    Wexton, Scott, Jackson Lee; Smith, Grothman, Smucker, Burgess,
    Carter, Cline, Boebert, Donalds, Feenstra, Good, and Carey.
        Chairman Yarmuth. This hearing will come to order. Good
    afternoon and welcome to the Budget Committee's hearing on the
    Department of Health and Human Services Fiscal Year Budget. At
    the outset, I ask unanimous consent that the Chair be
    authorized to declare a recess at any time. Without objection,
    so ordered.
        I will start by going over a few housekeeping matters. We
    will likely have votes during this hearing and will have to
    recess briefly. Because our witness has a hard stop time this
    afternoon, I strongly encourage Members to return promptly
    after votes to ensure they have time to question the witness.
        Now, the Committee is holding a hybrid hearing. Members may
    participate remotely or in person. For individuals
    participating remotely, the Chair or staff designated by the
    Chair may mute a participant's microphone when the participant
    is not under recognition for the purpose of eliminating
    inadvertent background noise. If you are participating remotely
    and are experiencing connectivity issues, please contact staff
    immediately so those issues can be resolved.
        Members participating in the hearing room or on the remote
    platform are responsible for unmuting themselves when they seek
    recognition. We are not permitted to unmute Members unless they
    explicitly request assistance. If you are participating
    remotely and I notice that you have not unmuted yourself, I
    will ask if you would like staff to unmute you. If you indicate
    approval by nodding, staff will unmute your microphone. They
    will not unmute your microphone under any other circumstances.
        I would like to remind Members participating remotely in
    this proceeding to keep your camera on at all times, even if
    you are not under recognition by the Chair. Members may not
    participate in more than one committee proceeding
    simultaneously. If you are on the remote platform and choose to
    participate in a different proceeding, please turn your camera
    off.
        Finally, we have established an email box for submitting
    documents before and during Committee proceedings and we have
    distributed that email address to your staff.
        Now, I will introduce our witness.
        This afternoon we will be hearing from the Honorable Xavier
    Becerra, Secretary of the Department of Health and Human
    Services.
        I now yield myself five minutes for an opening statement.
        Secretary Becerra, I am not sure if it still feels strange
    to be on this side of the dais, but it is always great to
    welcome a friend to our committee. Thank you again for
    testifying today on the President's proposed 2023 budget for
    the Department of Health and Human Services. I also want to
    commend your leadership during what has been an incredibly
    difficult time for our nation as we continue to battle the
    COVID pandemic and its impact on American families.
        When considering this budget proposal, it is important to
    look back to the beginning of this crisis. To put it bluntly,
    our public health system was woefully unprepared for COVID-19.
    Years of irresponsible austerity under the budget caps took a
    toll on our public health infrastructure and readiness. Former
    President Trump had gutted key public health agencies and, in
    an astonishingly shortsighted move, disbanded a White House
    Council charged with pandemic preparedness. Vaccine development
    was underway, but there was no distribution plan in place.
        Fast-forward one year. The American Rescue Plan has now
    helped us make considerable headway in the fight against COVID-
    19. It put in place a massive vaccination campaign, invested in
    state and local public health systems, and lowered health care
    costs for millions of Americans. Thanks to the American Rescue
    Plan, more than 216 million Americans have now been fully
    vaccinated against COVID-19, and American families saved an
    average of $2,400 on their annual health insurance premiums
    this past year.
        But we can't wait for the next pandemic, or rely on
    emergency action, to ensure our public health systems are up to
    the task. That is why the Biden budget request for HHS meets
    the needs of today, while strengthening our public health
    system for decades to come.
        This starts with an overall discretionary funding level of
    $127 billion for HHS, more than $13 billion over 2022 funding
    levels, along with major investments in our public health
    systems and surge capacity so we are prepared for future
    pandemics and biological threats. The Biden budget increases
    discretionary CDC funding by 28 percent and expands no-cost
    access to vaccines, including a new program to provide all
    recommended vaccines to uninsured adults for free.
        This budget proposes the smart, forward-looking investments
    we need. It invests heavily in research and development,
    including $5 billion for the newly established ARPA-H
    initiative to accelerate development of treatments and cures
    for devastating diseases, including cancer, diabetes, and
    Alzheimer's. The budget puts us on track to meet President
    Biden's goal of cutting cancer death rates by 50 percent over
    the next 25 years, which would save 300,000 lives and hundreds
    of billions of dollars annually, and lays out a strategy to
    reduce HIV infection by 75 percent over next three years.
        Two years of this pandemic have had far-reaching
    consequences for our society. This budget recognizes that. And
    it puts forth real resources to address challenges that COVID
    exposed and exacerbated.
        It dramatically expands mental health benefits and
    coverage. It lowers costs for mental health services by
    requiring private plans to cover mental health benefits and
    takes steps to address the persistent shortage of behavioral
    health providers. And it makes historic investments in youth
    mental health services and suicide prevention.
        This budget targets systemic health disparities and invests
    in vulnerable communities that have historically been left
    behind or ignored. This includes investments to lower America's
    unacceptably high maternal mortality rate, especially among
    Black and Native women, and substantial increases in funding
    for low-income women's health care through the Title X Family
    Planning Program. And, recognizing our obligations to Tribal
    communities, this budget provides $142 billion for Indian
    Health Services over the next decade, guaranteeing a stable
    funding source for IHS going forward.
        Finally, the Biden budget invests in our nation's children,
    with sizable increases for the Child Care and Development Block
    Grant program and Head Start.
        We have learned a lot from this devastating pandemic, and
    chief among those lessons is that our public health systems
    must be adequately funded and fully equipped to combat public
    health threats before they emerge. We cannot afford the human
    and economic costs of being unprepared again. This budget
    ensures that the next time we are hit with a health threat, and
    we will be, our public health infrastructure is ready to
    respond.
        It is also about making major discoveries, which will
    change the outlook for millions of Americans facing
    debilitating and life-threatening illnesses. The budget's
    massive investments in research and development will
    undoubtedly lead to new treatments and cures. It will save
    lives.
        Secretary Becerra, your Department has put forth a
    responsible, compassionate, and forward-looking budget. Thank
    you again for your leadership and for appearing before our
    Committee today. I look forward to your testimony.
        With that, I would like to yield to the Ranking Member, Mr.
    Smith, five minutes for his opening statement.
        [The prepared statement of Chairman Yarmuth follows:]

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        Mr. Smith. Thank you, Mr. Chairman. Welcome, Secretary,
    back to the Budget Committee. It is good to have you. It is
    good to have you in person.
        As the head of HHS, you oversee one of the largest budgets
    in the entire federal government--annually well over $1
    trillion. For 2023, President Biden's budget has proposed
    giving you a 12 percent raise to $1.7 trillion. And over the
    past two years, Congress has also given your Department
    trillions more to fight COVID. Such levels of funding demand a
    thorough examination of how, when, and where you have chosen to
    deploy those resources.
        When the Biden Administration came into power, it inherited
    two authorized and incredibly effective vaccines, therapeutics,
    testing, and a national distribution network. Yet, somehow, the
    government seemed to have its worst response yet to the
    pandemic in 2021. In his first month in office, President Biden
    shut down Operation Warp Speed--the Trump Administration
    program that had set you all up for success. In March 2021,
    Democrats passed their $2 trillion American Rescue Plan,
    claiming it was urgently needed for ``COVID relief.'' But less
    than 9 percent of those funds went directly to fighting the
    virus. Dozens of examples of billions of dollars worth of waste
    as a result of this law have been documented: taxpayer dollars
    going to build parking lots, golf courses, luxury apartments,
    and sports stadiums, among others. Your department diverted $1
    billion from an NIH study for long-COVID to house illegal
    immigrants at the border. You then back filled NIH's funding
    with money meant for COVID vaccines and testing. Last summer,
    you re-routed even more money--$2 billion to be exact--this
    time from the American Rescue Plan to house illegal immigrants.
        In short, our own government is using taxpayer dollars to
    prioritize illegal immigrants over its citizens.
        Over Christmas we saw a massive testing shortage. Thousands
    of people stuck freezing, in long lines, waiting for tests. It
    was later revealed during a Senate hearing by officials in your
    own department that the Biden Administration failed to place
    new testing orders for the first nine months of 2021. Such
    failures were not the result of a lack of funding t The
    American people have given generously and have sacrificed a
    great deal. These failures point to a lack of leadership and
    decisionmaking at the highest levels of the Biden
    Administration. Remarkably, the Biden Administration got $2
    trillion and ended up less prepared to battle COVID.
        The funding request in the President's budget comes out to
    an 11 percent raise for HHS--that is not including the tens of
    billions in extra emergency COVID money the White House is
    currently asking for, but fails to account for. That same
    budget cuts border security too. Clearly the Administration has
    learned nothing over the past year. The sad truth is that the
    President's budget fails to address the crises his
    Administration has created. In fact, it only makes them worse.
        Since President Biden took office, there have been more
    than 2.9 million border encounters, a 426 percent increase over
    the previous year. Over 12,000 pounds of fentanyl, enough to
    kill every man, woman, and child in America, have been seized
    by border patrol. In response, just last week, your department
    revoked Title 42--knowing full well it will lead to more
    illegal immigration.
        The mission of your department is to enhance the health and
    well-being of all Americans. And yet this budget that you are
    advocating eliminates protections for the unborn. It rejects
    the long-standing bipartisan prohibition against federal tax
    dollars going toward abortions.
        With credible concerns about COVID-19 originating from the
    labs in Wuhan, China, the budget does not prohibit funding for
    viral research in China. Nor does it increase oversight on
    taxpayer funded research. Reports indicate you allow teachers
    unions to edit CDC guidance that ultimately harmed millions of
    children by keeping schools closed. There is nothing in this
    budget that acknowledges or seeks to rectify those mistakes.
        Everywhere you look in this budget, enshrined are the
    failed policies that brought us to where we are today. I hope,
    Secretary, you are ready for some questions, because the
    American people have a lot of questions, and they want answers.
        Thank you and I yield back, Mr. Chairman.
        [The prepared statement of Jason Smith follows:]

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        Chairman Yarmuth. I thank the Ranking Member for his
    opening remarks.
        In the interest of time, I ask that any other Members who
    wish to make a statement submit their written statements for
    the record to the email inbox we established for receiving
    documents before and during Committee proceedings. We
    distributed that email address to your staff. I will hold the
    record open until the end of the day to accommodate those
    Members who may not yet have prepared written statements.
        Once again, I want to thank Secretary Becerra for being
    here this afternoon. The Committee has received your written
    statement and it will be made part of the formal hearing
    record.
        You will have five minutes to give your oral remarks and
    you may begin when you are ready.

       STATEMENT OF THE HONORABLE XAVIER BECERRA, SECRETARY,U.S.
              DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT

        Secretary Becerra. Chairman Yarmuth, Ranking Member Smith,
    and Members, thank you for having me. Thanks for letting me
    come back to the Budget Committee.
        Today more than 255 million Americans have received at
    least one dose of a COVID-19 vaccine, two-thirds of adults over
    age 65 have gotten their booster shots. And we have also closed
    the gap in vaccine rates we usually see for communities often
    left behind. It has paid dividends to surge resources,
    including tests and treatment to our hardest hit and highest
    risk communities. 325 million free COVID-19 at home tests
    shipped out, 270 million free N95 masks made available. From
    the $186 billion appropriated by Congress for the provider
    relief fund, $766,000 payments to over 400,000 providers who
    have received payments for COVID-19 services. That is over
    400,000 doctors, hospitals, community health centers,
    pharmacies, labs, nursing homes, and long-term care facilities,
    all receiving this critical support.
        This is real money, real relief, real results.
        On Monday I had a chance to meet with Medicare
    beneficiaries who are now able to purchase their over-the-
    counter COVID-19 tests with their red, white, and blue Medicare
    card. Mr. Chairman, this marks the first time that Medicare has
    covered an over-the-counter test at no cost to beneficiaries.
    That is a game changer.
        Beyond COVID-19, today more Americans have insurance for
    their healthcare than ever before. That includes a record
    breaking 14.5 million Americans who now have secured their
    health insurance through the Affordable Care Act. That is a big
    deal.
        Also this week the Biden Administration is issuing a rule
    that will fix the health insurance family glitch, which leaves
    out family members from affordable coverage. Less noticed, but
    just as important, we launched Operation Allies Welcome, an HHS
    led effort that has helped over 68,000 Afghan brothers and
    sisters resettle as refugees in America.
        And we are coordinating nearly $300 million in support
    nationwide for the launch of the 988 national suicide
    prevention lifeline later in July.
        HHS has also made key investments to close holes in our
    public health system in areas like maternal health, where we
    have extended Medicaid coverage for postpartum care for a new
    mother and her baby from two months to 12 months. The
    President's 2023 budget lets us build on that record of
    investment in America's health. It proposes $127 billion in
    discretionary budget authority and $1.7 trillion in mandatory
    funding, including a historic investment to transform the
    mental health infrastructure in our country, a priority I know
    many of you share.
        It also asks for $82 billion for the President's Pandemic
    Preparedness proposal to get ready for whatever might come next
    after COVID-19. Considering that COVID has cost this country
    more than $4.5 trillion in direct support from the federal
    government so far, this $82 billion investment is a no brainer
    to prepare for the next pandemic. The funding we are requesting
    as well would be end to end, which mean it would be for
    research, development, approvals, deployment, and effective
    response.
        Budgets represent not just dollars and investments, but our
    values and our priorities. This budget turns hardship into
    hope, inclusion into opportunity. And it is a commitment to
    finish the fight against COVID-19 and build a healthier
    America.
        On that note, I want to acknowledge our collective national
    failure to fund the Indian Health Services at the level needed
    to meet our constitutional treaty and our trust obligations to
    Tribal Nations in America. But even more importantly, the
    elemental level needed to provide fair and sufficient resources
    for Indian Country. I have seen these shortfalls firsthand in
    my visits to Indian Country. We must be serious about meeting
    our constitutional and legal obligations to address the health
    needs of more than 2.7 million patients served by IHS. The
    President's Fiscal Year budget takes a historic first step
    toward finally delivering on our long overdue commitments to
    Tribal Nations.
        In my written testimony I detail our proposal to convert
    the IHS budget to mandatory funding and to bolster it
    significantly over the next 10 years. This budget is strong and
    it is a great start, but we must continue to shine a light and
    hold ourselves accountable on our promises.
        Mr. Chairman and Members of this Committee, I look forward
    to working with you to make the President's 2023 budget a
    reality and to continue our efforts to give Americans real
    relief, real results, and real peace of mind.
        With that, I am prepared to answer any questions.
        [The prepared statement of Xavier Becerra follows:]

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        Chairman Yarmuth. Thank you very much, Mr. Secretary.
        And we will now begin our question and answer session. As a
    reminder, Members can submit written questions to be answered
    later in writing. Those questions and responses will be made
    part of the formal hearing record. Any Members who wish to
    submit questions for the record may do so by sending them
    electronically to the email inbox we have established within
    seven days of the hearing.
        Let me also say that I--because of the constraints we have
    today, a vote series that will interrupt the hearing for
    probably at least 45 to 50 minutes, I am going to be very
    strict with the gavel. And any Member who runs their time down
    to the last 10 seconds and asks a question, I am going to gavel
    them down and then ask for the response to be made in writing
    afterwards. That is fair to--I think fair to the witness and
    again will help us expedite the hearing.
        So, with that, I now yield five minutes to the gentleman
    from Texas, Mr. Doggett.
        Mr. Doggett. Thank you very much, and thank you, Mr.
    Secretary, for your important service.
        As you know, one of my principal concerns has been price
    gouging by pharmaceutical companies. I know that you have been
    here recently to ask the Congress to provide supplemental COVID
    funding, which is no doubt needed. But I just want to
    indicate--before I vote for it, I want a better idea of what
    taxpayers have already paid for COVIDfunding to date. It is
    billions of dollars to pharmaceutical manufacturers. And I
    think it is very important that your Administration do more
    than has been done to date to be transparent about that. The
    only contracts of those pharmaceutical contracts that have been
    released to the public have been heavily redacted. It is not
    sufficient to just stamp them top secret or trade secret to
    deny access to the public about the pricing and terms of those
    contracts. And I just hope you will review that with your staff
    and find a way to make more available to the public generally
    about what is in these contracts.
        And going forward, I think it is really important on the
    contracts that you enter that there be reasonable pricing
    clauses wherever the taxpayer has funded the research, as
    happened 100 percent on Moderna vaccine, so that there is a
    preserved interest of the taxpayer in the investment that has
    been made.
        You know, I don't believe there has been a president in the
    history of the United States who said more about the damage
    being done by the pharmaceutical industry than President Trump.
    Unfortunately, he did next to nothing about it. And it is
    pretty clear that this Congress still remains under a strangle
    hold from Big Pharma. If anything is to occur meaningfully to
    protect American consumers and taxpayers from pharmaceutical
    price gouging, it will have to come from this Administration.
    There are many things that the Administration could do on its
    own initiative. One small one is to proceed to grant the
    hearing that is pending now on the price of XTANDI, a prostate
    cancer drug that was developed with U.S. Army and NIH grants to
    determine whether it is fairly priced to consumers and what
    standards should apply. I would just ask you to review that and
    ways that the Administration can be helpful in responding so
    that at the end of this year this Administration's record is
    better than the Trump Administration's record. And it won't
    have to do much in order to achieve that objective.
        A second area you know that I am very concerned about is
    the coverage gap. A significant number of people--2 million in
    Texas according to CMS standards and over 6 million across the
    country--have been left out and left behind because of the
    failure of states to do their part with Medicaid expansion. I
    hope you will continue to make that a top priority to close
    that coverage gap. The provisions that are proposed in Build
    Back Better concerning adding these people into marketplace
    plans is a good way to address it. If that can't be achieved,
    as you know, I have a COVER Now Act that is designed to let
    cities, hospital districts, contract directly, perhaps
    demonstration projects. We could cover in just three cities in
    Texas half of the people that have been left out and left
    behind.
        So just to encourage you to work in all those areas.
        And, finally, one of the areas that I know you are working
    in already concerns President Biden's pledge to address the
    suffering that is occurring in our nursing homes across the
    country. The pandemic has exposed so many deficiencies, poor
    infection control, little corporate accountability, inadequate
    staffing, poor working conditions. President Obama had an
    excellent set of standard that he was proposing that had been
    dropped over the last four years. This is the type of action
    that family advocates across the country, like Sissy Standards
    in Austin, have been seeking. Perhaps you could just describe
    in the minute you have the general direction that you are
    taking on nursing homes and when you think we might see some
    reforms.
        Secretary Becerra. Congressman, thank you for the question.
    Good to see you.
        On nursing homes, we are going to try to work as
    aggressively and as swiftly as we can to undertake the
    President's proposals. One of those would be to strengthen the
    work force. A second one would be to do much more oversight. We
    intend to try to make sure that the staffing levels at these
    nursing homes are adequate so that they meet the needs of the
    residents who are there. We want to make sure that the moneys
    that we are providing, whether through the Medicare program,
    Medicaid program. If there are any government dollars that are
    being provided that we are getting our money's worth. And the
    most important thing we could tell you is that with your
    support, and if you continue to provide us with the resources
    that we need, we will be able to do some vigorous oversight.
    But first and foremost, we have to make sure that those nursing
    homes are keeping people safe from COVID, we have to make sure
    that they are providing--they are fully equipped and they are
    adequately staffed to make sure that they are providing
    pursuant to their charter.
        Chairman Yarmuth. For emphasis, echoes for emphasis.
        The gentleman's time has expired.
        I now recognize the Ranking Member, Mr. Smith, for 10
    minutes.
        Mr. Smith. Thank you, Mr. Chairman.
        Secretary, Operation Warp Speed under President Trump set
    the country up for success in its battle against COVID-19 going
    into 2021 with two effective and authorized vaccines,
    therapeutics, testing, and a national distribution network.
    Given that, why was the Biden Administration's response to
    COVID in its first year full of so many stumbles, given the
    tools provided and systems already in place when you all walked
    in the door?
        Secretary Becerra. Congressman, thank you for the question.
        And I want to take you back to where we were when President
    Biden took office. Less than 1 percent of Americans had
    received a vaccine. And we had a situation where the efforts
    were not nationally coordinated and we had to stand up an
    infrastructure to make sure that we could get not just
    vaccines, but therapeutics out. There was not one single
    therapeutic that--medicine that any American could take that
    would be available orally for that individual. There were at
    the time very few provisions for treatment. The tests that
    people would be--need to take, there were no tests available to
    Americans that they could take at home. And things have
    changed. As I said in my opening testimony, today more than 255
    million Americans have received a shot in the arm, more than
    560 million vaccines have been administered overall, when you
    count boosts and the rest, and we have now made available
    hundreds of millions of tests, we have ordered and paid for
    hundreds and most cases thousands of the therapeutic medicines
    that some people need who have contracted COVID. Night and day.
    Today we are opening up. We have gone through two major
    variants in that one year, and both more potent than the
    original natural virus. And so what we see is that progress has
    been made, but we are not yet out of the woods.
        Mr. Smith. Thank you, Secretary.
        One of the big concerns to me is this past year it appears
    that it was marked with a lot of chaos on the response front.
    There were more COVID deaths in 2021 than in 2020--in fact, by
    102,882 more to be exact. And this Administration started out
    with the vaccine. At least it was created. That is 128 percent
    more in COVID deaths in 2021 than 1920. Again, the vaccines
    were approved whenever you all walked through that door. And
    conflicting guidance coming from your CDC, masking, no masking,
    when to open, when not to open, contributed not just to
    confusion but undoubtedly to more Americans getting sick or
    suffering other consequences.
        You gave yourself $2 trillion in additional so called COVID
    relief funding on top of the $4 trillion Congress had already
    enacted. In retrospect, might it have been a bad decision to
    dedicate less than 9 percent of the $2 trillion from the
    American Rescue Plan to combatting COVID-19, particularly given
    the fact you are now asking for more money to Congress?
        Secretary Becerra. Congressman, first I would be interested
    in seeing your math, because I don't think it is accurate in
    terms of how we have deployed the resources that were given to
    us.
        We know here at HHS that what we have done with the money
    that you have made available. First, we say thank you for those
    who voted for those resources because they have been
    indispensable. But we have used them to be able to make
    available those hundreds of millions of vaccines to all
    Americans. No American is denied a vaccine to date, no American
    has had to pay a penny for those vaccines. We now have the
    therapeutic medicines that help you stay alive if you do
    contract COVID.
        Mr. Smith. So, Mr. Secretary, I just want to know, you feel
    like that there was enough money in the $2 trillion bill that--
    how much was allocated to HHS in the $2 trillion bill that
    passed Congress a year ago was sufficient?
        Secretary Becerra. Congressman, I will take every penny you
    all give us and we will make----
        Mr. Smith. Was it sufficient that was passed of the $2
    trillion?
        Secretary Becerra. We used every bit of it and we are
    beginning to now run out of that gas to keep it going. And we
    will need more----
        Mr. Smith. Thank you. Thank you, Secretary.
        I will just say we found numerous examples and my team
    would be more than happy to show that less 9 percent of the $2
    trillion actually went toward killing the virus. But the
    numerous examples that we did find was billions of taxpayer
    dollars being wasted--planting thousands of trees, building a
    high-end hotel, a spa, and golf courses, renovating a baseball
    stadium, new weight rooms, luxury apartments. The list goes on
    that was in that $2 trillion COVID package. How does spending
    $2 million of taxpayer dollars on planting trees in Syracuse,
    New York help fight COVID?
        Secretary Becerra. Congressman, what I can tell you is what
    we have done with the money that we received and what we----
        Mr. Smith. Does planting trees in Syracuse, New York help
    fight COVID?
        Secretary Becerra. As I said, I can speak to you what we
    did with our money and we have made very good use of the money
    keeping Americans alive and healthy.
        Mr. Smith. I will take that as a no. And I also think that
    sending $1,400 checks to Japanese citizens living in Japan did
    not help stop COVID. I wonder what that is all about.
        But there seems to be a lot of decisionmakers in this
    Administration. We have Gene Sperling as the American Rescue
    Plan Czar, we have Jeff Zients as the COVID Response
    Coordinator. It makes me wonder who is ultimately responsible
    for making decisions on whether it is appropriate for state and
    local officials to spend $4 million building a new beach
    parking lot in South Carolina or $250 million of COVID relief
    on state parks in Michigan. Where does the buck stop? With you,
    Mr. Sperling, Mr. Zients, President Biden? Who is making those
    decisions?
        Secretary Becerra. Congressman, if you have any questions
    about the way HHS has deployed its resources, I am more than
    willing to answer those questions. We feel very confident that
    what we can show is the American people are receiving real
    results as a result of the work that was done by HHS employees
    nationwide.
        Mr. Smith. You know, I appreciate that. Maybe from the
    prior $2 trillion COVID bill we shouldn't have used $783
    million in stimulus checks to convicted prisoners, including
    the Boston Marathon Bomber.
        Since I do want to talk about resources that were delegated
    to the HHS in that spending bill, let's jump to that. Can you
    tell us how much funding your department has spent over the
    past year plus to fly illegal immigrants from the border to
    various communities across the country?
        Secretary Becerra. If you are asking for the last 365 days,
    it might be more difficult. But I can give you an idea
    generally of what we have done with some of the money that we
    have received.
        Mr. Smith. Did you use any of the money in the HHS budget
    to fly illegals from the Southern Border to other communities
    in the country, yes or no?
        Secretary Becerra. We have an obligation, Congressman, to
    make sure that that those migrant children who are
    unaccompanied by an adult have a safe place to stay while they
    are temporarily going through their immigration process. We--
    housing those----
        Mr. Smith. So you did?
        Secretary Becerra. Well, we house some of those immigrant
    children until we are able to find a sponsor, if we are able to
    find a sponsor who will house that immigrant while the child is
    waiting for its hearings.
        Mr. Smith. So can you tell me within this budget, show me
    in this budget where you are planning to use taxpayer dollars
    to fly illegal immigrants from the border to various
    communities throughout this country? And how many taxpayer
    dollars do you estimate you will spend in the months to come in
    such flights? Where is it at in the budget?
        Secretary Becerra. You can find the information under the--
    I am sorry, the Office of Refugee Resettlement that deals with
    the unaccompanied migrant children. And what we are obligated
    to do by law is take possession and custody of a child once
    they have been placed in the hands of Department of Homeland
    Security. They are only allowed to keep those children for a
    short amount of time. We must then take them and we place them
    in a facility that is able to care for children. Not all of
    those facilities are there on the border, in American
    communities along the border. So we do make sure that we place,
    if we can, in a licensed care facility that is able to care for
    children.
        Mr. Smith. Also, there has been a lot of conversation about
    money being transferred, $2 billion in fact, that was taken
    from the strategic stockpile and for COVID testing, that was
    used with illegals at the Southern Border. Where was the
    authority to do that?
        Secretary Becerra. So I am not sure where you brought the
    strategic stockpile in, but what I can tell you is that the
    COVID moneys that we have used, including some of the moneys to
    address the needs of those migrant children, because of COVID
    they were not immune from getting COVID and we would have to do
    the systems and the processes necessary to make sure that they
    were tested, make sure that they were not COVID positive, so
    they would not infect others around them, including the
    children. And so we did use some of the COVID money made
    available through Congress to address the COVID related
    concerns and services necessary for migrant children.
        Mr. Smith. I see my time is running out in seven seconds.
        Secretary, thank you for being here.
        Secretary Becerra. Thank you.
        Chairman Yarmuth. The----
        Mr. Doggett. Mr. Chairman?
        Chairman Yarmuth. Yes, the gentleman from Texas.
        Mr. Doggett. The Ranking Member raises a number of examples
    that concern me and I think it would be helpful if you could
    put the information you were going to give Secretary Becerra
    into the record so that we can evaluate those, determine if
    those were decisions made in the huge bill that we approved or
    by state and local governments using that money or where it was
    spent. I don't think any but the last you discussed had
    anything to do with the Secretary of Health and Human Services,
    but it is something that our Committee in our oversight role
    certainly needs to look to see if this money was misspent in
    any way.
        So I just ask that you do that.
        Chairman Yarmuth. Is the gentleman willing to do that?
        Mr. Smith. I am more than happy to submit to the record.
    Also, I would love for this Committee to have an oversight
    hearing so we could look into the--how the money was spent. We
    have sent a request to the Chairman and it would be awesome if
    we could just not submit to the record but actually have a
    hearing and a discussion of oversight of $2 trillion.
        [Articles submitted for the record follows:]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Mr. Doggett. Thank you.
        Chairman Yarmuth. I thank both of you.
        I now recognize the gentlewoman from Illinois, Ms.
    Schakowsky, for five minutes.
        Ms. Schakowsky. Thank you, Mr. Chairman, and thank you, Mr.
    Secretary. Always great to see you.
        I wanted to talk about seniors--no surprise--because I am
    the Chair of the Task Force on Aging and Families, and this has
    been a priority for me, as you know.
        So there is nearly 1.3 million seniors and people with
    disabilities who are living in nursing homes right now and each
    one of them deserves a really good quality of life. The
    pandemic was just terrible, you know. No. 1, of people who
    died, people in nursing homes that, you know, was kind of a
    deathtrap situation in many ways. And, you know, public dollars
    through Medicare and Medicaid make up 70 percent of long-term
    care funding. So taxpayers are really paying for these
    institutions. And yet what we see is private equity firms have
    gotten more involved and they have been--nursing homes often--
    too often I think, are seen as a way to really make some money,
    sometimes milking them for the money. And we need to do better.
        So, Secretary Becerra, we are really grateful to President
    Biden for the initiative to improve nursing home quality,
    safety and oversight, and we really welcome what was set as
    almost $500 million included for the Center for Medicare and
    Medicaid Services, CMS, for that purpose.
        So what I really want to know, and what keeps me concerned,
    is whether this is actually going to be enough to address the--
    what I think is a really big issue of making sure that we are
    able to improve care in long-term care facilities.
        Secretary Becerra. Congresswoman, first, great to see you
    again and thank you for the hug earlier in the hallway.
        Ms. Schakowsky. I wasn't going to mention that. It was a
    good hug.
        Secretary Becerra. The President made it very clear that we
    are going to really go in and look deep at nursing homes,
    because we saw so many Americans die as a result of COVID. That
    is where we saw the greatest number of Americans dying early
    on.
        Ms. Schakowsky. Over 200,000.
        Secretary Becerra. Yes. And unfortunately dying by
    themselves because they couldn't be joined by their family
    members.
        And so we just can't experience that again. So the
    President has laid out some pretty strong markers. We are going
    to do more oversight. I mentioned this to Congressman Doggett.
    We are going to make sure that we find out if these facilities
    are adequately staffed, if they have people who are adequately
    trained. The President in his budget does provide resources
    that makes it possible for us to provide additional relief to
    about a million and a half caregivers and families so we can
    increase the access because the demand is so great. But we are
    also going to do something a little differently as well. There
    are a lot of those folks who are in nursing homes who don't
    have any choice because families don't have an alternative.
    Home and community-based services----
        Ms. Schakowsky. Yes.
        Secretary Becerra [continuing]. are a great alternative.
    Because if your loved one can be at home where he or she feels
    the most comfortable, surrounded by loved ones, cared for by
    loved ones, with some professional help, that is the best way
    you can go. I say that as a son who had a chance to watch his
    father pass away in my home and cared for him and my mother for
    four years while I was living in Sacramento. There is nothing
    like and we are going to--especially if you pass Build Back
    Better or some elements of it, we will be able to make game
    changing investments in home and community-based care.
        And I hope that what you do is realize that Americans are
    crying out for the ability to care for their loved ones closest
    to home as possible.
        Ms. Schakowsky. No question about it. And, you know, we
    also want to think about the work force and the workers
    themselves. And, you know, if you are a home care worker the
    average wage that you make is something like $12 an hour around
    the country. So it is really hard to get people to do that work
    even though they want to do that work. So we have to care for
    the caregivers, both the home caregivers, the family
    caregivers, and the people who work there too.
        So thank you very much. We are going to--anything we can do
    to work with you, with our task force to make sure that home
    and community based, as well as the facilities can benefit.
        So thank you.
        Secretary Becerra. Thank you.
        Chairman Yarmuth. The gentlewoman's time has expired.
        I now recognize the gentleman from Wisconsin, Mr. Grothman,
    for five minutes.
        Mr. Grothman. Thank you.
        I am going to lead off talking about one of my pet topics.
    I spoke last week with a Dr. Dror from Israel and he felt--it
    was a small study, I don't think the sample is enough that you
    could write home about it--but he found that people who were
    Vitamin D deficient were 14 times more likely to get severe
    COVID and 11 times more likely to die. I also talked to a Dr.
    Meltzer from the University of Chicago. I am not going to quote
    his numbers, but I think it would be accurate to say that he
    feels that over half of the COVID deaths could have been
    prevented with adequate Vitamin D. And a guy by the name of--
    his name is Carl Flager from Stanford, who--maybe similar
    amounts. And I have tried to in my own little world publicize
    it. But when you are talking about a life savings of that
    amount, it is very frustrating to me that you--and I will
    include your predecessor in the group--have done nothing to
    publicize that. I mean you can't turn around without running
    into things about social distancing or masking or vaccinations,
    enough that everybody has heard these things millions of times
    over, but the fact that Vitamin--and of course if you
    publicized Vitamin D more not everybody would take it, just
    like not everyone gets a vaccine, but I think you would get a
    lot of people to take it. And it is apparently good for other
    health problems other than just the COVID. I mean you talk
    about 11 times less likely to die, it is kind of a big number.
        In my district people are beginning to feel that the reason
    that the establishment doesn't push it is because you can get a
    big bottle of Vitamin D for $20 at Walgreens and they would
    rather--you know, there is no money to made in it so we don't
    push it.
        Could you give me your opinion of Vitamin D and say, in the
    future, with all of the money you have floating around, maybe
    you want to tell about these--you know, publicize it a little
    bit more for people?
        Secretary Becerra. Congressman, thank you for the question.
    No doubt that vitamin deficiencies lead to a lot of different
    consequences in the health of so many American people.
        Mr. Grothman. Eleven times more likely to die.
        Secretary Becerra. And so what I would say to you is that
    the health professionals and the scientists at Health and Human
    Services, whether it is at CDC or FDA, NIH, I know that they
    are doing some extremely important--some of the most cutting
    edge research. And I am not prepared to give you exactly what
    they are doing right now on the issue of Vitamin D, but I
    certainly am willing to followup with you. But I agree with you
    to the point that vitamin deficiencies can lead to lots of
    consequences for folks. And so we know that there are real
    efforts--should be under way to make sure that we are doing the
    things that are most basic and cost effective to try to keep
    people healthy.
        Mr. Grothman. Well, I mean there are so many studies out
    there. Now, I think the problem they have is all these studies
    show correlation not necessary causation. But when you have
    things like 11 times more likely--and, you know, I can give you
    these names of these professors from around the country. I mean
    the idea that we are two years into this pandemic and--I guess
    even Dr. Fauci--who I have a low opinion of--I guess even he
    has privately told people how much Vitamin D he takes, but for
    some reason when he gets on TV he zips his mouth.
        I do feel--and like I said, your predecessor is in the same
    boat, because I certainly tried to publicize it before Biden
    was elected. Couldn't get a lot of movement then either. But I
    want you to look at it, maybe publicize it, and maybe you can--
    you know, we could have saved a lot of lives. I mean I think
    300-400,000 in my opinion, but.
        I talked to you in the Labor Committee with regard to what
    I felt was too much emphasis on racial groups, that sort of
    thing, by your agency. I will mention here--maybe you will
    recognize it--new payment model for physicians who implement
    anti racism in their care plan. And an implication in some of
    the monoclonal antibodies distribution that race should come
    into play. I have the documentation here. Do you feel your
    office is emphasizing--I mean to me, a person is a person. I
    will say with regard to Vitamin D, they could have emphasized
    that dark skinned people are more likely to be Vitamin D
    deficient. I think I am the only who talks about that as well.
    You could have really saved a lot of lives there.
        But, yes, do you feel you are pushing this divisiveness by
    race a little bit too much in your agency?
        Chairman Yarmuth. I am going to have to say the gentleman's
    time is expired.
        Secretary Becerra. And, Mr. Chairman, I can answer in--oh,
    it is expired.
        Chairman Yarmuth. OK.
        Secretary Becerra. But I would say the answer is a
    straightforward no. we are looking toward equity to make sure
    no one is excluded.
        Chairman Yarmuth. I thank the Secretary for that quick
    response.
        I now recognize the gentleman from Michigan, Mr. Kildee,
    for five minutes.
        Mr. Kildee. Thank you, Mr. Chairman. Mr. Secretary, it is
    always good to see you.
        Secretary Becerra. Thank you.
        Mr. Kildee. Good to have to you back.
        Secretary Becerra. Thank you.
        Mr. Kildee. And thanks for being here.
        I was really pleased to see in the proposed budget
    regarding the Indian Health Service change that we have been
    long advocating for. The federal government, as we know, has a
    trust responsibility to ensure uninterrupted health access for
    Tribal Communities. It is something that you and I worked
    together on when you were here in Congress.
        Currently, the Indian Health Service is funded differently
    than other health programs, as you know, like the VA for
    example. This unequal treatment means that access to healthcare
    is often at risk in the event of a government shutdown. And of
    course this is not a hypothetical situation. When the
    government partially shut down from 2018 to 2019 the staff
    employed at the Indian Health Service clinics had to work
    without pay and important preventive tribal health programs
    were forced to stop. And that is just not right.
        As a Member of this Committee, I have been advocating for
    some time for parity between IHS and other federal health
    programs. And I think the Chairman--I wish to thank President
    Biden himself for including this initiative in the annual
    budget. And I am committed to working with the Administration
    to get this fixed. And I wonder if you can perhaps address how
    important permanent funding, funding that is not subject to the
    whims of congressional action and being suspended by a shutdown
    could have an impact on tribes that deliver services, tribes
    like the Saginaw Chippewa Tribe that I represent. And,
    particularly, if you just might address how this initiative and
    others might help address care for Tribal Communities.
        Secretary Becerra. Congressman, first, thank you for your
    leadership on this issue for so long. I think you mentioned it,
    I think we feel we have a moral obligation to help our
    veterans, we have a moral obligation to help seniors who have
    contributed to the Medicare program, we have a moral obligation
    to our children to make sure that they can grow up health and
    we provide the CHIP program for them, Medicaid. We not only
    have a moral obligation to our Tribal Communities, we have a
    constitutional obligation. It is in the Constitution. And in
    the treaties that we have signed, we have a trust obligation to
    do these things, yet we have never done it. And it is high time
    we do. And it has been a--as I said, a moral failure on the
    part of the nation to not recognize it, perhaps because the
    Native American population is so small some people can ignore
    it, but we shouldn't because we are talking about the health of
    human beings, our brothers and sisters.
        And so I am proud that President Biden is the first
    president to step forward and say it is time to recognize not
    just our moral obligation, but our constitutional and legal
    obligation to Indian Country to do what we are supposed--we
    should have been doing a long time ago for these Tribal
    Nations.
        Mr. Kildee. Well, I thank you for that. And I know you
    worked with and served with my late uncle, Dale Kildee, who
    actually once served as a Member of this Committee as well. And
    this was part of his life's work. And so the fact that we are
    in now a position to see this action taken I think is in many
    ways a testament to his long work in this subject. So I thank
    you for that.
        Secretary Becerra. Amen.
        Mr. Kildee. Another subject that I have been working on and
    spending a great deal of time on has to do with the access to
    affordable clean water. We all know what took place in my
    hometown of Flint, Michigan. If it were only just an anomaly
    and not a warning to the rest of the country it would be sad
    enough, but it really is just a warning.
        The problem that we have though is that in many of the
    communities like my hometown, water is really expensive. An
    average family in Flint pays $864 a year for water. Some people
    pay into the thousands of dollars a year for drinking water.
        So I was happy that we were able to work together to form
    the Low Income Housing Household Water Assistance Program,
    secured a billion dollars for that effort. The program is
    making a difference, but it is set to expire at the end of 2023
    and water is not going to suddenly become affordable at the end
    of 2023 in many of those communities. And I wonder if you might
    just discuss your thoughts on the Low Income Housing Household
    Water Assistance Program, what it means for places like Flint,
    Saginaw, Bay City and others? And what the Administration hopes
    to do in extending funding for this really important water
    assistance program.
        Secretary Becerra. Congressman, the President's budget
    proposes to build on that program because it is so essential. I
    can point to communities in California where they can't open
    the tap anymore because water will either not flow or it is too
    dangerous to drink. And so it is the same whether it is at
    Flint or at some town in California or throughout the country.
    No one in America in the 21st century should not be able to
    open the taps and be able to drink the water. It is incredible
    in the richest nation in the world that we are talking about
    this. That is why the President has decided we are going to
    invest in this and we are with you.
        So I hope that you continue to champion this because it is
    just the right thing to do. We should be able to take for
    granted that we are going to have safe drinking water for our
    kids.
        Mr. Kildee. Well, thank you so much, Mr. Secretary.
    Appreciate those answers as we appreciate your presence here
    and your great work.
        And I yield back, Mr. Chairman.
        Chairman Yarmuth. The gentleman's time is expired.
        I now yield the gentleman from Texas, Dr. Burgess, five
    minutes.
        Dr. Burgess. Thank you, Mr. Chairman. Mr. Secretary, thank
    you for being here today. Thanks for being in person. We love
    virtual hearings, but this is much better.
        So ARPA-H, have you given any thought to where that is
    going to be located?
        Secretary Becerra. Yes, sir. We made the decision under the
    omnibus bill. We were given some direction on this. ARPA-H will
    be a very autonomous agency, it will have a director that
    reports directly to the Secretary, in this case me. It will be
    able to use the assets under the auspices of the NIH. It will
    likely be housed--because it will be a smaller, a much smaller
    entity--it will likely be housed in a separate facility because
    we want it to be nimble. And it will work under different
    direction because it will not be constrained by some of the
    requirements that we see in law for government employees.
        Dr. Burgess. So a suggestion for you. I would locate it in
    the state of Texas if you want it to be nimble.
        Let me ask you a question. You know, Title 42, we are all
    hearing about it. The Administration says public health, part
    of Title 42 expires May 23. The numbers of people who are
    likely to enter the state of Texas is already high and it is
    likely to be staggeringly high. So are you making any
    provisions in your budget for preparing people in communities
    that are going to be the recipients of very large numbers of
    people who are likely to not speak the language, who may be low
    skilled, going to put strains our education systems, going to
    put strains on our law enforcement, on our hospitals? How are
    we preparing the communities to withstand that? Since we are
    not going to protect the border obviously.
        Secretary Becerra. Congressman, first, thank you for the
    question.
        There is an inter-agency process under way so we can all
    make sure that we are following through on our obligations. On
    HHS's end we are trying to be supportive when it comes to some
    of the healthcare issues that might be encountered. We also
    have responsibility, as I mentioned earlier in some questions,
    for any of the migrants who might come across as minors.
        Dr. Burgess. So let me--you know, I am well aware of that.
    I have multiple visits to all our facilities since 2014.
        Title 42 enacted March 20 of 2020, the death rate from
    Coronavirus at that point was probably, what, 10,000, if that.
    Is there a public health emergency posed by the rampant
    importation of fentanyl across our Southern Border? What is the
    No. 1 cause of death for people 18 to 48 right now?
        Secretary Becerra. What I can tell you is that there is
    clearly a crisis going on when it comes to drug overdose and
    drug use. That is why we did change the strategy we have for--
    with regard to drug overdose.
        I will tell you as well that the Title 42 provisions that
    you mention deal with public health in a particular way. It
    deals mostly in terms of quarantine. It is different from the
    public health emergency declaration that is based on different
    law. But in both cases they are premised on the health of the
    country and the health of the particular communities. They are
    not based on immigration standards.
        Dr. Burgess. Yes. But here is the problem, the danger to
    the American people is substantial. And the numbers are going
    to be staggering. Customs and Border Protection, DHS personnel
    on the border will be distracted by the large numbers of people
    that are just simply flooding across the border, leaving open
    the possibility for the vast importation of drugs,
    predominantly fentanyl, which is so terribly deadly. And we
    almost can't keep up with it. It is a true public health
    emergency. If there were a time to enact or to keep Title 42,
    it would be because of this fentanyl crisis. And I hope you
    will look into that.
        Let me ask you another question. Big bump in NIH funding.
    Of course, as somebody who spent his life in healthcare, it is
    a good thing. But I am really worried about the development, or
    the possible development of a virus in the Wuhan Institute of
    Virology. Even Jon Stewart has acknowledged that. Are we
    continuing to fund things like gain-of-function research in
    adversarial countries?
        Secretary Becerra. Congressman, I think this question has
    been answered before. The NIH does not fund gain-of-function
    research in adversarial countries.
        Dr. Burgess. But yet it happened. And we need to know why
    it happened and it must never happen again.
        Secretary Becerra. Congressman, I don't know what you are
    saying the ``it'' is, but we neither funded gain-of-function
    research at Wuhan or at any adversarial country, and I don't
    believe the science and the facts are in yet to determine what
    the source of COVID has been.
        Dr. Burgess. Well, I will be happy to provide you the
    documents from the--Dr. Danzig and the work that was done. It
    has been well documented in the late press. It is not anything
    that is classified. I will provide that to you.
        There are a number of other questions I couldn't get to. I
    will be submitting those in writing. I look forward to your
    responses.
        Secretary Becerra. Thank you.
        Chairman Yarmuth. The gentleman's time has expired.
        They have called votes now about six minutes, so we are
    going to have two more 5-minute periods. That will be Mr.
    Horsford and Ms. Boebert, and then we will recess through the--
    and there are two votes. So we ought to able to come back
    within 25 or 30 minutes after we recess.
        I now yield five minutes to the gentleman from Nevada, Mr.
    Horsford.
        Mr. Horsford. Thank you, Mr. Chairman. Good to see you,
    Secretary Becerra.
        I want to commend the Department of Health and Human
    Services and our entire healthcare profession. I don't care
    what Administration, we need you to succeed so that we can
    crush this pandemic, save lives, get our economy back on track,
    kids back in school safely, and families together.
        So, first, I am not here to, you know, come up with reasons
    to beat you up. I do believe there has to be accountability.
    And the first thing I want to speak to is the COVID-19 pandemic
    resources. As we learned from the past two years, the pandemic
    can only be addressed when we protect every single person. With
    an easily transmissible virus like COVID, none of us are truly
    safe unless everyone, especially those in our most vulnerable
    communities, has access to test, treatment, and an effective
    vaccine. Fortunately, HHS was able to do just that through the
    Health Resources Services Administration's, HRSA, uninsured
    program. Unfortunately, my Republican colleagues have demanded
    that any COVID-19 emergency supplemental be offset by other
    cuts. So now we are far too late in addressing the current
    shortfall in emergency funds that our country needs to continue
    to stem the damage from the pandemic.
        Now, I sent a letter a few weeks ago regarding HRSA's
    uninsured program. Sadly, that same week HRSA announced that
    they would stop accepting new claims for testing and
    treatment--in the middle of a pandemic. I don't know how that
    helps communities, small businesses, our economy's recovery
    when we are cutting off the very support that is needed.
        So, Secretary Becerra, would you be able to speak to just
    how crucial it is for Congress to pass an additional round of
    COVID relief funds to continue to protect Americans, our
    businesses, and along with the $82 billion requested in the
    budget for our public health infrastructure, to continue to
    protect Americans from COVID-19 or any future pandemic?
        Secretary Becerra. Congressman, I don't know if I can say
    it better than you did, and I haven't had a chance since I have
    been in hearing all day, but I haven't taken a look at the
    recent numbers for today for COVID. I get those every day, the
    reports and the briefings. But we are now at one of the lowest
    points we have been at for COVID infections, hospitalizations,
    and deaths. And we are also at a point of running out of the
    money it takes to keep that fighting going to, as you say,
    crush COVID-19.
        This is the wrong time--I used an analogy in a committee
    hearing just earlier today saying that we are one the--we are
    within--inside the one yard line within the 2-minute warning of
    the football game and we need that touchdown to win. And this
    is not the time to cutoff the resources we need to go over the
    goal line. We know what we need to do, we have been doing it
    effectively. The economy is opening up. We are all here today,
    most of us, without masks. This is not the time to have us run
    out of the funding. And so I urge Congress to provide us with
    the resources we need, not just to do the provider relief
    funding for those who provide services to the uninsured, but to
    continue the therapies, the vaccines, the tests, masking we
    need.
        Mr. Horsford. And I just want to underscore this, you know,
    when the prior Administration was in, when the prior President
    came to the Congress with a proposal, many Democrats, including
    myself, voted for that package--CARES, the family support
    resources that was passed. And yet now it is like under this
    Administration in the same middle of the pandemic, we don't
    have one Republican on the other side who is willing to support
    the American Rescue Plan or the funding that is needed to crush
    this virus.
        I would like to finish my time talking about Title X. For
    too long Title X has been woefully underfunded. There is no
    reason why someone's income level or their zip code they were
    born in should prohibit them from being able to access
    affordable, high quality, community-oriented family planning or
    sexual health services.
        So my question, Secretary, is could you explain some of the
    adverse consequences of patients foregoing important care
    because of a lack of adequate funding for Title X, especially
    in rural areas?
        Secretary Becerra. Congressman, I think we all know that
    there are too many families in America, and COVID pointed this
    out even more, that don't have access to the care they need.
    They fall through the holes, the gaps in the system, especially
    in our rural and inner cities poor communities.
        Family planning services under Title X are a lifesaving
    service that is made available to families which had been
    cutoff for too many. And our President has made a commitment to
    restore some of that funding and allow those providers to be in
    the game again.
        What we are going to do is make sure that if you are
    seeking family planning services, you can get it from any
    organization that is qualified and professionally prepared to
    provide you those family planning services so we can provide
    those needs to rural, urban, and suburban families throughout
    this country.
        Chairman Yarmuth. The gentleman's time has expired.
        I now recognize the gentlewoman from Colorado, Ms. Boebert,
    for five minutes, and after which we will recess.
        Ms. Boebert. Thank you, Mr. Chairman, and thank you,
    Secretary Becerra. Thank you for being here today. I appreciate
    you coming before the committee.
        To start off, as the Secretary of Health and Human
    Services, can you define for this Committee what is a man?
        Secretary Becerra. You are looking at one.
        Ms. Boebert. Great. So you are a man. I like that. Can you
    tell me can men get pregnant?
        Secretary Becerra. Unless you know something I don't, I
    think the answer is pretty obvious.
        Ms. Boebert. What is that answer, sir?
        Secretary Becerra. I am asking you, is there something you
    know that I don't know that would say that a man could----
        Ms. Boebert. Well, I am asking what you know. Can men get
    pregnant?
        Secretary Becerra. I am not aware of it.
        Ms. Boebert. OK. Well, Mr. Secretary, materials coming from
    your department, you have referred to mothers as birthing
    persons, replacing that title with.
        Secretary Becerra. Are mothers not persons?
        Ms. Boebert. Mothers are persons, but it seems to be more
    inclusive, like you are trying to include another gender in
    that.
        Secretary Becerra. I am all about inclusion, Congresswoman.
        Ms. Boebert. There you go.
        So, well, you know, just as a mother of four boys, I am not
    necessarily offended at that. I am a person. But it is just
    unscientific and absurd----
        Secretary Becerra. How so?
        Ms. Boebert. To include men in that. If you are going to be
    inclusive----
        Secretary Becerra. A person?
        Ms. Boebert. If you are going to be inclusive in birthing
    persons, yes.
        Secretary Becerra. Well, but it seems to me like you are
    trying to define----
        Ms. Boebert. Let us back up.
        Secretary Becerra. the
        Ms. Boebert. Reclaiming my time. Can men get pregnant? Then
    we don't need to include them in it. Mothers are mothers.
        Moving forward. Mr. Secretary, I want to read for you from
    a document from your office, the Office of Population Affairs.
    It says in here, and I quote, ``Gender affirming care
    encompasses many facets of healthcare needs and support. It has
    been shown to increase positive outcomes for transgender and
    non binary children.'' Mr. Secretary, what is a transgender
    child?
        Secretary Becerra. A child in America is a child in
    America. And I hope you and I can love that child just as much
    as we do our own child.
        Ms. Boebert. Can you define what a transgender child is?
        Secretary Becerra. That is a child in America and it is an
    American citizen child who needs the services and love just the
    way any other child does.
        Ms. Boebert. Mr. Secretary, do you believe that a child is
    capable of making life altering decisions to maim themselves?
        Secretary Becerra. So let me just say to you that I don't
    agree with your premise, but what I will say to you is children
    know much about themselves and with the help of their----
        Ms. Boebert. Do you believe that children are capable of
    making the decision to self mutilate?
        Secretary Becerra. Again, I don't necessarily accept the
    premise of your question.
        Ms. Boebert. Well, Mr. Secretary, I mean you have gender
    affirming care for young people. So this is something that you
    have looked over----
        Secretary Becerra. I don't equate gender affirming care to
    mutilation. So if that is where you are going, then you are not
    going to get the answer you want.
        Ms. Boebert. So, Mr. Secretary, here, can you tell me if
    there have been mastectomies, penectomies, or hysterectomies on
    children?
        Secretary Becerra. I mean, I----
        Ms. Boebert. And have taxpayers funded that?
        Secretary Becerra. So I could probably use the help of my
    wife, who is an OB/GYN, who could talk more, or maybe Dr.
    Burgess could help us out here.
        Ms. Boebert. For gender affirming care. To be included in
    that.
        Secretary Becerra. I am sorry, pose the question one more
    time please?
        Ms. Boebert. In this gender affirming care, Mr. Secretary,
    have there been tax dollars put forward to fund mastectomies,
    penectomies, and hysterectomies for sex reassignment purposes
    for minors with gender dysphoria.
        Secretary Becerra. So Americans are entitled to receive
    healthcare services. If they are entitled to receive any of the
    services that you just mentioned, then it would be against the
    law for us to try to deny them that care.
        Ms. Boebert. So for the record, you favor HHS's funding
    being able to--for sex reassignment? For surgeries on minors?
        Secretary Becerra. I will do everything I can to defend any
    American, including children, whether or not they fit the
    categories you have mentioned or not, and if they talk about
    gender affirming care, I am there to protect the rights of any
    American.
        Ms. Boebert. Mr. Secretary, I want to turn to a different
    document. Your office released this ``Gender Affirming Care is
    Trauma Informed Care''. In this document you clearly state that
    gender affirming care included puberty blockers, hormones, and
    surgeries for minor children. You go on to assure parents that
    there is no scientifically sound reason to doubt hormones and
    surgeries are helpful to minor children. You also discuss this
    in a document that the potential for removing children from
    their parents is on the table if they are not providing gender
    affirming care.
        Mr. Secretary, do you think that parents who believe in two
    genders only should have their children removed from them?
        Chairman Yarmuth. Mr. Secretary, you can answer or respond
    in writing. Her time is expired.
        Secretary Becerra. I can respond very quickly.
        Chairman Yarmuth. OK.
        Secretary Becerra. Congresswoman, I believe in supporting
    and protecting transgender youth. I believe that they along
    with their parents and their caregivers will make the best
    decisions. And I would really urge that politicians like you
    stay out of their business.
        Ms. Boebert. I would urge that children get to stay with
    their parents, no matter what parents they----
        Chairman Yarmuth. The gentlewoman's time is expired.
        The committee will----
        Ms. Boebert. Mr. Chairman, may I please have unanimous
    consent----
        Chairman Yarmuth. No you can't. No, you may not.
        Ms. Boebert [continuing]. to----
        Chairman Yarmuth. We are in a very tight timeframe and
    there are votes being called.
        Ms. Boebert [continuing]. enter this into the congressional
    record?
        Chairman Yarmuth. You may--oh, yes, you----
        Ms. Boebert. Thank you, sir.
        Chairman Yarmuth. Without objection, you may do that.
        [Letter and documents submitted for the record follows:]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        All right. The Committee will be in recess. Please hurry
    back after the second vote.
        [Recess]
        Mr. Scott. Thank you, Mr. Chairman, and thank you, Mr.
    Secretary for being with us today.
        We have heard a lot about inflation, and it is a global
    problem. There is nothing we have done in America that created
    inflation, and Germany, France, Great Britain, but it is
    something we have to deal with. It is my understanding that
    your Administration has helped people. Last year a typical
    family of four got four $1,600 checks, over $5,000--$1,400
    checks, over $5,000 in stimulus checks. Two children would be
    over $6,000 in child tax credits. What we usually hear is a
    $3,500 increase in costs. Well, that is over $10,000 that your
    Administration has helped to pay those additional costs, in
    addition to the earned income tax credits, SNAP benefits,
    better ACA premiums, extra unemployment compensation, and
    others. So you are actually helping people do something about
    inflation.
        You are also addressing the root causes, supply. Getting
    things to market will help and you have made investments in
    ports, roads, bridges, airports, and rail, getting things to
    market. If you can't get them to market, you will have less
    supply that businesses will jack up the prices. You are getting
    more people to work with investments in childcare, you are more
    efficient with job training and higher education. So you are
    actually doing something about it. Others are just sitting on
    the sidelines complaining, like it is going to help them get
    elected. And generating headlines like the one in the New York
    Times the other day. It said Republicans wrongfully accuse
    Biden for higher gas prices. But you are actually doing
    something--you have already done something about it.
        Are you doing anything about it going forward to help
    people with inflation, like helping with drug prices, better
    jobs, childcare, college prices? Are you continuing to work to
    help the average family deal with inflation?
        Secretary Becerra. Congressman, thank you for the question.
    And I won't do as good a job as the President can in talking
    about the things that have happened in his first year in
    office, but to have created more jobs in one year than any
    President in his first year in office in history is a
    remarkable achievement in the face of a pandemic. When you take
    a look at the fact that we reduced child poverty in ways never
    seen before in our lifetime because of the work that you all
    did in passing the American Rescue Plan, the fact that there
    are more Americans insured for healthcare today than ever
    before, and many of them Affordable Care Act, is a testament to
    the work that the President is doing. We are reducing the cost
    of that health insurance policy for Americans, we are going to
    try to do everything we can to make sure that on Medicare we
    continue to reduce the cost that seniors pay for prescription
    drugs. I could go on. And the fact that today Americans are
    going back to work and we are able to return mostly to normal,
    and if we continue to be cautious we should be able to defeat
    COVID if you all give us the resources to do this.
        Those are all pointing in the right direction.
        Mr. Scott. Thank you. And you are doing it in a fiscally
    responsible way. You know, of course, that every Democratic
    administration since Kennedy has left office with a better
    deficit situation than they inherited, without exception. And
    every Republican administration has left office with a worse
    deficit situation than they inherited, without exception. And
    President Trump was well on his way to fulfilling that trend
    before the pandemic.
        A few days ago the OMB Director told us that we can expect
    the Biden Administration, with your budget, to improve the
    deficit. So within that fiscally responsible budget, can you
    say what you have got in the budget for Head Start and early
    Head Start?
        Secretary Becerra. We are increasing the resources for Head
    Start with Build Back Better. If you all could get it across
    the finish line we would do a dramatic--it would make a
    dramatic difference in being able to increase the number of
    kids and families that could qualify to have their kids go to
    Head Start. And, as you and I know having kids, giving them the
    opportunity to learn before they start kindergarten sets them
    on a path to real growth and opportunity when they go onto
    college.
        Mr. Scott. Childcare is so important. What do you have in
    the budget to improve access to childcare?
        Secretary Becerra. Well, on top of the several billion
    dollars that the American Rescue Plan made available to help so
    many families that were urgently in need of help when COVID was
    really hitting us hard, we are proposing, and we hope through
    the Build Back Better agenda that we would be able to not only
    increase the number of families that would receive childcare
    service, that they wouldn't have to pay more than 7 percent of
    their income for those childcare services. And we hope we would
    also be able to then push to make sure that the work force
    within the childcare services sector would be able to see an
    increase in their salary and with it an increase in their
    training and education.
        Mr. Scott. Thank you, Mr. Chairman.
        Chairman Yarmuth. The gentleman's time has expired.
        I now recognize the gentleman from Ohio, Mr. Carey, for
    five minutes.
        Mr. Carey. Thank you, Mr. Chairman. Thank you, Secretary.
        Secretary Becerra. Of course.
        Mr. Carey. Given the mounting evidence about the origins of
    COVID-19 and that the People's Republic of China has been
    clearly involved in covering up, or at the very least brazenly
    withholding information about the pandemic's beginning, does
    the President's budget provide for or allow for funding
    particularly NIH grant funding for viral research for the
    People's Republic of China?
        Secretary Becerra. The President's budget includes no
    dollars for China to do viral research. Has not and will not.
        Mr. Carey. So you can guarantee that any HHS funding
    requested in the Fiscal Year 1923 budget will not go either
    directly or indirectly to the People's Republic of China?
        Secretary Becerra. I can guarantee you that the federal
    government--this Administration and HHS, whether it is NIH or
    any other agency that might have granting authority, is not
    looking to give any money to the People's Republic of China.
        Mr. Carey. Thank you.
        Your budget also proposes more than $75 million for health
    equity programs and climate research, among other things, while
    reducing funding for the rural hospital grants in my district
    and children's hospital graduate medical education. How does
    HHS justify prioritizing the progressive wish list of Biden
    over investment in rural health and children's hospitals?
        Secretary Becerra. Congressman, I would love you to show me
    the numbers, because what I know contrary to what you have just
    said, we are actually making more investments in rural America
    when it comes to healthcare. We are actually increasing the
    number of health professionals that we will be able to locate
    in rural facilities throughout the country. And so I would be
    interested in seeing where you are getting this information
    because it is, as far as I know, misinformation.
        Mr. Carey. I would be happy to have your staff work with my
    staff to get that information.
        Secretary Becerra. I look forward to that.
        Mr. Carey. Last, I think there is a couple of other things
    I would like to mention. The budget also mentions support for
    rural hospitals, as you have indicated, and yet doesn't provide
    any substantial funding for rural health--is my numbers. So we
    will work with you on that.
        Secretary Becerra. Please.
        Mr. Carey. In fact, only $43 million above Fiscal Year
    1922, and in fact decreases the funding for the Rural Hospital
    Flexibility grants by $5 million. By contrast, the same sub-
    agency, Health Resources and Service Administration, dedicates
    $5 million in new funding for grants to address and implement
    bias on healthcare providers, $1 million in new funding to the
    National Academy of Medicine to study biases, recognition, and
    clinical skill testing in certain medical schools, $20 million
    in new funding for diversity work force, $25 million in new
    funding to diversity of the nurse work force, and $10 million
    to support curricula developed in minority serving
    institutions.
        How does HHS justify prioritizing millions more in radical
    bias training and work force diversification than investments
    in rural health? And you are saying it does, so I would be
    happy to hear your answer on that and I would be happy work--
    your team work with my team to get those answers.
        Secretary Becerra. First, thank you for letting me answer.
    Again, we don't have to necessarily agree, but I appreciate you
    letting me answer.
        One very important clarification. As I mentioned before to
    someone, the budget that we presented was based on what we saw
    coming forward under the continuing resolution, which you know
    is at a different funding level, much lower than the omnibus,
    which was the end result for the budget. Because we had to be
    fiscally responsible and base our 2023 projections on what we
    had from 2022, and those were based on the CR, we lowered all
    of our projections, that is why you might see some areas of
    funding that seem lower. We are absolutely prepared to work
    with you and others to make sure that we now--now that we know
    what the omnibus provided us, give you the true reflection of
    what we would like to invest in those areas.
        But I will tell you that we are making major investments in
    rural American when it comes to healthcare.
        On the issue of equity and diversity, we are simply trying
    to do what I would hope you would want us to do. If you found
    that the federal government were letting out grants and
    resources to every place but your congressional district, you
    probably would be interested in finding out why. Well, there
    are many communities in America that are being left out all the
    time, whether it is in research trials, where you don't find
    every American has a chance to participate, which skews the
    results of those research trials because we are only looking at
    a particular segment of America and hoping to apply that
    throughout the country. What I would say to you is--you are
    being gracious to let me answer--I am more than willing to work
    with you to show you that not only do these programs work to
    provide every American with opportunity, but in rural America
    we are making major investments.
        Mr. Carey. Thank you, Secretary.
        Thank you, Chairman. I yield back.
        Chairman Yarmuth. The gentleman yields back.
        I now yield five minutes to the gentleman from New York,
    Mr. Higgins.
        Mr. Higgins. Thank you, Mr. Chairman. And, Secretary,
    welcome. Great to see you again.
        And so your budget, Health and Human Services, is about
    $1.9 trillion proposed, a 27 percent increase. Justification
    is, among other things, pandemic preparedness. You know, we
    just went through months of a very difficult time with SARS-
    CoV-2 because for many, many months there was no vaccine.
    Really the best thing that our healthcare system could do is
    provide people that were stuck with COVID-19 with Tylenol to
    reduce fever and pain. And then, you know, a pretty miraculous
    biomedical achievement in the Messenger RNA was established.
    Not a new technology, but certainly refined for this. And when
    medical researchers went into it, the anticipation, the hope
    was that they would be able to achieve 60-65 percent, maybe 70
    percent efficacy. These vaccines are 85-90-95 percent
    effective.
        The thing that concerns me is that if there was a--if we
    just went through SARS-CoV-2, there was a SARS-CoV-1 17 years
    ago, with 70 percent of the genetic similarity to that of SARS-
    CoV-2. Predating this Administration and going back 17 years,
    why weren't we better prepared in terms of pandemic
    preparedness given that we had experienced SARS-CoV-1 when
    COVID-19 hit?
        Secretary Becerra. Congressman, first, good to see you and
    let me try to give an answer. I am not going to pretend that I
    know what was going on in the mindset of HHS administration 17
    years ago.
        But what I will tell you is that we have been learning more
    and more as we go through each of these episodes. And it is
    unfortunate that the previous Administration decided to stand
    down on pandemic preparedness when they dismantled the very
    organization that was set up to prepare us for pandemics. They
    did that right before COVID hit. What I will tell you is that
    our scientists and our healthcare medical professionals have
    learned a great deal about some of these viruses and they are--
    they believe that they are getting very close to having a pan
    SARS type of vaccine that could be effective against any future
    viruses that are of the COVID source.
        What I will tell you is that that science relies the public
    and private sector working together and for the federal
    government to be making the investments early and up front that
    give our scientific community and our private sector community
    the confidence to know that if they too really invest big sums
    of money into this, they will bear fruit. And that is what we
    have to continue forward. That is why the President has in his
    proposal--budget proposal an $82 billion plan to go to what
    comes next after COVID.
        Mr. Higgins. The Advance Research Projects Agency--
    Healthcare, includes $5 billion. The President's Moonshot
    Initiative, which is a very, very welcome sign. But I also see
    that in addition to that net new money for that program, there
    is a $200 million to the National Cancer Institute. And I would
    just ask that, you know, the Administration take a look at that
    and perhaps Congress can make a change of that to boost the
    amount of funding to the National Cancer Institute.
        Because I often say that the only failure in cancer
    research is when you quit or you are forced to quit because of
    lack of funding. And we are at a point in terms of developing
    new therapies, particularly immunotherapy, where these are
    major game changes in a 50 year federal effort to cut cancer
    and cancer deaths, which is very important.
        And, finally, the Provider Relief Fund, phase four.
    Applications were allowed between December and May. I have the
    only public hospital in my district, the Erie County Medical
    Center, and I just ask you to look at reviewing and expediting
    their phase four Provider Relief Fund allocation because, as
    you know, hospitals have taken a major hit during this
    pandemic.
        So congratulations on the wonderful job that you have done
    and the job that your--Health and Human Services has done in
    the past year. Much appreciated.
        Chairman Yarmuth. The gentleman's time has expired.
        I now recognize the gentleman from Florida, Mr. Donalds,
    for five minutes.
        Mr. Donalds. Thank you, Mr. Chairman. Mr. Secretary, thanks
    for coming in.
        Let us hop to it. Got a lot of stuff.
        Back in February 2021 how many children did your department
    take possession of from Homeland Security because of the surge
    of illegal immigrants at the border under the Biden
    Administration?
        Secretary Becerra. Congressman, I don't have that number
    before me, but I can get that to you.
        Mr. Donalds. All right. So let me ask a second question. In
    response to what was happening at the border, back in February
    2021 it was the position of your agency, your department, to go
    through the process of setting up tent facilities at Fort Bliss
    and other facilities across the country. How many facilities
    does HHS currently have in operation that houses illegal
    immigrant children in the United States?
        Secretary Becerra. So, Congressman, right now we have a
    number of unaccompanied migrant children who are applying for
    asylum and therefore have a basis under our laws to be here
    while they go through their process. We have a number of
    facilities. There are scores of facilities that are what we
    call licensed care facilities that are--have the license in the
    state where they are residing to offer care. There are scores
    of them throughout the country that we use. Most of the care
    there.
        Mr. Donalds. So I have seen some of our facilities. I have
    toured a couple of them unbeknownst to staff. I just kind of
    showed up, you know. That is the purview you kind of have as a
    Congressman.
        Secretary Becerra. At the licensed care or the emergency--
    --
        Mr. Donalds. Well, these were the facilities at Fort Bliss.
        Secretary Becerra. Emergency.
        Mr. Donalds. When they were still setting up Fort Bliss I
    walked on the base and saw some of the facilities.
        Secretary Becerra. Right.
        Mr. Donalds. I also saw, if you are in that section, that
    it appears to me that HHS was--actually has contracts with
    various hotels throughout the United States that would house
    young migrant children in hotel facilities where it seems like
    HHS would contract for the hotels and they would cover up the
    marquee and we were housing young children. Do you happen to
    know how many hotels that HHS currently has under contract
    holding migrant children?
        Secretary Becerra. There are no hotels under contract.
        Mr. Donalds. Not anymore?
        Secretary Becerra. There are no kids under--in hotels.
        Mr. Donalds. You sure about that?
        Secretary Becerra. Unless you know something I don't.
        Mr. Donalds. I mean I have seen the facilities. Are you
    sure?
        Secretary Becerra. Name me a hotel.
        Mr. Donalds. Well, the marquee is covered up, sir. Under
    contract for HHS.
        Secretary Becerra. We are more than willing----
        Mr. Donalds. Let us move on. In the facilities that you
    have where you hold children, how many nurses has HHS
    contracted with to actually provide healthcare to children who
    are being housed by HHS and how many of these nurses have been
    relocated from hospitals throughout the pandemic where they
    could have worked in our hospitals with respect to COVID-19,
    but they were actually being contract with by HHS?
        Secretary Becerra. OK, Congressman, you are convoluting
    different things into one----
        Mr. Donalds. That is not a convolution.
        Secretary Becerra. Yes you are.
        Mr. Donalds. If you contract with nurses, and I have
    hospitals in my district that can't find nurses because they
    are losing contracted nurses to Texas or Arizona, that is not a
    conflict. There is a pool of people who have an ability to
    work. So how many nurses have been contracted with by HHS?
        Secretary Becerra. So, Congressman, again, you have to
    distinguish between the licensed care facilities and the
    emergency intake sites that we operate.
        Mr. Donalds. In the emergency intake sites, how many nurses
    has HHS contracted?
        Secretary Becerra. I can try to get you any numbers we
    have, but they are--because they are emergency intake sites--
    and this is important--we don't provide the same level of
    services that you get in a licensed care facility. By being a
    licensed care facility, they have some of those licensed
    professionals there providing services.
        Mr. Donalds. How many licensed care facilities does HHS
    currently have dealing with the illegal immigrant issue caused
    by the Biden Administration?
        Secretary Becerra. I want to make sure I don't misspeak,
    but it could be--it is at least dozens if not hundreds.
        Mr. Donalds. OK, question. How many teachers currently are
    contracted with by HHS? Because in one of the facilities there
    was actually education being going on and there is a contract
    associate with that. How many teachers are contracted?
        Secretary Becerra. Again, are you speaking licensed care
    facilities?
        Mr. Donalds. These are the emergency care facilities.
        Secretary Becerra. I would have to get you that number
    because, again, we are not obligated to provide educational
    services at these emergency intake sites.
        Mr. Donalds. OK. Real quick, I know we--sometimes these
    hearings it just seems like we are going back and forth, but
    that is because we have a limited amount of time and a lot to
    get to.
        Quick question, when I was at one of the border control
    facilities, I believe it was down by Fort Bliss, El Paso
    section, there are buses and there are motor coaches that were
    coming and picking up children 15 at a time, 20 at a time, 30
    at a time. How many buses has HHS contracted to move illegal
    immigrant children across the United States away from holding
    facilities by the Department of Homeland Security?
        Secretary Becerra. So, Congressman, I would ask you make
    sure that your reference is accurate. These kids have requested
    asylum. Whether or not they----
        Mr. Donalds. It is regardless of their asylum question, it
    is how much has HHS contracted with to move children across the
    United States.
        Secretary Becerra. But their presence here is not as you
    categorize it because they have requested asylum and therefore
    it is an unfair characterization. And they ultimately have to
    be----
        Mr. Donalds. Did they request asylum at the Southern Border
    at an illegal point of entry? Yes or No? Is the Southern Border
    an illegal point of entry for immigration purposes? Yes or no?
        Secretary Becerra. When you are requesting asylum, you are
    conveying that you are trying to escape persecution.
        Mr. Donalds. All right, real quick, 15 seconds. Last
    question, Mr. Secretary. Title 42 is about to be undone by the
    Administration. Does your budget account for a surge of new
    migrants, illegal immigrants, however you want to phrase it,
    that are going to come to the Southern Border and request
    asylum under the most broad interpretation of asylum in
    American history? Is HHS prepared in the current budget to deal
    with the massive increase of people that are going to come to
    the United States, including illegal immigrant children?
        Secretary Becerra. We appreciate the work that Congress has
    done to provide us resources to try to provide the legally
    obligated services for these unaccompanied migrant children. We
    are going to do the best we can with the resources that we
    have.
        Chairman Yarmuth. The gentleman's time has expired.
        I now recognize the gentlewoman from the Virgin Island, Ms.
    Plaskett, for five minutes.
        Ms. Plaskett. Thank you. Thank you very much, Mr. Chairman,
    for holding this hearing. I want to thank you, Mr. Secretary,
    for your patience and for your service in the Biden
    Administration.
        I want to personally thank you for your leadership when you
    were a colleague here and all of the advice and support you
    gave me as a new Member coming to work for the people of
    America. So thank you and I know that your staff are incredibly
    happy to work with you.
        I wanted to ask you some questions that were specifically
    relate to Medicaid. What is the level of Federal Medicaid
    funding for the Territories and does the President's budget
    include throughout this budget window? Are you aware of what
    that would be?
        Secretary Becerra. I can tell you because whether that was
    as a colleague or now as a secretary of Health and Human
    Services, we do not adequately provide resources to the
    territories. And the President has made it one of his goals to
    try to change that. So working with Congress, because we do
    need statutory authority, we hope to be able to do that.
        Ms. Plaskett. And that statutory authority is the request
    that you have for Congress to do that?
        Secretary Becerra. We have requested, and we supported,
    eliminating Medicaid funding caps for the Territories.
        Ms. Plaskett. Thank you. That, of course, would be
    incredibly important. The Congress has since 2017, after the
    hurricanes hit--and I know Chairman Pallone as well has worked
    tirelessly to bring this up--in the Virgin Islands alone, just
    leveling the FMAP number and making it more equitable with the
    states based on population has allowed in the Virgin Islands to
    increase the amount of individuals by over 20,000. That has
    really been a game change for our hospitals and for others. So
    I thank you for that and your desire to support us.
        HHS funds the welfare rules data base maintained at the
    Urban Institute to capture the rules regarding determining
    eligibility and benefits for TANF assistance. It does for 50
    states and the District of Columbia, but doesn't include the
    Virgin Islands, Puerto Rico, and Guam. Additionally,
    supplemental security income is not available to the Virgin
    Islands, Puerto Rico, and Guam and these jurisdictions operate
    public assistance programs instead for the populations aided by
    SSI elsewhere.
        Has HHS considered expanding the Welfare Rules Data base to
    those other territories so that eligibility and benefits rules
    are available for those jurisdictions, as well as the 50 states
    and the District of Columbia?
        Secretary Becerra. You are pointing out, Congresswoman, the
    long-standing disparities that exist for the Territories. And
    you have my commitment to make sure we can try to work toward
    eliminating those. We probably need your help in changing some
    of the statutory provisions that make it difficult for us to
    get there, but we are actively committed to working with you to
    try to get there.
        Ms. Plaskett. Thank you.
        On July 26, 2021, I sent a letter on behalf of the
    congressional Black Caucus, as co-led with my colleague,
    Congresswoman Robin Kelly, who has been tireless in this, as
    the Chair of CBC Health Braintrust. It was signed by 38 Members
    of our Caucus. The letter specifically requested that your
    department would work to ensure meaningful access to the
    potentially curative sickle cell disease therapies on day one
    of their approval by the FDA. Received a response from you--
    thank you--on November 1 of 2021. I would like to ask where the
    department with respect to convening a multi stakeholder dialog
    about identifying and providing solutions to help remove
    barriers that stand between sickle cell patients and those
    potentially curative therapies.
        Secretary Becerra. Congresswoman, we are doing more than
    had been done previously. But let me suggest to you--in fact,
    let me make the invitation right now--this is one of those
    areas where I have spoken to our team and we have spoken to a
    lot of the outside advocates on this. I think under this
    Administration we could move to actually help all Americans who
    suffer from sickle cell get past the pain that they constantly
    suffer. We have learned so much. And with the technology that
    we have today, there is no reason why we couldn't target sickle
    cell.
        And so having done a meeting at NIH on this particular
    issue, I think that we are prepared to tell you that if you are
    interested we would like to join with you, because if we can
    get the resources we could really blow this one out of the
    water.
        Ms. Plaskett. Well, thank you for that. This has been a
    disease that has really just been pain managed by government as
    well as our researchers and we recognize now through some
    incredible work that this may be a disease that we can cure. It
    would be just phenomenally changing. I have lost a number of
    family members to disease and I think it is something that we
    can get through.
        Secretary Becerra. And what is really traumatic is that
    often times people come into a caregiver saying they are in
    such pain, but they are not believed. People don't----
        Ms. Plaskett. Yes.
        Secretary Becerra. And it is not until they find out that
    they have sickle cell that they realize, OK, you must be
    undergoing severe pain. But it is the difficulty of people
    presenting with pain and not being believed. That is what is
    really hard to believe.
        Ms. Plaskett. Thank you so much.
        And I yield back.
        Chairman Yarmuth. The gentlewoman's time has expired.
        I now recognize the gentleman from Pennsylvania, Mr.
    Smucker, for five minutes.
        Mr. Smucker. Thank you, Mr. Chairman. Good to see you,
    Secretary.
        I have two issues that I would like to bring up. One is
    specific to my state, at least I am aware of it only in my
    state. I have been troubled by efforts underway in the state
    led by Governor Wolfe through Medicaid officials at the
    Pennsylvania Department of Human Services. And I support the
    right--I have hospitals in my area and providers that some are
    members of--are unionized and others are not, and I certainly
    support the right of workers to unionize, but for the first
    time there would be provisions in the Medicaid program that
    would force collective bargaining and essentially force
    unionization on physicians, hospitals, nursing homes, and other
    health facilities, again through really unprecedented and I
    think unlawful contractual requirements for providers that are
    participating in the Medicaid Managed Care Program, which we
    call Health Choices. And I think the outcome would potentially
    be it will deny healthcare access for over 250,000 Medicaid
    beneficiaries across the Commonwealth or force them to travel
    longer distances to receive needed care.
        And, as you know, CMS will have the ultimate say on whether
    to accept these contracts and accept them if they would with I
    think these burdensome politicized and unnecessary unionization
    requirements. And more importantly, I think CMS also will have
    the opportunity on the other side--other hand to protect access
    to care for Medicaid beneficiaries across Pennsylvania by
    blocking these specific contract provisions.
        So I ask you to look at those when they come across.
        And I have three questions for you, just yes or no. would
    you agree that regardless of how one feels about unionization,
    working families, women and children, who rely on the Medicaid
    program should never be used as pawns in workplace organizing
    advocacy and that State Medicaid officials should never attempt
    to hijack healthcare from poor and vulnerable beneficiaries in
    an effort to force a political outcome? Would you--yes or no?
        Secretary Becerra. I think you know that I am going to say
    that is a question that doesn't--that calls for more than just
    a yes or no because you planted so many little time bombs in
    it.
        What I will tell you is that the objective of Medicaid is
    to expand services. And so we will do everything we can to make
    sure that we are increasing the number of Americans who have
    access to good quality healthcare.
        Mr. Smucker. Do you feel that Medicaid Managed Care
    contracts are the appropriate forum for a Governor or for CMS
    to push partisan labor priorities?
        Secretary Becerra. I have got enough jurisdiction as it is,
    I am not going to take on the role of Governors and tell you
    what they should or shouldn't do.
        Mr. Smucker. Well, I thank you for that, but you will be--
    CMS, maybe not you personally, will be approving these
    contracts. So----
        Secretary Becerra. But based on the issue of whether it
    is----
        Mr. Smucker. Yes.
        Secretary Becerra [continuing]. increasing access to care
    at a better price.
        Mr. Smucker. So maybe could I just get at least a
    commitment to closely examine these provisions, which, again, I
    think aren't lawful, that I think will deny care to
    Pennsylvanians?
        Secretary Becerra. Absolutely.
        Mr. Smucker. And will you work with my office to ensure
    that uninterrupted seamless access to care remains available
    for Pennsylvania's Medicaid population?
        Secretary Becerra. You have my commitment. You have----
        Mr. Smucker. Thank you.
        Now, just briefly, looking at the clock, discussing the
    President's budget, you know, he includes $73 million in new
    spending, $16 trillion in new debt over the next 10 years and
    really doesn't address sort of the driver's of cost in the
    Medicare program, the Medicare Hospital Insurance Trust Fund
    Part A is projected to face insolvency by 2026, only a few
    short years away, at which point it will only be able to pay
    for 91 percent of Part A scheduled benefits, cutting $44
    billion that year, is current projections. And there is no
    reforms in this budget to change that. Previous budgets
    included policies--and these were in the previous
    Administration--policies that would save Medicare hundreds of
    billions of dollars, while last year's budget, Biden's budget,
    called for an expansion of Medicare benefits. And I think
    straining the service for 63 million Americans that depend on
    the program.
        So another year gone by, insolvency another year closer. Is
    your agency examining any meaningful solutions to ensure that
    we can continue the promise that has been made to individuals
    relying on Medicare?
        Secretary Becerra. Congressman, in 10 second I am going to
    do what I knew was going to be impossible--I am going to
    respond to that question very quickly.
        First, I think we can all agree that if we are going to
    look to reform Medicare to keep it going strong forever, we
    should be cutting costs not benefits. And if we can all agree
    to that, we are going to make some progress.
        Second, this budget actually does increase the strength of
    Medicare. Even the actuaries say that. It does that by
    increasing program integrity----
        Mr. Smucker. Just one quick question. I mean don't you
    think we should be talking about solvency and putting forth
    good----
        Secretary Becerra. Absolutely.
        Mr. Smucker [continuing]. proposals to increase the
    solvency rather than adding new benefits at this time?
        Secretary Becerra. Well, if you don't want to cut benefits,
    then we are in the ballgame to talk. But if you start talking
    about cutting benefits to try to move when we know there is
    still waste and fraud in there, then that is a non starter. But
    we are going to move toward value care versus volume of care
    and we are going to work with you closely because, as you know,
    and I say this having served in this chamber for 24 years, the
    real people who can make sure Medicare is there in the long run
    for our grand kids are you all, not us. Because you have the
    votes to change the laws.
        Mr. Smucker. Thank you.
        Secretary Becerra. We will work with you.
        Chairman Yarmuth. The gentleman's time is expired.
        I now recognize the gentlewoman from Virginia, Ms. Wexton,
    for five minutes.
        Ms. Wexton. Thank you, Mr. Chairman.
        Now, I wasn't in here earlier, Mr. Secretary, but I
    understand that someone on the other side of the aisle made
    some rather hurtful and hateful and ignorant comments about
    transgender kids. And I know that a lot of our friends across
    the aisle may think that that is good politics, but to me at
    the end of the day, all they are doing is bullying defenseless
    children. And where I come from that is not good politics.
        Now, I don't understand how any adult, especially a Member
    of Congress, can say these things when they understand what a
    big problem youth suicides are in the LGBTQ community. And in
    case they don't know what a big problem that is, I have some
    statistics. Because according to the Trevor Project, 46 percent
    of LGBTQ youth seriously considered attempting suicide in the
    past year, including more than half of transgender and non--
    does that sound like statistics that you are familiar with Mr.
    Secretary?
        Secretary Becerra. That is what we are hearing.
        Ms. Wexton. OK. Thank you.
        And if you don't trust the Trevor Project, how about these
    statistics from the American Academy of Pediatrics, more than
    half of transgender male teens who participated in the survey
    reported attempting suicide in their lifetime, while 30 percent
    of transgender female teens said that they attempted suicide.
    Among non binary youth, 42 percent of respondents stated that
    they had attempted suicide at some point in their lives.
        Is that consistent with what you are hearing?
        Secretary Becerra. That is what we are hearing.
        Ms. Wexton. OK. So it is just really shocking to me that
    our colleagues across the aisle that picking on this group of
    kids, who are among the most vulnerable on the planet really,
    think that that is good politics, because to me it is not. I
    think that these kids need to be supported.
        How about you, Mr. Secretary?
        Secretary Becerra. And if I could just add, they are
    children. I don't care what you call them or what they look
    like, they are children. I have three. I hope you will respect
    my three daughters as much as I will respect your children and
    anyone else's. It makes no difference what they call themselves
    or what they want to do. They have a life, we should respect
    it, and stay out of their business.
        Ms. Wexton. Thank you, Mr. Secretary.
        And just because you all don't understand it, doesn't mean
    it is not real, doesn't mean it is not valid, and doesn't mean
    that they should be vilified. It certainly doesn't mean that.
    So I hope that you all do that.
        And to all the transgender kids across the country, please
    know that you do have supporters here in Congress.
        Secretary Becerra. Amen.
        Ms. Wexton. And, Mr. Chairman, I do appreciate your
    indulgence because this is so horrifying to me what is
    happening with our friends across the aisle. I do hope that
    they will reconsider because this is a very--a vulnerable
    population and they certainly need our support, not our
    vilification.
        Thank you, Mr. Chairman.
        And, with that, I will yield back.
        Chairman Yarmuth. The gentlewoman yields back.
        I now recognize the gentleman from Virginia, Mr. Good, for
    five minutes.
        Mr. Good. Well, I don't--thank you, Mr. Chairman--and I
    don't know to whom the previous comments were directed, but it
    will change the start of my remarks at least.
        You know, it is--I think it is demonstrated that those
    transgender youth or those gender confused youth that when we
    come alongside them and encourage that confusion or reinforce
    that confusion or deceive their parents about that confusion,
    we solidify the emotional strains, the psychological strains,
    and the problems that happen as a result of that. Why don't we
    follow--why don't we follow the god created science of two
    genders? Why don't we help a child who is confused about their
    gender work through that? Study after study shows that most of
    them will find their way back appropriately if we just support
    them in the right way in that confusion instead of trying to
    help them to be more confused about how God created them. God
    makes no mistakes. And it is really a travesty that we would
    try to politicize children in this way and that we would have
    school systems come alongside and support these children in
    their confusion and deceive the parents about that confusion,
    and we would also have entertainment companies and politicians
    and all the rest try to do that, instead of teaching the
    children the truth. Instead of teaching them the truth and
    teaching them that God created design of two genders, which we
    all know to be true. We get into instead harming these
    children--harming these children by supporting them in this
    confusion in a negative way quite frankly.
        Mr. Secretary, who do you think--changing gears--should be
    permitted to illegally enter our country?
        Secretary Becerra. Who? I am sorry.
        Mr. Good. Who do you think should be permitted to illegally
    enter our country?
        Secretary Becerra. Well, you are talking about violating
    the law if you are saying it is illegal. Why would we permit
    anyone to violate the law.
        Mr. Good. I agree with that. We are certainly doing that to
    the tune of 2 million last year. We are helping those illegally
    enter our country of 2.2 million last year. So you don't think
    anyone should be allowed to enter our country illegally?
        Secretary Becerra. Well, you have mischaracterized what is
    happening. Because we have laws and----
        Mr. Good. It would be great if we would actually enforce
    and follow the laws that we have. That is correct. Do you think
    anyone should be turned away who tries to enter our country
    illegally?
        Secretary Becerra. Anyone who doesn't have the
    authorization to be in this country does not have the right to
    stay.
        Mr. Good. If you had your way, how many illegals would you
    allow into our country?
        Secretary Becerra. Again, there are migrants----
        Mr. Good. Do you think there should be some limits to that?
    What is the end game? How it should be or should it be at all
    limited?
        Secretary Becerra. May I respond?
        Mr. Good. This budget, the President's budget, the Fiscal
    Year budget, the 1923 budget he has proposed includes $150
    million cut for immigration and customs enforcement. Provides
    $4 billion however to reward Central American countries that
    are flooding the U.S. with illegal immigrants, however contains
    zero accounting for the amount of taxpayer dollars that are
    being spent on flights to transport illegal aliens from the
    border to the interior of the country, making every town a
    border town, every state a border state. My home community of
    Lynchburg, Virginia, we just had an illegal alien convicted of
    murder, MS13 gang member, who was put in this country
    illegally, making even my community in Lynchburg, Virginia a
    border town, a border community.
        This budget also contains zero accounting for the amount of
    taxpayer dollars that are spent on housing for these illegal
    aliens on top of the already $2 billion that was diverted from
    the American Rescue Plan to the border for COVID-19 testing,
    vaccines, therapeutics, and so forth for non-Americans.
        The President's plan to further reduce border funding for
    our agencies will require HHS to help in a greater capacity to
    process these illegals into the country. Not to prevent, but to
    help process them, facilitate them into the interior of our
    country. Do you think the Administration is prepared to
    effectively vet the surge of illegal aliens that will result
    from this reduced enforcement funding in addition to the
    termination of Title 42?
        Secretary Becerra. You wish----
        Mr. Good. Are we ready for the surge?
        Secretary Becerra. Do you wish me to respond to the
    question?
        Mr. Good. Go ahead.
        Secretary Becerra. We are doing everything we can to make
    sure that we deal with any migrant child who is unaccompanied
    that comes into our custody from DHS.
        Mr. Good. We are prepared to go from 7,000 a day to 18,000
    a day?
        Secretary Becerra. We have a legal obligation----
        Mr. Good. I know those are not all UACs or not all
    children, but.
        Secretary Becerra. We have a legal obligation to make sure
    that any child who is unaccompanied does not stay in DHS
    detention----
        Mr. Good. So all of our efforts to be--to get them through,
    to get them into the interior of the country instead of trying
    to percent this from happening.
        Does the President's budget seek to combat the fentanyl
    that is pouring across the border at all? Because with this
    reduced funding on the border enforcement piece of it--he said
    in the state of the Union that he wants to fight the opioid
    epidemic. We are having it come across in record numbers,
    killing a record number of Americans. Is there anything in the
    budget that is going to help enforce or combat the fentanyl
    that is pouring across the Southern Border?
        Secretary Becerra. I hope you are not implying that our
    border patrol and customs and enforcement agents aren't doing
    their job at the border----
        Mr. Good. I am absolutely declaring that we are not letting
    border patrol do their jobs.
        Chairman Yarmuth. The gentleman's time----
        Mr. Good. Absolutely we are not letting border patrol do
    their job. Absolutely.
        Chairman Yarmuth. The gentleman's time has expired.
        You may respond if you want. Any further----
        Secretary Becerra. I disagree with him. They are working
    hours long in to try to do their work. It is unfair to
    criticize them for the work that they are doing and say that
    they are not doing enough.
        Chairman Yarmuth. I now recognize the gentlewoman from
    California, Ms. Chu, for five minutes.
        Ms. Chu. Well, first I just have to make a statement in
    response to what was said earlier. Yes, God makes no mistakes
    and that means that transgender kids are not a mistake and
    deserve our support to be who they are.
        Well, turning to a different subject, what I came to ask
    about which was, Secretary Becerra, wonderful to have you here
    today. I wanted to ask about reproductive choice. And, first, I
    would like to thank you for working with the President to once
    again deliver a budget request free from the harmful and
    discriminatory Hyde Amendment. Instead, this budget rightly
    includes significant funding increases for the Title X Family
    Planning program and the teen pregnancy prevention program,
    both of which help our most vulnerable access the reproductive
    healthcare that they need.
        So I wanted to ask about the Medicaid free choice of
    provider requirement. We have a disturbing trend in recent
    years where extreme Republican Governors and state legislators
    have taken access to deny Medicaid patients their legal right
    to seek services from the providers of their choice. states
    such as Missouri, Arkansas, Mississippi, Louisiana, and South
    Carolina have instituted bans of state Medicaid funds going to
    all eligible family planning providers. Courts have even issued
    injunctions in several states to stop such bans.
        Can you discuss HHS's plan to enforce the Medicaid free
    choice of provider requirement so that everyone can access
    services like contraception, STI testing, and reproductive
    counseling of their choice?
        Secretary Becerra. Absolutely, Congresswoman. Please make
    sure you say hello to everybody back home that I don't get to
    see much these days.
        We have to--as I always say, it is our job to comply with
    the law and enforce the law. One of the laws that we have on
    the books is that if we are offering family planning services,
    it is available to anyone who is qualified to offer family
    planning services. And that means people who are the
    beneficiaries, the individuals who need those family planning
    services, should have access to those programs. We should not
    be restricting them because we don't like what else they might
    do beyond that family planning service.
        And so we are going to simply enforce the law, make sure
    that we are in compliance with the law, and make sure, as you
    said--and thank you for the work that you have done on this--
    make sure Americans have a choice of going to a provider that
    can provide them with that family planning service.
        Ms. Chu. Thank you for that.
        And I want to say that one of the benefits of the
    Affordable Care Act's birth control benefit was that everyone
    could access the contraceptive method of their choice cost
    free. However, this promise has unfortunately not been realized
    for many, even those who have insurance. Some health insurance
    companies are still imposing out-of-pocket costs on birth
    control, which is in direct violation of the law. When they
    don't comply with the law, the impact is greatest on people for
    whom even a small copay for birth control is too great a
    barrier between them and the care that they need. And that is
    why I was proud to join Representative Lois Frankel in sending
    you a letter requesting that your agency, along with Treasury
    and the Department of Labor enhance your enforcement actions
    and improve public awareness around the ACA's contraceptive
    requirement.
        Secretary Becerra, I know you have experience with this
    during your time as our state's attorney general, can you
    discuss how HHS plans to ensure insurance companies are
    complying with the law and that the public is aware of their
    rights under the ACA? Will patients be the ones responsible for
    reporting violations or will HHS proactively be investigating
    plans to ensure compliance?
        Secretary Becerra. Congresswoman, we are taking proactive
    steps to make sure that those providers and those insurers who
    are out there receiving federal support for their work
    understand their obligation under the law to make sure that
    services that are provided for under law under the Affordable
    Care Act are made available to anyone who qualified, and that
    of course includes women and contraceptive services.
        So we are going to double down on this to make sure that we
    both inform providers of their responsibility and make sure
    that we hunt down those who are violating the rights of
    Americans to access the services they are entitled to under
    law.
        Ms. Chu. And let me thank you for your leadership in
    ensuring Title X Family Planning Program. This is the nation's
    only program dedicated to providing family planning services
    for people with low incomes, but has been underfunded for a
    decade. The budget finally invests $400 million for this
    program, which is the highest funding in the history of this
    program.
        So I wanted to make sure that everybody knew that that is
    in this budget and it is a great thing for the women of this
    country.
        Thank you.
        Secretary Becerra. Thank you.
        Chairman Yarmuth. The gentlewoman's time has expired.
        I now recognize the gentleman from Iowa, Mr. Feenstra, for
    five minutes.
        Mr. Feenstra. Thank you. Thank you, Chairman Yarmuth and
    Ranking Member Smith. Secretary Becerra, thank you for being
    here. I appreciate your comments.
        I am looking at this and thinking what twisted webs we
    weave. The Fiscal Year 1922 omnibus bill just passed with
    Democrats of the House and the Senate and the White House.
    Every chamber passed the current budget, President signed it
    into law, and the Hyde Amendment, which bans federal funding of
    abortion was in it. And yet can you confirm that to include the
    Hyde Amendment for Fiscal Year 1922 funding bill, your budget
    does not. Can you--I am wondering why that is.
        Secretary Becerra. It is not because the President has made
    it very clear that he wants to make sure that we are providing
    under the law all of the services that America should be
    entitled to.
        Mr. Feenstra. But he signed the bill, the Democrats
    approved the bill. I am missing something here. I mean you have
    control--Democrats control the House, the Senate, and the
    presidency. He signed it and yet now he is not doing that? I am
    missing this.
        Secretary Becerra. What he signed was the current Fiscal
    Year budget, the omnibus----
        Mr. Feenstra. So it was good then, but not now? Is that
    what you are saying?
        Secretary Becerra. Are you suggesting that we shut down
    government?
        Mr. Feenstra. No, I am just simply suggesting I want to
    know why is this happening? I mean----
        Secretary Becerra. If he didn't sign it, we would have had
    a shutdown of government. And so are you suggesting he not----
        Mr. Feenstra. No, he has--I am saying he has signed--he
    signed a bill that the Hyde Amendment was in it and now you are
    saying we don't want it anymore.
        Secretary Becerra. But what you--are you saying he had a
    choice. Could he have extracted the Hyde Amendment?
        Mr. Feenstra. I am saying that everybody agreed to it, so
    you would assume----
        Secretary Becerra. I don't think everyone agreed to it, but
    certainly it had to be included----
        Mr. Feenstra. It is signed.
        Secretary Becerra [continuing]. in order to get that
    omnibus to the President's desk. I mean, Congressman, I don't
    know how long you have been around here, but that is the way--
    --
        Mr. Feenstra. I would like to clarify one other point.
        Secretary Becerra. Yes.
        Mr. Feenstra. Thank you, thank you.
        Last week the OMB Director Young testified to the committee
    that the budget assumes that even given insolvency that
    Medicare spending would continue at its current rates. I also
    asked the director to clarify how according to page five of the
    Department of Treasury's green book, the budget can work when
    it assumes that Congress will pass Build Back Better last
    year--it assumed that yet, which we didn't, right. But the
    bill--the book is assuming that. Those two assumptions make
    absolutely no sense to me. Assuming Build Back Better was
    passed, it also assumes that Medicare will go bankrupt,
    insolvent, earlier.
        On the reverse, expanding Medicare under the assumed Build
    Back Better law, which they say is in here, would drastically
    change Medicare spending. So Medicare spending account for 15
    percent of all of our spending and it is going up dramatically.
        So my question is, Mr. Secretary, why doesn't the budget
    address this--Medicare is on track to be insolvent by 2026?
        Secretary Becerra. Congressman, if you read the budget, you
    will see that the President's budget request does provide
    further support to strengthen Medicare.
        Mr. Feenstra. Yes, yes, yes, I agree, but it also in the
    same budget creates Build Back Better. So then it dramatically
    expands Medicare.
        Secretary Becerra. More services to seniors is a pretty
    good thing and----
        Mr. Feenstra. I am not arguing that. I am simply saying,
    based on the budget, that you are dramatically expanding
    Medicare under the Build Back Better, which is in the budget.
    It is assuming that on page five. And yet I just heard you talk
    to Congressman Smucker and you are saying, you know what, we
    will be OK. That is not what the budget says.
        Secretary Becerra. If you read the budget, you would
    realize that----
        Mr. Feenstra. I read it very close.
        Secretary Becerra [continuing]. it reduces the deficits in
    the long-term. It actually provides for a very fiscally
    responsible way----
        Mr. Feenstra. But not the unfunded liability of Medicare.
        Secretary Becerra. Congressman, there are provisions in the
    President's budget that extend the fiscal strength of Medicare.
    There are provisions in there that would provide for further
    program integrity. And as I mentioned earlier----
        Mr. Feenstra. I agree with that.
        Secretary Becerra. And as I mentioned earlier, I believe
    this Administration is prepared to speak to anybody who wants
    to talk about strengthening Medicare by cutting costs, not by
    cutting benefits.
        Mr. Feenstra. Right. OK. Thank you. Thank you for that. But
    I don't need any more comments, but I just want to say this.
    When you add Build Back Better and all that you are doing for
    Medicare, all the extra pieces, Medicare is going to go
    insolvent a lot faster. It will. And you don't have to----
        Secretary Becerra. You are saying we should not improve
    Medicare for seniors?
        Mr. Feenstra. I am simply saying to you as your budget does
    one thing--it is sort of a shell game, right. It is a shell
    game.
        Secretary Becerra. No, no, no.
        Mr. Feenstra. We are going to do this, this dangling thing
    over here, but don't look over here at what is going to happen
    in 10 years.
        Secretary Becerra. No, no. The President's budget reduces
    the deficit. It does so because it is fiscally responsible. At
    the same time, the President clearly wants to make sure we
    improve Medicare services and benefits.
        Mr. Feenstra. Short-term. Short-term it does. But I am
    looking 10 years out and that is what the budget doesn't--thank
    you.
        I yield back.
        Chairman Yarmuth. The gentleman yields back.
        I now recognize the gentlewoman from California, Ms. Lee,
    for five minutes.
        Ms. Lee. Thank you, Mr. Chairman.
        Hello, again, Mr. Secretary. Nice to see you.
        Let me just clarify one thing with regard to the Hyde
    Amendment. The Hyde Amendment was passed--I was a staff person
    here for the late--the honorable late Congressman Ron Dellums.
    When Henry Hyde inserted the Hyde Amendment in the mid-'70's,
    that Amendment was to deny the full range of reproductive
    healthcare, including abortions, to low-income women and women
    of color. Thank goodness our bill did not include that after
    all of these years when we sent that to the Senate. And so the
    Senate unfortunately held it up and the government could have
    shut down if it hadn't been for the negotiations. And so who
    sacrificed for making sure that the government would not shut
    down? It was low-income women and women of color. And we are
    going to continue until we provide equity, racial justice, for
    everyone, every person in this country, and that includes black
    and brown women and low-income women.
        And so, Mr. Secretary, I just want to make sure that is
    clarified, that the government could have shut down. And I am
    glad that you signed the omnibus bill, but we are going to keep
    fighting until justice is done. So thank you very much.
        Let me ask you about HIV and AIDS. During the Labor HHS
    Appropriations Subcommittee hearing last year you mentioned
    that the budget for the new $9.8 billion mandatory spending
    PrEP delivery program largely focuses on bulk purchasing of
    generic drugs.
        So let me ask you, with regard to the Administration, why
    has it designated the funding as mandatory rather than
    discretionary? And have you connected with the stakeholders?
    And also is there a consensus on how the $2.8 billion will be
    distributed? With the availability of low cost and free drug
    programs for people who are uninsured, I am hearing from the
    HIV community that access to the drug is not the issue. What I
    have heard is that clinics need funding to cover lab services
    and medical visits for the uninsured. There is also a need for
    community outreach programs and provider education and training
    programs and other wraparound services.
        And so can we ensure that the new PrEP program focuses on
    these support services also? And how is this going to be
    structured, given that it is right now not discretionary?
        Secretary Becerra. Congresswoman, I think, as always, this
    is the President's proposal. I suspect that you and your
    colleagues will try to work this budget to make it something
    that works as best as possible. We will be there to support.
    What we do want to do is make a commitment to make sure that
    everyone has an opportunity to have the lifesaving therapies
    that are available now to anyone with HIV/AIDS. And we will do
    everything we can to make it affordable for everyone in
    America.
        And so we are more than willing to work with you. If you
    think there are some better ways of doing it, we are certainly
    willing to listen. This is the President's budget proposal. At
    the end of the day, as you just finished your discussion in
    terms of the omnibus you all will determine what the budget
    looks like, but we hope what it will do is make a major
    investment in PrEP and doing all the things that we need to do
    to really tackle HIV/AIDS.
        Ms. Lee. Thank you very much. And we will work with you on
    that because I think we have some ideas about a better way to
    do this.
        Also, the National Academy of Sciences, Engineering, and
    Medicine issued a report recently on primary care that
    estimates 85 deaths per day in the United States are the result
    of declining access to primary care. Your budget proposes a $5
    million increase for training in primary care medicine, thank
    goodness. Is the proposed investment in primary care part of a
    larger strategy to address the growing shortage of primary
    care? And also we are working with an initiative that the
    National Academy put forth in recommending some pathways and
    strategies for black medical physicians and engineers. And the
    African American community, you know, is lacking in terms of
    African American primary physicians.
        Secretary Becerra. And, Congresswoman, COVID made it even
    more clear how much of a gap there is in getting professionals,
    healthcare professionals into many communities in this country.
    And so we are absolutely committed in making a difference
    there. We want to increase the funding that we have for the
    pipeline of those medical professionals. We want to make sure
    that they are able to afford getting those medical degrees. We
    want to make sure that we provide them--I should give you a
    real quick example--my son-in-law is about to finish in about
    two months his residency program as a pediatrician. He will be
    as a result of a federal program that--Public Health Service
    Corps Program--he is now about to serve for five years in a
    medically under served are of the country. He was able to do
    that and go to medical school without having to pay for it
    because he has made that commitment to serve for five years.
        Ms. Lee. Mr. Secretary, you said your son-in-law? Mr.
    Chairman, we served together in the California legislature and
    I remember your--when your twins were born.
        Secretary Becerra. Yes, yes.
        Ms. Lee. So congratulations.
        Secretary Becerra. Yes. That is where they are now. She is
    now married and her husband is finishing his residency program.
        Ms. Lee. My God.
        Secretary Becerra. Yes, I know.
        Ms. Lee. Congratulations.
        Secretary Becerra. Thank you.
        Ms. Lee. Well, thank you again and we look forward to
    working with you.
        Secretary Becerra. Thank you.
        Chairman Yarmuth. The gentlewoman's time is expired.
        I now recognize the gentleman from Virginia, Mr. Cline, for
    five minutes.
        Mr. Cline. Thank you, Mr. Chairman. Thank you, Mr.
    Secretary, for being here again. I got to speak to you last
    week on the Labor HHS Sub and I appreciate you being here.
        Secretary Becerra. Thank you.
        Mr. Cline. Earlier you stated that gain-of-function
    research was not directly or indirectly funded and that U.S.
    taxpayer dollars did not go to the Wuhan laboratory. Is that a
    correct statement?
        Secretary Becerra. The National Institute of Health and HHS
    does not fund gain-of--I lost it.
        Mr. Cline. Gain-of-function.
        Mr. Becerra. Gain-of-function--thank you very much. It has
    been a very long day. Gain-of-function research and certainly
    not directly to or even indirectly to Wuhan Institute of
    Virology.
        Mr. Cline. OK. I am looking at a letter from October 20,
    2021 where a top NIH official responded to Ranking Member Comer
    at EcoHealth Alliance, a nonprofit that has sent U.S. funds to
    the Wuhan lab, had not been transparent in their work. So
    apparently there were funds that were sent from NIH to the
    EcoHealth Alliance and from the EcoHealth Alliance to the Wuhan
    lab. Would you agree with that?
        Secretary Becerra. You are now speaking about Eco Lab and
    some of the funding it may have done with some of its subs. You
    asked me about direct or indirect funding by NIH and I said to
    you that we do not do direct or indirect funding to the Wuhan
    lab.
        Mr. Cline. OK. You wouldn't call that indirect funding?
        Secretary Becerra. For the gain-of-function research
    issues, no. As far as I know, we have not done any direct--we
    have not contracted with someone to do direct or indirect
    research on gain-of-function.
        Mr. Cline. What would you call it when money is sent from a
    government agency to a sub, EcoHealth Alliance, and then
    directly to Wuhan lab for the purpose of gain-of-function
    research?
        Secretary Becerra. I say show me what you got. Let me see
    what makes you say that.
        Mr. Cline. Well, the letter I have is from your NIH on
    October 20 and it states that EcoHealth Alliance did send money
    to the Wuhan lab.
        Secretary Becerra. To do gain-of-function research?
        Mr. Cline. Gain-of-function research was occurring and it
    was known to NIH that it was occurring when the grant was asked
    for.
        Secretary Becerra. Read to me please where it says that the
    NIH funded EcoLab to do gain-of-function research through the
    indirect funding of Wuhan Institute.
        Mr. Cline. What I am saying is that the EcoHealth Alliance
    received money from the----
        Secretary Becerra. OK. You can confuse a number of things
    together to try to reach a conclusion----
        Mr. Cline [continuing]. federal government.
        Secretary Becerra [continuing]. but that doesn't mean that
    we funded gain-of-function research.
        Mr. Cline. If the money from NIH went to EcoLabs and
    EcoLabs funded the Wuhan lab efforts at gain-of-function
    research, that is indirect funding.
        Secretary Becerra. Congressman, are you asserting that the
    only funding or the only research that EcoLabs does is with
    Wuhan and only on gain-of-function research?
        Mr. Cline. Are you insinuating that somehow money is not
    fungible and that money provided from the federal government
    doesn't somehow support efforts to do something that an entity
    could be engaged in at the same time?
        Secretary Becerra. I am trying to answer your question.
    Your question was does the federal government, does HHS, or
    does NIH fund gain-of-function research to the Wuhan lab--
    research the Wuhan Institute of Virology does, and I said to
    you no.
        Mr. Cline. Well, money is fungible, as you well know. And I
    would argue to the contrary. And so if you don't wish to amend
    or clarify your statement, I will just----
        Secretary Becerra. I think it is clear, Congressman.
        Mr. Cline. I think it is intentionally evasive on the part
    of you and on the part of NIH. You avoid taking responsibility
    for funding gain-of-function research.
        Secretary Becerra. Congressman, I don't want to be evasive,
    I just want to respond to your question as you posed it. If you
    want me to answer the question about whether EcoLab may do any
    other types of research or fund others, that is--that might be
    a different question. But you are asking if we, the federal
    government, are funding the Wuhan Institute of Virology to do
    gain-of-function research, and the answer is no.
        Mr. Cline. Well, EcoLabs knows that they funded it, NIH
    knows that EcoLabs funded it, you know that they funded it, the
    American people know that they funded it, and I am disappointed
    in the evasion today.
        I yield back.
        Chairman Yarmuth. Does the gentleman have an interest in
    submitting documentation for the record?
        Mr. Cline. Mr. Chairman, I am happy to submit the letter
    from EcoLab to NIH for the record.
        Chairman Yarmuth. OK, without objection.
        The gentleman's time has expired.
        [Letter submitted for the record follows:]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        I now recognize the gentleman from Pennsylvania, Mr. Boyle,
    for five minutes.
        Mr. Boyle. Thank you, Mr. Chairman. It is wonderful to see
    literally the first person who welcomed me after my election
    eight years ago back. Mr. Secretary, thanks for being with us.
        And I want to focus on something that actually I have not
    heard for quite a while, at least in this hearing, and
    something I fear we are not focusing on the way we should be in
    Congress or even in society, and that is our twin challenges of
    substance abuse problems as well as the mental health crisis.
        You might recall about four or five years ago actually the
    substance abuse issue, the closely related overdose issue got a
    lot of attention, which is a good thing. But it is then, partly
    I suspect because of the pandemic, but partly because the media
    has a short attention span--unfortunately this subject has kind
    of receded in the public's attention, which is completely
    contrary to where we actually are in both of these twin crises.
    For example, and this is according to the CDC, in a 12 month
    period ending in April 2021 we had an increase of 28.5 percent
    over the exact same period the year before in terms of drug
    overdoses, now over 100,000 a year for the first time in
    American history.
        And then with respect to the mental health crisis, just
    anecdotally, I won't even cite statistics, the number of people
    in my own life, close to me, who have now suffered with this.
    The number of friends I have who have a loved one who has
    suffered. It is not overstating the situation to call it a
    crisis.
        So I was really impressed with your testimony. I was so
    glad that you focused on both of these issues in your written
    testimony. Also the commitment to invest more than $100 billion
    over 10 years to transform the mental health as well as
    substance abuse disorder coverage system in the country. And I
    was hoping, and wanted to give you the opportunity to talk a
    little bit about beyond the dollars and sense what exactly that
    means.
        Secretary Becerra. Congressman, thank you for that.
        One of the things it means is trying to finally remove the
    stigma. If you are right now caught in this trap of substance
    abuse disorder, it is tough to get out. I mean just the
    addiction is tough, but facing the stigma that is attached to
    it is sometimes very difficult for folks to overcome. We don't
    want to blame you for having become addicted to this disease,
    we want to help you get out of it.
        And so one of the things we are doing is we are trying to
    turn toward the evidence to tell us how to go about doing
    substance use services. And so we changed the strategy
    altogether. We are now focusing not just on preventing people
    from getting addicted and not only treating, but now to
    following them through the process so they actually succeed
    long-term. And even before that, trying to help them not harm
    themselves. You know, we want to save a life, but we also want
    to keep you from harming yourself along the way.
        And so our strategy is far different and I hope what we do
    is proof that we want to be there for you in the long run.
        Mr. Boyle. Well, I am happy to hear that with respect to
    substance abuse.
        And just briefly on the mental health side of it, I would
    bring to your attention--though I am certain that you are aware
    of it--that when--although this is the case actually with
    both--it is not just the person who is suffering either from an
    addiction or from a mental health issue, but the family that is
    affected. Sometimes, especially with respect to mental health,
    sometimes it is actually the family that is suffering even more
    acutely. And so anything we can do to provide resources to the
    families. There are just far too few in our society and we have
    a lot of people in our country who are hurting because of that.
        Secretary Becerra. Congressman, there is where the home and
    community-based services that we are going to try to really
    beef up so that people can receive care as close to their loved
    ones as possible become so important. And so the degree that we
    can support someone, whether it is because of mental illness or
    because of substance use disorder, get the treatment they need,
    services they need, as close to home as possible, the better
    off we will be.
        Mr. Boyle. Well, finally, just in the 30 seconds
    remaining--and I don't have a silver bullet on this, I don't
    think anyone does--but what many have found, my family
    included, is that if you have a loved one who has a mental
    health issue, but the loved one doesn't recognize the very
    serious issue, there are far too few options for the family.
    And, of course, we are a country that believes in civil
    liberties. That is right, but there has to be a better of
    balancing civil liberties with the desire of a family to get
    love and care to one that desperately needs it.
        Secretary Becerra. Amen.
        Mr. Boyle. Thank you.
        I yield back.
        Chairman Yarmuth. The gentleman's time has expired.
        I now recognize the gentleman from Georgia, Mr. Carter, for
    five minutes.
        Mr. Carter. Thank you for being here, Mr. Secretary.
        I have got a quick question for you to begin with. It is
    about the Medicare A--the Medicare Area Wage Index. I am sure
    you are familiar with that. And it is hurting hospitals in my
    district.
        Now, I represent South Georgia. Keep in mind there are two
    Georgia's, there is Atlanta and everywhere else, and I am
    talking about everywhere else, OK. And I am talking about a
    very rural area. And it is really hurting our hospitals. And I
    have got legislation. It is H.R. 4066, the Save Rural Hospitals
    Act, and it establishes an area wage adjustment for Medicare
    hospital payments. I just want to ask you if you will commit to
    working with us to get this fixed so that we can help rural
    hospitals.
        You are familiar with the plight of rural hospitals.
        Secretary Becerra. Yes.
        Mr. Carter. You are familiar with how important they are to
    these communities and you know that they are struggling. You
    know a lot of them are closing down. This will help. And we
    need your help on this and I just want to get that commitment
    from you.
        Secretary Becerra. With the number of facilities that are
    closing down in rural America, it is alarming. Absolutely, you
    have my commitment to work with you. We may not agree on every
    solution, but I am absolutely committed to working with you.
        Mr. Carter. Good. I hope you will look at this legislation.
    Again, it is H.R. 4066.
        Secretary Becerra. Will do.
        Mr. Carter. And it is bipartisan and it is good legislation
    that will help us as well.
        Secretary Becerra. Will do. And if you need any technical
    assistance on that, please turn to our team and we will be
    there to help.
        Mr. Carter. Thank you. I appreciate that.
        Mr. Chairman, I would like to ask unanimous consent to
    submit this letter from the Tennessee Hospital Association and
    signed by nine other states, including the state of Georgia,
    regarding the Medicare Hospital Area Wage Index.
        Chairman Yarmuth. Without objection.
        Mr. Carter. Thank you.
        [Letter submitted for the record follows:]

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        Now, Mr. Secretary, I want to ask you about--I actually
    sent you a letter, a letter about this, had 53 signatures of my
    colleagues on it. It has to do with the President's Fiscal Year
    2023 budget. And once again it promotes taxpayer funding of
    abortions by excluding the longstanding bipartisan Hyde
    Amendment protections that prohibit the use of taxpayer dollars
    to subsidize abortion services. Are you aware of that?
        Secretary Becerra. Congressman, I am fully aware of this
    issue and the deeply held beliefs that really reside behind it.
        Mr. Carter. Thank you.
        I want to--the letter that I sent you and that was signed,
    as I say, by 53 of my colleagues, mentioned in there our
    concerns about the Task Force on Reproductive Health. And you
    are familiar with that? I believe that is something----
        Secretary Becerra. I started it up.
        Mr. Carter [continuing]. that was implemented, instigated
    by your office.
        Secretary Becerra. It absolutely was.
        Mr. Carter. OK. You know, that was on the 49th anniversary
    I believe of Roe v. Wade where you announced that you would be
    forming this task force with the explicit purpose, as I
    understand it, of promoting abortion in response to pro life
    laws passed by states and to increase abortions in foreign
    countries.
        Secretary Becerra. Congressman, I have long supported
    reproductive decisions and privacy under Roe v. Wade.
        Mr. Carter. OK. But what about the Hyde Amendment? And what
    I am getting at here, 73 percent of Americans oppose using
    their tax dollars to pay for abortions in other countries--73
    percent. And just recently in January a majority of Americans
    opposed taxpayer funding for any abortions here in America as
    well. So we are talking about taxpayers' dollars here being
    used for something that they are opposed to. And that is for
    taking the life of the unborn. And that is from my perspective.
        The task force, as I understand it, it formalized the pro
    abortion advocacy at home and abroad that has been--it has
    already been promoted through HHS. Does this new task force
    intend to use federal funds to advocate against state laws
    protecting the unborn?
        Secretary Becerra. The purpose of the task force is to make
    sure that we are enforcing the laws that are in place and
    protecting people's right under those laws.
        Mr. Carter. Including the Hyde Amendment?
        Secretary Becerra. Any law that is in place, we will make--
    --
        Mr. Carter. Including the Hyde--that is easy, yes or no.
    Including the Hyde Amendment?
        Secretary Becerra. We will enforce and protect the rights
    of people under all our existing laws.
        Mr. Carter. Including the Hyde Amendment, yes?
        Secretary Becerra. We will----
        Mr. Carter. OK.
        Secretary Becerra. OK.
        Mr. Carter. I am a pharmacist, I am not a lawyer, so you
    can use your lawyer talk with me, but I----
        Secretary Becerra. I am being pretty clear, we are going to
    enforce every law----
        Mr. Carter. Pretty clear--and that includes the Hyde
    Amendment, which protects the unborn and prohibits the use of
    taxpayers' money for abortion?
        Secretary Becerra. As I said, we are going to protect every
    person's rights under existing law. I am not excluding any
    particular laws, I am just going to make sure I enforce the
    laws properly. I am obligated to comply with the law. And so if
    there is a law in place, I am going to comply with it.
        Mr. Carter. Good. And that shows us and tells me how
    important it is that we make sure that the Hyde Amendment rules
    are added into any budget and into any laws and any
    appropriations that we have.
        So thank you, Mr. Secretary, for being here. Appreciate
    your indulgence.
        And I yield back.
        Secretary Becerra. Thank you for your questions.
        Chairman Yarmuth. The gentleman yield back.
        I now recognize the gentleman from New York, Mr. Jeffries,
    for five minutes.
        Mr. Jeffries. Thank you very much. Good evening, Mr.
    Chairman, good evening to our very distinguished witness. Good
    to see you. I have had the opportunity to call you Chairman
    Becerra, General Becerra, and now Secretary Becerra. I
    appreciate your distinguished record of service. And, of
    course, welcome back to the House of Representatives.
        When President Biden came into office in early 2021, I
    believe about only 2.8 million Americans were fully vaccinated
    against COVID at the time. Is that correct?
        Secretary Becerra. Less than 1 percent, that is correct.
        Mr. Jeffries. And about 15 months later, how many Americans
    are fully vaccinated?
        Secretary Becerra. Over 217 million.
        Mr. Jeffries. That is an extraordinary accomplishment. Does
    that happen by accident or how did that actually occur?
        Secretary Becerra. It is neither accident or coincidence.
    It was a lot of hard work on the part of many of the people at
    HHS and throughout government, and a lot of the folks out
    therein the private sector and in local government as well.
        Mr. Jeffries. None of my colleagues on the other side of
    the aisle supported the American Rescue Plan. How instrumental
    was the American Rescue Plan in helping to stand up a public
    health infrastructure with respect to both the vaccination
    accomplishments that you and others within the Biden
    Administration are responsible for, as well as our general
    efforts at working through this deadly once in a century
    pandemic?
        Secretary Becerra. Indispensable. Without it, hundreds of
    millions of Americans wouldn't have the level of protection
    they have, hundreds of thousands of healthcare providers,
    doctors, nurses, hospitals, healthcare clinics would not have
    been able to receive reimbursement for some of the cost they
    incurred to provide those services to Americans to stop COVID.
        Mr. Jeffries. The American people are understandably
    fatigued as it relates to this deadly pandemic and it has been
    with us now for two plus years, and we have been through
    multiple variant, Delta variant, Omicron variant. Now we have
    got a sub variant. I believe officially it is referred to as
    BA.2, I believe. But this is still a challenge and more than
    900,000 Americans have been killed by COVID-19. That is an
    extraordinary amount of people. That is a lot of pain and
    suffering and death that have been experienced in every
    community across America, rural, urban, suburban, exurban,
    small-town America, Appalachia. How should we be thinking about
    this moment that we are in as Congress is contemplating
    additional funding for the next phase of working through this
    pandemic?
        Secretary Becerra. Don't go AWOL. Not at this time, not
    when we are so close. This is not the time to turn off the
    burners that let us go ahead and--as one of your colleagues
    said--Mr. Horsford said--to crush COVID. This is our chance to
    crush COVID, this is the wrong time to not provide the
    resources to crush COVID.
        Mr. Jeffries. I agree. And in terms of the possibility, or
    at least the recommendation, that I believe has now been
    publicly made in terms of perhaps the importance of an
    additional vaccination shot, certainly for people who have got
    preexisting conditions that may cause a COVID infection to be
    far more deadly, and certain age groups--I believe now north of
    50--does the Administration currently have the resources
    necessary to ensure, as has been done up until this point, that
    vaccinations are available for every American who chooses--who
    has the freedom of choice and exercises that freedom, to get
    vaccinated?
        Secretary Becerra. We have fortunately made investments
    that allow us to have vaccines that we need for what we know we
    must do. But if we get to the point, for example, of requiring
    doses for the fall, another boost in the fall, we probably
    would not have the resources to provide that to all Americans,
    if indeed FDA says it is appropriate to provide that to those--
    and CDC says it is appropriate to provide those--all adults 18
    and over or perhaps even children as well. We would not have
    the therapeutic medicines that we need if we have another surge
    in the fall. We are running out of those resources. We did a
    lot of planning, so we have vaccines in place for those who
    need them today, but we don't have the resources--and
    therapeutics as well and some of the testing, but that is going
    to quickly dwindle. And remember, we are at the front of the
    line in getting these vaccines, these therapeutics because we
    made the investments early in big numbers. We don't do that, we
    go to the back of the line.
        Mr. Jeffries. And, last, how important do you think making
    the investments in terms of the availability of therapeutics
    will be for us to get to a point where we can return to some
    semblance of new normal as we emerge from the current phases of
    the pandemic?
        Secretary Becerra. It is critical. It is the all of the
    above approach because certainly the vaccines are the best way
    to deal with this because if you could prevent the contraction
    of COVID, that is the best thing. But if someone does get it,
    to keep them from going to the hospital or perhaps dying,
    therapeutics are very important. And so all of that, along with
    the testing, along with the masks, along with the things that
    keep us safe, are critical to crush COVID.
        Mr. Jeffries. Thank you, Mr. Chairman. And thank you, Mr.
    Secretary, for your testimony and for your service.
        Secretary Becerra. And thank you to you.
        Chairman Yarmuth. The gentleman's time has expired.
        I now recognize the gentlewoman from Texas, Ms. Jackson
    Lee, for five minutes.
        Ms. Jackson Lee. Thank you very much, Mr. Chairman, and
    thank you, Mr. Secretary. It is a pleasure to be in the room
    with you.
        And let me acknowledge that America has a great deal to be
    thankful for this Administration and under your leadership. You
    were an early appointee and we are delighted that people are
    living because we took hold of the reigns and had a no nonsense
    plan to ensure all Americans--and I want to emphasize in
    particular impoverished and uninsured Americans as well.
        In the state of Texas we are literally the poster child--we
    are the poster child for the poor handling of COVID in the
    early stages. We have upwards of some 90,000 cases and maybe
    50,000 dead. And we continue to have the issue of low
    vaccination rates in different portions of our state. We
    somewhat fell victim to no masks, fights about masks, and other
    destructive elements that certainly were not positive.
        So I want to just go right to the heart. The Administration
    put forward a very positive and effective COVID package that
    would include impoverished being able to be covered or the
    uninsured, as well as to make sure that there will be dollars
    for those who may be coming in petitioning for asylum and
    making sure that those individuals might be vaccinated. In
    addition, we were very much concerned about the international
    aspect of a very small world.
        Can you tell me what medical health impact a skinny COVID
    has? We certainly want to move forward on a COVID bill, but
    what do we leave out and what danger do we face?
        Secretary Becerra. Congresswoman, we disclose how we
    utilize the resources we get. What it simply means is that we
    will be back sooner than you think saying we are here again, we
    are depleted in our resources, and we need to finish the job.
    And so I will simply say to you that we are going to use
    whatever resources we give us the best we can to keep COVID at
    bay. And I hope that we don't let our guard down and have some
    future variant come back and to squeeze us the way it back in
    2020.
        Ms. Jackson Lee. One of the issues that we all face is
    mental health and substance disorder. You have put a sizable
    amount in the President's budget--or in your budget. Tell me
    what you are doing agency wide to ensure the parity between
    physical and mental health. My colleague just spoke about the
    dangers, the damages. I would add that one of the most
    dangerous calls are domestic violence calls for police
    officers, but in the mix of that is someone having a mental
    health crisis.
        Secretary Becerra. So, Congresswoman, I don't think there
    is any other way to say it but that the President's budget is a
    game changer. It takes mental health services and the approach
    to tackling mental health conditions to a different level. When
    you are willing to commit not only discretionary but mandatory
    dollars to the degree the President has so that we can help
    states attack the prices that we see in our communities on
    mental health. I hope what Congress will do is accept the
    challenge and help us, because there are people crying out
    today for help. We are getting ready to launch the 988 three
    digit code that will be available for people to call. Similar
    to 911, 988 will be for those who are suffering severe mental
    stress and who are on the verge of doing something that they
    will regret. We want to make sure that when that system goes
    live nationwide that if someone is going to take the time to
    make the decision to call us instead of going the wrong
    decision, they get an answer, not be put on hold or get a busy
    signal.
        Ms. Jackson Lee. Let me just quickly indicate, I would
    hope--as you well know, we have those community public health
    clinics around America. I would like to see us dedicate some
    totally to mental health services. And I hope, as well
    continue, we will have an opportunity to discuss that.
        Let me just quickly say--let me thank you for the emphasis
    on childcare, Head Start, the block grants. And you might
    comment on how important that is coming out of the pandemic.
        As I do that, let me ask unanimous consent to put into the
    record an article dealing with White House burdens initiative
    to address long-term COVID-19, and then an article about UMC
    Hospital in Houston.
        Chairman Yarmuth. Without objection.
        Ms. Jackson Lee. Thank you.
        [Articles submitted for the record follows:]

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        I would like to raise the UMC Hospital and just ask that I
    get a report back on that issue and to see whether there is any
    reconsideration. But I would appreciate your comment on the
    mental health. And then thank you for what occurred in the CMS
    settlement that gave us a lifeline until September regarding
    Medicaid. I would like to continue working with you on how we
    can solve that 1115 problem.
        But could you just comment very briefly on the childcare
    that you all have invested in here that I congratulate you on?
        Thank you.
        Secretary Becerra. Yes. And I will be brief because I know
    time has expired.
        I will simply say this, Congresswoman, I remember the days
    when the talk was every parent should--if you are going to have
    a child, start thinking about you are going to invest now for
    your child's college education, so start putting away money now
    so you can afford the tuition of your child. Well, today
    Americans are being told not only to save for that college
    tuition for your child, but be ready because the age of one or
    two, whenever you start childcare, you are essentially spending
    college tuition level amounts to get basic childcare for your
    two-or 3-year-old. That is incredibly difficult for any family
    that is middle class or below. We need to do something to make
    childcare affordable. We have a very productive work force. We
    don't want people leaving the work force because they can't
    find quality childcare. We also have to treat those people who
    work in childcare as human beings and professionals, pay them
    the salary so they don't go off and decide to go flip burgers
    because they can get more money doing that.
        Ms. Jackson Lee. Mr. Chairman, I yield back. Mr. Chairman,
    thank you.
        Chairman Yarmuth. The gentlewoman's time has expired.
        I now yield myself 10 minutes and I promise I will not take
    anywhere near that time.
        We will have no problem getting you out of here well before
    your hard stop and we appreciate your patience and
    responsiveness.
        There are just a couple of things I want to address. One is
    my colleague here, the Ranking Member, talks a lot about the
    American Rescue Plan and his figure, which I will accept as
    accurate, that--even though I don't know what criteria he
    established--that only 9 percent of the $1.9 trillion was spent
    on--directly on COVID combatting COVID. But the name of the
    bill was not the American COVID Treatment bill or COVID
    Prevention bill, it was the American Rescue Plan. And it was
    named that because we understood that there was a terrible cost
    enacted--or a terrible cost that was experienced at every level
    of our economy and our society, that families were impacted
    negatively, that businesses were impacted negatively, that
    local and state governments were impacted negatively. And that
    without the federal government stepping in that there were
    going--there is going to be real damage done at the human level
    and at the economic level.
        So we allocated a great deal of money to state and local
    governments. And because in prior relief packages we had set
    very strict criteria that resulted in I think virtually every
    one of us getting complaints from our mayors and county
    executives and Governors that we put too many restrictions on
    that money, we need to give them more flexibility. So we did
    that. I fully admit that I think the Ranking Member is right,
    some of the projects that have been funded, some of the uses
    that some localities have made of the funds certainly don't
    comply with the spirit of what we were doing, although they
    would make the argument that their budgets were impacted
    generally and these were things that, as one of our Republican
    colleagues said, money is fungible sometimes, and with state
    and local budgets it can be.
        But we also gave hundreds of billions of dollars, allocated
    hundreds of billions of dollars to schools so that they could
    make the return to school safer and smoother for the students.
    And that there would be money available to do remedial
    education for students who had lost ground when they were out
    of the classroom for such a long period of time.
        So, you know, I think it is really not fair to say that the
    American Rescue Plan wasn't actually all related to COVID,
    because it was the impact of COVID and not just the disease
    itself.
        Just wanted to make that point.
        And then the one thing I want to ask you is--because my
    Republican colleagues again talked about immigration a lot
    during this hearing and you and I have a common experience with
    immigration policy. In this Congress we spent six or seven
    months in 2013 every afternoon trying to write a comprehensive
    immigration reform bill. And, as a matter of fact, we did. And
    we had eight Members, four Republicans, four Democrats. And
    final analysis, seven of us signed off on it at the time. And
    the Senate had already passed a comprehensive immigration
    reform bill on a bipartisan basis earlier that year in 2013.
    And the Republican leadership of the House at that point was
    unable to take our proposal--or unwilling to take our proposal
    and put it before the membership. And we were fairly
    convinced--I think you would agree--if our package had gone
    before the House that it would have passed again on a
    bipartisan basis.
        The only question I have of you, looking back to that time,
    is all of the problems we face in immigration right now--now
    all of them, but how do you think the current immigration
    situation would be if we had been able to pass that bipartisan
    proposal in 2013?
        Secretary Becerra. It would not be. And we would not be
    facing these circumstances had we passed that law. Because, as
    you recall, Mr. Chairman, it dealt with all components. It
    provided border enforcement in ways that were aggressive and
    smart, it provided for the needs of our industries and our
    communities when it came to how we would bring in immigrants
    into the future, and it provided for a rational way to deal
    with those who have been in this county for years, like the
    dreamers, and a way to rationalize how to address them. Some
    would get to stay, others would not. And I think if we had
    passed that law we would have had a rational approach to the
    border. And it makes it very difficult when you continue to see
    a broken immigration system wreak havoc on our policies.
        Chairman Yarmuth. And after that experience--and I confess
    I came into that process way behind the curve on my
    understanding of immigration law. I don't still know why I was
    part of that group. I think I was put there to be the answer to
    which one of these doesn't belong. But I do joke that actually
    Kentucky was a border state in the Civil War, that is how I got
    there.
        But one of the things that occurred to me and, you know, I
    think you just said it essentially, is that this is not an
    optional exercise for this country to do a comprehensive
    immigration reform, it is mandatory. And the fact that we are
    not pursuing that aggressively is tragic and is exactly the
    reason that the problems we are facing now exist
        Secretary Becerra. And if--Chairman, if you would allow me,
    I would--the fact that we are going through this situation at
    the border because we don't have a system that lets us process
    individuals who make a claim for asylum in the appropriate way,
    it doesn't work. And when it doesn't work we are sending very
    mixed messages around the world. And we need to make it work
    because everyone looks at the U.S. as a place where things
    work.
        Chairman Yarmuth. I appreciate that input.
        And before we say goodbye to you, I just want to invite
    you, if the documentation that Mr. Cline is submitting comes,
    if you would like to view that, whatever documentation, and
    respond for the record, that would be great.
        Secretary Becerra. Appreciate that, Chairman.
        Chairman Yarmuth. OK.
        And with that, I will yield back the balance of my time.
        And if there is no further business before the committee, I
    thank you again for your testimony and your service, and this
    hearing is adjourned.
        Secretary Becerra. Thank you.
        [Whereupon, at 5:27 p.m., the Committee was adjourned.]

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