[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:]
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