[House Hearing, 118 Congress]
[From the U.S. Government Publishing Office]
EXAMINING THE POLICIES AND PRIORITIES
OF THE DEPARTMENT OF HEALTH AND
HUMAN SERVICES
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON EDUCATION AND THE WORKFORCE
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED EIGHTEENTH CONGRESS
SECOND SESSION
__________
HEARING HELD IN WASHINGTON, DC, MAY 15, 2024
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Serial No. 118-50
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Printed for the use of the Committee on Education and the Workforce
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via: edworkforce.house.gov or www.govinfo.gov
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U.S. GOVERNMENT PUBLISHING OFFICE
59-983 PDF WASHINGTON : 2025
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COMMITTEE ON EDUCATION AND THE WORKFORCE
VIRGINIA FOXX, North Carolina, Chairwoman
JOE WILSON, South Carolina ROBERT C. ``BOBBY'' SCOTT,
GLENN THOMPSON, Pennsylvania Virginia,
TIM WALBERG, Michigan Ranking Member
GLENN GROTHMAN, Wisconsin RAUL M. GRIJALVA, Arizona
ELISE M. STEFANIK, New York JOE COURTNEY, Connecticut
RICK W. ALLEN, Georgia GREGORIO KILILI CAMACHO SABLAN,
JIM BANKS, Indiana Northern Mariana Islands
JAMES COMER, Kentucky FREDERICA S. WILSON, Florida
LLOYD SMUCKER, Pennsylvania SUZANNE BONAMICI, Oregon
BURGESS OWENS, Utah MARK TAKANO, California
BOB GOOD, Virginia ALMA S. ADAMS, North Carolina
LISA McCLAIN, Michigan MARK DeSAULNIER, California
MARY MILLER, Illinois DONALD NORCROSS, New Jersey
MICHELLE STEEL, California PRAMILA JAYAPAL, Washington
RON ESTES, Kansas SUSAN WILD, Pennsylvania
JULIA LETLOW, Louisiana LUCY McBATH, Georgia
KEVIN KILEY, California JAHANA HAYES, Connecticut
AARON BEAN, Florida ILHAN OMAR, Minnesota
ERIC BURLISON, Missouri HALEY M. STEVENS, Michigan
NATHANIEL MORAN, Texas TERESA LEGER FERNANDEZ, New Mexico
LORI CHAVEZ-DeREMER, Oregon KATHY MANNING, North Carolina
BRANDON WILLIAMS, New York FRANK J. MRVAN, Indiana
ERIN HOUCHIN, Indiana JAMAAL BOWMAN, New York
VACANCY
Cyrus Artz, Staff Director
Veronique Pluviose, Minority Staff Director
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C O N T E N T S
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Page
Hearing held on May 15, 2024..................................... 1
OPENING STATEMENTS
Foxx, Hon. Virginia, Chairwoman, Committee on Education and
the Workforce.............................................. 1
Prepared statement of.................................... 4
Scott, Hon. Robert C. ``Bobby'', Ranking Member, Committee on
Education and the Workforce................................ 6
Prepared statement of.................................... 9
WITNESSES
Becerra, Xavier, Secretary, U.S. Department of Health and
Human Services............................................. 11
Prepared statement of.................................... 13
ADDITIONAL SUBMISSIONS
Chairwoman Foxx:
Letter dated May 15, 2024, from Associated Builders and
Contractors (ABC)...................................... 118
Houchin, Hon. Erin, a Representative in Congress from the
State of Indiana:
Article dated April 2, 2024, from The Center for Public
Integrity.............................................. 108
Takano, Hon. Mark, a Representative in Congress from the
State of California:
Document dated May 2024, titled ``Professional
Organization's Position Statements on Care for
Transgender People''................................... 32
Document dated May 2024, titled ``Care for Transgender
Youth and Adults: Evidence Compilation''............... 51
QUESTIONS FOR THE RECORD
Responses to questions submitted for the record by:
Secretary Becerra........................................ 119
EXAMINING THE POLICIES AND PRIORITIES
OF THE DEPARTMENT OF HEALTH AND
HUMAN SERVICES
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Wednesday, May 15, 2024
House of Representatives,
Committee on Education and The Workforce,
Washington, DC.
The Committee met, pursuant to notice, at 10:16 a.m., in
Room 2175, Rayburn House Office Building, Hon. Virginia Foxx,
(Chairwoman of the Committee) presiding.
Present: Representatives Foxx, Thompson, Walberg, Grothman,
Allen, Banks, Owens, Good, Miller, Kiley, Bean, Burlison,
Moran, Chavez-DeRemer, Williams, Houchin, Scott, Courtney,
Bonamici, Takano, Adams, DeSaulnier, Norcross, Jayapal, Wild,
McBath, Hayes, Omar, Leger Fernandez, and Manning.
Staff present: Cyrus Artz, Staff Director; Nick Barley,
Deputy Communications Director; Mindy Barry, General Counsel;
Isabel Foster, Press Assistant; Daniel Fuenzalida, Staff
Assistant; Sheila Havenner, Director of Information Technology;
Amy Raaf Jones, Director of Education and Human Services
Policy; Alex Knorr, Legislative Assistant; Georgie Littlefair,
Clerk; CJ Mahler, Professional Staff Member; John Martin,
Deputy Director of Workforce Policy/Counsel; Hannah Matesic,
Deputy Staff Director; Audra McGeorge, Communications Director;
Rebecca Powell, Staff Assistant; Ian Prince, Professional Staff
Member; Heather Wadyka, Professional Staff Member; Seth Waugh,
Director of Workforce Policy; Maura Williams, Director of
Operations; Brittany Alston, Minority Operations Assistant;
Ilana Brunner, Minority General Counsel; Theresa Tilling-
Thompson, Minority Professional Staff; Scott Estrada, Minority
Professional Staff; Stephanie Lalle, Minority Communications
Director; Veronique Pluviose, Minority Staff Director; Andre
Lindsay, Minority Professional Staff; Daniel Foster, Minority
Senior Health and Labor Counsel; Dhrtvan Sherman, Minority
Research Assistant; Ellie Berenson, Minority Press Assistant;
Banyon Vassar, Minority Director of IT; Carrie Hughes, Minority
Director of Health & Human Services Policy; and Jessica
Schieder, Minority Economic Policy Advisor.
Chairwoman Foxx. Good morning. The Committee on Education
and Workforce will come to order. I note that a quorum is
present. Without objection, the Chair is authorized to call a
recess at any time. Good morning again and welcome. Thank you
everyone for joining us to conduct the Committee's yearly
oversight of the budget request for the Department of Health
and Human Services, HHS.
I am pleased to note that this is the final Committee
hearing with a cabinet level official slated for this Congress.
At the beginning of the 118th when I took the gavel, I promised
to make oversight a top priority. Over this time, the Committee
has operated with the utmost respect and scrutiny toward every
hard-earned taxpayer dollar spent by this administration.
Therefore, Secretary Becerra, it is only fitting that the
committee's last cabinet level oversight hearing this Congress
deals with one of the biggest department budget requests in
history. For starters, this budget has an eye-popping top line
of 1.84 trillion dollars.
When I saw the mandatory spending numbers of 1.7 trillion,
I could not help but think of it as an albatross upon the necks
of young Americans. I have been in Congress long enough to know
that there are few things more permanent than mandatory
spending. The proposed spending in this budget represents an 8-
percent increase over the Fiscal Year 202024 enacted level,
which more than doubles year-over-year inflation.
This unsustainable rate of spending is baked in as a
function, a mandatory obligation, and the aging population.
Today, there are more 64-year-olds than 4 year olds in this
Nation. I think that is something worth repeating. Today there
are more 64-year-olds than 4 year olds in this Nation.
Every day 11,000 more reach 65, with only 10,000 children
born. These statistics are an anomaly that would be foreign to
any other point in American history. What is more, the American
healthcare system is too expensive, complex and inefficient for
what we get. We spend nearly 18 percent of our GDP on
healthcare, whereas other developed countries spend much less.
Rather than investing in innovation, and empowering
employers to lower costs, this administration is hell bent on
shouldering the employer sponsored health plans with burdensome
and costly regulations. For these reasons, 1.84 trillion is not
simply a number, it is a story.
It is a demographic and fiscal catastrophe smuggled into
the enormous top line of this budget. It is the legacy of older
generations, and it is the inheritance of younger ones. While
unfathomable, it is not going to hold a candle to future HHS
budgets if we do not get spending in check.
Furthermore, each dollar proposed in this budget represents
a policy priority. Again, the burden of HHS's partisan agenda
is going to fall heaviest on younger generations, which is made
clear by some notable exclusions in the budget. Nowhere does
the budget contain the word fentanyl, save one instance in a
footnote. Fentanyl overdose is the leading cause of death for
Americans 18 to 45.
More than car crashes, cancer, and suicides combined. The
budget does nothing to address it. Nowhere does this budget
mention the Biden border catastrophe that not only fuels the
Fentanyl epidemic, but also child trafficking. Under your watch
the Office of Refugee Resettlement transferred 85,000
unaccompanied minors to sponsors who were unable to be reached
upon followup.
These migrant children are effectively lost. Nowhere does
this budget support the longstanding Hyde Amendment, one of the
greatest protections for America's youngest and most
vulnerable. In forcing taxpayers to fund abortions, HHS is
trampling on the rights of the unborn, and religious Americans.
Finally, nowhere does this budget contemplate the negative
effects of transgender surgeries on minors. Instead, it funds
them. In 2022, HHS issued guidance stating that ``Gender
affirming care,'' improves ``physical and mental health,``
despite citing zero research or studies. The lack of scientific
evidence supporting these procedures is an absolute scandal.
In an ideal world the HHS budget would represent a positive
vision for a healthier country. Yours is a tax and spend
monstrosity that papers over the numerous social pathologies
inflicting our Nation. Fentanyl abuse, child trafficking,
abortion on demand and genital mutilation, to name a few.
Secretary Becerra, a chasm separates Republicans and Democrats
on these issues, but I do not expect to reach an agreement
today on many of them.
I propose we work together for the remainder of your tenure
toward our shared goals. The Lower Cost More Transparency Act,
which passed the House by a wide bipartisan margin of 320 to
71, would be a great place to start. Whereas, Medicare price
controls are polarizing, we can find common ground in price
transparency.
We should also work together toward expanding telehealth
benefit access to Americans, especially those in rural areas.
Although I appreciate the budget calling for a ban on facility
fees in telehealth, it worries me that this administration has
not made it a priority to restore employer's ability to offer
telehealth accepted benefits.
Last, we can do better to coordinate the implementation of
the No Surprises Act, to ensure it aligns with congressional
intent. While the law has successfully protected millions of
patients from receiving a surprise medical bill, the tri-
agency's implementation of the independent dispute resolution
process has been a disaster.
I worry it will only drive up healthcare costs further. It
is my hope that Congress and the White House can come together
and craft their responsible budget for Fiscal Year 202025 that
addresses these concerns. As for my other concerns with the
general direction of the HHS, you will get to answer for those
today. With that, Secretary Becerra, I look forward to your
testimony, and I yield to the Ranking Member for an opening
statement.
[The statement of Chairwoman Foxx follows:]
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Mr. Scott. Thank you, Madam Chair, Secretary Becerra, good
morning. Thank you for being with us today. It is always a
pleasure to welcome you back to the Committee. You are familiar
with this room, not only from your previous appearances before
as Secretary, but because you and I started our congressional
careers right here in this room over 30 years ago.
It is great to see you back on Capitol Hill and I thank you
for your dedication to public service. Under your leadership,
the Department of Health and Human Services has made historic
progress in helping workers and their families access quality,
affordable care. Last Congress, congressional Democrats passed
the American Rescue Plan Act without a single Republican vote.
That law enhanced premium tax credits to lower monthly
costs for low-income Americans, especially by eliminating the
subsidy cliffs, so that more individuals could get coverage and
get help getting coverage. We also passed the Inflation
Reduction Act, which was enacted into law to extend the tax
credit enhancements, cap the cost of insulin for people on
Medicare, and for the first time ever, direct the Federal
Government to negotiate lower prices for prescriptive drugs
covered by Medicare.
These decisive actions yielded positive results. For
example, during the 2024 open enrollment period a record 21.4
million Americans signed up for the Affordable Care Act
coverage. That is not all, just last week the administration
took further steps to improve access to coverage by announcing
a final rule that would expand healthcare coverage to dreamers.
We also know that protecting our Nation's health goes
beyond improving access to health insurance. Recently, the
department updated several regulations that will improve the
lives of workers and their families. For example, the updated
Section 504 regulations will protect disabled individuals from
discrimination in programs that receive Federal funding through
HHS.
This will ensure that people with disabilities have equal
access to quality care and are treated fairly in systems that
are supposed to protect their health and welfare of all
Americans. Additionally, the department issued a number of
final regulations that support the healthcare workforce,
seniors in nursing homes, and people with disabilities who rely
on Medicaid.
Taken together, these rules will work to improve access to
and quality of healthcare. Unfortunately, my colleagues on the
other side of the aisle frequently talk about their commitment
to our Nation's health and safety, but they have not backed up
their words with actions.
For example, my colleagues may talk about the child labor
problems today, however the reality is that Republican State
legislators in many states across the country are working to
reverse child worker protection laws, and despite our multiple
requests for a hearing on this persistent and growing problem,
the majority of this Committee has yet to schedule a hearing,
or advance legislation to advance child labor violations.
Moreover, we have seen Republicans attempt to sabotage
quality healthcare coverage and undermine access to healthcare
and other services that our constituents need. They restrict or
criminalize a woman's access to abortion, jeopardizing the
health of women, and work against the necessary care that
supports the health of transgender individuals.
Despite these efforts, congressional Democrats and the
Biden administration will continue working to lower
prescriptive drug prices, strengthen the ACA and improve
transparency for healthcare consumers. Many Democrats remain
focused on helping this administration build on our progress to
expand access to care for our most vulnerable communities,
lower the costs of quality care, and meet the changing
healthcare needs of workers and their families.
The Biden's administration's proposed investments
underscore your commitment to protecting the health and well-
being of every American, and so Secretary Becerra, thank you
for your work, and thank you for joining us today, and I look
forward to the discussion. I yield back.
[The statement of Ranking Member Scott follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairwoman Foxx. Thank you, Mr. Scott. Pursuant to
Committee Rule 8-C, all members who wish to insert written
statements into the record may do so by submitting them to the
Committee Clerk electronically in Microsoft Word format by 5
p.m., 14 days after the date of this hearing, which is May 29,
2024.
Without objecting, the hearing record will remain open for
14 days to allow such statements and other extraneous material
referenced during the hearing to be submitted for the official
hearing record. I now turn to the introduction of our witness.
We have as our witness, Secretary Xavier Becerra, from the U.S.
Department of Health and Human Services located in Washington,
DC.
We thank you for being here today and look forward to your
testimony. I'd like to remind the witness that we have read
your written statement, which will appear in full in the
hearing record. Pursuant to Committee Rule 8-D and Committee
practice, I ask that you limit your oral presentation to a 5-
minute summary of your written statement, and I would like to
remind the witness to be aware of his responsibility to provide
accurate information to this Committee. I now recognize
Secretary Becerra.
STATEMENT OF HON. XAVIER BECERRA SECRETARY, U.S. DEPARTMENT OF
HEALTH AND HUMAN SERVICES, WASHINGTON, D.C.
Secretary Becerra. Chairwoman Foxx, Ranking Member Scott
and members of the Committee, thank you for the invitation to
discuss the President's 2025 budget for the Department of
Health and Human Services. Let me place this 2025 budget in
context.
When President Biden took office in January 2021, COVID was
ravaging our families and our economy, Americans were dying at
the rate of two or three 9/11s every day. Let me repeat that.
Every day the sum total of two to three 9/11s was taking the
lives of Americans in this country because of COVID.
In January 2021, the number of Americans with health
insurance was, like our jobs and the economy, down and on the
canvas. Prescription drug prices were skyrocketing, with
patients and their pocketbooks at the mercy of big pharma and
its profits. We changed that. Today, 3 years later, nearly 700
million shots of COVID vaccines have gone into the arms of
Americans.
COVID is still around, but we can now manage it like the
flu. Today more than 300 million Americans, a record number,
can go to the doctor and hospital and not go bankrupt because
they have their own health insurance. More than 46 million of
those 300 million Americans count on the Affordable Care Act
for their insurance, another record.
Today, while big pharma is still big, the President's new
prescription drug law has brought down the price of insulin to
$35.00 per month for Americans on Medicare. As we speak, we are
in negotiations with those big drug companies to lower the
prices of even more prescription drugs, even as they sue us to
stop us.
The President's budget doubles down on the investments that
made the comeback of our jobs, our economy, and our health
possible. It does not just protect Medicare. It strengthens it
beyond our lifetime. This budget lays out a vision for a nation
that invests in its most vulnerable, fosters innovation, and
protects every American's access to the care she needs.
Perhaps most importantly, it continues our shift from a
health system that treats illness to one that sustains
wellness. All told, the Fiscal Year 202025 budget proposes 130
billion dollars in discretionary, and 1.7 trillion dollars in
mandatory funding to advance our mission and invest in key
priorities. Let me share some of those highlights.
The budget provides Medicaid-like coverage to low-income
individuals in the outlier states that have not expanded
Medicaid under the Affordable Care Act. When that happens,
another 1.5 million of our fellow Americans will secure
healthcare coverage, and the peace of mind that comes with it.
This budget builds on the largest investment in behavioral
health in a generation. It bolsters a 988 suicide and crisis
lifeline. It gives young people support at home and in school.
The President's investments in behavioral health workforce
would add 12,000 new psychiatrists, psychologists, clinical
social workers, marriage and family therapists, counselors, and
peer support specialists at a time when their services are
desperately needed.
Across HHS, the budget tackles the maternal health crisis
by improving access to pre-and post-natal care, supporting
emergency care services, and expanding maternal care in rural
and underserved communities. We are also making childcare more
affordable for working families, and more available where
families live and work.
This budget would fund more than 750,000 slots for our
children in Head Start and provide universal preschool for our
Nation's four million 4-year-old children, and eventually
include our 3-year-olds as well. Our budget grows and
strengthens our cybersecurity initiatives to ensure patient
safety and privacy, and to keep our hospitals and providers,
especially smaller ones, those in rural communities, running
and secure.
Finally, this budget further advances our preparedness
efforts by investing in counter measures to combat biological
threats, and antimicrobial resistant germs by expanding our
monitoring of supply chains, and by improving information
sharing across Federal, State and local governments.
We cannot reduce the health and well-being of Americans to
a line on a budget spreadsheet, but we can transform the
numbers on that balance sheet into real investments, and
services that sustain health and promote wellness for all
Americans. That is what this 2025 budget by President Biden
does.
I thank you for the time, I look forward to taking your
questions.
[The prepared statement of Secretary Becerra follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairwoman Foxx. Thank you, Mr. Secretary. Under Committee
Rule 9, we will now question the witness under the 5-minute
rule. I ask members to keep your questions succinct, so the
witness has time to answer. I recognize myself for 5 minutes of
questioning.
Mr. Secretary, this Committee's efforts helped lead to the
passage of the historic No Surprises Act, however the law's
independent dispute resolution process has been mired in
litigation, delays and faulty implementation. Data shows that
77 percent of disputes are ruled in favor of providers, and the
Brookings Institute now anticipates that the IDR process will
raise costs and premiums, contrary to the law's goals.
What is HHS doing to improve the operations of the IDR
process under the No Surprises Act? Are you concerned that the
law's current implementation will raise healthcare costs for
employers and employees?
Secretary Becerra. Madam Chair, thank you for the question.
You are right, because there was a mad rush to try to make this
independent dispute resolution process work, I think we saw
that the gates got overcrowded, and as a result we saw that
there were delays.
The arbitrators were wondering if they were going to get
paid. There were a limited number of arbitrators. We think most
of that has now sort of settled. We are now beginning to see
that the cases that are coming through are eligible to be
processed through this dispute resolution process. Initially in
that first year we saw scores of these cases that were
ineligible, and of course it took time.
Since an arbitrator only gets paid for a case that is
actually adjudicated and completed, arbitrators were getting
very unhappy because they were having to adjudicate claims that
did not go anywhere.
Chairwoman Foxx. We are very concerned about the increased
costs, so what are you going to do about that?
Secretary Becerra. By having been able to essentially scrub
the system so that it now is much more efficient, so that the
claims that come in will have an opportunity to go before an
arbitrator. We are beginning to see them run a little faster.
Because the courts have given us a little more guidance on how
they wish to see us interpret the law, it should go faster as
well.
Chairwoman Foxx. Thank you. I am concerned about our
regulatory overreach by HHS over self-insured health plans. The
recent notice of benefit and payment parameters final rule, and
the Section 1557 nondiscrimination in health programs and
activities final rule saddles self-insured health plans with
new Obamacare regulations.
Under current law, self-funded plans are not subject to
Section 1557 are regulated by the Department of Labor. Will you
confirm that it is HHS policy that self-insured health plans
are not subject to HHS regulation, and will you commit to
abandoning any unlawful HHS efforts to regulate self-insured
health plans.
Secretary Becerra. Madam Chair, let me make sure I give you
accurate information, because we have seen an evolution there.
I do not want to give you an answer that is not complete, so if
it is okay, let me followup with you to give you the precise
answer.
Chairwoman Foxx. Okay. We would like that answer right
away. No delays please.
Secretary Becerra. I commit to giving you that.
Chairwoman Foxx. I would like to ask about parental rights
in the Head Start program. The Head Start statute goes out of
its way to describe parent and family engagement in Head Start
services. In the Department's recent Head Start Workforce
proposed rule there is even language that claims to ensure,
``Programs are consulting and engaging with current parents and
families to be involved in the methods the program uses.''
However, the proposed rule strikes from current regulation
the requirement that parent consent--parental consent be
obtained for mental health consultation. What is the Office of
Head Start trying to hide? Does HHS intend to complete mental
health consultations on children without parental consent?
Secretary Becerra. Madam Chair, there is nothing that's
being hidden. What we are trying to make sure we do is provide
the services that are important for any child in the Head Start
program. We want to make sure that whether it is ensuring the
physical safety a child, we are also addressing any mental
health concerns. We can also followup with you if you have
particular concerns with some of the language, but I can
guarantee that what is going on in this rule on Head Start
proposed rule is the best interests of the child.
Chairwoman Foxx. Well, we will see, but we think that needs
to be clarified, and that you are not giving mental health
consultations on children without parental consent. With that,
I yield, and I recognize Mr. Courtney for 5 minutes.
Mr. Courtney. Thank you, Madam Chairwoman, and again, Mr.
Secretary, it is good to see you in the people's house, your
real home, in Washington. Again, I would just like to begin my
questions by noting the fact that your department's Medicare
Board of Trustees just issued its 2024 solvency report about a
week ago, which was really nothing short of astonishing.
In 2023 the Trustees projected that Medicare would run into
solvency issues in 2031. Again, a week ago they pushed that out
by 5 years to 2036. Again, that is partly because we have such
a strong job market, and stock market, the revenue that is
coming into the program is much stronger than anyone expected.
Also, the report noted that the Inflation Reduction Act is
expected to lower Part B drug spending by about 9 percent
starting in 2028. Again, you mentioned the price negotiation,
which is again, very much going to help patients, but this
report suggests that this actually is going to address the
question of Medicare solvency for not just seniors, but working
age Americans and young people. Is that correct?
Secretary Becerra. That is correct. The Inflation Reduction
Act is working, just as you all thought it might.
Mr. Courtney. In your testimony you noted that the 2025
budget included legislative proposals, which again, would use
that drug negotiation authority to even further strengthen the
Medicare trust fund. Again, I think the term was that it would
basically, you know, make it solvent for the long-term future.
Secretary Becerra. For our lifetimes. Beyond our lifetimes.
Mr. Courtney. Can you talk about that a little bit because
I really think that is something that for people who really
question the solvency of these programs, is really a profound
statement.
Secretary Becerra. Yes. It is not rocket science. You just
have to be willing to invest your dollars and your savings that
you incur from having better programs in healthcare back into
the healthcare system. As a result of what President Biden is
proposing with the legislation you all passed, to help us
negotiate down the prices of prescription drugs, you pump that
money back into the system and guess what?
Now you guaranteed the strength of the Medicare system
beyond our lifetimes.
Mr. Courtney. Mr. Scott, along with his colleagues on the
Energy and Commerce Committee and the Ways and Means Committee
introduced a measure The Lowering Drugs Costs for American
Families Act, which again would take the benefits of that price
negotiation, and actually make it available to the rest of the
country in terms of employer-based plans, or individual market
plans. Again, that was in the bill when we passed the measure
in the House, and unfortunately did not make it through the
Senate. Again, can you sort of talk about again, the
department's perspective on this because really this is about
lowering drug costs for everyone.
Secretary Becerra. Congressman, as you recall from the
President's State of the Union Address, he is right where you
are, and where Congressman Scott is. He would like to see the
benefits we see for Medicare recipients, and lower drug costs,
expanded to include every American. There is no reason why only
Americans who are in the Medicare program should get $35.00 or
less insulin. Why should not every American get it? He is very
supportive of this effort to expand access to more affordable
prescription drugs to all Americans.
Mr. Courtney. One other sort of ripple effect of again, the
department's work in terms of prescription drugs is that some
of the drug manufacturers have almost kind of been shamed into
announcing that they want to actually lower the price of
insulin and inhalers, you know, for Americans.
Again, I mean I think it is creating a virtuous sort of,
you know, environment where again, it is encouraging and
realizing that for people who sell into this market, you know,
they really--it is not sustainable to overcharge people based
on their age. Again, can you talk about, you know, again that--
again really non-mandatory, but still beneficial impact of the
Inflation Reduction Act.
Secretary Becerra. Once again, when you make it so that the
drug companies have to actually negotiate on prices versus just
dictate to the American people what the American people must
pay, you inject a little competition and guess what? You get to
lower prices. I keep telling folks that competition is as
American as apple pie.
What we are doing in the prescription drug space is saying
companies, let us negotiate, get the best price because we have
a right to be competitive for the seniors on Medicare, and for
every American to get good prices, so we are not paying two or
three times the price for medication here in the U.S. above
what others pay around the world.
Mr. Courtney. As someone who suffers from seasonal
allergies, I was really excited about the inhaler development,
so again, thank you for your great work, and again, lowering
costs for Americans. I yield back.
Mr. Walberg [presiding]. The gentleman yields back. I now
recognize the gentleman from Pennsylvania, Mr. Thompson.
Mr. Thompson. Thank you, Mr. Chairman. Mr. Secretary, it is
good to see you. As you may know I spent nearly three decades
in healthcare, as a therapist, rehabilitation services manager,
and licensed nursing administrator prior to being elected to
Congress. I served patients from rural communities throughout
central Pennsylvania during that time and learned that the
barriers that these communities face in accessing quality,
affordable healthcare.
While I appreciated your stated goals of expanding coverage
and access, the care that you detailed in your testimony, your
Agency's recently finalized rule establishing minimum staffing
requirements for nursing homes seems to fly in the face of
these goals. Mr. Secretary, do you believe that nursing homes
across the country today have enough staff to meet their
current needs?
Secretary Becerra. Congressman first, thank you for the
work that you did in this space because it is obviously
essential for so many families. There is obviously something
going on within the nursing home industry where while they
represent about less than one-third of 1 percent of all
Americans living in nursing homes, when COVID hit we saw 20
percent of people dying living in nursing homes.
That disparity shows that there is something going on.
Mr. Thompson. Well, Mr. Secretary, I will say that was
because of one of the huge contributing factors to that was bad
policy by Governors like my former Governor who required that
the readmission of nursing home residents diagnosed with COVID
back into these populations, it was--many of these people died
as a result of bad public policy that was put forward.
I mean, but getting back to my original question, do you
believe that nursing homes across the country today have enough
staff to meet the current needs? Yes or no?
Secretary Becerra. I believe that too many of these long-
term care facilities are not providing the staffing. In fact,
the comments we received to our rule made it clear when people
are talking about having five CNAs, certified nurse assistants
available for 55 residents, clearly that is not enough.
When people are talking about a resident had a stroke and
was on the floor for more than 15 minutes because it was
breakfast time, not enough staff knew, and it was not until
they were collecting the food trays that they discovered there
was this person on the floor who had suffered from a stroke,
clearly there are not sufficient numbers of qualified people.
Mr. Thompson. Obviously, I keep close contact obviously,
having worked with older adults, and specifically everything in
the past including that. I think perhaps the only former
licensed nurse administrator between the House and the Senate.
I may be wrong about that, but I think that may be accurate.
It is certainly not what I have heard from nearly every
provider in my District. I would encourage you to engage with
these providers more closely to learn about current conditions
on the round. It is important for Federal agencies to engage
with local providers and stakeholders, and I would encourage
you to do more of that, certainly in the future.
According to your Department's own estimates under the
proposed staffing minimums, nursing homes around the country
would need to hire nearly 13,000 registered nurses and 76,000
nursing assistants. That is actually where I started my career,
working as a nursing assistant, as I worked my way through my
undergraduate degree.
Can you certify here today that not one senior across the
country will lose access to care as a result of this proposal?
Secretary Becerra. Congressman, what I can certify is that
one single American, your loved one, my loved one is going to
go into a nursing home, we are going to try to make sure that
they are provided with safe, quality care because there will be
the staff necessary to provide that care.
Mr. Thompson. Well yes, but in terms of access, having
available facilities are still open is an incredibly important
part of that. Do you believe that nursing homes in rural areas
that already face staffing shortages will be forced to close
their doors, or drastically reduce the number of seniors that
they serve if this minimum staffing mandate takes effect?
Secretary Becerra. The rule takes into consideration rural
health facilities and nursing homes facilities, as well as
smaller nursing home facilities. We provide them with a longer
transition time to adopt these new rules. We also provide them
with a hardship exemption. They can show that it would be tough
for them to meet the standards, they have more time.
We have listened to a lot of the facilities, and especially
those in rural communities, and those that are small.
Mr. Thompson. in terms of listening, how do you expect
nursing homes to pay for the costs of implementing this rule,
which your agency estimates will cost between 1.5 billion to
6.8 billion to fully implement?
Secretary Becerra. Congressman, the way I ask the question
is what kind of operation do you have now if you are saying you
do not have the people you need to provide quality care to the
people who are your residents? What we are simply saying is you
should have a minimum level. We are not telling them they have
to hire more than that, we are just saying have a minimum
level, so you do not have the situation as occurred in Ohio
where an individual who was in a nursing home was suffering
from a wound.
Because they did not get wound care, and diaper changes and
feeding, ultimately that wound became a bedsore. That bedsore
then got to the bone and ultimately led to death.
Mr. Thompson. Having worked many years in nursing homes,
both as a delivering that care, and as an administrator, I
certainly understand that, but also understand that when you
are dictating and mandating from Washington without bringing
the people to the table that provide the care, what you are
doing is actually creating a decrease in access to care at a
time when our population is aging.
Thankfully most people age with dignity and do not go on to
a nursing home.
Mr. Walberg. The gentleman's time has expired. I now
recognize the gentlelady from Oregon, Ms. Bonamici.
Ms. Bonamici. Thank you, Mr. Chair. Welcome back to the
committee, Mr. Secretary. Nice to see you. Thank you for
visiting Oregon, we had last year a wonderful conversation
about behavioral health, and the need to grow the workforce.
What I want to focus on first this morning is the roundtable
conversation we had about how to address the challenges around
substance use among our Nation's youth.
We heard from John and Jennifer Epstein from Beaverton,
Oregon, who tragically lost their son Cal, when he took what
was a fake pill that turned out to be fatal. The Epstein's
turned their grief into action, and they worked with the
Beaverton School District, and they created a curriculum called
Fake and Fatal, to spread awareness of the danger.
A compelling story. I know you heard them tell that story.
The program is already saving lives. The Beaverton School
District has not lost a student to fentanyl poisoning since
they implemented the program in 2021. With that lesson as our
guide, my committee colleague who was just here, Mr. Kiley and
I have introduced the Fentanyl Awareness for Children and Teens
in Schools or FACTS Act.
It establishes a pilot program at HHS encouraging the
development of partnerships between local or State educational
agencies, local and State public health agencies, and nonprofit
organizations to provide that necessary education, awareness,
and prevention regarding the misuse of synthetic opioids.
I am grateful that the chairwoman who is also no longer
here, cares about this issue and mentioned it in her opening. I
do want to clarify, however, that even though she said that
fentanyl was only mentioned once in the budget, in fact in the
justification documents, for example, for CDC it is mentioned
21 times, and for SAMHSA 22 times. Mr. Secretary, I know you
care about this issue, so will you tell us what the department
is doing to address the issue of synthetic opioid overdose in
youth, and how would implementation of policies like the
bipartisan FACTS Act support your ongoing efforts?
Secretary Becerra. Congresswoman, thank you. Thanks for the
work that you are doing, and I appreciated the chance to visit
with the Epsteins and other families who have gone through
these difficult times. Maybe some folks did not see the mention
of fentanyl in the President's budget, but the President
mentions fentanyl nearly 50 billion times, because that is the
amount of money he is putting in his budget to address
fentanyl.
Most of that is going in to control at the border, and to
make sure that fentanyl does not cross the border, and is not
trafficked in this country. Several billions of those dollars
that the President puts in his budget for fentanyl are for the
Department of Health and Human Services to work with folks like
those we met in Oregon who are trying to prevent people from
overdosing.
This is a priority for the President, for this
administration, and we look forward to working with you on your
legislation, and other efforts to try to keep Americans alive.
Ms. Bonamici. I appreciate that, Mr. Secretary, and I do
urge the Committee to bring up this bipartisan bill that
Representative Kiley and I, and I believe Representative
Chavez-DeRemer as well, has co-sponsored. It is really
important. This is going to save lives. Now I want to turn to
the importance of the care economy, and how Federal policies
can help American families.
I will start with just a couple easy yes or no questions.
Is making childcare more affordable a pro-family policy, Mr.
Secretary?
Secretary Becerra. Yes. I am always careful when someone
says it is a yes or no, but that is a pretty clear yes or no,
and that is a yes.
Ms. Bonamici. For Fiscal Year 2024, House Republicans
actually proposed a cut in Head Start funding that would reduce
the availability of affordable childcare for more than 51,000
children. Would that kind of cut be considered pro-family?
Secretary Becerra. It would make it very difficult for us
to operate.
Ms. Bonamici. Thank you. Also, Mr. Secretary, does
President Biden's Fiscal Year 2025 budget increase funding for
affordable childcare and high-quality early childhood
education?
Secretary Becerra. Dramatically.
Ms. Bonamici. That makes a difference, and I thank you for
your leadership. I recently led more than 160 House Democrats
in calling for House leadership to increase the Child Care and
Development Block Grant funding to more than 12 billion
dollars. My question, Mr. Secretary, is how will investing in
affordable, accessible childcare benefit not only children and
families, but also businesses and the economy?
Secretary Becerra. Congresswoman, perhaps the greatest
benefit is that families will have the freedom to work where
they want and earn the income they need if they know they have
decent, quality childcare for their kids. It will also help the
people who are actually providing the childcare because right
now many of these folks are leaving the childcare industry
because they can make more money flipping burgers at a fast
food joint.
We need to treat them as professionals. They are taking
care of the future of this country, and we should pay them
adequately, so they are able to stay and make that a
profession.
Ms. Bonamici. Mr. Secretary, do you agree that Federal
investment is necessary because there is no market solution to
this? We cannot just raise the tuition so we can pay the
providers more because it is already too expensive. Can you
emphasize the importance of a Federal investment here, and what
it does to the economy?
Secretary Becerra. It is a Federal State partnership. We
provide some of the resources, but we need the states to also
chime in and do their part.
Ms. Bonamici. Thank you very much, and I look forward to
working with you, and hopefully my colleagues on both sides of
the aisle about expanding access to affordable, accessible
childcare, and I yield back the balance of my time.
Mr. Walberg. I thank the gentlelady. Her time has expired.
I now recognize myself. Secretary Becerra, welcome back. As you
may or may not recall last time that you were before this
Committee I asked you about HHS's vetting procedures in light
of reports that unaccompanied children were being placed with
sponsors who were exploiting these children.
At that time, you stated that you believed sponsors were
properly vetted by HHS. In February, the HHS Office of
Inspector General issued a report examining whether the Office
of Refugee Resettlement took steps that were required to ensure
the safe release of unaccompanied children through sponsor
screening and followup calls.
One of the findings from the report stated that the case
files of 16 percent of unaccompanied children, who were
released to sponsors did not contain any documentation that a
required safety check on the sponsor was conducted. Mr.
Secretary, ORR received referrals for nearly 119,000 at least
according to our records, of unaccompanied children in the
Fiscal Year 1923.
That could mean over 19,000 children were released to
sponsors without proper safety checks. Yes or no, do you still
stand by your statement to me last year that HHS properly
vetted sponsors?
Secretary Becerra. I stand by my response. Congressman, we
need to clarify. You have mixed different numbers because the
report that you reference OIG is from 2021, and now you
mentioned 2023 numbers, and what you have to remember is in
2021, in the Spring of 2021, we were barely coming in.
We were taking over a program that had essentially been
dismantled by the previous administration, so it was difficult
to have spots for these children, and it was difficult to have
an operation to be able to send them to sponsors, as we are
required by law. Things are very different from that point in
2021 today.
Mr. Walberg. Then let us talk about that. My notebook is
over there, or I would debate you a little further. Let us not
quibble on that. What changes have been made as a result of
this audit, and second, what changes have been made in regards
to release of unaccompanied children to individuals who have
previously sponsored children?
Secretary Becerra. We have continued over those 3 years to
improve the services that are provided to children. I would
refer you to our foundational rule, which just became final
this year, which takes a lot of those best practices. Today,
for example, we have enough space for the children that are
coming to us from the Department of Homeland Security.
We are no longer having to use convention centers to house
these kids because we did not have the infrastructure in place.
We established the infrastructure, which is the most important
thing because now they are getting the healthcare they need,
they are getting the services they need as we prepare to send
them to a vetted sponsor.
Second, we are trying to followup with your help in getting
the resources. We are able to do not just the referral to a
sponsor, but hopefully, if you give us the resources, we will
be able to do followup. We do not have authority to do
followup. We are not required to, but we believe it is a good
idea to do it.
If you give us the resources, we will continue to do more
followup with these kids.
Mr. Walberg. If a child who was under the care of HHS
unaccompanied children program is found to be a victim of human
labor trafficking, is the sponsorship immediately terminated,
and does the Federal Government reclaim custody of the child?
Secretary Becerra. You have touched on the issue, the
difficulty. Once we find the sponsor and transfer the child to
the sponsor, we no longer have jurisdiction authority over that
child. When you ask, will the sponsorship be terminated? We do
not have the authorities to just terminate, because we do not
have sight on what happens to the child once the child is in
the sponsor's hands.
You are welcome, and I have offered this before, Congress
is welcome to give us more authority so we can follow them.
Mr. Walberg. Immediate action is taken. Immediate action is
taken though once you find out there is a problem there?
Secretary Becerra. Yes, yes. If we are alerted, we will
contact the appropriate authorities, but we do not have
jurisdiction to try to stop that activity. Remember, if you are
talking about a child being exploited in labor, they are
already outside of our custody because kids that are in our
custody stay in our custody, they do not go out and work.
Mr. Walberg. Are there circumstances under which the child
would be returned to an immediate relative of the original
sponsor?
Secretary Becerra. I am sorry?
Mr. Walberg. Are there circumstances under which the child
will be returned to an immediate relative of the original
sponsor?
Secretary Becerra. That is our priority to make sure that
we can place the child closest to whom they know. A parent, if
there is a parent available, maybe a relative, we seek to have
them if they pass the vetting.
Mr. Walberg. Is there a vetting process for them as well?
Secretary Becerra. Yes, there is. No one gets to sponsor a
child without going through a vetting process, even if they are
the parents.
Mr. Walberg. We hope that that continues if that is the
change that has been made.
Secretary Becerra. Yes.
Mr. Walberg. My time is expired. I yield back. I now
recognize the gentleman from California, Mr. Takano.
Mr. Takano. Thank you, Mr. Chairman. Mr. Secretary,
welcome. Thank you for being here today. I am thrilled to see
that the Department of Health and Human Services recently
finalized and released its regulations under Section 1557 of
the Affordable Care Act, and many thanks to you and your team
for your diligent work.
Mr. Secretary, can you describe what the final rule for
Section 1557 does, and why your department felt it was
important to finalize it?
Secretary Becerra. Congressman, thank you. Under Section
1557, along with the Civil Rights statutes, we have all an
obligation to ensure that no American is discriminated against,
whether it is based on race, religion, ethnic origin. At HHS,
to make sure that healthcare services are provided without
discrimination, we take action under our Office for Civil
Rights, principally under Section 1557.
We have made sure it is clear under Section 1557 that every
American deserves to have protection for access to the care
that they need, and we will make sure that regardless of your
status as a transgender individual, or an LGBTQ American, that
you will have access to the care that you need.
Mr. Takano. You mentioned LGBTQ and transgender, but this
addresses issues related to people, you know, women.
Secretary Becerra. Everyone.
Mr. Takano. Discrimination. Everyone.
Secretary Becerra. Everyone.
Mr. Takano. As you know, LGBTQ Americans face severe health
disparities because discrimination in healthcare facilities is
rampant. There are over three times more--they are three times
more likely to avoid, postpone, or skip medical care. According
to a 2022 survey, 15 percent of LGB individuals, 32 percent of
transgender and non-binary individuals, and over half of
intersex individuals reported experiencing some form of refusal
of care by a doctor, or other healthcare provider within the
last year.
LGBTQ people of color reported an even higher rates of
refusal. How would this rule impact LGBTQ patients?
Secretary Becerra. Yes. I should note, Congressman, it is
even worse for young people who are LGBTQ. If it is bad for
adult LGBTQ Americans, it is even worse when you talk about our
adolescents, and suicide rates are higher, the outcomes are
worse, and we need to reach those individuals in our country.
What Section 1557 does is it shows them that there will be
a protection for them. We obviously need them to report.
Someone has to let us know that there are violations occurring,
so we can go in and stand up and enforce any actions that
discriminate against these individuals. We made a good start in
making sure the rule is much clearer about protecting all
Americans.
Mr. Takano. Well, thank you. My Republican colleagues have
been less concerned with the benefits of increased access to
healthcare, and more concerned about what this rule would
supposedly force providers and insurance carriers to do. I
would like to ask a few clarifying questions.
You might answer with just a yes or no if you feel
adequate. Mr. Secretary, does this rule require doctors to
perform any procedures, or provide treatments that are outside
the scope of their practice?
Secretary Becerra. No. Of course not.
Mr. Takano. Does this rule require--does this rule just
require that providers provide the same care as services to
transgender individuals that it would to other non-transgender
individuals?
Secretary Becerra. We do not dictate what services they
provide. A medical professional determines what services an
individual needs, and we do not get in the way of that. We just
want to make sure that if an individual needs that care, they
receive it.
Mr. Takano. Well, thank you. Is the Federal rule for
Section 1557 consistent with numerous court cases, including
the Supreme Court decision in Bostock, and most recently a
decision on the Fourth Circuit Court of Appeal that
discrimination against individuals on the basis of their gender
identity and sexual orientation is sex discrimination?
Secretary Becerra. Yes of course. We took into account
those various decisions in rendering the rule.
Mr. Takano. Thank you. Does this rule establish a new
standard of care for any condition?
Secretary Becerra. It simply protects people's access to
the care that they need.
Mr. Takano. Well, thank you. Mr. Secretary, we know that
gender affirming care is medically necessary care that has been
endorsed by every major medical association. I ask unanimous
consent to enter into the record the position statements of 30
professional medical associations in the care of transgender
people.
Among them are the American Academy of Pediatrics, the
American Medical Association, the American Psychological
Association, and the World Medical Association.
Mr. Walberg. Without objection.
[The Information of Mr. Takano follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Takano. Recently we have seen unprecedented attacks on
access to gender affirming care, particularly from minors with
doctors and hospitals that treat youth facing threats of
violences, and some families making the difficult choice to
relocate to a different State. Mr. Secretary, I think my
colleagues would agree that Americans have a right to access
necessary medical care. Do you feel that parents have the right
to seek evidence-based care for their children?
Secretary Becerra. We should all have the right to seek
evidence-based care.
Mr. Takano. Well, Mr. Secretary, I would just like to offer
another--to respond to Chairwoman Foxx's concern about the lack
of research surrounding gender affirming care. I woud like to
submit for the record a 19-page bibliography of research
demonstrating that individualized and age appropriate medical
care for transgender people improves mental health, and overall
well-being.
These are peer reviewed research studies that have been
published in journals such as the New England Journal of
Medicine, the Journal of Adolescent Health and Pediatrics.
Mr. Grothman [presiding]. So ordered.
[The Information of Mr. Takano follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Takano. Thank you, Mr. Secretary, for being here, and I
yield back.
Mr. Grothman. Okay. I guess I will call on myself for 5
minutes. I would like to talk a little bit about the Office of
Refugee Resettlement. How many minors without parents--do you
know how many have been allowed in this country in the last 3
years?
Secretary Becerra. Congressman, I do not have the precise
number, but it has been over 100,000 over the last few years
each year.
Mr. Grothman. How many each year?
Secretary Becerra. Over 100,000.
Mr. Grothman. Every year. Every year in this county we let
100,000 kids in without either parent, right?
Secretary Becerra. We process these children, and they come
to our custody because they are unaccompanied children.
Mr. Grothman. Okay. Do you know how many you are keeping
track of right now, or how long you keep track of a 14-year-old
who shows up at the border? How long do we keep track of them?
Secretary Becerra. To clarify the way this works, if a
child crosses the border, and does not have an adult
supervisor, the DHS, Department of Homeland Security has 72
hours within which they must transfer that child into HHS's
care because they are not equipped to handle children.
We then will process the children. Get all the information
on the child. We then hold custody of that child, as we work to
find a sponsor who we vet because by law we are supposed to
place that child in the most appropriate setting for children,
and it is not in large congregate care, so we go through that
process.
Mr. Grothman. Percentage wise, how many are going to
another relative?
Secretary Becerra. How many are going to a relative?
Mr. Grothman. Yes.
Secretary Becerra. The vast majority.
Mr. Grothman. Okay. Do we need DNA testing to make sure it
is really a relative?
Secretary Becerra. DNA testing is one of the tools that we
use to try to identify the individuals who are seeking----
Mr. Grothman. How frequently percentage wise do we do a DNA
test of----
Secretary Becerra. It depends, because often times we get
some very credible information on the identify of both the
child and the sponsor. If we need to do the confirmation, we
will go to something like DNA.
Mr. Grothman. Do we know to this day where those kids are?
Whether they moved on somewhere else? Even if it is a relative,
say an uncle or whatever, do we do followup to see if they are
in an appropriate place?
Secretary Becerra. Yes, and as I tried to mention before,
we have the records of the sponsors, and so we could reach out
to the sponsors to find out about these children afterwards.
Mr. Grothman. I think the New York Times once published
something. I do not quite believe their numbers.
Secretary Becerra. They are not correct.
Mr. Grothman. A large number, I will believe that tens of
thousands of children in this country, and we do not know where
they are or who is taking care of them. Is that true?
Secretary Becerra. People talk about them being lost. That
is all inaccurate. Remember that they are placed with a
sponsor. We no longer have jurisdiction to followup with them.
We try because we think it is important, best interests of the
children. We make an effort to try to contact both the child
and the sponsor three different times.
Mr. Grothman. Okay. Go ahead.
Secretary Becerra. Yes, three different times. The number
that you are citing from the New York Times is based on the
fact that some of those children and sponsors do not respond to
us. We do not have the authority to make them respond. They are
not lost.
Mr. Grothman. That of interest though. I guess--I am for
keeping families together, okay, and I am going to give you two
more questions.
Secretary Becerra. Yes.
Mr. Grothman. Do you feel that if somebody comes here
without a parent, a 14 year old, a 15 year old, why do we not
at least try to turn them back to their country of origin? Is
there any reason why we do not do that if a 14-year-old kid
shows up? My parents are not here, well, we are going to look
for a foster parent. Why do we not send them back home where
maybe their parents can take care of them.
Secretary Becerra. Congressman, that may be the end result.
The difficulty is----
Mr. Grothman. Well, it may be, but why is it not the norm?
Secretary Becerra. Well, I cannot say it is not the norm.
What I can tell you is it takes so long to process the case of
that child in Immigration Court that it could be four or 5
years before we finally decide what the status of the child
will be. Whether the child stays, or whether the child goes
back.
It is the fact that the process takes so long that leaves
this child in limbo.
Mr. Grothman. Oh, okay. I am going to go ahead with one
more question.
Secretary Becerra. Yes.
Mr. Grothman. Even if in our country, if there is a divorce
or something, our court system tries to keep both parents in
contact with the child.
Secretary Becerra. Yes.
Mr. Grothman. It bothers me that when a parent shows up
with one child in this country, we can allow them in this
country, rather than saying hey, wait a minute, you are here
from whatever country, you are from Brazil. Why do you--why do
we not wait, and you see if you can come here with both
parents. We are not going to take a parent and a child and
leave the other parent in some other country.
When we would not allow that maybe even for a parent to
move to a different State. Why do we not, at least in that
case, try to keep the families intact?
Secretary Becerra. You have struck on the problem we have
with the broken immigration system. We cannot do that because
everyone is entitled to a due process hearing, and because it
takes forever to hold the hearing, we cannot get to the point
of adjudicating to what you just said. That is the difficulty
when you have a broken system that does not let you process all
these individuals, not just the kids, but the adults as well,
it takes forever to finally get justice, whatever that justice
might be.
It may be going back to the home country.
Mr. Grothman. Dr. Adams.
Ms. Adams. Thank you, Mr. Chairman. Thank you, Secretary
Becerra, for testifying before the Committee today, and
certainly I enjoyed having you in my District. I look forward
to your next visit. Let me ask you in terms of the Office of
Civil Rights.
The Office of Civil Rights has opened a Federal civil
rights investigation into a Los Angeles Hospital for its
treatment of black women in labor and delivery, which follows
several lawsuits filed by Charles Johnson, following the death
of his wife, Kira Johnson, who my bill in the Momnibus package
is named for.
It addresses the role that racial bias and racial
disparities in maternal health outcomes have. Can you speak
briefly to the OCR's work as it relates to racial
discrimination in maternal health settings.
Secretary Becerra. Absolutely Congresswoman, and thanks for
your efforts in this area because I know that maternal health
and trying to get justice when it comes to access for maternal
health is something very important to you. I cannot comment
specifically about the case of Ms. Johnson because it right now
is under investigation.
What I can tell you is that the Office for Civil Rights
investigates cases of discrimination, whether race, religion,
national origin under Section 1557, which you mentioned, but
also under Title 6 of our Civil Rights laws. We are prepared to
conduct investigations if information comes to our attention.
Ms. Adams. Okay. Thank you. The CDC estimates that
approximately 700 women die each year in the U.S. from
pregnancy related complications, and we know that disparities
exist among black American, Indian and Alaskan Native women who
are about three times as likely to die from pregnancy related
causes compared to white women.
Given that more than 80 percent of pregnancy related deaths
are preventable, can you please elaborate a bit on how the
budget invests in improving maternal health outcomes across the
country?
Secretary Becerra. Absolutely Congresswoman. The
President's budget, if you look at it closely, invests close to
400 million dollars to try to address this issue of maternal
mortality and morbidity. As you know, we have engaged in
numerous efforts over these last 3 years to try to attack this
problem.
You are likely aware of the fact that under the Medicaid
program today, we have instituted, with your help, instituted a
program where instead of offering only 60 days of postpartum
care to a woman in Medicaid, for herself and for her child,
today a State is able to offer 365 days of postpartum care to
that woman and her child.
That now has been taken up by 45 of our 50 states who have
the program. The interesting thing about that is there are
still five states that have not seen it fit to offer to their
women and children in their State, access to healthcare
services when they could.
Ms. Adams. Yes, we need to work on that. According to KFF,
that study, it compared white women to women of color have
higher pregnancy related mortality rates, and more likely to
live in states with abortion bans and restrictions, have higher
uninsurance rates, and face greater financial barriers to
seeking out of State abortions.
These findings suggest that Dobbs widened the existing
stark racial disparities in mental health while also putting
black women, especially at risk for further criminalization.
What steps has HHS taken to combat widening racial disparities
in maternal health being exacerbated at the State level by
abortion bans?
Secretary Becerra. Yes Congresswoman, I think we should
note that in these states that now restrict access to the care
that a woman needs for reproductive services, the growing
number of women who are going to be impacted most are women of
color because typically they are the ones that have the lowest
income.
They are the ones that have least opportunity to access the
care they need in another State because they do not have the
resources or the capability to leave the State they may have
commitments, and so forth. It becomes very difficult in these
states for women period, but for women of color it is
desperation.
What are we doing, I mentioned some of the work that we are
doing to make sure that all women have access to the care that
they need, even in these states that are restricting access to
reproductive healthcare services, the Medicaid program that
offers care for a woman and her baby postpartum care for 365
days is available.
The close to 400 million dollars that will be there for
maternal mortality and morbidity work is going to be available
to all of those states. We are doing what we can. We just
instituted a rule that will protect the privacy of that woman's
healthcare needs, and the privacy of her physician and provider
so that they can feel comfortable engaging in conversations
about the reproductive health services a women needs.
Ms. Adams. Thank you, Mr. Secretary, and again thank you
for all of your incredible work. We appreciate it, and you are
welcome to come back to my district any time. Mr. Chairman I
yield back, my time is up.
Chairwoman Foxx. The gentlelady's time has expired. Mr.
Allen, you are recognized for 5 minutes.
Mr. Allen. Thank you, Madam Chairman, and thank you Mr.
Secretary for being with us today. Now that the Federal
Government owns and is running healthcare, we are encountering
disastrous problems throughout the country. We are losing
providers because of the oppressive policies of HHS and CMS.
Patients are compromised by complicated rules requiring
prior approvals and limits on care, and rehabilitation. It is
not free market, and it is not free patient, it is all governed
by this branch of the government. We are spending four trillion
in this country on healthcare. 1.6 trillion in taxpayer dollars
on healthcare in this country.
When Medicare began law, three people were paying for each
one Medicare recipient. Today, one American is paying for every
three Medicare recipients. We have had some difficult policy
made in the last 80 years in healthcare. It is a runaway train.
I have asked you this question every time you have come to
this, and I have served on the Healthy Future Task Force, and I
could not get an answer there either.
I keep asking, you know, where are all the dollars going?
Who is getting them? Is it the Federal agencies? The providers,
you know, their incomes are decreasing as I understand it.
Practices, hospitals are consolidating because of this problem,
it is creating a problem everywhere.
I have asked you that question. Have you all figured it out
over there? Can you give me a breakdown of where every Federal
and paid dollar goes for healthcare?
Secretary Becerra. Well, here is the interesting thing
Congressman, I could tell you where the Federal dollars go
because we keep an accounting of it. I cannot tell you where
the private sector dollar goes. You mentioned prior
authorization. That has nothing to do with the Federal
Government. Prior authorization is something that the insurance
companies came up with to try to keep providers from being able
to offer the services that they believe are necessary.
We do not--we cannot get in that space because that is done
by a private entity, that private business. I would tell you
that the answer to your question where are those dollars going,
it is the middlemen. We have heard about all the money that is
going into the PBMs. PBMs are the ones that are essentially the
go between, between pharmaceutical companies and the
pharmacies, and the dispensing.
In between the pharmaceutical companies and the pharmacies,
a whole bunch of money is in that system.
Mr. Allen. Not to cut you off, but I have got limited time
here, but realize the insurance companies are basically in bed
with the Federal Government. I mean the Federal Government----
Secretary Becerra. I have never seen them next to my
pillow. I will tell you that.
Mr. Allen. Yes, Democrats passed a partisan bloated
Inflation Reduction Act, and the drug price setting provisions
in this bill make developing treatments even more difficult by
not allowing the cost of the development to be recouped,
especially for small molecule products. Due to these differing
timelines, there is concern in the medical community that the
law does not provide enough time for small molecule
manufacturers to recoup research and development costs.
Could you tell me yes or no, will HHS address the different
timelines between small and large molecule drugs to ensure it
does not increase the cost of drugs for patients, and does not
disincentivize the innovation of drugs in the future?
Secretary Becerra. If you are speaking about the
negotiation program that we are engaged in with drug companies,
we cannot seek to negotiate the prices of some of those drugs
that you just mentioned until they have been on the market for
many, many years.
Mr. Allen. Yes, you are.
Secretary Becerra. We have taken that into account.
Mr. Allen. Yes, okay.
Secretary Becerra. Innovation we take into account what
they charge, or what they say they invest in research and
development in any price negotiation.
Mr. Allen. All right. Yes, is what I needed to hear. Back
in February, the National Association of Attorneys General sent
a letter to congressional leaders on behalf of a bipartisan
group of 39 Attorneys Generals, including Georgia's AG Chris
Carr, urging action on pharmacy benefit manager practices.
This letter outlines several PBM practices, such as spread
pricing, tying their own compensation to the list price of
medicine, they are increasing costs to millions of patients,
employers, and community pharmacies, not only in my State, but
across the country. Since you have mentioned on record that HHS
is currently enforcing the drug price transparency rule, I am
assuming that you also agree something needs to be done to
protect patients and stakeholders from such practices?
Secretary Becerra. As I mentioned, PBMs, we would all like
to do more with.
Mr. Allen. That would be a yes?
Secretary Becerra. We would all like to see you do more
when it comes to PBMs.
Mr. Allen. Okay. I have a few more questions. I will submit
those for the record. I am out of time, and I yield back, thank
you.
Chairwoman Foxx. Thank you, Mr. Allen. Ms. Jayapal, you are
recognized for 5 minutes.
Ms. Jayapal. Thank you, Madam Chair. Secretary Becerra, it
is good to see you. Congratulations on the important work that
President Biden and your department have done to lower
prescription drug prices, to improve transparency for patients,
and to bring the number of Americans without health insurance
down to historic lows.
This is very, very important work, and of course you know
that despite these historic lows, there are still 25 million
people who are uninsured in America. On top of that many
Americans are still under insured, meaning that even if you
have insurance of some kind, you simply cannot afford
healthcare.
The premium tax credits that we included in the Inflation
Reduction Act serve as a very important patch for our broken
for-profit healthcare system to immediately lower costs for
Americans, but as you know my belief is that we are only going
to have full accessibility when we transition to a single payer
Medicare for all, improved Medicare for all model.
Medical providers are steering patients toward bank loans
and credit cards that saddle them with interest on top of their
medical debt. It is really unimaginable that in the richest
country in the world, 23 million Americans owe 220 billion
dollars in medical debt, the majority of whom owe over
$10,000.00 in debt, which just continues to accumulate
interest, and meanwhile we have private insurance companies
that are doing everything they can to continue to raise
premiums, and lower care, and part of that is an increasingly
public effort to privatize Medicare.
As you know, I am the proud lead sponsor of improved
Medicare for All because I believe it is time to make sure that
our healthcare system prioritizes people over profits. A recent
Congressional Budget Office study estimates that transitioning
to a Medicare for All system would actually save 650 billion
dollars per year in costs, and so I am going to continue to
work on that.
In the meantime, I want to discuss what can be done right
now to improve healthcare for all Americans and prevent
wasteful subsidies to corporate insurers that offer what I call
Medicare Disadvantage plans. It is estimated that the Federal
Government will overpay Medicare Disadvantage companies
approximately 83 billion dollars in 2024 alone.
83 billion dollars. That is at least four times as much
money as we would need to expand traditional Medicare to cover
dental, hearing, and vision benefits. A report from the
Committee for Responsible Budget showed that over the next
decade these overpayments will increase the national debt by at
least 2 percent of GDP and advance Medicare trust fund
insolvency by 3 years.
I want to thank you, particularly, for your very strong
2025 Medicare Disadvantage rate notice that your department put
out in April, as it takes key steps to curb these drastic
overpayments. How can Congress continue to partner with your
department to go further in curbing overpayments?
Secretary Becerra. Congresswoman, thanks for all the work
you have done on this, and I would say that probably the most
important thing you can do to help us with this is
transparency. We need to get behind the curtain of these
insurance companies to find out how they are operating because,
as you mentioned, they are getting paid more than the
traditional Fee-for-Service Medicare.
We want to see how they are spending the money because in
some cases they are saying they do not have enough, and they
are going to have to start cutting services, and it is not
Medicare that would be cutting, it would be the insurance
companies.
Ms. Jayapal. Not only are the plans exorbitantly costly,
but without that kind of meaningful oversight that you are
talking about with bad actors, these plans actually have
negative health impacts on Americans. An analysis from the
National Bureau of Economic Research found that if CMS canceled
contracts with the worst performing 5 percent of MA plans, it
would save 10,000 plus lives per year.
Can you tell me what resources your department needs to
strengthen enforcement mechanisms and how strong oversight of
these plans can actually promote health equity and healthcare
for people across the country?
Secretary Becerra. I probably need 5 minutes to give you
the full answer because as you know, the Centers for Medicare
and Medicare Services has been underfunded for more than a
decade when it comes to its budget, even though it has been
asked to do the lion's share of work at HHS when it comes to
Medicare and Medicaid. If we had an agency that was fully
resourced, we could certainly be more aggressive in trying to
do the work to get behind that curtain that I mentioned, so we
could see exactly how taxpayer dollars are being spent by all
these recipients of these dollars, insurance companies and so
forth.
Ms. Jayapal. I really appreciate your work on this, and I
have to tell you that my, and I have said this to you
separately outside of the hearing, I am hearing from
constituents every day who are getting pulled into these
Medicare Disadvantage plans, promised a whole bunch of stuff
that they do not get, and ultimately then end up trying to get
off of them, which is extremely difficult in many cases, and
get back on traditional Medicare.
I think we need to continue to improve traditional
Medicare, and make sure that we provide healthcare for all
Americans, thank you for your work.
Chairwoman Foxx. Thank you. Mr. Banks, you are recognized
for 5 minutes.
Mr. Banks. Mr. Secretary, the number of children who have
come across our southern border on your watch and Joe Biden's
watch is estimated at 481,535. Last year alone it was 137,000,
and if you compare that to the last year of President Trump's
term, on his watch in the last year of his term it was less
than 25,000, so a pretty significant and dramatic increase of
unaccompanied children coming across the southern border.
The New York Times says that your Department has lost
contact with 85,000 minors, and that statistic is over a year
old, so undoubtedly it has risen in the past year.
Congressional Research Services says that 75 to 80 percent of
unaccompanied children are now traveling with smugglers, and
those smugglers have reportedly sold migrants into situations
of forced labor or prostitution, forms of human trafficking, in
order to recover their cost.
The Coalition Against Trafficking and Women says that 60
percent of unaccompanied children caught by cartels and are
exploited through child pornography and drug trafficking. The
New York Times has reported that almost one in three migrant
women, including a large population of young girls, are
reported to be sexually assaulted, over one in three of them,
coming across our southern border.
Mr. Secretary, is it the policy of this administration to
return children, unaccompanied children, coming across the
southern border back to their families where they came from, or
is it to send them into the United States away from their
families instead?
Secretary Becerra. Congressman, let me address that
question as it pertains to the Department of Health and Human
Services because we do not engage in immigration activities. We
accept the children that the Department of Homeland Security
has encountered.
Mr. Banks. Is it the policy of the Biden administration
return children back to their families, or to send them into
the United States to sponsors, or to someone else never to be
seen from again? What is the policy?
Secretary Becerra. The administration policy, and I will
try to speak generally because again it goes beyond my
jurisdiction, but generally the policy is to abide by what the
law says we must do. When someone requests an asylum hearing,
by law they are entitled to an asylum hearing.
Mr. Banks. Let me ask this a different way. If a 15-year-
old girl came across the border from say Guatemala, would we
send her back to her family in Guatemala, or would we keep her
in the United States?
Secretary Becerra. If she requested an asylum hearing, we
would by law be required to offer her a hearing.
Mr. Banks. How many children have we returned back to their
families in the country they came from on your watch?
Secretary Becerra. That would not be something I have
information on because I have----
Mr. Banks. Thousands, hundreds? Can you estimate?
Secretary Becerra. I am not going to speculate, but that is
something that you can ask the Department of Homeland Security.
Mr. Banks. You and I both know the answer to that is zero.
Zero children that you have returned back to their country. Let
me ask you this, hypothetically you and I have something in
common. We both have girls. If my daughter or your daughter was
smuggled to Guatemala, would we expect Guatemala to return our
daughters back to us, our families in the United States of
America, or would we expect them to keep them in Guatemala?
Secretary Becerra. Again, you Are asking me to speculate. I
will tell you I would do anything I have to do to get my
daughters back.
Mr. Banks. Yes. Why is the Biden administration not doing
that?
Secretary Becerra. We have to respect what the law says,
and the law says you have to provide someone with an
adjudication of their claim for asylum.
Mr. Banks. The law says that because Joe Biden has made
that the law. One of his first acts as President was to----
Secretary Becerra. That is inaccurate.
Mr. Banks. Unaccompanied minors under Title 42. He did
that. You did that. You are responsible for that law, and you
have never--by the way, have you ever come to this Committee
and asked us to change that law? Do you support changing that
law to allow us to send those children back to their families
in the country they came from?
Secretary Becerra. The President has asked you all to
change the law. There was a bipartisan bill to change the law.
Mr. Banks. I think--I have only got a limited time left. I
think the reason that you are doing this, Mr. Secretary, and
your boss Joe Biden is because Democrats are getting rich off
of it. The Global Refuge CEO and NGO that you funnel a lot of
money to, her salary is $520,000.00, and it doubled over 3
years.
The former CEO of an NGO called Southwest Key Programs made
three and half million dollars. The new CEO makes a million.
The CEO of Endeavors, who was an Obama administration aid, made
$600,000.00 in 2022. A former Biden transition official, who
helped you vet political appointees, helped endeavor and secure
a 520 billion dollar no bid contract.
These groups are making hundreds of millions of dollars and
now you are asking us to give you 9.3 billion dollars to funnel
to more of these NGO's so that your Democrat friends and donors
can get even more rich. I think that Is shameful, it Is
sickening, and I am going to do everything I can to fight
against it. Madam Chair, I yield back.
Chairwoman Foxx. The gentleman's time is expired. Ms. Wild,
you are recognized for 5 minutes.
Ms. Wild. Thank you, Madam Chair. Secretary Becerra, good
to see you again. When you were in my District not too long
ago, we briefly discussed mental health issues and I want to
return to that. In recognition of May as Mental Health
Awareness Month I would like to discuss what the department is
doing to address the very real mental health crisis that
continues to affect so many Americans.
At the very top of that list my concern has to do with kids
and online safety, and their health, or the harmful impact.
According to CDC data, children between the ages of eight to 12
spend an average of more than 5 hours a day on their screens,
while teenagers log over 8 hours every day on their devices.
I am not entirely sure whether that includes school, you
know, interactive time online or not, but either way that is a
lot of hours. I am a really proud supporter of the bipartisan
Kids Online Safety Act, which would require social media
platforms to protect minors from specific online harms, like
promoting eating disorders, substance abuse, suicide, sexual
exploitation.
I know the Surgeon General has indicated that he will
prioritize the mental health of children. As tech companies,
quite frankly, massively profit through traffic generated by
young users. First, can I assume that you would agree with the
Surgeon General's assessment that children are vulnerable and
at risk?
Secretary Becerra. No doubt our children are vulnerable.
Ms. Wild. Can you describe for us what your department has
done along the lines of protecting kids from the harms of
social media, particularly with regard to mental health issues?
Secretary Becerra. Congresswoman, we have tried to provide
support where we can. Most of the areas where we have
jurisdiction relate to providing services, treatment, and so
for example, standing up the nationwide 988 suicide and crisis
lifeline, so that kids who are experiencing real challenges,
mental health challenges for example, know where they can go.
We have provided behavioral services in the schools, and we
are doing more and more of actually providing, through
Medicaid, behavioral health services in the schools so we can
approach a child while they are in school. We are doing more of
that, but what we do not have is we do not have the authorities
or jurisdiction to try to regulate the social media industry.
Ms. Wild. The content, and I understand that, that is why I
was trying to ask my question in such a way that it was focused
on, and I understand you pretty much have to deal with their
health situation, without being able to address the root cause
because that is not under your jurisdiction.
You mentioned suicide, and one of the things I am terribly
concerned about is that in Pennsylvania suicide is the third
leading cause of death for children and young adults aged 10 to
25, which is to me just unfathomable. We created the 988
suicide and crisis lifeline, which I was a proud supporter of,
very happy about that.
How does your budget for 2025 support the continued
improvement of these kinds of services?
Secretary Becerra. This President has invested more money
in behavioral health than any previous President, and his
budget continues that increase in services and support. We
believe it is important when nine in 10 Americans are telling
you that America is experiencing a mental health crisis, you
have go to do something, it is really impacting our children.
You mentioned the issue of social media. We know we have to
be there. We are trying to work with our states. The more
resources you give us, the more we can help our states.
Ms. Wild. Yes. Well, I hear you on that, and one of the
things I will say, you mentioned behavioral health in schools.
Every school superintendent I talk to, and I have talked to
many in my District, their No. 1 flag for me is that they need
more trained and educated therapists, counselors, that kind of
thing, many of our schools, elementary schools, you know one
counselor is shared among five or six schools, which of course
does not allow them to get to know the children at all.
I am glad that your budget is focused on that, and that the
President is focused on that, and I want to make sure that the
states know exactly what they need to do to access the help
they need. In the last 20 seconds here, is there anything in
particular you would highlight for the states?
Secretary Becerra. I believe the number is now somewhere
around 15 states that have taken up the challenge that we put
before them to increase Medicaid services in the schools for
behavioral health. Not every State is doing this. They have to
submit a waiver authority so they can do this.
Rather than have to find that your child in your class is
having troubles, and send them off to the principal and say
they need to be referred to some physician, you have the
behavioral health specialist right there in the school, and you
can do it immediately.
Ms. Wild. Thank you very much for your focus on mental
health. With that, I yield back, Madam Chairwoman.
Chairwoman Foxx. Thank you. Mr. Owens, you are recognized
for 5 minutes.
Mr. Owens. Thank you. Mr. Secretary, I had not planned on
going in this direction, but I cannot help it at this point. We
just had one of our colleagues talk about some of the evil that
is happening at our border. There is no longer a rapid DNA test
as of June 2023 because of the Biden administration, which
means we can no longer tie children coming across the border
with the people bringing them across the border.
There are reports that 85,000 children are being lost. So
far, the best you can give us is that they are not lost, just
that people are not answering the phone. We are now hearing
about children that are used and reused going back and forth to
the border because of the cartel. We are talking about slavery,
rape, abuse of children, stealing of children. You say that if
this is your child you would do everything you could to stop
it. What about other people's children?
How can you remain part of an administration that allows
this evil to happen? We talk about it. We are going to take
lunch in a little bit, we move on, and nobody thinks about it
other than the folks that have been impacted. These parents,
their children have been stolen. They cannot just give it up
the way it seems like the Biden administration is doing.
Let me just say this because it appears that there is a big
hit on private market. Let me tell you what happened in the
private market. A private company did the same thing, they
would be shut down after losing the first ten kids. Then those
who would be responsible for it, we will find them in orange
suits, paying a price for decades because of losing 85,000
children.
I think it is disgusting to be honest with you. We are not
in the 1800's, the slave trading. We are not in the 1930's
where we allowed the Nazi's to do the same thing with the Jews.
We are seeing this real time. We are sitting here talking about
the lives of children, adults, and yet there seems to be no
concern about resolving it.
Let me do this. I need to say that. I have heard your
answers, so I know right now that is not on the top of your
agenda. There has been a plethora of rules coming through our
administration, this administration. A new rule called the Non-
Discrimination in Health Programs and Activities is an example
of one of the rules that HHA members have now put together.
I am curious, who on your team is responsible for putting
together and deciding on these rules? Do you have a team? A
group of people that do this, that say this is what we are
going to do now for this particular industry?
Secretary Becerra. We have a very large team because we
have a number of agencies. We have CMS, we have NIH, we have
FDA----
Mr. Owens. Okay, but within those agencies there has to be
somebody. You have a small team, there has to be somebody
making these rules.
Secretary Becerra. That is correct.
Mr. Owens. All right. Who are they? Is it possible to get
the names of these bureaucrats that are changing, literally,
the industries that we see across the board?
Secretary Becerra. I am not sure. Congressman, that all
goes through a public comment period. Everybody sees what we
are doing.
Mr. Owens. I am sorry?
Secretary Becerra. There is no rule that becomes final that
has not gone through a public comment where you and everyone
else----
Mr. Owens. When you go through that process, somebody comes
up with the rules. We are talking about----
Secretary Becerra. Before that rule becomes final you get
to see it, everyone gets to see it.
Mr. Owens. No, no, no, I am not talking about what goes
through the process. Who makes up these rules? Who is sitting
at the table? You have physicians sitting at the table, but it
comes down to that is going to be impacting physicians?
Secretary Becerra. Yes.
Mr. Owens. Okay. This rule we have here, the Non-
Discrimination of Health Program, I want to understand, by the
way, physicians do have religious liberties, right? They still
have that opportunity to be able to act based on their
religious conscience.
Secretary Becerra. Everyone does.
Mr. Owens. Okay. The Non-Discrimination and Health Program,
would that require doctors to provide gender affirming care
regardless of their religious beliefs?
Secretary Becerra. No one is forced to do anything that
goes beyond their civil liberties.
Mr. Owens. Even though that is a rule, they are not forced
to do this in their situation in their industries?
Secretary Becerra. The rule does not force any physician to
do something that is against their religious beliefs.
Mr. Owens. Okay. Well, I was told differently, but we will
make sure to followup on that one.
Secretary Becerra. Yes.
Mr. Owens. If in case--so I guess in this case here that
the rules really are not rules. It is just a suggestion?
Secretary Becerra. No. These are rules.
Mr. Owens. All right. It is a rule. Are you saying then
that they can decide not to just do whatever the rule might say
then?
Secretary Becerra. If it goes against their religious
beliefs, under the law they have protections for their
religious beliefs, therefore they would not be forced to do
something that goes against their religious beliefs.
Mr. Owens. Okay. All right. Well, I am glad to hear that. I
was told differently. Let me just wrap up here, and I just have
a few seconds. We are going to make sure we--I think the
American people hold this administration accountable for what
is happening at the border. 85,000 lives of innocent children
is not acceptable in this country, no longer, and the fact that
you are in a position in the administration, you should have
some sway to make sure that those that are part of this process
are making changes.
Secretary Becerra. Congressman, if I could just, in 5
seconds just respond.
Mr. Owens. Yes.
Secretary Becerra. If 85,000 children were lost, you, me,
everyone in this room would have taken action. That number is
inaccurate. That is not a statistic, that is real.
Mr. Owens. What is the real number? How many have been
lost?
Secretary Becerra. That is the thing, they are not lost.
They are there.
Mr. Owens. They are just not answering the phone. In other
words, the response is they are not answering the phone.
Secretary Becerra. Congress did not give anyone----
Mr. Owens. Let me say this. When you leave it, you give it
to a sponsor, they do not answer their phone, you do not know
where those kids are, they are lost. Let us just keep--if you
do not know where they are, you do not have the address, you
cannot go and pick them up. You cannot do any welfare, okay and
with that, I want to yield back my time, thank you.
Chairwoman Foxx. Yes. We invite the Secretary to send us
proof that you know where those kids are. Ms. McBath, you are
recognized.
Mrs. McBath. Thank you so much Madam Chair. Good afternoon,
or good afternoon, Secretary Becerra. It is very good to see
you. Thank you so much for coming before us today. For more
than a year my bill to cap the cost of insulin at $35.00 a
month has been lowering prescription drug costs for our
seniors.
This life saving medication is more affordable for millions
thanks to our work here in Congress, and your work in the
Biden-Harris administration, so thank you once again for that
Mr. Secretary, but I believe we can do a lot more, as we all do
in this room.
The fact of the matter is that insulin is still too expense
for working families in America, especially for those who have
young children. Parents are still waiting in the line at the
pharmacy after work, or during their lunch break, and being
forced to pay 20 or 30 times more than what citizens of other
developed nations are paying for this lifesaving drug.
Just, you know, actually it is just a few dollars for the
manufacturers to produce it, but of course, you know, our
constituents are paying far more money for this life saving
drug. I am just proud to be the lead here on this Committee, on
our efforts to lower the price of insulin for every American in
the United States. Mr. Secretary, can you briefly discuss your
budget request that ensures that every American has access to
insulin at a price point that they and their families can truly
afford?
Secretary Becerra. Congresswoman first, thank you for the
work that you did to make it possible for so many Americans to
benefit from $35.00 or less insulin. We in this budget, we
proposed that that $35.00 amount be available to every
American, not just to those in the Medicare program. Medicare,
66 million Americans, it is great for the 66 million, but there
are 332 million or so Americans in this country, everyone
should have access to reasonably priced insulin and other
prescription medication.
Mrs. McBath. Well, thank you. I would also like to discuss
our efforts to protect survivors of domestic and family
violence. The House did pass my bill. I am really grateful for
that. The bipartisan Family Violence Prevention and Services
Improvement Act, as we call it, FVPSA, they passed that last
Congress to reauthorize and improve family and domestic
violence prevention and support programs.
As the only source of Federal funding that is actually
dedicated to supporting domestic violence programs and the
shelters around the country, this program is really a lifeline,
truly a lifeline for organizations and for families that they
are doing their best to escape this cycle of violence that they
find themselves in.
Could you please use what time that you actually have left,
and you have quite a bit of time, so please expound as much as
you can, to talk about the importance of reauthorizing the
Family Violence and Prevention Services Act.
Secretary Becerra. Congresswoman, there is no doubt that we
are seeing families, children suffer as a result of domestic
violence because we treat it as a criminal activity. We lose
out because we should also treat it as a healthcare crisis
where we need to improve the health of the families that are
impacted most by this domestic violence.
We are trying to do what we can. In the money that was made
available through the bipartisan bill to address gun violence,
there were some moneys that we invested to address domestic
violence because many times that domestic violence is actuated
through the use of weapons.
What we are trying to do is more immediately reach families
before the violence occurs, and that means giving people
alternatives. There may be a case, for example that the
individual, a spouse for example, may not have any other
options but to leave. Sometimes they have nowhere to go.
If we can increase the options for a safe place for that
person to go, we can probably save a life and probably help
ensure that the family can start to recover. We are going to do
everything we can in this issue of domestic violence because we
consider that type of violence we see in this country as a
healthcare crisis that must be addressed immediately,
especially because of the mental health concerns that we see
for so many of these family members.
Mrs. McBath. Well, I just want to thank you so much for all
the work that you and the administration do. Is there anything
else that we specifically here on the hill can do to help
expedite that very kind of support that you need because we
know that exponentially a lot of the domestic violence cases
are growing.
Gun violence cases are growing across the country. I think
all the empirical data continues to show that, you know, we are
in a public health crisis as you stated. Is there anything
specific that you need from us to help do what you need to do
to protect Americans?
Secretary Becerra. Treat this as a healthcare crisis so
that way we are able to receive some of the resources to try to
address this as a healthcare crisis. Second, you mentioned it,
data. We need to have good data to see what we can do, where we
need to do it, and we need to collect the data, and then be
able to assess it.
Mrs. McBath. I thank you so much. I appreciate you. I yield
back the balance of my time.
Chairwoman Foxx. Thank you, Ms. McBath. Mr. Good, you are
recognized for 5 minutes.
Mr. Good. Thank you, Madam Chair, and welcome back Director
Becerra. I appreciate you being here, Secretary. Do you think
abortion is a good thing?
Secretary Becerra. I think--my wife is an OB/GYN. I will
tell you----
Mr. Good. Do you think abortion is a good thing?
Secretary Becerra. Congressman, if it is a service that is
needed in terms of providing good health----
Mr. Good. Do you think abortion is a good thing?
Secretary Becerra. I think abortion is a service that is
essential for many women.
Mr. Good. Do you think abortion is a good thing? That would
be a yes or no answer?
Secretary Becerra. I think I have answered your question,
but----
Mr. Good. You have not answered it. Do you think abortion
is a good thing.
Secretary Becerra. I think for many women it is a----
Mr. Good. Do you think abortion is a good thing?
Secretary Becerra. I think for many women----
Mr. Good. Okay. Do you think abortion is something that
should be reduced, or something that should be expanded?
Secretary Becerra. I think women should have access to the
healthcare services they need.
Mr. Good. Do you think abortion is something that should be
reduced, or something that should be expanded?
Secretary Becerra. I think women should have access to the
healthcare that they need.
Mr. Good. Do you think that abortion should be reduced or
expanded? Do you think it is something that is a good thing
that should be expanded? We ought to have more of it, and
celebrate that as success, or do you think it ought to be
reduced, it is a bad thing. We ought to do everything we can to
reduce abortion. One or two of the directions.
Secretary Becerra. Women having access to healthcare is a
good thing----
Mr. Good. Which one do you believe, should be reduced or
expanded.
Secretary Becerra. If the question is do I think having
access to healthcare is a good thing, having access to
healthcare is a good thing.
Mr. Good. I did not ask you about healthcare. I asked you
about abortion.
Secretary Becerra. Abortion is healthcare.
Mr. Good. Killing a child, terminating a child in the womb
is healthcare?
Secretary Becerra. Access to the healthcare a woman needs
is important.
Mr. Good. That would make sense, that that is how you would
view it with your policies on it. On May 6th, HHS issued a
final rule titled Non-Discrimination in Health Programs and
Activities, that uses Affordable Care Act to advance the
radical left, that would be you, agenda to redefine sex by
including sexual orientation and gender identify as classes
protected from discrimination.
Further, the rule also says discrimination on the basis of
pregnancy termination can be a form of sex discrimination. Let
me read that again. The rule says discrimination on the basis
of pregnancy termination can be a form of sex discrimination.
Can you explain what this means? How is pregnancy termination
now a class of people that needs to be protected?
Secretary Becerra. Women need access to care. If they need
reproductive care and they are denied it, they are now having
their rights abridged.
Mr. Good. If we do not provide coverage for the termination
of a pregnancy, the killing of a child in the womb, which by
the way, I might add, the No. 1 killer in America is what? You
are Health and Human Services, what is the No. 1 killer in
America?
Secretary Becerra. Why not tell me since you are going to
tell me anyway.
Mr. Good. Go ahead. What is the No. 1 killer in America?
Secretary Becerra. I will let you tell me. You do not seem
to want me to have the answer to the question, so I will let
you answer.
Mr. Good. Heart disease, yes they are numbers two and
three, No. 1 killer in America is abortion. The No. 1 killer in
America is abortion. Your rule says that if a woman's health
insurance plan is not giving her the unfettered right to end
her child's life, then she can claim she has been discriminated
against. That is correct?
Secretary Becerra. The way you described it, no.
Mr. Good. Okay. Why do you not clarify it then?
Secretary Becerra. A woman should have access to the care
that she needs.
Mr. Good. Let me ask that a different way. It would not be
discrimination to not cover the ability for a woman to kill her
child in the womb. For that not to be covered is not
discrimination. You are not saying that?
Secretary Becerra. I would not characterize it the way you
have, so I can try to answer the question, but I would not
answer the question that you have posed, because it is posed
inaccurately.
Mr. Good. Do you believe that someone who opposes abortion
should be accused of discriminating against a woman because
they choose not to end the life of a child? Is that
discrimination? If you oppose abortion, you oppose the
termination of life in the womb, the killing of a child in the
womb, that that's discrimination?
Secretary Becerra. If a person is being denied the
healthcare that they need, then that requires action to be
taken.
Mr. Good. It is bad enough that this regulation applies to
Obamacare, but of course you did not stop there. The rule also
states that the HHS Office of Civil Rights will extend non-
discrimination enforcement to third-party administrators
contracting with group health plans that are self-funded.
This is reaching into a whole new category of private
insurance. Now, under your regime, every employer sponsored
health plan would be required to provide gender affirming
procedures. That is an interesting term that you and your
colleagues like to use, and abortions, and it could even force
medical professionals to violate their expertise if they
believe these things, these procedures are wrong or harmful,
which they are, or their beliefs on the best care in a plan for
individuals, particularly children.
Worse yet, your budget proposes a 17 million dollar
increase for the Office of Civil Rights, so you can weaponize
the Department against doctors who do not want to provide
abortions to women. The question is why do you, and the rest of
Biden administration, why are you so determined to violate
American's religious beliefs through abortion and so-called
gender reassignment mandates?
They are mandates, but why are you so determined to violate
American's religious beliefs through that?
Secretary Becerra. We are not. We actually protect and are
willing to enforce the religious beliefs and conscious
protections that are afforded to all Americans.
Mr. Good. Well, we do not see that in this rule. There is
no need for the rule, non-discrimination and all this, not give
you or HHS the authority to mandate this nationwide abortion
and gender reassignment surgeries, and I yield back Madam
Chairwoman.
Chairwoman Foxx. Ms. Manning, you are recognized for 5
minutes.
Mrs. Manning. Thank you, Madam Chair. I do not know about
you, but I need a breath after that appalling attack on women's
healthcare, so let us take a breath and move on. I would like
to start by responding to some comments made at the top of the
hearing regarding the proposed budget.
The investment in our young people, in their health and
education is critically important for the future of our
country. If we do not ensure that all of our children get a top
quality education, including preschool, and the healthcare they
need, we will fail to create future scientists, physicians,
nurses, teachers, tech innovators, artists, and business
leaders from diverse walks of life who will ensure the future
of this great country.
I want to thank you for presenting us with a budget that
invests in our future, our children, including universal
preschool, which will help all kids get the start they need to
achieve. I would like to move to another area, and that is an
area of crisis in this country, and that is mental health.
In your testimony you State that HHS is transforming the
way we deliver behavioral healthcare. I am delighted to see
that because I met yesterday with a constituent from one of my
major hospital systems, Cone Health, and he raised the urgent
need for more options for treating people, especially young
people, with mental health problems.
Earlier this week I met with a group of our police
officers, and they gave me the same message. We need more
options for effectively treating people with mental health
problems. Secretary Becerra, you are no doubt aware that the
mental health crisis is overwhelming our emergency rooms across
this country, which are often forced to keep patients until a
bed in a long-term facility opens up.
Can you talk about what HHS is doing to relieve the stress
on our emergency rooms, and find more effective options for
treating people with mental health problems?
Secretary Becerra. Congresswoman, thank you for the
question. One of the things that we are trying to do is work
with states who are the ones who have oversight over the
hospitals and mental health services, to make it possible for
them to expand their mental health services, so you do not take
up an emergency room bed for someone who really is in need of
behavioral health services and is not there for some physical
emergency need.
What we are doing, for example, with many states is
offering them a chance to modify the way they use Medicaid
dollars, so that they can expand access to Medicaid dollars in
the behavioral health space. Some states have taken us up on
this opportunity, so that they are showing that they can take a
person, whether in an emergency room, or someone who is
homeless, take them off the street, provide them with mental
health services, housing, stabilize them, and therefore keep
them out of that emergency room in the future.
That saves everyone money, including the Medicaid program,
and so we are willing to engage with a State that wants to come
up with innovative ways to use Medicaid dollars because if at
the end of the day we are saving Medicaid money by having that
person treated more directly by the State, it is a good thing
for everyone.
Mrs. Manning. Great. I hope you will make sure that CMS has
a proper code, so that they can get reimbursed for those
creative, innovative purposes, because that is a problem. Also,
we are seeing mental health crises in our schools, and I have
visited schools across my District that are desperate to have
more school psychologists, nurses, social workers, to help our
young people deal with the mental health crisis.
I have introduced a bipartisan bill to integrate mental
health wellness programs and necessary resources into our
school wellness programs. Can you tell us how your budget would
help address the mental health issues our students are
experiencing?
Secretary Becerra. Here again, while the President tries to
invest a substantial amount of money as I mentioned, more money
for behavioral health than any we have seen in our generation,
but more precisely, working, for example through Medicaid
again, trying to get the Medicaid program directly into the
schools to provide behavior health services to children, so
they do not have to wait until they leave the classroom, leave
the school, and then go to a doctor to get the mental health
services they need.
They can get it right there on campus, so that we could
start to treat these issues quickly for children, and we can do
that without costing a school or the school district dollars
that they would otherwise spend for learning because they're
able to draw down Medicaid dollars.
Mrs. Manning. Thank you. I was going to talk about my Right
to Contraception Act, which will help defeat the attack on
women's right just to even have birth control, but I am out of
time, so I want to thank you for your testimony. I yield back.
Chairwoman Foxx. Thank you, Ms. Manning. Ms. Miller, you
are recognized for 5 minutes.
Ms. Miller. Secretary Becerra, in your final rule titled
Non-Discrimination in Health Plans and Activities, you mandate
that private health plans provide sex change operations on
children, and abortions for minors, or risk losing their
Federal funding. This rule certainly would violate the
religious conscience of thousands of doctors and medical
providers.
What would your Department do if a doctor refused to
provide the treatments mandated by this rule?
Secretary Becerra. Congresswoman, first, that was not
accurate what you said, and a provider, if they for religious
reasons object, they are not forced to provide any particular
service.
Ms. Miller. Well, your rule says that gender identity and
sexuality is protected under the title Sex Discrimination, so
it says that a doctor cannot refuse service to a patient for
that care, and I actually do not believe you. Your Department
has a history of violating the closely held religious beliefs
of people, and doctors do need to know.
Would you tell me today can you commit here today that your
Department will not withhold Federal funding from hospitals or
doctors who refuse to provide the gender affirming care that
you are, you know, mandating if it violates their religious
beliefs?
Secretary Becerra. Now, Congresswoman, I recognize you are
going somewhere completely different. First, you started
talking about how a doctor should have the right to not offer
particular care. Then you stretch it out to provide for the
system wide services, very different.
Ms. Miller. Yes. You have put out this guidance, and
doctors do need to know.
Secretary Becerra. Yes.
Ms. Miller. What are you going to do if they refuse to
provide this care?
Secretary Becerra. A doctor, if that doctor has religious
objections, that doctor under these rules is not required to
offer care.
Ms. Miller. Okay. You are committing here today that you
will not withhold Federal funding.
Secretary Becerra. Doctors do not get Federal funding,
ma'am.
Ms. Miller. The hospitals do.
Secretary Becerra. Okay. We are not talking about the
hospitals. Do not confuse the two.
Ms. Miller. Okay.
Secretary Becerra. A doctor is not a hospital.
Ms. Miller. Doctors are working in these hospitals. Are you
going to say today, are you committing that you will not
withhold Federal funding from those healthcare facilities?
Secretary Becerra. If a healthcare facility is violating
the law, and not providing the service they are required to,
they are not entitled to the resources.
Ms. Miller. We believe that you would withdraw Federal
funding. Mr. Secretary, the United Kingdom recently banned
private health providers from performing gender affirming care
on minors. Their decision relied on a study that stated puberty
blockers may damage a minor's ability to think and reason, and
that the rationale for suppressing puberty at all remains
unclear.
Mr. Secretary, are you worried that other countries are
banning puberty blockers for children, while here in the United
States the number of children on puberty blockers continues to
increase each year, as you can see here?
Secretary Becerra. Congresswoman, we rely on the best
medical evidence in knowing what services to provide, or to
support and provide reimbursement for. Those services----
Ms. Miller. Your Department is marketing these drugs to
children. The guidance on your website tells children how great
puberty blockers are, and so you are getting--I want to stop
people like you that are forcing these non-reversible
treatments on children. I am asking on behalf of parents across
the country.
Secretary Becerra. Yes. If you would accurately portray
what we were doing it would be easier to respond to your
questions. You continue to mischaracterize what we have said.
Ms. Miller. I am not mischaracterizing you or what you are
promoting.
Secretary Becerra. Read then what we are doing.
Congresswoman, why do you not read what we are doing----
Ms. Miller. You have put out this guidance. You are
promoting the use of dangerous, toxic chemicals that are not
reversible, that are experimental. You are promoting
unnecessary surgical mutilation, and it is a fact that 80
percent of our youth that struggle with gender dysphoria end up
growing out of it.
I can say that no rational or compassionate person would be
promoting this. Joe Biden and his administration are attempting
to force doctors and medical providers to go against their
closely held religious beliefs, and are forcing toxic,
experimental drugs on young children. It is a fact. These drugs
and procedures have serious side effects and will take away
their ability to ever have children.
The Biden administration is also distorting the ruling in
Bostock to push the far-left political agenda. Justice Gorsuch
was clear in his majority opinion that this ruling only applies
to Title 7. It does not give Joe Biden license to push radical
policies like this rule. History will show how wrong you and
Joe Biden are on this issue. Thank you, and I yield back to Dr.
Foxx.
Chairwoman Foxx. Thank you. Mr. DeSaulnier, you are
recognized.
Mr. DeSaulnier. Thank you, Madam Chair. Mr. Secretary, nice
to see you as always. Wonderful job. Your work on reducing
costs for Americans, I am somebody who benefits from that.
Since being diagnosed with stage four leukemia 10 years ago my
medication used to be one of those medications that was three
to $400.00 more than the rest of the developed world, in spite
of the fact that American taxpayers paid for most of the basic
research.
I am grateful for that. Tell me the consequences, the most
recent spending bill, appropriations did not fund the 21st
Century Cures Act. How does that affect all the good work we
have been doing for people like myself who are living longer
lives because of their investments as taxpayers in cancer
research and deployment?
Secretary Becerra. Congressman, I have to before I answer
the question just say you look good, and it is always good to
see you, and when you are looking good.
Mr. DeSaulnier. You should run for office.
Secretary Becerra. I just appreciate it because I remember
our days when we were together, and it is always great to see
that, you know, when fighters come out of this winning, so I am
glad you are standing and fighting. In terms of the question,
the delays in reauthorizing critical legislation that lets us
continue the discoveries, continue making more readily
available and reducing the costs of some of these lifesaving
medications is just time that we are losing.
There is no reason. Everyone knows how the Cures Law has
helped people like you and others. We should get to the task of
reauthorizing it yesterday.
Mr. DeSaulnier. I want to ask you a question about another
something near and dear to me as a survivor of suicide, your
work on suicide prevention. We have had a lot of discussion
here about mental health. The CDC's report that almost a third
of adolescent girls in this country have seriously considered
or attempted suicide.
You have an action plan. Can you speak to that?
Secretary Becerra. Yes. Anytime you hear stories that 10-
year-olds are contemplating suicide you have to wonder what is
going on in this country and so we are, because of the
President's commitment, we are able to devote more resources to
help states try to tackle this. Again, we do not operate the
programs directly at the Federal level.
You know, we are too far removed, but we support the
states, and the local health departments, and mental health
departments that provide these services. What we are doing is
we are being more aggressive in trying to get moneys directly
into some of these mental health programs for young people. I
mentioned how we are trying to get into the schools with
behavioral health programs.
We are also committing several hundred millions of dollars
in workforce development, so we get more of the behavior health
specialists that we need. I mentioned in my opening testimony,
this President's budget would make it possible for us to hire
12,000 additional psychiatrists, psychologists, therapists and
so forth.
Mr. DeSaulnier. Yes. I would love to work with you more.
Madam Chair, you and I have discussed this when we had the
gavel, and I was Chair of the HELP Subcommittee, we had good
bipartisan talks about this, but since parity we have had a 300
percent increase and a reduction on the shame associated with
suicide and mental health, but we have had a similar decrease
in young people going into the field.
My Mental Health Matters Act, I would love to work with
your Department and with the Chair, to figure out if we can
make that, because it seems like a bipartisan consensus that we
need to invest more in the deployment of behavioral health, and
what we have learned about the neuroscience of how we operate.
I wanted to ask you a question about the Kaiser
Foundation's report on denials of billing requests. I have had
comments. A friend I went to college with who owns a primary
care practice in Bethesda, bought it from his dad, his brother
runs it. He called me and said we are spending all of our time
on these denial of claims.
Kaiser says that almost 50 percent of claims of one insurer
has been denied. There is another claim from Kaiser that almost
80 percent. I have heard this from my providers. My dentist
told me this week that they spend all their time, these small
firms, just trying to get--this came about, according to
Kaiser, from actions that the previous administration did to
undermine your ability to actually oversee this, and this--the
majority party's inability to fund you at a level that we can
hold the insurance companies accountable.
I really want to work on this. I talked to clerical people
in my doctor's office, they said they are spending all this
time just trying to work on claims that used to go through that
were well substantiated, but you cannot provide the oversight
to make the insurance companies--the inefficiency of this is
outrageous.
Secretary Becerra. Yes. What you are pointing out is the
difference between in the Medicare program for example, what is
traditional Medicare, Fee-for-Service, versus the managed care
program called Medicare Advantage. Medicare Advantage, we do
not have that sight that you are mentioning. We cannot dictate.
We cannot tell them, hey, we hear you are not paying your
bills.
Providers can bill directly under Fee-for-Service
traditional Medicare to a Medicare program, and Medicare pays
them directly. Under the managed care program, Medicare
Advantage, we do not do that. We pay the insurers early before
they even provide a service. Then they get into this hassle of
prior authorization, all the rest, and providers have a heck of
a time trying to get reimbursed by the insurance company.
Mr. DeSaulnier. People give up.
Secretary Becerra. Yes.
Mr. DeSaulnier. Thank you, Madam Chair.
Chairwoman Foxx. Thank you. Mr. Burlison, you are
recognized for 5 minutes.
Mr. Burlison. Secretary Becerra, according to the
Congressional Budget Office, they estimate that the ACA plans
cost the taxpayers three times as much as an employer sponsored
plan. With that being said, is it beneficial or better that we
would encourage more policies to migrate toward an employer-
sponsored plan, as opposed to the ACA?
Secretary Becerra. Congressman, remember there is a
difference between an employer-sponsored plan, an ACA plan, the
Medicare program, Medicaid, all of them are different. The
reason that there may be a great cost in an ACA plan is because
these are individuals that do not work for a large employer,
cannot take advantage of the large pool of employees that would
be part of a system, that the employer gets discounts because
they are bringing a whole bunch of people into the system.
Mr. Burlison. Would it not be great if they get the
discount? The taxpayers win, they win. Is that not a good deal?
Secretary Becerra. It would have been great, but remember
before the Affordable Care Act came into play all these folks
could not find insurance because the insurance carriers would
not----
Mr. Burlison. They did. I mean arguably, we had high risk
pools, and I do not want to get into that. That is pretty
detailed stuff, but would it not be great if we found a way to
reduce the employer-sponsored plans by 29 percent? Obviously
more people could be able to afford to get access to health
insurance.
Secretary Becerra. Reducing the cost of healthcare would be
a great thing.
Mr. Burlison. Especially in the private market, and then it
would save the taxpayers even more, right? We are no longer
paying for them to be on the ACA.
Secretary Becerra. The more people who are insured, the
less it costs all of us.
Mr. Burlison. We have the association health plans, which
was an innovative idea. They have--a lot of the associations in
America have had a long-standing interest in allowing
themselves to combine lies to create those larger pools that
you are talking about. In 2018, the Department of Labor issued
a final rule to expand access to these associated health plans,
which actually did reduce the cost of insurance premiums by 29
percent.
Just recently, the Department of Labor issued a final rule
to rescind that 2018 rule. How do you think that that is going
to have an impact on the costs and the access of affordable
care for patients?
Secretary Becerra. Recognize that the actions that you are
speaking about were done by the Department of Labor, not by the
Department of Health and Human Services, but what I can tell
you about the various types of offerings, health insurance
offerings that are out there, what you want to make sure is
they all provide a core level of services, the basic level
essential services that anyone would want, preventative care
for example, maternal healthcare, natal care.
We want to make sure that you are providing the basic
services. If you start to go outside of the Medicare program,
Medicaid program, employer insurance, or the Affordable Care
Act, you start to get into the weeds, and the gray areas where
these providers of these plans can avoid providing some of
those basic services. That is the problem with some of these
association-based plans.
Mr. Burlison. No. I absolutely disagree. There is no
difference between an association-based plan. When they go out
to bid for pricing.
Secretary Becerra. I guarantee you there are big
differences.
Mr. Burlison. There is a difference because they are able
to negotiate in bulk. I have a different line of questioning I
want to get to before time expires. Last year you testified
before this Committee, and I asked about the 85,000
unaccompanied alien children that your Department was not able
to regain contact with.
You made repeated comments that the moment that you were
able to place them with the vetted sponsor, you lose custody.
You do attempt to call them, correct?
Secretary Becerra. Yes.
Mr. Burlison. How many have you been able to contact?
Secretary Becerra. Well, I would say that the majority we
contact at some point, whether it is the child or the sponsor.
Mr. Burlison. Do you have the number?
Secretary Becerra. I could try to get you a number because
again, they do not have to--they are not under--they are under
no obligation to reach out to us.
Mr. Burlison. You did prep for this right? Like last year,
that was a course of dialog questions, that you got a lot of
questions about.
Secretary Becerra. Yes.
Mr. Burlison. I assume that you were----
Secretary Becerra. I prepped for budget questions, budget
questions.
Mr. Burlison. Right. You would say that this is a concern,
that you would agree that it is concerning the number of
children that we are not able to identify?
Secretary Becerra. What I am concerned is that members in
Congress continue to ask me if I am concerned. I would ask you
are you concerned enough to give us authority, so we could
actually track these kids? We do not have authority to track
them.
Mr. Burlison. When you are placing these children do you
ask? Do you ascertain whether or not the homes that they are
being placed into, that they are able to actually work if they
are eligible to legally work in the United States? Is that one
of the questions you ask?
Secretary Becerra. Children should not be working. They
should be going to school.
Mr. Burlison. I am asking because why would you place them
in a home where no one can provide any kind of support.
Secretary Becerra. You cannot become a sponsor if you
indicate that you do not have the wherewithal to support a
child.
Mr. Burlison. That means that they are able to legally work
in the United States? Can you verify that?
Secretary Becerra. We make sure that they have their income
that would be needed to care for the child. That is part of the
vetting process.
Mr. Burlison. Legally?
Secretary Becerra. You know, we are not INS, we are not the
Department of Homeland Security. Our job is to find someone who
can care for this child.
Mr. Burlison. Surely you can connect with them. My time is
expired.
Chairwoman Foxx. Thank you. Ms. Omar, you are recognized
for 5 minutes.
Ms. Omar. Thank you, Secretary Becerra, for being here with
us today. Since Dobbs, Republican politicians have been
attacking women's reproductive healthcare, and in turn
jeopardizing the lives of millions of women. Can you tell us
what steps HHS has taken to ensure that women continue to have
access to comprehensive reproductive healthcare, including
abortion?
Secretary Becerra. Congresswoman, we have taken a number of
steps. Obviously, everything will fall short of what the
protections that Roe versus Wade had provided to women, but for
example, we have gone all the way to the Supreme Court to
protect a woman's access to medication abortion, Mifepristone.
We have gone all the way to the Supreme Court protecting a
woman's right to emergency care services.
We are continuing to enforce laws that require providers
and insurers to offer contraception services to women. We just
issued a rule that would protect the health information privacy
of women and their provider, so that that cannot be used
against them. I could go on, but I suspect you have more
questions.
Ms. Omar. No, thank you so much for that answer. I am
really concerned about the epidemic of the opioid crisis that
we are looking at that is shattering the lives of thousands of
people across Minnesota. My family has lost close and personal
friends to this epidemic. In Minnesota, opioid involved
overdose deaths increased 43 percent from 2020 to 2022.
The number of deaths has more than doubled since 2019.
Indigenous Minnesotans are dying at over nine times the rate of
white Minnesotans, and black Minnesotans at over three times
that rate, and we are seeing a disturbing increase in addiction
rates among East African--the East African immigrant
population.
I am deeply concerned about these disparities and about
ensuring that hard to reach communities are receiving the care
and services that they need. I see that in the budget you have
requested 1.6 billion for the State Opioid Response Grant and
two million for the Youth Prevention and Recovery Initiative,
specifically.
Can you tell us what steps the agency is taking to make
sure that the Federal funding is going toward culturally
competent care? How are you going to serve the underserved
populations?
Secretary Becerra. Congresswoman, we are making every
effort to try to encourage states to adopt culturally competent
programs, so that they can reach the populations that are often
neglected or underserved. We continue to try to stand up
opportunities for them to get funding to increase the number of
clinicians and professionals who are coming from communities
where there is a shortage of those individuals.
We could use more resources to truly push the envelope on
this, but we are making every effort, for example, to also
collect data. That gives us a better sight on where there are
absences of the professionals that we need. We are trying to
also recruit people, help states recruit people who have lived
experience, so that when they go out to be the professional,
they have gone through some of those experiences that they are
now trying to help people with.
Ms. Omar. Yes. It looks like those impacted are getting
younger and younger. I know that there are resources that are
focused on education and deterrence. What do you think can be
done to better assist folks who are already addicted, as well
as the parents considering that many of those suffering are
under the age of consent and need their parent's approval for
treatment?
Secretary Becerra. I had mentioned on several occasions
already how we are trying to get states to adopt Medicaid
innovations that would allow us to use Medicaid dollars in a
school to provide behavioral health services in a school, so a
child and a family member do not have to wait until you find a
doctor that you can send your child to help with substance
abuse or mental health services.
We are hoping--there are about 15 states that have worked
with us to change their programs, their Medicaid programs, to
accept those dollars. We have several programs, one called
Project Aware, that is specifically focused on children to try
to help them address issues like drug use, suicide prevention,
and we are trying to expand those services working with states
to see if they will adopt them.
Ms. Omar. Our kids are really in desperate need, so I hope
those services reach them. Thank you so much.
Chairwoman Foxx. Thank you. Mr. Kiley, you are recognized
for 5 minutes.
Mr. Kiley. Mr. Secretary, under Federal law folks who are
here illegally in this country are not eligible for Medicaid
benefits, but some states have circumvented this by using State
funds to expand eligibility for their Medicaid programs to the
entire population of undocumented immigrants. Do you support
those initiatives?
Secretary Becerra. Congressman, they have not circumvented
any law, they are just using their own State resources to do
what they want for the populations in their State.
Mr. Kiley. Do you support those initiatives?
Secretary Becerra. Absolutely.
Mr. Kiley. You do? You support expanding eligibility like
your own State of California has, at a cost of 3 billion
dollars to every person who is in the State illegally?
Secretary Becerra. The State has decided it wants to make
sure as many of its people, if not all of them, have access to
healthcare.
Mr. Kiley. You just said you support that. Is that an
administration policy, or your policy?
Secretary Becerra. You asked me, and I answered as an
individual.
Mr. Kiley. You do. Okay. Do you know if the administration
has a position on it? Do they agree with you and support that
policy?
Secretary Becerra. The administration would not interfere
with a state's decision to use its own money.
Mr. Kiley. Sure. You said you support it, so does the
administration support expanding eligibility for Medicaid
programs to all undocumented immigrants?
Secretary Becerra. Congressman, as you know, we use Federal
dollars, and we make sure the Federal dollars are used
properly. A State can use its State dollars as it wishes.
Mr. Kiley. Okay. You support it personally, but not
necessarily the administration?
Secretary Becerra. No. I do not want to speak for the
administration because we would not have a position on how a
State, your State, my State, uses its own dollars.
Mr. Kiley. I am sure you do, you would, I mean there are
all kinds of positions the President has about what states are
doing, but he has not spoken his position.
Secretary Becerra. Okay. Then you can ask the President.
Mr. Kiley. Okay. You started your testimony by talking
about COVID, and you said we can now manage it like the flu.
There are 30 universities in this country that still have
COVID-19 vaccine mandates for students. Do you think it is time
they ended those?
Secretary Becerra. They are managing it.
Mr. Kiley. I am sorry?
Secretary Becerra. We are trying to manage COVID, and
everyone can manage it as they see fit.
Mr. Kiley. Well, that is certainly not how the
administration conducted its policy during the pandemic, there
were all kinds of mandates and various programs. Is there any
authority, health authority under your jurisdiction that at
this point even recommends universities to have COVID vaccine
mandates?
Secretary Becerra. The recommendations principally put out
by the CDC show best practices that everyone could employ.
Mr. Kiley. Right, so do they recommend vaccine mandates at
universities right now?
Secretary Becerra. The recommendations are pretty clear.
States can then do what they wish.
Mr. Kiley. Is that a yes or no for universities?
Secretary Becerra. It is the states have the ability to do
what they believe is best for their populations.
Mr. Kiley. Just right now, you as the Secretary of Health
and Human Services, you have no opinion on whether it is a good
thing for these universities to continue their COVID vaccine
mandates in May 2024?
Secretary Becerra. Well, we have expressed what we think is
best practice in those policies that have been articulated by
the CDC.
Mr. Kiley. Okay. Is it best practice right now for a
university to have a vaccine mandate for COVID or not?
Secretary Becerra. Well, the best practices have been set
out by CDC, then any entity, whether it is a university or
State then decides how it wants to move forward.
Mr. Kiley. What is the best practice for a university?
Should they have vaccine mandates now? Yes or no?
Secretary Becerra. There are thousands of universities. I
am not going to speak for thousands of universities.
Mr. Kiley. Are you familiar with the biolab that was
discovered in Reedley, California, that was set up with links
to China?
Secretary Becerra. I am familiar with it.
Mr. Kiley. This was, you know, discovered last year, or
maybe even sooner, and there were all kinds of pathogens there.
It was actually set up by an international fugitive named Jesse
Zhu who is currently under Federal indictment. Local officials
found pathogens like E. Coli, hepatitis B, hepatitis C, HIV and
malaria and others, and yet when local officials reached out to
the CDC for help, they refused to provide it.
This is from a report from the Select Committee on the
Chinese Communist Party. It says, ``Based on their initial
observation in March 2023, local officials began to reach out
to additional Federal authorities for assistance. Local
officials spent months repeatedly trying to obtain assistance
from the CDC, but the CDC refused to speak with them.''
On a number of occasions it was reported by local officials
that the CDC hung up on them mid conversation. Why did the CDC
not come in and try to help when local officials discovered the
situation?
Secretary Becerra. I do not think that is an accurate
representation of what CDC has done.
Mr. Kiley. They did. You disagree with the Committee's
report?
Secretary Becerra. I do not think it is an accurate
description of what CDC has done.
Mr. Kiley. I see. Did the CDC test the samples they found
at the lab?
Secretary Becerra. I would have to get back to you on what
the CDC precisely did.
Mr. Kiley. According to the report here, the local
officials asked them to test the samples, these dangerous
pathogens, and they did not do so. Does that sound inaccurate
to you?
Secretary Becerra. I think you are leaving out a good part
of the story.
Mr. Kiley. What part is that?
Secretary Becerra. I would have to get back to you. I do
not have a direct understanding right now. Again, I came to
testify on the budget, but I can get back to you and let you
know what CDC did, or did not do.
Mr. Kiley. Do you have confidence right now that there are
not similar labs with links to the Chinese Communist Party in
the United States?
Secretary Becerra. Recognizing that these labs are licensed
by the states, the 50 states, and not by the Federal
Government, it would be difficult for me to answer that
question. I do not--the states do not work for me.
Mr. Kiley. Well, I mean but you do have responsibility for
public health in this country, and so right now as the
Secretary of Health and Human Services, do you have confidence
that there are not similar illegal biolabs like the one that
was discovered in Reeley throughout this country?
Secretary Becerra. I do not know what every State has in
its governance rules for the establishment of some of these
labs, so if the question is do I have confidence that all the
states are doing the right thing, I have to say probably not.
Mr. Kiley. Thank you. I yield back.
Chairwoman Foxx. Ms. Hayes, you are recognized for 5
minutes.
Ms. Hayes. Thank you. Thank you Mr. Secretary for being
here. I want to talk to you a little bit about social
determinants of health, which as you know are conditions where
the environment that people are born in, live in, work in,
learn, play, worship, affect their healthcare outcomes.
As of January 1, 2024, the Center for Medicare and Medicaid
Services began requiring healthcare organizations to screen for
the five risk factors, which they determined to be food, food
insecurity, interpersonal safety, housing insecurity,
transportation and utilities.
I know that the Department has done work in this area, but
my concern is states are really unclear as to what this can
look like. In California and West Virginia, they have done some
of these things, but there really is no clear--I hesitate to
use the word roadmap, because I know that the Department has a
roadmap, but it is not clear guidance. The thing I want to ask
you about today is that under the ACA 85 percent of premium
dollars are directly toward patient care, and then the other 15
percent are the medical loss ratio formula.
The things I just talked about--those social determinants
of health are not included under the patient care section. Is
there--can you speak a little bit to how we can change that and
start to look at some of those determinants as part of the
entire healthcare spectrum?
Secretary Becerra. Absolutely, and thank you for the
interest in addressing social determinants of health. By
statute we are either constrained or permitted to do a certain
number of things. Social determinants of health, if you look
through most statutes, are not included in the provisions of
most statutes.
What we are doing is trying to elevate the issue of what
can cause bad health, or bad health outcomes, which as you just
mentioned, can include social determinants of health. We are
making every effort we can to make sure that anyone who is out
there doing healthcare recognizes that if you are not
addressing these social determinants of health, you are missing
the boat in trying to keep people healthy.
Ms. Hayes. Thank you. I appreciate that. I introduced
legislation called the Social Determinants for Moms Act, which
really talks about how all of these things, as they relate to
maternal health, and my legislation was included as part of the
Black Maternal Health Momnibus.
It asks for the creation of a task force to better address
these things in this country. Do you think that the creation of
a task force to at least collect data on these things would be
a step in the right direction?
Secretary Becerra. Absolutely. Although we need to do more
because we need to be able to change statutes or regulations to
include social determinants of health.
Ms. Hayes. Switching gears here a little bit, I want to
talk about the final rule that was issued recently by the
Department of Health and Human Services. Can a doctor be
investigated criminally or administratively for providing care
to me for cancer?
Secretary Becerra. Can you repeat the question?
Ms. Hayes. Sure. Is it--let me see how I want to ask this
question, I am trying to get somewhere. Can I be discriminated
against for providing care if I had cancer?
Secretary Becerra. For not providing you care?
Ms. Hayes. Yes?
Secretary Becerra. Again, you have to put it in context. Is
that--is the person working in a place that holds itself out as
providing----
Ms. Hayes. As a woman. If I--I guess I am trying to get to
the point if I had cancer, if I had heart disease, if I had a
mental health condition, if I had osteoporosis, could a doctor,
would a doctor be investigated for providing care? Would I be
investigated for seeking care? Would I be investigated for
obtaining care?
Secretary Becerra. I think I hear what you are--if they are
receiving reimbursement from the Federal Government, then they
would have to offer you the care.
Mrs. Hayes. If I sought----
Secretary Becerra. Unless they have a religious objection.
Mrs. Hayes. If I sought abortion care would I have the
right to have that care or doctor deny me that care?
Secretary Becerra. You would have the right to have that
care if they are seeking reimbursement by a Federal department,
Medicare, Medicaid, if it is required by law.
Mrs. Hayes. Thank you. If it is required by law, thank you.
In my last few seconds, I do want to bring up something that I
have heard talked about on the other side a lot about the care
of unaccompanied minors at the border. I want to remind my
colleagues that in the last administration we had a crisis of
understaffing, of children being lost, of us not really
knowing.
I want to commend the Department for some of the work that
they have done to improve these programs. 24/7 case workers,
increased shelter networks, increased post-release services. My
time is running out, but I want to say that unlike the child
welfare system, you do not have the ability to monitor children
after they leave your custody, even if they are with a vetted
sponsor.
Secretary Becerra. That is correct.
Mrs. Hayes. So, I guess you could followup and say what are
some legislative fixes that Congress could make to make sure
that our connection to these children goes beyond the point
where they are turned over to family members or loved ones, so
that we can make sure that they are in fact safe, and not
falling victim to unsavory actors or trafficking or some of the
other things that have been brought up in this Committee
hearing today.
Chairwoman Foxx. We will invite the Secretary to put those
suggestions in writing. Ms. Chavez-Deremer, you are recognized,
and I note you have your father with you today, and we welcome
him.
Ms. Chavez-Deremer. Thank you. Thank you, Madam Chair.
Secretary Becerra, the Low Income Household Water Assistance
Program, administered through HHS makes a huge difference for
low-income households, as you know, assisting with water and
wastewater bills. It is really a great example of how
government is working for the people.
For those who do not know, if the water is about to be
cutoff due to inability to pay the bill, or something far too
real, it makes it difficult for families. This program makes
sure that that water can stay on. All Oregonians, all
Americans, for that matter deserve reliable access to clean
water.
In fiscal years 1921 through 1923, Congress provided 1.1
billion dollars for this program, helping over 1.6 million
families. Even so, utility costs have been skyrocketing to
compensate for the historic underpricing of water services, as
well as to pay for the rising costs of infrastructure, aging,
deferred maintenance, sporadic trends in customer bases, and
even the ever-constant burdens of regulatory compliance.
The government needs to act, that is why Congressman
Sorenson, and I introduced a bill to permanently authorize this
program, so that safe and reliable water services always
reached those who need it most. Mr. Secretary, can you speak to
some of the highlights of this program's functionality at HHS?
With that, do you foresee HHS continuing to adequately
administer this program? Should it be authorized and funded in
future years?
Secretary Becerra. Congresswoman, thank you for the
question, and congratulations on having your father here.
Ms. Chavez-Deremer. Thank you.
Secretary Becerra. I remember the first time my dad came he
was very proud, so I imagine he is extremely proud of your
accomplishments.
Ms. Chavez-Deremer. Thank you.
Secretary Becerra. Very important, you and I come from
areas where often times there is a ton of water, and then
sometimes there is drought.
Ms. Chavez-Deremer. Or at the same time.
Secretary Becerra. At the same time, yes. We have to adjust
the way we think of energy, electricity, we have to recognize
that water is indispensable, and so we would love to work with
Congress to make sure that we have a program in place that can
continue to provide families with the resources they need to
just basically live.
Ms. Chavez-Deremer. Great. Thank you. I want to move on to
another subject that is important. HHS has played a critical
role in cannabis reform, and I want to applaud both you and
your team for that. Earlier this month the country took a huge
step forward thanks to the research your agency conducted, the
DEA finally rescheduled cannabis.
In response the Department of Justice for the first time in
half a century has said it will treat Federal cannabis
violations as low-level offenses. As a proud lead of the
state's 2.0 Act, which would ensure that every State has its
right to determine the best approach to cannabis within its
borders, this was really good, welcoming news.
Federal guidance has always been a nightmare in this space,
and it is more important than ever to create a safe and
professional environment for one of the fastest growing
industries in America. This has proven to be a responsible
process, but unlike Oregon's approach which was to
decriminalize all drugs at the same time, was not a good plan.
Three years ago, Oregonians voted for Measure 110. I hope
you are familiar with what I am talking about because they told
Oregonians that it would reduce drug abuse. Instead, drug abuse
exploded and people fighting addiction have been left to fend
for themselves. Then thankfully, there was a small fix in the
legislature this year that would somewhat repeal and really
answer the cries that people were asking, it was not the right
approach.
Unfortunately, law enforcement, healthcare and homelessness
providers and homelessness, which is a growing sector in our
community, they're really suffering from this addiction. Mr.
Secretary, as the former Attorney General of California, and
now head of HHS, what are the lessons do you believe that were
learned from Measure 110, if you are familiar, and as the
United States is rapidly growing toward classifying cannabis
with its possible Federal legalization, how can we ensure that
Measure 110 will not be a mistake that is made across the
country?
Secretary Becerra. Congresswoman, you said a mouthful.
Ms. Chavez-Deremer. I know.
Secretary Becerra. Let me see because I am aware of the
measure. I do not know the details of it, I know that they
are----
Ms. Chavez-Deremer. Let me give you the details.
Secretary Becerra. Sure.
Ms. Chavez-Deremer. We recognize addiction is a serious
problem. We know that access to drug treatment is important in
a healthcare approach that is fair and reasonable, but that
particular legislation means no arrests anymore, only given a
citation.
For that citation, if you call 1-800-I-Need Help With Drug
Addiction, you could pay, you know, forego your $100.00 fine.
What did that lead to? It led to mass amounts of drugs on the
streets, an open market, and we were not helping the people who
needed it most. It did not work. That being said, Mr.
Secretary, our Governor did not do us any good in Salem, and
she kept Measure 110 on life support.
I find that unfortunate, but I need you to commit to my
office that the states act in any future legislation will deal
with it as you did in other areas, and not continue with really
the failed process of decriminalization of cannabis in other
ways as it followed Measure 110.
I would like your support and connection on that issue.
Secretary Becerra. More than willing to work with you on
some of these issues. Remember, the cannabis action has not yet
been finalized, but more than willing to work with you. We work
based off of evidence, and so whatever we do has to be evidence
based.
Ms. Chavez-Deremer. Thank you. With that, Madam Chair, I
yield back.
Chairwoman Foxx. Thank you. Ms. Leger Fernandez, you are
recognized for 5 minutes.
Ms. Leger Fernandez. Thank you so much Chairwoman Foxx and
Ranking Member Scott. It is great to see you again, Secretary
Becerra, although I must admit it was a lot more fun when we
were talking about rural health and there was mariachis, great
art and food trucks, but here we are.
Secretary Becerra. Those food trucks are not bad.
Ms. Leger Fernandez. For too long, and I know you were just
a year earlier, the country has suffered from opioid epidemic,
and 2022 nearly half of young adults, age 18 to 25 had either
mental illness, or substance use disorder. I do not want to see
another headline of a promising young person lost to overdose.
That is why I am introducing, and I am working with the
Committee around my Campus Prevention and Recovery Services for
Students Act. Right now, colleges must operate programs to
support students struggling with addiction. My bill makes sure
those programs are evidence based, and the Department of
Education coordinates with SAMHSA.
Secretary Becerra, can you tell us why we need to focus on
evidence-based programs to address addiction, and how SAMHSA
can be a key partner to the Department of Education, and these
schools?
Secretary Becerra. Congresswoman, thank you for the work
you do here because what we are finding, and we probably have
anecdotal evidence in our own homes, that oftentimes young
people do not connect the facts with what they are doing, what
they are seeing.
They think it may not be a problem if you have four or five
drinks and that that is not going to cause you any issues. Or
they may not believe that there may be harm if you are taking
particular drugs, even something like marijuana. It is
important that we have data that shows what the true facts are
so we can present that to our children, so they have a better
understanding of what might come before them.
Ms. Leger Fernandez. Thank you. Working with SAMHSA will be
key for us. At the CHC on the Road event we had extensive
discussion on the risk of closures of rural hospitals. Over 30
percent of all rural hospitals in the country are at risk of
closing. In my district alone, Alta Vista Regional closed its
labor and delivery unit, Portales, the Roosevelt General
Hospital reduced its staff hours.
One bright spot, however, is HRSA's Delta Region Community
Health Systems, which provides assistance to strengthen local
healthcare systems across the Mississippi Delta region. HRSA
does not currently fund similar grants in any western rural
communities.
Secretary Becerra, do you think that western rural states
like New Mexico would benefit from a similar program, and how
can we work together to make that happen?
Secretary Becerra. One of the things that the President--
President Biden has done is given us opportunities and
resources to focus on rural healthcare systems because as you
have said, they are very stressed, but we could use more
support to make that happen. You mentioned that the Delta
Region Community Health Systems program, which has been very
successful.
I suspect there are other regions of the country similar in
scope that could also benefit, so I would be more than willing
to work with you on something like that.
Ms. Leger Fernandez. Okay we will look at that. I know it
comes down to funding as well, and we need to remember, and
people on this Committee need to remember we want to support
some of the positive programs that you have heard on both sides
of the dais here, it takes resources.
We both grew up in bilingual households and understand the
importance of making sure our workforce is culturally and
linguistically competent. In my district alone 34 percent of
households speak a non-English language at home, and we know
immigrants--immigrants get the job done, right?
We are vital to our future success as a Nation, including
adding seven trillion dollars to the economy in the next 10
years, seven trillion. One trillion dollars in government
revenue, right? We are paying taxes. We are key. Immigrants are
key to our success, so we must make sure that we can also serve
them in our medical environments, take care of their healthcare
because they so often take care of us.
Can you share with us how HHS is expanding the number of
bilingual physicians?
Secretary Becerra. Congresswoman, thank you for the
question, and as a son of immigrants I can attest to what you
have just said. What we are trying to do is make sure that as
we expand the network of especially community health centers,
that they are able to provide the services that are needed by
the populations around them. More and more we are finding that
to offer the linguistically and culturally competent care that
is required, you really do need to bring in a workforce that
can do that immediately.
We are trying to support those efforts to try to bring in
more physicians, more nurses, more healthcare providers, who
come from communities that are often disadvantaged.
We are also trying to make sure that we support services so
that the communication between those communities and the
healthcare providers are sufficient because sometimes if the
communication is not sufficient, the wrong information gets
passed, or insufficient information gets passed, and you could
have terrible health outcomes. We know that there is a lot of
work that we can do.
Ms. Leger Fernandez. Thank you very much. Indeed,
bilingualism is a superpower, and I want to thank you for that
work. My time is expired, and I yield back, Madam Chair.
Chairwoman Foxx. Thank you, Ms. Leger Fernandez. Mr. Bean,
you are recognized for 5 minutes.
Mr. Bean. Thank you very much, Madam Chair. A very good
afternoon, Mr. Secretary, welcome back. I have got my very
first question is something that unites us all, how about that.
It also unites the American people because we're fired up. We
are all fired up against people stealing our money.
Medicaid and Medicare fraud, how much? Do we know how much
is being stolen before our eyes, Mr. Secretary?
Secretary Becerra. We do not have a precise number, but we
know that there are folks who are always gaming the system.
Mr. Bean. It is a very big number, and how about this? I
have got a report from the National Healthcare Anti-Fraud
Association, there is such an association that does a little
tracking. They say it is 100 billion. Does 100 billion sound
about right, or is that just getting started?
Secretary Becerra. You know, I have heard many numbers, but
I would not be surprised.
Mr. Bean. It is a big number. Mr. Secretary, the American
people tell me we want our money back, and hopefully that we
are going after it. CNBC just did a little news story where
they interviewed crooks that are stealing our money, and they
say--the crooks say, it is just so easy.
It is unbelievable. I know that the administration is
pursuing and persecuting people, some will say that have not
committed crimes at all, but what are we doing to go after bad
guys that are stealing our money?
Are we putting them in jail? Are we going after them?
Secretary Becerra. We are. We have a team at HHS who does
investigations. By the way, we are proposing four billion
dollars to help us do the investigation, for fraud detection.
For every dollar we have asked we agree to return about three
to five dollars to the taxpayers.
Mr. Bean. Do we track that? We should put that on a
website. This is how much money we have got back. Now when you
find somebody that has committed fraud, do we kick them out of
the program, and can we ban them for life? Do you do that, Mr.
Secretary?
Secretary Becerra. We try to remove those who have violated
the law.
Mr. Bean. I hope we do because we want our money back.
There is an issue, you know this, the American people who have
health insurance and are covered sometimes get surprised by
medical billing. They think they either go in for a procedure,
or have an emergency procedure, and they get multiple bills,
yet they had health insurance.
Congress, 2 years ago, passed the No Surprises Act to say
enough. The only surprise has been the implementation of your
administration that is kind of fumbled the ball, or at least
that is what doctors are telling me. They are telling me it is
a big surprise that it is not done yet. Is this on your radar
screen, Mr. Secretary, to fix this problem?
Secretary Becerra. Absolutely. Everybody saw the new game
in town, and everybody tried to get in, and only certain ones
were eligible and so that is what caused some of the chaos.
Mr. Bean. I hope you will consider that I meet with
doctors. There are anesthesiologists, there are dermatologists,
there is everybody here say it, we cannot get relief.
Secretary Becerra. The good thing is, the consumers are now
out of that food fight.
Mr. Bean. Let us hope so, but people are not getting paid,
and it is no fun to work for free, and that is what is
happening. Mr. Secretary, Florida, and I represent the free
State of Florida, the Florida Department of Children and
Families just put out a report this week citing disturbing
findings, and that is that NGO's, non-governmental
organizations operating under the guidance of the Office of
Refugee Resettlement, under your leadership, are placing
children in unsafe, unvetted settings.
Even worse, are explicitly prohibited from reporting
concerns to law enforcement. Are you aware of this report?
Secretary Becerra. Actually, the State of Florida took the
initiative to remove the licensing requirement for these care
centers, which does not make any sense.
Mr. Bean. Well, it does not make any sense that this report
has come out that is devastating. I know we have talked about
the 85,000 kids that are missing that we cannot find that you
have called. I know you are calling to try to locate them, but
we are still putting them, according to this report, we are
putting them in places that you do not.
Secretary Becerra. It is not accurate, but I understand
what you are trying to say.
Mr. Bean. 10-4, so you are aware of their report. I know
just earlier you talked about if a kid comes to our border and
crosses the line, and you gave the example of a 15-year-old
kid. A 15-year-old kid wants a hearing. Then that 15-year-old
kid is not sent back home, they are allowed to stay and given a
hearing.
What if that kid is 12 years old and says I want a hearing.
Would we do that for a 12 year old?
Secretary Becerra. If an individual crosses the border and
says I am seeking asylum by law----
Mr. Bean. Even 12? 12? Okay. 9? 7? What age do we say you
know what, you belong with your parents? What age? You said a
12 year old can do it. They cannot get a tattoo in America
because they are not old enough, but you are saying a 12 year
old can say I am leaving my family, and we keep them, so a 7-
year old?
Would you say a 7-year old is enough to say I want a
hearing, and you would not say you need to stay, we are not
going to put you back with your parents? Is that what you are
saying, Mr. Secretary?
Secretary Becerra. It is not what I say, Congressman, it is
what you and Congress have said, and by statute you say that if
an individual requests asylum.
Mr. Bean. Mr. Secretary, I just think it is unacceptable as
a parent that if you have these young kids are coming in and we
not only are losing them, but we are not putting them back with
the family.
Secretary Becerra. Then you have to change the law.
Mr. Bean. Thanks for coming out today, and with that Madam
Chair I yield back time.
Chairwoman Foxx. Thank you, Mr. Bean. Ms. Houchin, you are
recognized for 5 minutes.
Ms. Houchin. Thank you, Madam Chair. Thank you, Mr.
Secretary for coming before us today. I am going to pick right
up where Mr. Bean left off because I too am a mom who is very,
very concerned about the number of kids who have gone missing,
unaccompanied minors who have gone missing under your watch.
You have said repeatedly.
Secretary Becerra. Congresswoman, let me repeat again, no
child has gone missing under our watch.
Ms. Houchin. Excuse me, it is my time.
Secretary Becerra. No child has gone missing under our
watch, just to correct you.
Ms. Houchin. No children have gone missing on your watch?
Secretary Becerra. Under our watch, no child has gone
missing.
Ms. Houchin. You know where all of those 85,000 kids are?
Secretary Becerra. Those children that are in our custody,
we know where they are.
Ms. Houchin. The ones that are in your custody, okay. You
keep repeating that.
Secretary Becerra. It is hard for me to contact people I do
not have custody over.
Ms. Houchin. Let me--this is my time, Mr. Secretary. I am
looking at a report from Axios, back in 2021, and this says
this is critical of the Trump administration. Roughly one in
three calls made to release migrant kids and their sponsors
went unanswered, raising questions about the government's
ability to protect minors after they are released to family
members, or others in the U.S.
Mark Greenberg, who oversaw the unaccompanied and minors'
program during the Obama administration was briefed on Axios's
findings and says that is very dismaying. If large numbers of
children and sponsors are not being reached, that is a very big
gap in efforts to help them. Under the Trump administration,
Axios reported that there were 1,500 kids that he lost that
could not be accounted for, 1,500 kids under the Trump
administration.
Under your administration that number is close to 85,000.
On March 1, 2023, the Homeland Security Act of 2022 transferred
responsibility for the care and placement of unaccompanied
children from the Commission of the Immigration and
Naturalization Service to the Director of the Office of Refugee
Resettlement.
Who does the Office of Refugee Resettlement, who does that
Director report to?
Secretary Becerra. Congresswoman, if you want us to have
jurisdiction over these children you can give us that authority
by law. Right now, we do not have the authority to follow these
children, and that is why it is inaccurate for you to say that
we have lost any of them.
Ms. Houchin. Let me just go on. Let me just go on because I
think that is inaccurate.
Secretary Becerra. I wanted to correct the record because
you have misstated what we do at ORR. I just wanted to correct
the record, Congresswoman.
Ms. Houchin. Excuse me, this is my time. Please stop
filibustering.
Secretary Becerra. I understand Congresswoman, I just want
to correct the record of what you said.
Ms. Houchin. Madam Chair? Office of Refugee Resettlement is
under the Department of HHS, that is your department. Since
then, since March 1 of 2003, ORR has cared for thousands of
children incorporating ``child welfare values.'' ORR takes into
consideration the unique nature of each child's situation, and
incorporates child welfare principles when making placement,
clinical case management, and release decisions that are in the
best interest of the child.
Are 85,000 missing children, is that in their best
interest?
Secretary Becerra. Again, Congresswoman, you are
mischaracterizing what is going on.
Ms. Houchin. I do not believe I am, sir. I worked in child
welfare, and what is happening----
Secretary Becerra. If you think 85,000 children are
missing, why have you not tried to pass a law to make sure we
could find them? If you are so concerned.
Ms. Houchin. I believe that is what happening is you are
releasing them from your custody. That is what I believe is
happening.
Secretary Becerra. No. We are doing what our law requires
ma'am.
Ms. Houchin. Is that under ORR authority that it is your
responsibility to care for those children.
Secretary Becerra. While they are in our custody.
Ms. Houchin. It is your responsibility to watch out for
them, it absolutely is.
Secretary Becerra. Okay, but you do not recognize and
understand the law. The law has not given us the authority to
do what you just said, Congresswoman.
Ms. Houchin. Let me go back to according to the FBI more
than 98 percent of all children that go missing in the United
States are found, however less than 1 percent of all migrant
children reported missing to HHS between October 2019 and April
2023 have been found. This I would like to submit for the
record, this is from the Center for Public Integrity.
A spike in reports of missing and runaway migrant kids.
Beginning in 2020 up to 2022, we see if you can see a huge
spike in the number of reports of missing and runaway migrant
children, again, under HHS authority, only 1 percent of those--
--
Secretary Becerra. They are not under HHS authority ma'am.
I keep trying to clarify that for you.
Chairwoman Foxx. Without objection.
[The information of Ms. Houchin follows:]
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Ms. Houchin. Thank you, Madam Chair. I am extremely
frustrated as a mom, as a former child caseworker, you know, it
was--Democrats were very critical of Donald Trump and his
administration when there were 1,500 kids that fell into this
category. Under this administration there is an unbelievable
number of 85,000 missing migrant children.
I would encourage the Department to not release these kids
when they find placement, and to keep track of them for their
own personal safety. With that I would like to yield the
remainder of my time to Representative Owens.
Mr. Owens. Thank you. Thank you so much. I just have to
clarify a couple things. The rule that we talked about earlier
says that the gender identity of sexuality is protected under
Title six discrimination. I want to clarify. You mentioned that
the doctors are not forced to, they are not punished. What
about the institutions that hire these doctors?
If the institutions that hire these doctors tied into your
Federal funds do not adhere to this discrimination that this
rule is now tied to, are they defunded, are there taken away
funds?
Secretary Becerra. Congressman, I hope you understand the
way the----
Mr. Owens. One at a time. It is a yes or no, are you
punishing the institution?
Secretary Becerra. We are not punishing, no.
Mr. Owens. There is no punishment for breaking the rule?
Secretary Becerra. These institutions understand what they
are supposed to do if they are going to take Federal dollars.
Mr. Owens. Okay. You are going to punish--you take away the
dollars, right?
Secretary Becerra. No. We--they decide that if they want to
take a Federal dollar, they must follow Federal rules.
Mr. Owens. You will take away their dollars, they are
deciding, but you are putting that out if they do not----
Chairwoman Foxx. Mr. Owens, we will ask the Secretary to
please respond more thoroughly to the question.
Secretary Becerra. Which question is that?
Chairwoman Foxx. From Mr. Owens. I will get--make sure that
question is clarified. Thank you.
Secretary Becerra. Thank you.
Chairwoman Foxx. Mr. Moran, you are recognized for 5
minutes.
Mr. Moran. Thank you, Chairwoman. Secretary Becerra, I want
to talk to you about something that I think is very bipartisan,
so let us take a deep breath. I know a lot of stuff we talked
about here today is partisan in nature, and frankly, a lot of
it we disagree with. I think there is something we can agree
on, and that is we can agree on the protection of children from
child abuse.
We can agree that we should not just prevent it, but we
should protect those that are in those situations and get them
out as soon as possible. Would you agree with that?
Secretary Becerra. I would.
Mr. Moran. Yes. Mr. Secretary, the Child Abuse Prevention
and Treatment Act, also know as CAPTA authorizes grants to
states to assist communities to prevent child abuse and
neglect. Your department is tasked with overseeing the
implementation of CAPTA as you are aware.
I believe that as I mentioned everybody here should be on
the same page with trying to prevent sexual abuse, and the
exploitation of children. It is awful, and it should be
stopped. I am sure you agree with that as you said, correct?
Secretary Becerra. As I say, no child should be abused.
Mr. Moran. That is right. I am sure you are also aware that
a high number, a high percent of abusers are actually connected
either by family or close friendships to those that they abuse.
Are you aware of that as well?
Secretary Becerra. I think you are accurate.
Mr. Moran. Yes. The numbers that we see across the board is
about 90 percent of those that are being abused are being
abused by those that are closest to them, and that is just so
despicable. In Texas, the average child spends about 7 hours a
day in their school system. That means that most students are
spending a good portion of their day, sometimes more with
teachers and with staff, and school personnel than they are
with their family members at home.
That provides an opportunity for them to cry out when
necessary. That also provides an opportunity for those teachers
and staff to recognize those students that are being abused
throughout the day, and then to help step in, in that moment.
Would you also agree with that?
Secretary Becerra. You said a lot. For the most part I do
believe that we have to make sure that we are providing ways
for children to communicate that they are being abused, or to
be able to spot the abuse.
Mr. Moran. Yes. In fact, skilled personnel are critical to
help identify child abuse cases. I think they account for about
52 percent of all identified child abuse cases that are
actually reported. With that in mind, I strongly believe that
lots of child sexual abuse can be prevented or stopped through
our educational institutions with enhanced prevention policies
and enhanced opportunities for guidance in that area.
Do you believe it is important for teachers, school
employees, and other care givers who work with children to be
educated about the signs of children being sexually abused?
Secretary Becerra. I know in some areas of the country they
do receive some training, but certainly I think the more that
are teachers, and those who have--who are surrounded by
children most of the time should have some training.
Mr. Moran. Yes. I agree. Do you think additional resources
for teachers, school employees, and other caregivers would be
helpful in these efforts for them to be able to identify and
report so that we can combat sexual abuse?
Secretary Becerra. I think most teachers would say that
that would be a good thing to provide the resources for them to
be trained and have the resources to implement.
Mr. Moran. I completely agree with you. In fact,
Representative Wild, who is a Democrat from Pennsylvania and I,
are working on this exact issue. I have reintroduced what is
called the Jenna Quinn Law of 2024, named after Jenna Quinn, a
sexual abuse survivor from Texas. This bill would allow HHS to
use existing Federal funds to be used for eligible entities for
increasing evidence based or information training on sexual
abuse prevention.
It does exactly what you and I just agreed needs to
actually happen, is we need to open up additional resources. No
additional cost to taxpayers, but more resources here where
schools and institutions can tap into these existing resources,
and get education and training for their teachers so they can
report these sexual abuses.
Data has shown that after this law passed in Texas, and it
has passed in a lot of states, educators report abuse at almost
four times the rate than before. It sounds like good progress
in my State.
Nearly every Committee member on this Committee in their
own home State has enacted a version of this. Their states have
enacted that version. I think it is time that we have a
national strategy to stop child sexual abuse, and I think the
Jenna Quinn Law of 2024 would be a good way to do it. I hope
you will take a look at it.
With that I am going to reserve and yield the remainder of
my time to the gentleman from Utah, Mr. Owens.
Mr. Owens. Okay. Thank you so much. I just wanted to kind
of on that last question I had for you. Are you saying then you
are not going to punish the doctors that have religious freedom
to say no to these operations. Is there any consequence to the
institutions that are hiring these doctors? Yes or no?
Secretary Becerra. Congressman, if you understand the way
this works, an institution is seeking Federal reimbursement
dollars.
Mr. Owens. That Federal reimbursement would end if they do
not----
Secretary Becerra. They accept the reimbursement dollars
under certain conditions. They have to follow the rules of
Federal law.
Mr. Owens. Those rules would be their employees have to
make sure they do these operations.
Secretary Becerra. They have to make sure they are offering
services. If they hold themselves out----
Mr. Owens. I am just going to say and then I will finish
up. We have taken a lot of time for this one question. I think
it is very stealthy the way you guys are approaching this. You
are not hurting the doctor, but you are hurting their employee,
that is what it comes down to. You are taking away their funds.
Secretary Becerra. No. It is----
Mr. Owens. The result is the same.
Secretary Becerra. Congressman, it has been very direct,
and again, people have conscious rights, religious rights.
Mr. Owens. You are punishing the institution. I yield back,
I think--I yield back.
Chairwoman Foxx. Mr. Scott, you are recognized for 5
minutes.
Mr. Scott. Thank you. Welcome again, Mr. Secretary. Mr.
Secretary, you have got a lot of questions about problems at
the border. A lot of complaints. Are you familiar with the
legislation negotiated by Senator Lankford from Oklahoma?
Secretary Becerra. Generally familiar with it, yes.
Mr. Scott. That would have solved a lot of problems. What
happened to that bill?
Secretary Becerra. Well, my understanding is that the
Republican leadership in the House that they would not put it
up for a vote, and the Republicans in the Senate, after the
negotiations by a Republican Senator decided to bury it as
well.
Mr. Scott. That they could continue to complain rather than
actually do something. Is that right?
Secretary Becerra. It would have addressed many of the
issues that many of these members have raised.
Mr. Scott. Thank you. The nursing home rule, have you found
any correlation between staffing and deaths in nursing homes,
not just anecdotal, but on a statistical basis where there is a
correlation between staffing and deaths in the nursing home?
Secretary Becerra. Substantial.
Mr. Scott. Okay. You mentioned, and I think you got cutoff,
how life was before the Affordable Care Act. People with
preexisting conditions could not get insurance, insurance rates
were skyrocketing every year, millions of people were losing
their insurance every year. The benefits they could sell--they
did not have any essential benefits.
We now have the lowest proportion of America with--the
lowest uninsured. Do you have proposals to make it even better,
to lower the number of people uninsured?
Secretary Becerra. Absolutely.
Mr. Scott. Particularly in states without Medicaid
expansion?
Secretary Becerra. That is right. The 1.7 million Americans
would have access. North Carolina just recently last year
expanded Medicaid more than 600,000 of their population have
qualified. They are almost at that number who have actually
signed up now to get healthcare.
It is a remarkable thing when you can so quickly give
people access to good quality care.
Mr. Scott. Thank you.
Secretary Becerra. By the way, they also got a bonus check
for 1.6 billion dollars for expanding Medicaid.
Mr. Scott. Thank you. You mentioned mental health, the
historic investments in mental health. Is that in addition to
the fact that we now have mental health parity, so the
insurance policy, private insurance covers mental health, and
more people have insurance, particularly under the Affordable
Care Act and Medicaid expansion?
Are those investments in addition to those?
Secretary Becerra. In addition. Although I think you
recognize Congressman that most insurers are still not fully
implementing the law that requires parity in treatment of
mental health the way we treat physical health.
Mr. Scott. Are you trying to enforce that mental health
parity?
Secretary Becerra. We are trying to make it clear that that
is the law.
Mr. Scott. Head Start is under the jurisdiction of Health
and Human Services, not Education. What services are provided
in the Head Start program that make it more appropriate for
Health and Human Services than Education to be the appropriate
department?
Secretary Becerra. We provide a full spectrum of care
within the Head Start program so it is not just the educational
service because you are talking about children who are under
the age of 5. What we are trying to do, and we have a proposed
rule that is out there, that would try to make sure that every
slot that has made available for each State for a Head Start
child is used, because we have too many slots that are not
being used.
We are also trying to make sure that we professionalize the
Head Start workforce because too many of the teachers at Head
Start are being paid less than what you can make going to flip
burgers in a fast food joint.
Mr. Scott. Do the services like vaccinations and things
like that, do those extra services that you provide that would
not be provided in Education, do those services make a
difference?
Secretary Becerra. Absolutely. All those additional
services make a difference.
Mr. Scott. Childcare is a challenging problem for all
families. Child Care and Development Block Grant provides
childcare services for low-income families. Do all that
qualify, can they get childcare assistance?
Secretary Becerra. It is tough. The President's budget
would make available childcare services to 16 million of our
children who are lower income. It would provide them, their
families with access to care where for about $10.00 a day they
would get access to care, which probably saves them by the time
the year is up, more than $7,000.00 on what the average cost of
childcare would cost most families.
Mr. Scott. What have you done in 504 Rehabilitation Act to
help those with disabilities?
Secretary Becerra. For the first time in about 50 years, we
have updated Section 504, which is so important to Americans
with disabilities because it lets them be treated the way they
should be, as Americans. Not as second-class Americans. A
doctor cannot make a judgment that because you are disabled,
they do not need to offer you some of the services they might
offer to an able-bodied American.
It is going to be game changing for many Americans who for
the longest time found themselves being treated as second-class
or put at the end of the line because of their disability.
Mr. Scott. Thank you, Madam Chair.
Chairwoman Foxx. Thank you, Mr. Scott. Thank you, Mr.
Becerra, for being here today. Without objection, there being
no further business, the Committee stands adjourned.
[Whereupon, at 1:08 p.m., the hearing was adjourned.]
[Additional submissions by Chairwoman Foxx follows:]
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[Questions and responses for the record submitted by
Secretary Becerra follows:]
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