[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:]
    
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]    
        
    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:]
    
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]    
    
    
    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:]
    
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]    
        
    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:]
    
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]    
    
    
    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:]
    
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]    
      
    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.]
    
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]