    [Senate Hearing 117-171]
    [From the U.S. Government Publishing Office]

                                                            S. Hrg. 117-171

                          NOMINATION OF XAVIER BECERRA
                            TO SERVE AS SECRETARY OF
                           HEALTH AND HUMAN SERVICES

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

                                    HEARING

                                     OF THE

                        COMMITTEE ON HEALTH, EDUCATION,
                              LABOR, AND PENSIONS

                              UNITED STATES SENATE

                        ONE HUNDRED SEVENTEENTH CONGRESS

                                 FIRST SESSION

                                       ON

       EXAMINING THE NOMINATION OF XAVIER BECERRA, OF CALIFORNIA, TO BE
                     SECRETARY OF HEALTH AND HUMAN SERVICES

                                   __________

                               FEBRUARY 23, 2021

                                   __________

     Printed for the use of the Committee on Health, Education, Labor, and
                                    Pensions

    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

            Available via the World Wide Web: http://www.govinfo.gov

                                   __________

                        U.S. GOVERNMENT PUBLISHING OFFICE
    46-751 PDF                 WASHINGTON : 2022

    -----------------------------------------------------------------------------------

              COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS

                        PATTY MURRAY, Washington, Chair
    BERNIE SANDERS (I), Vermont          RICHARD BURR, North Carolina,
    ROBERT P. CASEY, JR., Pennsylvania       Ranking Member
    TAMMY BALDWIN, Wisconsin             RAND PAUL, M.D., Kentucky
    CHRISTOPHER S. MURPHY, Connecticut   SUSAN M. COLLINS, Maine
    TIM KAINE, Virginia                  BILL CASSIDY, M.D., Louisiana
    MAGGIE HASSAN, New Hampshire         LISA MURKOWSKI, Alaska
    TINA SMITH, Minnesota                MIKE BRAUN, Indiana
    JACKY ROSEN, Nevada                  ROGER MARSHALL, M.D., Kansas
    BEN RAY LUJAN, New Mexico            TIM SCOTT, South Carolina
    JOHN HICKENLOOPER, Colorado          MITT ROMNEY, Utah
                                         TOMMY TUBERVILLE, Alabama
                                         JERRY MORAN, Kansas

                         Evan T. Schatz, Staff Director
                   David P. Cleary, Republican Staff Director
                      John Righter, Deputy Staff Director

                               C O N T E N T S

                                  ----------

                                   STATEMENTS

                           TUESDAY, FEBRUARY 23, 2021

                                                                       Page

                               Committee Members

    Murray, Hon. Patty, Chair, Committee on Health, Education, Labor,
      and Pensions, Opening statement................................     1
    Burr, Hon. Richard, Ranking Member, a U.S. Senator from the State
      of North Carolina, Opening statement...........................     3
    Feinstein, Hon. Dianne, a U.S. Senator from the State of Nebraska     6
    Padilla, Hon. Alex, a U.S. Senator from the State of California..     7

                                   Witnesses

    Becerra, Hon. Xavier, Sacramento, CA.............................     9
        Prepared statement...........................................    10

                              ADDITIONAL MATERIAL

    Statements, articles, publications, letters, etc.
    Murray, Hon. Patty:
        Letters of Support for the nomination of Xavier Becerra to
          serve as Secretary of Health and Human Services............    48
    Paul, Hon. Rand:
        Letters of Opposition for the nomination of Xavier Becerra to
          serve as Secretary of Health and Human Services............   139
    Marshall, Hon. Roger:
        State vaccine plans:.........................................   144

                             QUESTIONS AND ANSWERS

    Response by Xavier Becerra to questions of:
        Sentor Burr..................................................   145
        Sentor Paul..................................................   165
        Sentor Collins...............................................   168
        Sentor Cassidy...............................................   169
        Sentor Murkowski.............................................   172
        Sentor Braun.................................................   180
        Sentor Marshall..............................................   186
        Sentor Scott.................................................   195
        Sentor Tuberville............................................   205

                          NOMINATION OF XAVIER BECERRA
                            TO SERVE AS SECRETARY OF
                           HEALTH AND HUMAN SERVICES

                                  ----------

                           Tuesday, February 23, 2021

                                           U.S. Senate,
           Committee on Health, Education, Labor, and Pensions,
                                                        Washington, DC.
        The Committee met, pursuant to notice, at 10:03 a.m., in
    room SD-430, Dirksen Senate Office Building, Hon. Patty Murray,
    Chair of the Committee, presiding.
        Present: Senators Murray [presiding], Sanders, Casey,
    Baldwin, Murphy, Kaine, Hassan, Smith, Rosen, Hickenlooper,
    Burr, Collins, Cassidy, Murkowski, Braun, Marshall, Romney,
    Tuberville, and Moran.

                      OPENING STATEMENT OF SENATOR MURRAY

        The Chair. The Senate Health, Education, Labor, and
    Pensions Committee will please come to order.
        Today we are holding a hearing on the nomination of
    Attorney General Becerra to be Secretary of Health and Human
    Services. Senator Burr and I will each have an opening
    statement, and then I will recognize Senators Feinstein and
    Padilla to introduce Attorney General Becerra. After Attorney
    General Becerra gives his testimony, Senators will have five
    minutes each for a round of questions, and I am happy to stay
    for a second round if any Senator has any remaining questions.
        Before we begin, I want to walk through the COVID-19 safety
    protocols that are in effect. We will follow the advice of the
    attending physician and the Sergeant at Arms in conducting this
    hearing. We are all grateful to everyone who has worked so hard
    to get this set up and to help everyone stay safe and healthy.
        Committee Members are seated at least six feet apart, and
    some Senators, including myself, are participating by video
    conference. While we are unable to have the hearing open to the
    public for in-person attendance, live video is available on our
    Committee website at help.senate.gov.
        Thank you, Attorney General Becerra, for joining us. While
    we have never been able to meet in person since your
    nomination, I have appreciated our conversations so far about
    how to tackle the challenges our Nation is facing, starting
    with this pandemic, and our past experiences working together
    when you were in Congress to help families stay safe and
    healthy. I look forward to hearing more from you today and
    working with you again, both virtually and hopefully in person
    soon.
        If there's one thing that's clear as this pandemic
    continues to rage, it's that we have a lot of work to do and no
    time to waste. After four years of President Trump relentlessly
    attacking families' health care and a year of him refusing to
    lead the fight against this pandemic, our country is in crisis.
    The uninsured rate, drug prices and health care costs have gone
    up. Confidence in our public health agencies has plummeted.
    Already painful health inequities have grown deeper and more
    damaging for communities of color, and the Trump administration
    let the COVID-19 pandemic absolutely spiral out of control as
    testing, contact tracing, and vaccinations fell behind.
    Hospitals were overcrowded, health care workers were pushed to
    the brink, and hundreds of thousands of people lost their
    lives. They didn't just send things off the rails, they left us
    in the deep ditch.
        While the days of President Trump's head-in-the-sand
    approach to crisis management are thankfully over, this
    pandemic is not. We need to work with the Biden administration
    to quickly take additional steps on COVID relief and move
    swiftly to make sure they have their full team in place,
    including strong leaders at the Department of Health and Human
    Services, who will work with us to end this pandemic and
    rebuild a stronger, fairer country.
        Given the urgency of this crisis, I'm hopeful that after
    today's hearing and the Finance Committee hearing tomorrow, the
    Senate will move quickly to confirm Attorney General Becerra.
    Attorney General Becerra has the experience and the principles
    needed for this important role. He certainly knows how to work
    with Congress after serving as a Member of the House of
    Representatives for 24 years.
        He didn't spend his time in Congress trying to repeal laws
    that protect patients with preexisting conditions and help
    families get health care. He did work to pass laws that
    expanded coverage, like the Children's Health Insurance Program
    and the Affordable Care Act.
        As California's Attorney General, he has proven himself as
    an executive leader by seeing one of the Nation's largest
    justice departments through one of the most challenging periods
    in recent history. As Attorney General he has fought for
    patients, not for pharmaceutical companies, and even won a $70
    million settlement against drug companies for blocking cheaper
    generics. He has fought to defend families' health care in
    court, and as Secretary he will work with Congress to make sure
    every patient can get quality, affordable health care.
        While the Trump administration ignored crises that impact
    public health, like this pandemic and climate change and
    systemic racism, Attorney General Becerra has taken them on. He
    has held companies accountable for flouting COVID-19 safety
    rules and putting workers at risk. He established a new office
    at his department focused on environmental justice, including
    how pollution and public health hazards disproportionately hurt
    communities of color. And he has worked throughout his career
    to advocate on behalf of communities of color across health,
    immigration, education, and more.
        Overall, his record tells a story that is clear,
    compelling, and persuasive. He has fought against
    pharmaceutical companies, opioid manufacturers, tobacco
    companies, and polluters, and for more affordable, quality
    health care for every patient, including women, communities of
    color, the LGBTQI community, people with disabilities, and
    migrant children.
        With a record like that, I have no doubt that as the
    Secretary he will put special interests on notice, put patients
    and public health first, and put science, data, and experts
    back in the driver's seat. And he would also bring an important
    perspective to this role as a first-generation college student
    and the first Latino Secretary of Health and Human Services.
        I look forward to working with him and the Biden
    administration to not only address the immediate challenges of
    this pandemic, getting testing and contact tracing scaled up,
    and continuing to increase our vaccinations, but also to make
    progress on so many other fronts, like making sure health care
    in this country is truly a right, not a privilege; reversing
    the attacks on women's health from the previous administration;
    helping every family get quality, affordable child care;
    reunifying migrant children with the parents they were
    separated from by the Trump administration; rooting out
    systemic racism in health care that has inflicted a deadly toll
    on communities of color during this pandemic; and building a
    strong public health system to tackle future pandemics, the
    maternal mortality crisis, the mental health crisis, the opioid
    epidemic, and so many other challenges.
        There is much work to be done, and with this pandemic the
    clock is already ticking, and the reality is we are already
    way, way behind. We all want this pandemic to end, which means
    we should all want the Biden-Harris administration to succeed,
    and we should be getting qualified nominees like Attorney
    General Becerra on the job as quickly as possible.
        I hope to see strong support on both sides of the aisle for
    your nomination, Attorney General Becerra, and I look forward
    to working with you.
        Finally, I would like unanimous consent to enter into the
    record 54 letters of support for Attorney General Becerra's
    nomination as Secretary of Health and Human Services signed by
    individuals and groups representing patients, health care
    providers, hospitals, public health experts, advocates, and
    researchers.
        So ordered.
        [The information referred to can be found on page 49]
        The Chair. Now I would like to recognize Ranking Member
    Burr for his opening remarks.

                       OPENING STATEMENT OF SENATOR BURR

        Senator Burr. Thank you, Madam Chair. Thank you for
    scheduling this hearing today and the consideration of the
    nomination of Xavier Becerra to be Secretary of Health and
    Human Services. I welcome my colleagues on both sides of the
    General.
        As I said at our first hearing, Senator Murray and I have
    worked together on a range of health care issues, including FDA
    user fee agreements, critical public health reauthorizations,
    and efforts to fortify our Nation's public health preparedness
    framework.
        I look forward to our continued collaboration to help
    America's patients and families, and believe that the key to
    our success in addressing the most pressing health challenges
    facing our country will be the strong leadership from this
    Committee, working together in a bipartisan fashion with this
    new administration.
        General Becerra, welcome. I appreciate the opportunity
    yesterday to sit down with you and talk. Our relationship goes
    back a number of years in the House.
        I want to take a moment to recall the HELP Committee
    hearing for former HHS Secretary Silvia Burwell. Ms. Burwell
    came before the Committee as an Obama administration nominee,
    not as a nominee of my own political party. At the end of my 5
    minutes of questions, I informed my colleagues that I would be
    supporting Ms. Burwell, and urged them to do the same. I
    provided a key reason for this support, her portfolio of
    expertise in addressing the unique challenges faced by HHS. She
    held a deep knowledge of the issues at hand and had
    unquestionable experience in the management and execution of
    complex health care issues facing our country. The need for
    extensive health care experience at the helm of HHS has never
    been more important than today.
        I hear regularly from families in North Carolina about the
    problems caused by Federal overreach into their health care
    choices. A decade after the passage of the Affordable Care Act,
    people in my state are still burdened by its policies and
    struggling to make ends meet as a result.
        Not only have you supported the major expansion of the
    Affordable Care Act, but you have also been an advocate for
    more government interference between Americans and their
    doctors. During your time in Congress, you supported Medicare
    for All proposals, which would end private insurance and remove
    the private sector from health care coverage, denying the
    American people the innovation and actually affordable health
    care coverage models it offers. As exemplified by the COVID-19
    pandemic, with the extraordinary development of vaccines and
    treatments, the input of the private sector is vital to solving
    the most pressing health care issues facing our country and
    cannot be ignored or in any way undervalued.
        Over the last year, the pandemic caused by the novel
    coronavirus has brought the public health agencies under the
    jurisdiction of this Committee to the forefront of the American
    debate. January 31 marked 1 year since Secretary Azar declared
    a public health emergency with only a couple of COVID cases in
    the United States. The framework this Committee developed under
    the Pandemic and All-Hazards Preparedness Act, which we all
    call PAHPA, and its continued bipartisan reauthorizations laid
    out a roadmap for our response and allowed for early
    prioritization of the development of countermeasures to
    identify, mitigate, treat, and prevent an emerging disease like
    COVID-19.
        This important law created BARDA, the Biomedical Advanced
    Research and Development Authority, to help bring
    countermeasures rapidly through a risky phase of drug
    development. We recently received a disturbing report about the
    Obama administration's mismanagement of this critical agency
    from the Office of the Special Counsel, and we will be
    examining that very closely to ensure that such blatant
    failures don't happen again under this administration. BARDA's
    capabilities, with assistance from other Federal partners, have
    allowed us to reach yet another critical juncture in our COVID-
    19 response, a life-saving vaccine. This effort is making
    history and breaking scientific ground, bringing a vaccine to
    Americans and the world in a matter of months. American
    innovation and ingenuity are rescuing us from the devastation
    of a global pandemic.
        General Becerra, your actions as the Attorney General for
    California and during your tenure in Congress reveal somewhat
    of a disregard for the value of this ingenuity, calling for
    policies that would undo decades of investment in, and support
    of, American biomedical research. The incentive to innovate has
    been, and always will be, the linchpin in our ability to bring
    hope to American patients. Countermeasures for COVID-19,
    platform technologies to treat a multitude of rare diseases,
    and breakthroughs to delay the devastating effects of
    Alzheimer's and dementia will all come before this
    administration.
        An HHS Secretary nominee that has demanded manufacturers
    hand over protections for their innovations and discouraged the
    development of treatments for life-threatening diseases should
    be cause for concern for all Members of the Committee and the
    Senate. As a Congressman, you advocated for the use of the
    march-in right authority for drugs with priority review
    designation at the FDA and signed a letter urging HHS to use
    this authority to address increasing drug prices. But, in fact,
    the Bayh-Dole Act, which was passed in 1980, is very prescribed
    on the criteria for exercising march-in rights, and former
    Senators Bayh and Dole themselves said that they did not intend
    government to set prices and intentionally omitted referencing
    pricing in the law. Francis Collins, the Director of the NIH
    serving now three presidents and someone who is widely
    respected on both sides of the aisle, has rejected this
    approach, and as usual we would all be wise to listen to
    Francis. As a lawyer and a former legislator, you know better
    than to try to distort the law beyond reason for a preferred
    policy objective.
        In the midst of a pandemic, the HHS Secretary should not be
    someone who advocates for this deliberate misuse of the law or
    discourages the development of treatments for life-threatening
    diseases. The utilization of march-in rights in these
    circumstances, as you have historically advocated, can have a
    chilling effect on countermeasure development and the next
    generation of treatments and cures for the American people.
        As I look at the current status of the pandemic, I believe
    we must identify those areas of success in our framework, those
    that need work, and the challenges we did not anticipate in our
    earlier efforts. It's important for all of us to agree that
    there were successes and there were failures in the past year
    so that we can both learn. Accelerating the administration of
    COVID vaccines and broadly applying what we have learned during
    this pandemic are complex health care challenges, but they are
    only the first set of tasks the next leader of HHS will face.
    Following the immediate response, the Department will play a
    role in modernizing our public health preparedness programs,
    memorializing the efficiencies gained in our regulatory
    agencies, and in building the architecture of a health care
    delivery system for the future.
        These tasks will require sound policy experience. By the
    time Secretary Azar arrived, he had an extensive career in the
    biopharmaceutical sector and previously served in a leadership
    role at HHS. Secretary Price was a physician. Secretary Burwell
    tackled difficult health issues during her tenure at the White
    House Budget Office, and Secretary Sebelius served as the
    Kansas Commissioner of Insurance. This is the level of
    expertise that the American people deserve and that the
    continued response to the pandemic demands.
        Let me just inflect here. Members of Congress are granted
    security clearances because they become Members of Congress.
    It's automatic. Members of Congress do not become subject-
    matter experts just because they're Members of Congress, just
    because they sit on a committee that has health
    responsibilities. I've said often that I think you can count on
    both hands and both feet the number of Members of Congress that
    can actually understand the health care system in America. I
    may be wrong, but I think I'm right. So, it doesn't
    automatically give you expertise because we serve on this
    Committee.
        I am concerned at this time in Congress, and as the
    Attorney General sits before us, I'll say what I've said to him
    privately: I'm not sold yet. I'm not sure that you have the
    necessary experience or skills to do this job at this moment.
    I'm not sure that you have the appropriate respect for the
    private sector and innovation and intellectual property needed
    to bring more exciting treatments and cures to save lives in
    this country.
        General, you have an opportunity today and tomorrow in
    public hearings to prove that expertise is there. I told you I
    would remain open for this hearing and tomorrow's Finance
    hearing, which I think I may be the only one sitting in both of
    them. You'll be tired of seeing me by then, I can assure you of
    that. But I do come with an open mind, and now the job is up to
    you.
        Thank you, Madam Chair.
        The Chair. Thank you so much, Senator Burr.
        We will now turn it over to Senator Feinstein to introduce
    Attorney General Becerra.

                     STATEMENT OF SENATOR FEINSTEIN

        Senator Feinstein. Madam Chair Murray----
        Senator Burr. Make sure that microphone button is on.
        Senator Feinstein. Hello.
        Senator Burr. You got it.
        Senator Feinstein. Madam Chair Murray, Ranking Member Burr,
    Members of the Committee and colleagues, I'm very proud to have
    known Xavier Becerra for years as both a friend and a
    colleague. He spent decades serving California. He is currently
    the state's attorney general and previously served 12 terms as
    a Congressman from Los Angeles.
        Mr. Becerra was the first in his family to receive a four-
    year college degree--congratulations--earning his bachelor of
    arts in economics from my alma mater, Stanford University, and
    later his J.D. from Stanford Law School.
        As a member of the House of Representatives, he was a
    strong advocate for the health care of his constituents, and he
    fought to make affordable care affordable.
        As California's attorney general, he's been a staunch
    defender of the Affordable Care Act, leading 20 states and the
    District of Columbia in defense of the Affordable Care Act
    before the Supreme Court.
        As part of his focus on protecting the health of Americans,
    Mr. Becerra worked with Nebraska Attorney General Doug
    Peterson, a Republican, to lead a bipartisan coalition of 43
    attorneys general to reduce youth exposure to tobacco products
    like e-cigarettes, which continue to pose significant health
    risks to children.
        He has also worked on a bipartisan basis with multi-state
    coalitions of attorneys general on other health priorities that
    align with the work of this Committee, which include increasing
    access to COVID-19 treatments, as well as addressing the opioid
    epidemic and the considerable harm it has done to families.
        As our state's attorney general, Xavier Becerra leads the
    Nation's second largest department of justice and has major
    experience leading large and diverse organizations. We believe
    this positions him to successfully lead the Department of
    Health and Human Services, which is the Nation's largest
    Federal agency by budget.
        As secretary, he'll lead the Nation's top health agency
    charged with enhancing the health and well-being of all
    Americans. He comes well equipped to do an excellent job, and
    personally I am very proud of him.
        It is with great pleasure that I am here both to endorse
    and to support his candidacy.
        Thank you, Madam Chair.
        The Chair. Thank you, Senator Feinstein. Great to have you
    with us today.
        Now we'll turn to Senator Padilla for his introduction.

                      STATEMENT OF SENATOR PADILLA

        Senator Padilla. Thank you, Madam Chair Murray, Ranking
    Member Burr, for inviting me to address the HELP Committee
    today to also introduce my friend, California Attorney General
    Xavier Becerra. It's indeed an honor to introduce a fellow
    Californian for this important post.
        Our Nation is going through one of the toughest times we
    have faced in recent memory. The COVID-19 pandemic has taken an
    incredible toll on our lives and on communities across the
    United States.
        As we all know, COVID-19 deaths in the United States just
    surpassed half-a-million people. The devastation has
    disproportionately impacted working-class communities and
    communities of color, very similar to the very neighborhoods
    that Attorney General Becerra and I grew up in. These
    communities are hurting and dying at alarming rates, and they
    desperately need someone who knows these communities to their
    core.
        The Los Angeles Times just published an article on Saturday
    showing the disparity in vaccination rates across Los Angeles
    County, just for example, where wealthy neighborhoods like
    Beverly Hills are being vaccinated at five times the rate of
    minority communities such as South Los Angeles.
        That's why I am honored to introduce Attorney General
    Becerra today as the nominee for Secretary of the Department of
    Health and Human Services.
        If confirmed, Attorney General Becerra will be the first
    Latino Secretary of Health and Human Services, an honor I know
    he will not take lightly because it won't just be an honor, he
    views it as a tremendous responsibility.
        Throughout his upbringing and time as a public servant,
    Xavier Becerra has shown his passion for people and his
    commitment to improving the lives of those he serves.
        As you've heard, his parents immigrated from Mexico, just
    like my parents did, with a dream of building a better life for
    themselves and their family.
        As Senator Feinstein mentioned, Attorney General Becerra
    was the first in his family to graduate from college, earning
    both his undergraduate and law degree at Stanford University.
        While at Stanford, he also met his wife, Dr. Carolina
    Reyes, a widely respected obstetrician who helps care for women
    with high-risk pregnancies in underserved communities.
        Attorney General Becerra's first job out of law school was
    working with individuals with mental health disorders, a health
    issue that is too often overlooked, especially in communities
    of color.
        He also worked for a time at the California Department of
    Justice before serving in the California State Assembly.
        He was elected to Congress in 1992, where he quickly gained
    and maintained a reputation for being a strong supporter of
    reproductive health, protections for seniors, mental health
    parity, and the Children's Health Insurance Program, which we
    refer to as CHIP.
        Yes, Xavier was also instrumental in drafting and passing
    the Affordable Care Act, which has helped provide access to
    quality health care for millions of Americans who were
    previously uninsured.
        But his work has not stopped there.
        As Attorney General of California, he made it his mission
    to tackle structural inequalities within our health care
    system. Attorney General Becerra was the leading force behind
    the lawsuit to protect the Affordable Care Act and to maintain
    protections for people with pre-existing conditions and for
    those suffering from a mental illness.
        Over the past year, Attorney General Becerra fought to
    protect frontline health care workers from further exposure to
    COVID-19, and he stood up for homeowners struggling with their
    mortgage payments.
        I know public service is not just a job for Xavier. This is
    a commitment to honor the sacrifices of his parents, and an
    opportunity to bring greater equity, greater opportunity, and
    greater hope for all Americans.
        Xavier is a proven leader who is uniquely qualified to take
    on the challenges of this moment, with a vision of equity and
    compassion.
        I urge the Committee to support his nomination. Thank you.
        The Chair. Thank you very much, Senator Padilla. I'm glad
    to have both of you here today.
        Now, Attorney General Becerra, welcome. Thank you so much
    for being here today. We are looking forward to hearing from
    you, and you can now begin your testimony.

       STATEMENT OF THE HONORABLE XAVIER BECERRA, SACRAMENTO, CA

        Mr. Becerra. Thank you, Madam Chair, Ranking Member Burr,
    and Members of the Committee, for this opportunity to speak to
    you.
        To Senator Feinstein and Senator Padilla, a special thanks
    for your kind introduction.
        I also wish to thank my family: my North Star, Dr. Carolina
    Reyes, who is here with me, and our daughters Natalia, Olivia,
    and Clarisa, and Clarisa's husband Ivan. Everything I do,
    including this, is a family affair.
        I am here because my parents, Manuel and Maria Teresa, who
    had only their health and hope when they settled in Sacramento,
    taught me to earn the American Dream. A construction worker
    with a sixth-grade education and a clerical worker who arrived
    in her teens from Guadalajara, Jalisco, Mexico, they never saw
    the inside of a college classroom, but they sent all their kids
    to one, or to the military.
        We lost my dad last year on New Year's Day. When the end
    came, my dad knew we were there with him, at his side, in our
    home.
        Sadly, hundreds of thousands of Americans haven't had that
    closure this past year. That, Senators, is why I'm here today.
        The COVID pandemic has killed 500,000 Americans, many of
    them alone, without their families.
        Millions more have lost their jobs and health care. That is
    not the America my parents would believe possible.
        To meet this moment, we need strong Federal leadership.
    That's what President Biden is demonstrating. If I'm fortunate
    to be confirmed, I look forward to joining the President in
    this critical mission.
        I understand the enormous challenges before us and our
    solemn responsibility to faithfully steward this agency that
    touches almost every aspect of our lives. I'm humbled by the
    task, and I'm ready for it.
        The mission of HHS, to enhance the health and well-being of
    all Americans, is core to who I am.
        When I was a child, my mom had a health scare. She was
    rushed to the hospital after hemorrhaging at home. The image is
    seared in my memory.
        We were lucky: my mom is now 87 years young.
        Better put, we were blessed. My dad, the laborer, had
    insurance through his union, Laborers' Local 185. We didn't
    have much, but we didn't have to face the threat of unpaid
    medical bills or even bankruptcy.
        Over two decades in Congress, I worked to ensure every
    family had the assurance of care that mine had. I helped expand
    the Children's Health Insurance Program. I helped write and
    pass the Affordable Care Act. From the Ways and Means
    Committee, I fought to strengthen and modernize Medicare and
    how we finance it.
        As Attorney General, I created a health care rights and
    access unit. We cracked down on Medicare and Medicaid fraud. I
    worked to hold opioid manufacturers accountable for the
    addiction crisis. I've taken on hospitals and drug-makers who
    unfairly jack up prices on patients. I have protected patients'
    privacy.
        If confirmed, I'll work with you to continue this type of
    work and to address HHS' biggest challenges.
        That, of course, starts with COVID. The President has
    ambitious goals, 100 million vaccine shots in arms in his first
    100 days, increasing access to testing, sequencing the virus so
    we're prepared for the variants, and reopening schools and
    businesses. HHS has a central role in meeting all of these
    goals safely and equitably.
        As Attorney General, I saw the importance of this on the
    frontlines. I worked with my colleagues in other states, both
    Republicans and Democrats, to make COVID treatments more
    readily available. I am ready to work with you, with our state
    and local partners and across government to get this right.
        Next, we must ensure people have access to quality,
    affordable health care. If confirmed, I will work with you to
    strengthen our Medicare and Medicaid lifelines, reduce the cost
    of health care and prescription drugs, and ensure we are
    accountable, spending resources wisely and effectively.
        I won't forget the other ``H'' in HHS, human services. I
    want to work with you supporting our vulnerable children, those
    in foster care, strengthening Head Start, and expanding access
    to child care.
        Finally, we must restore faith in our public health
    institutions. That starts with putting science and facts first
    and showing respect for our career workforce.
        No one understands your states and your communities better
    than you. We may not always agree, but if I'm fortunate enough
    to be confirmed, I will always listen to you. I will keep an
    open mind. I will look for common cause. And I will work with
    you to improve the health and dignity of the American people.
        I want to thank you for this opportunity to share my
    vision.
        [The prepared statement of Mr. Becerra follows:]
                      prepared statement of xavier becerra
        Thank you, Madam Chair, Ranking Member Burr, Members of the
    Committee. I'm grateful for the opportunity to speak with you.

        A sincere ``thank you'' to Senators Feinstein and Padilla for their
    kind introduction.

        I also want to thank my family--my wife, Dr. Carolina Reyes, who is
    here with me, and my daughters Clarisa--along with her husband Ivan,
    Olivia and Natalia--for their constant love and support.

        I am here because my parents Manuel and Maria Teresa--who had only
    their health and hope when they settled in Sacramento--were tireless
    believers in earning the American Dream. A construction worker with a
    sixth-grade education and a clerical worker who arrived in her teens
    from Guadalajara, Jalisco, Mexico. They never saw the inside of a
    college classroom, but they sent all their kids to one, or to the
    military.

        We lost my dad last year on New Year's Day. When the end came, my
    dad knew we were there with him--at his side, in our home.

        Sadly, hundreds of thousands of Americans haven't had that closure
    this past year. That, Senators, is why I'm here today.

        The COVID pandemic has killed 500,000 Americans, many of them alone
    without their families. Millions more have lost their jobs and health
    care. That is not the America my parents would believe possible.

        To meet this moment, we need strong Federal leadership. That's what
    President Biden is demonstrating. If I'm fortunate to be confirmed, I
    look forward to joining the President in this critical mission.

        I understand the enormous challenges before us and our solemn
    responsibility to be faithful stewards of an agency that touches almost
    every aspect of our lives. I'm humbled by the task. And, I'm ready for
    it.

        The mission of HHS--to enhance the health and well-being of all
    Americans--is core to who I am. When I was a child, my mom had a health
    scare: she was rushed to the hospital after hemorrhaging at home. The
    image is seared in my memory.

        We were lucky: my mom is now 87 years old.

        Better put, we were blessed: my dad had insurance--through his
    union, Laborers' Local 185. We didn't have much, but we didn't have to
    face the threat of unpaid medical bills or even bankruptcy.

        Over two decades in Congress, I worked to ensure every family had
    the assurance of care that mine had. I helped expand the Children's
    Health Insurance Program. I helped write the Affordable Care Act. From
    the Ways and Means Committee, I fought to strengthen and modernize
    Medicare and how we finance it.

        As California's Attorney General, I created a health care rights
    and access unit and cracked down on Medicare and Medicaid fraud. I
    worked to protect people's health--holding opioid manufacturers
    accountable for the addiction crisis, and successfully taking on
    hospitals and drugmakers who unfairly jacked up prices on patients. I
    protected patients' privacy.

        If confirmed, I'll work with you to continue this type of work, and
    to address HHS' biggest challenges:

        First, COVID. The President has ambitious goals--100 million
    vaccine shots in arms in his first 100 days, increasing access to
    testing, sequencing the virus so we're prepared for the variants, and
    reopening schools and businesses. HHS has a central role in meeting
    these goals--safely and equitably.

        As Attorney General, I saw the importance of this on the
    frontlines. I worked with colleagues in other states--both Republicans
    and Democrats--to make COVID treatments more readily available. I am
    ready to work with you, our state and local partners, and across
    government, to get this right.

        Second, we must ensure people have access to quality, affordable
    health care. If confirmed, I will work with you to strengthen our
    Medicare and Medicaid lifelines, reduce the cost of health care and
    prescription drugs, and ensure we are accountable, spending resources
    wisely and effectively.

        I won't forget the other ``H'' in HHS: human services. I want to
    work with you supporting our vulnerable kids, those in foster care,
    strengthening Head Start, and expanding access to child care.

        Third, we must restore faith in our public health institutions.
    That starts with putting science and facts first and showing respect
    for our career workforce.

        No one understands your states and communities better than you. We
    may not always agree, but if I'm fortunate enough to be confirmed, I
    will always listen to you and keep an open mind . . . find common cause
    . . . and work with you to improve the health and dignity of the
    American people.

        Thank you for the opportunity to share my vision.
                                     ______

        The Chair. Thank you very much, Attorney General Becerra.
        We will now begin a round of five-minute questions, and I
    ask all of our colleagues to please keep track of the clock and
    stay within the five minutes. We have a lot of Senators today,
    two votes. I'm happy to stay if any of you have additional
    questions, but I'm going to try to keep us all within the five
    minutes on the first round.
        Since this pandemic began a year ago, more than 28 million
    people in our country have been diagnosed now with COVID-19,
    and more than 500,000 have died. It's a tragedy made worse by a
    failure in leadership.
        The Trump administration's denial of the severity of this
    emergency and its constant attempts at political interference
    devastated public health and eroded public confidence. The
    Trump administration refused to stand up an adequate testing
    strategy. They demanded FDA authorize unproven COVID-19
    therapeutics. They left states and tribes to compete against
    each other for limited supplies. They failed to provide
    sufficient guidance to our schools and workplaces, and elevated
    conspiracy theories and muzzled scientists. They rejected
    science and misled the public throughout the response,
    exacerbating existing racial and ethnic health inequities.
        Even with the vaccines, we saw delays in orderly vaccine
    deliveries and false information about available supply; lack
    of communication between Federal, state, tribal, and local
    officials; and now the Nation faces major challenges with
    vaccine confidence, the inevitable outcome of political
    interference and false information.
        We need a strong Federal response driven by evidence, with
    a comprehensive national plan. So my question to you, Attorney
    General Becerra, is if you are confirmed as Secretary, will you
    empower HHS' scientists and experts to be leaders in the
    Nation's COVID response?
        Mr. Becerra. Madam Chair, thank you for the question and
    the work that you've done in all of these efforts to move us
    forward. I completely agree with what you said. Science must
    come first. We must ensure that people trust what we say. We
    have to earn their respect and their trust. We want them to
    participate in the vaccination program. We want them to
    continue to mask and socially distance and to wash their hands.
        Absolutely, I look forward to working with you to make sure
    that we gain that trust with the American people and we do it
    in a transparent way so that, at the end of the day, people
    know that when we took action, it was because science demanded
    it.
        The Chair. Good, I appreciate that. And as you know, I
    pushed the Trump administration hard for a detailed vaccine
    plan for six months, and I'm really glad the Biden
    administration is taking that challenge seriously now. So we
    need to work together to make widespread vaccination a reality.
        I wanted to ask you what can we do to make sure there's
    widespread trust and confidence in COVID-19 vaccines?
        Mr. Becerra. Well, Senator, as I mentioned, what's probably
    most important is that people believe that what we are asking
    them to do is the best course of treatment and action for their
    health. We have a ways to go to regain the trust of the
    American people, but if we let the experts, as we said, the
    scientists lead, I believe soon people will see the results.
    And if they see the results, we know they care about their
    families and their loved ones. No one wants to see the number
    of 500,000 grow and the number who have died.
        If we're transparent, if we show accountability, if we do
    this in a way that earns their respect, we will make progress
    and we will make it swiftly. I thank President Biden for his
    ambitious goal of 100 million shots, vaccine shots, in 100
    days, moving forward to try to reopen the majority of our K-8
    schools safely. All of those goals are critical goals, and I
    look forward to working with you, if I'm fortunate to be
    confirmed, to make it a reality.
        The Chair. Good. And in addition to knowing they can trust
    their government to respond effectively to a crisis, people
    should also be able to trust they have the health care
    available to them when they need it. You have been a leader in
    the fight to bring affordable, quality health care to everyone,
    and over the last four years, as we know, the Trump
    administration didn't just attempt to repeal the ACA through
    Congress, jeopardizing coverage and protections for people with
    pre-existing conditions, it also sabotaged the law through
    executive action, issuing rules that made health care harder to
    get, more expensive, patients and families paying for more
    costs out of their pocket and stuck with junk insurance plans.
        We have a lot of work to do to reverse the damage and get
    people the care they need. So will you work with us to help
    ensure everyone has access to quality, affordable health care?
        Mr. Becerra. Madam Chair, I can guarantee you that is part
    of my core in what I have done. My father used to tell me the
    stories of when he was a young man, how he could not walk into
    establishments because of the signs that said ``No Dogs,
    Negroes, or Mexicans Allowed.'' My father was a U.S. citizen,
    and those stories are in my mind. That is one of the reasons
    why I have always fought to make sure that we are inclusive,
    whether it's inclusive based on race or ethnicity or geography.
    Rural Americans are entitled to know that we are counting them
    as well.
        I look forward to working to make sure that we close all
    gaps and reach every corner of our country to make sure
    everyone is safe from COVID.
        The Chair. Thank you very much.
        My time has expired. I will turn it over to Senator Burr.
        Senator Burr. Thank you, Madam Chair.
        I'm going to save my questions to the end of the hearing,
    so I'm going to yield my time to Senator Collins.
        Senator Collins. Thank you, Senator Burr.
        Welcome, Attorney General Becerra. I want to talk to you
    about our Nation's schools. About half of K-12 students are
    still not spending any time in classrooms, with resulting
    losses in academic achievement, literacy, social and emotional
    development, not to mention the stress on their parents.
    Experts tell us that these extended absences are causing large
    learning problems, especially for lower-income students.
        In a recent op-ed in the Washington Post, two public health
    experts were critical of the new CDC School Reopening
    Guidelines. They suggested that while you need six feet for
    adults, that it is safe if you have masks and other procedures
    for students to only be kept three feet apart.
        It's not just these public health experts. The American
    Academy of Pediatrics has similarly said that schools should
    weigh the benefits of strict adherence to the six-feet spacing
    rule, with the potential downside if remote learning is the
    only alternative.
        My question to you is this: Won't maintaining this six-foot
    recommendation despite these very credible alternative views by
    health care experts prevent many schools from resuming full-
    time, in-person learning this year, and possibly even into next
    year? And keep in mind, some of these students have not been in
    school since last March.
        Mr. Becerra. Senator, you pose the question that's on the
    minds of parents throughout this country every day. The
    preeminent concern must be the safety of our families. No one
    wants to risk the life of their child, and certainly no one
    wants to have a child become the reason an adult becomes ill
    from COVID.
        I will tell you what I believe is the best approach, and
    that is to let science guide us and let the experts determine
    when it is safe. Remembering that schools and education are a
    local issue and where the Federal Government has a partnership,
    we provide the guidance. We should not be the ones making the
    final decision on how and when a school will reopen because
    those are local decisions, but we must work with them and
    provide the guidance, the support, the resources to make sure
    that those schools do reopen as soon as possible and as safely
    as possible.
        I can commit to you that I will work with you and leaders
    in Congress, but especially local leaders in our school
    districts, to make sure that we have provided the partnership
    they need to know when it's safe to reopen their schools for
    their kids.
        Senator Collins. Well, I would suggest that when the
    American Academy of Pediatrics is suggesting the harm, these
    other public health experts, that we need to broaden who we're
    listening to.
        Let me, in my remaining time, switch to another issue. As
    chairman of the Senate Aging Committee, past chairman, I held
    the first congressional hearing on the impact of COVID on
    seniors living in nursing homes and other congregate care
    settings, and I've heard from numerous health care providers
    about the difficulty and expense of paying for additional staff
    and COVID-related facility improvements, PPE, et cetera.
        In my state, more than a dozen nursing homes have closed in
    the past six years, and many more are struggling to keep open.
        I was astonished that in a $1.9 trillion COVID package, the
    Administration did not include any money for a provider relief
    fund which would help these nursing homes. Do you support
    providing additional assistance to long-term care facilities,
    our rural hospitals, community health centers, and other
    providers?
        Mr. Becerra. Senator, thank you for the question, and I
    know how hard you've worked on these matters. I will tell you
    that, absolutely. I can tell you that if I was fortunate to be
    confirmed, that it would be a top priority to make sure that we
    are providing the resources necessary. We've seen how so many
    of these assisted living facilities, nursing homes and other
    facilities that care for aged and disabled Americans haven't
    had the resources. They're short on workers, and we've seen the
    crisis of COVID hit them hardest. So we have to provide the
    help.
        I believe it's important, and I believe President Biden
    will be there to provide the support, whether it's through the
    provider relief fund or simply by making sure that we are
    providing resources that are already allocated to make sure
    that we're working closely with those facilities that have been
    hit the hardest.
        Senator Collins. Thank you. There's an excellent proposal
    in the package that 10 Republicans have presented to the White
    House that I hope you'll take a close look at.
        Thank you, Senator Burr and Senator Murray.
        Mr. Becerra. Thank you, Senator.
        The Chair. Thank you so much.
        We will turn to Senator Sanders.
        Senator Sanders. Thank you, Madam Chair.
        Mr. Attorney General, welcome. Let me start off by stating
    what you already know, that the United States is the only major
    country on earth not to guarantee health care to all people.
    Today, some 90 million Americans are either uninsured or
    underinsured, and despite that, we are spending twice as much
    per capita on health care as do the people of any other nation.
    And on top of that, we pay by far the highest prices in the
    world for prescription drugs, resulting in one out of four
    Americans not being able to afford the medicine that they need.
        My first question is what are you going to do, if
    confirmed, to move this country forward to provide health care
    to all people, and also substantially lower the cost of
    prescription drugs?
        Mr. Becerra. Senator, thank you very much for the question
    and for your tireless commitment to making sure all people in
    this country have health care.
        I believe President Biden made it very clear. If we work
    hard to build on the Affordable Care Act, and if we continue to
    make improvements, we will get to that point where we will
    finally, as the leading nation in the world, be able to say
    that we truly do cover all of our people. No one should have to
    experience what I saw as a child when my mom was whisked away
    to the hospital, not knowing if they'll be able to afford the
    care. I believe that we are moving in that direction, and
    President Biden is committed. He has said, without mistake,
    that we are going to build on the Affordable Care Act, and that
    is what I hope to do.
        In that regard, Senator, I have to mention that I think
    there is unanimity, bipartisan support, for tackling the high
    cost of prescription medication. And I can assure you that will
    be one of my priorities, is to deal with it swiftly. I have
    tried to tackle it as the Attorney General. I tried to work on
    that when I was in the House, and I look forward to working
    with you and Members of this body in the future.
        Senator Sanders. Could you give us any more specificity as
    to how we lower the cost of prescription drugs? Because the
    truth is, Members of Congress have been talking about this
    issue for decades, and yet the pharmaceutical industry is
    enormously powerful. They make huge amounts of campaign
    contributions, spend billions over years on lobbying. They
    continue to be in a position where they can charge Americans
    any price they want. In the case of insulin, for example, we
    pay ten times more than our neighbors in Canada do because we
    have no regulations over them.
        Can you give us a little bit more specificity as to how we
    take on the drug companies and lower prescription drug costs?
        Mr. Becerra. I think, Senator, we can all agree that the
    price that we're paying for some of these prescription drugs is
    far higher than it should be. All you have to do is travel to
    another country, whether Canada or another country in the
    world, to find that we're paying way more than the people in
    some of these countries are paying.
        I took on a number of the pharmaceutical companies, these
    drug makers, by trying to go behind the curtain on how they
    reach their pricing, and we were able to prove that there is
    collusion at times going on. There's a process called ``pay for
    delay'' where companies will essentially collude with each
    other to not have a second company put a generic product on the
    market to compete with the brand-name product, and therefore
    keeping the price of that brand-name pharmaceutical product
    high.
        We were able to succeed in going behind that curtain and
    trying to undercut that type of anti-trust activity. We can
    also make sure that----
        Senator Sanders. Let me just stop you. Mr. Attorney
    General, in the midst of a dysfunctional health care system,
    our primary health care system is awful in the sense that many,
    many millions of people, even those with insurance, can't find
    a medical home, can't find a doctor when they need to.
        Are you supportive of a significant growth in community,
    federally qualified community health centers around this
    country so that we can make sure that every American,
    regardless of income, has access to decent quality health care?
        Mr. Becerra. Senator, absolutely. That is one of the ways
    that we were able to reduce by almost one-half the uninsured
    rate in my former congressional district after the
    implementation of the Affordable Care Act, because our
    community health centers were there to be supportive of people
    who didn't have access to hospitals and doctors previously.
        Senator Sanders. In a similar vein, we have a crisis in
    that we do not have enough providers, doctors, nurses, others
    in underserved areas, whether they're urban or rural. Are you
    supportive of expanding the National Health Service Corps?
        Mr. Becerra. Absolutely, as well. And here I want to thank
    the work that you and the Members of Congress have done to
    increase the number of graduate medical education slots by
    about a thousand that will be available throughout the country
    so we can place these future doctors in places where they're
    needed most, in some of our rural communities, in some of our
    inner-city communities, making sure that we're meeting the
    needs of people moving forward.
        Senator Sanders. We recently learned some shocking
    information, that life expectancy in the United States as a
    result of COVID has gone down for the African American
    community. It is unbelievable in terms of what we're talking
    about, an average of 2.7 years of decline. What can we do to
    make sure that we improve access, health care access to
    minority communities in this country?
        Mr. Becerra. Senator, as you know, I've worked a long time
    on these issues, oftentimes with you and others who believe
    that we should not have the gaps in our health care system,
    that we miss far too many communities too often. What I can
    tell you is that if we collect better data that helps us
    understand where the shortages are, who we're missing, we'll
    also be able to then provide better treatment.
        The first thing is we need to make a better effort at
    collecting the data that we need. I do want to thank the
    scientists and experts who made sure that when we're doing the
    studies in search of a vaccine, the studies did include some of
    these oftentimes forgotten communities in their trials.
        We also have to make sure that we are reaching out, and
    sometimes the best way to reach out to some of these
    communities is use the local civic and religious leaders that
    are trusted in the community so we can make sure we're not
    missing anyone.
        The Chair. Attorney General, we're----
        Senator Sanders. Madam Chair, thank you very much.
        Mr. Becerra. I look forward to working with all of you on
    numerous ways to try to make sure that we deal with health
    disparities.
        The Chair. Thank you so much.
        Senator Cassidy.
        Senator Cassidy. Hey, Attorney General, nice to see you,
    and thank you for that visit we had on the phone.
        I echo what Senator Burr said, which is that I'm concerned
    that--I mean, you're a very highly trained attorney with great,
    impeccable credentials. I'm a physician. What would you as an
    attorney think if I, the physician, were nominated to be the
    United States Attorney General as opposed to Merrick Garland?
    You would say the guy's not qualified. Maybe HHS Secretary, and
    maybe not, but certainly not Attorney General. So you can
    imagine the kinds of concerns I have regarding your nomination.
    With that said, as Senator Burr said, I have an open mind and
    just want to go through it.
        I'm just going to talk about some of the things that we've
    talked about on this Health Committee and see what your
    thoughts are, and to give us a sense of comfort about the
    training that you bring.
        A huge issue has been the 340B program. We've had at least
    one, maybe two or three hearings on this since I've been a
    Senator, and it's big stakeholders, all of them claiming that
    they're totally righteous, and the truth being somewhere in
    between.
        In that, two key questions. Do we need a statutory
    definition for ``contract pharmacy'' and a statutory definition
    for ``patient''? If yes, what would those definitions be? And,
    by the way, you may not have thought about this, and I get
    that. I'm not going to ask you the entire breadth of HHS, but
    just some different sorts of questions, and I will be at
    Finance tomorrow just to kind of let us know the degree to
    which you're prepared for this job.
        Mr. Becerra. Senator, thank you for the question, and thank
    you for the opportunity previously to sit with you and discuss
    some of these matters.
        The 340B is an indispensable program for some of our most
    underserved communities. I know you know this, but for the
    public that may not understand what the 340B program is, it
    works with our safety net providers to make sure that some of
    these forgotten communities have access to some of the
    essential medications that they need for a reasonable price.
        What we must do is make sure that the law is followed. Your
    question asked if we should have a statutory definition for
    ``contract pharmacy'' or for ``patient.'' I think the first
    thing we have to do is enforce the laws that we have in place.
        Senator Cassidy. Let me say, though, that the law currently
    does not have such statutory definitions. So if you think it
    important that they have them, if so, how would you define it?
        Mr. Becerra. Senator, I'm more than willing to work with
    you and Members in Congress, if I'm fortunate to be confirmed,
    to see if we have to move in that direction. But we've had the
    340B program for a while----
        Senator Cassidy. That is a process. I guess I'm asking more
    than a process question. I'm asking either a philosophical or
    a, yes, I'm familiar enough with the program to have an opinion
    on it question.
        Mr. Becerra. Senator, what I'm hoping to say in response to
    your question is that we've had the program in place. It was
    only recently that we had an issue arise from the drug makers
    saying that they wanted to change the way it operates. We had
    the previous administration issue an advisory opinion that said
    that the program should move forward as is, so I----
        Senator Cassidy. I have limited time, so I'm going to move
    on because, actually, when I was in the House with you,
    probably 8 to 10 years ago, industry was raising the issue of
    340B as an issue. So it's just to say that.
        Let me ask you again. Senator Sanders asked about diabetes,
    a very expensive condition. Some stakeholders suggest that we
    counter insulin price increases by requiring health plans to
    pass 100 percent of all rebates on to patients. What would be
    your thoughts regarding that?
        Mr. Becerra. Senator, I do believe--and thank you for the
    question--that we must continue to see the cost of prescription
    drug medication go down, especially some of these life-saving
    treatments where people don't have a choice. I do believe the
    rebate program must be enforced. I also do believe that we have
    seen instances where there have been providers, folks who have
    not followed the law. I will tell you that you can't play a
    game with indispensable drugs.
        Senator Cassidy. But specifically, the 100 percent of
    rebates being required to be passed back to the patient.
        Mr. Becerra. What I will say to you, Senator, is I will
    look into that, and I'm more than willing to work with you.
    Right now we have a proposal that I believe was rushed out that
    would in many ways take sides in this debate, and I would
    simply say that we have to protect the Part D program for our
    seniors and do it the right way. And so I'm more than willing
    to look at this program if I'm fortunate to be confirmed and
    work with you on it.
        Senator Cassidy. Thank you, Attorney General Becerra.
        I yield.
        The Chair. Thank you, Senator Cassidy.
        Senator Casey.
        Senator Casey. Madam Chair, thank you very much for your
    leadership of this Committee and this hearing.
        I want to welcome Attorney General Becerra and thank him
    for his willingness to continue public service, not only to the
    people of his home state up to this point in time but to the
    people of our Nation.
        Mr. Attorney General, your story is a great American story,
    the story of your own success and that of your family, your
    parents, and we're grateful for that commitment to public
    service.
        Secondly, I think you're well prepared to lead this
    critical agency during a time of crisis, the worst public
    health crisis in a century; and, of course, a jobs and economic
    crisis.
        If you would excuse the long predicate to my question, I
    want to get a few things on the record dealing with an
    important piece of legislation that both Chair Murray and
    Ranking Member Burr worked with me to pass, the Pandemic All-
    Hazards Preparedness Act. In the last reauthorization, we
    extended a national advisory committee on children and
    disasters. That was a good step forward. We also created two
    new national advisory committees, one on seniors and disasters,
    and a second national advisory committee on individuals with
    disabilities and disasters.
        The National Advisory Committee on Children and Disasters
    provided valuable recommendations to the Federal Government
    since it was first established in 2013 to respond to different
    types of emergencies that can impact children. In 2019 we
    passed the most recent reauthorization of Pandemic All-Hazards
    Preparedness. We included two additional advisory committees
    for those populations that are frequently left out of disaster
    planning, both seniors and people with disabilities.
        It's been a source of real frustration of mine that the
    last administration took no action, no action at all, to stand
    up these two national advisory committees, one on seniors and
    disasters, and the other individuals with disabilities and
    disasters.
        Additionally, despite having the infrastructure in place,
    the Advisory Committee on Children and Disasters, the first,
    the original advisory committee, has also not been
    reestablished despite a call for applications last year.
        In a pandemic where both seniors and people with
    disabilities have been disproportionately and adversely
    impacted, both have been overlooked, and at the same time
    children's daily lives and their education has been disrupted.
    We've got to take action to make sure these advisory committees
    are up and running.
        My question is really simple. As Secretary, upon
    confirmation, will you ensure that the Department is fulfilling
    its obligation under the law to establish and maintain these
    three advisory committees?
        Mr. Becerra. Senator Casey, thank you for the question and
    all the work you did on PAHPA, along with some of your
    colleagues. You had me at hello on this one. Absolutely, on
    these advisory committees, we need to move forward.
        My first job as an attorney was representing Americans who
    needed disability services. I established a disability rights
    bureau at the California Department of Justice. We have a very
    aggressive and active children's justice bureau in the
    California Department of Justice which was established by now
    Vice President Harris.
        I will tell you that on this, I look forward to the
    partnership, if I'm fortunate to be confirmed.
        Senator Casey. Thanks very much. My second and final
    question, in the interest of time, is throughout your career
    you've been interested in the question of social determinants
    of health and how the lack of life-enhancing resources, whether
    it's food or housing or education or health care, are
    considered to be among the root causes of the health
    disparities we've heard so much about.
        When you were in the House we worked together on this, and
    I know you've worked with other Members as well. We've seen how
    COVID-19 poses a greater risk to people with pre-existing
    conditions, as well as especially to Black Americans and others
    who live in communities of color, and this has shown us we
    still have a lot of work to do on these issues.
        Can you speak about your interest in social determinants of
    health and how your work over the years will instruct your
    efforts to address the health, racial, and ethnic disparities
    that confront our Nation?
        Mr. Becerra. Senator, first, it was a pleasure to work with
    you on the IMPACT Act and dealing with the social determinants
    of health and trying to address disparities. We've gone a long
    way from those early days. We know we need the data. We know we
    have work to do to fill those gaps. And I'm just thrilled to
    see that so many Members on both sides of the aisle, both
    chambers, are working toward addressing health disparities, and
    I look forward to continuing the partnership I had with you
    previously and with the Members on this Committee.
        Senator Casey. Thanks very much.
        Thank you, Chair Murray.
        The Chair. Thank you very much, Senator Casey.
        Senator Murkowski just arrived. Are you ready to go?
        Senator Burr. Senator Murray recognized Senator Murkowski
    next.
        Senator Murkowski. Thank you. I couldn't hear her, so I
    wasn't sure where we were.
        The Chair. Okay, I'm on. Can you hear me now?
        Senator Burr. Yes. We're recognizing Senator Murkowski
    next.
        The Chair. Yes, that's what I said. Sorry, I think I was on
    mute.
        Senator Murkowski. Thank you.
        Welcome to the Committee. I appreciated our discussion some
    days ago and the opportunity to drill down just a little bit
    further. You come to this nomination with the background and
    experience that you've had over in the other body. You are one
    who comes from a pretty urban area. We've had an opportunity to
    speak about some of the specifics that are Alaska specific, but
    more broadly to rural itself. And as a Member of this
    Committee, as health matters are brought to bear, I always will
    ask a question, many questions, about rural health care, along
    with Senator Collins here, and so I'll start with that
    generally.
        You represented a population, a dense, urban congressional
    district. So as HHS Secretary, how will you champion policies
    to provide what we both acknowledge is sorely needed with
    regards to health care in both urban and rural parts of the
    country? And specifically, how do you make sure that we have
    adequate representation when it comes to the priorities of HHS
    when it comes to accessing rural health care? Because our
    challenge is access to the care. When you don't have access to
    the care, it's costly and just very generally challenging.
        Mr. Becerra. Senator, first, thank you for that opportunity
    to chat with you previously. I enjoyed your laser focus on
    these issues, and I think it's appropriate.
        The challenges that the folks in your state face are unique
    to rural communities. Other states face it. But I think, as you
    explained so well, even for Alaska sometimes it's unique even
    among rural communities. And I will tell you that what we must
    do is make sure that we are prepared to meet those unique
    needs, whether it's the workforce--oftentimes we forget about
    that--the transportation obstacles that folks in the State of
    Alaska will face, dealing with broadband, just making sure
    there's access. Telehealth I know has become very important. We
    discussed that, as well.
        Let me tell you that the most important thing I can do is
    try to assure you that as much as the needs in rural America
    are unique, I always would tell folks when I was a member of
    the House that while I represented one of the most densely
    populated areas of the country, we had some of the greatest
    disparities. We didn't have to travel 1,500 miles to find the
    disparities. We could just travel 15 miles from East Los
    Angeles to Beverly Hills to see the disparities that existed.
        But again, rural communities do face a different challenge.
    Fifteen miles is very different from having to travel 1,500
    miles in one state. So I will say to you that what I should do
    more than anything else, if I'm fortunate to be confirmed, is
    take you up on that invitation to go to Alaska to see firsthand
    the challenges that the people in Alaska face.
        Senator Murkowski. Well, I would encourage that, and I
    would encourage that visit early.
        One of the areas where we have, I think, been innovative
    with regards to distribution of the COVID-19 vaccines that are
    out there is how, through the IHS, we've really been utilizing
    the experience of a distribution system that has been set up
    and, just again, an ability to make things happen, not because
    we're following somebody else's guidelines but because we know
    the need is there.
        You're going to be making some pretty key decisions with
    regards to funding allocations for provider relief, for
    testing, for vaccine distribution, and what I've been hearing
    from folks back home is when we get the vaccine, we are really
    good at pushing it out. In fact, we're number one in the
    country right now in terms of percentage of Alaskans that have
    been vaccinated. But I would ask for your support to make sure
    that when these funding allocation decisions are made, that
    funding for rural areas is going to be prioritized as well.
        Mr. Becerra. Senator, I know that you and Senator Manchin
    are working on legislation to do just that, and as I said to
    you in our conversation, I commit to you I'll be at that table
    talking with you and those who understand the unique needs of
    rural America. The last thing I need is to be one who doesn't
    address these disparities in an aggressive manner. As I said, I
    am fortunate that my mother is now 87 years of age. Most people
    in my neighborhood at that time did not have health insurance
    and probably would not have survived such a difficult time as
    seeing your mom whisked away to the hospital.
        Absolutely, I'm committed to working with you to make sure
    that we do, whether it's through resources or through the
    workforce, provide the types of services that are needed in
    rural America.
        Senator Murkowski. One thing about COVID-19 is we have
    really shone a spotlight on where these health disparities are.
        Mr. Becerra. Yes.
        Senator Murkowski. Focusing on those in rural areas I think
    is key.
        Thank you, Madam Chair.
        The Chair. Thank you, Senator Murkowski. I think we all
    agree on that. Thank you.
        Senator Baldwin.
        Senator Baldwin. Thank you, Chair Murray.
        Again, General Becerra, welcome to the HELP Committee. It's
    always good to see a familiar face from our days working
    together in the House on the Affordable Care Act.
        As Chair Murray indicated in her opening statement, the
    previous administration never put a priority emphasis on public
    health. They did not work to protect those with pre-existing
    health conditions. In the midst of the COVID-19 pandemic, the
    previous administration actually drilled down on their efforts,
    many different efforts, to sabotage our health care system,
    actively seeking to overturn the Affordable Care Act in court.
        As you know, this particular court case threatens to take
    away coverage to millions of Americans, people like a
    constituent of mine, Kirsten from Green Bay, Wisconsin. At 11
    days old, she was diagnosed with a serious heart defect, and
    she was airlifted to Children's Hospital in Milwaukee,
    Wisconsin to undergo closed heart surgery.
        Kirsten is now 24 years old, and because of the Affordable
    Care Act and the nearly 20 operations that she has undergone,
    she has had coverage. And she wrote to me, ``All of these
    procedures are the reason I'm alive today. Health care should
    be a right for all Americans and not a privilege for the few.''
    I couldn't agree more.
        I think I wanted to start with two overarching questions
    before digging down into some more specifics. As HHS Secretary,
    we have basically--to provide greater access, we have to not
    only repair the damage but also to build back better with our
    health care system. So I'm asking what are the key ways in
    which you could strengthen our health care system after the
    damage that's been done in the previous administration? What
    would you go after first? And then how would you work to build
    back better in ensuring that even more people have access to
    affordable, quality health care coverage?
        Mr. Becerra. Senator, thank you for the question, and it's
    great to see you again. I hope if all goes well and I'm
    fortunate to be confirmed, I will once again get to work with
    you, as I did for so many years when we were both in the House
    and then you went to the Senate.
        Let me tell you that I can just take the words of our
    President himself, because he too has said health care should
    be a right and not a privilege. That's a great place to start,
    if you have the most powerful person in the world saying that.
        Secondly, he has, as you mentioned, said that we must build
    on what we've had with the Affordable Care Act to make it
    stronger, to provide better quality care at more affordable
    prices.
        Two things I can tell you right off. One is something that
    the Administration has already moved on, and that is to have an
    open enrollment period, a special open enrollment period for
    Americans who have lost their insurance and who have never had
    it. Right now during COVID, this is the worst time to not be
    insured. So the open enrollment period will give a lot of
    Americans, millions of Americans, a chance to get covered
    again.
        Secondly, as you know, because I know this is important to
    you and Members in the Congress, we've got to deal with this
    cliff that so many Americans face. When they're in middle class
    status, if they happen to get a little too high in their
    income--and high doesn't mean high, just middle class--and you
    get a pay bump after last year, all of a sudden you find that
    you fall off this cliff when it comes to the tax credits that
    are made available to you through the Affordable Care Act to
    help you afford your insurance plan under the market exchanges
    in the Affordable Care Act.
        We've got to do something to address that cliff that too
    many families are facing to make the Affordable Care Act a
    reality for more families. There are any number of things that
    I know you've worked on that we can look at, but I want to just
    mention just those two principal ones, and if you'd like I can
    go further.
        Senator Baldwin. Thank you for that.
        I wanted to get into a very specific area of the COVID-19
    pandemic, and that's increasing--we know at the start of the
    pandemic, increasing our ability to test was essential to our
    ability to track down and slow the spread of the virus. The
    same is true for finding and tracking variants that we find now
    emerging. We can't afford to make the same mistakes we did at
    the early stages where testing was virtually unavailable.
        I've introduced a bill to assist the CDC with resources and
    to support its needs to dramatically scale up sequencing of
    coronavirus mutations. As HHS Secretary, how would you ensure
    that all of our Federal health agencies are working together to
    do their part and take on the next phase of this pandemic in
    tracking the emergence of these mutations?
        Mr. Becerra. I know that the time is short to respond, so
    I'll just say very quickly, one, we need to coordinate much
    better, whether it's within the Department of Labor when it
    comes to people who have insurance through their employer and
    what happens if they happen to lose their job, whether it's
    working with the Department of Education when it comes to the
    issue of how we reopen our schools, we need to just coordinate
    much better.
        I will tell you this, we have to be transparent. We have to
    use data to drive our decisions. We have to let the American
    public understand how we do that. And if we do it right, people
    will have faith that what we're proposing will work. I look
    forward to working with you and your colleagues to make sure
    that we have a partnership with the American people because
    they believe we know what will work.
        Senator Baldwin. Thank you.
        The Chair. Thank you, Senator Baldwin.
        Senator Braun.
        Senator Braun. Thank you, Madam Chair.
        I enjoyed our lengthy conversation when we visited the
    first time. I think it went well over a half-an-hour. I've got
    three questions; I want to tell you that up front.
        But for many of us, your record has been very extreme on
    abortion issues. Other pro-life groups have put a lot of
    information out there that basically you've been against pro-
    life on the record. Also some issues with religious liberty
    manifesting itself in where you actually took to court Little
    Sisters of the Poor.
        I'm not going to go into the details of that, I think it
    says enough, but I do want to ask you this question. If you get
    through the proceedings intact and you are the HHS Secretary,
    you're going to be representing everyone, and this is a very
    succinct question to the point. Will you commit to not using
    taxpayer money to fund abortions and abortion providers?
        Mr. Becerra. Senator, if I can start by first saying thank
    you very much for the lengthy conversation we had, I definitely
    appreciate it. And while we probably will not agree on all the
    issues, I can say to you that we will definitely follow the law
    when it comes to the use of Federal resources. So there I can
    make that commitment, that we will follow the law.
        Senator Braun. Not really the particular answer I was
    looking for, but I'll take that because I want to move on to
    the next question.
        Operation Warp Speed, I'll never forget in the early
    discussions we had with the FDA, CDC, there was squabbling
    within the bureaucracies about how we were going to get this
    effort made that we all knew even at that time, with the
    peculiarity of the disease, it was going to be the real light
    at the end of the tunnel. Being an entrepreneur, knowing how
    the business world works, knowing that pharma has been so
    stodgy with its record in terms of coming to the forefront with
    new cures and so forth, mostly impeded by some of the
    regulatory impediments, will you acknowledge that was probably
    the most important variable in this whole tough journey with
    COVID-19, that we broke the paradigm of how things normally
    work by galvanizing pharma to come up with vaccines that took
    basically one-fourth to one-fifth the time predicted before?
        Mr. Becerra. Senator, let me agree with you that had it not
    been that we essentially knocked some heads and said
    everybody's got to come to the table, and it's got to be the
    private sector working with our government and our local
    leaders, we probably wouldn't have had that success. What we've
    learned from COVID, what FDA has learned, I hope FDA has
    learned, and if I'm fortunate to be confirmed I'll make sure
    they've learned, that we can do things with a fast pace and
    still ensure safety.
        I think the gist of what you're asking is something that I
    agree with, and that is that we should take the lessons that we
    got from COVID so we can do this faster and smarter and safer
    the next time.
        Senator Braun. Would it be a stretch for you to say that
    you can give that credit to the Trump administration?
        Mr. Becerra. Certainly they worked on it very hard, and it
    was a whole-of-government, along with a private-sector
    response, and there are a lot of people to thank. But without
    the work that the previous administration did, we would
    certainly not be here.
        Senator Braun. Good. Now let's get to the part where we
    spent most of our discussion on. I, as the most vocal Senate
    Republican, have said since I've been here that the health care
    system is broken. Anything that costs twice as much as what it
    does elsewhere, delivering results, and I know we have some
    things that are stellar but generally not good. We had a robust
    discussion about whether you want to throw more government into
    a broken system, and here I think there would be government
    support if you're embracing the thing most popular next to term
    limits--next to term limits, which means it's up there around
    90 percent--health care transparency across the board.
        Before you answer, I notice that you're supported by the
    American Hospital Association, American Medical Association, 55
    to 60 percent the cost of our broken health care system; the
    Association of Health Insurance Plans. The only one missing is
    PhARMA, and I think I know why. Tell me that you would be there
    to push health care transparency to fix the system before you
    throw more government at it.
        Mr. Becerra. Senator, here I want to thank you for the work
    that you've done on this issue and, quite honestly, that
    Congress has done to try to move us forward. The American
    people are entitled to know what they're buying, and especially
    if it's a life-or-death situation.
        What I can say to you is we will do robust enforcement to
    make sure that price transparency is there for all Americans,
    because for far too long people have never had an idea of what
    they're going to pay if they walk into a hospital.
        Senator Braun. Thank you.
        Mr. Becerra. Thank you.
        The Chair. Thank you, Senator Braun.
        Senator Murphy.
        Senator Murphy. Thank you very much, Madam Chair.
        Let me concede Senator Burr's point that just because you
    sit on a committee of jurisdiction in Congress does not make
    any of us subject-matter experts on the areas in which we hold
    hearings. But sitting before us is a health care expert. I have
    worked with him very closely in the House on the development of
    the ACA. I've watched his work as Attorney General. This is
    someone who is in the weeds of health care policy, health care
    coverage, and I think we're very lucky to have him lined up to
    be the next Secretary.
        I wanted to, frankly, build off of Senator Braun's
    comments, because I think the health care industry delights
    when we spend all of our time here talking about who pays
    instead of how much we're paying. I mean, we talk about health
    care in this country as if it is primarily a question of
    coverage, whereas the real problem here is a problem of price.
        You've done a lot of work in this area. I think a lot about
    the Sutter Health case in which you went after a huge health
    care provider that had essentially cornered the market so as to
    drive up the cost of deliveries in the Sacramento area so that
    nobody in the country was paying more than families were to
    deliver a baby there.
        From your experience working in this area of trying to
    assure competition both in the provider space and the insurer
    space so as to drive down prices, what do you envision the
    Federal Government is able to do to try to make the
    marketplace? And I think transparency is a piece of this, but
    some of this is also just anti-competitive practices amongst
    providers and insurers. What can the Federal Government do here
    to try to have a functional marketplace in which prices are
    going down rather than being set?
        Mr. Becerra. Senator, first, I appreciate the question, and
    it's great to see you again, and I hope to have a chance to
    work with you, as well, in the future.
        I actually think Senator Braun hits on something very
    important, transparency. If consumers knew what they were
    paying, they would really push to make sure prices go down, not
    just that they know the price but that the price goes down.
    That's why our effort was supported up and down the State of
    California when we went after the largest health care provider
    in northern California, because people just had an instinctive
    feeling that the prices they were paying were way too high.
        What we have to do is be able to go behind the curtain. You
    have to be able to see how they're operating, how they're
    cutting some of these deals, and that is important. You all can
    help in Congress to give us the tools to enforce, and I would
    hope that I could work with you in the future to make that
    happen should I have the good fortune to be confirmed.
        I would also tell you this, that we want to always spur
    innovation, and we need the pharmaceutical industry in America
    to always feel like we've got their back to innovate. COVID is
    a perfect example of how we can come up with a vaccine. But we
    have to make sure that we're getting our dollars' worth, and I
    think this is where you all can give us more tools to make sure
    that we're getting our money's worth from all the different
    stakeholders in the industry.
        Senator Murphy. I think transparency is a great place to
    start. I think there are limits to the gains you can get with
    respect to transparency alone, because the most expensive
    interventions that people have with the health care system are
    often at the moment when they are least able to shop around. So
    I think the work that you've done to try to really go after
    these monopolies or these quasi-monopolies, that I think is
    really important, and I look forward to working with you on
    that.
        My second question is around another issue that I know is
    very important to you, and that's mental health parity. We have
    a great bipartisan coalition on this issue because we've
    already got a law on the books that says insurers have to cover
    mental health just like they cover physical health, but we know
    that's not really how it works out there. Anybody who has a
    child with a mental health diagnosis can tell you they've got
    to go through hoops and red tape and bureaucracy that nobody
    has to go through when they are trying to get a cancer
    treatment or reimbursement for an orthopedic procedure.
        Tell us a little bit about your commitment to this issue,
    how you think that HHS can really push forward, because we
    don't necessarily have to spend a lot more money here, we can
    just make sure insurance companies are actually providing the
    benefit that they have promised to people, and we'll get a
    whole bunch more mental health coverage paid for.
        Mr. Becerra. Senator, you said it right. I could take you
    back more than 30 years when I started working on this issue
    representing folks who had mental disabilities. We have, as you
    said, laws in place; we've just got to enforce them. We have to
    do the oversight, and there I would look forward to working
    with you to do that oversight to make sure that the
    stakeholders in our health system are applying the law
    correctly.
        We have to make sure that we don't let people fall through
    those cracks. We have to coordinate with the Department of
    Labor, because the Department of Labor has a lot to do with how
    these programs are implemented to get us to parity when it
    comes to mental health services.
        We can do a lot, and I know many of you are trying to work
    on this. I look forward to working with you on this because it
    is the hidden secret out there that everybody knows about the
    need to do more, but too often what's left in the crevice is
    reaching parity when it comes to mental health services.
        Senator Murphy. Great.
        Thank you, Madam Chair.
        The Chair. Thank you very much.
        Senator Romney.
        Senator Romney. Thank you, Madam Chair.
        Mr. Becerra, good to see you again. I appreciated our
    meeting; it was very informative.
        Just a couple of comments based on the conversation that's
    been going on with Senator Murphy and Senator Braun. In the
    State of Massachusetts, where I served for a number of years,
    we did put in place an extensive transparency program. It gives
    very good data on the cost of various procedures in different
    hospitals, for instance, as well as their success rate in those
    procedures.
        But interestingly, the consumer has very little interest in
    that data because for them, the price is zero. In our system,
    individuals do not have an incentive to shop around for bypass
    surgery, for instance, even if they have time to prepare for
    it, because it's free. Once you go past your deductible, and
    many people have gone through their deductible during the year,
    it's paid for 100 percent by their insurer or the Federal
    Government, and so it's free. So they don't care whether it
    costs $10,000 or $100,000 to have bypass surgery.
        I'd suggest that it's important in your role to look at how
    we create a true marketplace, as Senator Murphy was indicating,
    which means that the consumer has interest in what something
    costs and therefore is anxious to shop around, particularly for
    elective surgeries and other high-cost treatments. Health
    savings accounts does that. In other countries they have co-
    insurance as a way of increasing a marketplace. So I'd just
    offer that as a thought.
        There's a division in our country with regards to the issue
    of abortion, of course, as you know, and mainstream Republicans
    and Democrats disagree. But most people agree that partial
    birth abortion is awful. You voted against a ban on partial
    birth abortion. Why?
        Mr. Becerra. Senator, here I understand that people have
    different deeply held beliefs on this issue, and I respect
    that. I have worked, as I mentioned, for decades trying to
    protect the health of men and women, young and old. And as
    Attorney General my job has been to follow the law and make
    sure others are following the law. And I'm also sitting in
    front of a high-risk Ob/Gyn who for several decades had the
    work of protecting the health of women and a future baby.
        I will tell you that when I come to these issues I
    understand that we may not always agree on where to go, but I
    think we can find some common ground on these issues because
    everyone wants to make sure that if you have an opportunity,
    you're going to live a healthy life. I will tell you that I
    hope to be able to work with you and others to reach that
    common ground on so many different issues.
        Senator Romney. I think we can reach common ground on many
    issues, but on partial birth abortion it sounds like we're not
    going to reach common ground there.
        Let me turn to Medicare. You want to expand Medicare, as
    the President does. Our current Medicare program is on track to
    go bankrupt. The Trust Act is going completely insolvent. How
    are we going to expand something that's already on the track to
    go bankrupt? What's the answer? And this is obviously of grave
    concern not just with respect to Medicare, but Medicare is the
    biggest one. It's the largest portion of our Federal spending
    that's growing much faster than the economy and which has the
    potential to sink our economic standing.
        Mr. Becerra. I believe all of us will agree that our
    Medicare beneficiaries, seniors who paid into the system for so
    many years, should not be the ones who suffer when it comes
    to----
        Senator Romney. Totally agree. No one on either side of the
    aisle thinks that people who have retired or who are near
    retirement ought to see any change in the program that would
    affect the quality of care they receive or the benefits, no
    question.
        Mr. Becerra. I appreciate you saying that. So really that
    means we're on track to--we have consensus that we have to find
    a solution, and here's where I'll tell you one of the things
    that President Biden has proposed is to allow Americans to
    essentially buy into what is considered Medicare at an earlier
    age. But rather than use the current Medicare system, which, as
    you mentioned, involves a trust fund, he would try to bring
    some revenue in from the general fund so that we're not
    impacting the trust fund.
        There are ways to do this----
        Senator Romney. Well, we do spend a lot of money from the
    general fund now.
        Mr. Becerra. We do. Yes, we do. But as we said, the
    priority should be to make sure Americans have good quality
    health care.
        Senator Romney. I think we've pointed out that we have a
    problem here, which is if it's already running a huge red-ink
    program, expanding it is not going to make things easier. We're
    going to have to find some way to make this work, and I don't
    know that the Administration has determined what that might be.
        My last brief question is this, which is that California
    has a lot going for it--the sun, the high-tech sector, great
    universities--but it's also known for high taxes and high
    regulation. Businesses have been leaving California. My state
    is a great beneficiary of that. Republicans say watch out, if
    the Democrats get in charge, they'll make the whole country
    like California.
        Is that true? Is California working, or is California
    making a mess of things?
        Mr. Becerra. First let me tell you, thank you for
    applauding many of the things that California does. But
    California has recognized that we're one of 50 states. I will
    say this: We may be one of 50 states, but we're the fifth
    economic power in the world. We create more jobs----
        Senator Romney. Well, you're big.
        Mr. Becerra. Yes, we are. But there are a whole bunch of
    big countries that can't do what California does. What we've
    been successful at is graduating more people from college than
    anyone else, having the number-one industry in high-tech, at
    the same time we're No. 1 in agriculture, we're No. 1 in
    manufacturing, if you believe that, just as we're No. 1 in
    entertainment and tourism. We have been able to bring
    innovators to the state.
        But you're right, we have to face a lot of challenges as
    well, and I think California recognizes that. We are fortunate
    to be part of this great country we call America, and so I
    thank you for giving me a chance to boast about my state.
        The Chair. Thank you, Senator Romney.
        We will turn to Senator Kaine.
        Senator Kaine. Thank you, Madam Chair.
        Thank you, Attorney General Becerra. Congratulations on
    your nomination.
        There's been some discussion around the table about your
    experience, and I just was reflecting that as Lieutenant
    Governor, Governor, Senator, I've worked with six HHS
    secretaries. Five have been attorneys or business people, and
    they've had multi-year tenures. One was a physician, and his
    tenure was measured in a matter of a few months. That's not to
    say that a physician couldn't be a great HHS secretary, but
    we've had plenty of good business folks and lawyers who have
    been strong HHS secretaries of both parties.
        Here's what I like about your experience, and not only your
    time in Congress working on the pivotal laws that will inform
    much of the work that you do, but I like that you are coming
    from a state government. I was, frankly, at the beginning of
    the Biden administration, a little nervous when I saw the COVID
    panel put together. It didn't have a lot of people with state-
    level implementation expertise. The fact that you are coming as
    the Attorney General of California with state-level experience,
    that you have a nominee to be your assistant secretary for
    health, Dr. Rachel Levine, who is the chief health official for
    the Commonwealth of Pennsylvania and the President of the
    National Association of State and Territorial Health Officials,
    I think that will put in the top two health spots in HHS a
    strong state focus.
        We can do all kinds of great things here. If they're not
    able to be implemented at the state level, what good are they?
    So I appreciate that aspect of your experience.
        Let me move to my questions, so many things I want to ask
    you about.
        I'm very, very concerned about the mental health needs of
    our health care workers. What they've experienced before COVID,
    but certainly since March, on an unprecedented scale, having
    them manage end-of-life discussions with patients, holding
    iPads in front of their faces so they can talk with their
    family because their family can't come into the hospital, this
    is going to have a significant consequence in our health care
    profession for a very long time.
        We also have health care workers who still, still today,
    are worried about seeking mental health counseling because of
    stigma, because of concern about licensing or credentialing or
    that they could, through some regulatory move at the state
    level, face career-ending or--jeopardizing consequences.
        You're married to a physician. Tell me the ways you would
    prioritize the mental health of our doctors, nurses, and health
    care professionals should you be confirmed as HHS Secretary.
        Mr. Becerra. Senator--by the way, first, thank you for the
    work you've done on this issue for so long. And you're right,
    at the state level, when you're in government at the state
    level, that's where the rubber hits the road. What you all do
    in Congress, what I used to do when I was a member of the
    House, is come up with the ideas, and we pass it into law, but
    it's the state elected leadership that has to make it work. And
    I have done everything I can to make sure that California,
    through the leadership of our Governor and our state leaders,
    is putting into effect the safety protocols and all the regimes
    necessary to make sure that we move forward.
        On the mental health of our workers, public health workers
    especially, we have to make sure we provide them with the
    resources. Two, they should know that they are essential and
    they will be priority one when it comes to vaccines. Three, we
    have to make sure that they are rewarded. They should not have
    to worry about whether they have enough money coming home to
    feed the family. We also have to make sure that we don't give
    stigma to getting mental health services. I faced this a lot in
    law enforcement with peace officers who are afraid oftentimes
    to get mental health services because they're afraid that will
    go on their record and it will deprive them of opportunities to
    continue forward.
        We have to make providing mental health services something
    that's part of life. Just like you get an annual check-up,
    mental health should be part of that, as well. And that goes
    back to a previous conversation about making sure that we treat
    mental health the same way we treat physical health. If we
    provide the resources to provide parity to mental health, then
    we'll prove to people that we're serious about addressing
    mental health concerns.
        Senator Kaine. Thank you, Mr. Attorney General. Today,
    Senator Bennet and I are reintroducing a bill we have called
    Medicare-X, which is a vigorous public option bill that's
    similar to what President Biden campaigned on. I'm not going to
    ask about that because we're just introducing it, but I hope to
    have the opportunity to work with you.
        One last question, and this is back to the state issue,
    coordinating with Governors and state officials. The acting HHS
    Secretary recently indicated that it's likely that the public
    health emergency related to COVID might be extended throughout
    2021. Talk a little bit about how you would work with Governors
    and others as the Administration is making that decision so
    that they can have ample planning time for the ending of the
    emergency period.
        Mr. Becerra. Certainly, Senator. First, science and data
    have to drive our decisions. If there's going to be a
    declaration of an emergency, a health emergency, or a
    continuation of it, it has to be based on real data, something
    that gives us that information.
        Secondly, we have to be in partnership with the folks who
    have to implement it. As I said before, we can say what we've
    got to do, but it's the folks who have to do it who have to
    make it work, and so we have to do that in partnership. That
    means bringing the information to them early so they're part of
    those data-driven solutions----
        Senator Kaine. I'm over my time, and I want to be
    respectful of my colleagues, but thank you very much.
        Madam Chair, I yield back.
        Mr. Becerra. Thank you.
        The Chair. Thank you so much, Senator Kaine.
        I understand that Senator Marshall has not returned;
    correct?
        Senator Burr. That's correct, Madam Chair.
        The Chair. Okay. So I'll turn it to Senator Hassan.
        Senator Hassan. Well, thank you, Madam Chair and Ranking
    Member Burr.
        Welcome, Attorney General Becerra. Thank you for being here
    today, for your interest in service, and thank you to your
    family too, because this is a family commitment, so we deeply
    appreciate your service.
        Mr. Becerra. Thank you.
        Senator Hassan. I want to start with talking to you about
    the opioid epidemic. As you know, it has devastated communities
    all across my state. Since 2017, I've worked with colleagues to
    secure billions of dollars in state opioid response grants,
    including more than $86 billion for New Hampshire. This funding
    has enabled states to expand access to life-saving treatment
    and services for those struggling with substance misuse, and
    we're finally beginning to see results, with death rates
    decreasing.
        But I am deeply concerned that hard-won progress is in
    jeopardy because the hardest-hit states, including New
    Hampshire, are at serious risk of a dramatic cut in state
    opioid response grant levels under the program's current
    funding formula.
        Mr. Becerra, if confirmed, will you commit to working with
    me and the Substance Abuse and Mental Health Services
    Administration, SAMHSA, to ensure that states do not experience
    a dramatic cut in state opioid response grant funding, a cut
    that could jeopardize our efforts to turn the tide on the
    opioid epidemic?
        Mr. Becerra. Senator, absolutely, you have that commitment.
        Senator Hassan. Well, thank you.
        I want to turn now to another issue connected to substance
    misuse. As you know, one major hurdle that keeps people who
    have substance use disorder from accessing the support and
    treatment that they need is the existence of the so-called X
    waiver, the requirement that doctors who want to prescribe
    medication-assisted treatment receive a waiver or essentially
    permission in order to prescribe buprenorphine. This waiver
    limits the number of medical professionals who are able to
    prescribe this treatment even though it's considered the gold
    standard in medication-assisted treatment. The waiver
    requirement does not improve patient safety, but it does limit
    access to care. About 40 percent of counties across the United
    States lack a waivered practitioner who is able to provide this
    treatment.
        Senator Murkowski and I plan to reintroduce our bipartisan
    MAT Act, which would eliminate the burdensome waiver
    requirement. We also sent a letter to President Biden inviting
    him to work with our bipartisan group of Senators and
    representatives on this issue, and we are encouraged that he
    has expressed support for this change.
        Do you agree with President Biden about the need to
    eliminate this waiver, and will you commit to working with our
    bipartisan group on this much needed reform?
        Mr. Becerra. First, thank you for the work that you and
    Senator Murkowski have done on this issue. As you said,
    President Biden is supportive of moving forward. We have a
    pause, as you know, on a number of these rules that are in
    place, but I think there's a commitment on the part of this
    administration to make sure we're providing that treatment that
    is indispensable for so many families.
        Senator Hassan. Yes, it is one of the sad and disturbing
    ironies of this crisis that doctors don't need special
    permission to prescribe opioids but they do need special
    permission to prescribe the medication that would help people
    combat the disorder and get better.
        Mr. Becerra. If I could just add, Senator, I think here the
    President's goal is to get it right.
        Senator Hassan. Right.
        Mr. Becerra. We don't want to end up in court and delay it
    even further.
        Senator Hassan. Right, I understand that.
        Let me turn to another issue. As you know, Senator Cassidy
    and I spent several years working with former HELP Committee
    Chairman Alexander and current Chair Murray on bipartisan
    legislation to end the practice of surprise medical billing. It
    was a great example of the type of bipartisan work that can be
    accomplished in the Congress when we work together to find
    commonsense solutions.
        Now that the surprise medical billing legislation has been
    signed into law, the responsibility to implement these
    protections will fall to the Department of Health and Human
    Services. So if confirmed, you're going to be responsible for
    implementing these policies quickly and in a manner that
    protects consumers and reflects congressional intent.
        If confirmed, will you commit to working with us on a
    bipartisan basis to ensure that one year from now the rules
    issued by HHS include strong protections for consumers that
    reflect the priorities and intent of our legislation?
        Mr. Becerra. Senator, we've got until the beginning of 2022
    to get this done. I know this one is important to you and so
    many. Thank you for the work you did to succeed. I hope we are
    truly a partner with you on this, and I know that we've got to
    get this arbitration provision right, along with the consumer
    protection.
        Senator Hassan. Well, thank you for that. I appreciate that
    commitment and look forward to working with you.
        Just one last thing. We're all grateful to the scientists
    and public health experts who worked so quickly to develop the
    Moderna and Pfizer vaccines. I believe in their effectiveness.
    But we also know that we are seeing the emergence of new COVID-
    19 variants and that we're going to need to continue research
    and surveillance efforts so that we can continue to develop
    effective treatments and vaccines.
        What steps do you believe we have to take to be prepared to
    respond to the emergence of these new variants and protect our
    vulnerable populations?
        Mr. Becerra. Senator, sequencing is so critical. We have to
    have the scientists tell us what the next iteration of that
    virus may look like. We have to stay ahead of the game because
    we're now with this vaccine getting a grip on COVID. But if a
    variant takes off, we don't want to go back to square one. So
    we need to be doing the sequencing. We need to provide the
    scientists with what they need. We have to also rely on data.
    But we have a tremendous job to do to make sure we stay ahead
    of the variants.
        Senator Hassan. Thank you very much.
        Thank you, Madam Chair.
        The Chair. Senator Hassan, thank you so much.
        I believe we have Senator Rosen available. Senator Burr,
    did you want to go next, or----
        Senator Burr. Senator Rosen is fine, Senator Murray.
        The Chair. Okay. I'm going to go over and vote and return.
    So on our side I believe we have Senator Rosen and Senator
    Smith. I will let them go. Do you want to go in-between them or
    after them?
        Senator Burr. No, we'll keep the order. If another
    Republican comes in the meantime, we'll swap them in. But I'll
    go vote, as well as you.
        The Chair. Okay. If we can do that, then, we'll go to
    Senator Rosen, Senator Smith. If a Republican comes in, we'll
    put him or her between you, and Senator Burr and I will return.
        Senator Rosen. Okay. Thank you, Madam Chair and Ranking
    Member.
        Here we are. Thank you, Mr. Becerra, for being here with us
    today. Thank you for your commitment to serving our Nation. I
    really appreciate the great and productive conversation that we
    had at the meeting last week. I look forward to learning more
    about your plans to combat the pandemic, to quickly distribute
    the vaccines, address our Nation's provider shortage which we
    know is really important, and increase our access to quality,
    affordable health care. I do urge this Committee to facilitate
    a swift confirmation for Mr. Becerra so he can get immediately
    to work.
        Vaccines are on everybody's minds, right? Of course, the
    pandemic has hit Nevada particularly hard, especially with so
    much of our economy relying on the travel and tourism industry.
    The best way to revive Nevada's economy and save lives is to
    increase the number of vaccines. We have to continue to build
    on the good work that President Biden has already done and work
    together to make sure that no one is left behind and that the
    response is equitable.
        Mr. Becerra, we see more vaccines coming into our states
    over the last few weeks, but it's really critical that the
    allocation formula is updated with the most recent population
    data so rapidly growing states like Nevada get their fair
    share. Will you commit to be sure that all the data is as up to
    date as possible as we begin to distribute--continue to
    distribute vaccines across the country?
        Mr. Becerra. Senator, thank you for the question; and, by
    the way, just for the yeoman's work that you and others have
    done in the State of Nevada, which is probably one of the
    hardest-hit states.
        Absolutely, I commit. We will work with you to make sure
    that the data is accurate. We want to make sure, as I said
    before, that we are sending the product, the vaccines, all that
    is needed, where it is needed most, and so we definitely look
    forward to working with you to make sure Nevada gets its fair
    share.
        Senator Rosen. Thank you. Another issue, of course, we
    always have this problem in Nevada and many places across the
    country, but the pandemic has really shone a spotlight on that,
    our provider shortage issue in every county. Every county in
    Nevada has a shortage of health care providers. The pandemic
    has accelerated the urgency for us to address these issues and
    all the challenges that surround it. Our state ranks last for
    per capita number of general surgeons, 48th for primary care,
    and 45th for physicians overall.
        Some Nevadans in our rural areas travel about 300 miles
    just to find a specialist to provide the care they need. We're
    working hard to increase our number of doctors. The University
    of Nevada Las Vegas School of Medicine are graduating their
    non-rural class this year, so that's great for our state, but
    we have to do more. We have to increase our graduate medical
    education slots. These are critical to addressing our provider
    shortages, the slots that were included in the last recovery
    package, but of course we have to do more.
        Will you commit to working with us to ensure that Nevada
    institutions and other states with similar issues as ours
    receive their fair share of the new graduate medical education
    slots? And what else do you think you can do to help us
    increase our provider shortages across the medical spectrum of
    doctors, nurses, and the like?
        Mr. Becerra. Senator, thank you for the question. First I
    have to say thank you to you and your colleagues for including
    the 1,000 slots, the GME slots for graduate medical education
    so that we could actually see those future doctors in places
    like Nevada and throughout the country, so thank you for that.
        As you know, President Biden has made the commitment. He
    wants to put 100,000 new public health workers out there to
    help states like Nevada make sure that you're reaching all your
    communities and protecting them with vaccines and all the
    different types of things we have to do to protect them from
    COVID, and we just have to be there, generally speaking, for
    the long term. My wife has mentioned to me how it looks like
    there's an increasing number of Americans who are applying to
    medical school. Maybe it's because they've seen just the yeoman
    effort performed by so many medical professionals and they see
    that as a truly worthy profession to be in. Whatever it is, we
    should take it and we should reward those who go into the
    health professions.
        I look forward to working with you and your colleagues to
    make sure that becomes a reality so we can service the needs of
    all our people.
        Senator Rosen. Thank you very much. And just in the quick
    time I have left, I just want to know what you think we should
    do in communities of color. Some of our minority communities,
    COVID has hit them the very hardest. How do we ensure greater
    protections for them? What are you planning to do in that
    regard?
        Mr. Becerra. Senator, thank you for the question. I look
    forward to working with you on this. Let's just use data to
    drive decisions so that they're done transparently. Let's make
    sure that we make every effort to reach everyone. Some
    communities, whether rural or inner-city urban, we'll need
    mobile clinics so we make sure they get the COVID vaccination.
    We can do things, but we have to work with those communities,
    use their civic and religious leaders that they respect to help
    us reach populations that too often have gone absent.
        Senator Rosen. Thank you so much. I think my time has
    expired. I look forward to working with you and this
    administration. Thank you.
        Mr. Becerra. Thank you.
        Senator Smith. Attorney General Becerra, this is Senator
    Smith calling in. I think since everybody is now in the midst
    of voting, I'll just jump in here and have a chance to ask my
    questions.
        It's great to see you again. I want to congratulate you on
    your nomination. I so enjoyed the chance to talk with you a
    couple of weeks ago I guess it was, and I could hear in your
    comments your commitment to public service and your deep belief
    in the power that we have to do good for people in this role,
    which I really appreciate.
        We are nearly a year into this economic crisis and public
    health crisis caused by COVID, and we're not going to get out
    of the economic crisis before dealing with the public health
    crisis, and we know that this is going to require significant
    leadership and a national strategy. This has been what many of
    my colleagues have been talking about today as we ask you
    questions about this.
        I want to just say at the outset that you clearly have the
    experience and the record of accomplishment to lead the
    Department of Health and Human Services. This is a large and
    complicated, massive agency with significant responsibilities.
    I just want to point out or remind everybody that as California
    Attorney General, you run one of the largest state departments
    of justice in the country, and that you've also spent over 30
    years of your career in public service fighting to help
    patients and families get the care that they need. Your record
    of standing up to price gouging by large hospital chains,
    taking on the big opioid manufacturers, defending the health
    care for millions of Americans is a record of accomplishment
    that I think qualifies you so well for this position. So, thank
    you.
        Mr. Becerra. Thank you very much for that, and I look
    forward, if I'm fortunate to be confirmed, to work with you on
    some of these issues, and I hope you'll invite me to your great
    state. I have so many good friends, including your attorney
    general, who I would love to see, and there are many things to
    do.
        Senator Smith. Yes, that's right. You and Attorney General
    Ellison have joined forces on many issues, especially and
    including holding these big pharmaceutical companies
    accountable for price gouging. So I'm grateful for your work.
        I want to take my time that I have left talking to you a
    little bit about another area of great importance to me and to
    so many families and businesses in my state, which is the issue
    of child care. Even before the pandemic, families were really
    struggling to find affordable, high-quality child care. This is
    an issue across the country and across my state, in rural areas
    as well as in metropolitan areas.
        I have spoken to parents in Minnesota who are confronted
    with driving 50 miles to take their children to the child care
    center, to the child care provider that they can find, and this
    challenge has become even worse with COVID because so many
    child care providers have literally gone out of business or had
    to close their doors because of the challenges that they faced.
        This is why I have worked so closely and hard with Senator
    Murray and also Senator Warren to call on Congress to provide
    $50 billion of relief to stabilize the child care system,
    because child care is essentially infrastructure for our
    families. I know that you have a real interest in this and that
    you understand the importance of elevating human services as
    part of health and human services in your role.
        Could you please talk to us a little bit about your
    priorities when it comes to child care, high-quality affordable
    child care, how you see this challenge, and what you'd like to
    see us do to make sure that child care is available for
    families so that we can keep women in the workforce and we make
    sure our kids are getting the very best start?
        Mr. Becerra. Senator, thank you for the question. You were
    breaking up a bit, but I do believe you were asking how we
    would meet this challenge of providing child care to American
    families. What I can tell you is, first, I hope you have great
    success with your colleagues in trying to move your legislation
    forward. We need to stabilize this field because child care
    providers have been some of the hardest hit in America because
    of COVID. The services they provide, especially when they're
    done well and safely, are indispensable to the rest of America
    that needs to get back to work.
        I hope to work with you, if I'm fortunate to be confirmed,
    to try to move on this because I think now America--maybe 30 or
    40 years ago we hadn't settled on this, but now America
    realizes how important our child care workers are to our
    livelihood, to our economy, and I hope that you have success as
    you move forward, and I look forward to using the tools at HHS,
    if I'm fortunate to be confirmed, to help you get there.
        Senator Smith. Well, thank you. I look forward to working
    with you on that. This is a crucially important issue, so thank
    you very much.
        Mr. Becerra. Thank you.
        Senator Smith. Madam Chair, I'll give back my time.
        The Chair. Okay. Thank you so much, Senator Smith.
        We will turn to Senator Tuberville.
        Senator Tuberville. Thank you, Madam Chair.
        Good morning.
        Mr. Becerra. Senator, good to see you again.
        Senator Tuberville. A couple of questions real quick.
        Mr. Becerra. Yes, sir.
        Senator Tuberville. I'm concerned about President Biden's
    freeze, as we talked about some of those regulations that
    President Trump had put in. As HHS Secretary, how are we going
    to get the price of insulin down? We've got to get it down.
    People can't afford it.
        Mr. Becerra. Very quickly on the issue of the freeze, I
    think pretty much every administration when they come in, they
    want to take a look at the landscape and see where things are
    so as they come in they can move forward. So there is a pause
    in many of the rules that were being proposed and moved
    forward, but I guarantee you that as quickly as the President
    and his team can, we will get back to moving forward on some of
    these administrative actions.
        In terms of insulin, first, Senator, thank you for the--
    actually, I thought it was a great conversation. I hope I
    didn't take up too much of your time. You were gracious with
    your time.
        On insulin, patients have to come first. We have to make
    sure that they're not going to get caught in this mess about
    how much it costs. But there's no reason why the price of
    insulin should jump by essentially 100 percent overnight, and
    we have to deal with that. We want to make sure the drug
    manufacturers are properly compensated, but at the same time
    these are life-saving medications that people need, and we have
    to make them available. So I look forward to working with you
    and your colleagues to make sure we can do that.
        Senator Tuberville. One other thing I'm concerned about
    with drugs. I talk to rural pharmacies, especially in the State
    of Alabama. They're like hospitals. They're like doctors'
    offices, because they're the only connection they have to
    health care in some of these areas. We're losing some of them
    because of PBMs. They're getting priced out. I saw the good
    work you've done with several attorney generals across the
    country. Please explain your plan with PBMs and cutting out a
    little bit of that middleman where our pharmacies can make some
    money.
        Mr. Becerra. Yes. The Pharmaceutical Benefit Managers have
    a role, right? But, as we discussed----
        Senator Tuberville. I haven't figured it out yet, but----
        Mr. Becerra. Well, the role can't be to just be middlemen
    and to gouge the price and take too big a cut, but they do play
    an indispensable part in the way we run through the process of
    dispensing medications. And so what we have to do is keep them
    on their toes; and, as you mentioned, on a bipartisan basis. A
    number of us, state AGs, took on the PBMs, because at the end
    of the day they're supposed to serve the purpose of getting a
    good price for Medicare for the drugs that our seniors need. So
    we didn't come up with a solution just as state AGs. Much of
    this has to be done at the Federal level, and I look forward to
    working with you on that because they serve a purpose, but it's
    got to be the purpose of getting good priced medication to our
    seniors.
        Senator Tuberville. It seems like they're working more for
    the bigger pharmacies, and the hospitals and the smaller
    pharmacies are paying these rebates, and they're paying all
    their profits. We just can't lose them in these rural areas
    across the country. If we do, we're going to be in serious
    trouble because we're losing--in Alabama, for instance, we've
    lost 14 hospitals in 10 years, rural hospitals, and the only
    thing they have left is a pharmacy.
        When you're confirmed, I'd love for you to pay close
    attention to them, make sure these people make a little money,
    make a little money so they can stay open.
        Mr. Becerra. I'm looking forward to working with you, if
    I'm fortunate to get confirmed, because, as you said, the
    little guy, especially since they service some of the small
    communities, should not be the ones that lose because the big
    guys are trampling all over them. So I look forward to working
    with you.
        Senator Tuberville. Thank you. Thank you very much.
        Thank you, Madam Chair.
        Mr. Becerra. Thank you, Senator.
        The Chair. Thank you.
        Senator Marshall, I believe that Senator Marshall--or
    Senator Moran is not back; is that correct? I believe that is
    true.
        Sorry, Attorney General Becerra. We have Members and folks
    who are coming and going. I know that Senator Burr is going to
    return in a minute.
        Is Senator Marshall available?
        Senator Marshall. Yes.
        The Chair. Great. I will turn it to Senator Marshall.
        Senator Marshall. Okay, Madam Chair. Thank you so much.
        Welcome to the hearing here, Mr. Becerra. We're glad to
    have you.
        I want to first, if I could, just submit for the record the
    vaccine distribution plans from every state in the Union. I
    think that we had most of these back in October. Maybe there
    was some confusion about those, and we've got all 50 of them
    here, if that's Okay with you, Madam Chair.
        The Chair. Yes.
        [The information referred to can be found on page 144.]
        Senator Marshall. Let's talk, first of all, about maybe
    pharmacy prices. Over the past three to four years, pharmacy
    prices have pretty well stabilized in this country, between no
    growth in price to maybe 2 percent. And my question is what
    stabilized the price, and what role do you feel that Pharmacy
    Benefit Managers have to do with the price of pharmacies at the
    counter?
        Mr. Becerra. Senator, thank you very much for the chance to
    answer the question. Senator Tuberville just touched on that
    issue.
        As I mentioned, PBMs play a role. They have an important
    role to make sure that we get these prescription medications to
    the source, to the consumer, to the senior on Medicare, and so
    we have to make sure that everyone is doing their part. Right
    now, we see that there's a growing fight developing between the
    manufacturers of these medications and PBMs and the providers,
    and what we have to do is make sure that, at the end of the
    day, our seniors aren't the ones that pay the price. They're
    the ones that need the drugs. We have to make sure they get
    them at a good cost.
        I can't tell you I can give you the solution in the time
    that you have, in the five minutes, but I certainly am willing
    to work with you because that is before us right now.
        Senator Marshall. How many Pharmacy Benefit Managers are
    there, and how much of the market do they control?
        Mr. Becerra. That's a great question. I can try to get back
    to you on that one.
        Senator Marshall. Well, I think there's four of them, and
    they control over 80 percent of the market.
        You know, one of my concerns as I look over at HHS and the
    office here, I've been there once or three times, and I look
    around, there's lots of lawyers, lots of bureaucrats, but how
    many nurses and pharmacists and doctors and those type of
    people are actually working here in Washington, DC. at HHS?
    What percentage of your staff of--what is it, 80,000 people?
        Mr. Becerra. Well, first, you're gracious to call them my
    staff. I have not yet been confirmed. I hope that's a signal
    that maybe I will be confirmed. A great number of them are
    health care professionals. Certainly the people that are at the
    top levels of some of our important agencies--CDC, NIH, FDA--
    have health care and medical backgrounds. And we're going to
    make sure that the team--and I know this from speaking to the
    President--that the team in place at HHS will have the
    expertise that we need to do all the work, because HHS isn't
    just about delivering on services in health care, it's about
    being good stewards of the purse because, as someone said
    earlier, HHS has the largest budget of any Federal agency,
    including Department of Defense.
        Senator Marshall. All right. Let's talk about value-based
    health care for a second. Some of the legislation that we
    worked on is legislation called the regulatory sprint to
    coordinated care, and what that had to do with was stop anti-
    kickback for doctors that are participating in value-based
    care, and another one of our signature legislations we worked
    on is prior authorization issues. I'm a practicing doctor
    myself. It's pretty cumbersome to have a person who has never
    practiced medicine tell me I can't do a surgery that I think is
    necessary.
        Just in general, how do you feel about value-based health
    care and what its impact could be on, frankly, the cost and the
    quality of health care?
        Mr. Becerra. First, if I could just comment and say this is
    where the practical work that you have done informs the work
    that Congress must do, because you can talk about these things
    not just from your own thoughts but because of your practice.
        What I will tell you is that when it comes to making sure
    that we are administering these programs, we have to make--
    forgive me. Can you pose the question again? Because I was
    going to go off on a different tangent.
        Senator Marshall. Yes. What do you think of value-based
    health care, and in particular allowing physicians to
    participate in value health care arrangements?
        Mr. Becerra. If we have time I'll go to the point I was
    going to make, but I know your time is expiring. We have been
    moving--I remember during the entire Affordable Care Act
    debate, it was all about making sure we were talking about
    value versus volume. Instead of having people just coming
    through your door and not really tracking them, it's are we
    extracting value out of the service that you as a doctor or a
    hospital provided, so that we follow that patient all the way
    through.
        If we truly do this the right way, we will reduce the
    number of visits, we'll reduce the number of incidents, and
    we'll provide quality care instead of quantity of care.
        Senator Marshall. Great. And when I talk about value-based
    health care, I think about patient outcomes, I think about the
    patient experience divided by the cost of that, and I look
    forward to a second round of questions. That went by pretty
    fast.
        Mr. Becerra. Yes, it did.
        Senator Marshall. Thank you.
        Mr. Becerra. Thank you, Senator.
        The Chair. Thank you very much.
        We will go to Senator Moran.
        Senator Moran. Chair Murray, thank you very much.
        Attorney General, nice to see you. Thank you. I'll try to
    get through, I think, three topics as quickly as I can. Let me
    start with 340B drug pricing.
        Mr. Attorney General, you led a multi-state letter to HHS
    to address the discounts and the drug manufacturers' discounts
    to covered entities in the program. Our Kansas attorney general
    joined you in that letter. But I continue to hear that 340B has
    been a significant issue for as long as I've been in the
    Senate, maybe as long as I've been in the Congress. But we
    continue to hear of dire circumstances with our health care
    providers, our hospitals, particularly our community health
    centers.
        The Community Health Center of Northeast Kansas is
    expecting to lose $300,000 of revenue this year alone due to
    the 340B issue they're facing. LaBette Health has lost almost
    $700,000 in revenue.
        If confirmed as the Secretary, how do you intend to protect
    the integrity of the 340B program and to make sure that it
    works for the provider, but as well for their patients?
        Mr. Becerra. Senator, thank you for the question. Here I
    will tell you that the previous administration issued some
    guidance. They issued an advisory opinion, and we'll try to
    build on the work that's been done in the past. But what we
    must do is we cannot sacrifice patients. They should not be the
    ones that suffer as a consequence of the fight that's going on
    here. I will guarantee to you that, if I am fortunate to be
    confirmed, I look forward to sitting down and working with you
    and others who are interested in addressing this issue, because
    340B has become an indispensable program for some of these
    providers who are really helping some of our neediest
    populations.
        Senator Moran. As you may know, the rural hospitals are on
    the cusp. COVID has not been helpful. But they're always
    hanging on by a thread.
        Mr. Becerra. That's right.
        Senator Moran. The 340B program is perhaps one of the most
    important. If it disappears in providing resources to hospitals
    and their patients, we're going to lose another series of
    hospitals in Kansas, and I assume California and across the
    country.
        Mr. Becerra. Agreed.
        Senator Moran. Let me ask you, Attorney General, I want to
    talk about the Nation's health care infrastructure in the world
    of transplants. This country has the world's leading transplant
    surgeons and hospitals, but thousands of people die every year
    because of the scarcity of donated organs. Currently there are
    100,000 Americans waiting on a kidney transplant.
        Do you agree that HHS should be working to increase the
    number of kidney transplants nationwide?
        Mr. Becerra. We have to do much more because, you're right,
    there are too many people who are going with unmet need and
    dying.
        Senator Moran. If you're the Secretary at HHS, will you act
    against policies that are expected to reduce the number of
    kidney transplants nationwide?
        Mr. Becerra. I certainly will try to work with you on some
    of these issues. It would be difficult to make a commitment
    right now before I have a chance to step into the shoes.
        Senator Moran. Well, let me tell you that Secretary Alex
    Azar told me, he told us that he was powerless to prevent
    changes in policies from taking effect. I hope at HHS, as the
    Secretary, you would have the capabilities of dealing with the
    agencies within your department who deal with this issue. Would
    that be your desire?
        Mr. Becerra. Well, those sub-agencies will know that will
    be my desire.
        Senator Moran. The HHS contractor responsible for organ
    transplants, the United Network for Organ Sharing, is currently
    under a bipartisan investigation by our Finance Committee but
    is still set to implement a policy in mid-March that affects
    kidney transplants. So I've set the stage for you in asking my
    questions. This policy was opposed by a large majority of
    transplant professionals, and the government's data predicts it
    will result in fewer transplants and more patients dying.
        I need your commitment that you will work with me and
    others in similar circumstances to see that the transplant
    program is improved, not harmed, and that organs that are
    donated in a region are able to stay within that proximity to
    be donated to those who need them within that region.
        Mr. Becerra. Senator, you have my commitment to work with
    you on that.
        Senator Moran. Thank you very much.
        Let me finally highlight the importance of telehealth.
    We've seen this for as long as I've been in Congress. We've
    been working to increase broadband services across the country.
    We've seen in the COVID-19 response the inability to do so in
    the area of education and health care. There were a number of
    provisions in the CARES Act and other legislation that waives
    certain requirements for telehealth, including reimbursement at
    rates as if you were in the office of the provider as compared
    to on telehealth.
        Mr. Becerra. Yes.
        Senator Moran. Those, I hope, will garner your support, and
    I think what we've learned is they're not just necessary during
    COVID, they are necessary into the future after the days of
    COVID are behind us. And again, I would ask you if you agree
    with that sentiment and will work to see that the provisions
    that we've made to enhance the availability of telehealth
    continue.
        Mr. Becerra. Senator, wholeheartedly I believe that we're
    going to be doing an expansion of telehealth. COVID has taught
    us so much. It's also the issue of broadband, making sure
    communities have access to broadband. But if we don't learn
    from COVID how telehealth can help save lives, then we're in
    trouble. So I think we're going to advance, and I look forward
    to working with you on it.
        Senator Moran. Attorney General, thank you for your
    answers.
        Mr. Becerra. Thank you.
        The Chair. Thank you very much.
        Senator Burr has not yet returned. We're waiting for
    Senator Hickenlooper. I'm going to go ahead with my second
    round of questions, and hopefully Senator Burr will return. I
    believe Senator Marshall wanted a second round, and he'll be
    able to do that.
        Attorney General Becerra, this pandemic has really caused
    significantly more hardship for communities of color, worsening
    underlying health inequities resulting from really a long
    history of structural racism, discrimination and bias, and I am
    deeply frustrated by how the Trump administration ignored those
    inequities in its pandemic response and in many cases made them
    worse.
        I issued a report on the impact of the pandemic on
    communities of color last year that included several
    recommendations about the need to address health inequities in
    this country, and we've got to make progress in addressing
    those recommendations. We need to offer support to Black,
    Latino, Tribal communities and other communities of color to
    make sure that those who are suffering the most from this
    pandemic are at the forefront of our response. We need to
    address discrimination within our health care system by
    investing in health care providers who will serve those
    communities and combat implicit bias in health care delivery.
    And we have to work to make sure that all people, including
    families of color and people who are paid low incomes, have
    access to high quality, affordable care. And we need to make
    some new financial investment in the health of communities of
    color.
        We've got to do better, not just on COVID but on a lot of
    our health care issues that are particularly harmful for
    communities of color, issues you know well: maternal mortality;
    ensuring that people of color, pregnant and lactating women,
    people with disabilities and other underserved populations are
    included in research and clinical trials. Our work to combat
    health inequities must be woven into the fabric of everything
    we do to advance public health and create a fairer health care
    system.
        Attorney General Becerra, you have expressed that health
    care equity will be a priority for you, and I actually have
    been very heartened to see the President appoint leading
    experts to his COVID-19 Health Equity Task Force. Can you
    comment on how you will incorporate health equity across your
    work as Secretary?
        Mr. Becerra. Senator, you said it so well. What I can add
    is that we will have a team at HHS that lives and breathes the
    desire to have health equity. We will have people who have
    experience in that field, and we will move to make sure that we
    have the resources put in place.
        Something as simple as making sure, as I think I mentioned
    before, that our surveys are--when NIH is doing a study, or CDC
    is doing work, that we are including these populations that
    have often been left behind so that when we get results, we get
    results that are good for everyone, especially those
    communities that have been left out in the past.
        We have to make sure we reach out to these communities
    because they're just starving to hear from us. They want to
    know that they count. And if we turn to their respected
    leaders, religious and civic leaders that are in their
    communities, we'll be able to have that access to them, to be
    able to approach them and get things done the right way.
        But it does start here in making sure that our policies
    reflect our words, and it sure does help, as you said, to have
    the leader of this country, the President of the United States,
    say he's committed to it and demonstrate it by one of the first
    things he did is empaneling this COVID Task Force on Equity.
        The Chair. Great. I look forward to working with you on
    that.
        I do want to take a moment to highlight HHS' role in child
    care and early childhood education. We know that even before
    this pandemic our Nation was facing a child care crisis.
    Parents across the country were paying more than they could
    afford for child care, and they were really struggling to find
    available child care in their communities. And early childhood
    educators were earning poverty-level wages despite doing
    critical work each day to support our children, our families,
    and our economy.
        Now the coronavirus pandemic has further destabilized our
    child care sector, and child care providers are now at risk of
    permanent closure, while parents are, of course, continuing to
    struggle to meet their child care needs. This is,
    unfortunately, still a responsibility that disproportionately
    falls on women, and it is one of the reasons that we are seeing
    so many women leave the workforce today. So we need a strong
    child care system to advance our Nation's economic recovery so
    parents can get the child care they need to return to work.
        Attorney General Becerra, you have advocated during the
    pandemic for additional investments in the child care sector.
    You've been a supporter of early childhood education since your
    time in Congress. So I wanted to just ask you to comment on
    that, on what action you see that we will need to take for
    affordable child care for our working families.
        Mr. Becerra. Senator, I think the COVID pandemic has made
    clear to so many Americans how indispensable child care workers
    are and how they are worth their weight in gold. And I hope
    that what we see as a result of COVID is a true recognition of
    the value of child care workers, of our teachers, and reward
    them properly so that we can make sure that we have the
    professionals we need taking care of the future leaders,
    perhaps a future president, a future senator of America, and it
    is in their hands that we put our most precious possessions and
    the future of our country.
        The Chair. Well, thank you very much.
        I know that Senator Burr has returned. We're waiting for
    Senator Hickenlooper to jump online. Is Senator Hickenlooper
    available yet? If not--Senator Hickenlooper, if you're on, if
    you're ready----
        Senator Hickenlooper. Yes, I am. We're trying to get the
    vote in, so I apologize for being a little bit late to the
    party.
        I wanted to, first off, congratulate our nominee for
    Secretary of Health and Human Services. I think you're going to
    bring deep experience and clearly your passion for public
    service to the Department.
        Health care and small businesses, they go hand in hand. I
    think small businesses are the heart of our community, but they
    often face a razor-thin margin, a challenge made dramatically
    worse by this pandemic. And even before the pandemic, in 2019,
    a Commonwealth Poll found that 74 percent of small business
    owners had considered the cost of providing health insurance to
    their employees as either a major or a minor problem.
        How would you suggest and think about, or how would you
    plan to support small businesses and their employees and help
    them make sure they can access the health insurance that they
    need at an affordable cost?
        Mr. Becerra. Senator, first, thank you very much for giving
    me a chance to sit down with you. I appreciated the
    conversation we had.
        President Biden made it very clear in his rescue package we
    need to do more. Some of the support, the resources will be
    focused on our small businesses. We have to make sure that we
    don't forget those.
        One of the things that we can do at the Federal level,
    because we contract out so much of the work that we do, is to
    make sure that our agencies are looking to hire small
    businesses to do the work, the contracting work that we must
    have done. And so we should have an emphasis, and I hope to be
    able to work with our Small Business Administration
    administrator to make sure that so much of the work that will
    emanate from HHS does go to our small businesses throughout the
    country.
        Senator Hickenlooper. Right, and we agree with that. As you
    know, many providers, primary care physicians, dentists, eye
    doctors, nurse practitioners, are often small businesses
    serving the health care needs of towns across the country. And
    yet the American Association of American Medical Colleges
    projects that by 2030 we could have a physician shortage of
    upwards of 100,000. The main shortage will be in primary care.
    The hardest hit will obviously be rural and underserved urban
    communities.
        What can we do to provide more support and increase the
    number of primary care practices, especially in those rural and
    underserved areas?
        Mr. Becerra. I speak as someone who, at the kitchen table,
    hears this constantly from my better half about what we can do
    to really get the medical community to be more robust, and one
    of those things is, especially with primary care physicians,
    give them a chance to know that they will be rewarded for
    everything they do. Too often, those future doctors go into
    specialty care fields. There is more remuneration in those
    fields. But primary care, everyone has to go through their
    primary care doctor before they can see a specialist. So it's
    important that we reward the work that's being done by those
    primary care physicians.
        You all made a major investment in getting more doctors out
    there in the future when you put in 1,000 slots in the GME
    program to bring out more future physicians, and I will tell
    you that it's become clear how indispensable our health care
    workers, especially our medical professionals, are. What I hope
    we find is that our medical schools, our nursing schools, all
    our health care teaching institutions see a rise in the number
    of people who are applying to become the next generation of
    health care givers who save lives.
        Senator Hickenlooper. Well, we agree with that. My next
    question--and again, I should have started off and thanked you
    for spending some time with me before this hearing, but we
    talked a little bit about climate change, and I appreciated
    very much your perspective, and we agreed that climate change
    does really pose a major threat to public health. We have
    directly seen the devastating effects of flooding and wildfires
    in Colorado, and really growing natural disasters are harming
    communities across the country. Look at Texas and much of the
    South this last week.
        Increasingly, frequent natural disasters are harming air
    quality, water quality, and really public safety in communities
    around the country. As HHS Secretary, how would you respond to
    the growing health impacts of climate change, and how would you
    go about addressing the fact that these public health impacts
    disproportionately harm communities of color and other
    vulnerable communities?
        Mr. Becerra. I could spend far more time than we have,
    Senator, to talk about some of these things, but let me just
    mention a couple. Just last year places like San Francisco,
    Sacramento, very urbanized areas, lost sight of the sun when we
    saw these wildfires raging outside of our areas but the smoke
    reaching our densely populated urban areas.
        We have to do something much more, and we have to do it for
    those communities that are hit first and worst. That's why at
    the California Department of Justice I established the
    Environmental Justice Bureau, because too often decisions that
    are made today won't be seen until later having an effect on
    our communities, and those that are hit first and worst will be
    those disadvantaged communities.
        Our Environmental Justice Bureau works with our local
    leaders to make sure that as we think about development, we
    think about the future and what the impact will be. But there
    is no doubt, in the breadbasket of the world, the Central
    Valley of California, one in every four children has asthma.
    That should not be. And we have to tackle this now because if
    we don't, it won't just be one in four children who has asthma,
    it will be far worse.
        I look forward to working with you and your colleagues to
    make sure we can truly address the health effects of climate
    change.
        Senator Hickenlooper. Thank you very much, and I look
    forward to working with you, as well.
        The Chair. Thank you, both of you.
        Senator Marshall, I understand you had an additional
    question.
        Senator Marshall. Thank you again, Madam Chair. Maybe just
    a couple of quick ones.
        RU486 is a drug I've never prescribed, but unfortunately
    I've had to take care of people with complications from it--
    cramping, bleeding, hemorrhaging in the emergency room. I've
    been told that you have supported removing current safety
    regulations and I just wanted to know your position on that.
    Not only am I concerned about the physical care of that patient
    but anyone that's taken this pill for an abortion obviously
    needs emotional support, and I just hate to see those drugs,
    and birth control pills for that matter, handed out like candy.
    These drugs do have serious complications. I do want women to
    have access to family planning, but the RU486 drug very much
    concerns me.
        Mr. Becerra. Senator, thank you for the question.
    Mifepristone, labeled as RU486, when I took action along with
    many of my state AG colleagues, it was to try to make sure that
    all Americans had access to the care they needed without having
    to worry about COVID becoming a danger. The fact that we are
    able to dispense care without having to have our families
    actually show up at the doctor's office, through telehealth and
    other means, is something that we should really build on. And
    any obstacles to getting safe care should be removed. The
    letter that we directed on RU486 was to make sure that women
    who wanted to take advantage of health services that they had
    within their reach didn't have to do so by risking the
    contraction of COVID in order to get that health care. That was
    the purpose of that letter, to make sure that, like any
    American, we don't jeopardize health through the contracting of
    COVID for Americans who need to access certain care.
        Senator Marshall. Great. I'm in favor of telemedicine, but
    COVID is not an excuse for sloppy medicine.
        The Office of Global Affairs is the diplomatic voice of
    HHS, and frankly I have a lot of concern with the World Health
    Organization. We need a strong World Health Organization, but I
    think they've lost their way. I think they helped cover up the
    origins of this virus, and there is so much we could learn from
    getting access to the original records, going back and
    understanding how this virus has mutated. They probably have 20
    years of data studying bat dung on what this virus has done
    would help us prepare a multivalent vaccine for the future. But
    instead, the World Health Organization appears to be working
    for the Communist Party of China.
        Do you support us getting back in the World Health
    Organization? We get 24 percent of their budget, but yet
    they're not being a good friend to America or the rest of the
    world right now.
        Mr. Becerra. Senator, thank you for the question and for
    expressing your concerns to make sure that, if we're going to
    be involved with these international organizations, that there
    is value not just for us but for everyone.
        What I can tell you is that President Biden has made it
    very clear he's committed to getting back into the World Health
    Organization. At the G7 meeting that just recently occurred,
    HHS was represented so we could try to move forward to try to
    deal with COVID beyond our borders, because our security, our
    economic, our health security, really depends on not just
    controlling COVID within our borders but outside our borders.
        It is important that we engage with our community global
    partners as best we can and, as you said, make sure that
    everyone is held accountable, not just the U.S. but everyone is
    held accountable when we participate in these global bodies.
        Senator Marshall. Okay. Lastly, I believe with all my heart
    that we can have herd immunity from this virus in April or May
    if the President and his team, you, do your job and Governors
    do their job. There's incredible news coming out this last week
    that the vaccines, after one shot, are 75 to 80 percent
    effective. We've already given 75 million people vaccinations.
    We'll have 90 million vaccinated by the end of this month. This
    country has the capacity to do 3 million flu vaccinations a
    day. We do that every year. We can give 3 million COVID virus
    vaccinations every day. That should put us over 150 million
    people by the end of March.
        Now, many of us think that 25 or 50 percent of Americans
    have already been exposed to the virus, have had the virus, so
    I think that it's feasible to have herd immunity in April or
    May. And I know that you're not going to promise that we can do
    that, but if we don't have a goal to achieve what others don't
    think we can do, we're not going to ever get anywhere.
        What would be your goal to have herd immunity, what
    timeframe?
        Mr. Becerra. Senator, great question, and I know this is
    something near and dear to you. I think President Biden has
    been very clear. He's going to push the limit in making us get
    there and do it safely. That's why he said before he even took
    office and knew what he was inheriting that his goal was to
    have 100 million shots in American arms within the first 100
    days. But if these trends continue, as you just mentioned, that
    does bode well for all of us. So we're not going to give up.
    The President has now secured another 100 million doses of
    vaccines, so we are now on course to have the 600 million
    vaccines, and you're talking now about two shots, so enough to
    cover every adult in America with a vaccine. I hope what you
    have just articulated is where we're going, because if that's
    the case, then not only is the health of America going to
    improve quickly but our economy will, as well.
        Senator Marshall. One hundred million in 100 days is not
    acceptable. We can get there by April or May if we do our jobs.
    So good luck, and we're here to put wind beneath your sails as
    we go forward. Thank you.
        Mr. Becerra. Thank you. We look forward to that wind
    beneath our wings.
        The Chair. Senator Burr.
        Senator Burr. Thank you, Madam Chair. Thank you for holding
    this hearing.
        General, thank you for taking over two hours of fire from
    every Member of this Committee.
        Madam Chair, I'm going to submit my questions for the
    record. No sense in me taking up any additional time.
        The Chair. So ordered.
        [The information referred to can be found on page 145.]
        Senator Burr. But I would like to conclude by saying this.
    If we don't handle COVID correctly, we're going to see the most
    dramatic demographic shift in America, and you and I may not be
    claiming the successes of our state because they may be in far-
    flung rural areas hunkered down and operating off of the
    Internet in some fashion, Zoom or something.
        If we don't get our kids back in school, we're not going to
    grow the talent that we need in the future. And the jury is out
    whether a one-year interruption or a two-year interruption
    kills a whole generation. None of us knows the answers, but we
    ought to be doing everything we can to minimize that today.
        The last thing, if we don't learn from what we've gone
    through, if we don't learn from our experiences with COVID,
    make the changes we need to, reauthorize the things that
    worked, plan on other zoonotic diseases that could jump to
    humans and really invest in companies that can develop the
    technologies that make vaccine production even shorter than
    what we've seen with COVID-19, then I will assure you this will
    be devastating to our children and our grandchildren. We may
    not be here as legislators, we may not be here as citizens, but
    our children and our grandchildren are counting on us to make
    the right decisions.
        I am convinced that the table has been set, and the
    question is will we collectively go to that table and handle
    some very tough issues.
        General, sir, I thank you for being here.
        Chair Murray, thank you for holding this confirmation
    hearing, and I look forward to working with you. Actually, I'll
    see you tomorrow, and then I'll work with Ranking Member Crapo
    and Chairman Wyden to see when your nomination goes to the
    floor.
        Thank you, Madam Chair.
        The Chair. Thank you very much, Senator Burr.
        That will end our hearing for today. I want to thank
    Attorney General Becerra for joining us to talk about how he's
    going to work with Congress to end this pandemic and help
    people get quality, affordable health care and root out
    systemic racism in our health care system, and tackle many
    challenges facing our families and patients and health care
    workers today.
        I want to thank all of the Members of this Committee for
    participating. Given the continued urgency of this pandemic, I
    hope the Senate can work together to confirm Attorney General
    Becerra in a quick, bipartisan way.
        For any Senators who wish to ask additional questions of
    the nominee, questions for the record will be due by Wednesday,
    February 24th at 5 p.m.
        The hearing record will remain open for 10 days for Members
    who wish to submit additional materials for the record.
        On Thursday, February 25th, we will convene in this room at
    10 a.m. for a hearing on the nomination of Dr. Vivek Murthy to
    serve as Surgeon General, and the nomination of Dr. Rachel
    Levine to serve as Assistant Secretary as well.
        The Committee stands adjourned.

                              ADDITIONAL MATERIAL

      LETTERS OF SUPPORT FOR THE NOMINATION OF XAVIER BECERRA TO SERVE AS
                     SECRETARY OF HEALTH AND HUMAN SERVICES
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                              State vaccine plans:
        https://www.aafp.org/dam/AAFP/documents/patient_care/public_health/
    State-COVID19-Vaccine-Distribution-Plans.pdf.
                                   Colorado:
        https://covid19.colorado.gov/for-coloradans/vaccine/vaccine-for-
    coloradans.
                                   Minnesota:
        Minnesota Guidance for Allocating and Prioritizing COVID-19
    Vaccine-Phase 1A (state.mn.us).
                                   Louisiana:
        COVID-19VaccineFAQ_12092020.pdf (la.gov).
                                     ______

                                     [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                    ------

        [Whereupon, at 12:34 p.m., the hearing was adjourned.]

                                      [all]