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

                         THE FISCAL YEAR 2022 HHS BUDGET

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

                                VIRTUAL HEARING

                                   BEFORE THE

                             SUBCOMMITTEE ON HEALTH

                                     OF THE

                        COMMITTEE ON ENERGY AND COMMERCE
                            HOUSE OF REPRESENTATIVES

                        ONE HUNDRED SEVENTEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                                  MAY 12, 2021

                                   __________

                               Serial No. 117-30

    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

         Published for the use of the Committee on Energy and Commerce

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

                                   __________

                        U.S. GOVERNMENT PUBLISHING OFFICE
    48-145 PDF                  WASHINGTON : 2023

    -----------------------------------------------------------------------------------
                       COMMITTEE ON ENERGY AND COMMERCE

                         FRANK PALLONE, Jr., New Jersey
                                       Chairman

    BOBBY L. RUSH, Illinois              CATHY McMORRIS RODGERS, Washington
    ANNA G. ESHOO, California              Ranking Member
    DIANA DeGETTE, Colorado              FRED UPTON, Michigan
    MIKE DOYLE, Pennsylvania             MICHAEL C. BURGESS, Texas
    JAN SCHAKOWSKY, Illinois             STEVE SCALISE, Louisiana
    G. K. BUTTERFIELD, North Carolina    ROBERT E. LATTA, Ohio
    DORIS O. MATSUI, California          BRETT GUTHRIE, Kentucky
    KATHY CASTOR, Florida                DAVID B. McKINLEY, West Virginia
    JOHN P. SARBANES, Maryland           ADAM KINZINGER, Illinois
    JERRY McNERNEY, California           H. MORGAN GRIFFITH, Virginia
    PETER WELCH, Vermont                 GUS M. BILIRAKIS, Florida
    PAUL TONKO, New York                 BILL JOHNSON, Ohio
    YVETTE D. CLARKE, New York           BILLY LONG, Missouri
    KURT SCHRADER, Oregon                LARRY BUCSHON, Indiana
    TONY CARDENAS, California            MARKWAYNE MULLIN, Oklahoma
    RAUL RUIZ, California                RICHARD HUDSON, North Carolina
    SCOTT H. PETERS, California          TIM WALBERG, Michigan
    DEBBIE DINGELL, Michigan             EARL L. ``BUDDY'' CARTER, Georgia
    MARC A. VEASEY, Texas                JEFF DUNCAN, South Carolina
    ANN M. KUSTER, New Hampshire         GARY J. PALMER, Alabama
    ROBIN L. KELLY, Illinois, Vice       NEAL P. DUNN, Florida
        Chair                            JOHN R. CURTIS, Utah
    NANETTE DIAZ BARRAGAN, California    DEBBBIE LESKO, Arizona
    A. DONALD McEACHIN, Virginia         GREG PENCE, Indiana
    LISA BLUNT ROCHESTER, Delaware       DAN CRENSHAW, Texas
    DARREN SOTO, Florida                 JOHN JOYCE, Pennsylvania
    TOM O'HALLERAN, Arizona              KELLY ARMSTRONG, North Dakota
    KATHLEEN M. RICE, New York
    ANGIE CRAIG, Minnesota
    KIM SCHRIER, Washington
    LORI TRAHAN, Massachusetts
    LIZZIE FLETCHER, Texas
                                     ------

                               Professional Staff

                       JEFFREY C. CARROLL, Staff Director
                    TIFFANY GUARASCIO, Deputy Staff Director
                      NATE HODSON, Minority Staff Director
                             Subcommittee on Health

                           ANNA G. ESHOO, California
                                    Chairwoman
    G. K. BUTTERFIELD, North Carolina    BRETT GUTHRIE, Kentucky
    DORIS O. MATSUI, California            Ranking Member
    KATHY CASTOR, Florida                FRED UPTON, Michigan
    JOHN P. SARBANES, Maryland, Vice     MICHAEL C. BURGESS, Texas
        Chair                            H. MORGAN GRIFFITH, Virginia
    PETER WELCH, Vermont                 GUS M. BILIRAKIS, Florida
    KURT SCHRADER, Oregon                BILLY LONG, Missouri
    TONY CARDENAS, California            LARRY BUCSHON, Indiana
    RAUL RUIZ, California                MARKWAYNE MULLIN, Oklahoma
    DEBBIE DINGELL, Michigan             RICHARD HUDSON, North Carolina
    ANN M. KUSTER, New Hampshire         EARL L. ``BUDDY'' CARTER, Georgia
    ROBIN L. KELLY, Illinois             NEAL P. DUNN, Florida
    NANETTE DIAZ BARRAGAN, California    JOHN R. CURTIS, Utah
    LISA BLUNT ROCHESTER, Delaware       DAN CRENSHAW, Texas
    ANGIE CRAIG, Minnesota               JOHN JOYCE, Pennsylvania
    KIM SCHRIER, Washington              CATHY McMORRIS RODGERS, Washington
    LORI TRAHAN, Massachusetts               (ex officio)
    LIZZIE FLETCHER, Texas
    FRANK PALLONE, Jr., New Jersey (ex
        officio)
                                 C O N T E N T S

                                  ----------
                                                                       Page
    Hon. Anna G. Eshoo, a Representative in Congress from the State
      of California, opening statement...............................     2
        Prepared statement...........................................     3
    Hon. Brett Guthrie, a Representative in Congress from the
      Commonwealth of Kentucky, opening statement....................     4
        Prepared statement...........................................     6
    Hon. Frank Pallone, Jr., a Representative in Congress from the
      State of New Jersey, opening statement.........................     7
        Prepared statement...........................................     8
    Hon. Cathy McMorris Rodgers, a Representative in Congress from
      the State of Washington, opening statement.....................     9
        Prepared statement...........................................    11

                                   Witnesses

    Xavier Becerra, Secretary, Department of Health and Human
      Services.......................................................    13
        Prepared statement...........................................    15
        Answers to submitted questions \1\

                               Submitted Material

    Letter of May 11, 2021, from Hon. Val B. Demings, et al., to
      Xavier Becerra, Secretary, Department of Health and Human
      Services, submitted by Mr. Tonko...............................    83
    Fact sheet, ``Losing Texas' Waiver Extension Destabilizes the
      Health Care Safety Net,'' Texas Hospital Association, submitted
      by Mr. Burgess.................................................    88
    Press release of April 19, 2021, Texas Council of Community
      Centers, Texas Council of Community Centers Expresses Deep
      Concerns About Impact of Federal Government's Reversal of the
      10-Year 1115 Waiver Extension, submitted by Mr. Burgess........    90
    Article of April 30, 2021, ``White House is split over how to
      vaccinate the world,'' by Dan Diamond and Jeff Stein,
      Washington Post, submitted by Mr. Burgess......................    91
    Editorial of May 3, 2021, ``A patent-free `people's vaccine' is
      not the best way to help poor countries,'' Washington Post,
      submitted by Mr. Burgess.......................................    96
    Letter of May 3, 2021, from Michelle McMurry-Heath, President and
      Chief Executive Officer, Biotechnology Innovation Organization,
      to President Biden, submitted by Mr. Burgess...................    98
    Statement of Americans for Tax Reform, ``Biden Admin Surrenders
      on American IP Rights,'' submitted by Mr. Burgess..............   101
    Editorial of May 6, 2021, ``Biden's Vaccine IP Debacle,'' Wall
      Street Journal, submitted by Mr. Burgess.......................   103
    Commentary of May 6, 2021, ``President Joe Sanders,'' by
      Kimberley A. Strassel, Wall Street Journal, submitted by Mr.
      Burgess........................................................   107
    Statement of AUTM, ``Patent Waiver Strikes Damaging Blow to the
      Future of Innovation,'' by Stephen J. Susalka, Chief Executive
      Officer, submitted by Mr. Burgess..............................   111
    Statement of Novavax, May 7, 2021, submitted by Mr. Burgess......   113

    ----------

    \1\ Mr. Becerra's answers to submitted questions have been retained in
    committee files and are available at https://docs.house.gov/meetings/
    IF/IF14/20210512/112595/HHRG-117-IF14-Wstate-BecerraX-20210512-
    SD004.pdf.
    Letter of April 27, 2021, from Mr. Burgess, et al., to Xavier
      Becerra, Secretary, Department of Health and Human Services,
      submitted by Mr. Burgess.......................................   114
    Letter of February 26, 2021, from Hon. Abigail D. Spanberger, et
      al., to Acting Secretary Cochran, Department of Health and
      Human Services, submitted by Mr. Burgess.......................   118
    Statement of Americans for Limited Government, ``Biden's
      monumental World Trade Organization Covid mistake,'' May 10,
      2021, submitted by Mr. Burgess.................................   127
    Statement of the Children's Hospital Association, ``Impact of the
      Texas 1115 Waiver Extension Recission on Children's
      Hospitals,'' submitted by Mr. Burgess..........................   128
    Commentary of May 9, 2021, ``Patent Busting Won't Help Vaccinate
      the World Faster,'' by Luciana Borio and Scott Gottlieb, Wall
      Street Journal, submitted by Mr. Burgess.......................   129
    Article of May 7, 2021, ``North Carolina city could be next to
      house unaccompanied migrant children,'' by Anna Giaritelli,
      Washington Examiner, submitted by Mr. Hudson...................   133
    Article of May 10, 2021, ``Valley family pleads with FDA for
      access to experimental drug for fatal children's disease,'' by
      Sonu Wasu, ABC 15 Arizona, submitted by Mrs. Lesko.............   134

                        THE FISCAL YEAR 2022 HHS BUDGET

                                  ----------

                            WEDNESDAY, MAY 12, 2021

                      House of Representatives,
                                Subcommittee on Health,
                              Committee on Energy and Commerce,
                                                        Washington, DC.
        The subcommittee met, pursuant to call, at 10:30 a.m., via
    Cisco Webex online video conferencing, Hon. Anna G. Eshoo
    (chairwoman of the subcommittee) presiding.
        Members present: Representatives Eshoo, Butterfield,
    Matsui, Castor, Sarbanes, Welch, Schrader, Ruiz, Dingell,
    Kuster, Kelly, Barragan, Blunt Rochester, Craig, Schrier,
    Trahan, Fletcher, Pallone (ex officio), Guthrie (subcommittee
    ranking member), Upton, Burgess, Griffith, Bilirakis, Long,
    Bucshon, Mullin, Hudson, Carter, Dunn, Curtis, Crenshaw, Joyce,
    and Rodgers (ex officio).
        Also present: Representatives Doyle, Schakowsky, McNerney,
    Tonko, Clarke, Rice, and Lesko.
        Staff present: Joe Banez, Professional Staff Member; Shana
    Beavin, Professional Staff Member; Jacquelyn Bolen, Health
    Counsel; Jeffrey C. Carroll, Staff Director; Waverly Gordon,
    General Counsel; Jessica Grandberry, Staff Assistant; Tiffany
    Guarascio, Deputy Staff Director; Stephen Holland, Health
    Counsel; Saha Khaterzai, Professional Staff Member; Una Lee,
    Chief Health Counsel; Aisling McDonough, Policy Coordinator;
    Meghan Mullon, Policy Analyst; Juan Negrete, Junior
    Professional Staff Member; Kaitlyn Peel, Digital Director; Tim
    Robinson, Chief Counsel; Chloe Rodriguez, Clerk; Samantha
    Satchell, Professional Staff Member; Kimberlee Trzeciak, Chief
    Health Advisor; Rick Van Buren, Health Counsel; C.J. Young,
    Deputy Communications Director; Alec Aramanda, Minority
    Professional Staff Member, Health; Sarah Burke, Minority Deputy
    Staff Director; Grace Graham, Minority Chief Counsel, Health;
    Nate Hodson, Minority Staff Director; Peter Kielty, Minority
    General Counsel; Emily King, Minority Member Services Director;
    Clare Paoletta, Minority Policy Analyst, Health; Kristin Seum,
    Minority Counsel, Health; Kristen Shatynski, Minority
    Professional Staff Member, Health; Olivia Shields, Minority
    Communications Director; Everett Winnick, Minority Director of
    Information Technology.
        Ms. Eshoo. So good morning, everyone. Welcome to the
    Subcommittee on Health, which will now come to order.
        Due to COVID-19, today's hearing is being, obviously, held
    remotely. All Members and witnesses will be participating via
    video conferencing.
        As part of our hearing, microphones will be set on mute to
    eliminate background noise, and Members and our witness, you
    will need to unmute your microphone each time you wish to
    speak.
        Documents for the record should be sent to Meghan Mullon at
    the email address we provided to your staff. And all documents
    will be entered into the record at the conclusion of the
    hearing.
        The Secretary, as I said, has a hard stop at 2:00 p.m.
    Eastern Standard Time. So, as I just mentioned a few moments
    ago, I will be--I will have to enforce the 5-minute clock to
    ensure there is enough time for all subcommittee members to ask
    questions.
        I know that there are full committee members that are
    joining us today. I hope we have time for you to ask questions.
    We will do our best, but the subcommittee members will,
    obviously, come first.
        So the Chair now recognizes herself for 5 minutes for an
    opening statement.

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

        Welcome, Secretary Becerra. You are so welcome here, and we
    wish you every success. As you succeed in leading HHS, the
    American people will succeed.
        The Secretary and I are classmates. We came into the
    Congress at the same time.
        And Mr. Secretary, you have inherited a position with
    enormous responsibilities, especially as our Nation recovers
    from COVID-19. I think you are already making progress. HHS and
    the Biden administration have administered over 200 million
    COVID-19 vaccine doses and are on track to vaccinate 70 percent
    of American adults by the Fourth of July. That would be a new
    kind of celebration of the birth of our country. New COVID-19
    cases are at--thank God--at a 7-month low. We are seeing
    children safely going back to school, States reopening, and
    normalcy--some normalcy--returning.
        The Biden administration has moved quickly to reverse the
    damage done to our healthcare system by the previous
    administration: enrolling over 1 million more Americans in the
    ACA health coverage and reversing the draconian cuts to in-
    person enrollment help; rescinding the approval of several
    States' unlawful Medicaid work requirements; ending the
    discriminatory public charge rule, which would have penalized
    people for legally using healthcare services such as Medicaid;
    returning the U.S. to the World Health Organization; protecting
    women's health by proposing regulations to end the title 9 gag
    rule as well as ending the global gag rule; and ending
    discrimination in healthcare based on gender identity or sexual
    orientation. These actions are in addition to quickly and
    responsibly distributing the billions of dollars in emergency
    public health funding provided through the American Rescue
    Plan.
        President Biden's fiscal year 2022 budget request continues
    these achievements by helping American families rebuild from
    the COVID-19 crisis, healthier and safer than before. The
    budget request addresses the systemic failures revealed by the
    pandemic, by restoring and expanding public health capacity by
    providing the CDC with its largest budget increase in 2
    decades--in 20 years--supplying $1.6 billion for the Community
    Mental Health Services Block Grant, more than doubling our
    Nation's mental health funding. That is an issue, Mr.
    Secretary, that every member of this subcommittee has spoken to
    and worked on.
        Investing $10.7 billion to end the opioid crisis after last
    year's tragic record-high number of overdose deaths: another
    bipartisan issue. And addressing our Nation's racial health
    disparities by increasing the Indian Health Service's budget by
    $2.2 billion; and making major investments at the CDC to reduce
    maternal mortality, especially for Black women.
        Importantly, the President's request also provides $6.5
    billion to launch the Advanced Research Projects Agency for
    Health, ARPA-H, which holds the promise for transformational
    advanced biomedical research.
        I very much look forward to hearing more about this today,
    about what the administration envisions for this agency, but
    there is still so much more to do. I think there always is.
        Our national security is at risk, because our dependence on
    foreign manufacturing for medical supplies and pharmaceuticals
    continues. We are unprepared for the avalanche of patients who
    will need care for chronic long COVID. We still don't have an
    effective or easy-to-access treatment for COVID-19. And our
    Nation continues to face stark and persistent racial
    disparities in health coverage, chronic disease, and mortality.
        So we have a lot more work to do, Mr. Secretary. We look
    forward to working with you to develop a budget and policies to
    improve our Nation's health and well-being. And we thank you
    for being with us today.
        [The prepared statement of Ms. Eshoo follows:]

                    Prepared Statement of Hon. Anna G. Eshoo

        Welcome Secretary Becerra. You are so welcome here and we
    wish you every success. As you succeed in leading HHS, the
    American people will succeed. The Secretary and I are
    classmates, we came into Congress at the same time. And Mr.
    Secretary, you've inherited a position with enormous
    responsibilities, especially as our Nation recovers from COVID-
    19.
        You're already making progress. HHS and the Biden
    administration have administered over 200 million COVID-19
    vaccine doses and are on track to vaccinate 70% of American
    adults by the Fourth of July. That would be a new kind of
    celebration of the birth of our country. New COVID-19 cases are
    at, thank God, a 7-month low. We're seeing children safely
    going back to school, States reopening, and some normalcy
    returning.
        The Biden administration has moved quickly to reverse the
    damage done to our healthcare system by the previous
    administration by:
         Enrolling over 1 million more Americans in ACA
    health coverage and reversing the draconian cuts to in-person
    enrollment help.
         Rescinding the approval of several States'
    unlawful Medicaid work requirements.
         Ending the discriminatory public charge rule,
    which would have penalized people for legally using healthcare
    services such as Medicaid.
         Returning the U.S. to the World Health
    Organization.
         Protecting women's health by proposing regulations
    to end the Title X gag rule, as well as ending the global gag
    rule.
         And ending discrimination in healthcare based on
    gender identity or sexual orientation.
        These actions are in addition to quickly and responsibly
    distributing the billions of dollars in emergency public health
    funding provided through the American Rescue Plan.
        President Biden's fiscal year 2022 budget request continues
    these achievements by helping American families rebuild from
    the COVID-19 crisis healthier and safer than before.
        The budget request addresses the systemic failures revealed
    by the pandemic by:
         Restoring and expanding public health capacity by
    providing the CDC with its largest budget increase in 20 years,
         Supplying $1.6 billion for the Community Mental
    Health Services Block Grant, more than doubling our Nation's
    mental health funding,
         Investing $10.7 billion to end the opioid crisis
    after last year's tragic record high number of overdose deaths,
         And addressing our Nation's racial health
    disparities by increasing the Indian Health Service's budget by
    $2.2 billion and making major investments at the CDC to reduce
    maternal mortality, especially for Black women.
        Importantly, the President's request also provides $6.5
    billion to launch the Advanced Research Projects Agency for
    Health (ARPA-H), which holds the promise for transformational,
    advanced biomedical research. I look forward to hearing more
    today about what the administration envisions for this agency.
        But there's still more to do. Our national security is at
    risk because of our dependence on foreign manufacturing for
    medical supplies and pharmaceuticals continues. We're
    unprepared for the avalanche of patients who will need care for
    chronic long COVID. We still do not have an effective or easy-
    to-access treatment for COVID-19. And our Nation continues to
    face stark and persistent racial disparities in health
    coverage, chronic disease, and mortality.
        So, we have a lot more work to do. We look forward to
    working with you to develop a budget and policies to improve
    our Nation's health and wellbeing. Thank you for your
    testimony.

        Ms. Eshoo. The Chair now recognizes the ranking member of
    our subcommittee, the gentleman Mr. Guthrie, for his 5 minutes
    for an opening statement.

     OPENING STATEMENT OF HON. BRETT GUTHRIE, A REPRESENTATIVE IN
               CONGRESS FROM THE COMMONWEALTH OF KENTUCKY

        Mr. Guthrie. Thank you, Chair Eshoo, for having this
    important hearing.
        And thank you, Secretary Becerra, for being here today as
    we examine the fiscal year 2022 Department of Health and Human
    Services budget.
        I was alarmed to see the amount of spending that the
    administration believes we can afford after reviewing the Biden
    administration's ``skinny budget.'' In total, the proposed
    budget is more than an 8 percent increase over the amount
    appropriated for fiscal year 2021. This increase will be on top
    of the nearly 4 trillion Congress has already allocated for the
    COVID-19 pandemic in the first 5 COVID-19 relief bills.
        I supported these relief bills that were focused on
    providing needed COVID-related assistance for our country; $1.3
    trillion of this funding has yet to be disbursed from relief
    packages. That doesn't include the 1.9 trillion recently
    authorized for President Biden's COVID-19 package, which only 9
    percent goes towards fighting the virus.
        The HHS budget proposal in front of us today grows HHS by
    almost a quarter, with 131.7 billion included in the 1.5
    trillion fiscal year 2022 budget.
        I agree we need to improve public health infrastructure and
    better prepare for future public health emergencies. However,
    as we work on these improvements, we also have the
    responsibility to be good stewards of taxpayer dollars. We have
    seen firsthand how public-private partnerships such as
    Operation Warp Speed have allowed this country to get
    vaccinated and reopen months ahead of our peers around the
    world. I hope we can work across the aisle to fully evaluate
    the programs that need support, and allocate funds wisely.
        There is no doubt that we must continue to increase funding
    for the National Institutes of Health. In fact, Republicans
    have worked with Democrats to increase funding for NIH each
    year over the past five years. As we look at the budgets of
    Federal agencies that help with COVID-19 response efforts, we
    need to assess any increase in the context of their
    performance. I specifically want to mention my strong concerns
    with certain areas of what we know of the proposed budget.
        First, I am pro-life. I believe in protecting the unborn. I
    am very concerned with President Biden's comments on removing
    the Hyde Amendment. Hyde has been around since 1976, and agreed
    upon for both Republicans and Democrats for its inclusion in
    appropriation bills for years. I strongly disagree with
    removing this protection and allowing taxpayer dollars to fund
    abortion procedures.
        Secondly, I would like to speak with the current crisis at
    our southern border. Last Congress I served as ranking member
    of the Oversight and Investigations Subcommittee. The
    subcommittee held hearings on the management, care, and
    treatment of unaccompanied children. At that time, U.S. Customs
    and Border Patrol was experiencing a record number of
    encounters with unaccompanied children. And as a result, the
    Office of Refugee Resettlement was experiencing a number--
    record numbers of referrals. Since President Biden has taken
    office, there has been a rush of migrants arriving at our
    southern border. CBP and ORR are experiencing even higher
    numbers than they did in 2019.
        According to CBP data, starting in January of this year,
    the number of UCs and single minor land border encounters each
    month has been higher than the numbers were during those same
    months in previous years. As of May 2nd, 2021, there were over
    22,000 unaccompanied children in ORR's care. As a result, ORR
    has had to open several temporary influx care facilities and
    emergency intake sites, but has yet to open one of the
    temporary influx facilities that the Trump administration kept
    in a ``warm'' status to quickly stand up for surges in UC
    referrals.
        Further, there have been reports of thousands of migrant
    children being kept in overcrowded Border Patrol facilities for
    longer than 72 hours. I joined several of my colleagues on this
    committee to request information from the Biden administration
    on capacity issues, allegations of abuse, and COVID-19
    protocols. While we received responses to some of the questions
    yesterday, we await answers on the rest. The Biden
    administration must get a better grasp on handling this crisis
    and the massive influx of UC referrals.
        Secretary Becerra, I appreciate you being here today, and I
    appreciate our phone call yesterday. And I look forward to
    hearing your testimony and responses to important questions
    from my colleagues, and I yield back my time.
        [The prepared statement of Mr. Guthrie follows:]

                    Prepared Statement of Hon. Brett Guthrie

        Thank you, Chair Eshoo for having this important hearing,
    and thank you Secretary Becerra for being here today as we
    examine the fiscal year 2022 Department of Health and Human
    Services (HHS) budget.
        I was alarmed to see the amount of spending that the
    administration believes we can afford after reviewing the Biden
    administration's ``skinny budget.'' In total, the proposed
    budget is a nearly 9-percent increase over the amount
    appropriated for 2020. This increase would be on top of the
    nearly $4 trillion Congress has already allocated for the
    COVID-19 pandemic in the first five COVID-19 relief bills. I
    supported these relief bills that were focused on providing
    needed COVID related assistance for our country. $1.3 trillion
    of this funding has yet to be disbursed from those relief
    packages. That doesn't include the $1.9 trillion recently
    authorized from President Biden's COVID-19 package, which only
    9% ended up going towards stopping COVID-19. The HHS budget
    proposal in front of us today grows HHS by almost a quarter
    with $131.7 billion included in the $1.5 trillion fiscal year
    2022 budget.
        I agree we need to improve our public infrastructure and
    better prepare for future public health emergencies; however,
    as we work on these improvements, we also have the
    responsibility to be good stewards of taxpayer dollars.
        We have seen firsthand how public-private partnerships such
    as Operation Warp Speed (OWS) have allowed this country to get
    vaccinated and reopen months ahead of our peers around the
    world. I hope we can work across the aisle to fully evaluate
    the programs that need support and allocate funding wisely.
        There is no doubt that we must continue to increase funding
    for the National Institutes of Health. In fact, Republicans
    have worked with Democrats to increase funding for the NIH each
    year over the past five years. As we look at the budgets of
    Federal agencies that helped with COVID-19 response efforts, we
    need to assess any increases in the context of their
    performance.
        I specifically want to mention my strong concerns with
    certain areas of what we know of the proposed budget. First, I
    am pro-life. I believe in protecting the unborn. I am very
    concerned with President Biden's comments on removing the Hyde
    Amendment. Hyde has been around since 1976 and agreed upon for
    both Republicans and Democrats for its inclusion in
    appropriations bills for years. I strongly disagree with
    removing this protection and allowing taxpayer dollars to fund
    abortion procedures.
        Secondly, I would like to speak to the current crisis at
    our southern border. Last Congress when I served as Ranking
    Member of the Oversight and Investigations Subcommittee, the
    Subcommittee held hearings on the management, care, and
    treatment of unaccompanied children (UC). At that time, U.S.
    Customs and Border Protection (CBP) was experiencing a record
    number of encounters with UC, and as a result, the Office of
    Refugee Resettlement (ORR) was experiencing a record numbers of
    referrals.
        Since President Biden has taken office, there has been a
    rush of migrants arriving at the southern border. CBP and ORR
    are experiencing even higher numbers than they did in 2019.
    According to CBP data, starting in January, the number of UC
    and single minor land border encounters each month has been
    higher than the numbers were during those same months in
    previous years.\1\ As of May 2, 2021, there were over 22,000 UC
    in ORR's care.\2\ As a result, ORR has had to open several
    temporary influx care facilities and emergency intake sites but
    has yet to open one of the temporary influx facilities that the
    Trump administration kept in ``warm'' status to quickly stand
    up for surges in UC referrals. Further, there have been reports
    of thousands of migrant children being kept in overcrowded
    Border Patrol facilities for longer than 72 hours. I joined
    several of my colleagues on this committee to request
    information from the Biden administration on capacity issues,
    allegations of abuse, and COVID-19 protocols. While we received
    responses to some of the questions yesterday, we await answers
    on the rest. The Biden administration must get a better grasp
    on handling this crisis and massive influx of UC referrals.
    ---------------------------------------------------------------------------
        \1\ https://www.cbp.gov/newsroom/stats/southwest-land-border-
    encounters.
        \2\ https://www.hhs.gov/sites/default/files/uac-program-fact-
    sheet.pdf
    ---------------------------------------------------------------------------
        Secretary Becerra, I appreciate you being here today, and I
    look forward to hearing your testimony and responses to
    important questions from my colleagues.

        Ms. Eshoo. The gentleman yields back. The Chair now
    recognizes the chairman of the full committee, Mr. Pallone, for
    his 5 minutes of--opening statement, I am sorry.
        Good to see you, Frank.

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

        Mr. Pallone. Thank you, Chairwoman Eshoo. This is,
    obviously, a very important hearing, and it is really great to
    see our new Secretary, who is one of our colleagues and a
    former member of the Democratic leadership, Xavier Becerra.
        Great to see you, Xavier.
        At last year's hearing with the Trump administration,
    Democrats highlighted the implications of massive cuts that
    were being proposed to vital health programs, while
    simultaneously hearing Federal witnesses attest to the
    terrifying potential of the then-new virus known as COVID-19.
    The Biden administration's fiscal year '22 budget request is,
    comparatively, a breath of fresh air, and we can now bolster
    our Nation's public health agencies by acting on this request.
        I heard Mr. Guthrie express concern about the increases,
    but I believe that, given the pandemic, I think these increases
    are absolutely necessary. Overall, the request includes 131.7
    billion for HHS and its adjoining agencies, a 23.5 increase
    from the 2021-enacted level. This includes critical investments
    to improve our Nation's public health preparedness, such as 905
    million for the Strategic National Stockpile and 8.7 billion
    for capacity improvements and public health threat detection
    and assistance at the Centers for Disease Control. If enacted,
    this would be the largest budgetary increase for CDC in nearly
    20 years.
        The request also includes funding for vital safety net
    programs and for addressing health inequities in COVID-19 and
    beyond. It increases funding for CDC's Social Determinants of
    Health Program, it aims to reduce maternal mortality and
    morbidity through strengthening Maternal Mortality Review
    Committees, and provides a funding increase to the Indian
    Health Service, very important to many of our Members on this
    committee. It also provides an 18 percent budget increase for
    the Title X Family Planning program, and this program has
    historically served over 4 million low-income people a year by
    providing critical screenings and health services.
        Now, the Biden administration's budget request would also
    expand cross-agency research capabilities to combat life-
    threatening diseases. Through the National Institutes of
    Health, it would establish the Advanced Research Projects
    Agency-Health, or ARPA-H, a research agency that would
    initially focus on diseases such as cancer, diabetes, and
    Alzheimer's. I look forward to learning more about how the
    proposed agency's activities may build off NIH's existing
    research to find lifesaving cures. I know the President talked
    about this in his address, Mr. Secretary.
        And lastly, the budget request also makes significant
    investments in improving mental health and combating the opioid
    epidemic. It would provide $1.6 billion to the Community Mental
    Health Services Block Grant and 10.7 billion to fight the
    opioid crisis, which has been exacerbated--as we know, we have
    had hearings on this, Madam Chair--by the COVID-19 pandemic.
        Now, these investments are bold and necessary, but we can't
    stop there. The COVID-19 pandemic laid bare the impacts chronic
    underfunding of public health has had on our surveillance,
    preparedness, and response efforts. And it is my hope to work
    with the Biden administration to ensure rebuilding our public
    health infrastructure is a key component of any jobs and
    infrastructure plan.
        And we also have to take action to lower the cost of
    prescription drugs--the President mentioned it in his address--
    by passing H.R. 3, the Elijah Cummings Lower Drug Costs Now
    Act. And we have to make permanent the enhanced premium tax
    credits that we enacted into law on a temporary basis in the
    American Rescue Plan.
        The administration recently announced that nearly a million
    Americans signed up for health coverage during the Special
    Enrollment Period, and the enhanced subsidies are reducing
    monthly premiums by over 40 percent. Thank you again, Secretary
    Becerra, for really pushing that Special Enrollment Period. I
    know how important it is to you.
        We also have to ensure that low-income Americans have
    access to quality, affordable coverage. And now is the time to
    finish the work we began over a decade ago with the Affordable
    Care Act.
        Now, I just wanted to say this. I heard Mr. Guthrie mention
    ORR and the southern border and the unaccompanied children.
        You know, I have to be critical, Mr. Guthrie, because you
    somehow suggested that, you know, that the Trump administration
    played a positive role in this. Maybe that is not what you
    meant, but it sounded that way. And I have to say, after having
    gone through 4 years with the Trump administration, which
    forcibly separated children from their families, caused
    terrible damage to not only the children, but to the ORR
    program itself, I cannot see anything positive that came out of
    that.
        You know, during the time that they were in charge, the
    Republicans on this committee refused to even hold a single
    hearing to examine what was happening and hold the Trump
    administration accountable for their outrageous actions. So,
    you know, the Biden administration was left with this decimated
    system, but they are working hard to process those children
    humanely. And thanks to you, I know we are going to hold a
    hearing within the next month in our Oversight and
    Investigations Subcommittee, where the head of the ORR will
    testify, and we will examine how the ORR program is
    functioning. I like to be bipartisan, but I can't excuse the
    Trump behavior on this. And I think the Biden administration is
    doing their best to deal with was what was left in a terrible
    situation.
        Thank you, Madam Chair.
        [The prepared statement of Mr. Pallone follows:]

                 Prepared Statement of Hon. Frank Pallone, Jr.

        At last year's hearing with the Trump administration,
    Democrats highlighted the implications of massive cuts that
    were being proposed to vital health programs while,
    simultaneously, hearing Federal witnesses attest to the
    terrifying potential of the then-new virus known as COVID-19.
        The Biden administration's fiscal year 2022 budget request
    is, comparatively, a breath of fresh air. We can now bolster
    our Nation's public health agencies by acting on this request.
        Overall, the request includes $131.7 billion for HHS and
    its adjoining agencies, a 23.5 percent increase from the 2021
    enacted level. This includes critical investments to improve
    our Nation's public health preparedness, such as $905 million
    for the Strategic National Stockpile and $8.7 billion for
    capacity improvements and public health threat detection and
    assistance at the Centers for Disease Control and Prevention
    (CDC). If enacted, this would be the largest budgetary increase
    for CDC in nearly 20 years.
        The request also includes funding for vital safety net
    programs and for addressing health inequities in COVID-19 and
    beyond. It increases funding for CDC's Social Determinants of
    Health program, aims to reduce maternal mortality and morbidity
    through strengthening Maternal Mortality Review Committees, and
    provides a funding increase to the Indian Health Service. It
    also provides an 18 percent budget increase for the Title X
    Family Planning program. The program has historically served
    over 4 million low-income people a year by providing critical
    screenings and health services.
        The administration's budget request would also expand
    cross-agency research capabilities to combat life-threatening
    diseases. Through the National Institutes of Health, it would
    establish the Advanced Research Projects Agency-Health, or
    ARPA-H, a research agency that would initially focus on
    diseases such as cancer, diabetes, and Alzheimer's. I look
    forward to learning more about how the proposed agency's
    activities may build off NIH's existing research to find
    lifesaving cures.
        Lastly, the budget request also makes significant
    investments in improving mental health and combating the opioid
    epidemic. It would provide $1.6 billion to the Community Mental
    Health Services Block Grant and $10.7 billion to fight the
    opioid crisis, which has been exacerbated by the COVID-19
    pandemic.
        These investments are bold and necessary, but we must not
    stop there. The COVID-19 pandemic laid bare the impacts chronic
    underfunding of public health has had on our surveillance,
    preparedness, and response efforts. It is my hope to work with
    the Biden administration to ensure rebuilding our public health
    infrastructure is a key component of any jobs and
    infrastructure plan.
        We must also take action to lower the cost of prescription
    drugs for the American people by passing H.R. 3, the Elijah E.
    Cummings Lower Drug Costs Now Act. And we must make permanent
    the enhanced premium tax credits that we enacted into law on a
    temporary basis in the American Rescue Plan.
        The administration recently announced that nearly a million
    Americans signed up for health coverage during the Special
    Enrollment period and the enhanced subsidies are reducing
    monthly premiums by over 40 percent.
        We must ensure that low-income Americans have access to
    quality, affordable coverage. Now is the time to finish the
    work we began over a decade ago with the Affordable Care Act by
    once and for all closing the coverage gap, and ensuring that
    people have access to the protections of Medicaid regardless of
    what State they live in. We should also make permanent the
    American Rescue Plan's option to allow State Medicaid programs
    to cover women for 12 months postpartum.
        The Trump administration forcibly separated children from
    their families, causing terrible damage to not only the
    children, but the ORR program itself. Yet during their time in
    charge, Energy and Commerce Republicans refused to hold even a
    single hearing to examine what was happening and hold the Trump
    administration accountable for their outrageous actions.
        The Biden administration was left with a decimated system,
    but is working to process these children humanely. Thanks to
    the leadership of Secretary Becerra, I will hold a hearing
    within the next month in our Oversight and Investigations
    Subcommittee where the head of ORR will testify and we will
    examine how the ORR program is functioning.
        I look forward to hearing from the Secretary today, and to
    working on our shared priorities moving forward.
        I yield back.

        Ms. Eshoo. The gentleman yields back. The Chair now
    recognizes the ranking member of the full committee,
    Representative Cathy McMorris Rodgers, for her 5 minutes for an
    opening statement.

          OPENING STATEMENT OF HON. CATHY McMORRIS RODGERS, A
        REPRESENTATIVE IN CONGRESS FROM THE STATE OF WASHINGTON

        Mrs. Rodgers. Thank you, Madam Chair. Good morning,
    everyone.
        Just very quickly on the border: Under the Trump
    administration there was action taken very quickly to get more
    money, to actually get the border under control, to get
    families back together, to get more judges in place so that we
    could secure our border, and also help those that were knocking
    on our door. And I believe that more--we need--this needs to be
    a priority now.
        Unfortunately, the crisis at the border is being ignored by
    the current administration. And I know we are going to work on
    that some more. This committee has been at the forefront of
    this issue.
        Today we have Secretary Becerra with us, and I wanted to
    join in saying congratulations, and I too served with Secretary
    Becerra in the House of Representatives.
        And I look forward to working with you in this new
    position. Certainly, as Secretary of the Department of Health
    and Human Services, you are at the forefront of a critical time
    in our Nation's history, and as we turn the corner on the
    pandemic. And really, thanks to the historic innovation of the
    private sector and the Trump administration's Operation Warp
    Speed, we are delivering fast and effective and safe vaccines
    to millions of Americans. And it is something that we came
    together to accomplish, and it is an American success.
        We hope that your leadership will provide clear and
    consistent evidence-based guidance as we reopen, including 100
    percent of our schools, and bring optimism to America again.
        Mr. Secretary, after a year of lockdowns, fear, isolation,
    too many in our communities are battling the depths of despair.
    Our communities are seeing record-high overdose deaths. Mental
    health emergencies have increased. We know the pandemic and
    top-down government decisions from lockdowns and school
    closures, unfortunately, have made it worse. It is going to
    take our Nation's best and brightest in local communities,
    doctors, the private sector to fix these problems and deliver a
    solution that families desperately need and want.
        We have broken families, we have broken systems, and we
    must address it. Unfortunately, socialized medicine, a
    government-run healthcare system, is not the solution. It will
    only lead to--it won't lead to personalized care. We need
    personalized care for every individual, every person, to have a
    chance for a better quality of life.
        I am concerned about so many that have continued to
    advocate for a single-payer system and socialized medicine,
    Medicare for all. Centralized government healthcare is full of
    empty promises. This is the reality. Rather than provide
    certainty, it kicks roughly 180 million people off their
    employment-based plans and significantly raises costs. Rather
    than modernize our healthcare system to empower patients to
    catch up to the 21st century, Medicare for all would take us--
    would take back the clock to an outdated, politically
    influenced government takeover of our healthcare system.
        Just like Speaker Pelosi's drug price control scheme,
    single-payer will destroy innovation for new cures and
    breakthrough medical treatment. It will also limit access. CBO
    reported, ``Public plan might not be as quick to meet patients'
    needs, such as covering new treatments.'' That is CBO.
        My colleagues and I aren't going to accept the empty
    promises of socialized medicine. I will take freedom over empty
    promises for free stuff any day of the week. There is too much
    at stake as we crush this pandemic. Fight the depths of
    despair, and build a new future for a modern healthcare system.
    We should be taking action to make sure that people can make
    the best decisions for themselves.
        And I did want to address the border crisis. Illegal border
    crossings remain at a 20-year high. More than 22,000 children
    are in facilities right now. This is a record. We need to hear
    what we are going to do to slow this down. And in many cases,
    the administration, unfortunately, has been silent. We need
    accountability. We need to have answers.
        I appreciate you being here today. From the immediate
    crisis at the border to the long-term crisis that will result
    if we don't modernize our healthcare system, bring price
    transparency, empower individuals, empower patients, that needs
    to be our goal. So thank you again for joining us. I hope this
    is an opportunity to work together, to build trust, and to
    really focus on the American people and the best healthcare
    system in the world.
        And with that, I yield back.
        [The prepared statement of Mrs. Rodgers follows:]

               Prepared Statement of Hon. Cathy McMorris Rodgers

    INTRO
        Secretary Becerra, welcome to Energy and Commerce for the
    first time-and certainly not your last.
        You are leading the Department of Health and Human Services
    through a critical time as America turns the corner of this
    pandemic...
        ... thanks to the historic innovation of the private sector
    and the Trump administration's Operation Warp Speed to deliver
    safe and effective vaccines.
        Now the buck stops with you to provide clear and consistent
    evidence-based guidance as we reopen--including 100 percent of
    our schools--and bring optimism to America again.
    HEALTHCARE CRISES TODAY
        Mr. Secretary, after a year of lockdowns, fear, and
    isolation... our communities are battling the deaths of
    despair.
        Communities are seeing record high overdose deaths.
        Mental health emergencies have increased.
        We know the pandemic--and top-down government decisions
    from lockdowns and school closures--made them worse.
        It's going to take our Nation's best and brightest in local
    communities, doctors, and the private sector... to fix these
    problems and deliver the healthcare solutions families
    desperately need and want.
        Decisions made by the Federal Government or by politicians
    won't solve broken families and broken systems.
        It certainly won't lead to personalized care for every
    person to have a chance at a better quality of life.
        Which brings me to your lifelong advocacy for a single
    payer system and socialized medicine.
    EMPTY PROMISES OF MFA
        Medicare For All--centralized government-run healthcare--is
    full of empty promises.
        This is the reality:
        Rather than provide certainty, it kicks roughly 180 million
    people off their employment based plans and raises costs.
        Rather than modernize our healthcare system to empower
    patients to catch up to the 21st Century, Medicare For All
    would turn back the clock to an outdated, politically
    influenced, complete government takeover of our healthcare
    system.
        Just like Speaker Pelosi's drug price control scheme...
    single-payer will destroy innovation for new cures and
    breakthrough medical treatments.
        It will also limit access. CBO reported a ``public plan
    might not be as quick to meet patients' needs, such as covering
    new treatments.''
        My colleagues and I aren't going to accept the empty
    promises of socialized medicine.
        I'll take freedom over empty promises for free stuff any
    day of the week.
        There's too much at stake as we crush this pandemic...
        ... fight the deaths of despair...
        ... and build the new future for a modern healthcare
    system.
        We should be taking action to make sure people can make the
    best decisions for themselves to find the best care possible.
        Now, is the time. It's what people deserve after this
    pandemic. It's what they deserve 10... 20... 30... years from
    now too.
        That's why Republicans are leading for more price
    transparency--foundational to restoring the doctor-patient
    relationship.
        ... Lowering prescription drugs costs without government
    price controls that discriminate against Americans with
    disabilities and diseases.
        ... And spurring more private investment for breakthrough
    cures and treatments.
        These are the priorities that will lead to a better
    healthcare future and improve people's quality of life for
    decades to come.
        Before you release the full HHS budget...
        ...we urge you to take that into consideration and put
    aside any radical agenda that makes a lot of promises but falls
    short on real results.
    BORDER
        Now, turning to President Biden's border crisis.
        Illegal border crossings remain at a 20 year high.
        More than 22,000 children are in facilities under the care
    of Health and Human Services.
        This is a record.
        We need to hear from you an explanation on why the
    administration has been slow to address--and in many cases has
    been silent--on the ongoing public health and humanitarian
    crisis at the border.
        We need accountability--not more blame shifting between
    administration officials.
        We received your response yesterday to our request for
    information related to the management, care, and treatment of
    unaccompanied children.
        Thank you but many questions remain unanswered and we
    expect HHS--under your leadership--to be more responsive to
    Congressional oversight.
        We look forward to your response today.
    CONCLUSION
        From the immediate crisis at the border...
        ... to the long-term crisis that will result if we don't
    modernize our healthcare system...
        ... you have a lot of responsibility as Secretary.
        I want to thank you again for joining us. I hope this is an
    opportunity to build trust and develop a strong working
    relationship.
        Thank you.

        Ms. Eshoo. The gentlewoman yields back. I now would like to
    introduce our witness. In so many ways he doesn't need an
    introduction, because so many of us know him well.
        But let me just say that Secretary Becerra is the 25th
    Secretary of the Department of Health and Human Services. He
    previously served, just before he came back to DC, as the
    Secretary--served as the attorney general of the State of
    California, the second-largest Department of Justice in the
    country, outside of the DoJ in the--in Washington, DC. And he
    served, very importantly, for 12 terms in the United States
    House of Representatives. And we are all very proud of him.
        We are very proud of you, Mr. Secretary. So welcome to the
    subcommittee. You are no stranger, obviously, to the House.
    While you were not a member of the Energy and Commerce
    Committee, you were a part of the tax writing. So you did the
    tax work, we did the big policies. And it is really great to
    see you. As I said, to the extent that you succeed in leading
    this agency, the Nation will succeed, so we want to work with
    you to ensure that.
        So you are now recognized for your 5 minutes of opening
    statement. You look great, and take it away.

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

        Mr. Becerra. Chairwoman Eshoo, Ranking Member Guthrie, and
    members of the committee, first, great to see so many familiar
    faces, and thank you for the opportunity to appear before you
    to discuss the President's 2022 discretionary HHS budget.
        The COVID-19 pandemic has shed light on how health
    disparities and the lack of national coordination and funding
    can leave us vulnerable to crises. Now, more than ever, we must
    assure that HHS has the resources to achieve its mission and
    protect the health of our communities. The budget President
    Biden has put forward is targeted and forward-thinking to meet
    Department goals.
        For HHS the budget proposes $131 billion in discretionary
    budget authority. This $25 billion increase from fiscal year
    2021 underscores the administration's commitment to prepare the
    Nation for the next public health crisis, to address
    disparities in healthcare, and to support our State and local
    partners, and as well to invest meaningfully in behavioral
    health, among other very important priorities.
        To start, the budget provides $905 million for the
    Strategic National Stockpile, which has served a critical role
    in the COVID-19 response but is in need of upgrade.
        The budget also makes the largest investment in CDC in
    almost two decades. With these 2022 investments, CDC will
    address preparedness within the United States and strengthen
    global health security. As we continue to confront new and
    emerging COVID-19 variants as well as an accelerating surge of
    cases in places like India, support for CDC's work is ever more
    important.
        Madam Chair, the budget provides funding increases to
    address violence in our communities: $489 million to support
    and protect domestic violence survivors and $66 million to
    support victims of human trafficking and torture.
        Gun violence, very much a public health issue, is addressed
    by doubling both CDC and NIH funding for firearm violence
    prevention research.
        And to ensure that HHS is equitably serving all Americans,
    the discretionary request to invest over $200 million to reduce
    maternal mortality and morbidity, which disproportionately
    affects women of color, it funds a range of rural healthcare
    programs, and expands the pipeline of rural healthcare
    providers. It includes a $2.2 billion increase and advances
    appropriations for the Indian Health Services.
        The budget increases funding for title 10 family planning
    programs to improve access to vital reproductive and
    preventative health services and to advance gender equity.
        To help build the best possible future for our children,
    the budget provides $19.8 billion for the Department's early
    care and education programs, including 11.9 billion for Head
    Start, and 7.4 billion for the Child Care and Development Block
    Grant.
        The budget also invests in improving the child welfare
    system, particularly to address racial inequity.
        The President's budget also takes action to address the
    epidemic of opioids and other substance use, investing $10.7
    billion across HHS and increasing access to medications for
    opioid use disorder and expanding the behavioral health
    provider workforce, particularly in underserved areas.
        And in a notable investment, the budget provides $1.6
    billion to the Community Mental Health Services Block Grant to
    respond to the systemic strain on our country's mental
    healthcare system.
        To support innovation and research, the budget increases
    funding for NIH by $9 billion, 6.5 billion of which will go to
    establish the Advanced Research Projects Agency for Health,
    ARPA-H, with an initial focus on cancer and other deadly
    diseases. This major investment in Federal research and
    development will speed transformational innovation in health
    research and speed application and implementation of health
    breakthroughs.
        HHS plays a critical role in promoting the well-being of
    those who come across our border seeking refuge. The budget
    reflects that commitment by increasing funding for the Office
    of Refugee Resettlement to rebuild the resettlement
    infrastructure and ensure unaccompanied children are safely
    cared for.
        Finally, given the magnitude of HHS's work and the taxpayer
    dollars that are used to fund it, it is critical that we ensure
    our funds are used appropriately. The discretionary request
    invests in meaningful oversight and accountability, including
    efforts to combat fraud, waste, and abuse in Medicare,
    Medicaid, and private insurance.
        I want to thank the committee for inviting me to discuss
    the President's fiscal year 2022 HHS budget, and I want to
    thank the staff at HHS for their Herculean effort in fighting
    COVID-19 and protecting the health of their fellow Americans.
        To build back a prosperous America, we need a healthy
    America. President Biden's discretionary request builds on that
    vision.
        Madam Chair, thank you.
        [The prepared statement of Mr. Becerra follows:]
        [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

        Ms. Eshoo. Thank you, Mr. Secretary. We will now move to
    Member questions, and the Chair recognizes herself for 5
    minutes.
        You mentioned ARPA-H, and I am glad that you did. The
    President's budget contains $6.5 billion in it to create this
    new independent agency. Tell me what you--what the rationale is
    to have this in NIH. This is modeled on DARPA and ARPA-E, and
    it doesn't seem to me that, as extraordinary as NIH is, and the
    work that they do, that, you know, that successful independence
    that is the imprimatur of DARPA and ARPA-E is really there. So
    that is my--I know that you support the subagency, but if you
    could, comment on where you think it needs to be.
        Two other things. Our subcommittee was the first in the
    Congress to have a hearing on long COVID. We have powerful
    testimony, Mr. Secretary, from patients. When I asked both the
    CDC and NIH--because they both testified--when I asked them who
    is leading the coordinated whole-of-government response to what
    is taking place with long COVID, we were told there was no such
    leader or coordinator at HHS. So we need you to tell us, you
    know, what you are going to do about that. We need a
    coordinated response from the government, and we need someone
    to lead that.
        On the $6 billion provided for HHS for therapeutics in the
    American Rescue Plan, I think that we need a strategy for
    supporting the development of an effective therapeutic. It has
    been over a year since we have been--the pandemic has visited
    us, and the current monoclonal antibody therapies on the market
    really have not been as successful as we would have hoped. But
    newer monoclonal antibodies are being developed that could be
    delivered outside of a hospital setting, which is really
    important, and I think could be effective against variants. So
    I would like you to tell us how you are going to spend that $6
    billion.
        And on the Provider Relief Fund, I think maybe someone
    mentioned that in their opening statement. I think that the
    Trump administration failed at managing this. The money went
    out too slowly, and it wasn't a transparent process. So can you
    clarify for the subcommittee how much money remains in the
    Provider Relief Fund, and when you plan to disperse it, and is
    there a priority order for who receives it next?
        And my last question is I think that we need more resources
    in the FDA for inspections, both domestic and foreign. The
    foreign inspectors, actually, their work is voluntary. And I
    think that we have a long, long way to go on this. The American
    people depend on these inspections. Look what happened at
    Emergent. I mean, it is a national disgrace.
        So those are all my questions, Mr. Secretary, and you have
    2 minutes to answer. And if you can't answer all of them, of
    course, you will respond in writing. So welcome, and thank you.
        Mr. Becerra. Thank you. I was actually going to take 2
    minutes to just say thanks for having me and great to be with
    you. So I will try to cut that out, and go right to the
    questions.
        First, on ARPA-H, Madam Chair and Members, I think what
    President Biden is saying is we know what basic research can do
    for us. It leads to some of the greatest scientific
    discoveries. But sometimes we have got to move it faster
    because, for some people, contracting a disease is a death
    sentence, and it is a quick death sentence. So what President
    Biden has simply said is, let's accelerate this. If we have
    something innovative, something promising in the works, let's
    jump on it.
        And I applaud President Biden for wanting to devote
    energy--we can't do it with every particular condition or
    disease, but we can focus. You mentioned cancer. We talked
    about some of the deadly diseases. We can name any number of
    them. But what he is saying is we are going to partner with the
    private sector----
        Ms. Eshoo. But where do you want to put it? What is your
    view as to where this should be?
        Mr. Becerra. Well, I certainly know that NIH continues to
    do the basic research. I think we have any number of places
    that we could feel comfortable with it. But NIH continues to do
    the basic research. If we want to just lift that up and launch
    faster, we can discuss that.
        But the important thing is that we launch, and not let
    issues about--bureaucratically, where we are going to locate
    ARPA-H, get in the way of a great idea, because there are
    communities out there clamoring for us to help them find that
    next discovery that keeps their loved one alive.
        Let me--should I move on to some of the other questions----
        Ms. Eshoo. Please, as quickly as possible.
        Mr. Becerra. Sure. COVID response by HHS. Here I will tell
    you, Madam Chair, that we are fortunate to have the experts. We
    know this, whether it is CDC, at FDA, NIH. And with the
    President's team working on this, as well, at--we are
    coordinating. But there is--everyone is at the helm, all hands
    on deck. I can tell you that you don't put more than 200
    million shots in arms in a little over 100 days if you are not
    coordinating and working together.
        And so, at HHS, we have a team that will continue forward,
    working closely with the President. This is the priority, is
    making sure we beat out the COVID launching----
        Ms. Eshoo. My time has expired, Mr. Secretary. Thank you
    again. It is great to see you. And the Chair now recognizes Mr.
    Guthrie, again, the ranking member of our subcommittee, for his
    5 minutes of questions.
        Mr. Guthrie. Thank you, Madam Chair, and thanks, Mr.
    Secretary, for being here. And we did have hearings on the
    border before, and ORR before us. As a matter of fact, when we
    had the professionals before us, they said that the position
    really changed at the border.
        The situation got so much better after Congress finally
    passed the supplemental bill. And the supplemental was asked
    for some--I don't have the numbers in front of me, because I
    didn't prepare for this line of discussion, but the
    supplemental some time in midspring was asked for by the
    administration. We didn't pass it until some time in
    midsummer--I do not know that for a fact--with a majority of
    Republican votes. And the people who had the biggest concerns
    in the hearing voted against the supplemental. So I just want
    to set that record straight.
        But we did have your predecessor before us, Mr. Secretary.
    And as a matter of fact, there were some very passionate
    discussions from colleagues on the other side of the aisle to
    the point, when he got up and left, I said, ``Who in the world
    would want to take one of these jobs?'' And so I just want to
    say I am going to treat you with respect, and with--because
    your office deserves it, and you deserve it, as a person. So I
    appreciate that. But just because I am doing that doesn't mean
    I am less passionate about what is going on at the border
    today.
        And I just want to talk about--there was a--there was an
    article, I guess it was in Texas, investigating abuse
    allegations at a migrant facility. Just--it is the migrant
    facility in San Antonio that is holding over 1,600
    unaccompanied children, and the allegations of sexual abuse,
    insufficient staffing, children not eating, and tested positive
    for COVID not being separated. And I know you are aware of
    that.
        I just wanted to say, has ORR investigated these
    allegations? And if so, what can ORR share about these
    allegations?
        And have you had the opportunity to visit an ORR facility?
    I know I have had the opportunity to do so. And if not, when do
    you plan to do so?
        So if--the allegations, and if they have been investigated,
    would be the first question.
        Mr. Becerra. Congressman Guthrie, thank you very much for
    the question, and thank you also for the manner in which you
    have asked the question. I appreciate that.
        We are absolutely on top of any reports, any allegations of
    abuse. We take our role very seriously in making sure that, not
    only do we follow the law when it comes to the care of these
    migrant children, but that we provide them with the well-being
    that they deserve while they are in our custody. Temporary as
    it might be--and we don't get into the discussion about their
    immigration status, whether they are going to be sent back home
    or not--but we make sure we take care of them. So any report we
    will investigate, and we continue to do that.
        But what I can tell you is the several thousand children
    that have come through our custody are all being cared for and
    cared for well.
        Mr. Guthrie. Thank you. I think they were before, once they
    got into the ORR facility. You have some professionals there
    that are outstanding, and they really worked hard and did a
    really, really good job.
        So switching to drug pricing, we are--all want lower drug
    pricing. All Americans want lower drug pricing. Though the
    President said in the State of the Union, as we talked about,
    that if we can't agree on everything, let's at least pass the
    things that we agree on. We have a bill, H.R. 19, that has 36,
    I think, unanimous, bipartisan bills that will make an effect
    on drug prices.
        Some people say it is small ball. It is not. If you reform
    Medicare Part D, it is every American over 65.
        And so what we want to talk--ask--the question is, one, can
    we not proceed on areas in which we agree, which would be H.R.
    19, that does make a difference?
        And if we go with H.R. 3, we had a hearing the other day,
    and the witness on the Democrat side kept talking about it
    would just be a--10 to a dozen bills, and bills that have been
    around--I mean, pills, or drugs that have been around for a
    long time and, therefore, really wouldn't affect innovation,
    because they have been around for a long time.
        But we all know that, in any business, you take your
    previous revenues and put them into your research to move
    forward. So I do think that was very dismissive of the problem
    of--H.R. 3 could case in moving forward. So can we not work
    together on what we agreed on?
        And two, if H.R. 3 is part of a package, it--let's hope it
    is not going to be a pay-for for other priorities. For
    instance, these are people's premiums, people's payroll taxes
    that they put in. We want to make sure that money--can you
    commit that money will stay in Medicare?
        Mr. Becerra. Well, Congressman, let me first agree with
    you, we need to work together. And I hope that you will test us
    at HHS if you need technical assistance, if our team can be of
    any service in helping you noodle through the particular issue,
    as we try to tackle what I think every American agrees with,
    and that is that we have to lower drug prices. Then, hopefully,
    we will--not only will the working together produce results,
    but we will do it quickly.
        And so I can guarantee you that, if you give us an
    assignment, we will take it on. And if you give us dollars to
    make it happen, we will keep that money where it is supposed to
    stay. We will follow the law. Whatever you all decide to pass,
    we will implement it and make sure we comply with whatever the
    prescriptions are within that legislation that you pass and
    have become law
        Mr. Guthrie. I only have 10 seconds. So would the
    administration, though, want the Medicare money to stay in
    Medicare if----
        Mr. Becerra. We want to make sure----
        Mr. Guthrie. Yes.
        Mr. Becerra. We certainly want to make sure that we are
    improving Medicare. And so we will look at what you all send us
    to make sure that we can not only improve Medicare but make
    healthcare better for all Americans.
        Mr. Guthrie. Thank you. Thank you for being here, and thank
    you for your testimony. And I yield back.
        Ms. Eshoo. The gentleman yields back. The Chair is now
    pleased to recognize the chairman of the full committee, Mr.
    Pallone, for his 5 minutes of questions.
        Mr. Pallone. Thank you, Madam Chair. And again, I don't
    want to pick on Mr. Guthrie, but I don't think he accurately
    portrayed what happened at the H.R. 3 hearing or what happened
    at the border.
        I mean, it is clear that President Trump's administration
    forcibly separated kids from their families at the border and
    caused terrible damage to the kids into the ORR program. You
    know, I don't want to debate that here, but I mean, to suggest
    otherwise I just don't think is accurate.
        Also, it--the President said in his joint address that he
    wanted to have legislation passed this year to lower the price
    of prescription drugs by giving his administration the power to
    negotiate prices, and specifically said that that money should
    be a pay-for for healthcare programs. I mean, I don't think
    there is any question that that should be used for, you know,
    things like ACA, Medicare, Medicaid. That is the President's
    position, and that is certainly my position.
        But I wanted to get into--quickly, if I could, Mr.
    Secretary, ask about negotiated prices, about public health
    infrastructure, and then, finally, mention the Provider Relief
    Fund. So let me quickly get into this.
        On the prescription drug issue in H.R. 3, I just want your
    opinion. The testimony at the hearing last week is that, in
    order to effectively reduce prescription drug costs, we have to
    have a comprehensive solution like H.R. 3 that includes
    negotiated prices. And so, from your perspective, is empowering
    the Secretary to negotiate drug prices an essential tool to
    lowering drug prices?
        Mr. Becerra. Chairman, absolutely. I think the President
    has made that very clear, and I will restate that. Absolutely,
    if we want to lower those drug prices, we have to have the
    ability to negotiate.
        Mr. Pallone. Well, thank you. Now, let me get to this
    second thing.
        In both the LIFT Act, which is our committee's
    infrastructure piece, and the Moving Forward Act, which passed
    in the House in the last session, we specifically included
    protecting and investing in the public health infrastructure.
    And I am not asking you to specifically comment on that
    legislation, but I just wanted to know whether you would
    support investments for our public health infrastructure--for
    example, improving our public health labs' infrastructure or
    modernizing our hospital infrastructure. We would like to have
    that as a component of any infrastructure package considered in
    Congress.
        And I know you said that you would support whatever we put
    forward, and that is fine. But I want you to--I wanted you, if
    you would, to comment on the need to have a public health
    infrastructure component in this, if you would.
        Mr. Becerra. Mr. Chairman, there is no doubt that the
    President and we at HHS have a wish list of what we would love
    to see you do, but we ultimately will work with whatever you
    are able to pass.
        But without a doubt, we must end the cycle of boom and bust
    funding for our public health infrastructure. We have to make
    the kinds of investments that we saw in the American Rescue
    Plan. That helped to secure long-term funding at the Federal,
    State, and at the local level. And so, for sure, we have to do
    this the right way, that gives real certainty moving forward of
    how we are going to be able to expand healthcare and make it
    more affordable.
        Mr. Pallone. All right. And the last thing, I guess, is not
    really a question, Xavier, but I did want to mention it. I
    wanted to mention that I am very interested in how the
    Department is distributing the critical funds provided by
    Congress over the last year through the Provider Relief Fund.
        You know, I was constantly trying to push your predecessor
    to get this money out in an effective way during the COVID
    crisis. And I understand our staffs have been in touch to
    schedule a briefing on the funds that remain. And I just want
    to urge the administration to permit providers who have
    received these critical funds to extend their availability
    through the end of 2021, as we continue to respond to COVID.
        You know, this Provider Relief Fund ensures that frontline
    workers can keep their doors open during this time, and it is
    just imperative that the funds go to those who need it the
    most.
        Again, I am not asking you a question, but you know--and
    everybody on this committee on both sides of the aisle knows--
    that we were very concerned during the pandemic under the Trump
    administration with the various tranches that some of that--
    much of it was not using formulas that actually got it out to
    the areas that had the greatest need. And so I just want to
    express our concern. If you want to comment on it, you can. I
    am not asking you a question, but if you want to comment on it,
    you certainly can.
        Mr. Becerra. Mr. Chairman, we hear you loud and clear. We
    couldn't agree more with what you have just said.
        And I will only add that, for me, what will be important
    with regard to the Provider Relief Fund, having been at the
    State level at the time that it was first being implemented, we
    are going to demand accountability and transparency as we
    disburse the remaining 25 billion or so that was originally in
    the pot and also the 8 billion or so that was made available
    for our rural communities.
        Mr. Pallone. Thank you so much.
        Thank you, Madam Chair.
        Ms. Eshoo. The gentleman yields back.
        The Chair now recognizes the ranking member of the full
    committee, Mrs. McMorris Rodgers, for your 5 minutes of
    questions.
        Mrs. Rodgers. Thank you, Madam Chair. I am concerned. I am
    concerned, because it sounds like the Democrats want to take
    the Medicare dollars and pay for ACA policy again. But I am
    going to move on.
        Mr. Secretary, I thank you for your commitment to price
    transparency. You recently responded to a letter, and I do hope
    that that is an area where we can work together to enforce the
    rule and continue to get that price transparency, which is so
    important to patients across the board.
        I have some questions here. Mr. Secretary, I know President
    Biden is noted for saying, ``Don't tell me what you value. Show
    me your budget, and I will tell you what you value.'' The one
    thing that I hope that we can all agree on is the dignity and
    the value of every life, including those Americans with
    disabilities and debilitating diseases.
        For years now, the National Council on Disability, an
    independent Federal agency, has warned policymakers about
    relying on quality-adjusted life years. That is QALYs. So, Mr.
    Secretary, first I wanted to ask, do you agree with the
    National Council on Disability and the Consortium of Citizens
    with Disabilities that relying on QALYs is an unacceptable and
    discriminatory policy?
        Mr. Becerra. Congresswoman, thank you for the question, and
    I couldn't agree more with you, that we have not done enough to
    focus on issues of health for folks with a disability. More and
    more, we are beginning to realize that so many of our loved
    ones actually have a disability, whether physical or mental.
    And more and more, we are learning, unfortunately, to our
    detriment, that we haven't provided the same level of resources
    and commitment to tackle those types of conditions as we have
    for the more common types of physical ailments.
        And so I will tell you that I absolutely agree with the
    general concept that we have to do a better job of making sure
    we are targeting money, and getting things done for Americans
    with a disability. What I will tell you is that a----
        Mrs. Rodgers. So--yes.
        Mr. Becerra. I am sorry.
        Mrs. Rodgers. OK.
        Mr. Becerra. Go ahead.
        Mrs. Rodgers. Well, I wanted to ask specifically regarding
    QALYs, the--this policy of a quality-adjusted life year. And I
    wanted to ask if there would be any provisions in your budget
    that would give you, as Secretary, the authority to set prices
    based upon foreign drug prices that are established using
    quality-adjusted life years.
        Mr. Becerra. Congresswoman, let me say this. I know that
    the team at HHS can probably give you some particulars on this.
    I won't profess to be the expert. And so what I will do is
    just--I will take this matter back to the folks at HHS, and I
    look forward to being able to respond to you----
        Mrs. Rodgers. OK.
        Mr. Becerra [continuing]. As quickly as possible. Again, if
    it involves drug prices, we are going to do something.
        Mrs. Rodgers. OK. Well, we all are committed to bringing
    down drug prices, prescription drug prices for patients.
        One of my biggest concerns with the proposal right now that
    is before this committee is that, in an effort to bring down
    prescription drug prices, it includes a reliance on foreign
    drug prices developed using QALYs. So foreign drug prices that
    measure quality-adjusted life years, so they are determining
    the value of an individual, especially an individual with
    disabilities. And so that is one issue that we really need to
    address.
        I wanted to ask also about Medicare for all, because we
    continue to hear the drumbeat about Medicare for all. And we
    know that households with employer-sponsored health coverage
    would, on average, have more than $10,000 less in disposable
    income every year with this policy. Medicare for all, or
    single-payer system, would cost more than 32 trillion over 10
    years, a doubling of our projected taxes over that period. And
    I just wanted to ask if you would commit in your budget to not
    include a Medicare-for-all proposal that would take away
    employer-sponsored health insurance from 180 million Americans.
        Mr. Becerra. Congresswoman, I can assure you that the
    President has spoken with a clarion voice on this issue. He
    campaigned on this, and everything he has done so far makes it
    very clear: We are going to work to make sure that we can
    expand the Affordable Care Act, make it better. And, as a
    result of the American Rescue Plan, I think every--virtually
    every American can say it is actually much better, and
    certainly the million people who have in the last few weeks
    signed up to get a plan under the Affordable Care Act are
    showing full proof that the----
        Mrs. Rodgers. OK, thank you.
        Mr. Becerra [continuing]. ACA is----
        Mrs. Rodgers. I have one more question, one more question.
        During your confirmation hearing, Senator Daines said--or
    you responded to Senator Daines and said, ``My job will be to
    make sure that I am following the law. The Hyde Amendment,
    which is current law, makes it illegal to use taxpayer dollars
    to fund elective abortions.'' Do you continue----
        Ms. Eshoo. The gentlewoman's----
        Mrs. Rodgers. OK.
        Ms. Eshoo. The gentlewoman's time has expired.
        Mrs. Rodgers. OK, I will ask that question in writing.
    Thank you, Madam Chair.
        Ms. Eshoo. Thank you. I think we are all going to be
    submitting questions in writing to the Secretary.
        The Chair is pleased to recognize the gentleman from North
    Carolina, Mr. Butterfield, for your 5 minutes of questions.
        Mr. Butterfield. Thank you, Madam Chair, for convening
    today's hearing. And thank you to our good friend Secretary
    Becerra this morning.
        Good morning, Mr. Secretary. It is good to see you. I wish
    we had time to chat this morning, but I am going to get right
    to it. I would like to focus just a few minutes of my time on
    the investments in biomedical research put forward in this
    proposal.
        For decades, publicly funded research has laid the
    foundation for the treatments and cures patients use today.
    NIH, which has long enjoyed bipartisan, bicameral support, is
    the largest public funder of biomedical research in the world.
    And the positive impact of this agency is clear: Heart disease
    and stroke and diabetes are less deadly, cancer mortality rates
    are also, overall, on the decline, Americans are living longer,
    healthier. Yet there is always more we can do to support the
    health of our constituents.
        And so I applaud the administration for investing more
    resources into biomedical research, and I am really interested
    in learning more about the proposed Advanced Research Projects
    Agency. We call it ARPA. I am interested in learning more about
    this.
        Mr. Secretary, the funding request put forward $6.5 billion
    for the creation of ARPA-H, which I understand is part of a
    larger $51 billion request for NIH. Can you talk with us about
    the responsibilities for this new agency?
        Mr. Becerra. Congressman, absolutely. And it is great to
    see you. We will consider this a 5-minute chat.
        What I will tell you is that ARPA-H is meant to complement,
    not compete with, NIH's basic research. And what we will do is,
    hopefully, be the springboard to take some of those budding
    ideas and actually start them off fast track. And we are going
    to partner far more with the private sector because we know
    that they are incubating some of these things, as well. But if
    you don't have a dedicated source of funding for that, with an
    agency that has a proven track record, as you have said, of
    success, it is hard to get the private sector to believe that
    they should make the same investment to try to do this.
        COVID-19 is now being attacked by successful vaccines. Why?
    Because it was a partnership, and we did everything to
    accelerate those vaccines as much as we could while still
    maintaining safety. And so ARPA-H gives us a chance to say, on
    something in the future, we are going to do the same thing.
        Mr. Butterfield. How do you envision the work of ARPA-H
    coinciding with other NIH institutes, such as the National
    Center for Advancing Translational Sciences, or the work of NIH
    in general?
        How are we going to coordinate these efforts?
        Mr. Becerra. As I said, Congressman, they are going to
    complement each other because, remember, NIH does the
    foundational research. Before you can ever run, you have to
    learn how to walk. And before you can walk, you have to learn
    how to crawl. NIH is the body that has shown us,
    scientifically, with facts, how you learn how to crawl, walk,
    and then run.
        What we are simply saying with ARPA-H is, look, this kid is
    learning how to walk a lot faster than we thought. Shouldn't we
    invest a little bit more money to find out why it is that that
    is the case?
        And it then complements the work that NIH has already done
    to let us launch on some of these innovations. Because I
    guarantee you, Congressman, if you or I had a loved one who was
    dying of Alzheimer's, we would want to know if there is some
    innovative, promising research out there, that we could launch
    it faster.
        Mr. Butterfield. I am glad you mentioned Alzheimer's, Mr.
    Secretary. The request identifies a few specific diseases like
    Alzheimer's and cancer and diabetes. And, although I think we
    can all agree that scientific progress in these areas would be
    welcome, how might this agency target other important areas,
    like heart or respiratory diseases, which are also leading
    causes of death?
        Mr. Becerra. Congressman, that is the big question, right?
        And I will tell you, the best response that I can give you
    is we will follow the science. We won't let politics drive us.
    It will be the science, because what we want is for Americans
    to have confidence that, when we launch, it is because we are
    driven by the data and the science, not because we decided to
    drive it in the direction of one politician or the other. It
    has got to be science-driven.
        Mr. Butterfield. This is innovative and exciting. Thank you
    very much, Mr. Secretary.
        I yield back, Madam Chair.
        Ms. Eshoo. The gentleman yields back.
        It is a pleasure to recognize the gentleman from Michigan,
    the former chairman of the full committee, a highly valued
    member, Mr. Upton, for your 5 minutes of questions.
        Mr. Upton. Well, thanks very much, Madam Chair. And Mr.
    Secretary, and friend, welcome back before our committee. We
    have got a couple of questions.
        You know, as we know, the drug industry helped our country
    get into this very enviable spot, having access to lifesaving
    vaccines for COVID-19, in large part because of what we were
    able to accomplish in this committee, unanimously, when we
    passed 21st Century Cures, which President Obama signed in
    December of 2016. And while certainly the industry deserves
    credit for the speed and efficacy of these medications, and we
    made sure that there were no safety standards that were
    removed, while I understand the desire to help other countries
    suffering from COVID--and look what is happening in India, for
    sure--I want to make sure that it is a responsible way for all
    parties, which is why a number of us are very concerned about
    the administration's recent support of the waiver to release
    and transfer the IP for the vaccine, which may have a real
    chilling effect on innovation in the future.
        So Dr. Gottlieb argued that a much more effective means of
    helping other countries would be to, in fact, ramp up
    production here, here in the U.S. And I would like to ask, did
    the administration consider other options besides IP transfers,
    like what Dr. Gottlieb suggested?
        And if so, what were they, and why were they rejected in
    favor of the IP transfer issue?
        Mr. Becerra. Congressman, first, great to see you again.
    Thank you for the question, critical question.
        I have to first say there is no country that has done more
    to help the world when it comes to tackling COVID than the
    United States of America. And that is because of the generosity
    of Congress, our Federal Government, but most importantly, the
    American people.
        And what we are going to continue to do is help, as we are
    in India, for example, with the pipeline of PPE. We are doing
    everything we can to help them accelerate the production of
    more vaccine. We are going to do our part, as a global citizen
    and as the most important country and powerful country in the
    world.
        What I will tell you is that, when you have extraordinary
    circumstances, as we have with this pandemic, you have to apply
    extraordinary measures. And so we are going to do everything
    under the sun, the all-of-the-above list, to try to see what we
    can do to try to help the global community recover. And what we
    are doing is exactly that. We are going to do it at the same
    time we want to respect those that make those innovations
    possible.
        And so we are going to try to promote the access to
    vaccines and promote access to the materials, the PPE, and so
    forth, that the world needs, but do it the right way, because
    we understand that this is a partnership, not just among
    countries but with the private sector, as well.
        Mr. Upton. But did you actually look at going back to the
    industries, the Pfizer, which happens to be in district, go
    back to those and ask if they could further ramp up their
    production that, in fact, we might be able to send those doses,
    rather than share that IP technology?
        Mr. Becerra. Absolutely. The Biden administration has been
    having conversations with the industry from the very beginning.
    And it continues to this day. No action has been taken without
    having consultation with all those who are stakeholders. And
    certainly, the industry that has helped create these vaccines
    is part of the stakeholder group.
        Mr. Upton. I know we have talked a little bit about ARPA-H
    in this hearing, and Chair Eshoo and others were involved in a
    meeting with the President at the Oval Office back in March. We
    are all, all very excited about ARPA-H and, obviously, we want
    to make sure that it doesn't interfere with the other functions
    at the NIH and--others that have.
        We have made the pledge, as we look to the future, as we
    look for an update on 21st Century Cures, to in fact include
    ARPA-H as part of that, to help us get that legislation
    through. I really appreciate your input to try and make sure
    that everybody is on the same page. And so we look forward to
    working on that. We are very pleased to see that in the
    President's budget. It was released early on, shortly after, in
    fact, the meeting that we had in the Oval Office. So we are
    looking forward to get that done.
        I might just compliment Janet Woodcock, the Acting Director
    of the FDA. She was a mighty big player, as we worked to listen
    to all the different parties, asking what we could do to
    expedite the approval of--the 21st Century Cures. I know you
    know her well, but I just--we appreciate her continuing to work
    with us and look forward to that relationship, particularly as
    we look to do an update, 2.0 on Cures.
        And with that, Madam Chair, I yield back.
        Ms. Eshoo. The gentleman yields back. I join him in his
    well-earned praise of Dr. Woodcock. She should be the next
    permanent Commissioner, I think, of the FDA.
        The Chair now recognizes Dr. Burgess of Texas for his 5
    minutes of questions.
        Oh, I am sorry, I am sorry, I am sorry, mea culpa. The
    Chair now recognizes the gentlewoman from California, Ms.
    Matsui, for her 5 minutes of questions, followed by Dr.
    Burgess.
        Ms. Matsui. Thank you very much, Madam Chair, for having
    this hearing.
        And, Mr. Secretary, it is really wonderful to see you in
    this new role. And I look forward to many other conversations,
    as we move forward.
        Over the past year our Nation has simultaneously confronted
    the COVID-19 crisis, multiple incidents of systemic racism, and
    an economic recession. Understandably, these crises have
    impacted the mental health and well-being of millions of
    people. In response, the Biden-Harris administration stepped in
    and requested $4 billion of emergency support through the
    American Rescue Plan for mental and behavioral health services,
    including certified community behavioral health centers.
        While these actions are important, we must continue to look
    ahead. This HHS funding request proposes $1.6 billion for the
    Community Mental Health Services Block Grant at SAMHSA. I do
    applaud the administration for this historic investment, as we
    know the block grant acts as an important safety net for some
    of our Nation's most vulnerable.
        Mr. Secretary, the pandemic has been especially disruptive
    for America's children. How will your Department prioritize the
    mental and behavioral health needs of children and young
    people?
        Mr. Becerra. Congresswoman Matsui, I feel like I am at a
    family reunion, and so forgive me for saying that, but it is so
    nice to see so many--by the way, there is a lot of
    disagreements, even among families, when they get into these
    reunions, so I understand that. But at the end of the day, we
    are still a family.
        Children--you hit it on the mark--I think we want to make
    sure we do everything we can to address the stresses that our
    kids have been facing. Sometimes they don't have the same
    markers, and they don't express it the same way, but we know it
    is there. And so we have made an historic investment in
    behavioral health and mental health services. SAMHSA will have
    an increased budget. We are going to do everything we can to
    deal with the trauma and the stress that kids are facing, and
    we look forward to working with you to make sure we do it
    right.
        Ms. Matsui. Well, thank you very much for that, Mr.
    Secretary.
        And also, I want to just take a minute to raise an issue
    that I know you are familiar with: the ongoing actions of drug
    companies who have chosen to rewrite the 340B program to deny
    discounts on drugs dispensed through--covered under contract
    pharmacy. As you know, HHS has issued an advisory concluding
    that these actions are illegal, yet drug companies have made it
    clear they do not intend to comply with the law.
        I, along with over 220 of my House colleagues. wrote a
    letter to you earlier this year outlining our strong opposition
    to these actions. The 340B is essential to providing access to
    care to low-income and rural patients. I encourage you to take
    swift enforcement action to put a stop to these efforts to
    undermine the program. That is my comment to you.
        OK, I am on to telehealth now. In the past year telehealth
    has truly taken root, and we have seen exponential growth in
    the adoption of virtual care across Americans of all ages,
    locations, and conditions. As Congress considers permanent
    telehealth reform, we will need the support of HHS in sharing
    evidence to assess how telehealth flexibilities extended in
    response to the pandemic impacted both the Medicare program and
    beneficiaries.
        With that said, Mr. Secretary, do you believe that there
    are some telehealth regulatory restrictions that Congress and
    HHS can work together to address in the near term that do not
    require additional data? For example, the statutory limitations
    on using telehealth at certain ZIP Codes, or requiring
    beneficiaries to travel to a clinical setting to receive
    virtual care.
        Mr. Becerra. Congresswoman, we learned a lot through COVID
    about telehealth, and there are some things that we can do
    without Congress having to pass a law to make telehealth work
    better. We have some flexibility, and we are going to do
    everything we can, based on what we learned, the facts and the
    evidence that we learned from COVID.
        What I will tell you, though, is that we are going to still
    have to find that mountain when it comes to broadband access
    around the country. We have to make sure that we deal with the
    transportation issues that sometimes make it--even with
    telehealth--difficult for families. And we have to have the
    flexibility to put the money where it should go. And so we will
    work with you, because I think we have all now learned that
    telehealth can be a godsend for those who don't have easy
    access to healthcare.
        Ms. Matsui. Right, absolutely. We found that out in this
    crisis, and certainly broadband access, that is also a purview
    of this committee too, so we will be working with you. Thank
    you very much, it was great to see you. And I don't know
    whether you are my constituent, but it is great--California.
        Thank you, and I yield back.
        Ms. Eshoo. The gentlewoman yields back, and the Chair now
    recognizes Dr. Burgess for your 5 minutes of questions.
        Mr. Burgess. I thank the Chair and, Mr. Secretary, welcome
    to our humble subcommittee.
        Mr. Secretary, I have got a couple of questions on the
    Texas Medicaid 1115 waiver that was originally issued back in
    2011, extended in 2017, and then Texas had received in early
    January a 10-year extension on the 1115 waiver. It wasn't a new
    program, it was an extension on an existing waiver.
        Since then, about 3 months later, the waiver extension was
    totally rescinded. And this has created a great deal of
    uncertainty for the State of Texas, certainly for doctors,
    certainly for patients, certainly for hospitals. It is very
    difficult for hospitals who are having to plan ahead for their
    fiscal year and plan for their financial stability and dealing
    with financial hardships from the pandemic.
        So could you tell the committee a little bit about the
    process involved in rescinding this waiver 4 months after its
    approval?
        Mr. Becerra. Congressman, first, great to see you, and
    thank you for the question. It is an important one, because it
    is not just Texas. There are a number of States who have
    requests for waivers.
        First, it is important to make it clear that Texas
    continues with its existing waiver, which still has, oh, close
    to 2 years to run. What we have been discussing with Texas is
    the extension, which was an extraordinarily long extension of
    10 years. Typically, they would run about 5 years. And it dealt
    with a lot of money.
        And so what we wanted to make sure is that, if there is
    going to be an extension of an existing waiver, that it
    complies with all aspects of the law. And where we found it
    deficient was in the public comment that--in the notice and
    public comment that was not provided for something with so big,
    in terms of money and for such a long time. And so we are
    working with Texas to make sure we address their interests and
    try to make sure that we can move forward with something to
    extend their waiver.
        Mr. Burgess. Yes, I am eager to know--my discussions with
    former CMS Administrator Seema Verma, here in the middle of a
    pandemic, and it was an existing program. And so it was not, in
    her opinion, it was not unusual to condense the comment period
    and allow for the extension.
        But can you just tell me at what point you became involved
    in the decision to rescind the waiver?
        Mr. Becerra. Guys, remember, we didn't--the previous
    administration didn't condense the notice and comment; they
    didn't hold any notice and comment. There was no opportunity,
    at the Federal level, to--for anyone to comment on this.
        Mr. Burgess. So when did you become involved in the
    decision to rescind the waiver?
        Mr. Becerra. Well, HHS has been working on this, CMS has
    been working on this since before I was confirmed. And we are
    working on it, simply because it did raise a number of serious
    concerns about how it was administered and promulgated.
        Mr. Burgess. OK, so here is the problem that I have, Mr.
    Secretary. There was an Acting Administrator prior to you,
    Acting Administrator Fletcher. But it seems unlikely that this
    decision would have--she would have made that decision on her
    own. Wouldn't that be unusual for an Acting Administrator to
    make a decision of that significance, just on their own?
        Mr. Becerra. Congressman, I am not--I can't tell you how
    other administrations have worked and how Administrators at CMS
    have worked with the Secretary. I am very involved. I try to be
    very involved with all the different shops within HHS. But I
    can tell you that, in this particular case, before I was
    confirmed and had a chance to sit in this seat, work was
    already being done on these particular types of waivers.
        So we continue to work with Texas. We have never not worked
    with Texas and your delegation, and we will continue to do so.
    At the end of the day, this is about making sure Texans and all
    Americans have good healthcare the right way. And we all comply
    with the law. So I think that, so long as we all can feel like
    there is public notice and comment provided, that we are
    providing the right resources to do the job for Americans, we
    will see an extension.
        But remember, this is an extension that would not take
    place until, what, 2023 or----
        Mr. Burgess. Let me just go back to the question, though.
    Has an Acting Administrator ever rescinded the State
    flexibility waiver before?
        Mr. Becerra. I can't answer that, because I don't know what
    previous Administrators have done.
        Mr. Burgess. And, well, and that would be the other part of
    the question: If an Acting Administrator has ever rescinded a
    State flexibility waiver previously, what about a State
    flexibility waiver granted by a previous administration?
        That is, a new administration coming in and going back and
    saying, ``No, you don't have that flexibility waiver, after
    all.'' It does seem to me [audio malfunction] and politically
    motivated decision.
        And I do have a number of things, Madam Chair, that I have
    submitted for the record, and I would ask those be made--
    ordered at the appropriate time at the end of the hearing.
        I recognize the constraints of time, Mr. Secretary, I will
    follow up with you about this. I appreciate your answers, and I
    will yield back.
        Mr. Becerra. Thank you.
        Ms. Eshoo. Yes, I asked at the beginning of the hearing
    that everyone stick with their 5 minutes. The gentleman's time
    has expired.
        The Chair now recognizes the gentlewoman from Florida, Ms.
    Castor, for her 5 minutes of questions.
        Ms. Castor. Well, thank you, Chairwoman Eshoo, for calling
    this important hearing.
        And thank you, Secretary Becerra, for joining us today. It
    is great to see you.
        It is also heartening to see President Biden's budget
    prioritize affordable healthcare for American families. It is
    clear that your aim is to help our communities back home build
    back better and healthier. And I wanted to share with you what
    I am hearing from Florida Families First.
        They are grateful for everything that is being done to
    crush COVID-19. It is remarkable that we have now reached the
    milestone, thanks to the American Rescue Plan and all the hard
    work of everyone, that we have 150 million Americans with their
    vaccination already. I know we have a ways to go, but kudos to
    you and everyone at NIH, FDA, CDC, all across the enterprise.
        I am also hearing how grateful they are for the Affordable
    Care Act. You know, ever since it was--it came into law,
    Florida has led in the number of signups in the healthcare.gov
    marketplace. But the--due to the American Rescue Plan, now we
    have been able to lower premiums and lower copays. And it was
    great to see--it is such a lifeline for families. And Florida
    had one-third of that million-person signup under the Special
    Enrollment Period. It was there when people lost their jobs
    during COVID. It has been there for them.
        And I also want to give credit to our navigators back home.
    They are the ones that are sitting with families, working
    through all of their options to choose the plan that is best
    for them. So thanks to HHS for making $80 million available for
    grants to our navigators. They are very excited about those
    additional resources, and you can see what it has meant for
    enrollment.
        But COVID-19 has also laid bare a lot of weaknesses. One of
    them was in data. It was a struggle, especially early on, to
    understand infection rates, testing. We had Governors like mine
    that actually tried to hide some of the data. They weren't
    being transparent. And I really appreciate you all in CDC
    saying that you are going to use the resources we have provided
    to update the public health data systems. And I want to work
    with you on that, going forward.
        And then, one other thing before I get to my question,
    thank you and President Biden for your leadership on addressing
    the climate crisis. Hotter temperatures and dirtier air and
    water are impacting the health of everyone, but especially
    folks on the front lines. And in this budget request you are
    proposing a new Office of Climate Change and Health Equity to
    help address the harmful impacts of the climate crisis,
    especially on communities of color and communities on the front
    line.
        So here is my question. It has to do with junk plans. The
    Trump administration finalized a rule to expand short-term,
    limited-duration plans. Of course, you know, these junk plans
    are not required to comply with the consumer protections in the
    Affordable Care Act. Oftentimes they discriminate against
    people with pre-existing conditions, they limit benefits, and
    they leave our neighbors back home, often, with these huge
    surprise bills. Even former Secretary Azar agreed, when I asked
    him if these plans discriminate against folks with pre-existing
    conditions, he agreed.
        So you are aware of how these junk plans operate, Mr.
    Secretary, aren't you?
        Mr. Becerra. Yes, I am, Congresswoman. And you are
    absolutely correct.
        Ms. Castor. So on January 28th, President Biden signed an
    Executive order directing your Department to review all
    existing regulations, guidance documents, or policies that
    undermine the Affordable Care Act, and raise costs on families,
    and undermine protections for pre-existing conditions. Has your
    Department undertaken a review of this junk plan final rule to
    ensure that it is consistent with the policies set forth in the
    President's Executive order?
        Mr. Becerra. We are undertaking that review, as we speak.
        Ms. Castor. Terrific. Well, we will be very interested in
    that.
        And also, the American Families Plan, if there is something
    that we need to do to make sure that healthcare is affordable
    for families, maybe continuing the policies we enacted in the
    American Rescue Plan to make sure the premiums and copays are
    affordable for families. And if there is something we need to
    do to address junk plans in a lot of these fly-by-night
    operations that take advantage of our neighbors----
        Ms. Eshoo. The gentlewoman's time has expired.
        Ms. Castor. Thank you, Madam Chair, I yield back.
        Ms. Eshoo. The gentlewoman yields back.
        It is a pleasure to recognize the gentleman from Virginia,
    Mr. Griffith, for your 5 minutes of questions.
        Mr. Griffith. Thank you very much, Madam Chair. I
    appreciate it.
        And, Mr. Secretary, I appreciate you saying earlier that
    you were willing to work with all of us, and I do greatly
    appreciate that.
        On May 14th of 2020, almost a year ago, we had a hearing in
    our committee, and a Michael Bowen of Prestige Ameritech told
    his story about how he invested in machinery to make masks, et
    cetera. At that time our country was struggling to find the PPE
    necessary----
        Ms. Eshoo. Would the gentleman suspend for a moment----
        Mr. Griffith. Yes.
        Ms. Eshoo. Because the clock is not correct. Whomever is in
    charge of it, please reset the clock so that the gentleman's 5
    minutes are--that he has the 5 minutes?
        [Pause.]
        Ms. Eshoo. Well, please reset the clock, whomever is in
    charge.
        [Pause.]
        Ms. Eshoo. Well, why doesn't the gentleman continue? I am
    sorry. All right, so I will try and time you on my watch. How
    is that?
        Mr. Griffith. Yes, ma'am. I appreciate it. Thank you very
    much.
        Ms. Eshoo. Thank you for talking about Mr. Bowen.
        Mr. Griffith. Yes, so Mr. Secretary, Mr. Bowen was very
    concerned and, you know, he wanted us to guarantee him
    contracts with the Federal Government because the last time he
    had done this--geared up and started making more masks--as soon
    as our crisis was over, or as soon as there was a supply from
    foreign suppliers, all of the sudden he had no business. The
    Asian markets shut him out. They put a lot of products onto the
    market at low prices, and he was not able to compete
    effectively, and he had to shut down a lot of his equipment. He
    had to put in mothballs, et cetera. And before he geared it
    back up he wanted to know, are we going to be buying American?
        Likewise, since that time, a number of companies--as a
    result of the need in this country--a number of companies in my
    district and across Virginia started making PPE. There is a
    company that I have been talking with out of Elaine Luria's
    district, there is a company in my district. I know there is at
    least three or four in my district that have started, and they
    are all saying the same thing: Now that, you know, the Asians
    have gotten a hold of the situation, they are once again
    dominating the market.
        And, in fact, one of my sources tells me that a recent
    contract was let where they could have competed just fine, but
    they weren't even aware of it. And a lot of folks who are
    supplying the Federal Government and other governments are, in
    fact, using these sources that are, you know, all approved, et
    cetera, and then they outsource it to China and other
    countries. So what are we going to do?
        Do we need--and I would submit that we do, but I want your
    opinion--do we need a Berry-style amendment to say that the
    Federal Government is going to buy its PPE from American
    manufacturers? Because if not, every time we have a crisis, we
    are going to have another boom and bust.
        You said earlier you didn't like boom-and-bust funding.
    That is what these small businesses in the United States are
    now facing, who were willing to make the PPE, make it at a
    reasonable cost, and sell it to whomever. But if they are just
    going to get shut down every time by markets overseas, it
    doesn't make sense, and it doesn't make sense for a long-term
    policy in the United States. What say you, Mr. Secretary?
        Mr. Becerra. Congressman, what I say is I am with you in
    everything you just said. If we didn't learn a lesson from
    COVID, that too much of our supply was not at our disposal--
    and, by the way, that is a risk for the life and health of our
    people--if we have to depend on others, then we are in trouble.
        Not only that, why is it that we can't have Americans
    producing what Americans need?
        And President Biden is on top of this. And we have a $10
    billion fund that you all made possible through the American
    Rescue Plan and other initiatives to try to make sure we boost
    domestic manufacturing. And we are going to be on that one. And
    I hope you all will work closely with us, because we want to
    prove to Americans that, if they are willing to make an
    investment and produce here, we want to support them, because
    there is no excuse for us to have to go somewhere abroad to get
    masks, when we got Americans willing to produce them here. And
    by God, I think this is one that we could take on on a
    bipartisan basis.
        Mr. Griffith. Well, I would agree it can be bipartisan. It
    is masks, it is gowns, it is gloves, it is everything.
        And on January 25th of this year, the President signed an
    Executive order ensuring the future is made in all of America
    by all of America's workers, and asked each of the agencies to
    look into that. Do you know what your agency has found out so
    far, or what we can do, even before we can maybe get a bill
    passed?
        Mr. Becerra. We are going to continue to do the work on
    that. We can report to you back, I look forward to talking to
    you on that.
        But what I can tell you is this, that we are going to make
    sure that the $10 billion that has been made available for
    Defense Production Act are accountable dollars, and that
    Americans take a look at where it went. And so we have to be
    transparent in the use of that money. And I hope you all will
    work with us to make sure that we----
        Mr. Griffith. Well, I heard from the chair of the full
    committee that we are going to be doing an ORR----
        Ms. Eshoo. The gentleman's----
        Mr. Griffith. Is my time up, Madam Chair?
        Ms. Eshoo. Just about.
        Mr. Griffith. All right.
        Ms. Eshoo. I think you have 5 seconds left.
        Mr. Griffith. All right. I am just going to say we are
    going to have to talk some more about ORR, but I would like to
    see us buying all the PPE for those facilities from American
    sources.
        Thank you. I yield back, Madam Chair.
        Ms. Eshoo. Amen to the gentleman. The Chair now recognizes
    the gentleman from Maryland, Mr. Sarbanes, for his 5 minutes--
    and just hold for a second.
        Whomever is controlling the clock, excuse me for putting it
    this way, you are doing a lousy job, because it is really
    messed up. And we need every second. Members need every second
    they can get to question the Secretary. So would you please
    reset the clock?
        Voice. It is a technical problem. They are trying to fix
    it.
        Ms. Eshoo. It is a technical problem? Well, you know what?
    We will keep track on our iPhones here.
        Mr. Sarbanes, you are recognized for your 5 minutes. I am
    sorry.
        Mr. Sarbanes. Thank you, Madam Chair.
        Secretary Becerra, welcome to the committee. It is great to
    see you, and thank you for coming to discuss the 2022 budget.
        Over the past year, obviously, we have made incredible
    investments in our healthcare system through bills such as the
    CARES Act, the American Rescue Plan. We have to continue to
    ensure there is robust funding for programs that will help us
    recover from the coronavirus pandemic and ensure the long-term
    viability and stability of our healthcare system. You are,
    obviously, in a very, very critical position to help facilitate
    that.
        In your testimony you wrote, ``Our experiences as children
    shape the adults we become, and support in childhood can mean
    success in the futur,'' and I couldn't agree more with that. I
    know we share a commitment to ensuring that our young people
    have what they need to succeed.
        One important program for our youth are school-based health
    centers, and I was proud to have my bill, the School-Based
    Health Centers Reauthorization Act, passed last December. My
    pride of ownership in that is really just derivative of an
    extension of Lois Capps' investment in that issue for many,
    many years, as you know, being a colleague and, obviously, a
    fellow Californian.
        School-based health centers provide high-quality,
    comprehensive primary healthcare, mental health services,
    preventive care, social services, and youth development to
    primarily low-income children and adolescents across the
    Nation, play a critical role in helping to reach underserved
    populations and achieve health equality.
        During this pandemic, many school-based health centers have
    been using telehealth to reach students and provide healthcare
    services they need. However, it is incredibly important that
    SBHCs are able to stay open, especially as children come back
    to school and may require a variety of oral, social, medical,
    mental health services.
        Can you speak to the investments that will be made in
    school-based health centers or similar programs for our youth
    in the 2022 HHS budget?
        And what additional investments would you recommend to
    ensure that children receive the health and mental health
    services they need following the coronavirus pandemic?
        Let me just add I look forward to working with you to
    expand the impact of school-based health centers and be as
    creative and innovative there as we can possibly be. Thank you.
        Mr. Becerra. Congressman, as usual, we are on the same page
    on this subject. And I will tell you that HHS will do
    everything it can to make these school-based health centers
    successful.
        As you know, we don't dictate to the locals how they do
    things, but we do help them. We assist with resources. We
    provide guidance. And I will tell you that, if we are smart, we
    will be able to use some of the investments that are in the
    President's budget to help with our children, whether it is
    children who are in need of special care, or whether it is
    those with a particular disability, or whether it is just
    making sure we get these kids back on track when they get back
    to school. We want to make sure that we are supportive.
        And fortunately, with the help of Congress, with your work
    and others' in American Rescue Plan--and if we get the American
    Family Plan through--I can guarantee you that HHS will be very
    busy working with our school-based healthcare centers to make
    sure that kids have what they need to succeed in life.
        Mr. Sarbanes. Thanks very much. I look forward to that
    collaboration.
        I yield back, Madam Chair.
        Ms. Eshoo. The gentleman yields back.
        The Chair now recognizes the gentleman from Florida, Mr.
    Bilirakis, for your 5 minutes of questions.
        Mr. Bilirakis. Thank you. Thank you very much, Madam Chair.
    I can't get this to work.
        Ms. Eshoo. You sound fine. It sounds like it is working.
        Mr. Bilirakis. Yes. I can't read that. OK, got it.
        Secretary Becerra--thank you, Madam Chair, I appreciate
    it--during your confirmation hearing you told Senator Daines
    that, when it comes to laws related to abortion--and I am
    quoting--``My job will be to make sure that I am following the
    law.'' And the question is, do you agree that partial birth
    abortion is illegal, sir?
        Mr. Becerra. Congressman, thank you for the question. And
    here, as I said in response to some of those questions during
    my confirmation hearing, we will continue to make sure we
    follow the law.
        Again, with due respect, there is no medical term like
    ``partial birth abortion.'' And so I would probably have to ask
    you what you mean by that to describe what is allowed by the
    law. But Roe versus Wade is very clear, it set a precedent, and
    a woman has a right to make decisions about her reproductive
    health. And we will make sure that we enforce the law and
    protect those rights.
        Mr. Bilirakis. OK, and you agree with this particular law?
        Mr. Becerra. Which law are we talking about, sir?
        Mr. Bilirakis. The law concerning partial birth abortion.
        Mr. Becerra. Well, again, as I said, there is no law that
    deals specifically with the term ``partial birth abortion.'' We
    are--we have a clear precedent in the law on the rights that
    women have to reproductive healthcare. And we--as I said in
    that confirmation hearing, we will follow the law and protect
    the rights of all Americans to their healthcare.
        Mr. Bilirakis. Thank you. So you will follow the law. You
    will enforce the current law. Thank you very much. I want to
    get on to the next question.
        Mr. Secretary, 93 to 95 percent of the 7,000 known rare
    diseases have no FDA approval therapy. I think you know this.
    For those who do have therapy available, the development
    process takes an average of 15 years. As the cochair of the
    bipartisan Rare Disease Caucus, I believe we can do better in
    the United States. And FDA--we know this--OK, do you agree that
    we can do better, and that one way to do this would be to
    ensure coordinated, dedicated efforts at the FDA to make sure
    they are aligned to address the unique challenges rare diseases
    patients face?
        So that is my question, sir.
        Mr. Becerra. Congressman, we should always strive to do
    better. That is what we believe here at HHS. And I hope you are
    supportive of our efforts with ARPA-H, because that will allow
    us to do better.
        Mr. Bilirakis. OK, and I believe coordination, of course,
    is the key. I introduced H.R. 1730, the Speeding Therapy Access
    Today, or the STAT Act, with my Rare Disease Caucus cochair and
    good friend, G.K. Butterfield. This bipartisan legislation, at
    its core, would create a center of excellence for rare diseases
    at the FDA. The Center of Excellence model has been embraced by
    the FDA in recent years and was originally authorized by the
    very popular, bipartisan 21st Century Cures Act of 2016.
        As we have been seeing with the oncology COE FDA, we know
    this model can help advance therapies and regulatory science.
    So the next question is--and I am not sure how much time I have
    left--but the next--yes, would you like to address that, sir,
    in any way?
        Mr. Becerra. Congressman, why don't you pose the question,
    so I know what you would like me to address?
        Mr. Bilirakis. OK, well, do you agree with the center of
    excellence, with regard to the rare diseases?
        Do you agree we can do better, that one way to do this
    would be to ensure coordinated, dedicated efforts at the FDA,
    make sure they are aligned to address the unique challenges
    rare disease patients face?
        Mr. Becerra. Congressman, I think that is being done, and
    certainly we can always try to do it better. But I think, at
    FDA, I think you can say that we have the strongest agency
    around in the world to try to deal with these innovations and
    these therapies and treatments that we need for these rare
    diseases. But we can always do better, no doubt.
        Mr. Bilirakis. I think this bill will really speed up the
    process. So I look forward to possibly discussing this with
    you, along with my cochair and colleague.
        Mr. Secretary, the next----
        Ms. Eshoo. The gentleman's time has expired.
        Mr. Bilirakis. Oh, it----
        Ms. Eshoo. And again, we apologize to Members for the mess-
    up with the clock that you see on your screens. But we are
    keeping track by iPhone, right to the second. So I think the
    gentleman yields back, we thank him, and the Chair is pleased
    to recognize the gentleman from Vermont, Mr. Welch, for his 5
    minutes of questions.
        Mr. Welch. Thank you very much.
        Welcome, and congratulations. Mr. Secretary, I have
    questions in three areas: one is the 340B program; two is the
    new ARPA-H program; and three is prescription drug price
    negotiation.
        I know you are concerned about access to healthcare in
    community health centers and community hospitals. And I have
    been alarmed, as my local hospitals and community health
    centers have been, that six pharma companies--I believe
    illegally--are not passing on the discounts required under the
    340B program. Is it the--your intention to enforce continued
    access to the discounts for our community hospitals and
    community health centers?
        Mr. Becerra. Congressman, first, great to see you.
        Secondly, we are on this one, because we know that
    vulnerable populations are at risk. And so everyone--I have
    been saying all along we have to follow the law. Everyone has
    to follow the law.
        Mr. Welch. OK, thank you. Second, we are all excited about
    President Biden's $50 billion program, ARPA-H. And, of course,
    that is going to focus on cures for Alzheimer's, diabetes, and
    cancer. Is there any consideration to including Lou Gehrig's
    disease, ALS, in research that would be benefited by that fund?
        Mr. Becerra. Congressman, that is where we are going to be
    working with you and the White House to make sure we know how
    to focus the money. We certainly could use more than 6 billion
    to address all these deadly diseases, but we are going to try
    to let the science drive us there, because that is the best way
    to ensure that we will have not just a good result, but one
    that people will trust.
        Mr. Welch. Thank you. Finally, on prescription drug
    pricing, there is some dispute here. Pharma companies do not
    want the U.S. to be involved in price negotiation, yet we have
    just had a recent example where negotiation was very
    successful. Government worked in partnership with pharma, we
    got the vaccine. There was an agreed-upon price: 19.50 per
    dose. The Pfizer executive is now saying after the pandemic
    they may go up to $175 per dose.
        My concern about healthcare in general is that the cost is
    too high and not sustainable. It hurts taxpayers, it hurts
    private employers trying to provide access.
        Pharma's concern about price negotiation is that the
    Government won't be fair. Now, pharma is happy with government
    providing patent protection, providing a market through the
    Part D program, providing taxpayer funding through Medicare and
    Medicaid.
        You would play a major role in any kind of price
    negotiation plan that occurred. How would you address the
    purported concern that, if the Government negotiated so that we
    did not continue to pay three times, four times what other
    countries pay, we would still be the leader on innovation?
        Mr. Becerra. Great question, Congressman. What I will tell
    you is, first and foremost, failure is not an option here in
    dropping drug prices. We have to do better, especially when we
    see the rest of the world paying less than we do for some of
    these same drugs.
        So President Biden has made it very clear he wants to see
    negotiation of these prices. We can make this a win-win for
    everyone, including the pharmaceutical industry. We have to
    make sure that we are partnering with them. We have to have
    them sitting at the table. But we have to make sure we are
    moving. There is no reason why Americans should be paying this
    much their for their prescription medication.
        And so, whether it is tough love, or, you know, sitting
    down and collaborating, one way or the other, we are going to
    have to drop the prices of drugs. And we want to have everyone
    who is a stakeholder be at the table when we do it.
        Mr. Welch. Thank you very much, Mr. Secretary.
        Madam Chair, I yield back.
        Ms. Eshoo. The gentleman yields back. The Chair is pleased
    to recognize the gentleman from Missouri, Mr. Long, for your 5
    minutes of questions.
        Mr. Long. Thank you, Madam Chair.
        And thank you, Secretary Becerra, for being here today.
    Good to see you again.
        And the President tasked HHS with a supply chain review of
    pharmaceuticals and API, among other sectors. At the time, he
    suggested that these sectors were so critical to the national
    security of the United States that their supply chains merited
    additional scrutiny. Last week, however, the White House
    announced that it was back in the negotiations to eliminate
    international IP protections for these same products.
        Can you share the status of the supply chain review and
    your views on the importance of ensuring the United States has
    a strong and innovative domestic biopharmaceutical industry,
    including our future pandemic response?
        Mr. Becerra. Congressman, first, great to see you again,
    and thank you for the question. And, actually, this is one
    where I hope you all will be very interested in working with us
    on this, because we want to work hard on this one. We want to
    pounce on this.
        President Biden has made it very clear. He made sure in the
    American Rescue Plan we had $10 billion so we could make sure
    we improve on domestic manufacturing and production, and we
    have to make sure that that supply chain is working. And so we
    hope we are able to work with you, because we know there are a
    lot of small businesses, innovators out there, who want to be
    able to compete, and they think they have got a good product.
    And so, if we are working with you, we will spot them, and we
    will let them know that we want them in the game.
        And so I don't know how better to say it than to say that,
    on this one, there is no separation, I think, between you and
    me when it comes to making sure that American manufacturers,
    American small businesses have a chance to compete to provide
    Americans what they need to keep themselves healthy.
        Mr. Long. Well, it just seemed like a complete reversal,
    though, from the administration policy, and that is what I am
    trying to get to the bottom of here, when last week, like I
    said, they announced that they are back in negotiations to
    eliminate what they said was very critical, IP--international
    IP protections for these products. So how do you weigh that
    out?
        Mr. Becerra. So, remember, Congressman, that what the
    President announced is a way to get a global response to this
    pandemic. And we are willing to sit down and negotiate to see
    if there is a way to deal with this.
        But everything is still the same until we have negotiated.
    And once again, the stakeholders--in this case, the
    pharmaceutical industry, which has intellectual property
    protections--gets to sit at the table as we figure out how we
    get vaccines and other COVID responses out as quickly as
    possible to places like India.
        But right now, when we are talking about domestic supply
    chains, domestic manufacturing, I don't think there is any
    separation between what you have said and what the President
    has said in making sure we are targeting American business for
    a lot of this resource that we are going to put out there to
    increase the domestic supply and keep that supply chain going
    with American manufacturers.
        Mr. Long. OK, I will have my staff follow up with yours,
    because I don't think that I am communicating well, and I don't
    think I am get my question out to you in the proper form,
    apparently.
        But currently, all of the Provider Relief Funds have been
    expended by June--or will be expended by June 30th, 2021. I
    have heard from several hospitals about the uncertainty
    surrounding this deadline, given the changes in the reporting
    guidelines. I know the Department of Treasury has issued
    guidance extending the timeline to the end of 2021 for State
    and local government funding extended under the CARES Act. Will
    HHS be issuing an extension to the healthcare providers
    regarding the use of provider relief funding?
        Mr. Becerra. Congressman, we are going to be working hard
    to make sure that we provide those healthcare providers who
    work very hard with the resources they need. Some of those
    folks have asked for an extension. We are looking at all that
    very, very closely.
        What I will tell you is that we are, again, going to be
    driven by the facts in this case to make sure those providers
    who have a need get those needs addressed. That is why you all
    passed the money, and that is why we are going to make sure
    that we can dispense it in a way that is not only accountable,
    but it really does go to those who need it most.
        Mr. Long. OK, thank you. And President Biden's
    administration announced a $6 billion investment in community
    health centers to expand access to vaccines in underserved
    communities. However, the current Medicare FQHC reimbursement
    system may create a barrier to access a COVID-19 vaccine.
        FQHCs are not paid separately for vaccines, but are
    reimbursed by CMS 12 to 18 months after the fact. This has been
    an ongoing problem for flu and monoclonal vaccines that have
    now reached critical levels in the administration of COVID
    vaccines to Medicare patients.
        Are you or will you commit to working with our health
    centers to address this issue so that they have the tools and
    resources that they need to provide expanded access to these
    vaccines?
        Mr. Becerra. We have always had a good relationship with
    the community health centers, and intend to have that, as well.
    So we will work closely with them. Yes, sir.
        Mr. Long. OK, thank you----
        Ms. Eshoo. The gentleman's----
        Mr. Long. It is good to see you, and I yield back.
        Ms. Eshoo. The gentleman's time has expired, he yields
    back. It is a pleasure to recognize two doctors coming up from
    our committee: the first, Dr. Ruiz of California, followed by
    Dr. Bucshon of Indiana.
        So you have 5 minutes, Dr. Ruiz, for your questions.
        Mr. Ruiz. Thank you very much.
        Secretary Becerra, thank you for being here. I want to
    touch on a few different topics today.
        First, I would like to commend the administration for
    prioritizing vaccine equity and the distribution of vaccines
    into our underserved communities. As a doctor and public health
    expert vaccinating my constituents in underserved communities,
    I can say firsthand that President Biden's Federal Retail
    Pharmacy Program, mobile clinics, and direct vaccine allocation
    to FQHCs are effective. However, we still have a ways to go in
    reaching a national herd immunity.
        And I am concerned by reports that vaccine rates are
    plateauing, while around 50 percent of Americans still need to
    be vaccinated, and with underserved communities still having
    low vaccination rates. In fact, the Desert Sun newspaper
    reported this week, after analyzing California, HHS, and Census
    Bureau data, that vaccine rates are still significantly higher
    in the White, older, wealthier ZIP Codes in my district by up
    to 30 percent, compared to poor, younger, minority communities.
    While some of that could be because older people were first to
    get the vaccine, older individuals in underserved communities
    still lag behind. And all ages have been eligible since mid-
    April.
        Secretary Becerra, since we have reached a plateau in
    vaccination rates, has there been a shift in the
    administration's efforts and methods around reaching the
    individuals that have not yet been vaccinated to address
    barriers like time, language, and transportation restraints?
        Mr. Becerra. Congressman, it is great to see you, and the
    answer is absolutely yes, there have been changes made. In
    fact, later this week I will be going to a rural community in
    California where there will be a small vaccination clinic
    targeting folks who are most underserved and the most difficult
    to reach in some of our rural areas.
        Mr. Ruiz. Thank you, and I think that is very, very
    critical, to partner with local communities and taking the
    vaccines to the people, and I applaud your efforts in doing
    that.
        So now, pivoting to an issue that this committee worked on
    prior to the pandemic, which is surprise billing, my Republican
    colleague, Dr. Bucshon, and I worked with several of our
    colleagues in a bipartisan manner to craft a solution that
    would, first and foremost, protect the patient from surprise
    medical bills and to create a solution that is fair to both
    providers and insurers, which included a baseball-style
    arbitrator, independent dispute resolution process that this
    committee and Congress adopted. And so I would like to ask you
    some questions regarding the implementation of the law.
        So first, regarding the IDR process, I urge the
    administration not to weigh any one factor to be considered by
    the arbitrator more heavily than the others. The legislation
    signed into law represents a balanced approach that treats
    providers and insurers equally and does not favor one party
    over another. I am concerned that, if any of the factors are
    weighed more heavily than the others, it will tilt the balance,
    resulting in an unfair system that will unintentionally lead to
    a benchmark rate which runs counter to congressional intent.
        Second, it is my understanding that HHS is meeting with
    stakeholders and requesting their input. I appreciate the
    administration soliciting feedback. I strongly urge you to move
    forward with a proposed rule that includes a full public
    comment period, so that the process is transparent and all
    stakeholders have an opportunity to comment, to provide
    feedback.
        Mr. Secretary, have you made a decision on the rulemaking
    process and whether it will include public comment?
        Mr. Becerra. Congressman, thanks for all the questions. We
    are going to make sure that people have an opportunity to know
    what is going on with these rules. We are going to try to move
    them as quickly as we reasonably can.
        What I will tell you is this: Paramount will be making sure
    that the patient is not--doesn't get in the mix of the--any
    fight that may exist. We are not going to weigh any side more
    than another, and we are going to make sure that we launch
    these committees as quickly as possible. That will help us make
    these decisions, because everything you have said is accurate.
        Mr. Ruiz. Thank you very much. And for my final question I
    would like to ask about an issue near and dear to me: advance
    appropriations for the Indian Health Service.
        As you know, IHS is severely underfunded and continuously
    struggles financially, which hurts patients' access and care.
    So, Mr. Secretary, can you talk about the benefits of advance
    appropriations and how it will help the IHS better serve our
    Tribal communities?
        Mr. Becerra. Our Tribal communities, as you know,
    Congressman, have been underfunded, severely underfunded, for
    too many years. President Biden has now made a major commitment
    to restore some of that funding, but he has also made the
    commitment that Indian country has been asking for for a long
    time, and that is that they be treated, when it comes to
    health, the way we treat every other aspect of healthcare for
    all other communities, and that is that they have
    predictability in their funding, moving forward. And that is
    why the advance appropriation is so critical. And that is why,
    with your help, we will get that done.
        Mr. Ruiz. Thank you very much, Mr. Secretary. I yield back
    my time.
        Ms. Eshoo. The gentleman yields back.
        The Chair is pleased to recognize the gentleman from
    Indiana, Dr. Bucshon, for your 5 minutes of questions.
        Mr. Bucshon. Thank you, Madam Chairwoman, I appreciate
    that.
        Secretary Becerra, thank you very much for appearing before
    the committee today. To show pretty significant bipartisanship,
    I am going to focus on surprise medical billing, as my
    colleague Dr. Ruiz has just mentioned, and particularly the
    agency's implementation of the No Surprises Act. As you
    probably know, Dr. Ruiz and I, as he mentioned, worked to
    advance legislation into law that is both fair and balanced
    and, most importantly, as you mentioned, takes the patient out
    of the middle of all of this. That is the key.
        The No Surprises Act establishes an independent dispute
    resolution process that allows both sides the opportunity to
    present a list of criteria to an arbiter to make their case.
    The list includes, among other factors, the median network
    rate, market share, good faith/bad faith efforts, and prior
    contracted rates.
        Some--in my opinion, biased--economists have suggested
    subverting the intent of Congress by suggesting HHS should
    implement the long-awaited--overemphasizes a low benchmark or
    qualified payment amount in the IDR process. Congress agreed to
    a deal that carefully balances a host of important arbitration
    criteria to make sure that no side has an unfair advantage.
        I want to echo what my colleague Dr. Ruiz's concern with a
    letter--in a letter that was sent, asking for any rule
    promulgated by HHS to follow congressional intent, in which the
    factors specified in the law must be weighted equally to ensure
    that patients have access to affordable and quality care.
        So my first question is, generally speaking, how do you
    intend to make sure the process is fair and balanced and
    doesn't just revert--reverting to a benchmark in practice--we
    don't want that to happen--which this compromise framework in
    the No Surprises Act was intended to avoid?
        Mr. Becerra. Congressman, thank you for the question. And
    first, I have to just say thank you for the work that you all
    did to get this done. And now we--it is our job, as you said,
    to follow the intent of Congress on this.
        And so the most important thing we can say is what you
    said. We have got to take the patient out from underneath the
    weight of these disagreements, and we make sure that that will
    be the case. When we move forward with the committees that will
    explore these things, we are going to make sure that we have
    taken patients into account.
        But to your point, we are not interested in favoring one
    side over the other in the dispute. What we do want to make
    sure is we take the patient out of the dispute altogether, but
    then we are going to be even-handed when it comes to the
    dispute itself. And so the factors that will go into that, that
    is--we are going to hear from everyone to figure out how we can
    have a balanced approach. And that is where your input will be
    important, because you all were the minds behind this, and we
    hope you will provide us with a good input as we move forward
    to get this up and going.
        Mr. Bucshon. I appreciate that, because we do feel like
    congressional intent is that all the factors be weighed
    equally. And the law----
        Mr. Becerra. We are with you.
        Mr. Bucshon [continuing]. You, as Secretary, along with
    consultation from Treasury and Department of Labor, define what
    the median network rate is--in-network rate is. Can you
    guarantee that the data to calculate the median, in-network
    rate is independent, valid, and transparent?
        Mr. Becerra. That is our goal, Congressman, and you will
    get to see the work that we do to make sure that is the case,
    and hold us accountable.
        Mr. Bucshon. I appreciate that, because the transparency, I
    think, at agencies is as important to Members of Congress, of
    course.
        Nothing is more frustrating--and you know this, because you
    were here for a while--when you work on legislation and then
    you see that it is implemented by an agency, and you have
    questions about whether or not that has followed congressional
    intent. So, if anyone understands that, it would be you.
        The No Surprises Act is clear that, no later than 30 days
    after the claim is submitted to a health plan, that the plan
    must issue an initial payment or a denial. How will you protect
    physician practices in the event that health plans fail to
    respond to the claim, that the claim is being considered--
    respond to the claim that the claim is considered de facto
    accepted by the health plan? Does that make sense?
        Mr. Becerra. I think I understand----
        Mr. Bucshon. Basically, how do you hold the plans
    accountable if they don't address the claim in a timely manner?
        Mr. BBecerra. Yes, and that is where the dispute resolution
    process will be critical, because there have to be teeth,
    right? And you understand this because, at the end of the day,
    when a decision is made, there has to be followthrough,
    especially by those that are providing the payment, the
    reimbursement.
        And so I hope what we will be able to show you is that we
    come up with a system that actually is accountable, and shows
    results because, at the end of the day, the public is not going
    to believe us, that we meant this, if we don't do it right. And
    while we keep them out of the dispute, at the end of the day
    somebody has to get paid.
        Ms. Eshoo. The gentleman's time has expired.
        Mr. Bucshon. OK, thank you, Madam Chair.
        Ms. Eshoo. Thank you.
        The Chair now recognizes the gentlewoman from Michigan,
    Mrs. Dingell, for your 5 minutes of questions.
        Mrs. Dingell. Thank you, Madam Chair and Ranking Member
    Guthrie.
        And Mr. Secretary, it is great to see you. I want to thank
    you for being here, and I really look forward to working with
    you on so many issues that we both care about, from the opioid
    crisis, the high prescription cost of drugs, to clean,
    accessible water. But today I want to talk about strengthening
    our Nation's readiness for the public health crisis.
        As you know, public health funding follows a pattern of
    panic and neglect, where large amounts of money are invested
    during a crisis. And then, once the crisis is over, funding is
    not adequately maintained. I think that maybe this pandemic has
    opened our eyes to the deadly shortcomings of this pattern. And
    this committee has worked to not only shore up the current
    needs but shed light on the realities of the needs to come,
    whether planned or not.
        So, Mr. Secretary, how is the administration's funding
    request for this year reflective of the Department's effort to
    break this cycle and achieve long-term public health
    preparedness sustainability?
        Mr. Becerra. Congresswoman, great to see you, and a
    critical question, because we saw, through COVID, how the
    stockpile needs to be modernized.
        I will say this. First, we have to make sure we have got
    the resources to make sure we have got the right amount of the
    supplies, that we have a supply chain that works. And so we are
    going beyond just putting product in storage and making it
    available. We are going to go into taking a look at how we
    actually distribute.
        You know, we need visibility on that supply chain, and we
    need to have accountability, as well. And, as we discussed
    earlier, to the degree possible, we should make sure that
    Americans are providing the product that we are using in that
    supply chain. And so we are going to work as hard as we can.
    The resources come through. I guarantee you what you are going
    to find is that we are going to lift up the strategic national
    stockpile in ways that make it a 21st century process.
        Mrs. Dingell. That is great, and I think we need to bring
    that supply chain back to this country as fast as we can.
        And just as an aside, I would also like to say that, in
    this recent surge, my nurses still lacked from--PPE supplies,
    and did not have N95 masks.
        So the funding request includes 905 million for the
    Strategic National Stockpile for supplies and maintaining
    restructuring efforts initiated during the pandemic. What are
    the Department's immediate priorities for the stockpile, and
    how will this be--funding be used for the critical improvements
    we need right now?
        Mr. Becerra. Congresswoman, some of that is pretty basic.
    We have to make sure we know what is in the stockpile. We have
    to know if it works and we have to know if it really meets the
    needs of the 21st century crises, the national pandemics that
    we might face. And so we have a lot of work to do.
        We have to make sure that we can work with the technology
    that lets us move instantaneously, because we know that it is
    not just a matter of having it in storage, it is getting it
    where it needs as quickly as possible because lives are at
    stake. So it is, essentially, all of the above, but we are
    going to have to do a scrub to make sure the SNS is really
    working for Americans the right way.
        And so I look forward to working with you on this, because
    I think we have learned that this is going to be a critical
    component of being able to respond adequately and quickly to
    any future healthcare crisis.
        Mrs. Dingell. I am going to sort of ask you my last two
    questions, because I don't have that much time, but I really
    want to work with you on this.
        I mean, what should we, as Congress, be considering as we
    conduct oversight on the COVID-19 response and consider
    possible legislation to address failures in preparedness?
        But also, as somebody who became--my district became the
    arsenal of health at the last minute, but there were startup
    problems, but they were doing both PPE equipment and the
    ventilators. What is the--how do we examine the role for more
    private-public partnerships in purchasing, securing, and
    stockpiling PPE?
        And what, if any, SNS capabilities can be better managed,
    maybe even at the State level than the Federal level?
        Mr. Becerra. Congresswoman, I think we learned a couple of
    things.
        One, we need to have better communication and coordination
    with the State and local partners that we have. They need to
    have a better sense of what we have got in the stockpile, how
    it is going to be dispersed, what they can expect.
        We also need to work with them a little closer so they know
    that we have to know that there will be results. If they want
    something, we have to know it is going to go to the right
    people at the right time. And so we have to have far more
    coordination.
        You know, there was a lot of disjoined activity occurring
    at the very beginning of this pandemic. And it wasn't clear,
    you know, if the left hand was guiding the right, or vice
    versa. We can't afford to have that happen. So better
    communication, better coordination, and stronger partnerships,
    not just with our local and State government partners, but with
    our private sector partners, as well.
        Mrs. Dingell. Thank you, Mr. Secretary. Twenty-four seconds
    doesn't let me ask another question, so I will yield back. But
    it is great to have you back.
        Mr. Becerra. Great to see you.
        Mrs. Dingell. Madam Chair, I yield back.
        Ms. Eshoo. The gentlewoman yields back. We thank her.
        It is a pleasure to recognize the gentleman from Oklahoma,
    Mr. Mullin, for your 5 minutes of questions.
        [Pause.]
        Ms. Eshoo. Can you hear me? Am I unmuted?
        Mr. Mullin. No, I was on mute.
        Ms. Eshoo. Oh, I see, OK.
        Mr. Mullin. I started talking, and I forgot to hit the
    little red button that says ``unmute.'' But, Madam Chair, thank
    you so much, and Mr. Secretary, thank you for being here.
        Last Congress we appropriated $47 billion for COVID
    testing. Do you know how much of those funds still are
    available?
        Mr. Becerra. Congressman, I don't have that number off the
    top of my head, but if you like, I could get back to you on
    that, or your staff.
        Mr. Mullin. Yes, I would appreciate it. We are just trying
    to figure out if--you know, what the funds are going to be used
    for, or if Congress is going to need to reappropriate those
    dollars. If--and if we are not going to be testing--because I
    believe we--if I am remembering this correctly, we appropriated
    an additional 50 billion that was provided in March for COVID.
    And the administration is saying now they won't need but about
    13 billion of that, which--that is a--you know, we got 37
    billion still sitting there.
        Do you have any idea, you know, what the intent is going to
    be with your office on how to use those funds?
        Are you able to use it in a different way or, once again,
    is Congress going to need to reappropriate these?
        Mr. Becerra. Congressman, excellent question. And what I
    will tell you is that, as you watch what is going on in India
    and we learn more about these variants that are popping up, we
    are not done, and no one should get any impression that we are
    done tackling COVID or whatever comes--you know, the mutants
    that come from--mutations that come from COVID. And so we have
    to continue an aggressive testing strategy. We have to continue
    to make investments to prevent the spread of COVID and its
    variants.
        And so I will tell you that, while we--I can't tell you
    exactly how much money is there right now, and I can get back
    to you on that, and we could certainly make sure that we are
    keeping you abreast of what the plans are to make sure that we
    continue to tackle COVID and whatever comes next.
        Mr. Mullin. Well, I have no doubt, you know, your
    dedication to tackling COVID. It is just, you know, with that
    much money sitting there, what we don't want to see is it is
    just sitting there, and it doesn't go away. What we have--we
    have a lot of accounts throughout government that--money is
    just sitting there that Congress appropriated for, and it is--
    it can't be used.
        So if there is a better way for us to appropriate it--for
    instance, as Mrs. Dingell was saying with PPE, if we need to
    reappropriate it for the Strategic Stockpile, if we need to use
    it more focused on rural areas--and that is an area--if we need
    to go to the--take it to the border--I mean, right now I think
    the President requested $4.3, roughly, billion for a refugee
    resettlement camp.
        And, I mean, kind of a question there: Does that 4.3, does
    that account for what is going on with the Biden border crisis
    right now on the southern border and the influx of the illegal
    immigrants?
        Mr. Becerra. So I think you asked two different things
    there. If you want, I can--on the question about the resources
    for testing, I will tell you that we can stay in touch with
    you. We appreciate your interest and concern. We are going to
    make sure that, whatever resources we have, we will use not
    only appropriately but transparently. And so we can stay in
    touch on how we are making the investments to keep Americans
    safe.
        On the issue of the border, Congressman, can I ask you to
    repeat that question one more time?
        Mr. Mullin. What I was--the reason why I was comparing the
    two is, do we need to reappropriate those dollars to what is
    happening on the border, with the crisis that is taking place
    there?
        Because the President authorized $4.3 billion to--for the
    refugee resettlement. And with the influx of the illegal
    immigrants that is coming across and the high amount of those
    that are being detained and not being tested, do we need to
    reappropriate funds to go to that sector?
        Mr. Becerra. Congressman, as you know, we--at HHS we have
    many obligations.
        Mr. Mullin. Right.
        Mr. Becerra. One of them is to make sure we continue to
    test the American public for COVID. We will continue to do
    that, and we will make sure that we are in touch with your
    office on the resources that it takes to do that.
        When it comes to the migrant children at the border, we
    have a responsibility to make sure that they are--their well-
    being is cared for for however long they might be in this
    country and whatever their ultimate status will be. Our job at
    HHS is different from DHS. We have to provide the care that we
    expect for any child. We will do this and, obviously, need
    resources to make that happen.
        Mr. Mullin. Mr. Secretary, it is not just that. It is the
    adults too. I mean, I fly through Dallas almost every week. And
    when you go through Dallas, what you will see is someone
    walking around with a manila envelope and a card that says ``No
    English.'' And they are being shipped to wherever. And it could
    be the day before when they were actually apprehended on the
    border, and there is no way they can be tested that quick.
        And so before we are letting these people, literally, be
    deported--or be transported, I mean--all over the United
    States, I think it would be wise for us to make sure they are
    being tested. And there is no way they are being tested right
    now. And so that is what I am getting at. Should we
    reappropriate those funds to go towards those testing?
        Mr. Becerra. Well, I would question the premise that they
    are not being tested, but I want to make sure that it is clear
    we have to put the resources where we need them. And at HHS,
    we--whether it is the testing issue, or with the children at
    the border, we have--together a responsible proposal to get
    both of those things done.
        Mr. Mullin. Right. I will yield back, but I would check
    into the testing----
        Ms. Eshoo. The gentleman's time--yes.
        Mr. Mullin. Thank you.
        Ms. Eshoo. The gentleman's time has expired. The Chair is
    pleased to recognize the gentlewoman from New Hampshire, Ms.
    Kuster, followed by Mr. Hudson.
        So you are recognized, Annie, for your 5 minutes.
        Ms. Kuster. Thank you so much, Madam Chair.
        And Mr. Secretary, wonderful to be with you. And thank you
    for your--today. Welcome back to the People's House, and
    congratulations once again on your confirmation as our Health
    and Human Services Secretary.
        The funding request for HHS put forward by the Biden-Harris
    administration is exactly what we need in this moment to
    address the many challenges facing our country.
        One challenge I look forward to working with you and other
    HHS agency officials on is how we can address the increasing
    number of drug overdoses and expand access to prevention,
    treatment, and long-term recovery services for those suffering
    from substance use disorders. An important priority of mine
    this Congress is identifying ways to expand access to care and
    treatment within incarcerated settings.
        Last Congress, Senator Booker and I partnered on new
    bipartisan legislation, the Humane Correctional Health Care
    Act, which would allow Medicaid to follow our justice-involved
    population during their time in Federal prison in order to
    provide much-needed mental health and substance abuse
    treatment.
        A catalyst to our recidivism crisis is that our justice-
    involved population does not receive adequate healthcare,
    particularly when it comes to treating mental health and
    addiction, leaving these vulnerable Americans with the same
    substance misuse disorders when they leave prison as when they
    arrive. And we all act shocked. We are not shocked when they go
    back to their diabetes. We shouldn't be shocked that their
    untreated mental health and substance abuse problems persist.
        Senator Booker and I are working on reintroducing
    bipartisan legislation. I would welcome the opportunity to work
    with your Department and CMS on this critically important
    public health issue.
        Now, with respect to the HHS budget, I was pleased to see
    it includes $10 billion across your agency to combat the
    substance misuse epidemic, which I understand is nearly a $4
    billion increase over the past fiscal year. I applaud this bold
    investment. I want to ask about your goals for this funding.
        Secretary Becerra, this is a significant amount of funding
    proposed to fight the drug epidemic. How will this be spread
    across your agency?
        And what actions do you plan to take with these
    investments?
        Mr. Becerra. Congresswoman, wonderful to see you again, and
    excellent question. And if we are able to continue with the
    resources that we have seen so far--and thank you for the help
    in getting some of those resources in the American Rescue
    Plan--we will be able to let SAMHSA at HHS really take the lead
    to try to address some of these concerns.
        And we know, because of COVID, it is an even sharper
    concern. Some 81,000 Americans died this past year from drug
    overdoses. And I think that is the largest number we have seen
    in quite some time. And it is clear that there are a whole
    bunch of Americans who are very stressed, and they need that
    assistance. So we are going to get out there and work with
    State and local partners the best we can.
        But SAMHSA will take the lead, and we will try to
    supplement what we can with the resources that our State
    partners have. We are going to try to be innovative, I will
    tell you that. We are going to try to make sure that we allow
    for those medically assisted treatment programs to get out
    there and do their job.
        We want to make sure that Americans know, especially the
    young population knows, that we want to catch them. We want to
    catch them before they fall completely. And I think, working
    with you, we can make a real dent in this and prove to
    Americans that we are serious about tackling this.
        Ms. Kuster. Well, thank you. And on behalf of all the
    members of our bipartisan Addiction and Mental Health Task
    Force, we look forward to working with you, as well.
        We know that only a fraction of patients with substance use
    disorders have access to [audio malfunction]. Can you discuss
    how--improve access to evidence-based treatment, including in
    rural communities like my district in New Hampshire?
        Mr. Becerra. And that is where Congress can--as I
    mentioned, it is important that we work with our State and
    local partners, because they are the ones that are going to be
    implementing on the ground.
        I will tell you, as my--in my former work as the attorney
    general for our State of California, we worked very hard to get
    to the point of actually having a major settlement with some of
    these drug manufacturers and drug distributors of opioids, to
    try to help make sure we put money into our communities to
    address the abatement needs of a lot of these jurisdictions,
    and to try to go out there and provide services.
        If we are smart, we are going to work closely with our
    partners to make sure that they take that settlement money, we
    take the money that is coming out of the American Rescue Plan,
    and we are applying it so that we are actually providing on-
    the-ground services quickly to a lot of our families.
        And so we have an opportunity to do something we haven't
    done in a long time, and that is actually make a dent in this
    crisis.
        Ms. Kuster. Well, thank you so much. And with that, I yield
    back.
        Ms. Eshoo. The gentlewoman yields back. We want to put more
    than a dent in it. We have dents, but we could--under your
    leadership, we want to rid ourselves of this.
        The Chair now recognizes the gentleman from North Carolina,
    Mr. Hudson, for your 5 minutes of questions.
        Mr. Hudson. Thank you, Madam Chair.
        And Mr. Secretary, welcome. Thank you for your time today.
    Like many Americans, I am concerned about the worsening crisis
    on our southern border. Data shows that crossings,
    unaccompanied minors, and drugs like fentanyl encountered at
    the border are at record highs. In fact, it was just reported
    by Border Patrol that apprehensions in April reached the
    highest total in 20 years.
        I recently visited the border and saw this humanitarian,
    public health, and national security crisis firsthand,
    specifically at the Donna migrant facility designed for 250.
    They were holding 3,500 children inside. I hope you agree this
    is a real crisis. And it appears the Government is running out
    of capacity to house more than 20,000 minors, a record-high
    number. This week I read a report that HHS is considering
    sending hundreds of those unaccompanied minors to a North
    Carolina city.
        And, Madam Chair, I would like to enter into the record an
    article from the Washington Examiner entitled, ``North Carolina
    City Could Be Next to House Unaccompanied Minor Children.''
        Mr. Secretary, can you confirm if this report is true?
        Have you already sent or are you planning to send minors to
    North Carolina?
        Mr. Becerra. Congressman, thank you for the question. And
    first, let me respond by saying that we are always trying to
    make sure that we are providing a safe and a legal shelter for
    the kids who are in our custody. And so we do. And as you
    mentioned, there are several thousand of them. Because it is
    our responsibility to take these kids from the Customs and
    Border Patrol detention centers and actually provide them with
    the type of housing that is expected for a child.
        But I will tell you that there is no plan that we have to
    shelter children in North Carolina. We are always looking for
    sites where we can provide the type of safety and security that
    children need. And we have sites throughout the country. But
    there is no plan that I could tell you right now to shelter
    children in North Carolina.
        Mr. Hudson. Thank you for that answer.
        You know, currently, if an American citizen wants to fly
    from Mexico to the United States, we are required to have a
    negative COVID test first. Before your agency sends migrants to
    some of these locations you mentioned around the country when
    you receive them from the Border Patrol, are they being given a
    COVID test before they are put on public transportation?
        Mr. Becerra. Congressman, they are absolutely being
    checked, because the last thing we can afford to do is have a
    spread of the virus at the locations where we are housing a
    number of these kids.
        And, as you probably are aware, we don't--we have them in
    quarters that are quite tight at times, and so we have to
    protect their safety and the safety of the Americans who are
    working with them. And so we absolutely make sure they are
    tested before they come to us.
        Mr. Hudson. So 100 percent of these minors that you are
    receiving of the 20,000 are being tested before they leave from
    the border location to enter the other places in the United
    States, 100 percent are being tested?
        Mr. Becerra. Absolutely.
        Mr. Hudson. Well, that is comforting. I appreciate that.
        And so, in March, I sent a letter to our North Carolina
    Governor and to the DHS Secretary because there was an article
    that was saying that migrants were not being COVID tested, and
    some that actually were tested, and tested positive, were then
    being put on buses. And one of the individuals being
    interviewed for the story said that he had a ticket to leave
    the next morning for North Carolina. So that is really where my
    concern is coming from, that--you know, that these individuals,
    if they are testing positive, were being put on transportation
    anyway.
        Could you tell me, when you were testing these
    unaccompanied minors, if they have a positive test, what is
    then being done with that individual?
        Mr. Becerra. Great question, Congressman. We have to make
    sure we isolate them from the rest of the population, which is
    one of the reasons why it has been such a tough assignment,
    because we have to make sure we have the space to accommodate
    these kids.
        Remember, we are still under a legal obligation, as a
    government, to move these children out of CBP's custody within
    a certain amount of time, 72 hours. And so, whether the child
    is positive or not, CBP is under a mandate to move them, and
    they come to us. And so we have to make sure that any child is
    safe. If there is a COVID-positive child, we have to make sure
    they are safe but that they are also not spreading the disease.
    And so we make accommodations, which is not easy. It is not
    cheap. But we do it, because that is the right thing to do.
        Mr. Hudson. Well, what I learned at the border, at the
    Donna facility, is there were children who had been there 28 to
    30 days. And so, I--you know, I imagine--you know, I am hopeful
    that you are able to comply with the law. At the time that
    wasn't happening.
        Mr. Becerra. Can I just--just to give you a sense, as of
    yesterday, there were zero children in Customs and Border
    Patrol custody who had been there more than 72 days--72 hours,
    excuse me, more than 72 hours. Zero kids. But you are
    absolutely right, there was a time when they had in their
    custody quite a few. But that has now changed. There are--the
    average time that a child is now in Customs and Border Patrol
    custody is 25 hours.
        And so, Congressman, what I can tell you is we at HHS have
    worked very hard to make sure that not only do we relieve the
    pressure that CBP was under in housing these kids, but we do it
    the right way, we do it legally, we do it responsibly. And
    while it takes some money and it takes some time, we are going
    to do it right.
        Ms. Eshoo. The gentleman's time has expired.
        Mr. Hudson. Thank you.
        Ms. Eshoo. I thank the gentleman.
        Mr. Hudson. Thank you, Madam Chair.
        Ms. Eshoo. Thank you. The Chair is pleased to recognize the
    gentlewoman from Illinois, Ms. Kelly, followed by the gentleman
    from Georgia, Mr. Carter.
        Ms. Kelly. Thank you, Chairwoman Eshoo, Ranking Member
    Guthrie, for your leadership and opportunity to serve an
    informed discussion on the Department of Health and Human
    Services' budget priorities.
        Secretary, it is always good to see you. Thank you for
    testifying before the committee today. I would like to discuss
    the issue of maternal health and maternal mortality in the
    United States.
        As noted in the administration's budget request, the U.S.
    has one of the worst rates of maternal mortality among
    developed countries in the world. In 2017 the U.S. recorded a
    maternal mortality ratio of 17.4 deaths per 100,000
    pregnancies, ranking last among industrialized countries. The
    numbers are far worse for Black women. In the same year, Black
    mothers experienced a maternal death ratio of 37.1 deaths per
    100,000 pregnancies, more than twice the rate of White mothers.
    The causes of death vary, but it is clear they are widely
    inequitable outcomes for maternal health in our country.
        I fully support your request to increase investments in
    maternal health. The HHS funding proposal requests increased
    funding for maternal mortality review committees, rural
    maternal healthcare, implicit bias training for clinicians and
    health workers, and State pregnancy medical home programs. Many
    of these proposals have also been priorities for the E&C
    Committee, and I believe these provisions are critically
    important to addressing the maternal health crisis.
        Secretary Becerra, improving maternal health outcomes
    requires assessable quality, preconception, prenatal, delivery,
    and postpartum care. How could the investments the
    administration has requested improve maternal healthcare and
    narrow these persistent inequities we see in maternal health
    outcomes?
        Mr. Becerra. Congresswoman, great to be with you, and thank
    you for the important question. I am glad you asked this
    question, because too many Americans don't realize that we have
    a maternal mortality crisis in America. It is just that it is
    hidden. It only occurs in certain communities, but it is a
    crisis. And we are going to tackle this.
        And I hope that we are able to work with you and others who
    are interested, because we are going to use an evidence-based
    intervention approach. We are going to go where we know the
    crisis exists. We are going to use the types of procedures and
    treatments that we know have worked.
        By the way, my wife will salute you for having asked the
    question, as a high-risk perinatologist essentially dealing
    with these types of crises. She wants to know that we are
    making the investments. And what we are going to do is go into
    the communities.
        And by the way, part of this is not just on the medical
    side. Part of this is just making sure a woman has access to
    the type of information and services she needs during the
    pregnancy to make sure that she doesn't end up having a crisis
    on delivery.
        And so we are going to work closely with those who know how
    to do this, and I guarantee you we are going to make a
    difference. That $200 million is going to be money well spent.
        Ms. Kelly. Thank you.
        Last Congress the House passed the Maternal Health Quality
    Improvement Act in an overwhelmingly bipartisan fashion. The
    bill included grants for implicit bias training similar to the
    proposals in the budget request as well as additional
    provisions to address maternal health and training for
    healthcare providers.
        Unfortunately, this bill did not become law last Congress,
    but I continue to believe these policies are critically
    important. Can you discuss the value of implicit bias training
    for healthcare providers, especially in the context of maternal
    health?
        Mr. Becerra. And here is where Carolina, my wife, could do
    a far better job because she has actually witnessed this, but
    what she would tell you is that, oftentimes, when a woman--
    especially a woman, but it could be anyone--comes in, if you
    don't have a provider, a physician who has--or other kind of
    provider who hasn't really experienced the type of circumstance
    that some of these--some of the patients come in with, it is
    tough. And we use our--these biases that we don't even know
    about, these implicit biases to make judgments and decisions
    about the healthcare for these patients.
        And so what we need to do is just understand that we need
    people who have that sensitivity. We have to provide the
    training. But more than that, we have to give the patients some
    control over this to make sure that they know where to go to
    get the care that they need. And that is where, if we tackle
    the implicit bias the right way, what we are going to do is
    actually ensure a better outcome for not just the patient, but,
    if it is a woman who is pregnant, for the future of our
    country.
        Ms. Kelly. Any other additional policies you want the
    committee to consider?
        Mr. Becerra. Well, I----
        Ms. Kelly. You could send them on, if you don't have them
    off the top of your head.
        Mr. Becerra. Well, listen, Medicaid has been relied on by
    so many of these mothers that we are talking about. If we could
    just make sure that we continue to support Medicaid, continue
    to urge some of those States that have not expanded their
    Medicaid to do so, we would really be dealing with this.
        And remember, we have now put a challenge out there. If
    there are States that want to expand care postpartum for a
    woman from 60 days to a year, we are with them and we will
    provide them some additional support.
        Ms. Kelly. Well, thank you so much. I look forward to
    working with you. I am proud to say Illinois was the first
    State to do it, so--with your help.
        Thank you so much, and I yield back.
        Ms. Eshoo. The gentlewoman yields back. And Mr. Secretary,
    no Member of the House of Representatives has done more on this
    issue than Ms. Kelly. So she is our leader on this.
        I understand that two Republicans, Mr. Carter of Georgia,
    Mr. Dunn of Florida, are not going to be questioning.
        So I am going to move to recognize Mr. Curtis of Utah for
    your 5 minutes of questions, followed by Ms. Barragan of
    California.
        Mr. Curtis. Thank you, Madam Chair.
        And Mr. Secretary, it is nice to be here with you today,
    and I regret--I have not been in Congress long enough to know
    you from your DC life, but it won't surprise you that you made
    a few headlines as attorney general in California, and I have
    heard of you. In that role you have led a charge against the
    previous administration's efforts to expand access to
    association healthcare plans. And I would like to discuss those
    for a minute.
        Although you have led that charge, research shows that
    premiums in States that allow these plans decreased,
    enrollments in ACA-exchange plans increased, and the number of
    new plans offered in these marketplaces increased by 61
    percent. Those are all good numbers. However, the individual
    marketplace, prior to the actions taken by the previous
    administration, which you oppose, tell a different story, and
    show an increase in premiums by 105 percent.
        Would you agree that, overall, philosophically, more plan
    offerings will strengthen our healthcare system and drive down
    costs, which is clearly the case here?
        Mr. Becerra. Congressman, first, I welcome the opportunity
    to get to know you and work with you, and thank you for the
    question and the thoughtful way in which you posed it.
        I will tell you that we want to make sure that Americans
    have a choice. Lots of choice, right? But we want to make sure
    that, when they choose, they are getting something that has
    value. And so whatever the source, however it is put together,
    we just want to make sure that Americans have a choice of plans
    that offer real benefits.
        Mr. Curtis. I certainly can't disagree with that statement,
    but I do feel like sometimes that--those of us make value
    decisions for other people, and that sometimes we need to let
    them make their own informed decisions.
        Now, let me just shift gears slightly. You have continually
    called for the ACA expansion while calling short-term plans
    ``junk plans.'' We have talked about that a number of times in
    this hearing. Despite this, the ACA plans have notoriously
    limited patient choices by cutting provider networks and
    implementing strict prior authorization standards, which only
    harm our most vulnerable patients.
        Isn't this just another form of health discrimination?
        And what would you say to rare disease patients with ACA
    plans who lost access to lifesaving care because of these
    actions?
        Mr. Becerra. Congressman, I bet you, if you and I sat down,
    we would find that we could agree on this issue because, at the
    end of the day, we are looking for comprehensive plans that
    have quality coverage for all Americans.
        And there is, under the Affordable Care Act, a place for
    some short-term plans. But it is truly short-term plans for
    those who need short-term care, who are in between jobs, for
    example, or who are going overseas for a little while, and
    can't--don't have the luxury to have a plan that is long-term,
    because you only need it short-term. So there is a place for
    that.
        But I think you and I would agree it is about quality, and
    making sure it is affordable for people. And the way you do
    that is to make sure that what they are getting is what they
    thought.
        Mr. Curtis. Well, let me be the first to invite you to Utah
    in your new role. We would love that conversation, and would
    love to have a thoughtful dialogue with you. And I can promise
    you a delightful experience out in Utah when your travels take
    you out that way.
        Let me--speaking of Utah, I have a very, very large rural
    part of my district. About 80 percent of my geography is rural,
    but only about 10 or 15 percent of my constituents. Telehealth
    has played just an amazing, critical role during the pandemic.
    There is an increasing sense that, I will say, the train has
    left the station and these expanded services should be made
    permanent.
        I am also aware that private insurers that have committed
    to permanently reimburse for telehealth services planned to
    that end.
        What specific plans do you have for HHS related to
    telehealth, as States reopen again?
        And what role do you see for Congress in making these plans
    permanent, especially for our seniors?
        Mr. Becerra. Congressman, I think just about everything you
    just said on telehealth I agree with. I would just--I would add
    a little bit.
        We have learned a lot from COVID on how to do this. We want
    to make sure we offer flexibility, but we want to make sure
    that we don't leave anyone out. And so it is a matter of making
    sure that we understand that telehealth requires broadband.
    There are certain communities, especially rural communities,
    that don't have access to good broadband. It is going to take
    resources to make sure that happens. Some parts of the country
    already can use telehealth, but what we don't want to do is
    find the inequities that we found as a result of COVID, where
    we leave certain communities, rural or poor, behind.
        And so we can do this working together, and it will take
    your effort, because some of these things we can do
    administratively, but a lot of it will----
        Mr. Curtis. I am going to run out of time, but I want to
    just tell you it is as if we teed each other up, because I
    wanted to talk broadband with you, and we just, hopefully--
    hopeful that you would support broadband as we reform it, and
    make it so it is more accessible.
        And, Madam Chair, zero seconds left. I yield my time.
        Ms. Eshoo. Good job, excellent job, Mr. Curtis. The
    gentleman yields back.
        It is a pleasure to recognize our California colleague, Ms.
    Barragan, for her 5 minutes of questions.
        Ms. Barragan. Thank you, Madam Chair, and thank you, Mr.
    Secretary, for joining us here today.
        Just to chime in a little on the conversation about
    migrants at the border, I was just at the Donna facility last
    Friday. There has been remarkable progress with the almost 80
    percent decline of kids that are now in Border Patrol custody.
    And that is why I want to applaud you, Mr. Secretary, for the
    work that you have done with HHS to get kids out of custody of
    Border Patrol as quickly as possible. When I was at the Donna
    facility, which, again, is a Border Patrol facility, there was
    no child there over 24 hours. So that has just been a success
    in the administration on their willingness to take action and
    to not have kids in Border Patrol custody.
        I mean, I did visit some of the HHS facilities, one there
    at Delphi and, of course, the one in Long Beach, right next to
    my district--one, Mr. Secretary, I know you are visiting soon--
    to see that not only are children being tested before they
    arrive but they are being tested for COVID throughout the
    entire week there. And so it is great that you are able to
    visit that facility and see firsthand.
        Mr. Secretary, I want to move on to a couple of issues that
    are near and dear to me. One is the issue of social
    determinants of health.
        We saw, as a result of the COVID-19 pandemic, that
    communities of color were hit very hard. And we have also seen
    that--how a community's resources directly impact the health of
    its residents. Unsafe or unstable housing, food insecurity, the
    lack of transportation, all these things put some populations
    at higher risk during this pandemic emergency. Addressing these
    social determinants of health is crucial to reducing health
    disparities not only during the current crisis, but we must
    work to strengthen our public health infrastructure into the
    future.
        I was excited to see that the President's budget request--
    $153 million to the CDC's Social Determinants of Health
    Program, which was modeled after my bill, the Improving Social
    Determinants of Health Act, or H.R. 379, which supports State,
    local, territorial, and Tribal health agencies--addresses these
    underlying issues that contribute to inequity.
        Mr. Secretary, can you talk about the administration's
    commitment to addressing social determinants and why you
    believe funding programs, including at the CDC, is crucial in
    addressing disparities?
        Mr. Becerra. Congresswoman, thank you for the question,
    great to be with you, and I look forward to working with you on
    this particular issue. I know this is a lifetime commitment for
    you, as it is for me.
        We are not only going to take the resources that the
    President wants to make available to us, but I have made it
    very clear throughout the Department, here at HHS, that equity
    will permeate everything we do. So it is not just in the
    programs that we are trying to administer or create, it is in
    everything that we will do at HHS. We take into account that we
    have to remember those who have oftentimes been left in the
    corners.
        And so those social determinants of health, by the way, we
    need good data to know what those determinants are. We have to
    make sure we are collecting good data. We have to make sure we
    are working really hard with our local partners to make sure
    they also get it. That equity should be at the forefront of
    what they do.
        And if you will give me a second, Congresswoman, I would
    like to just say thank you to you for your efforts and help in
    making sure that the Long Beach site that we are using for some
    of these unaccompanied migrant children is not only working,
    but working well. And I think I have to tip my hat to the
    people at the Health and Human Services agency who have been
    doing just a phenomenal job in making sure we do it the right
    way.
        Ms. Barragan. Well, thank you. Thank you, Mr. Secretary.
        I was excited to hear that the President discussed ending
    cancer as we know it during his joint address to Congress. I
    wish to take a moment to highlight one form of cancer, multiple
    myeloma. Unfortunately, my sister, who is only a year older
    than me, last November was diagnosed with multiple myeloma. It
    was pretty devastating for me and my family and, of course, to
    her and her family.
        This is a cancer that forms--is a type of a blood cancer--
    let me back up here. Multiple myeloma is a cancer that forms in
    a type of white blood cell and accumulates in the bone marrow.
    In 2021 it is estimated that there will be 34,920 new cases of
    myeloma, and an estimated 12,410 people will die of this
    disease.
        Unfortunately, large socioeconomic, geographic, and racial
    disparities exist in myeloma treatment, which can greatly
    impact patient outcomes. Among these disparities include
    delayed diagnosis, stem cell utilization rates, limited access
    to new therapies, and access to clinical trials.
        I just wanted to put this on your radar, Mr. Secretary, so
    that we can make sure we are looking at things like multiple
    myeloma when we are looking at where to invest the $6.5
    billion.
        And I also want to applaud the administration and you for
    looking at climate change and making sure that we are looking
    at this as a public health crisis and addressing that, as well.
        And with that, I yield back.
        Ms. Eshoo. The gentlewoman's time has expired. It is a
    pleasure to recognize Dr. Joyce of Pennsylvania for his--am I
    doing this right? Yes.
        Mr. Joyce. Thank you.
        Ms. Eshoo. Dr. Joyce, you are recognized for your 5
    minutes.
        Mr. Joyce. Thank you, Chair Eshoo and Ranking Member.
        This is a great opportunity to be with you here today,
    Secretary. I would like to return to some of the remarks that
    you made earlier, when it didn't seem clear that you understood
    what my colleague Mr. Bilirakis meant by the term ``partial
    birth abortion.'' And I think that it needs to be defined as it
    is in statute. Section 1531 of Title 18 U.S. Code is literally
    titled ``Partial Birth Abortions Prohibited.'' That statute
    very clearly defines this inhumane procedure in section B,
    subsection 1.
        So now, with that clarification, could you please recognize
    that that does exist in statute?
        And I would ask you, do you agree that this law is correct?
        Mr. Becerra. Congressman, thank you very much, and thanks
    for trying to clarify. I actually--I think I understood the
    question, and I think I understand your question, as well. What
    I am trying to explain is that the term ``partial birth
    abortion'' may be recognized in politics and by politicians,
    but it is not a medically recognized term.
        Perhaps, if you were to talk about what you probably know
    as dilation and extraction, which is a procedure used by OB/
    GYNs like my wife, to care for a woman who is having a
    difficult pregnancy, where there is a chance that the fetus
    will not survive, then we can talk about that.
        But what I am saying to you is that, under the law, a
    physician or any provider of healthcare must make sure that
    it--he, or she, it abides by the law. And right now, what our
    law says, and it is pretty settled, is that a woman is entitled
    to reproductive rights.
        And so my question is not so much with the term ``partial
    birth abortion,'' it is with what the rights are of a woman
    under our statutes and under our precedents to provide her with
    reproductive care that she is entitled to. And, as my wife
    would tell you, as an OB-GYN, is that the dilation and
    extraction procedure that is often used, late-stage abortions
    for women, it is to protect the health and life of that woman.
        Mr. Joyce. So, just for further clarification, partial
    birth abortions are prohibited right now under current statute,
    and that is something that you recognize, correct, Mr.
    Secretary?
        Mr. Becerra. Congressman, as I said, I recognize that the
    law provides women with reproductive rights, and that the Roe
    versus Wade decision made very clear under what circumstances
    women can exercise those rights.
        I will do everything I can to make sure we comply with
    precedent and the law when it comes to protecting a woman's
    right to her reproductive health.
        Mr. Joyce. And that does include enforcing this statute,
    correct?
        Mr. Becerra. I will make sure that we are providing women
    with the protections they need on their reproductive rights
    and, again, there--with all due respect, I know that this is a
    very sensitive issue for a lot of folks, but I think most
    medical practitioners will tell you they understand what a
    dilation and extraction procedure is. I doubt that most of them
    can give you a medical definition of what ``partial birth
    abortion'' is.
        Mr. Joyce. As a physician myself, Mr. Secretary, I think I
    clearly understand what a partial birth abortion is.
        Let's move on at this point in time, please, and I see we
    are narrowing down.
        During your tenure as the California attorney general, you
    sued the Federal Government to protect a California regulation
    that required churches to pay for abortions in their healthcare
    plans. You also sued the Little Sisters of the Poor, seeking to
    force a Catholic group of nuns to pay for contraception and
    abortions.
        During your confirmation hearing you stated that you would
    recuse yourself from participating in matters related to
    litigation you pursued against the Federal Government. Would
    you provide for us a list of every matter from which you would
    personally recuse yourself?
        Mr. Becerra. Congressman, first, to respond on to the
    actions that I took as the attorney general, again, as I said,
    I respect that there are different, deeply held beliefs on the
    matter of abortion. And what I did when I was attorney general
    was comply with the law and enforce the law.
        But I will say to you, to correct the record, I never sued
    any nuns. I never sued any organization that had a religious
    exemption. What I did was I took actions to make sure that
    providers, who are under obligation by law to provide services
    to all people, including women who are pregnant, did so. And
    so, however it might be described, the reality is that I simply
    protected the rights of Americans to get the healthcare that
    they are entitled to under the law.
        I have forgotten how the second part of that--or the second
    question that you had.
        Mr. Joyce. The second part asked you to include a list of
    any matters that you personally would recuse yourself because
    of previous litigation.
        Mr. Becerra. Yes, and I made it clear when I was getting
    confirmed that I signed an ethics agreement not to involve
    myself directly with any matters with which I was directly
    involved in litigation as attorney general for the State of
    California.
        Ms. Eshoo. Right, and the gentleman's time has expired.
        Mr. Joyce. Thank you----
        Ms. Eshoo. The Chair now--thank you. The Chair now
    recognizes the gentlewoman from Delaware, Ms. Lisa Blunt
    Rochester.
        Ms. Blunt Rochester. Thank you so much, Madam Chairwoman
    and Ranking Member, and thank you, Secretary Becerra, for
    joining us and presenting the administration's fiscal year 2022
    funding request for HHS.
        As a former Delaware deputy secretary of health and social
    services, State personnel director, and CEO of our Urban
    League, I understand all too well the challenges you would face
    under normal times. But your leadership during this pandemic is
    critical, and we are so fortunate to have you in your role as
    we recover and rebuild.
        I am also pleased to see our shared focus and priorities of
    strengthening outreach and enrollment in the ACA, a focus on
    the social determinants of health, telehealth, value-based
    healthcare systems, and systemic equity to improve outcomes.
    And I look forward to working with you.
        Today I want to focus on an issue that has
    disproportionately affected communities of color: climate
    change. For decades, policy decisions at the Federal, State,
    and local levels have led Black, Brown and indigenous
    communities living near toxic and polluted environments, even
    though the link between these conditions--air pollution and
    increased rates of illness like cancer and asthma--is well
    documented.
        The administration's funding request proposes establishing
    a new Office of Climate Change and Health Equity to reduce
    disparities in communities of color, low-wealth households,
    Tribal communities, and other marginalized groups overburdened
    by the health impacts of climate change.
        Mr. Secretary, can you discuss how this office will differ
    from existing HHS agency efforts around climate change, such as
    the NIH climate change and human health, and the CDC climate
    and health programs?
        Mr. Becerra. Congresswoman, thank you for the question, and
    I absolutely appreciate the chance to respond to that. We are
    going to focus directly now, as a result of these resources, on
    climate change.
        By the way, I should mention that, as attorney general, I
    established the Environmental Justice Bureau in our Department,
    because we know, as you have sort of said, it is our
    communities that are first and worst hit by climate change.
        And so we want to get there before the hit gets there. And
    in order to do that, we have to have the resources to start
    letting people know about clean water, about asthma when you
    have dirty air, about those toxic sites that might be built in
    your community, about the impact of building a large warehouse
    right next to a school and residential communities, where you
    are going to have semi trucks driving 24/7, right by all those
    communities, spewing diesel gas--diesel exhaust.
        And so we are going to get out there and work with
    communities to make sure we provide equity, but more
    importantly, we fight for--to protect the health of these
    communities.
        Ms. Blunt Rochester. And how does this proposal build on
    past presidential initiatives to tackle the disproportionate
    impact of climate change?
        Mr. Becerra. Well, the most important way is it actually
    has money behind it. And that gives us a chance to really do
    something. You can always talk. You just have to have the
    resources and the fuel to walk. And we intend to walk our talk.
        Ms. Blunt Rochester. Excellent. And my last question, I am
    going to kind of combine two. I want to talk a little bit about
    why the administration views it necessary to focus on health
    equity and also talk about what agencies or organizations will
    you seek to partner with through this office.
        Mr. Becerra. So COVID-19 exposed the worst parts of our
    system, where we miss people. I mean, they were hiding in plain
    sight, you and I know that. And now we see it. And so now we
    have an obligation to do something about it.
        And I think what we will do differently is we are not going
    to just rely on the traditional sources of support. We are
    going to go directly to these communities that have been worst
    hit and first hit and ask them, ``How can we help, because we
    know you have had to live this?''
        And, for the first time, I think we can say we are going to
    bring some real resources behind what we want to do.
        Ms. Blunt Rochester. Excellent, excellent. Thank you so
    much, Mr. Secretary. Again, we are looking forward to working
    with you on this issue as well as so many others. I was
    fortunate to work to push for marketing and outreach in our
    More Health Education Act in the last Congress for the ACA, and
    I am so glad to see the efforts that the administration has
    made, especially during a pandemic, to ensure more people have
    access to healthcare. And I am looking forward to working with
    you on other issues as well.
        Thank you, and Madam Chair, I yield back my time.
        Ms. Eshoo. Excellent. The gentlewoman yields back. It is a
    pleasure to recognize our resident pharmacist on our committee,
    Mr. Secretary, the gentleman from Georgia, Mr. Carter, for 5
    minutes.
        Mr. Carter. Thank you, Madam Chair. And thank you, Mr.
    Secretary, for being here.
        Mr. Secretary, it has been almost 14 months now since the
    COVID-19 pandemic started. And it began in China, we know that.
    But we still don't know the origin, as far as whether it
    started at a wet market or if it started at the Institute of
    Virology. And we haven't even had an investigation into telling
    us this. And we need to get to the bottom of it, obviously. And
    I am sure you agree with that. We need to know so that we can
    prevent this from happening again. That is crucial.
        I want to ask you very quickly, can you just give me your
    perspective on how the U.S. and the global community--because
    this, in fact, impacts all of us--how the global community can
    hold China accountable, and ensure that a credible
    investigation into the origin of the COVID-19 can be conducted?
        Mr. Becerra. Congressman, thank you for the question.
        I agree with you, we want to make sure that there is a
    transparent process that is based on evidence, that helps guide
    us in trying to take a look at this and dig down deep. We want
    to have accountability. We are now back on stage with the World
    Health Organization, working with them. And we provided some
    guidance to them on what we think would make for a critical,
    thorough, comprehensive review of the circumstances behind
    COVID-19.
        And so I look forward to partnering with you as we try to
    work with our international partners to make sure we get to the
    bottom of these things.
        Mr. Carter. Do you think that China and the World Health
    Organization should be pushed to allow an investigation into
    the possible origins, whether it be the wet market or the lab?
        Mr. Becerra. Well, we have already been pushing the WTO in
    trying to make sure that we do a thorough assessment of this.
    We have been in communication with China on any number of
    issues relating to COVID. And we are going to continue to push
    because, at the end of the day--I think you will agree with
    this--we have to understand how COVID surfaced, we have to
    understand how it spread, so we could try to make sure we are
    prepared for the next time we have this kind of a public health
    crisis.
        Mr. Carter. OK. Mr. Secretary, in 2017, this committee, the
    Energy and Commerce Committee, was instrumental in enactment of
    legislation that would allow consumers to have access to over-
    the-counter hearing aids. And it was bipartisan legislation, as
    is often the case out of this committee. I submit that this is
    the most bipartisan committee in Congress.
        And on the bipartisan basis, the House and the Senate
    repeatedly inquired of the FDA on the status of this
    regulation. But ever since last year, month after month, the
    FDA just says, ``It is a priority, but we can't tell you where
    the regulation is at.''
        I am hearing--and I have been told--that there are rumors
    that the regulation can't move until we have a permanent FDA
    Commissioner. Is that true?
        Mr. Becerra. First, that is not true. And secondly, if I
    can just say that my mom doesn't live in Georgia, but if she
    did she would vote for you right now, because she is one of
    those victims of these hearing aid marketing schemes and is
    anxious to hear my answer, just as you are.
        And so I look forward to working with you, because we are
    going to get that out. We don't have to wait until we have a
    permanent Commissioner. It is an important rulemaking, and we
    will work closely with you on trying to make sure that
    Americans, if they are going to participate in purchasing these
    hearing aids, they get what they are supposed to get.
        Mr. Carter. Do you have a date, a date certain, that you
    can tell me?
        I mean, is it----
        Mr. Becerra. Congressman, if I could tell you a date
    certain, I probably would have to give folks a date certain on
    a lot of other matters. We are working on it. But I can tell
    you--my mom is probably going to push harder than you are on
    getting a date certain----
        Mr. Carter. I understand. Is it still undergoing [audio
    malfunction].
        Mr. Becerra. It is still undergoing review----
        Mr. Carter. Any idea when that will be completed?
        Mr. Becerra [continuing]. On that, Congressman.
        Mr. Carter. Please [audio malfunction] suffer from
    antimicrobial--infections, and we have over 48,000--infections,
    and we have seen, with the COVID-19 pandemic, as it continues,
    a sizable number of patients are suffering from secondary
    infections, with CDC identifying resistant secondary
    infections, outbreaks as COVID-19--this reinforces, in my
    opinion, the urgent need to--for access to effective
    antimicrobial products as part of our pandemic preparedness and
    response.
        Can you commit to me, Mr. Secretary, that--working together
    to address the antimicrobial resistance in a way that creates
    [audio malfunction].
        Mr. Becerra. [Audio malfunction] deadly afraid of what
    happens if we overuse some of these [audio malfunction]. So
    absolutely, I look forward to working with you on that.
        Mr. Carter. We also need to----
        Ms. Eshoo. The gentleman's----
        Mr. Carter [continuing]. Work with the overprescribing of
    certain antibiotics, as well.
        Ms. Eshoo. The gentleman's time----
        Mr. Carter. As a pharmacist, I can tell you that is a
    problem.
        Thank you, Madam Chair and I yield.
        Ms. Eshoo. Yes, the gentleman's time has expired.
        The Chair is pleased to recognize the gentlewoman from
    Minnesota----
        Ms. Craig. Well, thank you so much----
        Ms. Eshoo [continuing]. Ms. Craig, for your 5 minutes.
        Ms. Craig [continuing]. Madam Chairwoman, and Mr.
    Secretary, it is great to see you again. The last time I saw
    you in person, I was in--we were in Eagan, Minnesota. So it is
    great to see you.
        I want to start just by saying thank you. I can't tell you
    how pleased I am about yesterday's announcement that HHS will
    enforce civil rights protections for LGBTQ Americans related to
    healthcare. So thank you so much for your leadership, and the
    administration's inclusion as a matter of policy.
        Also, as I listen to your testimony here today, it is all
    of the reasons and thinking behind why I am here. That is, we
    have got to have a robust funding program for the NIH, for CDC,
    restocking the national stockpile, addressing maternal
    mortality and morbidity. All of these things is exactly why it
    is such an honor to serve on the Health Subcommittee in this
    Congress. And I am just so proud of your leadership in this
    administration.
        Beyond all of that, in the funding for these agencies and
    making sure that we have world-class innovation coming out of
    them, my top priority in Congress is to lower the cost of
    healthcare and prescription drugs and improve access for all
    Americans.
        Last month I was proud to reintroduce a bill called the
    State Health Care Premium Reduction Act that would provide HHS
    with funding to help States set up reinsurance programs or
    extend financial assistance to folks on the individual market.
    We all know that that remains a critical issue, lowering and
    stabilizing the cost of healthcare out there in the individual
    market. According to the CBO, this bill would actually lower
    premiums by about 8 percent in the individual market.
        Secretary Becerra, do you have any comments on that, as a
    policy matter, and does HHS support, just as we did for a few
    years at the beginning of the Affordable Care Act, helping
    States with Federal funding to set up those reinsurance
    programs and lower premiums in the individual market?
        Mr. Becerra. Congresswoman, great to see you, and I
    absolutely agree with what you have said. We need to have a
    stable market. Reinsurance is one of the ways that we can help
    make sure we do.
        Ms. Craig. Well, thank you so much for that. Reinsurance,
    obviously, is just one tool, I know, that we can use to shore
    up the ACA and to make sure that healthcare is more affordable
    for hardworking Minnesota families.
        Next I want to turn to the American Rescue Plan just--for
    just a moment, which included health insurance premium
    assistance for so many Americans at a time when they are
    struggling financially. And I want to give credit to my
    colleague and classmate, Representative Lauren Underwood, for
    her championing and persistence in making sure that this was
    part of the American Rescue Plan.
        The landmark legislation extended ACA subsidies to more
    Americans, including, for the first time, individuals with
    income above 400 percent of the Federal poverty line.
        I also just want to take a moment to give this
    administration credit for reopening, for that Special
    Enrollment Period during a public health crisis, the ACA to
    Americans.
        So, Secretary Becerra, can you just briefly discuss the
    impact of the enhanced subsidies on premiums and how many
    individuals you have seen already with their monthly premiums
    decrease?
        Mr. Becerra. Congresswoman, the fact that there are a
    million new enrollees to the Affordable Care Act during the
    Special Enrollment Period shows what happens when you give them
    a chance to learn that they can save money. And that was
    because of what you all did with the American Recovery Plan, by
    giving us a chance to reduce the cost of their premiums.
        Now, the American Family Plan, which we hope that you will
    get to as well, will make permanent those savings that those
    Americans who are signing up for coverage are getting. And I--
    what is great is, if you get 4 million more Americans coming on
    board because they too will save money, that is what you have
    done. You have just put a major--and to the chairman's
    thinking--more than just a dent in the uninsured in America,
    you are really going towards getting us to the point where
    every American can really say healthcare is a right, not just a
    privilege.
        Ms. Craig. Secretary Becerra, you read my mind, because
    that was my last question to you about making that permanent.
    So thank you so much.
        In the time that I have remaining, I just want to note
    that--the importance of the 340B program, how important that is
    for providing access to care for low-income and rural patients
    in my district. I would encourage you to take swift action to
    protect that vital program.
        And with that, Madam Chairwoman, I yield back.
        Ms. Eshoo. The gentlewoman yields back. It is a pleasure to
    recognize the gentleman from Texas, Mr. Crenshaw.
        And it is great to have you with us. You are recognized.
        Mr. Crenshaw. Thank you, Madam Chair. It is always great to
    be with you, as well. I wish I could be with all of you in DC.
    But, you know, I guess there is a small benefit of this
    surgery. You can't go to DC for 6 weeks. But I do miss you
    guys.
        Mr. Secretary, thank you for being with us. I want to
    follow up on Dr. Burgess' questioning on the situation with
    Texas and our 1115 waiver, and I want to drill down as to why
    this happened.
        So this is a longstanding waiver, the extension of which
    was rejected by a career staffer at CMS who was temporarily the
    head of CMS. It doesn't seem likely that they just took it upon
    themselves to reject that waiver. Who told them to do that?
        Mr. Becerra. Congressman, I wish you well in getting back
    to DC, although I imagine you are not missing not being in DC
    and getting to stay in your home State.
        But on the question of the waiver, again, I think it is
    important to recognize that Texas still has its waiver. Its
    waiver continues in force. Nothing has changed. What we are
    talking about is an extension of 10 years that was added to the
    existing waiver without public comment and without notice. And
    that was--that is extraordinary, when you think about it, given
    that it was a 10-year waiver, not a 5-year or shorter waiver.
    And it--you are talking about billions of dollars.
        And so what CMS is doing is what we would expect CMS to do,
    is we are trying to make sure that we are transparent and we
    show accountability, because we have to make sure we are
    following the law, and we are working with your leadership in
    the State and along with your delegation to try to make sure
    that, as Texas moves forward, if it wants to continue the
    waiver, we are going to be working with you to make sure we can
    see that happen.
        Mr. Crenshaw. OK, so it had your full approval to revoke
    that waiver that was approved by the previous--or revoke that
    extension that was approved by the previous administration and
    had the White House's approval, your approval? It wasn't some
    staffer that went rogue.
        Mr. Becerra. Well, I can guarantee you that there is not a
    staffer that is going rogue. But remember, much of the work
    that was done was done before I was confirmed.
        But what I will tell you is I concur with the actions that
    were taken by CMS in looking closely and working with Texas to
    look closely at the waiver that they have asked for as an
    extension. Again, the existing----
        Mr. Crenshaw. Well, we understand there might be
    disagreements on the interpretation of the powers under COVID,
    right? They approved it in a fast-track way under COVID. That
    is what happened. Your administration disagrees with that
    interpretation. So be it.
        But to revoke an entire waiver, which has a massive effect
    for the future of Texas programs, I mean, it puts us into a
    very difficult situation because our entire system is
    predicated on this particular waiver, and it is a longstanding
    waiver too. You know, it is--yes, it is an extension of a
    longstanding waiver. This isn't some extreme thing. What is
    extreme is revoking an extension, which has never been done
    before.
        So, you know, if you have a procedural issue with it, I get
    that. But to take such an extreme action as a result is really
    hard for Texans to understand. And can you commit right now
    that, if they resubmit, that it will get approved?
        Mr. Becerra. Well, we are closely working with Texas to
    make sure, if they wish to resubmit, they can.
        But Congressman, I would have to say that any time you are
    talking about getting an extension 2 years in advance and using
    COVID as the reason why you had to do it without giving
    Americans a chance to know about it or to comment, that is, to
    me, is a stretch.
        All I know is that we have to abide by the law at HHS and
    at CMS. We have to be transparent in the way we do it. All we
    are asking is that Texas participate with us to make sure that
    that transparency is there.
        Mr. Crenshaw. OK, so they applied for it under the letter
    of the law. If they resubmit, can you guarantee that it will be
    approved if they submit it according to the law, as they
    already did?
        Mr. Becerra. If and when Texas resubmits, we will look at
    that, according to the law, and we will go through the process
    that provides for notice and comment, so we can make sure that
    we get the input of all stakeholders to make sure that whatever
    Texas does complies with the law and has the support of those
    who are going to be impacted.
        Mr. Crenshaw. My last question. You seemed to indicate
    earlier that you actually do not support or do not recognize
    the statute on partial birth abortions. Can we answer that more
    clearly now?
        Yes or no, do you recognize the statute that outlaws
    partial birth abortions?
        Mr. Becerra. So, again, trying to be as clear as I can on
    this. There are procedures that are used in providing women
    with the healthcare they need, including when they have----
        Mr. Crenshaw. It is a very clear statute, Mr. Secretary,
    please don't waver on this. The Supreme Court has already
    spoken on this particular statute. Do you recognize it, yes or
    no?
        Mr. Becerra. Well, I certainly recognize what the Supreme
    Court has said. And we will abide by what the Supreme Court
    requires, and we are going to make sure that we protect women's
    rights to healthcare.
        Ms. Eshoo. The gentleman's time has expired. We thank him--
    --
        Mr. Crenshaw. Thank you.
        Ms. Eshoo [continuing]. For his questions. And heal and be
    well.
        The Chair is now pleased to recognize----
        Mr. Crenshaw. Thank you, I yield back.
        Ms. Eshoo [continuing]. One of the fine doctors on our
    subcommittee, Dr. Schrier of Washington State, for 5 minutes.
        Ms. Schrier. Thank you so much, Madam Chair, and welcome,
    Secretary Becerra. Thank you for coming to this committee to
    talk with us about your priorities in the HHS budget.
        First, just as a pediatrician, I want to thank you for
    prioritizing children in so many ways. But I want to talk about
    something else today. I want to the Advanced Research Projects
    Agency for Health, ARPA-H, to focus on breakthrough research
    for diseases like cancer, diabetes, and Alzheimer's. We have
    just witnessed, with Operation Warp Speed, how quickly medical
    advances can happen when government targets investment and
    ameliorates that risk. And this keeps us right on the cutting
    edge of research and development to treat and cure some of our
    most devastating and dreaded diseases.
        Now, I was also especially thrilled to see the investment
    in the Office of the Assistant Secretary for Preparedness and
    Response, in ASPR, and I agree that defeating COVID-19 should
    be our current priority, along with preparedness for the next
    public health challenge or pandemic. This one has been quite a
    lesson in preparedness and in what we can even do better next
    time.
        And I would also suggest that readiness to quickly deploy a
    robust testing strategy, in addition to shoring up our national
    stockpile, is critical for this pandemic and for the next one.
        And depending on how effective the current vaccines
    remain--right now things are looking good--and also, depending
    on how many of us get vaccinated, testing might be able to take
    a back seat for right now, but that is a big may. And we have
    all seen how important rapid diagnostics are in containing
    disease and containing the spread.
        And we didn't do it well in the U.S. We really stumbled at
    first, we never really caught up. We are still not doing
    surveillance testing. Even today--and the vaccines are proven
    to be remarkably effective, but suboptimal public uptake and
    global circulation means that we are probably going to be
    living with COVID-19 for a long time. And I just want to make
    sure that we are using every tool we have. We still need to
    have a robust testing program for diagnosis and surveillance
    that includes inexpensive at-home tests that could be
    manufactured at scale, and we need it now, thinking about
    schools, and we will need it for future infectious disease
    threats.
        And the coordinated interagency work of the CDC, the
    Department of Defense, NIH, FDA, and ASPR is doing to reopen
    schools and get that testing to market is phenomenal. I want to
    highlight the work that ASPR has done with BARDA. However, even
    in their own assessment, they acknowledge that testing still
    needs to be more widely available, more affordable, and more
    convenient.
        So, Secretary Becerra, can you just tell us if you have
    plans for additional investments in ASPR, BARDA to continue
    developing and deploying a really sustainable and scalable
    testing strategy?
        Mr. Becerra. Congresswoman, thank you for the question. And
    listen, I can't agree more with what you have just said, and we
    discussed--I answered some questions about testing a little
    earlier.
        We are not done. Even if we fully vaccinate, we are not
    done. We have a lot of work to do because testing, it is the
    prevention part of dealing with an illness or a crisis. It is
    trying to avoid it from spreading and becoming the pandemic,
    the real crisis. And testing will be part of any package that
    we try to implement to make sure that we are dealing with
    healthcare crises moving forward.
        By the way, I would be remiss if I didn't thank you for the
    work that you have made in--done in helping us ensure that we
    have testing available for Americans throughout the country,
    and perhaps it is because of your own background and training
    that you understand that, in order to keep people healthy,
    especially our kids, we want to make sure that we know where
    the crisis might occur.
        And so we are going to continue to make investments. ASPR
    is critical. BARDA is critical. ARPA-H will be just innovative
    and breakthrough in helping us get there. So I hope we can work
    with you to make sure that testing is part of any program that
    we have to protect Americans.
        Ms. Schrier. I would love that. And I know there was a
    question earlier about what are we going to do with all this
    extra money for testing. I can think of a million ways to spend
    it, and one of them is having tests that cost--right now, $12
    each is our over-the-counter test, and that is just too much
    for using on a regular basis. So I could see investing boldly
    there. I could see deploying testing in elementary schools
    until we have vaccinations roll out and widely accepted for
    kids.
        Last question. You talked about Congress helping. Is there
    anything that you specifically need from Congress to make
    surveillance, home testing, scaling up possible?
        Mr. Becerra. Aside from the resources, I would tell you
    your connections. You know the people on the ground in your
    district who can help us most. Help us connect with them as
    quickly as possible.
        Ms. Schrier. OK, great. Thank you.
        Ms. Eshoo. The gentlewoman's time has expired. It is a
    pleasure to recognize the gentlewoman from Arizona.
        Mrs. Lesko, you have 5 minutes.
        Mrs. Lesko. Thank you very much, Madam Chair. Before I get
    to my question I would like to ask unanimous consent to submit
    a copy of an article from ABC 15 News in Phoenix for the
    record. It is entitled ``Valley Family Pleads with FDA for
    Access to Experimental Drug for Fatal Children's Disease.''
        Ms. Eshoo [audio malfunction]. Need to submit it.
        Mrs. Lesko. Thank you.
        Secretary Becerra, thank you for being here. The FDA's
    world-class drug [audio malfunction].
        Ms. Eshoo. Am I unmuted?
        Mrs. Lesko, you need to unmute. Can you hear us?
        Mr. Guthrie. I think she is frozen.
        Mrs. Lesko. Yes.
        Mr. Guthrie. There she is.
        Ms. Eshoo. There you are.
        Mrs. Lesko. I am unmuted on my side.
        Ms. Eshoo. All right, start your question again, because we
    didn't hear it.
        Mr. Guthrie. Madam Chair, I think she is freezing up.
        Ms. Eshoo. Yes, why don't we----
        Mrs. Lesko. All right. Can you hear me now?
        Mr. Guthrie. Yes.
        Ms. Eshoo. Yes, go ahead.
        Mrs. Lesko. All right, I am just going to use--I think what
    is happening is I have my statement, and I am just going to
    read it.
        Secretary Becerra, thank you for being here. The FDA's
    world-class drug approval process ensures medicines do
    exponentially more good than harm to the American public. But
    in rare situations, the only option for very ill people is a
    medicine that is not yet approved by the FDA. These are dealt
    with under the FDA's compassionate use or extended use program.
        I want to bring to your attention, sir, Woodrow Miller. He
    is a constituent of mine who is only 21 months old and,
    tragically, has Niemann-Pick Type C disease. NPC is a rare,
    progressive genetic disorder which can begin to show symptoms
    in children very early in their lives. Symptoms include
    difficulty moving limbs, an enlarged spleen or liver, a decline
    in intellect, dementia, seizures, difficulty speaking and
    swallowing, a loss of muscular functioning, loss of vision or
    hearing. The one glimmer of happiness in this very tragic
    prognosis is the medicine that doctors in the field of
    neurology believe can delay, for some children, the most
    impactful symptoms of the disease.
        Unfortunately, due to a discontinued clinical trial,
    Woodrow is not able to gain access to the medicine his doctor
    believes can help him. I have spoken to Woodrow's mother,
    Denise, and I want to do everything I can to help. Denise has
    spoken with many doctors. We have got letters from many doctors
    and heard Woodrow's doctor. My staff has also spoken with
    Denise and have been in touch with the FDA staff, both through
    the phone and email. FDA staff are sympathetic and responsive
    but have not found a path forward yet.
        Last week I sent a letter to Acting Commissioner Woodcock,
    asking her to review Woodrow's situation and use the
    authorities at her disposal to help Woodrow quickly gain access
    to the medicine his doctor recommends. Quite frankly, time is
    of the essence. I can't stress this enough. NPC is a
    degenerative disease. Once the child loses functions, it is
    unlikely he will regain them.
        Mr. Secretary, will you direct your staff to follow up on
    the status of FDA's response to my request to help Woodrow gain
    access to the medicine his doctors believe can help him?
        And will you emphasize they should use all appropriate
    options?
        Thank you, sir.
        Mr. Becerra. Congresswoman, first, thank you very much for
    pointing out what so many Americans, unfortunately, suffer, and
    that is the plight of loved ones with these very rare diseases.
    I am absolutely willing to make sure that I follow up with your
    request with Acting Commissioner Woodcock.
        And what I will tell you is what I said to the folks at the
    FDR recently--FDA, excuse me, FDA recently--and that is that I
    recognize their independence. They base their actions on
    science, not on politics and influence. And so I will
    absolutely communicate your message. I suspect that she is--she
    and her team are working on it, as well, and understand the
    heartfelt way that you have conveyed that message. And we will
    try to get back to you quickly as we can.
        Mrs. Lesko. Thank you, Mr. Secretary. I appreciate it. My
    constituent appreciates it. Anything you could do would be
    greatly appreciated.
        And I yield back, Madam Chair.
        Ms. Eshoo. The gentlewoman yields back.
        It is a pleasure to recognize the gentlewoman from
    Massachusetts, Mrs. Trahan, for your 5 minutes of questions.
        And I want to thank members for staying on time, because it
    looks like we are going to be able to accommodate everyone,
    including Mr. Doyle.
        So you are recognized for 5 minutes.
        Mrs. Trahan. Thank you, Madam Chair.
        Hi, Mr. Secretary, thank you so much for being here with us
    today. Your appointment has sent a clear signal that the
    Department will once again prioritize expanding affordable,
    accessible, high-quality healthcare for all Americans,
    including those in our underserved communities.
        In my district, no one has done more to deliver that
    quality, affordable care to the underserved, and under
    extremely challenging circumstances, than the nurses and
    doctors and administrators at Lawrence General Hospital in
    Lawrence, Massachusetts. They serve the 80,000 residents of a
    beautiful, bustling, diverse, and historic city on the banks of
    the Merrimack River, the force that powered America's
    Industrial Revolution.
        Eighty percent of the city's residents is Latino, and you
    may remember that the area was sparked by a series of natural
    gas explosions back in September of 2018.
        You know, just as the city was recovering, the pandemic
    struck, setting progress back. On a per capita basis, the city
    has suffered greater numbers of COVID infections than any of
    our 350 cities and towns in Massachusetts. And at one point,
    three-quarters of Lawrence General's in-patient capacity was
    dedicated to recovering COVID-19 patients.
        Time and again, Lawrence General has come through for the
    community, particularly the 20 percent living in poverty.
    Indeed, approximately 75 percent of its patient population is
    public payer, primarily Medicare and Medicaid.
        You know, last month I wrote to you, along with Senators
    Warren and Markey, asking the Department to give Lawrence
    General the highest possible consideration for aid--of Provider
    Relief Funds. And your congressional team has been extremely
    responsive and helpful. But I wanted to personally alert you to
    this issue, given the incredible strain that the pandemic has
    put on the hospital. The assistance that Lawrence General has
    received thus far has been instrumental in allowing the
    hospital to continue operating despite higher costs and lower
    revenues. However, even with that assistance, the hospital is
    in a fragile financial position. And I can only imagine this is
    the case for many safety net hospitals serving similar
    populations across the country.
        So, Mr. Secretary, given that the Federal relief to the
    Nation's hospitals thus far has significantly helped these
    facilities to serve on the front lines of the pandemic, does
    the Department plan on relieving hospitals of financial burdens
    even further through enhanced PRF relief or advanced Medicare
    payments or any other measures?
        Mr. Becerra. Congresswoman, first, thank you for the
    question.
        But secondly, thank you for the work that you have done on
    behalf of Lawrence General. We have learned a lot from Lawrence
    General. And I will tell you that Lawrence General and those
    safety net hospitals that were on the front lines deserve our
    attention.
        And when it comes to that Provider Relief Fund, it was
    meant--you all passed that so we could actually address the
    needs of those providers that stepped up to the plate. And so
    what I can tell you is that, having represented, when I was in
    Congress, a number of those safety net hospitals myself, how
    important it is that we not let them fall through the cracks
    because they are the ones that were there before we had the
    pandemic, serving these populations that were very vulnerable.
        And so I could only commit to you that, under my
    leadership, I hope that you will see that HHS is trying to do
    right by all those who stepped up to the plate, those safety
    net providers, and that we are doing the right thing with the
    Provider Relief Fund. That is why accountability and
    transparency will be so important as we disperse those final
    tranches of dollars.
        Mrs. Trahan. Well, I appreciate your thoughtful answer.
        On the topic of provider relief, I also just wanted to
    raise concern regarding equity of distribution of the Provider
    Relief Fund. Assisted living providers--elderly individuals--
    less than 2 percent of the Provider Relief Fund, and have only
    received about a third of that. You know, due to PPE needs,
    workforce needs, occupancy declines, assisted living caregivers
    suffer--losses in 2020 alone. Now, over half of assisted living
    facilities nationwide are operating at a loss, and 56 percent
    say they won't be able to sustain operations for another year.
    I recently signed a bipartisan letter asking HHS for a more
    equitable distribution of the remaining PRF to assisted living
    facilities.
        So, Mr. Secretary, how do you envision implementing an
    equitable distribution to these assisted living providers who
    need immediate assistance?
        Mr. Becerra. Congresswoman, that is a great question, and
    there is where the transparency that we will ensure is going to
    be, I hope, our best response there, because there is more need
    than there is money. And what we have to do is prove to you and
    others that, when we disperse those funds, it is based on real
    need, that we can be accountable for the dollars that we send
    out.
        And so I offer you the chance to continue to work with my
    team and me, as we try to make sure we do right with those
    Provider Relief Funds.
        Mrs. Trahan. Well, thank you so much, Mr. Secretary. And
    I--please consider this an open invitation to come to the
    Merrimack Valley to meet the wonderful professionals at
    Lawrence General some time soon.
        I thank you, Madam Chair. I yield back.
        Ms. Eshoo. The gentlewoman yields back.
        It is a pleasure to recognize Mrs. Fletcher from Texas for
    your 5 minutes of questions.
        Mrs. Fletcher. Thank you so much----
        Ms. Eshoo. Great to see you, Lizzie.
        Mrs. Fletcher [continuing]. Chairwoman Eshoo.
        And Secretary Becerra, thank you for sharing your
    priorities with us today, and your thoughts on the priorities
    of those on this committee. Unlike so many of my colleagues
    that I have heard earlier today, I arrived in Congress after
    you had returned to California to serve as attorney general. So
    I am glad to meet you today this way and very much look forward
    to working with you.
        You are taking the reins of HHS at a critical moment in our
    history. And there is so much work to be done as we emerge from
    this pandemic, and many issues that we have been working to
    address since before it began. And I want to take my time today
    to talk about an issue of critical importance in my district in
    Houston and across the country: the Title X Family Planning
    Program.
        I have become fond of reminding people that Title X--which
    is the only Federal program dedicated to family planning and
    which provides critical preventive healthcare services for
    millions of low-income Americans each year--Title X was born in
    Texas 7. It was introduced in Congress by my predecessor in
    this seat, then-Congressman George H.W. Bush. This program has
    long had bipartisan support across our community, and it plays
    a vital role in ensuring access to essential services.
        Unfortunately, the last administration's actions to impose
    an ideological domestic gag rule meant that millions lost
    access to care under this program, as thousands of health
    insurers were forced out of the program. Six States have gone
    more than a year without any Title X-funded health centers. In
    2019, 800,000 fewer patients received care under Title X as
    compared to 2018, and in 2020 the reduction was even greater.
        So I am pleased that the administration's budget request
    enhances the funding for Title X after years of flat funding so
    we can restore Title X to its true purpose intended by
    Congress: to provide preventive healthcare and family planning
    services to those who need it the most.
        I am interested in better understanding the
    administration's timeline for implementing changes to the Title
    X program and when we can expect the quality family planning
    providers that were shut out of the program under the last
    administration to be able to once again serve patients.
        Secretary Becerra, can you discuss the administration's
    request for additional Title X funding and why this increase in
    funding is so critical?
        Mr. Becerra. I absolutely can, Congresswoman, and I look
    forward to the opportunity to get to know you better and
    develop the friendships I have with many of the Members that
    you sit with.
        Listen, Title X is crucial. It is family planning. It is
    preparing our families for a bright future for their kids and
    them. It is making sure that we do the right thing. And we have
    to make sure that services are available. It is not just for
    women. Obviously mostly women, but it is not just for women.
    And you may know I did a lot of work when I was attorney
    general to protect Title X and its services, and we are going
    to fight just as hard.
        Thank you for what you did to make sure that there was $50
    million made available through the ARP so we could make sure
    family planning services were made available.
        We are going to do everything we can to restore some of
    those services. The President's budget increases funding for
    Title X. It is just the right thing to do. I mean, it is--we
    can't be about families first if we are not providing them with
    the services they need to make the right decisions about moving
    forward with their family.
        And so I will tell you that, working with those of you who
    are interested, we are going to launch as best we can, as
    quickly as we can, but we have to make sure we do it right. If
    we are going to promulgate rules, we have to do it the right
    way. And we are going to make sure that we do this right, so we
    can service the people who need those family planning services.
        Mrs. Fletcher. Great. Well, thank you so much for that.
    And, I guess, one quick follow-up. I would love to work with
    you on this and would love to know if you can tell us any more
    now about how you intend to restore the program to ensure that
    more patients are served.
        Mr. Becerra. Again, when we get closer to promulgating
    those rules, we will be able to work together. But I don't want
    to get too far ahead of ourselves because, as I said, we have
    to make sure we do this the right way.
        Mrs. Fletcher. OK, well, thank you for that. I appreciate
    your efforts. Title X is a critical aspect of our healthcare
    safety net, and millions of patients rely on access to care
    through this program each year. So I encourage you to address
    it quickly and look forward to working with you on that and to
    restoring the program.
        And with the time I have left, I do want to just touch on
    an issue that my colleagues from Texas have raised about the
    administration's withdrawal of its approval of Texas' 1115
    waiver extension.
        As you likely know, Texas is in a healthcare crisis. It has
    the highest uninsured rate in the country. It is certainly my
    hope that Texas will expand Medicaid, especially considering
    the incentives in the American Rescue Plan that we worked on in
    this committee. Now--but I hope we can work together to address
    the concerns that have been raised. It is clear that, even if
    Texas were to expand Medicaid, there would still be a need for
    some form of 1115 waiver to fund any existing uncompensated
    care in the State. And, of course, we hope it will be done in a
    transparent way and in a way that provides quality care to
    disadvantaged Texans.
        So I am glad to hear that you are working closely with
    people in Texas now, and I urge you to work with them to
    accomplish these vitally important objectives to our State. So
    thank you so much, Secretary Becerra.
        And with that I will yield back.
        Ms. Eshoo. The gentlewoman yields back. I don't see Mr.
    Schrader, so I am going to go to Mr. Doyle, who is waiving on,
    and he has been with us since the beginning of the hearing
    today.
        So you are recognized, my friend, for 5 minutes.
        Mr. Doyle. Well, I want to thank the chair, and my good
    friend, for allowing me to waive on to the committee.
        Mr. Secretary, congratulations to my friend and former
    colleague, Xavier. It is good to see you. It has been too many
    years, but good to have you back and in this very, very
    important position.
        I want to start out with an issue that is a matter of
    urgency for Pennsylvania and our Medicaid program. On January
    8th, the Trump administration put out a regulation around
    Medicaid managed care contracts that is going to force
    Pennsylvania to completely redo formulas for how our Medicaid
    program reimburses hospitals and nursing homes in 2022. This
    regulation reversed about a decade's worth of approvals for the
    way Pennsylvania pays our managed care providers. And while CMS
    believes Pennsylvania can transition to alternative directed
    payments, our Governor, our secretary of health, our hospital
    association, and I are all concerned that this does not fully
    account for the difficulties, risks, and implications of such
    an abrupt policy change.
        In fact, the real timeline only provides our State a few
    weeks to develop the needed policy changes, since they also
    need actuarial approval prior to the end of the year.
    Unfortunately, this scramble puts Medicaid payments to
    hospitals and nursing homes at risk during a pandemic, which I
    hope we can all agree is counter to our shared goals.
        Ultimately, this change could force hospitals and nursing
    facilities to limit Medicaid beneficiary access if they are
    faced with funding uncertainty, which does not seem to be in
    line with President Biden's larger efforts on healthcare. We
    understand CMS has concerns around current policies. And
    although we don't completely agree with those concerns, we
    really believe more time is needed to discuss this and develop
    a path forward that works for both sides.
        So my question is, Mr. Secretary, will you commit to
    working with us on this issue and consider delaying this new
    guidance for a year?
        Mr. Becerra. Congressman, good to see you, and thank you
    for the question. I know this is of importance to you, because
    I have had several conversations now with Governor Wolf on this
    particular subject, and we will continue to have those
    conversations. Our team is now chatting more directly with your
    folks back in Pennsylvania. You have my commitment that we are
    going to work--try to work through this.
        It is a complicated issue, and I can't even describe it
    all, because I have to have my folks at CMS sit down with me a
    little bit more, because in my first conversation with Governor
    Wolf I was hoping we would be able to get back to him really
    quickly, because I know that time is of the essence.
        But what I could commit to you is that we are going to be
    sitting down with Governor Wolf and his team and, if you would
    like, your staff as well, to make sure we work through this as
    best possible.
        Mr. Doyle. I appreciate that, and it is really important to
    us.
        Let me just ask you one more question too. It is a bit
    broader question, but something I am also excited to work with
    you on.
        I am sure you know the rates of antibiotic resistance have
    been on the rise for some time, and yet we still aren't seeing
    an active pipeline of new drugs to fight these resistant
    infections. So my question is, what resources does HHS plan to
    dedicate to the development of new antibiotics and
    antimicrobials in the coming year?
        And has HHS considered shifting the way we pay for
    antibiotics to ensure a steady stream of new drugs?
        Mr. Becerra. Congressman, it is going to be an all-of-the-
    above approach, because I think everyone is recognizing that we
    are beginning to lose those defenses against some of these very
    deadly diseases if we don't tackle this quickly. So we are
    willing to listen to whatever anyone has to offer.
        We certainly will take resources as well, because we do
    want to develop the next generation of antimicrobials so we can
    be ready. And so we will be ready on that.
        Mr. Doyle. Well, thank you very much, Mr. Secretary. It is
    good to see you back here in Washington.
        Madam Chair, I will yield back a minute to you, and thank
    you for your courtesy.
        Mr. Becerra. And Madam Chair----
        Ms. Eshoo. Thank you. Yes, thank you, Mr. Doyle.
        Mr. Secretary, let me ask you a quick question.
        Mr. Becerra. Yes.
        Ms. Eshoo. We have about, I think, 4 minutes left, but we
    have two Members that will bring their questions to you in a
    rapid manner. They have waived on to the committee. Can you
    stay with us just to accommodate the two?
        Mr. Becerra. It is hard for me to tell friends and
    colleagues no. So let me--if we can do this quickly, I will
    stick around.
        Ms. Eshoo. That was the right answer. That was terrific,
    music to my ears.
        All right, so we will go to Mr. McNerney of California for
    his 5 minutes.
        And if you can question faster than that, that would be
    terrific. You are recognized.
        Mr. McNerney. Well, thank you, Chairwoman Eshoo.
        And thank you, Secretary Becerra, it is great to see you. I
    think you are doing a great job this afternoon here.
        I appreciate the administration acknowledges the clear link
    between climate change and human health. The scientific
    community has been warning us for years about the consequences
    of climate change. What I wanted to do was expand upon
    Congresswoman Blunt Rochester's questions.
        The administration is requesting funding level increases
    for the NIH Climate Change and Human Health Program and the CDC
    Climate and Health Program. These initiatives fund research on
    the health impacts of climate change and adapt our public
    responses accordingly.
        The previous administration intentionally silenced the
    scientific community's concerns about climate change. How will
    you reverse the negative impacts of the prior administration's
    policies?
        Mr. Becerra. Congressman, great to see you, and of course I
    would get a scientific question from a scientist. I will say to
    you that we are--the fact that we are establishing, at the
    direction of the President, this office that will deal directly
    with climate change is a clear message of our commitment to
    deal with climate change as a healthcare--public health issue.
        And, you know, my work as AG in California, where we took
    on this issue, established the Bureau of Environmental Justice,
    we understand that those who are worst and first hit are
    usually those vulnerable communities. So we are going to tackle
    this one because we have no choice if we truly want to have
    Americans stay healthy,
        Mr. McNerney. Well, how--will increasing the budget for
    climate and health effects at NIH and CDC strengthen public
    health departments and labs in the response to climate change?
        Mr. Becerra. Without a doubt. And we will take whatever
    resources you can give us because, you know, there is not
    enough that we have right now.
        Mr. McNerney. Well, we know that climate change affects
    everyone, but it has disproportionate impacts on low-income and
    minority communities. For your perspective, how will investing
    in the NIH and CDC programs reduce these disparities?
        Mr. Becerra. You know, as much as California fights to have
    clean air, if you live--if you have a child in the Central
    Valley, there is a one in four chance that your child will have
    asthma. Why? Because of the air, the air quality. And so we
    have to do everything we can, working with our local partners,
    working with Congress, to make sure we are addressing this.
        Congressman McNerney, on this one you have me, I will try
    to do everything we can.
        Mr. McNerney. Very good. And, as you are aware, you just
    mentioned the Central Valley in California suffers from some of
    the worst air quality in the country. This has been made
    significantly worse by the wildfires. In fact, the New York
    Times article by Dr. Kari Nadeau suggested that the exposure to
    wildfire smoke is associated with genetic changes in children's
    immune cells. This is very disturbing.
        How can the HHS work with the DoE and the EPA to mitigate
    and prevent harm like this?
        Mr. Becerra. We each have jurisdiction, we each have
    responsibilities, and we each have reach to make a difference.
    And hopefully, coordinating, we can make a difference faster
    and further than if we try to do it all by ourselves.
        Mr. McNerney. That is great. I look forward to working with
    you, Secretary, and this is the big issue that affects all of
    us, but especially in the Central Valley.
        Thank you, I yield back.
        Ms. Eshoo. The gentleman yields back, and I thank him for
    yielding back the extra time.
        And last but not least, the Chair recognizes the
    gentleman--and that is what he is--from New York.
        Mr. Tonko, you are recognized for questioning.
        Mr. Tonko. Thank you, Madam Chair----
        Ms. Eshoo. I didn't want to say 5 minutes, though, because
    the Secretary has to run, so----
        Mr. Tonko. OK.
        Ms. Eshoo [continuing]. As quickly as you possibly----
        Mr. Tonko. Thank you, Madam Chair, for your--and thank you,
    Secretary Becerra. Congratulations, and thank you for your
    leadership in joining us today.
        I applaud the Department of Health and Human Services with
    their important step in moving forward with new buprenorphine
    practice guidelines that will save lives. But I am concerned,
    though, that the X waiver itself remains, which means
    prescribers will have to actively apply for what, essentially,
    will be a waiver to the waiver. This will leave an unnecessary
    barrier in place. Secretary, I appreciate your previous
    comments, that the X waiver requirement should be removed, and
    we look forward to working with you to accomplish this
    important goal.
        So my question is, was HHS limited in its actions it could
    take regarding fully implementing the X waiver and lifting
    patient caps?
        Mr. Becerra. Congressman, you know this better than anyone,
    you have worked on it harder than anyone, and you know the
    answer to that is yes, we were constrained.
        Mr. Tonko. So I have--I would like, Madam Chair, to enter
    for the record a letter supporting urgency in passage of the
    bipartisan Mainstreaming Addiction Treatment Act. It is signed
    by some 120 organizations.
        And as you know, I am a proud supporter of the MAT Act,
    which would fully eliminate the X waiver requirement and
    authorize the Secretary of HHS to conduct a national campaign
    to educate practitioners about the change in law and encourage
    providers to integrate evidence-based medication-assisted
    treatment into their practices.
        So would HHS support congressional action to authorize the
    Secretary of HHS to conduct a national campaign to do this
    education and encourage providers to integrate evidence-based
    medication-assisted treatment into their practices?
        Mr. Becerra. Congressman, it is crucial that we expand
    access. And so what I can tell you is we will absolutely be
    supportive of any congressional action to help us expand
    access. How you do it, I am no longer there, I no longer have a
    vote. I wish you well as you try to move this forward. I know
    you have been a champion on this issue. But please, help us
    have expanded access.
        Mr. Tonko. Thank you, thank you.
        My other issue is the Medicaid reentry, which would empower
    States to restore Medicaid eligibility for incarcerated
    individuals up to 30 days before their release to ensure that
    those transitioning will have immediate access to critical
    services, including mental health support, addiction treatment,
    and COVID testing. Granting the States this ability is a great
    way to respond to their quality of life and to destroy the
    statistics out there, which have too many people vulnerable to
    addiction as they are released.
        Is the President still committed to this population, and
    would he be willing to include this provision in his budget?
        Mr. Becerra. Congressman, you know the President has been
    talking about expanding access to healthcare to all. You know
    he has said it should be a right, not a privilege. And as we
    move forward with restorative justice to help those who have
    moved on in life, we certainly would have to make sure we are
    including them. So I can't--I won't speak directly for him, but
    I can tell you the commitment of this administration is to make
    sure everyone has access to quality, affordable healthcare.
        Mr. Tonko. Well, we--thank you. And I just hope you can
    consider talking to OMB about including the Medicaid reentry in
    your budget.
        And with that, you know, I thank you, Madam Chair, for your
    flexibility.
        And, Mr. Secretary, congratulations on your appointment,
    and I look forward to working with you.
        Ms. Eshoo. The gentleman yields----
        Mr. Tonko. I yield back.
        Ms. Eshoo. The gentleman yields back, and we want to thank
    the Secretary for his flexibility in accommodating those that
    just waived on.
        Mr. Secretary, thank you for a very full part of the day in
    joining us. We look forward to many other hearings and, very
    importantly, the day-to-day work with Members from the
    subcommittee, and others as well.
        Anyone that tuned into this had a front-row seat of how
    much work has been done on the good-news front relative to
    COVID but how much more work we have to do on behalf of the
    American people. And, you know, as a former Member of the
    House, there is nothing that kind of raises the ire of Members
    than not getting a direct answer to a direct question.
        So, you know, pursuant to the committee rules, Members have
    10 days to submit their additional questions for the record. I
    will do that, and ask you to respond as--in a really timely
    fashion, but get to the answer so that we can move down the
    road of making progress.
        So we wish you godspeed with this massive portfolio that
    you have.
        Everything that we do, and the words that are embedded in
    the statutes, in the legislation, those are all words that walk
    into peoples' lives. And we know--we have confidence that you
    understand that and have a great regard for it, having been one
    of the shapers of the words and legislation. Now you are an
    implementer.
        So we want to give the best language--put the best language
    forward, but we will, obviously, work very hard with you to
    make sure that there is implementation. So godspeed and thank
    you.
        I thank all the members of the subcommittee, those that
    waived on, and at this--oh, let me ask the wonderful ranking
    member.
        We have 18 documents to submit for the record. And I would
    like to request--I have a unanimous consent request that these
    documents, including Mrs. Lesko's, be placed in the record.
        Mr. Guthrie. There is no objection.
        [The information appears at the conclusion of the hearing.]
        Ms. Eshoo. Thank you, Mr. Guthrie. I appreciate that. You
    are always such a gentleman, a pleasure to work with.
        So at this time the subcommittee is adjourned.
        [Whereupon, at 2:08 p.m., the subcommittee was adjourned.]
        [Material submitted for inclusion in the record follows:]
        [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

                                     [all]