[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.]
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