[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]






                                


 
                 EXAMINING THE POLICIES AND PRIORITIES
                  OF THE U.S. DEPARTMENT OF HEALTH AND
                             HUMAN SERVICES

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

                                HEARING

                               Before The

                    COMMITTEE ON EDUCATION AND LABOR
                     U.S. HOUSE OF REPRESENTATIVES

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             SECOND SESSION

                               __________



             HEARING HELD IN WASHINGTON, DC, APRIL 6, 2022

                               __________

                           Serial No. 117-42

                               __________

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                    COMMITTEE ON EDUCATION AND LABOR

             ROBERT C. ``BOBBY'' SCOTT, Virginia, Chairman

RAUL M. GRIJALVA, Arizona            VIRGINIA FOXX, North Carolina,
JOE COURTNEY, Connecticut              Ranking Member
GREGORIO KILILI CAMACHO SABLAN,      JOE WILSON, South Carolina
  Northern Marina Islands            GLENN THOMPSON, Pennsylvania
FREDERICA WILSON, Florida            TIM WALBERG, Michigan
SUZANNE BONAMICI, Oregon             GLENN GROTHMAN, Wisconsin
MARK TAKANO, California              ELISE M. STEFANIK, New York
ALMA S. ADAMS, North Carolina        RICK W. ALLEN, Georgia
MARK DeSAULNIER, California          JIM BANKS, Indiana
DONALD NORCROSS, New Jersey          JAMES COMER, Kentucky
PRAMILA JAYAPAL, Washington          RUSS FULCHER, Idaho
JOSEPH D. MORELLE, New York          FRED KELLER, Pennsylvania
SUSAN WILD, Pennsylvania             MARIANNETTE MILLER-MEEKS, Iowa
LUCY McBATH, Georgia                 BURGESS OWENS, Utah
JAHANA HAYES, Connecticut            BOB GOOD, Virginia
ANDY LEVIN, Michigan, Vice Chairman  LISA McCLAIN, Michigan
ILHAN OMAR, Minnesota                DIANA HARSHBARGER, Tennessee
HALEY M. STEVENS, Michigan           MARY MILLER, Illinios
TERESA LEGER FERNANDEZ, New Mexico   VICTORIA SPARTZ, Indiana
MONDAIRE JONES, New York             SCOTT FITZGERALD, Wisconsin
KATHY MANNING, North Carolina        MADISON CAWTHORN, North Carolina
FRANK J. MRVAN, Indiana              MICHELLE STEEL, California
JAMAAL BOWMAN, New York              CHRIS JACOBS, New York
SHEILA CHERFILUS-McCORMICK, Florida  VACANCY
MARK POCAN, Wisconsin                VACANCY
JOAQUIN CASTRO, Texas
MIKIE SHERRILL, New Jersey
ADRIANO ESPAILLAT, New York
KWEISI MFUME, Maryland

                   Veronique Pluviose, Staff Director
                  Cyrus Artz, Minority Staff Director
                                 ------                                
                         C  O  N  T  E  N  T  S

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                                                                   Page

Hearing held on April 6, 2022....................................     1

                           OPENING STATEMENTS

    Scott, Hon. Robert C. ``Bobby'', Chairman, Committee on 
      Education and Labor........................................     2
        Prepared statement of....................................     2
    Foxx, Hon. Virginia, Ranking Member, Committee on Education 
      and Labor..................................................     3
        Prepared statement of....................................     3

                               WITNESSES

    Becerra, Hon. Xavier, Secretary, U.S. Department of Health 
      and Human Services.........................................     4
        Prepared statement of....................................     5

                        QUESTIONS FOR THE RECORD

    Responses to questions submitted for the record by:
        Mr. Xavier Becerra.......................................    81


                 EXAMINING THE POLICIES AND PRIORITIES



                  OF THE U.S. DEPARTMENT OF HEALTH AND



                             HUMAN SERVICES

                              ----------                              


                        Wednesday, April 6, 2022

                  House of Representatives,
                  Committee on Education and Labor,
                                                     Washington, DC
    The Committee met, pursuant to notice, at 8:59 a.m., in 
Room 2175, Rayburn House Office Building, Hon. Robert C. 
``Bobby'' Scott (Chairman of the Committee) presiding.
    Present: Representatives Scott, Courtney, Sablan, Bonamici, 
Takano, Adams, DeSaulnier, Jayapal, Morelle, Wild, McBath, 
Hayes, Levin, Omar, Stevens, Leger Fernandez, Jones, Manning, 
Bowman, Sherrill, Espaillat, Mfume, Foxx, Wilson of South 
Carolina, Thompson, Walberg, Grothman, Stefanik, Allen, Banks, 
Fulcher, Keller, Miller-Meeks, Owens, Good, McClain, 
Harshbarger, Miller, Fitzgerald, Cawthorn, Steel, Letlow, and 
Jacobs.
    Staff present: Amaris Benavidez, Fellow; Ilana Brunner, 
General Counsel; David Dailey, Counsel to the Chairman; Kyle 
deCant, Labor Policy Counsel; Ijeoma Egekeze, Professional 
Staff; Daniel Foster, Health and Labor Counsel; Christian 
Haines, General Counsel; Alison Hard, Professional Staff; 
Rasheedah Hasan, Chief Clerk; Sheila Havenner, D'Andre 
Henderson, Digital Manager; Danyelle Honore, Fellow; Eli 
Hovland, Policy Associate; Carrie Hughes, Director of Health 
and Human Services; Stephanie Lalle, Communications Director; 
Andre Lindsay, Policy Associate; Aileen Ma, Professional Staff; 
Kevin McDermott, Senior Labor Policy Advisor; Richard Miller, 
Director of Labor Policy; Kota Mizutani, Press Secretary; Max 
Moore, Staff Assistant; Casey Peeks, Professional Staff; Robert 
Shull, Labor Policy Staff; Michele Simensky, Oversight Counsel-
Labor; Theresa Thompson, Professional Staff; Banyon Vassar, 
Deputy Director of Information Technology; Sam Varie, Press 
Assistant; Claire Viall, Professional Staff; ArRone Washington, 
Clerk; Tanisha Wilburn, Director of Labor Oversight and 
Counsel; Cyrus Artz, Minority Staff Director; Gabriel Bisson, 
Minority Staff Assistant; Caitlin Burke, Minority Professional 
Staff Member; Michael Davis, Minority Legislative Assistant; 
Mini Ganesh, Minority Staff Assistant; Amy Raaf Jones, Minority 
Director of Education and Human Resources; David Maestas, 
Minority Fellow; John Martin, Minority Deputy Director of 
Workplace Policy/Counsel; Hannah Matesic, Minority Director of 
Member Services and Coalitions; Audra McGeorge, Minority 
Communications Director; Eli Mitchell, Minority Legislative 
Assistant; Ethan Pann, Minority Press Assistant; Krystina 
Skurk, Minority Speechwriter; Mandy Schaumburg, Minority Chief 
Counsel and Deputy Director of Education Policy; and Brad 
Thomas, Minority Senior Education Policy Advisor.
    Chairman Scott. Good morning. We are ready to begin the 
official hearing, and I will count down from five and then we 
will start, five, four, three, two, one. The Committee on 
Education and Labor will come to order.
    Good morning, everyone. I note that a quorum is present. 
The committee is meeting today to hear testimony on Examining 
Policies and Priorities of the U.S. Department of Health and 
Human Services. Pursuant to Committee Rule 8(c), opening 
statements are limited to the Chair and Ranking Member, and I 
recognize myself for the purpose of making an opening 
statement.
    Today, we are meeting to discuss the Department of Health 
and Human Services Budget Request for Fiscal Year 2023. 
Secretary Becerra, I am pleased to welcome you back to the 
committee, which we once both served on together to hear your 
vision to ensure that the well-being of our country is taken 
care of.
    We know the Biden Harris administration needs a robust 
COVID package to address both the immediate and long-term 
consequences of the pandemic. It is my hope that we can send 
the President that legislation in just a few days. We must also 
address our Nation's mental health crisis. I was encouraged to 
see recent budget proposals strengthens coverage, and expands 
access to behavioral healthcare, and I finally look forward to 
working with you and the Department to ensure that we address 
systemic inequities in healthcare.
    The pandemic laid bare long-standing biases, and barriers 
to healthcare, and to recite Dr. Martin Luther King's 
observance about inequities he once said that of all forms of 
inequality, injustice in healthcare is the most shocking and 
inhuman. This is a reminder that healthcare is also a civil 
rights issue.
    Thank you for your time, and I now recognize the 
distinguished Ranking Member, the gentlelady from North 
Carolina, Dr. Foxx, for her opening statement.
    [The Statement of Chairman Scott follows:]

  Statement of Hon. Robert C. ``Bobby'' Scott, Chairman, Committee on 
                          Education and Labor

    Today, we are meeting to discuss the Department of Health and Human 
Services' budget request for Fiscal Year 2023.
    Secretary Becerra, I am pleased to welcome you back to the 
Committee, which we once both served on together, and hear your vision 
to ensure the well-being of our country is taken care of.
    We know the Biden-Harris Administration needs a robust COVID 
package to address both the immediate and long-term consequences of the 
pandemic. It is my hope we can send the President that legislation in 
just a few days.
    We must also address our nation's mental health crisis. I was 
encouraged to see that the recent budget proposal strengthens coverage 
and expands access to behavioral health care.
    Finally, I look forward to working with you and the Department to 
ensure we address systemic inequities in health care. The pandemic laid 
bare the long-standing bias and barriers to health care. To recite Dr. 
Martin Luther King's observation about inequities, he once said, that 
of all forms of inequality, injustice in health care is the most 
``shocking and inhumane.'' This is a reminder that health care is also 
a civil rights issue.
    Thank you for your time. I now recognize the distinguished Ranking 
Member, the gentlelady from North Carolina, Dr. Foxx for her opening 
statement.
                                 ______
                                 
    Ms. Foxx. Thank you, Mr. Chairman. It is so nice to get 
started promptly this morning. Secretary Becerra, President 
Biden's HHS budget for Fiscal Year 2023 is full of misplaced 
priorities and reckless spending. If this budget passes, $127.3 
billion in discretionary spending would be allocated to HHS, 
meaning taxpayers would be forced to give your agency an 
additional 13 billion dollars.
    The staggering price tag does not even include your request 
for $22 billion for so-called COVID-19 funding. States are 
awash with Federal dollars, and your administration has still 
not provided Congress with adequate accounting of where past 
COVID-19 dollars have gone.
    HHS has delivered nothing but mixed messages over the past 
year from masking and vaccinations to school re-openings and 
the risk COVID poses to children. Nobody knows where the so-
called guidance begins, and the contradictions end. Your agency 
is leading the charge to expand the Affordable Care Act and 
Medicaid, dismantling employer-sponsored health insurance in 
the process.
    Expanded access to abortions have forced taxpayers to fund 
them. Impose socialist drug pricing controls, encourage minors 
to receive permanent gender reassignment surgery and hormone 
treatments, and stop the faith community from maintaining its 
identity while continuing to participate in programs to help 
those in need.
    This insanity makes it clear that HHS is more interested in 
serving a splinter group who identify as the progressive left 
than the American people. Today our colleagues across the aisle 
will sing your praises and act as if HHS is doing an excellent 
job. They will also conveniently gloss over the fact that HHS 
has demonstrated over and over again that its true north star 
is a radical, progressive ideology, devoid of reason and common 
sense.
    Mr. Secretary, HHS is a Federal agency funded by hard-
working taxpayers, not a social science experiment. You would 
do well to remember that. Thank you, Mr. Chairman. I yield 
back.
    [The Statement of Ranking Member Foxx follows:]

Statement of Hon. Virginia Foxx, Ranking Member, Committee on Education 
                               and Labor

    Secretary Becerra, President Biden's HHS budget for Fiscal Year 
2023 is full of misplaced priorities and reckless spending.
    If this budget passes, $127.3 billion in discretionary spending 
would be allocated to HHS--meaning taxpayers would be forced to give 
your agency an additional $13 billion. This staggering price tag does 
not even include your request for $22 billion for so-called COVID-19 
funding.
    States are awash with federal dollars and your administration has 
still not provided Congress with adequate accounting of where past 
COVID-19 dollars have gone.
    HHS has delivered nothing but mixed messages over the past year, 
from masking and vaccinations to school reopenings and the risk COVID 
poses to children.
    Nobody knows where the so-called `guidance' begins and the 
contradictions end.
    Your agency is leading the charge to: expand the Affordable Care 
Act and Medicaid--dismantling employer-sponsored health insurance in 
the process; expand access to abortions and force taxpayers to fund 
them; impose socialist drug-pricing controls; encourage minors to 
receive permanent gender-reassignment surgery and hormone treatments; 
and stop the faith community from maintaining its identity while 
continuing to participate in programs to help those in need.
    This insanity makes it clear that HHS is more interested in serving 
a splinter group who identify as the progressive left than the American 
people.
    Today, our colleagues across the aisle will sing your praises and 
act as if HHS is doing an excellent job.
    The will also conveniently gloss over the fact that HHS has 
demonstrated, over and over again, that its true North Star is a 
radical progressive ideology, devoid of reason and commonsense.
    Mr. Secretary, HHS is a federal agency, funded by hardworking 
taxpayers, not a social science experiment. You would do well to 
remember that.
                                 ______
                                 
    Chairman Scott. Thank you. I will now introduce our witness 
just very briefly. The Honorable Xavier Becerra is the 25th 
Secretary of the Department of Health and Human Services, and 
the first Latino to hold the office in the history of the 
United States.
    Previously he served 12 terms in Congress, including 
service on this committee. As Attorney General of the State of 
California. We appreciate the Secretary participating today. I 
look forward to your testimony, your written statement will 
appear in full in the hearing record, and you are asked to 
limit your oral presentation to a 5-minute summary. After your 
presentation, we will move to member questions. The witness is 
aware of his responsibility to provide accurate information, so 
we will therefore proceed directly with your testimony, so 
welcome Secretary Becerra.

STATEMENT OF HON. XAVIER BECERRA, SECRETARY, U.S. DEPARTMENT OF 
   HEALTH & HUMAN SERVICES, WASHINGTON, DISTRICT OF COLUMBIA

    Secretary Becerra. Mr. Chairman, Ranking Member Foxx, and 
members. Thank you for having me. It is great to be back. As I 
recall, I think my chair was somewhere way down there when I 
served on this committee, and it is good to be back. I will try 
to keep with the Chairman's admonition, and keep my remarks as 
short as possible, and hopefully you will have some time.
    Today more than 255 million Americans have received at 
least one dose of the COVID-19 vaccine, two-thirds of adults 
over age 65 have gotten their booster shots, and we have also 
been able to close the gap in vaccine rates we usually see for 
communities often left behind.
    It has paid dividends to surge resources, including tests 
and treatments to our hardest hit, and highest risk 
communities. 325 million free COVID-19 at home tests have been 
shipped. 270 million free N95 masks. From the 186 billion 
dollars appropriated by Congress for the provider relief fund, 
766,000 payments to over 400,000 providers who have received 
payments for COVID services. That is real money, real relief, 
real results.
    Beyond COVID 19, today more Americans have insurance for 
their healthcare than ever before. That includes a record-
breaking 14 and a half million Americans who secure health 
insurance through the Affordable Care Act. That is a big deal.
    Less noticed, we launched Operation Allies Welcome, an HHS-
led effort that has helped over 68,000 of our Afghan brothers 
and sisters who are refugees settle in America. We are 
coordinating nearly 300 million dollars in nationwide support 
for the launch of the 988 National Suicide Prevention Lifeline 
this July.
    HHS has also been making key investments to close holes in 
our public health system, in areas like maternal health, where 
we have extended Medicaid coverage for post-partum care for a 
new mother, and her baby from 2 months to 12 months. The 
President's 2023 budget lets us build on that record of 
investment in America's health.
    It proposes 127 billion dollars in discretionary budget 
authority, and 1.7 trillion dollars in mandatory funding, 
including a historic investment to transform the mental health 
infrastructure in our country, a priority I know for many of 
you. It also asks for 82 billion dollars for the President's 
Pandemic Preparedness Proposal, to get ready for whatever might 
come next after COVID-19.
    Considering that COVID has cost this country more than 4 
and a half-trillion dollars in direct support from the Federal 
Government so far, this investment of $82 billion is a no-
brainer to prepare for the next pandemic. The funding we are 
requesting will be end to end, which means it is going to be 
for research, development, approvals, deployment, and effective 
response.
    Mr. Chairman and members of the committee, this budget 
turns hardship into hope, and inclusion into opportunity, and I 
look forward to working with you to make it a realty to 
continue our efforts to give the American people real relief, 
real results, and real peace of mind, and I would be happy to 
answer any questions you might have.
    [The Statement of Secretary Becerra follows:]

Statement of Hon. Xavier Becerra, Secretary, U.S. Department of Health 
           & Human Services, Washington, District of Columbia

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