[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
                                
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                               __________

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