[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]
EXAMINING THE POLICIES AND PRIORITIES
OF THE U.S. DEPARTMENT OF HEALTH AND
HUMAN SERVICES
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HEARING
Before The
COMMITTEE ON EDUCATION AND LABOR
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTEENTH CONGRESS
SECOND SESSION
__________
HEARING HELD IN WASHINGTON, DC, APRIL 6, 2022
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Serial No. 117-42
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Printed for the use of the Committee on Education and the Workforce
GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT
Available via: edworkforce.house.gov or www.govinfo.gov
_______
U.S. GOVERNMENT PUBLISHING OFFICE
56-933 PDF WASHINGTON : 2025
COMMITTEE ON EDUCATION AND LABOR
ROBERT C. ``BOBBY'' SCOTT, Virginia, Chairman
RAUL M. GRIJALVA, Arizona VIRGINIA FOXX, North Carolina,
JOE COURTNEY, Connecticut Ranking Member
GREGORIO KILILI CAMACHO SABLAN, JOE WILSON, South Carolina
Northern Marina Islands GLENN THOMPSON, Pennsylvania
FREDERICA WILSON, Florida TIM WALBERG, Michigan
SUZANNE BONAMICI, Oregon GLENN GROTHMAN, Wisconsin
MARK TAKANO, California ELISE M. STEFANIK, New York
ALMA S. ADAMS, North Carolina RICK W. ALLEN, Georgia
MARK DeSAULNIER, California JIM BANKS, Indiana
DONALD NORCROSS, New Jersey JAMES COMER, Kentucky
PRAMILA JAYAPAL, Washington RUSS FULCHER, Idaho
JOSEPH D. MORELLE, New York FRED KELLER, Pennsylvania
SUSAN WILD, Pennsylvania MARIANNETTE MILLER-MEEKS, Iowa
LUCY McBATH, Georgia BURGESS OWENS, Utah
JAHANA HAYES, Connecticut BOB GOOD, Virginia
ANDY LEVIN, Michigan, Vice Chairman LISA McCLAIN, Michigan
ILHAN OMAR, Minnesota DIANA HARSHBARGER, Tennessee
HALEY M. STEVENS, Michigan MARY MILLER, Illinios
TERESA LEGER FERNANDEZ, New Mexico VICTORIA SPARTZ, Indiana
MONDAIRE JONES, New York SCOTT FITZGERALD, Wisconsin
KATHY MANNING, North Carolina MADISON CAWTHORN, North Carolina
FRANK J. MRVAN, Indiana MICHELLE STEEL, California
JAMAAL BOWMAN, New York CHRIS JACOBS, New York
SHEILA CHERFILUS-McCORMICK, Florida VACANCY
MARK POCAN, Wisconsin VACANCY
JOAQUIN CASTRO, Texas
MIKIE SHERRILL, New Jersey
ADRIANO ESPAILLAT, New York
KWEISI MFUME, Maryland
Veronique Pluviose, Staff Director
Cyrus Artz, Minority Staff Director
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C O N T E N T S
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Page
Hearing held on April 6, 2022.................................... 1
OPENING STATEMENTS
Scott, Hon. Robert C. ``Bobby'', Chairman, Committee on
Education and Labor........................................ 2
Prepared statement of.................................... 2
Foxx, Hon. Virginia, Ranking Member, Committee on Education
and Labor.................................................. 3
Prepared statement of.................................... 3
WITNESSES
Becerra, Hon. Xavier, Secretary, U.S. Department of Health
and Human Services......................................... 4
Prepared statement of.................................... 5
QUESTIONS FOR THE RECORD
Responses to questions submitted for the record by:
Mr. Xavier Becerra....................................... 81
EXAMINING THE POLICIES AND PRIORITIES
OF THE U.S. DEPARTMENT OF HEALTH AND
HUMAN SERVICES
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Wednesday, April 6, 2022
House of Representatives,
Committee on Education and Labor,
Washington, DC
The Committee met, pursuant to notice, at 8:59 a.m., in
Room 2175, Rayburn House Office Building, Hon. Robert C.
``Bobby'' Scott (Chairman of the Committee) presiding.
Present: Representatives Scott, Courtney, Sablan, Bonamici,
Takano, Adams, DeSaulnier, Jayapal, Morelle, Wild, McBath,
Hayes, Levin, Omar, Stevens, Leger Fernandez, Jones, Manning,
Bowman, Sherrill, Espaillat, Mfume, Foxx, Wilson of South
Carolina, Thompson, Walberg, Grothman, Stefanik, Allen, Banks,
Fulcher, Keller, Miller-Meeks, Owens, Good, McClain,
Harshbarger, Miller, Fitzgerald, Cawthorn, Steel, Letlow, and
Jacobs.
Staff present: Amaris Benavidez, Fellow; Ilana Brunner,
General Counsel; David Dailey, Counsel to the Chairman; Kyle
deCant, Labor Policy Counsel; Ijeoma Egekeze, Professional
Staff; Daniel Foster, Health and Labor Counsel; Christian
Haines, General Counsel; Alison Hard, Professional Staff;
Rasheedah Hasan, Chief Clerk; Sheila Havenner, D'Andre
Henderson, Digital Manager; Danyelle Honore, Fellow; Eli
Hovland, Policy Associate; Carrie Hughes, Director of Health
and Human Services; Stephanie Lalle, Communications Director;
Andre Lindsay, Policy Associate; Aileen Ma, Professional Staff;
Kevin McDermott, Senior Labor Policy Advisor; Richard Miller,
Director of Labor Policy; Kota Mizutani, Press Secretary; Max
Moore, Staff Assistant; Casey Peeks, Professional Staff; Robert
Shull, Labor Policy Staff; Michele Simensky, Oversight Counsel-
Labor; Theresa Thompson, Professional Staff; Banyon Vassar,
Deputy Director of Information Technology; Sam Varie, Press
Assistant; Claire Viall, Professional Staff; ArRone Washington,
Clerk; Tanisha Wilburn, Director of Labor Oversight and
Counsel; Cyrus Artz, Minority Staff Director; Gabriel Bisson,
Minority Staff Assistant; Caitlin Burke, Minority Professional
Staff Member; Michael Davis, Minority Legislative Assistant;
Mini Ganesh, Minority Staff Assistant; Amy Raaf Jones, Minority
Director of Education and Human Resources; David Maestas,
Minority Fellow; John Martin, Minority Deputy Director of
Workplace Policy/Counsel; Hannah Matesic, Minority Director of
Member Services and Coalitions; Audra McGeorge, Minority
Communications Director; Eli Mitchell, Minority Legislative
Assistant; Ethan Pann, Minority Press Assistant; Krystina
Skurk, Minority Speechwriter; Mandy Schaumburg, Minority Chief
Counsel and Deputy Director of Education Policy; and Brad
Thomas, Minority Senior Education Policy Advisor.
Chairman Scott. Good morning. We are ready to begin the
official hearing, and I will count down from five and then we
will start, five, four, three, two, one. The Committee on
Education and Labor will come to order.
Good morning, everyone. I note that a quorum is present.
The committee is meeting today to hear testimony on Examining
Policies and Priorities of the U.S. Department of Health and
Human Services. Pursuant to Committee Rule 8(c), opening
statements are limited to the Chair and Ranking Member, and I
recognize myself for the purpose of making an opening
statement.
Today, we are meeting to discuss the Department of Health
and Human Services Budget Request for Fiscal Year 2023.
Secretary Becerra, I am pleased to welcome you back to the
committee, which we once both served on together to hear your
vision to ensure that the well-being of our country is taken
care of.
We know the Biden Harris administration needs a robust
COVID package to address both the immediate and long-term
consequences of the pandemic. It is my hope that we can send
the President that legislation in just a few days. We must also
address our Nation's mental health crisis. I was encouraged to
see recent budget proposals strengthens coverage, and expands
access to behavioral healthcare, and I finally look forward to
working with you and the Department to ensure that we address
systemic inequities in healthcare.
The pandemic laid bare long-standing biases, and barriers
to healthcare, and to recite Dr. Martin Luther King's
observance about inequities he once said that of all forms of
inequality, injustice in healthcare is the most shocking and
inhuman. This is a reminder that healthcare is also a civil
rights issue.
Thank you for your time, and I now recognize the
distinguished Ranking Member, the gentlelady from North
Carolina, Dr. Foxx, for her opening statement.
[The Statement of Chairman Scott follows:]
Statement of Hon. Robert C. ``Bobby'' Scott, Chairman, Committee on
Education and Labor
Today, we are meeting to discuss the Department of Health and Human
Services' budget request for Fiscal Year 2023.
Secretary Becerra, I am pleased to welcome you back to the
Committee, which we once both served on together, and hear your vision
to ensure the well-being of our country is taken care of.
We know the Biden-Harris Administration needs a robust COVID
package to address both the immediate and long-term consequences of the
pandemic. It is my hope we can send the President that legislation in
just a few days.
We must also address our nation's mental health crisis. I was
encouraged to see that the recent budget proposal strengthens coverage
and expands access to behavioral health care.
Finally, I look forward to working with you and the Department to
ensure we address systemic inequities in health care. The pandemic laid
bare the long-standing bias and barriers to health care. To recite Dr.
Martin Luther King's observation about inequities, he once said, that
of all forms of inequality, injustice in health care is the most
``shocking and inhumane.'' This is a reminder that health care is also
a civil rights issue.
Thank you for your time. I now recognize the distinguished Ranking
Member, the gentlelady from North Carolina, Dr. Foxx for her opening
statement.
______
Ms. Foxx. Thank you, Mr. Chairman. It is so nice to get
started promptly this morning. Secretary Becerra, President
Biden's HHS budget for Fiscal Year 2023 is full of misplaced
priorities and reckless spending. If this budget passes, $127.3
billion in discretionary spending would be allocated to HHS,
meaning taxpayers would be forced to give your agency an
additional 13 billion dollars.
The staggering price tag does not even include your request
for $22 billion for so-called COVID-19 funding. States are
awash with Federal dollars, and your administration has still
not provided Congress with adequate accounting of where past
COVID-19 dollars have gone.
HHS has delivered nothing but mixed messages over the past
year from masking and vaccinations to school re-openings and
the risk COVID poses to children. Nobody knows where the so-
called guidance begins, and the contradictions end. Your agency
is leading the charge to expand the Affordable Care Act and
Medicaid, dismantling employer-sponsored health insurance in
the process.
Expanded access to abortions have forced taxpayers to fund
them. Impose socialist drug pricing controls, encourage minors
to receive permanent gender reassignment surgery and hormone
treatments, and stop the faith community from maintaining its
identity while continuing to participate in programs to help
those in need.
This insanity makes it clear that HHS is more interested in
serving a splinter group who identify as the progressive left
than the American people. Today our colleagues across the aisle
will sing your praises and act as if HHS is doing an excellent
job. They will also conveniently gloss over the fact that HHS
has demonstrated over and over again that its true north star
is a radical, progressive ideology, devoid of reason and common
sense.
Mr. Secretary, HHS is a Federal agency funded by hard-
working taxpayers, not a social science experiment. You would
do well to remember that. Thank you, Mr. Chairman. I yield
back.
[The Statement of Ranking Member Foxx follows:]
Statement of Hon. Virginia Foxx, Ranking Member, Committee on Education
and Labor
Secretary Becerra, President Biden's HHS budget for Fiscal Year
2023 is full of misplaced priorities and reckless spending.
If this budget passes, $127.3 billion in discretionary spending
would be allocated to HHS--meaning taxpayers would be forced to give
your agency an additional $13 billion. This staggering price tag does
not even include your request for $22 billion for so-called COVID-19
funding.
States are awash with federal dollars and your administration has
still not provided Congress with adequate accounting of where past
COVID-19 dollars have gone.
HHS has delivered nothing but mixed messages over the past year,
from masking and vaccinations to school reopenings and the risk COVID
poses to children.
Nobody knows where the so-called `guidance' begins and the
contradictions end.
Your agency is leading the charge to: expand the Affordable Care
Act and Medicaid--dismantling employer-sponsored health insurance in
the process; expand access to abortions and force taxpayers to fund
them; impose socialist drug-pricing controls; encourage minors to
receive permanent gender-reassignment surgery and hormone treatments;
and stop the faith community from maintaining its identity while
continuing to participate in programs to help those in need.
This insanity makes it clear that HHS is more interested in serving
a splinter group who identify as the progressive left than the American
people.
Today, our colleagues across the aisle will sing your praises and
act as if HHS is doing an excellent job.
The will also conveniently gloss over the fact that HHS has
demonstrated, over and over again, that its true North Star is a
radical progressive ideology, devoid of reason and commonsense.
Mr. Secretary, HHS is a federal agency, funded by hardworking
taxpayers, not a social science experiment. You would do well to
remember that.
______
Chairman Scott. Thank you. I will now introduce our witness
just very briefly. The Honorable Xavier Becerra is the 25th
Secretary of the Department of Health and Human Services, and
the first Latino to hold the office in the history of the
United States.
Previously he served 12 terms in Congress, including
service on this committee. As Attorney General of the State of
California. We appreciate the Secretary participating today. I
look forward to your testimony, your written statement will
appear in full in the hearing record, and you are asked to
limit your oral presentation to a 5-minute summary. After your
presentation, we will move to member questions. The witness is
aware of his responsibility to provide accurate information, so
we will therefore proceed directly with your testimony, so
welcome Secretary Becerra.
STATEMENT OF HON. XAVIER BECERRA, SECRETARY, U.S. DEPARTMENT OF
HEALTH & HUMAN SERVICES, WASHINGTON, DISTRICT OF COLUMBIA
Secretary Becerra. Mr. Chairman, Ranking Member Foxx, and
members. Thank you for having me. It is great to be back. As I
recall, I think my chair was somewhere way down there when I
served on this committee, and it is good to be back. I will try
to keep with the Chairman's admonition, and keep my remarks as
short as possible, and hopefully you will have some time.
Today more than 255 million Americans have received at
least one dose of the COVID-19 vaccine, two-thirds of adults
over age 65 have gotten their booster shots, and we have also
been able to close the gap in vaccine rates we usually see for
communities often left behind.
It has paid dividends to surge resources, including tests
and treatments to our hardest hit, and highest risk
communities. 325 million free COVID-19 at home tests have been
shipped. 270 million free N95 masks. From the 186 billion
dollars appropriated by Congress for the provider relief fund,
766,000 payments to over 400,000 providers who have received
payments for COVID services. That is real money, real relief,
real results.
Beyond COVID 19, today more Americans have insurance for
their healthcare than ever before. That includes a record-
breaking 14 and a half million Americans who secure health
insurance through the Affordable Care Act. That is a big deal.
Less noticed, we launched Operation Allies Welcome, an HHS-
led effort that has helped over 68,000 of our Afghan brothers
and sisters who are refugees settle in America. We are
coordinating nearly 300 million dollars in nationwide support
for the launch of the 988 National Suicide Prevention Lifeline
this July.
HHS has also been making key investments to close holes in
our public health system, in areas like maternal health, where
we have extended Medicaid coverage for post-partum care for a
new mother, and her baby from 2 months to 12 months. The
President's 2023 budget lets us build on that record of
investment in America's health.
It proposes 127 billion dollars in discretionary budget
authority, and 1.7 trillion dollars in mandatory funding,
including a historic investment to transform the mental health
infrastructure in our country, a priority I know for many of
you. It also asks for 82 billion dollars for the President's
Pandemic Preparedness Proposal, to get ready for whatever might
come next after COVID-19.
Considering that COVID has cost this country more than 4
and a half-trillion dollars in direct support from the Federal
Government so far, this investment of $82 billion is a no-
brainer to prepare for the next pandemic. The funding we are
requesting will be end to end, which means it is going to be
for research, development, approvals, deployment, and effective
response.
Mr. Chairman and members of the committee, this budget
turns hardship into hope, and inclusion into opportunity, and I
look forward to working with you to make it a realty to
continue our efforts to give the American people real relief,
real results, and real peace of mind, and I would be happy to
answer any questions you might have.
[The Statement of Secretary Becerra follows:]
Statement of Hon. Xavier Becerra, Secretary, U.S. Department of Health
& Human Services, Washington, District of Columbia
Chairman Scott, Ranking Member Foxx, and Members of the Committee,
thank you for the opportunity to discuss the President's Fiscal Year
(FY) 2023 Budget for the Department of Health and Human Services (HHS).
I am pleased to appear before you today, and I look forward to
continuing to work with you to serve the American people.
HHS addresses many of the challenges facing our country today-
ending the COVID-19 pandemic, reducing health care costs, expanding
access to care, improving health equity, ending HIV/AIDS, enhancing
child and family well-being, addressing the overdose epidemic, and
strengthening behavioral health--and we are making meaningful progress
on these priorities. Our work has never been more important, and I am
honored to lead HHS at this critical moment.
The Budget advances the HHS mission to enhance and protect the
health and well-being of all Americans. We are proud to be Congress'
partner in supporting the American people, and we are grateful for the
funding you have provided in support of the HHS mission. We take very
seriously our commitment to ensure we are good stewards of every dollar
in our budget.
Before I dive deeper, I first want to reflect on the Department's
incredible achievements over the past year to save lives and improve
health. Thanks to our work to develop and distribute vaccines and
boosters, over 215 million Americans are fully vaccinated against
COVID-19, and two-thirds of adults over age 65 have gotten their
booster shots--an unprecedented accomplishment that saves lives every
day. HHS procured and provided life-saving antivirals, monoclonal
antibodies, and ongoing testing support, with more to come. To date,
HHS has provided critical support that resulted in the emergency use
authorization (EUA) of 3 vaccines (2 of which are now fully licensed),
7 therapeutics, and 29 diagnostics against COVID-19. HHS has procured
millions of COVID-19 treatment courses for Americans, and is supporting
the President's pledge to directly provide 1 billion tests to American
households for free.
Testing capacity has dramatically increased, and we've supplied
free, high-quality masks to the American people. HHS has invested $250
million in U.S.-based manufacturing of personal protective equipment
(PPE) and $950 million in manufacturing the supplies and equipment
needed for vaccines, therapeutics, and diagnostic tests to strengthen
the public health supply chain. We distributed Provider Relief Funds to
support healthcare providers hit hard by the pandemic, and to reimburse
providers for testing, treatment, and vaccine administration for
uninsured patients. We provided guidance to support the safe return to
the classroom, enabling schools nationwide to reopen.
As the President has said, it is critical to get Americans back to
our more normal routines, while still protecting people from COVID-19,
preparing for new variants, and preventing economic and educational
shutdowns. HHS contributions over the past two years position our
country to move forward safely, and we look forward to working with you
to continue these efforts.
The country has seen historic increases in health insurance
enrollment through the Marketplaces, with a record 14.5 million people
signed up for 2022 healthcare coverage during the latest Marketplace
Open Enrollment Period. Uninsured rates fell last year after the
American Rescue Plan Act took effect, and continue to fall due to the
success of innovative and targeted consumer outreach campaigns. We are
implementing initiatives like the No Surprises Act, which establishes
new federal protections against certain kinds of surprise medical
bills. We are preparing for the expansion of the Suicide Lifeline with
the 9-8-8 implementation that will launch this summer. Working with our
interagency partners, we also launched interagency initiatives like
Operation Allies Welcome, a whole-of-government effort that helped over
68,000 Afghans to permanently resettle in 2021.
HHS has made key investments to address disparities and improve
equity and launched new efforts to protect vulnerable communities who
bear the brunt of climate change. We are prioritizing rural health and
the needs of our Tribal partners. We released a new HHS Overdose
Prevention Strategy and made significant investments in behavioral
health. It is also an Administration priority to advance legislation
that helps lower costs for families, including for child care,
preschool, and long-term care, and I look forward to working with
Congress to achieve this together.
The President's Budget will enable us to continue these critical
efforts and achieve our mission in FY 2023. The FY 2023 Budget proposes
$127.3 billion in discretionary and $1.7 trillion in mandatory budget
authority, including newly proposed mandatory funding for the Indian
Health Service and an historic mandatory funding request to transform
our ability to protect the nation from future pandemics and other
biological threats. These investments support families through early
education, behavioral health, and access to care. The Budget
demonstrates the Administration's commitment to reinvesting in public
health, research, and development to drive growth and shared prosperity
for all Americans by making major investments in priority areas,
including overdose prevention, mental health, maternal health, cancer,
and HIV/AIDS. COVID-19 has shown that health inequities and
insufficient Federal funding leave communities vulnerable to these
crises. The Budget advances equity and helps ensure our programs serve
people of color and other underserved communities with the
opportunities promised to all Americans.
Tackling COVID-19 and Preparing for the Next Biological Threat
First, I want to highlight that although HHS has made tremendous
progress in the fight against COVID, we now face a dire moment. As you
know, the Administration requested $22.5 billion for immediate needs to
avoid severe disruptions to our COVID response. We requested these
funds as emergency resources, in the same way Congress provided
multiple times on a bipartisan basis under the prior Administration. We
face unavoidable impacts of not receiving these resources. Testing and
treatment capacity will decline. The uninsured fund--which offers
coverage of testing, treatments, and vaccinations for tens of millions
of Americans who lack health insurance--will run out of money and stop
paying provider claims. Already, it has stopped accepting provider
claims for testing and treatments reimbursement, with the same soon to
follow for vaccinations. Many Americans will no longer be able to
access life saving monoclonal antibodies and antiviral drugs. We will
be unprepared for a new variant and unable to provide life-saving
vaccines to the American people. It is critical that we work together
to avoid these and other severe consequences.
Beyond the need for investment in immediate COVID-19 response
requirements, the FY 2023 budget builds on Congress' response
investments to transform our preparedness for biological threats and
strengthen national and global health and health security. The Budget
includes a historic $81.7 billion in mandatory funding over five years
across the Office of the Assistant Secretary for Preparedness &
Response (ASPR), CDC, the National Institutes of Health (NIH), and the
Food and Drug Administration (FDA) to support the Administration's
vision for pandemic preparedness.
This request provides $40 billion to the Office of the Assistant
Secretary for Preparedness and Response to invest in advanced
development and manufacturing of countermeasures for high priority
threats and viral families, including vaccines, therapeutics,
diagnostics, and personal protective equipment. It provides $28 billion
for the Centers for Disease Control and Prevention (CDC) to enhance
public health system infrastructure, domestic and global threat
surveillance, public health workforce development, public health
laboratory capacity, and global health security. It provides $12.1
billion to NIH for research and development of vaccines, diagnostics,
and therapeutics against high priority biological threats; biosafety
and biosecurity research and innovation to prevent biological
incidents; and safe and secure laboratory capacity and clinical trial
infrastructure. The Budget also includes $1.6 billion for the Food and
Drug Administration to expand and modernize regulatory capacity
information technology, and laboratory infrastructure to support the
evaluation of medical countermeasures.
Collectively, these activities will build capabilities the nation
urgently needs to respond to future pandemics and biological threats
from any source, strengthen international systems so that we can detect
threats early and respond to threats quickly, and enable us to boldly
and decisively act on the lessons from COVID-19.
In addition to this mandatory investment, the Budget also funds
critical ongoing response and preparedness efforts through
discretionary budgets. The HHS Coordination Operations and Response
Element (H-CORE) within ASPR is responsible for coordinating the
development, production, and distribution of COVID-19 vaccines and
therapeutics. The Budget requests $133 million for H-CORE, which is
critical to beat COVID-19 and for future emergency response efforts
beyond the pandemic, as ASPR builds an enduring response
infrastructure. These resources will support the necessary staffing,
acquisition support, and data analytics for COVID-19 countermeasures
when emergency funding is no longer available to cover these costs.
The Budget requests $828 million for the Biological Advanced
Research and Development Authority (BARDA), to develop novel medical
countermeasure platforms to enable quicker, more effective public
health and medical responses to detect and treat infectious diseases.
The Budget also requests $975 million for the Strategic National
Stockpile to sustain and expand the current inventory of supplies to
ensure readiness for potential future pandemics.
COVID-19 has shown the importance of timely, reliable data to
respond effectively to public health threats. The Budget makes robust
investments in science and public health to improve and protect health
at home and abroad, including at CDC for public health infrastructure
and capacity, data modernization, global public health protection, and
the Center for Forecasting and Outbreak Analytics. The Budget also
includes $197 million to expand state, local, tribal, territorial, and
international capacity to combat antibiotic resistance at CDC, as well
as an HHS-wide mandatory proposal to encourage the development of
innovative antimicrobial drugs.
Advancing Science and Research
The Budget prioritizes research and scientific advancement. We are
grateful for the support from Congress to establish the Advanced
Research Projects Agency for Health (ARPA-H), and the Budget proposes
$5.0 billion to revolutionize how to prevent, treat, and even cure a
range of diseases including cancer, infectious diseases, Alzheimer's
disease, and many others. This funding is part of a proposed $49.0
billion in discretionary funds for NIH to continue its incredible track
record of turning discovery into health. NIH invests in basic research
and translation into clinical practice to address the most urgent
challenges including preparing for future pandemics, reducing health
disparities and inequity, driving innovative mental health research,
and ending the overdose crisis.
The Budget proposes investments in NIH, CDC, and FDA to reignite
the President's Cancer Moonshot with an ambitious goal to reduce the
death rate from cancer by at least 50 percent over the next 25 years,
improve the experience of people and their families living with and
surviving cancer, and end cancer as we know it today. The Budget
includes increases for CDC to enhance a range of cancer related
programs and for FDA's Oncology Center of Excellence.
The Budget proposes $6.8 billion for FDA to continue to work with
developers, researchers, manufacturers, and other partners to help
expedite the development and availability of therapeutic drugs and
biological products, and to apply the best science in its food and
tobacco work. The Budget also proposes $527 million program level
resources for the Agency for Healthcare Research and Quality (AHRQ) to
support evidence-based research, data, and tools to make healthcare
safer, higher quality, more accessible, equitable, and affordable for
all Americans.
Importantly, the Budget also includes $25 million for CDC and $20
million for AHRQ to launch Centers for Excellence to study long COVID
conditions and equip health care providers and systems to deliver
patient-centered, coordinated care for this patient population.
Reducing Health Care Costs and Expanding Access to Care
To enhance the health and well-being of all Americans, the Budget
makes access to more affordable health care a top priority. The
Affordable Care Act (ACA), bolstered by the American Rescue Plan, has
expanded health insurance coverage to historic numbers of Americans and
the Budget builds on that legacy.
The American Rescue Plan made groundbreaking investments in the ACA
by expanding premium subsidies to make coverage affordable for millions
more Americans. As I mentioned earlier, a record-breaking 14.5 million
people have signed up for 2022 health care coverage through the
Marketplaces during the latest Marketplace Open Enrollment Period,
including nearly 6 million people who have newly gained coverage. The
American Rescue Plan lowered health care costs for most consumers and
increased enrollment to record levels. In fact, consumers saw their
average monthly premium fall by 23% compared to the prior open
enrollment period. As you know, the American Rescue Plan subsidies will
expire at the end of 2022 and without new legislation this will result
in millions of Americans losing this more affordable coverage. I look
forward to working with the Congress on this key priority. We are also
concerned about millions of vulnerable Americans who could lose their
Medicaid coverage when the COVID-19 Public Health Emergency ends. To
address this concern, CMS has provided multiple rounds of guidance to
state Medicaid and CHIP agencies that include a robust selection of
best practices and recommended strategies allowed under current law
when returning to routine operations after the Public Health Emergency
ends. For example, recently, CMS released a State Health Official
Letter that extends the time states have to process Medicaid
redeterminations after the end of the Public Health Emergency from 12
months to 14. HHS is also working to increase awareness of coverage
options through targeted outreach campaigns and making renewal of
coverage for those eligible easier to navigate. We also look forward to
working with the Congress to find solutions to providing coverage
options for the nearly 4 million Americans in non-covered states.
Additionally, the Administration supports strengthening home and
community-based services as an alternative to institutionalized care,
to ensure people have access to safe options that work for them.
Rising health care costs affect all Americans. HHS has taken steps
to increase competition, improve transparency, and strengthen consumer
protections. Under the No Surprises Act, a critical bipartisan law
passed by Congress, HHS continues to implement the law that shields
consumers from certain kinds of surprise medical bills and requires
greater transparency from providers. HHS also issued a proposed rule to
make hearing aids available to individuals over-the-counter that can
help provide consumers with more affordable options and lead to a more
competitive market.
I look forward to working with the Congress to lower health care
costs and expand and improve coverage for all Americans. Reaffirming
the President's charge in his State of the Union address, we will work
to lower the costs of prescription drugs, such as by capping the cost
of insulin at $35 per month, and to allow Medicare to negotiate payment
for certain high-cost drugs.
During the COVID-19 public health emergency, telehealth has been a
reliable resource for providers to reach patients directly in their
homes to ensure access to care and continuity of services. The
Administration is committed to supporting a temporary extension of
broader telehealth coverage under Medicare beyond the declared COVID-19
Public Health Emergency to study its impact on utilization of services
and access to care. I want to thank Congress for provisions included in
the FY 2022 Omnibus spending bill that extend Medicare telehealth
flexibilities for 5 months after the end of the public health
emergency.
Additionally, the COVID-19 pandemic highlights the importance of
vaccines and prevention. Long-standing, deep disparities exist in adult
vaccination coverage based on race and ethnicity, particularly among
Black and Hispanic populations as compared to other groups. The Budget
proposes Vaccines for Adults, a new mandatory program modeled after the
existing Vaccines for Children (VFC) program, to provide uninsured
adults with access to vaccines, free of charge, that are recommended by
the Advisory Committee on Immunization Practices. The Budget further
expands the VFC program to include allchildren under age 19 enrolled in
the Children's Health Insurance Program. The Budget also includes a
proposal to consolidate Medicare coverage of vaccines under Part B,
which will make vaccines more accessible, remove financial barriers,
and streamline the process for Medicare beneficiaries and providers.
The Budget continues to support the fourth year of the Ending the
HIV Epidemic initiative with $850 million in funding across CDC, HRSA,
IHS, and NIH for FY 2023. The initiative is critical to achieve
President Biden's plan to end the HIV/AIDS epidemic by 2030 and ensure
access to HIV prevention, care, and treatment. HHS works closely with
communities to support the four key strategies--Diagnose, Treat,
Prevent, and Respond--to end the HIV epidemic. The Budget also creates
a national program that invests $9.8 billion over 10 years to provide a
financing and delivery system to ensure everyone has access to pre-
exposure prophylaxis, also known as PrEP, and essential wraparound
services.
Tackling Health and Human Services Disparities
Advancing equity is at the core of the Budget. HHS works to close
the gaps in access to healthcare and human services to advance
equitable outcomes for all, including people of color and others who
have been historically underserved, marginalized, and adversely
affected by persistent poverty and inequality. HHS is committed to
carrying out the President's Executive Order 13985 on Advancing Racial
Equity and Support for Underserved Communities Through the Federal
Government. Even before the pandemic, we were not doing enough to
provide equitable preventive measures, services, and treatment options
in every community--and COVID has only made this disparity worse.
Maternal mortality in the United States is significantly higher
than most other developed nations and is especially high among Black
and Native American/Alaska Native women, regardless of their income or
education levels. The Biden-Harris Administration is committed to
promoting maternal health and ensuring equitable access to affordable,
quality healthcare for our nation's mothers. The Budget invests over
$470 million across AHRQ, CDC, HRSA, IHS, and NIH to reduce maternal
mortality and morbidity. This includes increased funding to CDC's
Maternal Mortality Review Committees and other Safe Motherhood
programs, HRSA's State Maternal Health Innovation Grants program and a
new Healthy Start program initiative, and other maternal health
programs across HHS.
The Budget also invests in maternal and broader women's health and
health equity, including $86 million for the Office of Minority Health
to focus on areas with high rates of adverse maternal health outcomes
and areas with significant racial or ethnic disparities. In addition,
the Budget also includes $42 million for the Office on Women's Health
to fund prevention initiatives that address health disparities for
women.
Black and Latino/Hispanic people, along with American Indian/Alaska
Native people, are much less likely than white people to have health
insurance. Evidence shows that expanding coverage is not only essential
for facilitating equitable access to health care, but also is
associated with reduced morbidity and mortality, poverty reductions,
and protection from debilitating financial bills. The Budget supports
policies to promote a stronger and more equitable health insurance
system beginning with new requirements for data on race and ethnicity
in Medicare.
The Budget also invests $35 million for a new initiative to
systematically identify and resolve barriers to equity in each Centers
for Medicare & Medicaid Services (CMS) program through research, data
collection and analysis, stakeholder engagement, building upon rural
health equity efforts, and technical assistance. CMS is committed to
obtaining more accurate and comprehensive race and ethnicity data on
Medicare beneficiaries, and to require reporting on social determinants
in post-acute healthcare settings. CMS also proposes to add Medicare
coverage for services furnished by community health workers who often
play a key role in addressing public health challenges for underserved
communities. These proposals will help identify, mitigate, and lessen
health disparities.
Health Centers are the first line of defense in addressing
behavioral health issues nationwide when resources are available. This
is particularly true for underserved populations, including low-income
patients, racial and ethnic minorities, rural communities, and people
experiencing homelessness. The Budget provides $5.7 billion for health
centers, including $3.9 billion in mandatory resources.
The COVID-19 pandemic has further disrupted access to reproductive
health services and exacerbated inequalities in access to care. HHS
commits to protecting and strengthening access to reproductive
healthcare, and the Budget proposes $400 million to the Title X family
planning program to address increased need for family planning
services. Title X is the only federal grant program dedicated solely to
providing individuals with comprehensive family planning and related
preventive health services in communities across the United States.
The Budget increases services to prevent child maltreatment and the
need for foster care, and supports states in moving towards child
welfare systems that provide more tailored and comprehensive prevention
services to a broader, more diverse group of families. Prevention
services and support are particularly important for at-risk Black,
Latino, Indigenous, Native American, and members of other under-served
communities, which have disproportionate involvement with the child
welfare system.
The Budget provides $3.1 billion for the Administration for
Community Living (ACL), reflecting significant demand increases for
critical services caused by population growth and pandemic impacts. ACL
supports caregivers and advances equitable access to health care,
education, employment, transportation, recreation, and other systems,
resources, and opportunities. ACL advances equity by targeting those in
greatest social and economic need, with particular attention on people
with disabilities and older adults who are marginalized due to race,
ethnicity, sexual orientation, gender identity, poverty, language
spoken, and who are at risk of institutionalization.
Lastly, the Budget takes a historic first step toward redressing
health disparities faced by American Indians and Alaska Natives by
proposing all funding for the Indian Health Service (IHS) as mandatory.
In FY 2023, the Budget provides $9.3 billion, which includes $147
million in current law funding for the Special Diabetes Program for
Indians. This substantial funding increases of $2.5 billion above FY
2022 enacted will support direct healthcare services, facilities and IT
infrastructure, and management and operations. It also provides
targeted increases to address key health issues that disproportionately
impact American Indians and Alaska Natives such as HIV, Hepatitis C,
opioid use, and maternal mortality. With current law funding for the
Special Diabetes Program for Indians, the total program level for IHS
is $9.3 billion in FY 2023.
To address chronic underinvestment in IHS, the Budget increases
funding for each year over ten years, building to $36.7 billion in FY
2032. This increase of 296 percent over the ten-year budget window
accomplishes funding growth beyond what can be accomplished through
discretionary spending. Over a five-year period, the budget will reduce
existing facilities backlogs, fully fund the level of need identified
by the Federal-Tribal Indian Health Care Improvement Fund workgroup and
support the modernization of the IHS electronic health record system.
Additionally, the Budget grows IHS funding to keep pace with inflation
and population growth. This request responds to the long-standing
recommendations of tribal leaders shared in consultation with HHS to
make IHS funding mandatory, and HHS will continue consulting with
tribes to inform future policy and budget requests. HHS appreciates the
strong partnership with Congress to grow funding for the IHS budget
over the last decade, and looks forward to continuing our shared
efforts to improve health care in Indian Country.
Strengthening Behavioral Health
HHS is committed to combating America's mental health and substance
use crises. The pandemic has had a devastating impact on mental health,
particularly for young people, by dramatically changing Americans'
experience of home, of school, of work, and in their communities. The
President has outlined a bold strategy for tackling the nation's mental
health crisis, calling for an increased focus on building system
capacity, connecting more people to care, and creating a continuum of
support to keep people healthy and help Americans thrive. I also
recently launched a National Tour to Strengthen Mental Health, to hear
directly from Americans across the country about the mental health and
substance use challenges they are facing and to engage with local
leaders to strengthen the mental health and crisis care system in our
communities. We are also working with the Department of Education to
develop and align resources to ensure children have the physical and
behavioral health services and supports that they need to build
resilience and thrive. Individuals who develop substance use disorders
are often also diagnosed with mental disorders--the budget addresses
the significant connection between mental health and substance use by
investing in a broad spectrum of behavioral health services.
The Budget includes new, historic mandatory investments in totaling
$51.7 billion over ten years to address the nation's behavioral health
crisis. In support of the President's call for reforming our mental
health care system to fully meet the needs of our communities, the
Budget includes a new $7.5 billion Mental Health Transformation Fund,
allocated over a 10 year period, to increase access to mental health
services through workforce development and service expansion, including
through health care and community settings that have not traditionally
provided mental health services but that are well-positioned to reach
more people. The Mental Health Transformation Fund will also support
the expanded use of evidence-based practices for mental health care, to
ensure that families and communities affected by mental illness receive
the highest quality care and supports.
The Budget improves Medicare coverage of mental healthcare and
makes access to such care more affordable by eliminating the 190-day
lifetime limit on psychiatric hospital services and requiring Medicare
to cover three behavioral health visits per year without cost-sharing.
In addition, the Budget would recognize licensed professional
counselors and marriage and family therapists as independent
practitioners who are authorized to furnish and receive direct Medicare
payment for their mental health services, aligns the criteria for
psychiatric hospital terminations from Medicare with that of other
healthcare providers, and applies the Mental Health Parity and
Addiction Equity Act to Medicare.
Additionally, the Budget establishes a Medicaid provider capacity
demonstration program for mental health treatment and establishes a
performance bonus fund to improve behavioral health services in
Medicaid. The Budget also expands and converts the Demonstration
Program to Improve Community Mental Health Services into a permanent
program. Further, the Budget prevents states from prohibiting same day
billing and allows providers to be reimbursed for Medicaid mental
health and physical health visits provided to a Medicaid beneficiary
that occur on the same day and requires that Medicaid behavioral health
services, whether provided under fee-for-service or managed care, be
consistent with current and clinically appropriate treatment
guidelines.
For people with private health insurance, the Budget requires all
health plans to cover mental health and substance use disorder benefits
and ensures that plans have an adequate network of behavioral health
providers. The Budget also establishes grants to states to enforce
parity between mental and substance use disorder and other medical
benefits.
The Budget also proposes $20.8 billion in discretionary funding for
behavioral health programs in FY 2023, including significant
investments in mental health programs such as the National Suicide
Prevention Lifeline, a free, confidential 24/7 phone line that connects
individuals in crisis with trained counselors across the United States.
The Lifeline receives calls from people with substance use; depression;
mental and physical illness; economic worries; loneliness; and concerns
about relationships and sexual identity. Ensuring the success of the
Lifeline particularly as it transitions to the universal 3-digit number
988 is a top priority for HHS.
To support the health workforce, the Budget includes $397 million
for Behavioral Health Workforce Development Programs and $25 million in
the National Health Service Corps funding specifically for mental
health providers. The Budget also includes $50 million for the Health
Resources and Services Administration (HRSA) for Preventing Burnout in
the Health Workforce. This investment will provide crucial support for
health workforce retention and recruitment, which is essential for
addressing current and future behavioral health workforce shortages.
Suicide remains the second leading cause of death among young
people between the ages of 10 and 34. Many youth, especially young
people of color, Indigenous youth, and LGBTQ+ youth, still lack access
to affordable healthcare coverage that is necessary for them to receive
treatment for mental health conditions.
The Budget also includes $308 million for Project AWARE and the
Mental Health Awareness Training program to expand support for
comprehensive, coordinated, and integrated state and tribal efforts to
adopt trauma-informed approaches and increase access to mental health
services. School and community-based programs like Project AWARE have
been shown to improve mental health and emotional well-being of
children at low cost and high benefit. Prevention is an investment in
our future, and it lowers adverse outcomes with high societal impact.
According to CDC data, drug overdose deaths increased nearly 30
percent in 2020. Last fall, I announced the release of a new,
comprehensive HHS Overdose Prevention Strategy for the nation, designed
to increase access to the full range of care and services for
individuals with substance use disorders and their families. This new
strategy focuses on the multiple substances responsible for overdose
and the diverse treatment approaches needed to address them.
The Budget invests $11.0 billion to combat the overdose crisis
across HHS in support of four key target areas--primary prevention,
harm reduction, evidence-based treatment, and recovery support--and
reflects the Biden-Harris Administration principles of equity for
underserved populations, reducing stigma, and evidence-based policy.
The Budget also proposes $553 million for Certified Community
Behavioral Health Centers Expansion Grants to provide coordinated,
high-quality, comprehensive behavioral health services. The Budget also
proposes to remove the word ``abuse'' from the agency names within
HHS--including the Substance use And Mental Health Services
Administration, the National Institute on Alcohol Effects and Alcohol-
Associated Disorders, and the National Institute on Drugs and
Addiction. Individuals do not choose to ``abuse'' drugs and alcohol;
they suffer from addiction, which is a chronic medical condition. It is
a high priority for this Administration to move past outdated and
stigmatizing language that is harmful to these individuals and their
families.
Supporting Children, Families, and Seniors
HHS has a responsibility to ensure our programs serve children
equitably, and the high-quality care of children positively impacts
their success later in life. The Budget proposes $20.2 billion in
discretionary funding for the Administration for Children and Families'
early care and education programs. This includes $12.2 billion for Head
Start to provide services to more than a million children, pregnant
women, and families, $7.6 billion for the Child Care and Development
Block Grant, and $450 million for Preschool Development Grants to
increase capacity of states to expand preschool programs.
The Budget expands home visiting programs over five years to
provide economic assistance, child care, and health support for up to
165,000 additional families at risk for poor maternal and child health
outcomes. This funding will help strengthen and expand access to home
visiting programs that provide critical services directly to parents
and their children in underserved communities.
The mandatory budget includes a $4.9 billion expansion of services
to prevent child maltreatment and the need for foster care. For
children who must be removed from their parents, the Budget includes
$1.3 billion in support for states to prioritize placing children with
kin, as well as a $3 billion increase for programs to stabilize and
support families and adoptive families, and a $1 billion increase in
support for the transition to adulthood for youth who experienced
foster care. While not part of HHS's budget, the Budget proposes to
make the adoption tax credit fully refundable so that more families can
benefit and to expand the credit to include qualifying legal
guardianships.
We face a public health crisis of violence in our communities,
which disproportionately affects communities of color. The Budget
includes $250 million for CDC for the Community Violence Intervention
initiative, in collaboration with Department of Justice to implement
evidence-based community violence interventions at the local level, as
well as funding for firearm violence prevention research. The Budget
also promotes prevention of and early intervention after adverse
events, like community violence, to mitigate longer term impacts,
including $15 million for CDC to advance surveillance and research
aimed at preventing Adverse Childhood Experiences. The Budget also
includes $519 million for ACF's Family Violence Prevention and Services
programs, including $250 million to provide direct cash assistance to
survivors of domestic violence.
The Budget supports FDA's public education campaigns to educate
youth about the dangers of e-cigarette use; provide resources to
educators, parents, and community leaders to prevent youth use; and
provide resources to help kids who are already addicted to e-cigarettes
quit using these harmful products. The
Budget includes $812 million for FDA's tobacco program, an increase
to enhance product review and evaluation, research, compliance and
enforcement, public education campaigns, and policy development.
The Administration for Community Living (ACL) protects seniors and
persons with disabilities from abuse through investments in Adult
Protective Services and the Long-Term Care Ombudsman Program. As the
populations served by ACL continue to grow, the Budget provides $139
million to protect vulnerable older adults. The Budget also bolsters
ACL's role as an advocate for older adults and people with
disabilities.
Refugees and Unaccompanied Children
Amid the COVID-19 pandemic, large numbers of unaccompanied children
continue to arrive at our Southern border. HHS is committed to
fulfilling our legal and humanitarian responsibility to care for all
unaccompanied children (UC) referred to us by federal partners. The FY
2023 Budget includes $6.3 billion in discretionary funding for the
Office of Refugee Resettlement, including $4.9 billion for the
unaccompanied children program so that HHS may continue to care for UC
safely and humanely, in alignment with child welfare best practices.
The Budget also proposes a mandatory contingency fund to provide
additional funds if there is a surge in UC referrals, as well as
mandatory funding to build towards universal UC legal representation.
HHS is committed to unifying these children with vetted sponsors,
usually a parent or close relative, as safely and quickly as possible,
and the Budget includes funding to implement critical programmatic
reforms and service expansions. The Budget also builds on the nation's
refugee infrastructure to support resettling of up to 125,000 refugees
in 2023, and requests authority to use these funds to support the
successful reunification of families who were cruelly separated under
the Trump Administration.
Improving Safety and Oversight Nursing Homes
Building on the President's State of the Union Address, the Budget
is committed to ensuring nursing homes are safe and providing high
quality care to vulnerable Americans by increasing funding for nursing
home health and safety inspections by nearly 25 percent. Additionally,
by increasing nursing home owners' accountability for minimum quality
standards, noncompliant facilities can be held financially responsible
for poor safety and care. The Budget also requests authority to publish
accreditation surveys for other healthcare facilities, like hospitals,
rural health clinics, and ambulatory surgical centers, which will
better inform the public when selecting care locations for loved ones.
The Administration also supports strengthening home and community-based
services to ensure people have access to safe options that work for
them.
Funding Core Program Operations
While the service provided by HHS continues to grow, investment in
the Department's operational needs ensures HHS can carry out its
mission to enhance and protect the health and well-being of all
Americans while maximizing our resources. This investment strengthens
administrative and operational resources throughout the Department
needed to ensure proper stewardship of resources entrusted to HHS by
Congress.
Providing Oversight and Program Integrity
Given the importance and magnitude of HHS' work, ensuring the
integrity of our spending is a core value and responsibility of HHS.
The Budget increases discretionary Heath Care Fraud and Abuse Control
program spending to a total of $899 million to provide oversight of CMS
health programs, strengthen OIG investigations, and protect
beneficiaries against healthcare fraud, yielding a return-on-investment
of $13.6 billion over ten years. The pandemic has unleashed new health
care fraud risks related to the implementation of billions in new
federal spending, as well as multiple provider regulatory and other
flexibilities. These funds are critical to help HHS root out bad actors
and ensure program integrity.
Conclusion
I want to thank the Committee for inviting me to discuss the
President's FY 2023 Budget for HHS. The Budget offers a vision for the
nation that reinvests in America's health, supports growth and
prosperity, and meets our commitments to the American people and
especially to the most vulnerable. I look forward to working with you
to fulfill that vision. If we step up in this moment, we can lay the
foundation now.
These are critical programs and issues that deserve attention and
adequate funding. Thank you for your partnership in advancing our
shared goal to improve the health, safety, and well-being of our
nation.
______
Chairman Scott. Thank you very much. Under Committee Rule
9(a), we will now question the witness under the 5-minute rule.
Again, I ask members to be very strict with the 5-minutes, and
not begin questions with just a few seconds left. I will be
recognizing committee members in order of seniority beginning
with the gentleman from Connecticut, Mr. Courtney.
Mr. Courtney. Thank you, Mr. Chairman and good morning, Mr.
Secretary. Those are eye-watering statistics in terms of the
pandemic response, which I think is going to go down in the
annals of our country's public health history, so
congratulations on the great work your department has done.
I wanted to focus for a second on another initiative that
you have taken on, which is last January when the Medicare Part
B premiums were rolled out, it jumped from $148.00 a month to
$170.00 a month, and again as you correctly pointed out at the
time, a large part of that was driven by the need to adjust
quickly to the FDA approval of Aduhelm, which was again a new
Alzheimer's drug, a calculation from CMS was based on the drug
manufacturer's price, which was $56,000.00 per patient per
year.
That subsequently because of public pressure was cut from
$56,000.00 per patient per year to $26,000.00 per patient per
year, but by then the Part B premiums were already in play and
were again taking a chunk of people's social security checks.
Again, you immediately, I think called on the department to
take a second look at this.
I led a letter with 31 members supporting your efforts. We
are in April right now. Can you give us an update in terms of
whether or not there is going to be hopefully some commonsense
adjustment based on the price change?
Secretary Becerra. Congressman, first it is good to see
you, and second, thank you for the work you have done to try to
protect seniors under Medicare. Aduhelm is probably something
we are going to start seeing more and more often because the
technology, the science driving medicines sometimes to our
table faster than before. This is the first time we have
actually seen a drug come forward that FDA has approved, at
least conditionally, for Alzheimer's.
You know there is a hunger out there in America for this
drug, for the thousands of people who are caring for their
loved ones. FDA makes a decision about whether it is effective
and safe to put this drug out on the market. The Center for
Medicare and Medicaid Services has to make and determine
whether or not something like that drug will get covered under
Medicare.
Two different agencies have two different platforms to work
under. We are going through the process, we hope very, very
soon we will get CMS's word on what will happen in terms of
coverage determination. We are also going to hear very soon
about the request I made to have a re-evaluation of the cost.
Once we get that we will report to you as quickly as possible.
I think that will come very.
I cannot give you the precise date because I do not drive
that, the science drives that, but I will do it soon.
Mr. Courtney. Thank you. I mean, I think this is actually
an unprecedented effort you know, but again given the price
pressure that seniors are facing right now, I think really any
relief would be very welcome, and I have certainly heard that
from my constituents.
Another part of the Budget that came over in that
discretionary spending was I think efforts to address the
opioid issue. Again, COVID sort of took over the healthcare
coverage, the public health coverage, but really, that
continuing epidemic of overdose has taken over this country is
continuous, like colliding epidemics.
I was wondering if you could talk about what the Budget is
focused on in terms of dealing with that second crisis for so
many Americans, which again in eastern Connecticut is very
real.
Secretary Becerra. We have seen it sweep from the northeast
into the rest of the country, and it is not getting better.
COVID has just exacerbated things. In fact, COVID exposed how
bad it really was in parts of the country. We are working with
your support in the American Rescue Plan, we are now able to do
far more in trying to help communities deal with opioid
addiction.
One of the things we did early on, less than a year ago,
was to provide three billion dollars in immediate support
because of your efforts on the American Rescue Plan, where half
of that money went to mental health services because of the
increasing stress we see people are facing mentally, but half
of it was also for drug overdose, and drug addiction.
We wanted to channel that as quickly as we could. We also
took a very important second step, Congressman Courtney, which
I am sure you are aware of. We changed the paradigm on our drug
strategy. We are getting rid of the taboos, we are getting rid
of the old way of thinking, and we are using science to drive
where we go because we not only want to save a life right
before they overdose, but we want to keep them from harming
themselves as they try to get past the addiction.
Harm reduction is now one of the principal components of
our strategy, along with post-treatment followup, so we make
sure we are keeping good track of you. We do not just--like
Fed-Ex drop off the medicine to help you and scoot out of town.
Chairman Scott. Thank you. The gentlelady from North
Carolina, the distinguished Ranking Member of the Committee,
Dr. Foxx.
Ms. Foxx. Thank you, Mr. Chairman. Mr. Secretary, I hope
your answers to my questions will be way more complete than
your responses from last year. I have asked this question
several times, and I expect a substantive response today. As
you know we're going very quickly through this hearing if we
can, so I would appreciate succinct answers.
The statute authorizing the FDA's temporary emergency use
authorizations for COVID-19 vaccines include a provision that
individuals must be informed ``of the option to accept or
refuse administration of the product, of the consequences, if
any, of refusing administration of the product, and of the
alternatives to the product that are available, and of their
benefits and risk.'' That is in the statute.
Would allowing states, public officials in schools to
mandate vaccinations violate the statute which allows the
patient the option to refuse. Yes or no?
Secretary Becerra. Congresswoman, are you asking if the
mandate, any requirements would be imposed by states, if those
are illegal, or any requirements imposed by the Federal
Government?
Ms. Foxx. Do they violate the statute?
Secretary Becerra. If you are speaking about any
requirements by State or local governments, I am not going to
try to venture into saying what they did, and whether under
their laws they are legal. I can tell you what we did at the
Federal level.
Ms. Foxx. Does it violate the Federal statute, yes or no?
Secretary Becerra. Congresswoman, I am trying to respond to
you. If you are asking me about State law, I do not represent a
particular State. I represent the Federal Government.
Ms. Foxx. I understand that is why I am asking you the
question. You represent the Federal Government. Can the states
pass a law that contradicts Federal law?
Secretary Becerra. The states can pass laws where they have
jurisdiction. If there is a conflict, then the Courts will
decide if there is an ability for the State to enact laws.
Ms. Foxx. You are saying the Federal Government had no
jurisdiction to pass this law?
Secretary Becerra. No, that is not what I am saying.
Ms. Foxx. Okay. I am going on to my second question. The
recent proposed rule on benefits and payments makes gender
transition procedures an essential health benefit offered by
all exchange plans. The proposed rule could force some medical
professionals to violate their expertise or beliefs on the best
care plan for individuals, particularly the children seeking
gender transition medical services.
Your administration continues to double down on this policy
by clearly targeting the states like Texas, which seek to
protect minors from life-altering, and irreversible surgeries
and unnecessary treatments. What safe harbors are included in
the proposed rule for religious providers, or other entities
that have objections to administering gender transition
treatments and surgeries on minors?
Secretary Becerra. Congresswoman, one of my duties, and one
of my former duties as the Attorney General in my State of
California was to not only enforce the law, but to comply with
the law. As Secretary, that is what I am doing now. I am not
only complying with the law, but enforcing the law.
If someone remains within the confines of the law, there
can be no action taken against them. We certainly, when it
comes to American's rights, whether you are transgender or not,
we will enforce your rights to be protected, and we will do
everything we can for the transgender community, especially our
youth to know that they will have the right.
Ms. Foxx. Okay well you are not answering the question, so
let me go on to my third question. You do not answer the
questions on the safe harbor. We thank you for the
administration's work to implement the No Surprises Act, which
was intended to put an end to an exorbitant charge from out-of-
network healthcare providers, and in getting lower costs for
families.
Unfortunately, litigation has caused a delay in the
implementation of this important law. You have said the
administration will issue revised rules in May. Can you commit
to that timeline to ensure certainty in the healthcare
marketplace? In a revised rule you commit to implementing the
law in a way that limits overuse and abuse of the arbitration
system and does not drive inflation and healthcare costs.
Secretary Becerra. Congresswoman, first thank you very much
for the support that Congress gave for this No Surprises Act
Law, which we are now implementing. We will make sure that what
we put out is something that helps us avoid the costly process
of arbitration. We think we have rules that will be in place
that will not only help avoid that type of litigation but will
protect the rights of individual patients not being blindsided
by these bills that they get after they have left the hospital
or medical center.
We will work with you where we can to improve the law, and
we will implement based on what you provided as to statutory
instructions.
Ms. Foxx. Well, this is a purely bipartisan issue. The
Chairman and I worked hard on it, and we would like to see it
implemented appropriately. Thank you, Mr. Chairman.
Chairman Scott. Thank you. The gentlelady from Oregon, Ms.
Bonamici.
Ms. Bonamici. Thank you, Mr. Chairman, Mr. Secretary. Nice
to see you. Thank you for your service and your work. I am
going to ask you about three issues, and I will put them all
out there and then let you answer each of them. Student
behavioral health, childcare, and nursing homes.
We know the pandemic did not affect all students equally,
and a recent GEMA Pediatric study found that depression and
anxiety doubled. It is a serious issue with students. In
Oregon, the University of Oregon is opening the Balmer
Institute for Children's Behavior Health, which is going to be
I think a model for the country working with our K-12 system.
I appreciate the President's budget process, and
investments in behavioral health, and the project where State
grants, but what additional steps can Congress take to support
efforts at HHS, and partnership with local communities to
address the complex mental health challenges facing students?
That is the first question.
The second one is about childcare. The American Rescue Plan
Act had the 39 billion dollars for childcare, which is
particularly important in children from underserved communities
that also provides as you know critical support for parents,
but there is still a gap between the cost of care and what
parents can afford to pay.
How have states spent these dollars? What can we do to
stabilize the childcare system, and why is it important to
provide a living wage for childcare, preschool and Head Start
workers as part of making systemic improvements in the care
community?
No. 3, the Biden administration unveiled its nursing home
reform proposal focusing on setting minimum staffing
requirements, and taking aim at private equity ownership. How
will these proposals lead to better treatment in the nursing
home? How can we raise standards without reducing access? What
you cannot answer in the time please submit for the record.
Thank you, Mr. Secretary.
Secretary Becerra. Yes, that was a mouthful Congresswoman,
let me see what I can get through. First behavioral health, as
you know the President made this one of his priorities. He
mentioned it in the State of the Union. We are working
vigorously to try to implement all that the President wants,
especially for kids.
You are probably aware that close to a quarter billion
dollars that we are investing in the Project Aware program for
State grants, that money will be used to help states train
teachers, parents, first responders, so we can move toward
youth mental health services, and so that will be important for
your State and others to have capacities to address those
needs.
We know that because of COVID the crisis has expanded. When
you have 100,000 Americans die from overdose, you know that
something is wrong. We are getting ready to implement the 988
three-digit lifeline for all Americans, so that if they are
willing to move in a different direction rather than go the
route of committing suicide, call someone and ask for help.
We want to make sure that they call the 988 number they do
not get a busy signal or put on hold. We will do everything we
can to try to help on behavioral health issues, especially for
our youth, childcare.
If we had Build Back Better, I could tell you a whole lot
more because we are so shy, so many American families, parents
have had to let go of their job so they can care for their kids
during the pandemic. We are now getting out of that, but still
the crisis is there. We do not pay enough for our childcare
workers.
The President's plan, and, so far, the budget just provided
some moneys, 39 billion dollars we put out there with your help
in the American Rescue Plan to help on childcare relief. It's
not enough. The issue is so big, childcare is very expensive
for parents, and it's very difficult for states because the
constraints they have.
Finally nursing homes, the President made it very clear. We
are going to do much more oversight on nursing homes. We are
going to make sure that staffing levels are improved, so we
look forward to working with you because we have got a clear
direction from the President. We are going to make this work.
Ms. Bonamici. Thank you. You did a great job, Mr. Secretary
answering the questions. I am introducing a resolution today
emphasizing the importance of those childcare investments. It
is important for not only the children and the families, but
also for the economy.
With the nursing home question there is still a bit of time
left, and I want to really focus on how the proposals can lead
to better treatment in nursing homes, and other long-term care
facilities. Raising standards without reducing access, your
thoughts on that?
Secretary Becerra. This is a tough area. I am not going to
say that we have clear answers, but we are not going to lower
standards. We are going to try and continue to raise them.
Ms. Bonamici. Important.
Secretary Becerra. The difficulty is for some of these
facilities it will cost them money to get there. Improve
services, we have to have more professionally trained
individuals, that costs money. That is why we are ready to
help. We want to provide support and assistance, but we also
know that there are a whole bunch of folks making a ton of
money in nursing home care, and not doing a very good job of
it, and that is where we want to extract that inefficiency,
sometimes a fraud.
We are going to continue to do program integrity to make
sure that we are getting real money, and real results for the
money we put in.
Ms. Bonamici. Thank you very much, Mr. Secretary, and Mr.
Chairman as I yield back, I just want to thank Jack Arriaga on
my staff who is leaving the team after more than 10 years to go
back to Oregon, and I just want to appreciate his work.
Chairman Scott. Thank you. The gentleman from South
Carolina, Mr. Wilson.
Mr. Wilson. Thank you, Mr. Chairman, and Mr. Secretary
welcome back, and it is good to see alumni do well.
Secretary Becerra. Thank you.
Mr. Wilson. We are happy for your success.
Secretary Becerra. Thank you.
Mr. Wilson. Mr. Secretary, I strongly support the expansion
of association health plans, which allows small businesses and
those who are self-employed to join together to obtain health
coverage for employees. These plans can reduce costs to allow
coverage across State lines, provide more choices, and be
better suited to meet the needs of employees.
The Department of Labor under the Trump administration
issues a rule to allow association health plans to be used
across State lines and allow more small businesses to
participate. Both the U.S. Chamber, and the Society for Human
Resources Management have urged the Biden Administration to
allow the rule on association health plans to move forward.
You have really in the past called association health
plans, junk health plans. How does the Biden administration
intend to support the ability of small businesses to provide
health coverage to their employees?
Secretary Becerra. I am sorry, Congressman, what was the
question?
Mr. Wilson. That is how does the Biden administration
intend to support the ability of small businesses to provide
health coverage for their employees?
Secretary Becerra. Yes, Congressman, thank you for the
question. The Affordable Care Act made many accommodations for
small businesses. We intend to make sure that all small
businesses cannot only provide their employees with a quality
plan, but they can do so and continue to operate, and do what
we all want to do is make a profit.
What we do not want is for individuals in this country to
be offered plans that offer them no protection at no rates. You
pay very little upfront, but then when you really need the plan
you get nothing, that is why we called them junk insurance
plans.
Mr. Wilson. I hope you really look into it even further.
The association health plans that I am familiar with have just
been very successful, and then sadly with the ACA the premiums
have just been astronomical. Please look into it.
Secretary Becerra. Okay.
Mr. Wilson. Additionally last year I noted to you how
grateful I was that HHS is taking initiatives to increase
cybersecurity for radiation dose, reconstruction program
affecting claimants under the Energy Employee's Occupational
Illness Compensation Program Act.
Unfortunately, as a result the National Institution for
Occupational Health and Safety and Health, has established a
temporary moratorium on completing these dose reconstructions.
Has the moratorium been lifted? If not, what is the timeline
and plan for lifting the moratorium? This is a key process for
many claimants with cancer, and the moratorium means that
workers from like at the Savannah River site in South Carolina
and Georgia, that I represent, are unable to proceed with their
claims.
Secretary Becerra. Congressman, you know I want to make
sure that we commit to continue to work with you on this
because I share the concerns that you have expressed. As you
are aware we completed the first phase back in September of
this initiative to try to make sure that we are protecting the
data that comes in.
We do not want any type of slippage to occur, and have any
kind of cybersecurity threat occur with very sensitive data,
but we will work with you because we know that the claims that
are being submitted, whether folks at Savannah, Georgia, or
otherwise--I am sorry, Savannah River site, or otherwise, are
crucial to make sure we process properly.
Mr. Wilson. Well again we have--hey I am the only person in
Congress who has ever worked at the Savannah River site, so I
know the dedication of the people who work there, and it is
just so inspiring in their services, particularly as we face an
incredible threat from Putin that we need to make sure that our
nuclear deterrence is there for peace.
Secretary Becerra. Right, I agree.
Mr. Wilson. I have represented Allendale County, South
Carolina which is the second poorest county in America, and it
is distant from modern health facilities, but we have all seen
the importance of access to telemedicine during the pandemic.
Laws enacted during the early days of the pandemic allowed for
flexibilities in how, when and whom telehealth could be
utilized in Medicare and employer-sponsored coverage.
The changes in Medicare and employer-sponsored coverage
were recently extended through the end of the year by Congress
in the Omnibus Funding Bill. Does the administration support a
continuation of these flexibilities beyond December 2022? In
particular, those that allow employers to offer telehealth at
no cost to their employees?
Secretary Becerra. Congressman, we are very supportive of
expanding the telehealth services that we now see being
provided as a result of the public health emergency as a result
of the pandemic. We need further authorities from you and thank
you for those who supported the omnibus bill, because it
provided a 5-month extension to the use of those telehealth
authorities.
We hope that you will continue to work to give us some of
those authorities so we can expand permanently access to
telehealth services for so many Americans, especially in rural
parts of our country.
Mr. Wilson. We have seen success already at the University
of South Carolina with handheld ultrasound, and so I hope that
has expanded, thank you. I yield back.
Chairman Scott. Thank you. The gentleman from Northern
Mariana Islands, Mr. Sablan.
Mr. Sablan. Yes, thank you very much, Chairman. Secretary,
welcome. It is very good to see you, and I hope you are doing
well. The Department of Health and Human Services is a huge and
very important Federal department as you know, Secretary, so we
felt that with your [inaudible], life and death to my
constituents, and I have a long list of thank you's.
I want to thank you for your decision to read Public Law
116-94 correctly, the permanent increase in Medicaid funding
cap for the Marianas and other insular areas. Thank you for
that, Mr. Secretary. Thank you as well for the President's
commitment in this Fiscal Year 23 budget to lifting the
Medicaid cap entirely, including the insular areas the same as
states in setting the [inaudible].
I thank you and your congressional staff, Kimberly
Espinosa, and [inaudible], the Marianas [inaudible] by mail
program, because we do not have delivery in the Marianas there
were hurdles to get in those, I can speak to, but your staff
helped with the fix. We are now working with Ms. Sharon to
focus on the free testing for Medicare Part B beneficiaries
that you announced. We do not have a CVS or a Walgreens, or any
of the chains.
We [are] confirming with our local pharmacies that they
will be participating. Last, I had a very good briefing just
last week with Mr. Craig Johnson, the financial [inaudible] as
we try to get one of our [inaudible] in line with HHS
regulations. Again, it was very helpful and responsible.
Mr. Secretary, you know for some disability under Medicaid
cannot go on forever, but you have not announced [inaudible]. I
just wanted to know Secretary Becerra, on the enforcement of
that policy some type of eligibility has been to my
constituents and to the delivery of the Marianas.
Turning now to early childhood education, the Budget
requests of 505 million dollars in new funding for a cost-of-
living increase to allow Head Start Programs to keep pace with
inflation without diminishing quality. The project also
includes $950 million to expand access to high-quality, early
learning opportunities, including for programming, increasing
the number of slots for Head Starts, and early Head Start
Programs for over 48,000 children and families.
My question, Mr. Secretary, is the administration for
children and families regularly measures the quality of Head
Start classrooms through the classroom assessments for the
system class, but suspended this obviously because of the
pandemic. What is the department's plan to ensure children
placed in Head Start classrooms are provided a quality
education?
Secretary Becerra. Congressman Sablan, first if I may begin
by saying it is always good to see you. Thank you for all the
work that you have done. What you do helps not only your
constituents, but it helps all those constituents in the
territories of this country, so I thank you for the work that
you have done.
On the issue of our kids and our schools, we are going to
do everything we can to continue to support the states who have
jurisdiction over the way our schools are run, and the local
school districts to make sure that we can provide them the
resources and help that we need. I should point out one of the
things that we are hoping to do is finally get healthcare
professionals back into our schools because we have seen how
important it is to keep our kids not just safe, but healthy,
and so we will look forward to working with you on any
proposals you might have on how we can advance the interest of
our children returning back to schools.
I want to be mindful of my time, but we could followup with
specifics to you, but I want to be mindful of the time in case
you have other questions.
Mr. Sablan. No, I do not. Thank you for that response, and
we will stay in touch. Best wish, sir. Mr. Chairman, I yield
back.
Chairman Scott. Thank you. Thank you. The gentlemen from
Pennsylvania, Mr. Thompson.
Mr. Thompson. Thank you, Chairman. Mr. Secretary, I
appreciate you taking the time to be with us today. It is good
to see you. As an experienced therapist rehabilitation services
manager, and a licensed nurse administrator in rural areas, I
have witnessed first-hand the importance of strong doctor/
patient relationships, and tailored healthcare delivery,
particularly in rural areas such as those within the
Pennsylvania 15th congressional District.
Expanded access to telehealth and telemedicine is vital in
providing care when physical facilities could be miles away.
Prior to the COVID-19 pandemic, healthcare providers began to
expand their capacity to deliver health services remotely to
their patients. The original intent of the service was two-
fold, to supplement in-person care for individuals and
underserved, or hard to reach areas, and to supplant in-person
care for patients who prefer using technology to access their
healthcare services.
The COVID-19 pandemic has laid bare the critical and
immediate need for expanded access to telehealth and
telemedicine services throughout the country. In the CARES Act,
and subsequent COVID-19 packages, Medicare, Medicaid, and
private health insurance plans were required to temporarily
require increased payments for telehealth services related to
COVID-19 treatment or testing, diagnosis, or treatment.
These packages also waived other telehealth restrictions,
encouraged the use of telehealth to provide access to care. Now
while this was an important and necessary first step toward
expanding these services, I believe we must continue to advance
the progress we have made over the past few years.
For these reasons I was proud to introduce H.R. 4437, the
Helping Ensure Access to Local Telehealth Act, or Health Act,
which builds off the provisions found in previously passed
COVID-19 packages. Specifically, the bill codifies Medicare
reimbursement for telehealth services rendered by community
health centers and rural clinics.
It removes the geographic restrictions related to
originating sites where the telehealth distance site providers,
a federally qualified health center or a rural health clinic
and allows these health facilities to continue to utilize audio
only telehealth visits for patients who do not have access to
quality broadband.
Mr. Secretary, I hope you agree that the ability to use
telehealth services during this crisis has demonstrated how
this technology can play a pivotal role in improving health
equity by increasing access to care for the vulnerable
populations. As we are working on the pandemic, Mr. Secretary,
does the administration support a continuation of these
flexibilities on a permanent basis?
Secretary Becerra. Congressman, first I applaud you for
being interested and putting those thoughts into paper and
legislation to help us on telehealth. We hope that we can work
with you to make some of those authorities permanent. We agree
with you that many of them are critical for communities to move
forward.
We hope that you will also look at the way we can be, make
sure that everyone is accountable because moving toward
telehealth could become a way that some try to abuse the
system, take advantage of it, and we want to make sure that
they do not ruin it for all the folks that really do need
telehealth services. We are looking forward to working with you
to expand access to telehealth services, to make sure it is
also done properly so that the taxpayers and those patients are
not abused.
Mr. Thompson. Absolutely. That is something we should be
doing throughout all healthcare. I have practiced healthcare
for 28 years before coming to Congress. I mean we have seen
that with other things, some folks who tried to take advantage
of Medicare billing, with some durable medical equipment that
quite frankly they were just there to bill the patient, not
really to provide proper care.
I mean, it is always a part of the healthcare system that
we need to manage and mitigate right?
Secretary Becerra. That is right.
Mr. Thompson. It should not prevent us from moving ahead
with the innovation this technology provides us. Mr. Secretary,
just one last quick--I am really deeply disappointed that the
administration's budget once again did not include the Hyde
Amendment which prohibits the use of Federal funds to pay for
abortions.
The Hyde Amendment has saved an estimated 2.4 million lives
since 1976. How can you tell 2.4 million Americans our country
would be better off if they were not born, or allowed to live
their lives, and so I am hoping and I am praying for the Biden
administration to be able to see just how wrong it is to not
support what has been a long-standing bipartisan part of the
Federal Government in the form of the Hyde Amendment?
Secretary Becerra. Congressman, if I can respond. This is
one of those areas where we always have a lot of discussion.
There are deeply held beliefs in this space, and I respect all
of that. My job now as the Secretary, versus as a Member of
Congress, is to now make sure that I am exercising my duties to
execute the law.
We are going to try to do it as best we can, staying within
the confines of the law, and making sure that we protect those
rights that people have under the law. I look forward to
working with you. I believe it is very important that women
have all their reproductive rights protected, but we can have
that conversation and hopefully get to a good spot.
Mr. Thompson. Well, let us remember the rights of those 2.4
million that would have not had life if it would not have been
for the Hyde Administration. Thank you, Mr. Chairman, I yield
back.
Chairman Scott. Thank you. The gentleman from California,
Mr. Takano.
Mr. Takano. Thank you, Mr. Chairman. Good morning, Mr.
Secretary. As you know, we both come from Southern California,
and California is a State that many parts of the country are
experiencing astronomical levels of homelessness. Do you agree
with me that the pandemic has contributed to I think the crisis
that we are seeing in California?
Secretary Becerra. Without a doubt.
Mr. Takano. Without a doubt. Mental health and addiction a
big part of the issue as well?
Secretary Becerra. Without a doubt.
Mr. Takano. The Boise decision, and it is a Federal
decision, a Federal Court decision, I am hearing from my local
services police, the county folks, that the refusal of services
by homeless people is a big part of the challenge. Have you
given much thought to this?
Secretary Becerra. I will tell you, Congressman, and by the
way great to see you again, but I will tell you that when I was
the Attorney General in the State of California, I worked quite
a bit with law enforcement. We were looking for ways to try to
tackle this working with the mental health service providers,
with social services because we knew that law enforcement was
not always going to be the best first responder to some of the
crises that we see, but I mean as Secretary we do not deal with
it as directly because my jurisdiction is not directly over
homelessness and local communities.
Mr. Takano. Thank you. I wondered what it was and I thank
you for reminding me of your background as Attorney General,
and also, your insight that the police departments are not the
most, are not necessarily the first line of defense.
Secretary Becerra. They will tell you that.
Mr. Takano. I ask you these questions because addiction and
mental health are part of the President's Unity Agenda, and I
am wondering how it is your department, if at all, because how
you can coordinate that with HUD or other places, or if you
need to, the administration has to rethink the department's
role?
Secretary Becerra. Congressman, we are actually doing a lot
in this space, but we do not have direct jurisdiction over
homelessness issues. For example, we changed the entire
paradigm for drug use overdose strategy.
Mr. Takano. Excuse me for interrupting, but who does have
direct jurisdiction?
Secretary Becerra. That is mostly a local issue. The
Federal Government can support, for example HUD, can deal with
some of the issues of housing, but not as directly.
Mr. Takano. Well, thank you. You know one thing I would
like to clear up is that as there are some unspent ARP funds at
the State and local levels. I am urging folks to get creative
in how they use this one-time money because that cannot be
embedded in police salaries, et cetera.
I have got businesses that were broken into--medical
offices actually because I think homeless people are looking
for maybe drugs, or they are looking for a place to go to the
bathroom. This is not a question--I want to sort of get it out
there, but is there a creative way for ARP funds to be used to
kind of help these small businesses, as well as the homeless
people in the short-term, while they are looking for a longer-
term solution?
Secretary Becerra. Absolutely. We have been trying to do
some of that at HHS. We have been trying to support really
innovative proposals and programs on the ground locally. We can
do some of that through demonstration projects, or pilot
programs. We do not fund the entire program. We cannot do it
nationwide, but we can target.
If it works, we can come back to you and say here is a
great program that works.
Mr. Takano. I think the one connection the feds and the
locals, I mean even though it is local jurisdiction, State and
local, the feds could be supportive is I am hearing that there
is a shortage of beds for addiction services. There is a
shortage of mental health professionals. How do we get the
facilities and the workforce stood up quickly?
Speed is of the essence. We cannot allow this problem to
keep festering.
Secretary Becerra. Congressman that is why we took 3
billion dollars of the American Rescue Plan money that you made
available to us, and we put 1 and 1/2 billion into mental
health services immediately throughout the country, and another
million--billion and a half into drug use addiction use right
away, services right away.
What that was meant to do is help the locals determine
locally what was best for them, versus having Washington tell
them what to do with it. We monitor the money. We hold them
accountable, but we try to let them use their best practices to
move forward.
Obviously, it is not enough. We are doing more. We changed
our drug strategy altogether to make sure that we deal not just
with addiction, but we deal with harm reduction, we deal with
treatment, and post-care services as well, so we follow folks
all the way through.
Mr. Takano. Well, I certainly hope you will work with those
of back in California where you come from, to find ways,
creative ways to stand up the mental health workforce quickly,
specifically to serve our homelessness, our youth that have
survived, our teenagers that have gone through a lot, and my
time is up. There are so many more questions, but always good
to see you, sir.
Secretary Becerra. Great to see you.
Chairman Scott. Thank you. The gentleman from Michigan, Mr.
Walberg.
Mr. Walberg. Thank you, Mr. Chairman and welcome back Mr.
Secretary, to a great committee room. Mr. Secretary, the
administration has requested an additional 22.5 billion dollars
to purchase COVID-19 vaccinations testing and therapeutics.
Currently, all COVID-19 vaccines are purchased by the Federal
Government, but as the pandemic winds down there needs to be an
offramp, I believe that transitions this responsibility to the
private market.
Insurance will need to establish new contracts and
negotiate prices to purchase these supplies, which will take
some time. My question, simple question, has the administration
begun to discuss this transition with insurers, yes or no?
Secretary Becerra. Yes.
Mr. Walberg. Thank you. Keep it up. Mr. Secretary, when the
public health emergency ends many people who no longer qualify
for Medicaid will have their coverage terminated. The Urban
Institute estimates that 65 percent of these individuals will
qualify for employer-sponsored insurance, which most people
like. What is your administration doing to ensure that these
individuals are aware of their private coverage options, which
are not on the ACA exchanges?
Second, how much time does the administration plan to give
healthcare payers to ensure smooth handoffs, and guarantee that
individuals do not become uninsured.
Secretary Becerra. Congressman, thank you for the question,
great question. We are working with every State with trying to
get them ready. We are trying to prepare them. We committed to
give at least 60-day notice on the public health emergency
pulldown.
We are going to try to work with them to make sure that
they are aware of all the options that these folks have because
you are right, there are millions of Americans who are getting
health insurance through Medicaid who might lose it, many of
whom as you just acknowledged will actually qualify, whether it
is employer-based health insurance, or whether it is the
Affordable Care Act insurance, or perhaps stay on Medicaid.
We want to make sure that they are aware of it, so we are
working with states. We could use your help. If you could
encourage your State leaders to stay in touch with us, so we
can make sure that we are coordinating with each State as they
look at the population and might lose coverage.
Mr. Walberg. Will do, I appreciate that. Again, the private
sector employer-sponsored insurance is overwhelmingly accepted
and approved.
Secretary Becerra. It is.
Mr. Walberg. If 65 percent of these individuals are capable
of receiving that, we need that to take place.
Secretary Becerra. It is good news. That means they are
working, so that means they can pay for their insurance as
well.
Mr. Walberg. Yes. Switching to another topic. Faith-based
organizations play an indispensable role as sub-recipients of
CAPTA and CSBG grants. I have a long history, as you know, of
service in the United States, of serving Americans to help
uplift them from poverty.
In fact, more than 50 percent of the families that choose
center-based care, choose religious based programs. Mr.
Secretary, do you think faith-based organizations should still
be included among recipients, and help carry out Congress's
goals to help in child abuse prevention, and to alleviate
poverty?
Secretary Becerra. Absolutely. Absolutely. In fact, they
are probably one of the dominant forces in helping us address
those things.
Mr. Walberg. I am delighted to hear that. I agree with you.
What steps will you take at HHS to ensure that these faith-
based organizations are able to continue to maintain their
religious character, while continuing to participate in helping
children and families? This of course is a First Amendment
concern.
Secretary Becerra. Congressman, first can I just say thank
you for the way you have asked the question because there will
be areas where there will be some conflict in policy.
Mr. Walberg. To say the least.
Secretary Becerra. Yes, but without a doubt the charitable
work that is done by these faith-based organizations we cannot
replace it. It would cost a ton of money for you all to figure
out a way to replace it. We have to continue to work with all
those organizations that have committed themselves to help
humanity.
What we will do is make sure that we are as supportive as
we can be, but we also want to make sure that we follow the
law. We want to make sure everyone follows the law, and
sometimes when there is a conflict we will have to turn to the
law, whether it is through the Courts or through you, to
determine how we do that. No one should have their rights
violated simply because the care is being provided in ways that
would discriminate against them.
Mr. Walberg. I agree, and to simply fall toward the
Constitution and the law is the best way to handle it. The
American people are committed I believe, to helping protect
American children from child abuse, assisting as many Americans
as possible from falling into poverty. Faith-based
organizations are essential providers in carrying out that
mission, and although you testified to the importance of
enforcing conscious and religious freedom rights under oath in
your nomination hearings, we remember that and hope that that
was solid.
Secretary Becerra. I am committed to that.
Mr. Walberg. Your actions contradict this to some degree in
carrying out the law in the Constitution. I call you back to
that, and we will be watching and hoping for the best there for
religious liberty. Thank you and I yield back.
Secretary Becerra. Please do so.
Chairman Scott. Thank you. The gentlelady from North
Carolina, Ms. Adams.
Ms. Adams. Thank you, Chairman and Ranking Member, for
hosting the hearing. Mr. Secretary, let me, first of all, thank
you for your partnership and for supporting priorities that are
important to me and the people of the district that I represent
in North Carolina. I did want to thank you for taking time to
visit me in Charlotte last July. You might remember during that
visit you talked about the importance of making long-term
investments in our future, and those investments are what I
want to ask you about today.
Specifically, to focus on the National Institute for
Occupational Safety and Health, NIOSH. As you know this is the
only agency in the Federal Government to pass this research
about the health and safety hazards faced by American workers.
The analytical perspective volume of the President's budget
submission says that the next Fiscal Year provides a critical
opportunity to invest in the capacity and infrastructure needed
to ensure that evidence is to inform decisionmaking for the
government.
You and I both hear a great deal about like how the
vitality of America's workforce. My question is do you agree
that NIOSH plays a valuable role in providing evidence that can
inform the decisionmaking for workplace health and safety?
Secretary Becerra. Congresswoman, I apologize. I did not
hear everything in your question. It is hard to make out some
of what you are saying. If you could just repeat the question.
Ms. Adams. Do you agree that NIOSH plays a valuable role in
providing evidence that can inform decisionmaking on a
workplace health and safety?
Secretary Becerra. Without a doubt. If we did not have
NIOSH producing some of the data the actions, we would be
taking at the worksite would not be as informed, and so
absolutely. We need to protect workers, not just their safety,
but their health, and NIOSH is indispensable in making that
happen.
By the way, I want to make sure it is clear. When we
formulated the budget that the President presented, this was
before we knew that Congress would pass the Omnibus Budget
Bill. We had to base our projections on what we had through the
continuing resolution, which as you know were far less in
funding for all the programs.
Many items in the budget, they are reflected based on what
we thought was going to be the case based on the continuing
resolution. Obviously, the Omnibus gave us more dollars, and
so, we are prepared to work with Congress and with the
Department of Labor to make sure that we are sufficiently
funding programs like NIOSH.
Ms. Adams. Right. Your current budget proposal though calls
for a 5 million-dollar reduction in funding for NIOSH compared
to the 2021. Is that the reason?
Secretary Becerra. That reflects a fact that if you take a
look at what the continued resolution was funding this at, at
the current level, we had to base any projections for the next
Fiscal Year for 2023 off of the current funding we had through
the continued resolution. As you know the CR had very low
funding levels.
Now, we can work forward based on what we got through the
Omnibus. The Omnibus had a higher level of funding for these
programs, so now, we could make our projections based on the
Omnibus, not the CR, and that is why I am saying we are willing
to work with you to make sure that NIOSH is properly funded.
Ms. Adams. Right. Let me ask you about ACA, you know, it is
the 12th anniversary--we just marked that. We know that the gap
in coverage still exists in my State. We have over 500,000 who
are still without access to health coverage. How will HHS
continue to build on the successes of the ACA, to advance the
administration's key priorities of expanding healthcare access,
reducing healthcare costs, and reducing health disparities?
Secretary Becerra. Congresswoman, I know this is an
important issue for you, and it is for me as well. We are doing
everything with the lens of equity involved, and that is why
for example when it came to the open enrollment period under
(video cuts out) too many folks in our communities do not
understand all the avenues [they] can use to get good coverage,
have never been given the chance to get familiar with good,
quality health insurance plans.
With these navigators, by quadrupling them, we were not
only able to help people understand what their rights and their
benefits could be, but also help them navigate the process of
getting to the best plan for them, not getting more coverage
than they need, but not getting less, and that is one of the
reasons why we saw a major uptick in the number of Black and
Latinos who signed up for affordable care under the ACA.
Ms. Adams. Great. Thank you, Mr. Secretary. We really
appreciate you being here. Mr. Chairman, I yield back.
Chairman Scott. Thank you. Thank you. The gentleman from
Indiana, Mr. Banks.
Mr. Banks. Secretary Becerra, during a House Energy and
Commerce Committee hearing on May 12 of last year, you were
asked whether you enforced the partial-birth abortion ban of
2003, which prohibits abortion providers from murdering a child
after it is born. Three different Representatives asked you if
you would uphold that law to which you outright lied to them,
saying there was no law that prohibited partial-birth abortion,
and then you dodged the following questions.
Your failure to uphold this law is made more drastic by the
fact that not only do you know that this law exists, you voted
against it as a Member of Congress in 2003. When myself and 157
other Members of Congress wrote you a letter about this issue
in July 2021, you showed contempt for every single member when
you sent a reply, which was only two sentences long, and
refused to acknowledge either the law or the questions at hand.
Now, I am going to ask you. Do you concede that partial-
birth abortion as defined in 18 U.S. Code Section 1531 is
illegal, and punishable by fine, imprisonment or both?
Secretary Becerra. Congressman, I will try to respond to
this as best I can as I did before, and that is to say to you
that having been a former Attorney General I know how important
it is to not only follow the law, but enforce it. As Secretary
of HHS, I will not only comply with the law, but enforce it.
When it comes to issues that sometimes we hold different,
and sometimes very deeply held beliefs, I will respect where
people's opinion is, but my job is to make sure I am enforcing
the law.
Mr. Banks. Do you concede that partial-birth abortion is
illegal per the law?
Secretary Becerra. Under the Supreme Court decision in Roe
v. Wade, women have reproductive rights that they are entitled
to enforce. That they are entitled to have the government
respect. I will do everything I can to make sure a woman's
rights and reproductive care are defended.
Mr. Banks. I take that as a no, you do not concede that
that is the law. 18 U.S. Code 1531, it seems pretty clear you
voted against it. You are well aware of the law, so you do not
concede that partial-birth abortion is illegal?
Secretary Becerra. As I said I understand that there are
differences----
Mr. Banks. It seems a very simple question. Will you commit
as Secretary of the HHS to ensure that the department acts in
accordance with the Supreme Court decision to uphold the ban on
partial-birth abortions decided in Gonzales v. Carhart?
Secretary Becerra. I am obligated as the Secretary of
Health and Human Services to make sure that I am complying with
the law, and that is what we will do.
Mr. Banks. Will you commit as the Secretary of HHS to full
oversight of HHS grant programs to ensure no grantees who
violated 18 U.S. Code Section 1531 continue to receive HHS
funding?
Secretary Becerra. We will do everything we can to make
sure we do vigorous oversight over all the programs that are
under the jurisdiction of HHS.
Mr. Banks. Last year, the University of Pittsburgh implied
that one of its federally funded research projects utilized
organs that might have been extracted from live fetuses.
Secretary Becerra will HHS investigate the University of
Pittsburgh's grotesque violation of the partial-birth abortion
ban?
Secretary Becerra. Congressman, we know that there are
practices and standards that must be followed when it comes to
fetal tissue. We will make sure we do everything we can to make
sure those practices and standards are followed.
Mr. Banks. You just told me you are going to follow the
law, but why have we not yet investigated this clear violation
of the law?
Secretary Becerra. You are more than welcome to submit to
us any information you have on any potential violation of the
law, and we will definitely make sure that we look into it.
Mr. Banks. Secretary, 157 of us sent you a letter and you
gave us a non-response, so how can we make sure that you will
look into this clear violation of the law?
Secretary Becerra. I responded to your letter Congressman,
and we will always respond to your letters as best we can.
Mr. Banks. On October 4, 2021, the Department of Health and
Human Services issued a final rule that allows Title X family
planning funding to flow to organizations that provide elective
abortion. This decision overturned a rule issued by President
Trump known as the Protect Life Rule.
According to a 2021 GAO report, between 2016 and 2018
before the Protect Life Rule was established, Title X funds
were Planned Parenthood's second largest Federal funding stream
at 182 million dollars, approximately 60 million dollars each
year. Secretary Becerra, do you believe that Federal taxpayer
dollars should be used to fund abortion? Yes or no?
Secretary Becerra. Congressman, I know this issue well. I
worked it when I was the Attorney General. I want to make sure
that the rights of women were protected, and the rights of
families that receive family practice services were protected.
Mr. Banks. Should taxpayers pay for it?
Secretary Becerra. The taxpayers have provided money for
family planning. We make sure that that is----
Mr. Banks. Do taxpayers pay for abortions?
Secretary Becerra. The taxpayer money is being used the way
it should be----
Mr. Banks. A simple question yes or no, should taxpayer
dollars be used to pay for abortions?
Secretary Becerra. I think I am responding to your
question, Congressman, by telling you that we use Title X funds
the way we are allowed to under the law.
Mr. Banks. I yield back.
Chairman Scott. Thank you. The gentleman from New York, Mr.
Morelle.
Mr. Morelle. Thank you so much, Mr. Chairman for holding
this hearing, and Mr. Secretary, thanks so much for being here.
I am proud of the budget request that HHS has put out. It is
clear you and the President were focused on the pressing
healthcare needs of families across the country, and I look
forward to working with you to make meaningful progress on
driving quality and promoting the well-being of all Americans.
I want to congratulate you on that. I want to ask you a
little bit about an issue I am focused on back in Rochester,
New York where I have the privilege of representing Monroe
County that relates to addressing social determinates of
health, and how we deliver services.
I was very glad to see considerable mention of these
factors in your budget request, both in terms of dollars, and
an emphasis on specific outcomes in areas such as maternal
health, chronic diseases such as high blood pressure. I also
applaud the coverage and reimbursement to services provided to
community health workers, and community-based organizations
given their impact on addressing social determinants and
improving health equity, which you mentioned earlier.
I would just like to welcome the opportunity to work with
your team on a project I lead in my community that seeks to
better connect healthcare, housing, food and food insecurities,
employment and education providers. We are working on an effort
to create a truly integrated health, education, and human
services delivery system that engaged people early on, or in
crisis with an effort to improve outcomes, reduce costs, and we
would welcome the opportunity. May I followup with your office
on that sir?
Secretary Becerra. Absolutely. If you look at the Budget,
we have an allocation in CDC to actually deal with social
determinants of health. We look forward to working with you on
that.
Mr. Morelle. Good. I will followup if I might, sir. I also
want to just mention local hospitals have been essential to our
communities, clearly during the last 2 years. It has really
shown both in terms of emergency, care, COVID-related care, and
people--they continue those hospitals and navigate subsequent
surges as they happen.
Each of us should be grateful for their continued work in
keeping our communities healthy, we should be doing everything
we can to ensure their fiscal health, and that they have the
resources to serve their patients in those areas, particularly
in underserved areas.
I was pleased to see in your budget $17.2 million to
support the 340B Drug Pricing Program, administrative support
to improve operations and oversight for the program. However, I
do want to highlight an issue that I have engaged with your
department over the last several months. For hospitals that
participate in the 340B Program, the disproportionate share of
hospital eligibility has been negatively impacted by the change
in pay ordinate makeup, as well as the inability to perform
certain procedures during COVID.
There is that measurement that we use. It is resulted in a
number of hospitals losing eligibility, and seeing the loss of
considerable resources that go along with it, so I was proud to
work with colleagues that recently passed the Omnibus to ensure
hospitals who lost their 340B eligibility have an opportunity
to apply to be reinstated, and I have a hospital in my district
currently looking to get reinstated.
My question is how ca historical investments included in
the Budget support the integrity and enforcement of 340B
Program, especially around drug companies who have taken it
upon themselves to limit savings through contract pharmacy
arrangements. I am sure you are aware of it, and how can we
support community-based hospitals who are often serving the
underserved communities? If you could just comment on that
answer?
Secretary Becerra. I can, and I thank you for the work that
you are doing on 340B. There are very few places where I go
when I am dealing with healthcare facilities where they do not
come to me and say can you please continue to work on 340B. It
is indispensable for us to be able to get some of these
medications to our patients, and so thank you for the work that
you are doing.
As you know we are going to work very hard, to the point
where we know we will probably end up in Court on much of what
we do, but we believe the 340B Program was there for patients,
not for manufacturers to make money, and we are going to do
everything we can to make sure that when medicine has to be
dispensed that those local pharmacies have the capacity to do
so.
Mr. Morelle. Well, thank you for that. I appreciate it, and
I will continue to work with our team. Just finally just to
underscore, I helped work on the No Surprise Act here. I worked
on it when I was a member of the New York State Legislature,
and New York's law.
One of the things we were clear to do when we wrote the law
is that the factors included in the IDR process to make sure
that no one single factor is prioritized in such a way that it
becomes a benchmark rate, that was the subject of a lawsuit, so
I not only appreciate your commitment to working quickly on
this, but also to make sure that the rulemaking is in line with
the statutory instructions, so I would like the opportunity to
make sure we followup with that as well sir.
Secretary Becerra. I look forward to following up with you
on that, and if you will recall in our rule, we did have
provisions that said that when you look at that arbitration
process, if a State has its own process in place, you fall back
to that state's process.
Mr. Morelle. I do appreciate that very much and appreciate
your leadership sir, thank you. I yield back.
Secretary Becerra. Thank you.
Chairman Scott. Thank you. The gentleman from Georgia, Mr.
Allen.
Mr. Allen. Thank you, Mr. Chairman and Mr. Secretary, thank
you for being here today. Yesterday, your administration
announced a new rule to address the so-called family glitch in
the Obamacare exchanges. Previous administrations have not
found legal authority to address the family glitch, despite a
push from liberal advocates.
I am concerned that this administration is taking steps to
interpret a decade old regulation is now unilaterally expanding
Obamacare at taxpayer expense. If this reinterpretation of
statute is legal, why was the family glitch not addressed
during the Obama administration?
Secretary Becerra. Congressman, thank you for the question.
As you know it is very important because hundreds the
thousands, if not millions of families depend on us getting
this right on the family glitch, there should be no family that
has to forego coverage because the breadwinner, the person who
is working, who has insurance can access that insurance, but
all of a sudden because of certain glitches in the law, the
family must be excluded from that policy. That makes no sense.
We will do everything we can to make sure that this is correct.
Mr. Allen. How much is this going to cost taxpayers?
Secretary Becerra. Well, we think it is going to help the
taxpayers because they are not going to have to worry about
having family members without health insurance, and so, we
think just as the Affordable Care Act has proven its success
for more than 30 million people, that taxpayers are going to
find that they are going to save themselves a lot of money by
getting rid of these glitches in the law that leave their
families and loved ones behind.
Mr. Allen. What you are stating here is that taxpayers
paying through the IRS and through the Federal Government, and
then to provide money to the provider is less expensive than
the individual in a private plan.
Secretary Becerra. We have been able to bring down the cost
of health insurance.
Mr. Allen. Yes, but you subsidized the cost sir with
taxpayer money. That is how you bring the cost down.
Secretary Becerra. Those taxpayers now are insured, and do
not have to use the emergency room as their first level of
care, which costs the taxpayers as you know, billions of
dollars because that is care that is far more expensive than
any actual preventative or primary care.
Mr. Allen. This change also impacts employer incentives to
offer family coverage to employees, even though employer-
sponsored family coverage is working for millions of Americans.
Will employers now be forced to invade their employee's privacy
by collecting information about the total household income?
Will employers now be subject to increased penalties?
Secretary Becerra. Actually, I think most employers are
going to be happy that we get rid of the family glitch, and we
are going to make sure we protect everyone's privacy, and I say
that not just as the Secretary, but as a former Attorney
General who fought very hard for privacy protections for the
people of California.
Mr. Allen. Okay, sir. Mr. Secretary, under the Biden
administration's watch we have a crisis at the border, and I
don't know what you all talk about at cabinet meetings, but I
hope this is one of the subjects that you talk about.
Obviously, you know, you're in charge of healthcare in this
country, and these open borders have exacerbated the opioid
epidemic in this country.
I mean it is said that we have lost over 100,000 people to
fentanyl, and there is enough fentanyl in this country to kill
every American seven times. In 2021, there was a 134 percent
increase in fentanyl seizures at our border, and you know the
administration barely allowed Title 42 public health order
during the pandemic, but the CDC is now lifting Title 42.
What is your position, and what are you doing about the
ongoing crisis of fentanyl pouring across our border as an
obvious health risk, and have you spoken to the CDC about why
they are removing Title 42 and discouraging that decision?
Secretary Becerra. Congressman, good question. You have
mixed a lot of important policies into the question, so let me
try to piece it out and deal with it for parts that we have
direct jurisdiction over, and that is Title 42. Title 42 as you
know is a public health measure.
It allows us in extreme cases to take actions which
ordinarily the government would not have the power to
undertake, including for example, under Title 42, quarantining
populations because of the severe stress we are under because
of in this case the pandemic.
Title 42 must be based on the science and the facts on the
ground in order to be able to survive a legal test. Title 42
has been in use, but CDC has been doing analysis on a constant
basis about whether the science and the facts still exist to
keep Title 42 standing. They have now reached the conclusion
that those facts based on the healthcare, science and facts are
no longer their main----
Mr. Allen. Well, we have proof that there are health risks
coming across our border, okay. We have got reports, certainly
the administration must be privy to those reports, and we need
to deal with it. One last quick question, well I am out of
time, so Mr. Secretary, thank you again, and I yield back.
Secretary Becerra. Thank you.
Chairman Scott. Thank you and I appreciate your refraining
from that last question. We are on a very strict timeline,
thank you very much.
Mr. Allen. Yes, sir.
Chairman Scott. The gentlelady from Washington, Ms.
Jayapal.
Ms. Jayapal. Thank you, Mr. Chairman, and welcome back to
the House, Secretary Becerra. It was great to see you
yesterday. Thank you for your work on fixing the family glitch,
which is going to lower costs for American people by bringing a
million more Americans into healthcare coverage. Two-hundred
thousand who are uninsured will finally get access to
healthcare coverage. That was a really big step, Mr. Secretary,
and I appreciate your work on that.
On Title 42, thank you for following the science. I find it
odd that my colleagues across the aisle would resist mask
wearing, or vaccinations, and yet you want to use a public
health title, Title 42 is a public health title to keep
immigrants out of the country. We know that that is
unfortunately the anti-immigrant sentiment is strong on the
other side.
Thank you for following the science and lifting Title 42.
Also, thanks for all the incredible work that you have done to
deliver COVID-19 vaccines and tests to patients throughout the
country. You will not be surprised that I want to ask you about
some of the profiteering that is happening with private
insurance companies.
Researchers have demonstrated that Medicare Advantage plans
inflate patient risk scores to get larger payments from the
Medicare Trust Fund, costing taxpayers over 50 billion dollars
a year. Your department's Budget provides $2.5 billion to
eliminate fraud and abuse in healthcare at the individual
patient or physician level, resulting in a projected 10 billion
dollars in savings in traditional Medicare per year.
However, Mr. Secretary, if we focused on Medicare Advantage
risk score profiteering, we could save five times that amount.
What plans do you have to stop fraud by these Medicare
Advantage companies, and why is there no budget allocated for
this much bigger, bigger problem of profiteering by private
insurance companies?
Secretary Becerra. Congresswoman, first good to see you,
and second, thank you for the work you have been doing. On this
issue, I harken back to my days as AG where we did everything
we could to go after some of that abuse that was occurring, the
fraudulent practices that cost patients and American taxpayers
so much money.
What I can tell you here is that we are going to make sure
that when it comes to the Medicare program, program integrity
will be one of the main priorities. We did include in our
budget moneys for program integrity so we can have a bigger
capacity to go after that fraud. Oftentimes, it is detected
first at the State or local level, but because it is a Medicare
program which is Federal, it then comes to us.
We are going to try to do what we can to work closely as I
did when I was an AG, working closely with others. We have got
to make sure we can take some action on this. Medicare
Advantage, there are clear signs that in many ways the Medicare
Advantage is not giving taxpayers the full deal that they are
entitled to, and so we will try to work with you to make sure
we can make advances there.
Ms. Jayapal. Well, that would be great to use some of that
budget to crack down on these corporations. For Americans under
the age of 65, the government pays over $300 billion per year
to subsidize high private insurance premiums, while close to
one in five medical claims are denied by these insurance plans.
These denials cause immense suffering, like they did for Laila,
a 10-year-old child who had to hold bake sales to pay for care
for her chronic pain condition after United Health denied her
claims.
Does HHS intend to use the funding that you have set aside,
this $2.5 billion in funding, for oversight to investigate
wrongful denials of care by private insurance companies?
Secretary Becerra. I would love nothing more than to have
those dollars available to do that, and I hope that you and
your colleagues are successful in getting that money across the
finish line in the budget.
Ms. Jayapal. If we get it across, we are going to do
everything we can to get it across, I just hope you use it to
investigate some of the profiteering practices of these private
insurance companies. Researchers reported that hospital
emergency rooms participate in the highest price gouging in
areas that serve patients of color, and uninsured patients.
Since many lawfully present immigrants are initially barred
from accessing public health benefits, like Medicaid and CHIP,
they are more likely to be uninsured and become the victims of
price gouging by hospitals. I know, Secretary Becerra, that you
as a lawmaker worked on removing this bar, as Secretary of
Health, would you be willing to work with me on my bill to
support removing this arbitrary barrier to public health
benefits?
Secretary Becerra. As we move toward universal coverage
that is one of the elements that has to be in place. I look
forward to working with you to finally get there, finally get
there if we can.
Ms. Jayapal. Thank you so much, Mr. Secretary.
Secretary Becerra. Thank you.
Ms. Jayapal. I yield back, Mr. Chairman.
Chairman Scott. Thank you. The gentleman from Wisconsin,
Mr. Grothman.
Mr. Grothman. Yes, I will go over a few of the programs. Do
you have a new payment model for physicians who implement anti-
racism in their care plans?
Secretary Becerra. I am sorry, Congressman?
Mr. Grothman. Do you have a new payment model for
physicians who implement anti-racism in their care plans? Are
you familiar with such a thing?
Secretary Becerra. You will have to give me more detail so
I can understand what your question relates to.
Mr. Grothman. Okay. Do you have an Office of Climate Change
and Health Equity?
Secretary Becerra. Yes, we do.
Mr. Grothman. Can you explain what that means?
Secretary Becerra. If you walked into many of the
communities throughout our country, they are suffering ill
health, many times driven by the fact that the climate has
exacerbated conditions. You have communities that no longer
have clean drinking water running through their taps because of
the drought that has occurred because of the climate change
that is occurring in this country.
You have people who are suffering conditions where they
cannot afford to pay for their heat because the conditions have
gotten so cold. Climate has affected everything, including our
health. We have an office that tries to make sure that we
protect people's health, and one of the ways we can do that is
to also take into account the effects of climate change.
Mr. Grothman. Sometimes, it is too cold, and sometimes, it
is too hot? Congressman, you said you had problems in
communities that----
Secretary Becerra. People are dying.
Mr. Grothman. You said sometimes you have people that you
have problems in communities because the communities are too
cold, correct?
Secretary Becerra. People are dying in some of these
communities because they do not have access to clean drinking
water. People are dying because they cannot afford to keep the
heat on in their apartment. People are dying, so we do not want
people to die. It is a bad health condition if you died, we
want to make sure we do everything to address it, including the
effects of climate.
Mr. Grothman. Could you explain what health equity means?
Secretary Becerra. Health equity? Fairness and inclusion.
We found out through COVID especially how we have gaps in our
system where there are communities that are left out
completely. Individuals falling into black holes when it comes
to care. We are going to do everything we can.
Mr. Grothman. I do not understand what you mean by left
out.
Secretary Becerra. Congressman, do you walk through your
communities? Do you walk into your District and find people who
do not have health coverage, and find people who cannot afford
to buy the food they eat?
Mr. Grothman. I think everybody. You know people go to the
hospital, sometimes the hospitals complain because they have
got to take care of people, and are not getting reimbursed, so
we have very generous local Medicaid programs for people who
want to sign up for them.
Secretary Becerra. I am sure you have poverty in your
District Congressman. Have you walked your District?
Mr. Grothman. Well sure. We know people who are poor in my
District.
Secretary Becerra. Then, you should understand what it
means to have health equity, so that those folks are not left
behind.
Mr. Grothman. Well, right now in Wisconsin, and I believe
everywhere around the country we have a Medicaid program for
people who are I guess what you described as poor.
Secretary Becerra. We still have some 25 to 30 million
people who do not have access to insurance, health insurance,
who have to use the emergency room often to get their care,
often by then, it is too late.
Mr. Grothman. Right. Now, we will say there is a new
guidance from the Food and Drug Administration, and the Centers
for Disease Control, that prompts healthcare systems to
prioritize COVID-19 treatments such as monoclonal antibodies
based on individual's race. Is that true?
Secretary Becerra. Based on their race?
Mr. Grothman. Correct.
Secretary Becerra. Can you show me what you are reading
from? I am not aware of anything where we prioritize based
solely on race.
Mr. Grothman. Maybe solely, not even partly?
Secretary Becerra. We prioritize based where the need is.
Mr. Grothman. Okay. Okay. Okay. Well, we will leave it at
that.
Secretary Becerra. Thank you, Congressman.
Chairman Scott. The gentleman yields back. The gentleman
yields back. The gentlelady from Pennsylvania, Ms. Wild.
Ms. Wild. Thank you, Mr. Chairman. Good morning, Secretary
Becerra. Good to see you again.
Secretary Becerra. Yes.
Ms. Wild. It was nice to see you yesterday. I want to use
my time today to talk about a pressing issue. The mental health
of our hard-working first responders. As you well know law
enforcement officers die by suicide at a greater rate than the
general population, and we must do more to support them.
I am proud to say I took action and secured millions of
dollars in funding in the American Rescue Plan to support the
mental health of our public safety officers. Under your
leadership at the Department of HHS, the funding I secured has
been awarded in grants to entities in Georgia, Colorado, and in
my home State of Pennsylvania, and is now working and getting
results.
I know this funding is working to develop and implement
training tools, and resources designed to reduce and prevent
burnout, depression, anxiety, suicidal thoughts and actions,
and substance misuse, but could you please share more about how
this funding is having an impact?
Secretary Becerra. First, I have to begin Congresswoman by
applauding you for the work that you have done on this issue.
Having served as the Attorney General for the Chief Law
Enforcement Officer of the larger State with the largest law
enforcement force in the Nation, I can tell you how many of our
men and women are suffering true stress.
Every year we would have a ceremony to acknowledge the
fallen officers in California. I cannot tell you what men and
women go through. It is more than appreciative what you are
doing to try to help folks who are in public service protecting
us day in and day out. We are going to work with you on your
legislation. Thank you for your support of the Burn the Brain
Act which made it possible for us to provide first responders
with more services, access to care, and I hope we will be able
to continue to do work on trying to remove the stigma that
occurs when a law enforcement officer has to seek out mental
health services.
Oftentimes, I have been told better not to do it because I
do not want that on my record. I want to be able to get
promoted, and I do not want anyone to think that I am suffering
from some kind of mental stress because that might endanger my
chance to go get promoted. We have a lot of work to do.
Men and women, I mean things have gotten very complicated
when criminals are better equipped with weapons than our law
enforcement officers, there is real stress. I thank you for
what you are doing because it is an untold story of how much
stress some of our first responders in law enforcement are
going through.
Ms. Wild. Well thank you, Mr. Secretary. I look forward to
working with you on this as we go forward. Are there other
things that you were aware of that we can specifically support
using the ARP funding, or supplemental funding to make sure
that we are supporting our first responders?
Secretary Becerra. Well above and beyond providing the
resources for further training and access to support, trying to
make sure that the privacy of officers is protected when they
do seek mental health services, I think it would be important
to continue the trend in some communities where first
responders, especially for example, our homeless. It does not
always mean the 911 call goes to the local police department.
This way if it is going to be someone in a uniform, law
enforcement uniform, they have someone who is prepared as a
mental health professional, as a substance use health
professional, or as a social service health professional, so
that the response is addressing the actual need of the person
that's on the streets for the reason the 911 call was made.
I think that would help our law enforcement officers
tremendously. There are some law enforcement agencies that
actually, now, some of these professionals ride along with
their officers to be able to do the response the best way
possible. The more we keep our officers focused on what they
were trained to do, protect and serve, the less we are going to
have situations where not only is the individual who is the
subject of the 911 call, but the officer becomes victims of
what could end up being a bad circumstance.
Ms. Wild. Thank you for that very thoughtful answer. In the
116th Congress, I co-introduced just such a bill with
Representative Beasley of Illinois, and you know sometimes my
colleagues on the other side of the aisle have derided this
notion of people with mental health training accompanying
police officers.
What I have heard from police officers in my district is
that it would be welcomed. They are not looking--we are not
looking to supplant the role of law enforcement officers. We
are simply working to assist them with that type of
legislation. Thank you very much, Secretary Becerra, and I look
forward to working with you, and I yield back, Mr. Chairman.
Secretary Becerra. Thank you for your work.
Chairman Scott. Thank you. The gentleman from Idaho, Mr.
Fulcher.
Mr. Fulcher. Thank you, Mr. Chairman, and Mr. Secretary for
being here. You know one of the gaps that we have in our
healthcare coverage is people who may be changing jobs, or are
in temporary employment, or starting new jobs, waiting for
health insurance, also for people who may not qualify for an
ACA subsidy.
Now, in my home State of Idaho, we have been a leader in
offering the Affordable Care Act compliant short-term health
plans, also known as enhanced short-term plans, or ESTP's.
These plans provide the same individual benefits as the ACA
plan, at a more competitive price.
They provide the same or similar pre-existing condition
coverage as an ACA plan, other medical issues during the period
of a requirement of a qualifying life event to occur. They have
a renewal guarantee of up to 36 months, and they are very, very
popular in ensuring significant savings.
With that, my question to you is will you commit to
ensuring that these plans can continue moving forward to help
get people the access to affordable insurance they need?
Secretary Becerra. Congressman, thank you for the question,
but I am not sure I can agree with everything you said because
a short-term plan should be short-term. Under the ACA each plan
insurers are now supposed to provide certain benefits to all
people who apply for their plans.
These short duration plans are meant to tide people over
until they can get into a more permanent plan. They are short-
term--they are allowed to evade some of the requirements in the
law when it comes to benefits. If these plans provided every
essential benefit that an Affordable Care Act Plan provided,
they would not have to be short-term, they could be long-term,
so there is a disconnect, I am sorry?
Mr. Fulcher. Mr. Secretary, if you happen to fall in that
category and you have temporary employment, or you are changing
jobs, you may not qualify for that subsidy, but in your
definition of temporary may be just a little bit different at
that point.
Secretary Becerra. Okay Congressman, I caught most of what
you said, but remember if you are a temporary worker, or if you
are trying to get access to a plan, it should not be a short-
term plan that is not meant to be a permanent fixture for you.
It is to tide you over. Some of these plans----
Mr. Fulcher. These are not permanent fixtures. There is an
extension period that goes up to 36 months. They are not
permanent fixtures, and that is why I am asking will you
continue--would you commit to maintaining the flexibilities
that have been allowed so far?
Secretary Becerra. We will do everything we can to make
sure there is flexibility for folks who need a short-term fix,
but to have these plans extended in ways, because again these
plans do not offer all the benefits to individuals that they
are supposed to under the law. We want to keep that as short
duration so they can get into a truly robust plan that provides
them all the benefits and coverage they need.
Mr. Fulcher. I do ask you to take a closer look at that. I
think you will find that those essential benefits are indeed
covered. We just need to continue to maintain that flexibility.
They are serving a purpose, and please take a closer look at
that. Can I shift gears before my time is out?
On October 4 of 21, HHS issued a final rule that reversed
the previous administration's rule preventing Title X family
planning funding to flow to organizations that provide elective
abortions. Now this directly conflicts with the underlying
Title X statute, 42 U.S.C. 300 A 6, and I am concerned Mr.
Secretary, over the administration's removal of the financial
and physical separation of the previous rule which there by
allows co-location of abortion providers in the same healthcare
setting, and that means that money can be flowed to abortions.
Please explain your reasoning on that, and for allowing the
barrier to be broken, given that allowance can use taxpayer
funding for abortions.
Secretary Becerra. Thank you, Congressman, for the chance
to respond. I think the answer is actually very clear. Title X
provides family planning funding. If you provide family
planning services, you are entitled to apply for family
planning funding. If restricting an organization that provides
family planning services simply because they provide a
particular service that you or someone else may not like, and I
say you generically, Congressman, it does not give us a reason
to exclude them from access to the funding for the family
planning services which they offer.
We are simply making sure that if you offer family planning
services you could qualify to receive some of the funding to
offer those family planning services.
Mr. Fulcher. I am out of time, and so I will close this.
Please understand that is a contact with the current statute,
and I encourage you to look at that. Thank you, Mr. Secretary.
I yield back.
Secretary Becerra. Thank you.
Chairman Scott. Thank you. The gentleman from California,
Mr. DeSaulnier.
Mr. DeSaulnier. Thank you, Mr. Chairman. Thank you, ranking
member, it is always a pleasure to see you both. Of course, Mr.
Secretary, a great Californian, nice to see you.
Secretary Becerra. Great to see you, Congressman.
Mr. DeSaulnier. Always a pleasure. I want to ask you a
question on two issues that I spent a lot of time on, on
another committee, on the Oversight Committee, both with former
Chair Cummings, and now the current Chair on the cost of
prescription drugs first, and then on opioids.
On prescription drugs, as a survivor of Leukemia, the drug
that keeps me alive for the last 7 years since I was diagnosed
with stage four, much of the research has come from taxpayer-
funded research, starting in World War I in the Department of
Defense.
Then through NIH and the American Cancer Institute. One of
the things would be nice to know is we have hearings with the
private sector is when our men have them invest in research,
but it would be nice for Members of Congress and the public to
be able to distinguish the taxpayer base funding that went into
for instance my medication.
It costs somewhere from $300.00 to $500.00 since I started
taking it for an American, but for an Australian it costs
$37.00, so clearly in a global marketplace we have had the CEO
of pharmaceutical companies come to Oversight. It would be
really helpful I think for Congress and the American public to
be able to understand not perfectly, but at least a little bit
in terms of an assessment of where the base investments for
these drugs came from, and how you can reduce private sector
investment, so that the public and private sector investment is
understood fully, and is maximized so more people like myself
can get life extending drugs with both private and public
investment.
My research shows that most of the basic research that got
the private investment started at NIH. Could you respond, and
try and help us distinguish?
Secretary Becerra. First, I have to respond by saying it is
a real pleasure to see you looking so robust, and active.
Mr. DeSaulnier. You are a long way away.
Secretary Becerra. I take joy, I take joy.
Mr. DeSaulnier. Thank you.
Secretary Becerra. In seeing you because I know how much of
a fighter you are, not just on this issue of fair and
reasonably priced drugs, but just a fighter in general. You
should be on a billboard. We should take you around. You are
the best marketing tool we have for the cancer moonshot. I will
say to you, you also make a tremendously important point.
That is why is it that Americans have to pay manifold times
more for the same drug that someone else in another part of the
world is paying so much less. In fact, those drugs as you
mentioned are actually invented, manufactured sometimes here in
the U.S.
That is why the President is so intent on trying to get
drug prices down by making sure we have the tools to do it.
That would include negotiating the prices, having more
transparency. What you're touching on is the issue of
transparency. Why can we not know better what it really costs,
and who actually funded that particular medicine?
I want you to be around vigorous for a long time, because I
may need you to accompany me as we go around the country trying
to make the case for better drug prices for Americans by giving
us a chance to have the tools that the President wants to
negotiate better prices, and have real transparency in drug
pricing.
Mr. DeSaulnier. Well, I would like to pursue it, Mr.
Secretary, because I think it is really important for us to
understand how we get these livesaving drugs so that we can
incentivize and continue to get them.
On opioids, we have had the Sackler family come and testify
to the Oversight Committee on there is still a lot of problems.
Our Department of Justice has to field them and hold them
accountable in my view. The states are doing a remarkable job.
In your previous job, we have talked about this. How do we get,
what are we doing to get this right?
We still want Americans to get the proper medication, but
we want to have that assessed properly. Your department is
doing work around this. How is that going? How can we help you?
Secretary Becerra. First, I have to applaud my former
colleagues in the State Attorneys General who really pushed
forward this case to hold accountable some of the
manufacturers, the distributors of opioids, and that was a
truly bipartisan effort on the part of the State agencies, and
I think they deserve a great deal of credit for getting tens of
billions of dollars back into communities to help address the
ills of opioids.
We can continue working with our State leaders, the AG's or
Governors. We are going to put major resources into our new
drug strategy, drug abuse strategy so that we get away from
stigmatizing individuals, and we try to get them to work on.
What we are going to try to do is make sure that we can get
across some elements of the Build Back Better proposal, the
President will be happy because if you all can get that
through, we will have the kind of resources we have not had in
a long time to try to help Americans stay alive.
Mr. DeSaulnier. Thank you, Mr. Secretary. My time is up. If
I am on a billboard I want to be on there with the Ranking
Member and the Chair.
Secretary Becerra. Amen.
Chairman Scott. Thank you. The gentleman from Pennsylvania,
Mr. Keller.
Mr. Keller. Thank you, Mr. Chairman, and I would like to
thank the Secretary also for being here today. I wanted to talk
a little bit about community pharmacies, healthcare providers,
you know. We talked about that to the patients using Medicare
Plan D, or Part D plan, price transparency is an essential
issue for Americans, particularly people that I represent in
central and northeastern Pennsylvania.
As has been the case for too long, pharmacy benefit
managers, or PBM's, play a significant role in the drug pricing
debate with certain anti-competitive tactics that increase the
patient costs at pharmacy counter, and claw back hundreds of
thousands in DIR fees from pharmacies months after drugs have
been dispensed, making it difficult to operate the small
businesses, and making it more difficult for providers to
deliver healthcare.
CMS has determined there was, and I found this hard to
believe, a 91,500 percent increase in DIR fees between 2010 and
2019. I think we could all agree that is pretty much
unacceptable growth in these fees, and it creates access issues
for many seniors in Part D, and increases the possibility of
pharmacy deserts across Pennsylvania and the United States.
CMS also anticipates that the average growth of pharmacy
DIR fees will increase roughly an additional 10 percent per
year. By taking action, we can help save America's seniors up
to 9 billion out-of-pocket costs. Mr. Secretary, since you were
before the committee last summer, CMS has issued its calendar
2023 Medicare Advantage and Part D Proposal Rule, which
includes among other things, inclusion of pharmacy price
concessions in the definition of negotiated price, and
clarification on definition of price concessions.
These stand to increase transparency for seniors, and
community pharmacy providers, more work can be done to close
loopholes and reduce unintended consequences. You know we have
heard from many self-insured employers frustrated with the lack
of transparency in the pharmaceutical supply chain,
specifically only three PBMs control three-quarters of the
market, limiting competition and innovation in the sector.
Notably these three PBMs also own or were owned by health
insurance companies. Additionally, the PBM business model would
create incentives for PBMs to prefer higher list price, higher
rebate drugs, which would increase drug spending for employers
and their employees, like all that background I think we agree
pretty much in all of that.
What would be our plans to address what PBMs have been
doing in having less transparency? How do we make them, what
would our plan be to make them more transparent for employers
and consumers?
Secretary Becerra. Congressman, thank you for describing
the situation because I don't think most Americans understand
how their drugs are priced and why. You have explained one
aspect of it, which is critical, and that's why CMS as you
mentioned, has put forward a rule that would change the way
these PBMs price their products so that we are actually going
toward the lowest price that has been negotiated vs. letting
them inflate the price.
We are right now in the process of reviewing all the
comments that have been received during the comment period for
that rule. We hope to be able to move something soon, but as
you can see from our rule, we are trying to make sure that we
drive the price at the point of sale that the individual, the
patient, feels down to what it really should be based on what
was negotiated. We look forward to working with you because we
have no doubt that folks are going to try to squirm through and
find another you know escape route to do something more than
provide the best price possible.
Mr. Keller. Yes, and I think transparency leads to better
quality.
Secretary Becerra. Absolutely.
Mr. Keller. It leads to a more affordable price. That
competition, I mean to me I embrace that because I think it is
beneficial to everybody concerned if we have, and I think we
agree on this.
Secretary Becerra. I concur.
Mr. Keller. The more transparency, I mean I do not have a
problem. We are in America. I do not have a problem with people
making money. The problem is it should be transparent, and that
transparency derives higher quality and better customer
service, and better pricing.
Secretary Becerra. Sunshine is the best disinfectant.
Mr. Keller. Yes. Thank you and I yield back.
Secretary Becerra. Thank you.
Chairman Scott. Thank you. The gentlelady from Connecticut,
Ms. Hayes.
Ms. Hayes. Good morning, Secretary Becerra.
Secretary Becerra. Good morning.
Ms. Hayes. Thank you for being here. Before I get to my
questions, there is something I just wanted to elevate for you.
It is not often that I have the undivided attention of the
Secretary, so I want to share something that I read. The Trevor
Project released the results of their national survey.
It said 52 percent of all transgender and non-binary young
people seriously contemplated killing themselves in 2020. More
than half thought it would be better to be dead, then trying to
live with the rejection, isolation, loneliness, bullying and
being targeted by politicians and activists pushing anti-trans
legislation.
You said many times today in this hearing that your job is
to follow the law, and enforce it. I appreciate your statement
reaffirming your commitment to support for LGBTQI+ children and
youth and their protection. What I ask you is in your authority
as Secretary, please protect these children. They are
somebody's children. They are our children.
That is not my question, but I just wanted to make sure I
said that to you because as a high school teacher I have had
many kids come to my class before school, after school, to have
conversations that they could not have with anyone else who
were scared and lonely, and felt abandoned by the adults around
them.
I just fear the direction that we are going, and just know
that it is more important now than ever to do our job to
protect these children.
In my State of Connecticut, nearly 1,300 people died last
year from overdose. That number is about 106,000 around the
country. The opioid crisis remains a major problem in my
district, particularly when it comes to access to care. On the
same note, I saw so many families struggle with identifying
that there was an issue with substance abuse, but desperate to
find care, or high-quality care, or something that they could
afford.
Many of these young people went on a 3-day hold in the
emergency room and went right back home with no additional help
or support. The Fiscal Year 2023 budget provides significant
investments in mental health, behavioral health, and substance
abuse service.
Can you share how these investments will translate into
access to care for my constituents? Particularly young people?
Secretary Becerra. Congresswoman, first thank you for your
comments earlier. I am--Amen is all I can say to what you just
said earlier, in terms of protecting every American. In terms
of what we are doing, we changed our strategy on drug use. We
are--two of our elements that we included that we all want to
do prevention, keep people off drugs.
We all want to do treatment to get them moving forward. We
have included two new elements to this as priorities. Harm
reduction. It is not just a matter of treating, it is keeping
you from harming yourself long-term, and the second--the
additional item, we put into this new strategy is followup
care. As I said earlier, we do not want to just be like FedEx.
We do not want to drop off the drugs to help you get better at
the door, and then you know get out of town.
We want to be there to follow you through to make sure you
in that life course we get you in the direction you want. We
are going to use those resources to go there, and we are going
to really focus on kids. We are going to make an emphasis on
foster youth, because we know the troubles that they often
face. We are there, and we look forward to working with you.
Ms. Hayes. I am very happy to hear you say that because as
we all know where we are learning addiction is a disease, and
for years after the rehabilitative services, people are still
struggling, so the harm reduction, the wraparound services, the
long-term care is incredibly important.
The budget provides an additional $30 million to support
the development of opioid overdose reversal treatments and
improve prevention services. What else can we do to provide
community health providers with sufficient resources to prevent
deadly overdoses and expand access to high-quality substance
abuse disorder treatments?
Secretary Becerra. I know you know this one, provide
support to the workforce. We do not pay them enough. They do
Gillman's work. Many of them are former addicts. If we could
let them know that we appreciate and elevate what they do, give
them esteem, we could get more people working in this area. If
we could help the workforce, and they are committed because
many of them are former drug users.
Let them know that we appreciate what they are doing to
save a life, I guarantee you, you would find a lot of people
who would turn their life around.
Ms. Hayes. You are absolutely right. I know that, I just
wanted to hear you say it on the record. We actually just
helped a constitute in my district with a very similar issue to
connect with our workforce development programs and get
training to go out into the community as a former abuser to now
help out on the other side. Mr. Chairman, I yield back. Thank
you for being here today.
Secretary Becerra. Thank you.
Chairman Scott. Thank you. The gentlelady from New York,
Ms. Stefanik.
Ms. Stefanik. Thank you, Mr. Chairman. Mr. Secretary, I
want to raise--I am hearing from thousands of constituents who
are very concerned about the mandate requiring masks among
children and toddlers in Head Start programs. We know, based
upon recent studies, that masks on young children cause limited
vocabularies, delayed speech development, and difficulties with
social interaction and confidence.
In addition, we know that face masks disrupt holistic
processing and face protection in school age children. Even the
World Health Organization states, ``Children aged 5 years and
under do not need to wear masks. Children of this age should
not wear masks for long duration.'' We know on the ground from
constituents that this rule is still in place. The CDC revised
its guidance on February 25 indicating that masks are no longer
necessary in the vast majority of this country.
Why is your agency still imposing this harmful mask mandate
on toddlers and young children in the Head Start Program?
Secretary Becerra. Congresswoman, thank you for the
question because obviously we are still within this pandemic,
and it is a very saline question. What I would say to you is
that we know that masks are safe, and they are effective. We
know that many of our children, especially those that are under
the age of five can still not receive a vaccine, and so
therefore they are in danger of contracting COVID.
Hundreds of families across this country would tell you
about how COVID does hit those under the age of five because
they have lost their child to COVID, and so we are going to do
everything we can to make sure those children are protected.
When you have something that is safe and effective like
masks they should be used, and we obviously understand that the
science is guiding us on the actual implementation of those
policies, but I will tell you that there is no contradiction in
fact that State that masks have proven an effective way to help
control COVID.
Ms. Stefanik. The position of you, Mr. Secretary, and the
position of President Joe Biden is to require masks in children
under the age of five, which science in fact noted the masks
hurt children, both in the development, whether it is
intellectual development, speech development. That is the
position of President Joe Biden.
Secretary Becerra. Congresswoman, as you know many Head
Start Programs.
Ms. Stefanik. It is a yes or no question. Is that the
position of President Joe Biden? You are the cabinet Secretary,
so the position of this White House, this administration is to
require masks only at this point for children in the Head Start
Program. There is no requirement for masks at K through 12
across this country, so now we are in a position where the only
mask requirements, and we know that science shows that those
least impacted by the COVID pandemic are the youngest of young
children.
Secretary Becerra. Congresswoman, the policies that the
President has espoused and that we implement are to make sure
everyone is safe and effective using the most proven methods
possible, and that is what we will do. Head Start, we are
reviewing the policies as we speak, but we will make sure that
we're protecting every child in America under Head Start
Programs.
Since Head Start is funded primarily through Federal
dollars.
Ms. Stefanik. Through taxpayer dollars. Taxpayers who do
not support this mask mandate on children in Head Start, on our
youngest of young children who the mask mandate is hurting the
most. My question to you is specifically what scientific
studies are you relying upon?
Are you saying that the HHS position is different than the
CDC guidance? Who are the experts in HHS that are circumventing
and coming over the top of the CDC recommendations?
Secretary Becerra. Congresswoman, I can only show you the
evidence that we have, the studies that have been done, the
accumulating evidence that we have seen that show that a child
wearing a mask is safe.
Ms. Stefanik. From whom? From whom? Who were the studies
conducted by? Do you believe the HHS has the authority to make
a different decision than CDC, different recommendation than
CDC?
Secretary Becerra. Congresswoman, I am more than welcome to
share with you the studies that have proven that wearing a mask
if you are a child helps, it is safe, and it is effective. We
are looking at studies that have looked at children at the age
of 2 years, and we have been able to show that in fact making
sure that Americans use masks.
Ms. Stefanik. What do you say to the studies about the
speech delay? What do you say to the studies about how in fact
the transmission rates, and the negative effects of COVID are
the lowest of the low when we are talking about children under
the age of 5? What do you say to those things?
Secretary Becerra. Congresswoman, the accumulating evidence
on child mask-wearing is showing that it does not impact their
language or emotional development.
Ms. Stefanik. It is showing that it does not work. It shows
that it does not work. This is by World Health Organization.
This is by the CDC.
Secretary Becerra. We can each have our opinion.
Congresswoman, you are telling your opinion.
Ms. Stefanik. Mr. Secretary, you are wrong on this
position. If it is the position of Joe Biden to require mask
mandates only on children under the age of 5, that is woefully
out of touch with the American people. It is also woefully out
of touch of health experts across this country.
I am glad you clarified that it is this President and your
agency that is circumventing the best scientific and medical
advice to impose these harmful mask mandates. I yield back.
Chairman Scott. Thank you. The gentlelady from Georgia,
Mrs. McBath.
Mrs. McBath. Thank you so much Chairman. Thank you for
convening this hearing, and thank you Secretary Becerra for
your continued service to our country. We truly do appreciate
your service. As you know during the public health pandemic, we
have seen the rising rates of substance use and overdose, gun
violence, and domestic violence, with many families that have
been sheltering at home. Victims of domestic and family
violence have become even more vulnerable.
I have seen too many families in my home State of Georgia,
suffer at the hands of domestic and family violence. We really
have to make sure that we are doing everything that we can to
protect these families, and families all across the Nation. It
is now time more than ever to secure additional investments in
protecting these survivors and protecting their children.
The pandemic has compounded the challenges that people
surviving intimate partner violence face every single day, even
as we continue our path toward a full recovery. To protect
survivors of domestic and family violence, the House passed my
legislation The Family Violence Protection and Services
Improvement Act (we will call it FVPSA) to authorize and
improve the Family Violence Prevention and Services Act
programs.
This budget actually includes over $500 million for FVPSA
funded and also FVPSA programs, building on the American Rescue
Plan Act, it was about 450 million dollars in emergency
supplemental funding to support survivors of intimate partner
violence.
Secretary Becerra, how would this additional investment
really work to strengthen the department's efforts to
distribute this critical funding, and how will this budget
support broader HHS efforts to help people who are
disproportionately impacted by intimate partner violence, and
help them to recover?
Secretary Becerra. Congresswoman, first, thank you for your
leadership in this area. I do not think anyone will challenge
the assertion that COVID causes many problems. One of them was
at home where we saw the increase in violence--domestic
violence, intimate partner violence, which was a travesty--
because here you are trying to stay safe by not going out, and
what you find is that you ended up with worse circumstances.
Thank you for the work that you have done on this issue.
The funding that you mentioned is more than double what it was
in the previous year. We hope that Congress, you and your
colleagues will find it fit to provide that additional funding.
We want to be able to increase the funding and the support for
those individuals who are the victims of that domestic
violence, but we also want to fund various essential things
like the hotline that people can call when they are in real
need, urgent need of safety and care.
We want to make sure that that hotline is available, and
that there will be someone available to answer that call when
you are in your moments of most need. We will continue to work
with you as we try to not only get the funding through, but
also the reauthorization of FVPSA in the future, but again
miles and miles of thanks for what you have done in this space.
Mrs. McBath. Well, thank you so much. As we approach Black
Maternal Health Week, and Mother's Day, which is coming up in
May, this budget invests actually $13.3 billion to support your
initiatives to reduce maternal mortality and disparities and
maternal health outcomes through what we know as evidence-based
interventions.
How will this help, how will this funding really help to
help strengthen the department's existing efforts to improve
maternal health policy and equity?
Secretary Becerra. Well again, thank you for the support
that you and others have lent to the Omnibus legislation to try
to get things across the finish line for so many of our
families in need. With the budget that we have through the
Omnibus, and if you all pass Build Back Better, even more will
be done, but what we are going to try to do is continue our
efforts to try to help deal with for example, maternal
mortality, morbidity, which is at outrageous levels in this
country because in some parts of our country, not everywhere,
but in certain communities, especially for example in the black
community, Native American community, you see high rates of
death of mothers who recently delivered.
You see the inability for some families to be able to cope
with the stress that comes with becoming a new family, and so,
we have put a proposal out there which some states are now
beginning to accept, which allows Medicaid to provide not just
60 days of maternal healthcare post-partum, but a full year of
coverage. We think that will go a long way in helping a lot of
families.
We also have specific programs that are targeted to help
women in areas who are disadvantaged, so we can make sure that
we're providing them with the help they need to prepare. My
wife, who is an OBGYN will tell you that many of these issues
can be resolved before the delivery, if we just give access to
services.
We look forward to working with you to strengthen not just
your legislation, but the efforts to help women as they get
ready to deliver.
Mrs. McBath. Well, thank you, Mr. Secretary, for your work,
and I yield back the balance of my time.
Chairman Scott. Thank you. The gentlelady from Iowa, Mrs.
Miller-Meeks.
Mrs. Miller-Meeks. Thank you, Mr. Chair, and thank you,
Secretary Becerra, for being here. I am just going to start
this by saying that I am a physician, and also former Director
of the Iowa Department of Public Health. In part because of the
Biden administration's deference to the teacher's unions, the
CDC's school reopening guidance suggested a far greater risk to
reopening schools than actually existed.
As a result, many students stayed at home far longer than
they should have. One year later the devastating impact of the
Biden administration's unwillingness to challenge its political
allies is clear. Let me State that in Iowa our schools opened
to in-person learning in August 2020.
In Nevada, as I talked about in this committee room before,
Nevada reopened its schools at the top of 2021 because between
March 16 of 2020, and June 30 of 2020, six students committed
suicide, and between July 1 of 2020, and December 31 of 2020,
an additional 12 students committed suicide, the youngest of
whom was 9 years old.
We know that the policy of keeping schools closed was not
only detrimental to learning, detrimental to child poverty, to
nutrition, to reporting of child abuse, but it was also
detrimental to the lives of these children with the lack of
interaction with other students and with their teachers.
Just last week the CDC released a survey data showing
increased rates of poor mental health, substance use, emotional
abuse, at home during the pandemic. Learning loss has also been
dramatic as I said, and the World Health Organization
anticipates that childhood poverty will have increased by 15
percent and will take decades to recover.
A National Bureau of Economic Research report late last
year found that remote learning contributed to highly
significant learning loss with much less pronounced drop in
scores among students who continued to attend school in person.
Secretary Becerra, looking back on the last year do you wish
your agency would have shown more courage in standing up for
children who desperately needed to be in school?
Secretary Becerra. Congresswoman, first some of the
statistics you mentioned are just devastating to see when
children die, and we have been talking a little bit about the
stress that families are feeling, so thank you for pointing
that out. I will tell you that whether it is through the CDC,
or whether it is through the FDA, in moving forward on COVID,
we have tried to do the best we can based on the science and
the evidence, and in protecting children we want to make sure
that we use the best science and the evidence.
The CDC has consulted with numerous stakeholders, whether
it is teachers, principals, whether it is education experts,
whether it is those who have run Departments of Health, or
education before, what we do is use the best guidance we can
from those experts, and the evidence that is before us with the
science to make the decisions.
I think as a result today virtually every child is back in
school.
Mrs. Miller-Meeks. You do not have any regrets that your
agency and you did not show more courage in standing up for
children. You mentioned the number of deaths that had occurred
in children. Do you know how many children have died of COVID-
19?
Secretary Becerra. I know it is in the hundreds. I do not
have the precise number because obviously it changes as the
days go by.
Mrs. Miller-Meeks. Are you aware that the CDC revised
downward the number of deaths that have occurred in children
from COVID-19?
Secretary Becerra. The CDC is constantly trying to make
sure we use the most accurate information available, and it
should surprise no one that we are trying to make sure that
people, the public has the best information possible.
Mrs. Miller-Meeks. The American Academy of Pediatrics just
published in March that 0.00 percent to 0.027 percent of all
COVID-19 deaths in children. That is the percentage rate, and
for that we are willing to create masks in children in the Head
Start program, or other programs that we know lead to learning
loss, lead to loss of communication, lead to detriment in their
learning in order for what scientific guidance?
Secretary Becerra. Congresswoman, I have three daughters. I
want to make sure I get to see my three daughters, and they get
to see their father pass away, instead of me seeing one of my
daughter's pass. We will do everything possible to make sure no
parents have to see their child die.
Mrs. Miller-Meeks. 0.00 percent to 0.02 percent of all
COVID in children has resulted in death, but yet the learning
loss is significant. It is permanent. I have children. I care
for my children. I am vaccinated. I have given vaccines. The
risk for children to transmit COVID-19 because of their immune
system is extraordinarily low. Who exactly are we protecting?
When we had programs that would mandate that teachers went
to the top of the line as it should be so that they would
reopen schools, but to continue a policy in children that's
detrimental to their speech, to their learning, to their
ability to progress in this country in the most critical years
of their lifetime is a policy that should not be imposed upon
our children. Thank you, Mr. Chair. I yield back my time.
Chairman Scott. Thank you. The gentlelady from North
Carolina, Mrs. Manning.
Mrs. Manning. Thank you, Mr. Chairman, and thank you,
Secretary Becerra, for being with us today. Like millions of
American families my family has felt the impact of high
prescription drug prices, and even with health insurance,
patients with chronic illnesses, like my daughter must navigate
burdensome policies, like step therapy and medical bills that
saddle them with outrageous out of pocket costs for treatments
they need to be healthy.
I am pleased to see President Biden's commitment to
lowering drug prices, and capping costs for Americans. Can you
expand on the steps HHS will take in the coming Fiscal Year to
ensure that price does not remain a barrier to patient's timely
access to essential medication?
Secretary Becerra. Congresswoman Manning, first thank you
for not just your interest, but your work, your leadership on
this issue. I will tell you that the President is committed to
making sure we reduce the cost of prescription medication.
There is nothing that can save Americans more immediately
money, and also, save lives and giving them access to
affordable drugs. We are going to continue to do everything we
can in this space.
We obviously look forward to working with you and your
colleagues to give us the real authority to do the things that
will really lower the costs of prescription medication, but if
Congress does not quite get there, we will use whatever
authorities we currently have to try to make sure that we seek
more price transparency from the drug industry, and we will do
everything we can to make the industry more competitive, so we
drop the prices as much as we can.
It surely will go a long way if Congress would help us have
the ability to negotiate drug prices for example, and to be
able to seek more transparency in the way drugs are priced and
marketed.
Mrs. Manning. Thank you. We will continue to work on this
issue because it is critically important to so many Americans.
Let me move on to a different issue. The health and financial
challenges of COVID-19, and the American Rescue Plan. We know
for the record 14.5 million Americans now have marketplace
coverage.
However, states like mine, North Carolina, and 11 other
states have still refused to expand Medicaid to ensure that
hard-working Americans have access to insurance coverage. In
this coverage gap that exacerbates racial and ethnic
disparities and health outcomes. What steps does the Biden
administration plan to help close that coverage gap, and reduce
these inequities?
Secretary Becerra. Congresswoman, thank you. As you are
aware because of your State, there are some 4 million Americans
who today could have healthcare insurance coverage through
Medicaid but do not because of the political decisions being
made at the State capitals of some 12 states.
It is unfortunate because those 4 million people suffer as
a consequence of that politics. We are going to do everything
we can to try to reach those people, but it is difficult
because we are limited in our authorities. That is why I hope
Congress is able to pass legislation through Build Back Better,
or whatever means you find that help close that Medicaid
coverage gap.
We know that there are proposals right now sitting before
you. We hope they are able to get there because there is no
reason why when the law permits it, politics should prohibit
it, and we think it is important that all those people get
covered.
Mrs. Manning. Thank you. Another area that the pandemic has
shone a light on is the problem we have with maternal
mortality, and the access that women have to the healthcare
that they need for prenatal health, contraception, and for a
wide variety of other healthcare needs.
I was pleased to see that the White House budget proposal
request a historical 400 million dollars for the Title X Family
Planning Program. Overall, how does this budget support Federal
efforts to address issues regarding access to high-quality
maternal and reproductive care?
Secretary Becerra. We are going to work as much as we can.
We are dedicating 474 million dollars to reduce maternal
mortality and morbidity. You mentioned the family planning
services funding. We are going to do everything we can to make
it clear that we want to make sure that when there is going to
be a baby coming into this world, both mama and baby are in
good health.
Mrs. Manning. Well thank you. My other colleagues have
talked about the critical issues we have seen arise with mental
health problems. I know my time is already almost expired but
let me just encourage you to do whatever you can do to help us
address this crisis of mental health problems in adults, and
also, in our students. I yield back the remainder of my time.
Secretary Becerra. Thank you.
Chairman Scott. Thank you. Next, we will have my
distinguished colleague from Virginia, Mr. Good.
Mr. Good. Thank you, Mr. Chairman. Thank you, Secretary
Becerra for being here with us again. Secretary, Mr. Secretary,
this administration's policies ensure that everything is about
the border. Everything is about the border, especially with the
termination of Title 42, not to mention of course ending MPP,
the Remain in Mexico policy, not to mention ramping up catch
and release, stopping the border wall, promoting amnesty,
refusing to implement E-Verify.
Essentially, we have opened the border, and we have
surrendered Operation Control to the crime cartels. One would
think that the HHS Secretary would be particularly concerned
about the 100,000 overdoses last year in our country, the
leading cause of death for those ages 18 to 45 a year ago, and
the administration's facilitation--purposeful facilitation,
quite frankly, to the policies of the increased bringing to our
country illegal drugs, fentanyl, other highly dangerous drugs
and so forth that are streaming across our border in record
numbers.
You would also think the HHS Secretary would be especially
concerned about the health threat posed by the cancellation, or
the termination of Title 42. I will come back to Title 42 in a
moment. Rather than invest in border security in light of all
of this, the millions of illegal crossing a year ago, estimated
to increase to maybe 5 million this year with the ending of
Title 42.
This budget cuts ICE funding by 150 million, and it
prioritizes the so-called climate crisis. Do you honestly
believe that the climate crisis is a greater threat to the
health, safety and security of Americans, than the invasion of
the southern border?
Secretary Becerra. Congressman, thank you for the question.
You tied together a lot of things, and so my response won't be
as direct as you would like. I am saddened that you----
Mr. Good. I would like to know if you think that the
climate crisis is a greater threat to the country and to the
safety, health and security of Americans than the invasion at
the southern border?
Secretary Becerra. The climate crisis is a true challenge
for us. The challenges which we face at the border I would not
describe them as you would, but there is a challenge that we
have at the border, and I think we have to make sure that we
have the laws in place.
Mr. Good. You do not think the climate crisis is a greater
threat than the invasion of the southern border?
Secretary Becerra. I am trying to answer the question.
Mr. Good. I would like a yes or no answer. Do you think the
climate crisis a greater threat to the health and safety and
security of Americans than the invasion at the southern border?
Or do you think the invasion of the southern border is a
greater threat?
Secretary Becerra. Well, if you could describe for me what
you mean by the climate crisis and the invasion at the border,
then I can give you a response.
Mr. Good. You would not say that the climate crisis is a
greater threat?
Secretary Becerra. The climate crisis a great threat. Our
border challenges are also great, and we have to tackle both,
and you need to need to have a----
Mr. Good. What is disappointing on the border crisis is
every effort and resource that is been directed there by this
administration has been to facilitate more illegals crossing
into our country, not to prevent it. As a matter of fact, that
is why they brought your department in to try to help
facilitate and accommodate those who are illegal and invading
and entering our country. Let us go back to Title----
Secretary Becerra. It is nonsense what you just said.
Mr. Good. Let us go back to Title 42. What led to Title 42
being terminated?
Secretary Becerra. The law and the science.
Mr. Good. What recommendations and advice did you provide
during the decisionmaking process leading up the reversal of
Title 42? What advice and counsel did you give on that from a
health standpoint.
Secretary Becerra. To follow the law and the science.
Mr. Good. The science being that the pandemic is over, or
should be declared over? We no longer need these additional
health precautions with Title 42?
Secretary Becerra. No, Congressman, you are uninformed.
Mr. Good. We still have the same threat from the pandemic
so to speak that we need to keep Title 42, or which is it?
Secretary Becerra. We do not and we have not----
Mr. Good. We are not going to turn people away because of
bringing COVID into the country under Title 42 anymore, but yet
the pandemic is not over, which is it?
Secretary Becerra. Do you wish me to answer?
Mr. Good. I would like you to answer succinctly.
Secretary Becerra. There is still a pandemic before us. It
is the not the same pandemic we faced before. The challenges we
face are different based on the science and the facts. We make
decisions on the pandemic.
Mr. Good. How concerned are you that with the estimates
that with the rescission of Title 42 that the 7,000 crossings a
day acknowledged by J. Johnson yesterday? I saw him interview
J. Johnson saying it is overwhelming. His words were it is
overwhelming our administration to have 7,000 a day, 1,000 a
day is too many.
We have got 7,000 a day. It is estimated this will take it
to 18,000 a day. How concerned are you about that?
Secretary Becerra. I deal with the health issues, but I
will tell you having served in this----
Mr. Good. Yes, what this is doing to our health services,
our healthcare, the threat to the Americans from a health
standpoint, from an education standpoint, from a social
services standpoint, from a security standpoint it is
unbelievable this administration would rescind Title 42, and
you would not counsel them not to rescind that.
Chairman Scott. The gentleman's time is expired. The
gentleman from New York Mr. Jones.
Mr. Jones. Thank you, Mr. Chairman. Secretary Becerra, it
is great to see you again. The President's budget request for
Fiscal Year 2023 proposes critical investment in public health,
and it advances health equity. Notably the budget includes new
innovative programs to amplify HIV prevention efforts, and
further LGBTQ plus equity and justice.
As you know LGBTQ plus people, and especially queer people
of color face health disparities linked to social stigma,
discrimination, and denial of their basic civil and human
rights, including under Federal law considering we still have
not passed the Equality Act due to Republican obstruction.
Under President Biden's proposed budget, the Department of
Health and Human Services will be using an equity-minded
approach, making sure treatments and preventative services are
available to the most vulnerable communities, including black
members of the LGBTQ plus community.
Secretary Becerra, I want to thank you for your commitment
to strengthening the National HIV/AIDS Strategy and working to
significantly reducing the number of new HIV infections in the
United States by the year 2025.
This proposed budget includes 9.8 billion dollars in
mandatory funding over 10 years to guarantee access to a drug
known as pre-exposure prophylactics, or PREP, free of cost for
all uninsured and underinsured individuals, and provides
essential wrap-around services, like HIV testing.
PREP is 99 percent effective at preventing HIV infection.
It is a life-changing, lifesaving drug. It has been 10 years
since the first FDA approval for this life-saving medication,
yet there is still so much more work to do in making PREP
accessible for everyone who needs it. Access to PREP has been
inadequate and inequitable.
While the rate of HIV infections among Black Americans is
eight times as high as among White Americans, just 9 percent of
the Black Americans for whom PREP is recommended have been
prescribed this vital preventative medication, compared to 66
percent of comparable White Americans.
This budget's historic investment in HIV prevention is
critical to improving public health, and I have got two
questions for you, Mr. Secretary. The first is this, what other
HHS efforts are part of the Biden administration's larger HIV
AIDS prevention strategy?
The second question is: Will the new proposal to make PREP
free of cost for all uninsured and underinsured persons extend
to all FDA-approved forms of PREP?
Secretary Becerra. Congressman, first great to see you
again, whether it is in New York or here, it is great to see
you and thank you for your work in this space. President Biden
made it very clear. We think if we really apply ourselves, we
can eliminate HIV/AIDS as a threat to human life, and it is
just a matter of putting our wheel to the grindstone.
Here we go, and the President has proposed as you have
mentioned, a major investment close to 10 billion dollars over
10 years to try to really get us to the spot where we are
offering services and the medicines that people need, in most
cases free of charge, and available to people, including in
spaces where we often neglect communities.
If we do this we think we could work with our partners that
are locally on the ground already, in providing some of those
services, and we could make it happen, but it is going to take
the effort that you and your colleagues can in pushing through
this budget request so we can make those kinds of investments
that people who are on the ground throughout this country are
looking for.
Mr. Jones. Thank you for that, Mr. Secretary. In February,
I sent a letter with Representative Richie Torres and 58 of our
House colleagues urging CMS, and the CDC to ensure that public
and private insurance plans cover a new FDA approved injectable
form of PREP known as Apretude at no cost to patients.
Just like the other forms of PREP, as our letter describes
the research shows that this injectable form of PREP is
significantly more effective at stopping HIV infection than the
pill form of PREP, and recently I was pleased to receive a
response from the CBC that says the CBC supports efforts to
ensure no cost sharing extends to all PREP medications approved
by the FDA, including Apretude, and looks forward to continued
collaboration with CMS to advance this effort.
Mr. Secretary, I look forward to working with you on this
effort moving forward and thank you for your time today.
Secretary Becerra. Thank you.
Chairman Scott. Thank you. The gentlelady from Michigan,
Ms. McClain.
Ms. McClain. Thank you, Mr. Chairman, and thank you, Mr.
Secretary for being here today. I want to followup, and I want
to do it in a respectful way, but I need your help connecting
the dots on the concepts for me. You had said earlier that we
want to protect our children. We all agree with that.
You made a comment that you want to make sure that your
children see you pass away first before you see your children.
I think as a parent, and for all the parents in this room, I
think that makes sense. The things that the American people are
struggling with, and I will say I am struggling with, is just
the hypocrisy of you, your department, and this administration.
I say this in the most respectful of fashions. You had said
as well when Ms. Miller-Meeks asked you roughly how many
children pass away, you said it was in the hundreds. I am in
agreement one child death is too many, right? We put all of
these restrictions on these young children, even though we know
that there are other risks.
No policy is perfect right? My question is this then, why
do you put your children in the car?
Secretary Becerra. We make sure we put the seat belts on
them as well.
Mrs. McClain. Right. We have car seats, right? Even with
that, even with the seat belts, even with the car seats.
Secretary Becerra. Right, there are things we have to do,
right?
Mrs. McClain. Exactly.
Secretary Becerra. We do all we can to protect them.
Mrs. McClain. As a parent you make that choice, right? If
you want to keep your child 100 percent safe from car
accidents, you would never put them in a car, right? If you
wanted to keep your child 100 percent safe from COVID, you
would never let them go to school, but we do not.
We as parents, and parents being the operative word, not
the government. If I am following your same logic, 608 children
died under the age of 12 in 2019 from auto accidents, roughly
hundreds, yet we as parents have that. We as parents have that
decision. You were taking away from the parents the decision of
how to raise our children, so the concept to me does not make
sense.
If we are going to follow the parental science, my
goodness, we leave it up to the parents to put the children in
a car, even with the seat belts, even with the car seats, just
seems a little, a lot of hypocrisy to me, and I wonder really
who we are trying to serve here. I mean that in a respectful
fashion.
Secretary Becerra. I appreciate the way you have asked the
question. Let me give you I hope a respectful response. My
three daughters were born very healthy. Some parents are not so
lucky. Sometimes you have a child who is immunocompromised.
That child will associate with my child, who is very healthy.
If my child contracts COVID and may survive it, that child
who is immuno-comprises might----
Mrs. McClain. I understand where you are coming from on
that.
Secretary Becerra. We have responsibilities for more than
just our own child.
Mrs. McClain. You are right, but then if you put your
child, whether they are immunocompromised or not in a car, your
reliance on somebody else's safe driving habits. It is the same
concept sir.
Secretary Becerra. Congresswoman, you are neglecting that
virtually every child in America today is back at school
because we took precautions.
Mrs. McClain. With masks. I think you need to put the
power. You need to give the parents the science. You need to
let the parents parent, the teachers teach. Put the power back
into the parent's hands sir.
Secretary Becerra. We all have to be responsible for each
other.
Mrs. McClain. Exactly. With hundreds of deaths in COVID,
and hundreds of deaths of car accidents, I think the American
people are only asking for the same consistent concept across
all areas, and I think the frustrating part is the parents want
to parent. Have a little faith in the parents. Have a little
trust in the parents, that they are going to do what is in the
best interests of their children, not you, your agency, or this
administration.
Secretary Becerra. Or a Member of Congress.
Mrs. McClain. Exactly. I would agree. Put the power back in
the parent's hands, and we have to look at risk to reward.
Every time you put your child in a car, sir, you are exposing
them to a drunk driver, an impaired driver, or a bad driver,
but that is your choice to make.
Secretary Becerra. We take all the precautions that we can.
Mrs. McClain. Let the parents do the same thing, thank you,
sir.
Secretary Becerra. Thank you very much.
Chairman Scott. Thank you. The gentlelady from New Mexico,
Ms. Leger Fernandez.
Ms. Leger Fernandez. Thank you so much Chairman Scott for
holding this hearing, and thank you, Secretary Becerra. Good to
see you again, and thank you for sitting here to answer our
questions. Here in DC we are within 30 minutes of seven
hospitals and a lot of amazing providers, right?
In my district however in New Mexico, which you know my
beautiful district, expectant moms from my hometown Las Vegas,
New Mexico, they have to drive an hour if they want to give
birth with a doctor.
In Gallup on the Navajo Nation, 42,000 Native Americans
will receive trauma care at the Gallup Indian Medical Center,
which is the only trauma care center within 150-mile radius.
This is what healthcare looks like in rural America. This is
what healthcare looks like in rural New Mexico.
We have a lot of amazing doctors and nurses we simply do
not have enough. I really want to thank you and the
administration for putting forth a budget that has mandatory
funding for the IHS. I just came from a Natural Resources
hearing. I am the Chair of the Subcommittee of Indigenous
People.
We were honoring Dean Young, and this was a passion of his,
and I am hoping that we will get this through with bipartisan
support, recognizing this as indeed his legacy. I want to talk
about the general need for all of us in rural America. What is
HHS doing to expand access to care in rural and tribal
communities in the short and long-term, especially coming out
of COVID which laid that devastating light on the number of
deaths and devastation because there was not enough care?
Secretary Becerra. Congresswoman, thank you for the
question. By the way it really is a beautiful district that you
have. One my dearest friends, my roommate for 4 years in
college, lives in Las Vegas, and if I can just really quickly
mention when we first met freshman year, he asked me where I
was from--Sacramento, California.
I told him I am sort of from a suburb of it, and then I
asked him where is he from and he said well, I am from Mora. He
said well, I am really not from Mora, I am from a suburb of
Mora, called Ladu, and when I finally had a chance to see his
home of Ladu, it is a cluster of a few homes, and it is what
you have in New Mexico, it is a beautiful place.
To your question, this budget is a groundbreaker when it
comes to IHS funding in Indian country. We are asking you to
move toward mandatory funding for healthcare services IIHS,
something that is going to be for the first time available if
you pass this, so that health centers in Indian country do not
suffer the consequences of a breakdown in budgeting authority
here where you may have an impasse and not get moneys across.
If it is based on discretionary funding, and you do not pass a
budget, they get no money. All the other health centers do
because it's mandatory funding. We also call for advanced
appropriations, which means they can project how much they will
have, so they can project----
Ms. Leger Fernandez. Right. The IHS I am great on. I love
the fact that you are doing it. I wanted to focus a bit on the
rest of rural America with regards to getting providers there,
getting them on the ground, and if you could answer that
quickly because I wanted to also talk about the Social
Vulnerability Index.
Secretary Becerra. We have a major focus on rural
communities, obviously the Provider Relief Fund. We were able
to drive additional dollars into rural health providers. We are
going to continue to seek out more authorities for telehealth
services because so many members in the rural communities rely
on telehealth today to receive their service'.
We will work with you to make sure we are getting good
care, quality care to people in rural communities.
Ms. Leger Fernandez. Well, thank you. I want to also then
turn to something else that affects rural communities, which is
the Social Vulnerability Index which as you know measures
factors like poverty, car access, et cetera. The Federal
Government has distributed COVID-19 resources, as I understand
it, mostly by population to the State.
If the agency used instead the Social Vulnerability Index,
vulnerable communities in rural Mexico, and other parts of the
country might get those medications especially quicker and
other resources. I ask this because I know that you have an
Equity index, but maybe not a Vulnerability Index, and when
there is not enough nearby care that is a problem. I was
wondering if you could address that.
Secretary Becerra. We have funds beyond those that are
distributed by formula that let us target areas that are in
real need, and that is how we are able to go into some of these
communities above and beyond what would otherwise come based on
a formula.
Ms. Leger Fernandez. Well, thank you, Secretary, my time is
up, but I will say I would love to work with you because I am
hearing that they are not getting the resources, so let us work
together. I yield back.
Secretary Becerra. I look forward to it.
Chairman Scott. Thank you. The gentleman from Wisconsin,
Mr. Fitzgerald.
Mr. Fitzgerald. Thank you, Mr. Chair. Thank you, Mr.
Secretary, for being here. Mr. Secretary, during your time as
AG of California you sued the Trump administration over 100
times. Some of those lawsuits were attempting to stop the Trump
administration's emergency declaration that would have in my
opinion secured the border.
There was a discussion earlier with Congresswoman Jayapal
about Title 42, and in my opinion, and every border agent that
I have spoken to, the repeal of Title 42 will make it worse. Do
you agree with the President's decision to rescind Title 42?
Secretary Becerra. Congressman, the decision was that of
the Director of the CDC based on the evidence that the CDC has.
The President follows the guidance of CDC. This is based on
science, and the facts on the ground. It is a decision made by
our health experts. Title 42 is a healthcare law.
Mr. Fitzgerald. Right. Like Congresswoman Jayapal alluded
to earlier, it was related to the COVID epidemic obviously.
Secretary Becerra. Correct.
Mr. Fitzgerald. If somehow that could be changed or
adjusted because obviously there is such an influx right now
that there has got to be concerns about what is coming across
the border.
Secretary Becerra. Congressman, again it is a thoughtful
question because there are challenges at the border. The
difficulty is when you try to use a healthcare law to deal with
immigration challenges, either through the Courts, or at some
point because of the science it becomes clear that you cannot
use a healthcare law, which is principally for the use of
quarantine to deal with a border issue challenge. That is why
the President his first day in office submitted an immigration
reform proposal to Congress to address a broken immigration
system.
Mr. Fitzgerald. Homeland Security is saying now as of
yesterday they are expecting an additional 18,000 more migrants
a day down that are coming across right now. I mean, my issue I
think would be how can we--first of all, let me just ask as a
former Member of Congress, as a Secretary, and as a former AG
of California, who is responsible for this, and how do we stop
what is happening at the border right now?
I mean we have to get control of this situation.
Secretary Becerra. I appreciate the chance to answer. I am
going a little out of my lane because I am the Secretary of HHS
but having worked here for 24 years on immigration reform, we
have a system that is broken when it comes to asylum. When you
can request asylum, and you wait four or 5 years before your
case is adjudicated, the difficulty is that a lot of folks in
these other countries are getting the message you can come
through.
You cannot come through and stay because you have to
qualify for asylum. The difficulty is it takes so long to
process an individual, that the message going back to some of
these sender countries is I can come through. That is not the
case.
Mr. Fitzgerald. With your experience then tell me how do
you think we fix this issue then? How do we secure the border?
Secretary Becerra. If you read the President's proposal for
immigration reform it would tackle this, and it is not that
difficult. What we have to do is protect due process, but we
have to get these cases through because there will be
individuals who will qualify for asylum, but there will be a
lot of individuals who will not, and they have to then through
the process, be returned.
Mr. Fitzgerald. Okay. Let me shift gears a little bit. The
average gas price in California is $5.82, probably the highest
in the Nation maybe.
Secretary Becerra. Hawaii, I think maybe is.
Mr. Fitzgerald. Do you feel responsible for any of this, or
do you see a linkage because when you were AG, you sued the
Trump administration to stop them from opening over a million
acres of land to oil and natural gas. I mean do you see the
linkage between the decisions that were made related to energy,
and what we're seeing right now?
I believe the administration is pushing it all on you know
what is going on in Ukraine, but I mean right out of the gate
when President Biden was sworn in as President, the first thing
he did was make some very high-profile decisions related to the
energy situation, and I believe that there is linkage there. Do
you believe that there is to the gas prices and the energy
prices we are seeing right now?
Secretary Becerra. Let me put it this way. First, I do not
think anyone challenges or contests the fact that the Putin
war, illegal war, has led to higher energy costs for everyone,
but aside from that, what I did as AG was try to get our State
to move as aggressively as it could to move away from foreign
oil for these very reasons. When you are dependent on foreign
oil this is what happens.
If we were not dependent on foreign oil, if we had our own
clean sources of energy we would not have to worry about what
the price of oil would be as a result of Putin's war, and so I
think the faster we move in the direction that California wants
to move, which is to move us away from these fossil fuels, the
less we are going to be you know sort of dependent on what
dictators like Putin do throughout the world.
Mr. Fitzgerald. Well, that is an ideology and we can talk
about you know those bigger issues I guess, but right now I
mean we find ourselves in a situation where the average
American cannot afford to fill up their tank at the pump, and
that is why either we have got to back away from that or figure
out a new strategy.
Chairman Scott. The gentleman's time has expired. The
gentleman from Michigan, Mr. Levin.
Mr. Levin. Thanks so much, Chairman Scott for convening
this hearing, and Secretary Becerra thanks so much for coming
to talk to us, at least part of the time, about the priorities
of the Department of Health and Human Services. Secretary
Becerra, I want to talk about the essential ACA reforms in the
American Rescue Plan. I was super proud to vote for the ARP and
it provided a 2-year enhancement of advanced premium tax
credits under the ACA.
This allows low-income folks to access low premium plans,
and because of this key provision more people are enrolling in
the exchanges. The recent enrollment period saw 14 1/2 million
people sign up either at the Federal level, or through state-
based marketplaces.
Now as you know, I believe there is a fundamental human
right you have to have universal healthcare in this country,
but I want to really get down to how do the enhanced tax
credits that Congress provided in the American Rescue Plan
contribute to the ACA's historical coverage gains last year?
What did we learn from the steps taken in the Rescue Plan,
and how do we build on the successes of the ACA provision
within the Rescue Plan?
Secretary Becerra. Congressman I know sometimes people do
not believe me when I tell them this, but there were people who
were looking at their potential choices on the marketplace for
a health insurance plan who are finding if they were eligible,
four out of five of them were finding a health insurance policy
where they were paying $10.00 or less a month for a policy for
health insurance coverage.
As I tell folks, go to a movie cinema, and see if you can
go see a movie, one movie for one night, for less than $10.00 a
month. Now you are talking about providing someone with
healthcare coverage, quality healthcare coverage, robust
coverage for less than $10.00 for an entire month. You cannot
do that.
Those premium supports made it possible for us to decrease
the cost of the premium by some 23 percent. You cannot beat it.
Thank you very much for what you did for the American Rescue
Plan to make it affordable for Americans, and as you pointed
out the result 14 1/2 million people, a record number applied
for health insurance coverage through the Affordable Care Act.
Mr. Levin. Another area that was really important was for
HHS was trying to make progress addressing the public health
challenges caused by COVID-19, and over the past year the
Department's invested 250 million dollars in U.S. based
manufacturing of PPE and 950 million in manufacturing the
supplies and equipment needed for vaccines, therapeutics and
diagnostic tests.
I think HHS has supported 90,000 vaccinationsites
nationwide, distributed over 500 million free at-home COVID-19
tests, shipped hundreds of millions of N95 masks to pharmacies
and community health clinics, and you know the COVID-19 relief
funding that we provided has been crucial to these efforts. Now
you face the challenge, and so to continue your efforts to
confront the future public health challenges we will face with
COVID-19 and beyond, how important is it for us to secure
additional COVID-19 relief funding to restore and preserve
live-saving prevention services?
I want to throw in there how are we going to you know
vaccinate the world unless we put money in there for you know
for the global aspect of this?
Secretary Becerra. Congressman, probably the analogy that
comes to mind most is 2 minutes to go, we are down less than a
touchdown, we are driving, we are going all the way to the goal
line. We still have our timeouts left. Then all of a sudden, we
are on the one-yard line ready to score for America on COVID,
beating back COVID, and we let the clock run while we could
easily use our three timeouts.
Right now, we have told Congress very clearly and the
American public that the money that was made available for us
to fund this fight against COVID has been depleted. We are not
going to be able to do the same purchase for therapeutic
medicines, we are not going to be able to do the same thing
when it comes to the tests, making them available, including
going to the test to treat model where you test, and if you
find out that you are COVID positive you could get treated
right away right there and then.
You cannot do all those things. It is wasting three
timeouts to go into the--plunge into, cross the goal line and
score the touchdown for the American people. We cannot do that.
I hope you and Members of Congress will find fit to provide us
with the resources we need to finish the job on COVID.
Mr. Levin. All right thanks, Mr. Chairman. I think my time
is expired, so I will yield back.
Chairman Scott. Thank you. The gentleman from North
Carolina, Mr. Cawthorn.
Mr. Cawthorn. Thank you, Mr. Chairman. Mr. Secretary, thank
you very much for taking time to come speak to our committee.
Mr. Secretary, do you have input and influence on health policy
within Department of Education?
Secretary Becerra. I am sorry say that again, please?
Mr. Cawthorn. Yes, sir, I was asking do you have input on
the health policy within the Department of Education?
Secretary Becerra. To the degree that we consult with the
Department of Education on some other proposals, we would have
that input, but if it is not within our jurisdiction, then we
do it on a consultative basis.
Mr. Cawthorn. Understood. As the Secretary of HHS, I am
curious to understand how this administration answers some of
the following questions I have, as I believe they will directly
impact the craft of education policy across the Nation.
Secretary, is it correct to say that the Secretary of Health
and Human Services, your role, is to protect the life and well-
being of human citizens within the United States?
Secretary Becerra. I am certainly responsible to make sure
the health and well-being of the American public is taken care
of.
Mr. Cawthorn. Understood, sir. Can I ask you just how do
you define a human life?
Secretary Becerra. How do I what?
Mr. Cawthorn. Define a human life?
Secretary Becerra. If you are out there making things
happen, you are surviving the tough challenges before us, if
you are making it through and you have a loving family that is
helping you out, all those things make it possible for
Americans to move forward in a way that let us them prosper and
become leaders for our country.
Mr. Cawthorn. Right yes sir, but in regards----
Secretary Becerra. Congressman, if I could ask you to speak
up because it is hard to make out what you are saying.
Mr. Cawthorn. Yes, sir I am curious. As you are the
Secretary of Health and Human Services, you know we really care
about when you start protecting the life of American citizens.
Following conception in the womb, how long after that would HHS
wait before they take any action to protect that life?
Secretary Becerra. Well, I would tell you that I am not a
physician. My wife is an OBGYN, and she could probably speak
more directly to some of those more medical technical issues.
What I will tell you is that based on policy and how I can act
as a Secretary of Health and Human Services, I am guided by the
law, and what it tells us we could do when it comes to
providing services to anyone at whatever stage you wish to
consider.
Mr. Cawthorn. Yes sir. Well, I believe the lack of clarity
in the answer like for when life begins in America, I believe
it has consequences. When you testified in front of the Energy
and Commerce meeting you previously stated there is no medical
term such as partial birth abortion. There is not a definition
of partial birth, but there is a definition of infanticide. Are
you aware of the Live Action News article where they say that 5
humans in America were found dead and aborted here in
Washington, DC?
Secretary Becerra. Congressman, what I can tell you is that
term is a politician created term, it is not a term that
physicians use, and not a term that my wife, an OBGYN uses to
address the issues of pregnancy. I understand where some of the
folks use that term are trying to go, but it is not a term that
the professionals in medicine use.
Mr. Cawthorn. Yes sir. I understand that. I mean Mr.
Secretary, it was not one, it was not two, it was five human,
five little babies that were left dead in DC a few weeks ago.
Quoting the article, ``A neonatal specialist called these
babies premature people. Humans within American.'' Secretary,
your ambivalence about the definition of human life is
instructive, and I believe in America is dangerous.
Secretary Becerra. Congressman, I am not ambivalent.
Mr. Cawthorn. Yes, sir, well this lack of clarity is
immoral and a monument to the erasure of proof in our time. Mr.
Secretary, you have pressed for Federal funding to combat pro-
life legislation, and promote abortion and grant their
euphemisms, but things like family planning against the will of
the people, and their elected representatives. Now, we have
five fetuses beyond the threshold of viability on the doorstep
of Washington, DC, and you cannot tell us what a human life is?
Those five children found in DC were just that. They were
children. They were babies, humans, not medical waste. The
callousness which this administration views life and the
sanctity of it is astonishing. A nation that cannot protect the
most precious, innocent, and vulnerable among us has a moral
compass that not only stained sir, but it is dead. With that
Mr. Chairman, I yield back.
Chairman Scott. Thank you. The gentlelady from Minnesota,
Ms. Omar.
Ms. Omar. Thank you, Chairman. Mr. Secretary, thank you so
much for joining us today for your testimony, and for coming
out to my district this past February. I would like to ask you
about drug prices, which is a topic of great concern for many
of my constituents and much of the country.
A recent RP study found that 75 of the 100 brand name drugs
that Medicare spends the most money on increased this year, and
surprising no top name drugs issued a price decrease. If
nothing changes, Medicare Part B beneficiaries who take an
average of four to five prescriptions a month, and have a
median annual income of under $30,000.00 will increase.
For many people that increase would have a ruinous effect.
As you know Medicare currently has no authority to negotiate
rebates for Part B drugs and an average payments higher net
prices for top selling brand name drugs than other programs
such as Medicaid, that has the ability to negotiate prices.
Mr. Secretary, if Medicare could negotiate drug pricing how
would that impact that budget?
Secretary Becerra. Congresswoman, can you repeat the
question itself?
Ms. Omar. Yes. If Medicare could negotiate drug pricing,
how would that impact the budget?
Secretary Becerra. Well, overall if we are able to
negotiate for lower prices, and Medicare therefore is
reimbursing manufactures of these drugs at a lower cost, then
it is not only a savings for the American taxpayer, but it is a
boom for the Medicare recipients who right now are having to
pay part of that cost out of pocket. It is a win/win for
everyone if we are able to negotiate to get the best price for
the product that we know is going to be essential for these
patients.
Ms. Omar. Would there be a budgetary savings for the
country as well?
Secretary Becerra. Undoubtedly. Undoubtedly the cost of
healthcare in America is higher than it is for any other
industrialized nation in the world. One of those reasons is
because we pay way too much for drugs, drugs that in other
parts of the world are sold for less than what we have to pay,
even if that drug may have been manufactured here in the U.S.
Ms. Omar. Right. Thank you so much for pointing that out.
Not only would our country save money, but the people of this
country will also have savings if Medicare was able to
negotiate Part B drugs. Mr. Secretary, according to recent
reports an estimate 122 million Americans, or 37 percent of the
population live in areas with a mental health professional
shortage.
To fill this gap the country needs approximately 6,400
additional mental health providers. A lack of cultural
competency further exacerbates the already disparities we are
seeing in mental health services. How does this new investment
in mental health transformation fund expand access to available
mental health providers for communities?
Secretary Becerra. Congresswoman, as you know the President
has made a request for close to 5 billion dollars in
discretionary funding, and close to 52 billion dollars over 10
years in mandatory funding to transform our mental health
system. It is a budget that has never been proposed by a
President before, to really tackle mental health.
I hope you and your colleagues are successful in helping
get this across the finish line because it will let us do so
many things, provide more services, help boost the salaries of
those precious mental health workers who are on the frontlines.
It will let us make sure we are moving toward those practices,
and those therapies that we know are most effective.
It will allow us to actually begin to treat mental health
with the same parody that we create general health.
Ms. Omar. I hope we are successful in passing it as well.
How would it address the specific culture and social needs of
populations that are dealing with disparities right now?
Secretary Becerra. The President's proposals, and something
we would implement at HHS include proposals where we would try
to go where the need is greatest, and where we have often been
absent, and so we are going to do everything we can as
Congresswoman, I have said before, we have done it with the
Affordable Care Act enrollment.
We did it with vaccines. We are going to go to places where
we have never seen our government try to push before because we
think everyone should be included.
Ms. Omar. Thank you so much. Chairman, I yield back.
Chairman Scott. Thank you. The gentlelady from California,
Mrs. Steel.
Mrs. Steel. Thank you, Mr. Chairman. Thank you Ranking
Member, and Secretary Becerra, it is really nice to see you. My
constituents, and many across America, have seen the importance
of access to telemedicine during the pandemic, innovation and
flexibility in healthcare policies are a win for Americans.
Americans have more access to telehealth services during
the pandemic, and this expanded service was very popular. We
then sadly witnessed a loss of telehealth services for those
who have high deductible health plans, coupled with health
savings accounts on December 31, 2021. Fortunately, relief was
reinstated on April 1, 2022, through the end of the year. While
this is a small victory, the coverage provided by the Omnibus
legislation is temporary. It will not cover the first quarter
of 2022, leaving employers with uncertainty about how to handle
plans for that period.
Again, it is important to note that 30 million Americans
lost access to healthcare for 4 months, especially for virtual
primary care, and behavioral health services. From those who
cannot afford to pay $7.00 at the gas pump, and drive to their
doctors, or are a single parent cannot afford to leave their
child at home, virtual care is an important tool in the
toolshed that will lower costs and expand access to care.
This is why we need permanency in telehealth. With this in
mind, Secretary Becerra as you know 50 percent of the
individuals within HSA savings in a zip code where the median
income is below $75,000.00, do you agree that families and
individuals with high deductible health plans coupled with the
health savings account should have access to first dollar
coverage of telehealth services?
Secretary Becerra. Congresswoman, I think we have seen the
value of telehealth as a result of this pandemic. We are
appreciative of the work done in Congress to pass the Omnibus
bill which gave the 5-month extension on some of the
authorities to have flexibility with telehealth. We hope you
work hard to extend some of those authorities permanently.
In the meantime, we are going to continue to do the
research that will give us the answers to how much telehealth
we can absorb and do right, because we want to make sure we are
accountable. Once you start to remove the actual presence of
the patient and the provider, there are a lot of folks who are
going to try to gain the system, and we want to make sure that
does not happen because telehealth has become too precious a
service for so many Americans who rely on it now.
We are absolutely committed to extending--working with you,
to extend permanently coverage of services for example where
the patient's home is considered the originating site. That is
something that is not permitted right now without the
extensions of telehealth authorities that you have given us.
We want to make sure that community health clinics,
federally qualified health centers, and rural health clinics
can continue to provide services at distance sites. There are
so many things about telehealth that we have learned. There is
still much we have to do, more that we have the evidence and
the data to help us make sure that we are all accountable and
that no one is gaming the system and taking taxpayer dollars
without really providing a service, the better off those
patients will be.
We are very much looking forward to working with you on
anything having to do with telehealth.
Mrs. Steel. Thank you, Secretary, because that was my bill
with Congresswoman Susie Lee. We worked together. We tried to
make it permanently, but it just had extensions, so you know
what we are going to make this one permanent, and I am very
glad to hear from you that you agree that it has to be
permanent.
How is the department approaching and analyzing telehealth
policies like these and beyond the current public health
emergency, and acting emergency?
Secretary Becerra. I think I heard the question. I know it
deals with the public health emergency, and the telehealth
authorities. I am going to venture a guess at what I think you
asked, and we have the authority to expand access to healthcare
services to telehealth because during this public health
emergency we were able to do things to stretch the laws
legally, in ways that allowed America to take care of all of
its people during his pandemic.
Once the public health emergency expires, once I remove the
declaration saying we are under the State of a public health
emergency, those authorities, the liberalized authorities that
I was able to extend to the American people go away as well,
and so the sooner that Congress moves forward to change the
statutes on telehealth, to give us that flexibility in the
areas where we have seen tremendous success, the better off the
American people will be.
Mrs. Steel. Thank you, Secretary Becerra, and I yield back.
Chairman Scott. Thank you. The gentleman from New York, Mr.
Bowman.
Mr. Bowman. Thank you, Mr. Chairman, and thank you
Secretary Becerra for joining us today. I want to start by
commending you for your leadership at HHS overall, at a time of
historic challenge. I know you and your team have been working
around the clock to fight the pandemic, expand affordable
healthcare, and implement President Biden's transformative
American Rescue Plan.
As you are aware, 150,000 and 200,000 children have lost a
parent or caregiver due to COVID-19, and 65 percent of all
youth experiencing COVID-19 orphanhood are children of color.
This Fiscal Year 2023 budget request provides $18.75 million to
support evidence-based behavioral health services, and
community violence to include the resilience in communities
after stressed and trauma grants.
Secretary Becerra, what other HHS programs have increased
access to culturally responsive community-based mental health
services for children?
Secretary Becerra. Congressman, thank you for your interest
and all the work you have done in this area. I will tell you
that we are able to allocate dollars where we see the need
greatest, where the gaps are also the biggest. That resources
we have would not cover all of the disparities we see, but it
helps address some of them.
I will tell you one thing that has been tremendously
helpful to us, and what I am committed to make sure we make
further investments in, and that is working with our community
health centers, those federally qualified community health
centers that serve so many of those people who are uninsured,
who fall through the gaps, and for example, we found that some
20 million Americans receive their vaccinations through
community health centers--more than two-thirds of them people
of color.
We know that through the community health centers, we can
reach people who are often missed, so we intend, I intend, to
make sure that we continue to make a major investment in our
community health centers. With your help, whether it is through
SAMHSA, whether it is through HRSA and our different agencies,
we are going to try to drive money and resources and support
where we see the absence of that support in the past.
Mr. Bowman. Thank you so much, Mr. Secretary. As you know,
community violence prevention is a public health issue, and
this budget adds more than 25 million for Project Aware and
recast grants to support the implementation of evidence-based
violence prevention programs.
How does this fit into the Department's broader efforts to
promote community violence intervention?
Secretary Becerra. Congressman, I am sure you will agree
that gun violence is a public health crisis. Therefore, HHS
must be part of that solution to get us beyond that violence,
and the trauma that occurs. We are proposing some 60 million
dollars within the CDC and the NIH to further firearm violence
prevention research. We hope you will support that. We have a
quarter of a billion dollars that would be within the CDC to
support community violence intervention initiative.
We would work in collaboration with the Department of
Justice to make sure that we can use evidence-based community
violence intervention strategies at a local level, so it is not
just that we are saying we know best in Washington, DC. No, we
are partnering up with some resources with folks on the ground
locally who are trying to address domestic community violence
right there in their communities.
Mr. Bowman. Thank you, Mr. Secretary. I have one more
question about quality childcare. Numerous times we hear that
80 percent of a foundation of a child's brain development
occurs in the first 1,000 days of life, which means the first 3
years of a child's life is critical for a child's health,
learning and executive function, making access to high-quality
affordable childcare for every child fundamental.
This is out of reach for so many. A report from the Center
for American Progress revealed that nearly 60 percent of
mothers with children under 3 are employed, yet the average
cost of infant care is more than 20 percent of their income, on
top of being unaffordable for many families, the supply of
childcare is far below what is needed.
Forever, licensed healthcare slot, there are five infants
to toddlers needed. This shortage is worse than it was for
three-to-five-year old's and has only worsened throughout the
pandemic. How does the budget request prioritize addressing
resources for all infants and toddlers in the first 1,000 days
of life that support their positive development?
Secretary Becerra. I know the time is almost expired, so I
will be brief to say through the American Rescue Plan, thank
you for the support of that bill, we were able to make major
investment in childcare services, but it was still only a drop
in the bucket of what we need to do.
It is incredible to believe that for some families who
cannot even find a way to save money for their children for
college, they find that in order to get childcare they would
essentially be paying college tuition starting when the child
needs to go into childcare, that is how expensive it is.
We absolutely have to do something to help, as well as help
make sure we have a professional workforce that is adequately
paid.
Mr. Bowman. Thank you, I yield back.
Chairman Scott. The gentleman's time has expired.
Gentlelady from Louisiana, Ms. Letlow.
Ms. Letlow. Thank you, Mr. Chairman, and Secretary Becerra,
it is good to see you here again. I first want to thank you for
coming before our committee to discuss the Fiscal Year 2023
budget priorities of your department.
One of the first things I would like to talk about with you
is telehealth, and what we have seen throughout this pandemic
are the benefits that telehealth has been able to provide so
many patients. As the pandemic winds down, and society begins
to return to normal, many of the telehealth flexibilities that
were part in place as part of the public health emergency, are
still being utilized in positive ways.
As you know and mentioned in your testimony in the Fiscal
Year 202020 Omnibus, many Medicare telehealth flexibilities
were extended for several months after the end of the public
health emergency. I have heard from patients and providers
alike about how much the flexible telehealth provisions have
helped them.
My district is very rural. If some patients are able to
conduct telehealth visits when it is applicable, it can save
them time, and with gas prices these days a lot of money too.
If there is one good thing that has come from the pandemic the
expansion of telehealth has made healthcare much more
accessible to many patients, and I am concerned about that
accessibility if these telehealth flexibilities are not
permanently extended.
My question is as we wind down this public health
emergency, and Congress begins to consider the permanency of
telehealth flexibilities, what do you see as the best way to
preserve, and even potentially expand telehealth availability
to patients moving forward?
Secretary Becerra. Congresswoman, thank you for the
question. Everywhere I have gone in communities that are far
more rural than urban areas that you can see the value of
telehealth. We will work with you to try to make sure that we
extend permanently some of the provisions that we have been
able to employ during this public health emergency.
For example, letting a person's home, a patient's home be
considered the site of the care makes it possible for us to
extend reimbursement to those providers for providing care to
those individuals. That expires. That ability to do that
expires once the public health emergency is pulled down.
We look forward to working with you to make sure that we
have learned from the lessons of COVID what works and does not
work, and we move it forward. I simply have to add because we
know someone is going to try to game the system that we ask you
for your help to make sure that the accountability measures, to
make sure that there is program integrity to telehealth are
there so that we don't let the bad apples ruin it for everyone
who needs telehealth.
Ms. Letlow. Thank you. Next, I would like to talk to you
about an issue I discussed last year. When this committee
discussed your department's Fiscal Year 202022 budget request,
I made clear how concerned I was that the department decided to
forego 40 years of bipartisan precedent and remove the Hyde
Amendment from your budget request.
You responded to me that, ultimately, it is Congress's
decision what will be included in the final bill when it comes
to the issues of the Hyde Amendment. My Republican colleagues
and I made it clear that any appropriations legislation that
does not include Hyde Amendment protections will not gain our
support.
The Hyde Amendment has been renewed every year on a
bipartisan basis. Just last month on March 9, it passed the
House of Representatives again with a Democratic majority and
was signed into law by President Biden in the appropriations
Omnibus for the Fiscal Year 2022.
That is why when the President's budget request for Fiscal
Year 2023 was released last week, I was disappointed to see
that the Hyde Amendment and several other long-standing pro-
life provisions were again weakened or removed. Since 1976, the
Hyde Amendment has saved over 2.4 million lives.
This policy also reflects the views of nearly 60 percent of
Americans who agree that taxpayer dollars should not be used to
fund abortions. My question to you is as the majority of the
American people continue to oppose their tax dollars funding
abortion procedures, and Congress has made clear that the Hyde
Amendment protections are remaining intact, why does the
administration continue to try and repeal this 40-year-old
bipartisan provision, and force American's tax dollars to fund
abortions?
Secretary Becerra. Congresswoman, thank you for the
question. Having served 24 years in this body I could tell you
I am very familiar with this issue. At the end of the day, you
all will decide what our budget looks like. This proposal put
forward by the President is his effort to try and let you and
the American public know where he would like to go.
I am a firm believer that a woman is the best judge of how
to provide for herself and her healthcare, and making that
decision along with her physician, not with politicians. when
it comes to the issues of abortion, I know that there are
deeply held beliefs. We may not always agree, but what we
should do is agree that everyone should have access to the
healthcare services they need, and at the end of the day you
all will decide what the President's budget looks like.
Ms. Letlow. Again, thank you for your time, Secretary. Mr.
Chairman, I yield back.
Chairman Scott. Thank you. The gentleman from New York, Mr.
Espaillat.
Mr. Espaillat. Thank you, Mr. Chairman. Thank you,
Secretary for your patience, and for your time with us today.
Secretary as you know the Fiscal Year HHS budget for 2023
proposes 127.3 billion dollars in discretionary funding. My
question is Secretary, how will this budget's new proposals for
expanded access to mental healthcare address the needs of our
Nation's most vulnerable, including those that have fallen
victim to the opioid abuse crisis without a lifeline of
healthcare services they so desperately need this increase,
discretionary funding, how will it impact on the mental
healthcare of those folks?
Secretary Becerra. Congressman, as you know from looking at
the President's proposed budget it is a game-changer when it
comes to mental health in America. It is proposing that we
actually begin to treat mental health the same way we treat
physical health, the general health needs of the population
should be no different whether it Is mental or otherwise, and
so the President really puts his money where his mouth is on
that one.
We hope that this Congress will support and pass the
President's budget when it comes to mental health services, or
drug use services as well because these are game-changers that
let us really go at the--of this, which is to try to provide
not just the preventative services, but the support for
treatment, the support for after treatment as you follow
someone through to make sure they stay off of the addiction, or
stay healthy with their mental health challenges.
At the same time, we also include something else that is
very important. Harm reduction. When it comes to those that are
on the verge of doing something to themselves up to and
including suicide, we want to be there to be supportive to get
them away from that direction.
I hope that you and your colleagues will find it fit to
take this country to where we have never gone before when it
comes to treating mental health.
Mr. Espaillat. Thank you. My second question Secretary is
that the President's budget also includes $7.6 billion for the
childcare and development block grant which is an increase of
1.4 billion dollars above the Fiscal Year 2022 level. How will
this increase be allocated to solve some of the inequities that
exist regarding childcare, and childcare providers, and allow
them to have access to perhaps better pay and a living wage?
I think this is important that childhood educators are paid
a living wage, and that they are competitive, and be able to
stay in the business of providing childcare for America's
working families. How will this help that direction?
Secretary Becerra. Congressman, the President's budget
dedicates additional dollars to childcare in ways that allow us
to begin to confront the challenges faced in communities that
do not often have access to affordable and quality childcare. I
will be honest with you. We will need far more resources to
help our states, and those local providers get to the point
where we can make childcare more affordable, meaningfully more
affordable, and that is why the provisions in the Build Back
Better legislation were so important.
They really let us take it to the next level, and I hope
that there is a chance that you will at least incorporate the
childcare provisions in a bill, or in this budget because
families are hurting. It became clear with COVID how badly they
are hurting, and how difficult it was for them to find quality
childcare. Now that we are getting all back to work it still is
very difficult when you are paying essentially college tuition
for your 2-year-old to get childcare, you understand how
difficult it can be.
We are ready to work with you. We are working with states
to try to make sure they expand into areas where there is a
lack of good quality childcare today, but we will need to
provide additional help and resources to make that happen, and
to get the workforce to get paid the way they should.
Mr. Espaillat. Secretary, I look forward to working with
you in that area, particularly as it pertains to family based
daycare providers who are acting more and more as an
alternative for working families because they provide a smaller
setting post-COVID-19 smaller setting that culturally sensitive
and linguistically competent, and often provide the services
that families seek.
I look forward to working with you to make it easier for
them, and more competitive for them to have a living wage.
Thank you so much, I yield back Mr. Chairman.
Chairman Scott. Thank you. Next is the gentlelady from
Tennessee, Mrs. Harshbarger.
Mrs. Harshbarger. Thank you, Mr. Chairman, and thank you,
Secretary, for being here today to answer questions. I have
been a pharmacist in East Tennessee for 35 years, and it is
very personal for me that Congress act, and act soon to lower
the cost of prescription drugs.
There is no doubt that we have to reform the ways pharma
companies price prescription medications, and sometimes
manipulate the system. Equally important to me is the need to
reform these practices and roles of pharmacy benefit managers.
These PBMs have exploited a lack of transparency and created
conflicts of interest, and have significantly distorted
competition, reduced choices for consumers, and ultimately
increased the price and the cost of drugs.
I am really pleased that CMS has recently proposed
regulations to reform the so-called direct and indirect
renumeration fees--PBMs in the Medicare Part D area. My
question is this. Do you agree that any congressional actions
to lower drug prices would be incomplete and lacking without
meaningful reforms to the PBM industry sir?
Secretary Becerra. I certainly hope Congresswoman, that you
all succeed in reforming the PBM structure because we find that
too many Medicare beneficiaries are paying far more for their
drugs out of pocket than they should. We need to increase price
transparency in this process, and we also have to try to make
sure that we are promoting market competition.
All of these things are important, that is why on these DIR
fees it is so important that Congress--if you can move forward,
we have a proposal that is working its way through the
rulemaking process. We hope it will have an impact to help
lower the out-of-pocket costs for consumers.
We are going to try to do what we can, but if Congress can
step in and give us some statutory authority, that would be
very helpful.
Mrs. Harshbarger. Well, we need a transparent, economical
and efficient way to achieve these goals, and you know the
public comment is open now with the FTC ruling that hopefully
people will send in their comments, and I am very willing to
work them as far as looking at the way they do business.
In a transparent world, I mean there are pharmacies closing
at every you know, when you look at 2,300 independent
pharmacies that have closed within a year, there is a problem.
These pharmacists were integral, especially in rural areas when
it comes to services they provide to these entities, to these
patients, it is very critical.
Secretary Becerra. I agree.
Mrs. Harshbarger. I mean there is so much in transparency,
and hopefully the FTC will make the ruling that they will do an
investigation into these problem areas, but I just wanted to
make sure that that's on your radar, it is very important to
me, and a lot of my colleagues, so that is just one area that I
think we can lower the price of prescription drugs for these
patients, and I appreciate you telling me that you are going to
be looking at that.
Secretary Becerra. It is a flashing red light on our radar
screen.
Mrs. Harshbarger. Well, absolutely. You ask for my help any
time and I am willing to do that sir.
Secretary Becerra. Thank you.
Mrs. Harshbarger. With that, Chairman, I will yield back.
Chairman Scott. Thank you. Next is the gentlelady from New
Jersey, Ms. Sherrill.
Ms. Sherrill. Thank you, Mr. Chairman, and thank you,
Secretary Becerra, for testifying before us today, for all of
your time. One of the lasting impacts of the pandemic is its
contribution to our Nation's growing mental health crisis, and
unfortunately mental and behavioral health challenges hit our
children especially hard.
As a mother of four school aged children, and had a front
row seat to the challenges our kids have endured over the past
2 years, these include remote learning, isolation from peers,
and limited access to care just to name a few. It is no
surprise that the number of individuals reporting symptoms of
depression or anxiety has increased from 11 percent before the
pandemic, to 41 percent in 2021.
Regrettably individuals seeking affordable mental health
services are facing significant barriers that for far too long
have kept quality mental healthcare out of reach for far too
many people. Even before the pandemic less than half of
individuals of mental illness receive services and treatment.
Time and again I hear from mental health professionals,
parents who feel helpless, and children who just need access to
care about the challenges of mental health provider shortage
and limited access. It is why I fought so hard to secure
funding in Fiscal Year 202022 Omnibus Appropriations Bill for
the Mental Health Association of Ethics and Suicide Prevention
Services in schools.
Secretary Becerra, can you please outline was provisions in
this budget will specifically address the complex mental health
challenges our children are facing, and how this funding will
specifically support kids in my district in North Jersey?
Secretary Becerra. Absolutely, Congresswoman. Thank you for
the work that you have been doing on this issue. As you know
the President in the State of the Union was very clear. He is
taking us in a totally different direction. He is upping
everyone's game. It is a game changer to see the kind of money
that the President wants to put in his budget, the close to 5
billion dollars in discretionary funding for mental health
services.
The close to 52 billion dollars in mandatory spending that
would come over in the course of the next 10 years. That could
help transform our mental healthcare system, and so I hope you
have success in getting that across the finish line, because
not only will it help us in dealing with this crisis that we
see in America, but in your particular district, your
providers, your advocacy organizations that are helping people
on the ground would have the help that they need to make it
happen.
We are looking forward to working with you on that, and I
hope that you will help us make sure that in your home State of
New Jersey that you all are ready to implement the 988 hotline,
to help those who are in mental stress, if they call, that they
actually get a voice that answers that call and provides them
with a service.
Ms. Sherrill. Thank you. I think that is so important.
Something else that is really hitting our families hard has
been childcare, so again as a working mother of four children I
could tell you that even before the pandemic the rising cost of
childcare and the long waiting lists were not working for New
Jersey parents.
Now we are facing an even deeper crisis, one of the worst
in the Nation. Access to affordable high-quality childcare is
crucial to solving our worker shortage, and fully reopening our
economy. We know that over 4.3 million women dropped out of the
workforce at the height of the pandemic, and more than 800,000
still have not returned.
Many of them due to childcare and school closures and
problems with accessing affordable care. These challenges
continue to significantly affect our economy. Women are still
missing 1.1 million jobs compared to pre-pandemic, while men
are missing just 470,000.
We need to change the status quo, and make long-term
investments in America's childcare, addressing the childcare
crisis will improve New Jersey families immediate well-being
and economic security while increasing state-wide economic
growth. Last year Democrats passed the American Rescue Plan,
which allocated critical dedicated childcare relief funding to
states, and we have seen many states use relief money to
stabilize the childcare sector.
Can you outline what else can be done to ensure states,
including New Jersey, are able to continue supporting families,
children, and educators in the long-term?
Secretary Becerra. Congresswoman, as you are aware the
President said that if we get his Build Back Better proposals
through, especially the proposal on childcare, we can try to
make sure that no parent, no families have to pay more than 7
percent of their income for childcare, which would be a
tremendous lift for so many families, some of them paying up to
one-fifth of all their income, simply to provide childcare.
He has also talked about how we have to have a professional
force. We have too many workers in the childcare industry who
are moving on because they could probably make more money
flipping burgers than they could trying to care for your child
or mine.
We have to make it a professional service that is being
provided. If we could elevate those people who do this work,
and they are front line workers in many respects. We would do
us a great deal of service if we can help the states who are
trying to find ways, avenues, to try to provide more access to
these providers to the services they need, so they can make it
more affordable for you and me and all the parents in America.
We would all benefit.
The reality is it is not free, and without some of the
investments that the President has requested, especially in his
Build Back Better proposal, it would be tough for us to be true
partners as a Federal Government in helping our State and local
partners get to the-of this.
Ms. Sherrill. Thank you and my time is expiring, but I
sincerely appreciate it, and have a great day, and I continue
to look forward to working with you.
Secretary Becerra. Thank you very much.
Chairman Scott. Thank you. The gentleman from New York, Mr.
Jacobs.
Mr. Jacobs. Thank you. Mr. Secretary, thank you for being
here.
Secretary Becerra. Thank you.
Mr. Jacobs. In September 2021, Mr. Secretary, records
obtained by the National Institute of Health regarding a 1.5
million dollar grant to the University of Pittsburgh to provide
fetal tissue for research related to genital urinary tract
issues, kidney, bladder, et cetera, raised concerns that the
university may have violated the law by altering abortion
procedures solely for the purpose of obtaining fetal tissue,
and that aborted babies were born alive and killed by organ
harvesting.
I and my colleagues have written several letters concerning
this matter, we remain concerned that the university may have
violated the law, and NIH regulations. If the tissue being used
for this research was derived from aborted babies who were born
alive and then killed by organ or tissue harvesting, would that
be a violation of law?
Secretary Becerra. Congressman, there are absolutely
standards that have been set for the use of fetal tissue. There
are laws in place to make sure we are protecting the practice
of securing that fetal tissue, and I think all of us understand
the--are very mindful of the importance of making sure that we
do this right way.
Fetal tissue has been instrumental in helping so many
Americans find life-saving treatment, and we have to make sure
that we are respectful of the standards that are in place to
make sure it can be done in the right way.
Mr. Jacobs. Thank you for that. You do agree that the
Federal Government has a duty to ensure taxpayer dollars are
not used for illegal harvesting of fetal tissue?
Secretary Becerra. We have to make sure that no taxpayer
dollars are used in ways that are not appropriate under the
law.
Mr. Jacobs. You mentioned about research that is derived
from this. Can you name a single clinical treatment that has
utilized fetal tissue research in this development, because I
was not able to find.
Secretary Becerra. Coming from California where we actually
passed an initiative, a statewide initiative, that provided
moneys to set up a center to do the research and help promote
this within the private sector, so we could harness the
energies and the science, I am more than willing to provide you
any number of studies, any number of examples of how fetal
tissue has not only been life-saving, but has promoted the
well-being of so many Americans who otherwise would not have
any other method for their treatment.
Mr. Jacobs. Thank you. We were not able to find a single
development even though it has been used for research since the
1920's, so I would appreciate that. I have another question
regarding Medicaid spending, Medicaid spending is in my mind,
an unsustainable path, ballooning more than 360 percent over
the last two decades.
The Trump administration had instituted some efforts to
reign in this spending, and put big guardrails on it. But this
administration has done the exact opposite. I am very concerned
of its long-term sustainability. I am also particularly
concerned for my State. As you the Federal Government typically
pays 50 percent, and the states pay 50 percent of Medicaid
obligations.
New York State is unique in that it saddles local county
governments with paying a portion of the county share. The
county I reside in, in Erie County, 70 percent, over 70 percent
of its county real eState taxes have to go to Medicaid
spending, 215 million dollars.
This is an extreme burden, one reason our property taxes
are so high, and why we're losing people and businesses in our
region. What are you doing in terms of making sure that
Medicaid is sustainable because I do not believe it is on a
sustainable path in terms of its exorbitant growth?
Secretary Becerra. Congressman, thank you for the question,
and I hope we can all agree that but for Medicaid, and the
ability to provide services to so many Americans during this
pandemic that we would have lost far more lives than we have.
We know that today Medicaid is providing services to more
Americans, some 80 million-plus Americans, that has kept them
in the game.
We know that once the public health emergency expires, that
opportunity to stay healthy and to have access to care through
Medicaid might expire for millions of those Americans, and so
we are going to work really hard to make sure that not only is
Medicare sustainable moving forward, but it is continuing to
provide the care that has kept so many Americans alive and
healthy.
We will look forward to working with you on that.
Mr. Jacobs. Thank you. I appreciate that, because I
understand what you are saying. I just do not believe that it
is sustainable, and there has not been an answer provided in
that. Thank you, I yield back.
Chairman Scott. Thank you. Does anyone else seek
recognition? If not, I will recognize myself for 5 minutes.
Thank you, Secretary for being with us today. A couple of quick
clean-up points. Normally, Congress needs to recall the parent
does not have a choice to have a car seat. Did the law not
require a car seat?
Secretary Becerra. Car seats are required under the law.
Chairman Scott. Okay. Vaccines are required by law--you
have to get a series of vaccines if you want to go to public
school. Is that right?
Secretary Becerra. Correct, those are required.
Chairman Scott. We talked about opening the schools.
Everybody wanted the schools open the question is whether we
could open them safely. A report came out just before the
pandemic started showing that 40 percent of the school
districts in this country needed to repair or replace the
ventilation systems in their schools, in half their schools.
Does it make a lot of sense to open a school in the middle
of an airborne pandemic when you have ventilation problems?
Secretary Becerra. Clearly, we know what can cause, what
can lead to the contraction of COVID, and we want to make sure
we are keeping everyone, including our children safe and
healthy.
Chairman Scott. At this point, I suspend and recognize the
gentlelady from Illinois, Mrs. Miller for her questions. Note
the time. The gentlelady from Illinois is recognized for 5
minutes.
Mrs. Miller. Thank you. Mr. Secretary, you are President
Biden's Health and Human Services Secretary. My first question
is very simple. What is a woman? Can you define the word?
Secretary Becerra. Congresswoman, I am looking at you and I
think you are a woman.
Mrs. Miller. Why, thank you.
Secretary Becerra. How much more do you want me to give
you?
Mrs. Miller. Well, if you are in charge of Health and Human
Services, we want a specific definition of what a woman is.
Secretary Becerra. Did you want a legal definition? Do you
want me to give you a definition I have grown up knowing all my
life? If you can be specific, I can give you more, but I see
before me a woman asking me questions.
Mrs. Miller. Well, biologically and genetically, do you
agree that women have XX chromosomes, and men have XY
chromosomes.
Secretary Becerra. As far as the science tells us, I know
of no science that would contradict that today.
Mrs. Miller. Mr. Secretary, can men get pregnant?
Secretary Becerra. You are asking me something that I know
of no evidence to the contrary.
Mrs. Miller. As the mother of seven children, I can assure
you that only women can get pregnant. The American people will
not take medical advice from someone that thinks that a man
could get pregnant. Mr. Secretary, the Biden administration
released shocking guidance titled Gender Affirming Care in
Young People, which encourages children to take dangerous
chemicals and have sex change operations that permanently end
their ability to ever have children.
Mr. Secretary, is it child abuse to perform a sex-change
operation on a 12-year-old child or younger?
Secretary Becerra. Congressman, why do you wish to
interfere in what that 12-year-old child, and that child's
parents would like?
Mrs. Miller. The American people want to know what the
Biden administration has planned for their children. These are
permanently altering drugs and surgery that will permanently
end the child's ability to ever have children. We want to know
please answer me yes or no, is it child abuse to perform a sex
change operation on a 12-year-old girl, yes or no?
Secretary Becerra. I am not going down that rat hole with
you.
Mrs. Miller. The American people want to know. Should
doctors be allowed to perform sex change operations on children
without their parent's consent?
Secretary Becerra. I think most Americans want to have
politicians stay out of the decisions that they and their
doctor make.
Mrs. Miller. Are you saying that there would never be a
situation where a sex-change operation, or chemical castration
will be done on a child without the parent's consent?
Secretary Becerra. Congresswoman, a decision made by an
individual with the consent, if necessary, by parents, with the
advice of their physician is usually going to be the best
decision that could be made. Why you, or any politician, want
to get in the way of that, it makes no sense.
Mrs. Miller. Will you ever--will the Biden administration
ever allow chemical or surgical castration of a child, or being
given puberty blockers without parental consent, yes or no?
Secretary Becerra. Congresswoman, you Are asking questions
that make no sense.
Mrs. Miller. No. These are sensical. The American people
want to know what the Biden administration has planned for
their children.
Secretary Becerra. This administration is----
Mrs. Miller. Are you going to cut parents out of these
decisions? These are life-altering decisions. Once you
chemically or physically castrate a child they will not be able
to have children.
Secretary Becerra. I appreciate your particular opinions on
this. This administration is not going to interfere with
decisions that are made.
Mrs. Miller. These are not my opinions. My constituents,
and the American people want to know what the Biden
administration has planned for their children. the guidance
says that puberty blockers are reversible. Please explain to
the committee how this process is reversed? How do you reverse
chemical and surgical castration sir?
Secretary Becerra. Congresswoman, if an American wishes to
receive services, and is entitled to those services, and a
doctor, after consulting----
Mrs. Miller. These are children. These are children.
Secretary Becerra. Most children when they are in
consultation with their parents and with a physician making
decisions, these are decisions that do not need to have
politicians interfering in it.
Mrs. Miller. You are saying that the Biden administration's
policy is that you will never cut out the parents--parents
consent before they are given puberty blockers, or sex-change
operations?
Secretary Becerra. This administration, and I as Secretary,
will make sure we are abiding by the law, and enforcing the
law, and letting politicians interfere with the decisions--
medical decisions being made by an individual and family, and a
consultation with their physician, is not----
Mrs. Miller. Mr. Secretary, do you believe taxpayers should
pay for chemical castration and sex-change operations? I know
that the HHS website has listed new procedures that will be
covered by Medicare and Medicaid, including facial bone
remodeling for fascial feminization, breast, chest construction
and laser hair removal, yes or no.
Mr. Secretary, should taxpayers pay for this?
Secretary Becerra. Congresswoman, I appreciate your fervor
in this.
Mrs. Miller. Yes or no, should they pay for it. The Biden
administration, are they planning to have taxpayers pay for
breast, chest reconstruction, laser hair removal, facial
feminization?
Secretary Becerra. We will continue to comply with the law
and provide people with the protections they need to get the
medical services they are entitled to.
Mrs. Miller. Thank you, sir.
Secretary Becerra. Thank you.
Chairman Scott. Thank you. I will resume. I think I had
about 3 minutes left. Thank you, Mr. Secretary. I was talking
about reopening schools. Everybody wanted schools reopened. The
ventilation problems, you cannot open the school in the middle
of an airborne pandemic with ventilation problems.
To open in a pandemic you need nurses, counselors, extra
buses to avoid overcrowding, PPE, things that cost money. To my
understanding the American Rescue Plan provided more money for
K through 12 education than any bill in the history of the
United States. Is that right?
Secretary Becerra. That is correct.
Chairman Scott. Sir, those schools could open safely, not
just open in the middle of pandemic, but could open safely. We
have heard a little bit about civil rights. During the Trump
administration HHS's Office of Civil Rights gave non-
discrimination waivers to taxpayer-funded child welfare
agencies in South Carolina, Texas and Michigan, that allowed
them to discriminate.
In other words, the family would come forward, would seek
services, and they would say no, we are not going to provide
you those services because of your religion. Now where I come
from, that family would be the victim of discrimination.
Incredibly, they are trying to redefine under the Trump
administration, they redefined the victim to be the agency, but
they are not allowed to discriminate, and they are the victim
of discrimination, and they were given waivers to discriminate.
Can you withdraw those waivers, so that the victims of
discrimination will no longer be victims?
Secretary Becerra. Congressman, you and I began service
here in this body together in 1993. We sat on this committee
together, we sat on the Judiciary Committee together. We both,
for all that time have worked to prevent discrimination, not to
promote it, and I am still in the same thing.
We are going to do everything we can to prevent
discrimination.
Chairman Scott. You are not doing anything to prohibit
faith-based organizations from participating, it is just that
they have to follow the civil rights laws and treat everyone
regardless of religion, is that right?
Secretary Becerra. As I said before, some of these
religious organizations have been some of the best champions of
getting families the care they need.
Chairman Scott. Now, Head Start is an HHS, and not an
education primarily because you are providing more services
than just education. What is the budget doing with Head Start,
particularly early Head Start?
Secretary Becerra. We have continued to try to increase the
funding for Head Start, but certainly if we could get Build
Back Better passed, we could go to the next level when it comes
to Head Start because we have so many families that don't have
the opportunity to have their children attend Head Start.
Chairman Scott. Can you comment on the services that are
provided by Head Start, and how you're doing on Head Start?
Secretary Becerra. Well as you know Congressman, Head Start
gives a lot of children and families that are more modest
income families an opportunity to try to catch up to those
families who are able to provide to their children educational
services before they start kindergarten.
Head Start is the one program begun decades ago that led to
a lot of middle class, lower middle-class families, get to the
point where their children are ready to start learning in
kindergarten and beyond, and so we want to continue to beef up
Head Start where we can, and if Build Back Better comes
through, I think we take Head Start to a new level.
Chairman Scott. Thank you, and I yield back the balance of
my time. I want to thank the Secretary for participating today.
Members of the committee may have additional questions for you.
We ask that you respond in writing. The record will be held
open for 14 days in order to receive those responses. I remind
my colleagues that pursuant to committee practices and
practice, witness questions for the hearing must be submitted
to the majority staff or the committee clerk within 7 days.
The questions submitted must address the subject matter of
the hearing. I now recognize the distinguished Ranking Member
for a closing statement.
Ms. Foxx. Thank you, Mr. Chairman. Mr. Secretary, it is
clear from your testimony and answers, or lack of answers, to
our questions of HHS and the Biden administration, are not
responsive to the needs of workers and families. Congressman
Allen asked if regulatory action to fix the family glitch will
cost taxpayer dollars.
You responded that it will save taxpayer dollars. However,
according to previous estimates from the Congressional Budget
Office, this is untrue. Past scores indicate this action will
cost taxpayers 45 billion dollars to cover an additional
million people.
I am disappointed that the administration's reckless
actions to increase spending, expand the Federal Government's
role in healthcare, and increase access to abortion. HHS
guidance has led to increased confusion for workers and
students. The agency's positions on reopening, masking
children, and vaccinations ignores the science, contrary to the
many times you said today you follow the science.
Further, the agency's attempts to force every American in a
government-run healthcare and institute price setting schemes
must stop. The administration is threatening access to life-
saving cures and undermining the employer sponsored insurance
system that millions of Americans rely on, and are pleased
with. It is good, Mr. Secretary that you came today in your
capacity for this committee to conduct oversight, and I am
asking that you provide thorough answers to the written
questions that will follow. Thank you, Mr. Chairman, I yield
back.
Chairman Scott. Thank you. I want to again thank the
Secretary for being with us today. I want to particularly thank
you for your work on the No Surprises Act. A lot of people will
be avoiding big surprises, and large bills, medical bills as a
direct result of the legislation that we worked together on in
the process of implementing.
I also want to thank you for solving the family glitch
problem that is a problem that had millions of people caught up
in a situation where the worker had affordable coverage on the
job, but unaffordable coverage for the rest of the family. They
could not get help on the affordable care act, and you have
solved that, so that if there is unaffordable coverage for the
rest of the family, that they can get help.
I want to thank you for all of your cooperation today and
look forward to working with you in the future. If there is no
further business, without objection, the committee stands
adjourned.
[Whereupon, at 12:37 p.m., the Committee was adjourned.]
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