[House Hearing, 118 Congress]
[From the U.S. Government Publishing Office]






                                 
 
                       EXAMINING THE POLICIES AND
                    PRIORITIES OF THE DEPARTMENT OF
                       HEALTH AND HUMAN SERVICES

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

                                HEARING

                               Before The

                COMMITTEE ON EDUCATION AND THE WORKFORCE
                     U.S. HOUSE OF REPRESENTATIVES

                    ONE HUNDRED EIGHTEENTH CONGRESS

                             FIRST SESSION

                               __________



             HEARING HELD IN WASHINGTON, DC, JUNE 13, 2023

                               __________

                           Serial No. 118-13

                               __________
                               
                               
                               
                               
                               
                               

  Printed for the use of the Committee on Education and the Workforce
  
  
  
  


        Available via: edworkforce.house.gov or www.govinfo.gov
        
        
        
        
                         ______

             U.S. GOVERNMENT PUBLISHING OFFICE 
 55-561            WASHINGTON : 2024      
 
 
        
        
                COMMITTEE ON EDUCATION AND THE WORKFORCE

               VIRGINIA FOXX, North Carolina, Chairwoman

JOE WILSON, South Carolina           ROBERT C. ``BOBBY'' SCOTT, 
GLENN THOMPSON, Pennsylvania             Virginia,
TIM WALBERG, Michigan                  Ranking Member
GLENN GROTHMAN, Wisconsin            RAUL M. GRIJALVA, Arizona
ELISE M. STEFANIK, New York          JOE COURTNEY, Connecticut
RICK W. ALLEN, Georgia               GREGORIO KILILI CAMACHO SABLAN,
JIM BANKS, Indiana                     Northern Mariana Islands
JAMES COMER, Kentucky                FREDERICA S. WILSON, Florida
LLOYD SMUCKER, Pennsylvania          SUZANNE BONAMICI, Oregon
BURGESS OWENS, Utah                  MARK TAKANO, California
BOB GOOD, Virginia                   ALMA S. ADAMS, North Carolina
LISA McCLAIN, Michigan               MARK DeSAULNIER, California
MARY MILLER, Illinois                DONALD NORCROSS, New Jersey
MICHELLE STEEL, California           PRAMILA JAYAPAL, Washington
RON ESTES, Kansas                    SUSAN WILD, Pennsylvania
JULIA LETLOW, Louisiana              LUCY McBATH, Georgia
KEVIN KILEY, California              JAHANA HAYES, Connecticut
AARON BEAN, Florida                  ILHAN OMAR, Minnesota
ERIC BURLISON, Missouri              HALEY M. STEVENS, Michigan
NATHANIEL MORAN, Texas               TERESA LEGER FERNANDEZ, New Mexico
JOHN JAMES, Michigan                 KATHY E. MANNING, North Carolina
LORI CHAVEZ-DeREMER, Oregon          FRANK J. MRVAN, Indiana
BRANDON WILLIAMS, New York           JAMAAL BOWMAN, New York
ERIN HOUCHIN, Indiana

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

                              ----------                              
                                                                   Page

Hearing held on June 13, 2023....................................     1

                           OPENING STATEMENTS

    Foxx, Hon. Virginia, Chairwoman, Committee on Education and 
      the Workforce..............................................     1
        Prepared statement of....................................     4
    Scott, Robert C. ``Bobby'', Ranking Member, Committee on 
      Education and the Workforce................................     7
        Prepared statement of....................................     9

                               WITNESSES

    Becerra, Xavier, Secretary, U.S. Department of Health and 
      Human Services.............................................    12
        Prepared statement of....................................    15

                         ADDITIONAL SUBMISSIONS

    Ranking Member Scott:
        Letter from Centers for Medicare and Medicaid Services 
          dated May 4, 2023......................................    84
        Article from The Tennessean dated October 31, 2022.......   120
        Letter requesting to schedule a child labor hearing dated 
          June 6, 2023...........................................   124
        Article from Scientific American dated May 12, 2022......   127
        Brochure from Education and Labor dated September 2022...   134
        Letter from Kristen Clarke, Assistant Attorney General, 
          Civil Rights Division, U.S. Department of Justice dated 
          March 31, 2022.........................................   143
        Article from NPR.org dated August 26, 2022...............   147
        Article from American College of Cardiology (ACC) dated 
          October 14, 2022.......................................   166
        Blog from American Academy of Pediatrics dated August 10, 
          2022...................................................   168
    Grothman, Hon. Glenn, a Representative in Congress from the 
      State of Wisconsin:
        Field Guidance #10 dated March 22, 2021 from the 
          Administration for Children & Families.................    28
        Field Guidance #11 dated March 31, 2021 from the 
          Administration for Children & Families.................    32
    Manning, Hon. Kathy, a Representative in Congress from the 
      State of North Carolina:
        Governor child care sign on letter dated June 13, 2023...    89
    Miller, Hon. Mary, a Representative in Congress from the 
      State of Illinois:
        FDA Warning from the Food and Drug Administration dated 
          July 1, 2022...........................................    57
    Stefanik, Hon. Elise M., a Representative in Congress from 
      the State of New York:
        Article from The New York Times dated April 17, 2023.....    92
        Article from The New York Times dated February 25, 2023..   103

                        QUESTIONS FOR THE RECORD

    Response to questions submitted for the record by:
        Secretary Xavier Becerra.................................   172


                       EXAMINING THE POLICIES AND



                      PRIORITIES OF THE DEPARTMENT



                      OF HEALTH AND HUMAN SERVICES

                              ----------                              


                         Tuesday, June 13, 2023

                  House of Representatives,
          Committee on Education and The Workforce,
                                                    Washington, DC.
    The committee met, pursuant to notice, at 10:17 a.m., House 
Rayburn Office Building, Room 2175, Hon. Virginia Foxx, 
[Chairwoman of the Committee] presiding.
    Present: Representatives Foxx, Thompson, Walberg, Grothman, 
Stefanik, Allen, Banks, Comer, Owens, Good, McClain, Miller, 
Kiley, Bean, Burlison, Moran, James, Chavez-DeRemer, Williams, 
Houchin, Scott, Courtney, Sablan, Wilson, Bonamici, Takano, 
Adams, DeSaulnier, Norcross, Jayapal, Wild, McBath, Hayes, 
Omar, Stevens, Leger Fernandez, and Manning.
    Staff present: Cyrus Artz, Staff Director; Mindy Barry, 
General Counsel; Jackson Berryman, Speechwriter; Michael Davis, 
Legislative Assistant; Cate Dillon, Director of Operations; 
Isabel Foster, Press Assistant; Daniel Fuenzalida, Staff 
Assistant; Sheila Havenner, Director of Information Technology; 
Taylor Hittle, Professional Staff Member; Claire Houchin, 
Intern; Amy Raaf Jones, Director of Education and Human 
Resources Policy; Alex Knorr, Legislative Assistant; John 
Martin, Deputy Director of Workforce Policy/Counsel; Hannah 
Matesic, Director of Member Services and Coalitions; Audra 
McGeorge, Communications Director; Rebecca Powell, Staff 
Assistant; Ian Prince, Professional Staff Member; Kent Talbert, 
Investigative Counsel; Heather Wadyka, Professional Staff 
Member; Seth Waugh, Director of Workforce Policy; Joe Wheeler, 
Professional Staff Member; Jeanne Wilson, Retirement Counsel; 
CJ Mahler, Professional Staff Member; Meghan Heckelman, Intern; 
Andre Lindsay, Minority Professional Staff; Banyon Vassar, 
Minority IT Administrator, Bob Shull, Minority Senior Labor 
Policy Counsel; Brittany Alston, Minority Operations Assistant; 
Carrie Hughes, Minority Director of Health & Human Services 
Policy; Daniel Foster, Minority Senior Health and Labor 
Counsel; Dhrtvan Sherman, Minority Staff Assistant; Ilana 
Brunner, Minority General Counsel; Jessica Schieder, Minority 
Economic Policy Advisor; Kota Mizutani, Minority Deputy 
Communications Director; Nekea Brown, Minority Director of 
Operations; Raiyana Malone, Minority Press Secretary; Stephanie 
Lalle, Minority Communications Director; Theresa Tilling-
Thompson, Minority Professional Staff; Veronique Pluviose, 
Minority Staff Director; and Angela Lopez--Albarran, Minority 
Intern.
    Chairwoman Foxx. The Committee on Education and the 
Workforce will come to order. I note that a quorum is present. 
Without objection, the Chair is authorized to call a recess at 
any time. Welcome, Secretary Becerra. Let me start by reviewing 
the OMB guidelines which govern your appearance before the 
Committee today.
    When testifying, OMB Circular A 11, Section 22 states, 
``Witnesses will give frank and complete answers to all 
questions.'' Frank and complete. I emphasize this point because 
Acting Secretary of Labor Su and your fellow cabinet official 
Secretary of Education Cardona have failed to be either frank 
or complete in appearances before the Committee so far this 
Congress.
    I watched earlier this year when you were unable to provide 
frank or complete answers to the Ranking Member of the Senate 
HELP Committee, Dr. Bill Cassidy, regarding questions about the 
Department of Health and Human Services, HHS telework policy. I 
hope you come prepared with more adequate responses today.
    Being forthcoming in your testimony and in answering the 
Committee's questions is not only important to our duty to 
conduct oversight, but also because the HHS budget is the 
largest in the executive branch. The President's Fiscal Year 
202024 budget request calls for a massive 144.3 billion in 
discretionary spending, and 1.7 trillion in mandatory spending.
    My colleagues know I hate those two words as being 
distinguished, but that is the way they are dealt with in our 
system. For context, one in every four dollars taken from 
taxpayers by the Federal Government is routed through HHS. It 
was not until the last 10 years or so that the word trillion 
became a part of everyday budget parlance. It is a worrisome 
trend.
    Budgets calling for more money and reckless spending are 
crushing everyday Americans. We have seen the inflationary 
effect of this administration's 5 trillion dollars of deficient 
spending reflected in four dollars for a dozen eggs and four 
dollars for a gallon of gas. Each dollar matters when wallets 
are stretched thin.
    The enormous HHS budget requires a critical eye. Our 
oversight duties can be summed up in three rhetorical 
questions. One, are you being a good steward of taxpayer money? 
No, Mr. Secretary, this administration has drastically 
increased the burden on taxpayers by quietly, but steadily 
moving enrollees from the small group market to Obamacare 
exchanges in Medicaid.
    The budget calls for the permanent expansion of Obamacare's 
advanced premium tax credits, which would lead to 1.6 million 
employees losing employer sponsored coverage, and costing 247.9 
billion over a 10 year span. The all-out assault on employer 
sponsored insurance is costly, but it is also the Trojan horse 
for Medicare for all.
    While most workers like their employer sponsored insurance, 
these plans are dwindling under the Biden regulatory scheme. 
Now, employee sponsored coverage represents under half of all 
plans, and fully socialist healthcare is all but certain as 
Medicare and Medicaid enrollees reach critical mass.
    Second, your regulatory scheme is hurting the taxpayer, but 
are your policies promoting a healthier America? Again, the 
answer is no. At the southern border, HHS has endangered 
countless minors through unaccompanied children programs, then 
covered it up through whistleblower intimidation.
    This means HHS knowingly transferred these children to the 
possession of others who were not their parents without 
ensuring that the child was healthy, or that the transfer was 
necessary. Ultimately, this negligence may have contributed to 
the deaths of at least two migrant children in the past few 
months, which the Committee learned about by reporting by Fox 
News and CNN.
    It is troubling that HHS did not think this tragedy 
warranted a phone call. Last, your policies are not promoting a 
healthier America, but are you committed to upholding the 
Constitutional rights of all Americans? Strike three. At least 
not with the respect to the First Amendment, which protects 
Americans' free exercise of religion.
    From the beginning, Secretary Becerra, your record has 
shown hostility toward faith-based groups. In fact, the only 
healthcare experience you had before assuming office was 
litigating an appellate court case in which you attempted to 
strong arm Catholic nuns into paying for others' 
contraceptives.
    You have carried the very same disposition toward religious 
liberty into your role as Secretary. Tooth and nail you fought 
religious groups by threatening them. St. Francis Health 
Systems knows you threatened to remove its Medicare 
accreditation if it did not extinguish the living flame in its 
chapel.
    That is not to say that HHS serves no religion, rather 
antagonizing faith-based organizations is merely an attempt to 
smuggle your department's pseudo religion through the back 
door. Mr. Secretary, HHS serves the civil religion of 
progressivism and radical gender ideology.
    Minors are undergoing irreversible sex change operations in 
this country, operations that you encouraged with your rhetoric 
and funding. Radical gender ideology is not a marker of a 
healthy country. On every axis, anxiety, depression, 
suicidality, self-harm, you name it, these children are 
unhealthy and in desperate need of a society-wide fix, not 
individual genital mutilation. In 1787, Thomas Jefferson wrote, 
``Without health, there is no happiness, and attention to 
health then, should take the place of every other object.'' In 
the spirit of Jefferson, let us recognize and remedy our 
national mental health sickness.
    It seems to me that it is the worst, where and when radical 
gender ideology is most pervasive. Maybe, Mr. Secretary, you 
should start there. With that, the Committee looks forward to 
your direct, frank, and complete answers, and I yield to the 
Ranking Member for his opening statement.
    [The prepared statement of Chairwoman Foxx follows:]
    [GRAPHIC] [TIFF OMITTED] T5561.001
    
    [GRAPHIC] [TIFF OMITTED] T5561.002
    
    [GRAPHIC] [TIFF OMITTED] T5561.003
    
    [GRAPHIC] [TIFF OMITTED] T5561.004
    

    Scott. Thank you, Dr. Foxx. Secretary Becerra, good 
morning. Thank you for being with us today. It is always a 
pleasure to welcome you back to the Committee. You are familiar 
with this room. You and I began our congressional careers in 
this room 30 years ago, and it is a pleasure to see you back.
    A pleasure to see you discuss your work as you protect our 
Nation's well-being. One of the enduring lessons reaffirmed in 
the COVID-19 pandemic is that when we invest in the health of 
our communities, we provide people with the tools and resources 
to care for themselves and their loved ones.
    Under your leadership, the Department of Health and Human 
Services made historic investments to help every worker and 
family get quality, affordable healthcare. Last Congress, we 
passed the American Rescue Plan Act, which you had a lot to do 
with. It enhanced premium tax credits, and lowered monthly 
costs for Americans, especially by eliminating the subsidy 
cliff, so more individuals could get affordable coverage.
    We also passed the Inflation Reduction Act to extend these 
tax credit enhancements, cap the cost of insulin for people on 
Medicare, and for the first time ever, direct the Federal 
Government to negotiate lower prices for prescriptive drugs 
covered by Medicare. These decisive actions have yielded 
results.
    Last August, we brought the portion of Americans without 
health insurance down to the lowest level ever. In the most 
recent open enrollment period, a record 16.3 million people 
signed up for marketplace coverage. You also know that 
protecting our Nation's health goes beyond improving access to 
health insurance, and that is why last Congress we also secured 
House passage of legislation to prevent child abuse, addressed 
domestic violence, and lift people out of poverty.
    Unfortunately, while my colleagues on the other side speak 
frequently about their commitment to our Nation's health and 
safety, they have not backed up their words with actions. For 
example, my colleagues may talk about child labor today. 
However, the reality is that they sought to hold our Nation's 
full faith and credit hostage, and threaten severe cuts in 
Federal resources that protect children, and prevent abuses 
from happening.
    The Republican State legislatures all over the country are 
working to reverse child worker protection laws, and despite 
our letter requesting a hearing on this persistent and growing 
problem, the majority has yet to schedule a hearing or advance 
legislation to address child labor violations.
    Instead, we have seen Republican politicians continue to 
attempt to sabotage quality healthcare coverage, and undermine 
access to services that our constituents need. The nation is 
witnessing the harsh restrictions and criminalization of 
women's access to abortions, jeopardizing the health of women 
and families across the country.
    We are all bearing witness to the baseless villainization 
of unnecessary care that supports transgender individuals, and 
you heard some of that just a moment ago. Earlier this year the 
Federal judge of the Fifth Circuit who previously tried to 
eliminate the Affordable Care Act before it was upheld by the 
Supreme Court, ruled to strip millions of Americans of access 
to preventive healthcare, and thankfully that ruling has been 
temporarily suspended.
    Just last week, the Committee majority voted to report out 
two bills that increase healthcare cost for vulnerable 
Americans by expanding association health plans, and blocking 
State and Federal consumer protections with stop loss 
insurance. In contrast, Committee Democrats and congressional 
Democrats, and this administration will continue working to 
lower prescriptive drug prices, strengthen the ACA, and approve 
transparency for healthcare consumers.
    Committee Democrats remain focused on how this 
administration can help build on our progress to ensure equal 
access to care for our most vulnerable communities, meet the 
changing healthcare needs of families, and lower the costs of 
quality healthcare and community support.
    The administration's proposed investments underscore your 
commitment to protect the health and well-being of every 
American. I thank you, Secretary Becerra, for your work and for 
joining us today, and I look forward to our discussion. Thank 
you, Madam Chair, and I yield back.
    [The prepared statement of Ranking Member Scott follows:]
    [GRAPHIC] [TIFF OMITTED] T5561.005
    
    [GRAPHIC] [TIFF OMITTED] T5561.006
    
    [GRAPHIC] [TIFF OMITTED] T5561.007
    
    [GRAPHIC] [TIFF OMITTED] T5561.008
    

    Chairwoman Foxx. Thank you, Mr. Scott. Pursuant to 
Committee Rule 8(c), all members who wish to insert written 
statements into the record may do so by submitting them to the 
Committee Clerk electronically in Microsoft Word format by 5 
p.m., 14 days after the date of the hearing, which is June 27, 
2023.
    Without objection, the hearing record will remain open for 
14 days to allow such statements and other extraneous material 
referenced during the hearing to be submitted for the official 
hearing record.
    I now turn to the introduction of our distinguished 
witness. We have before us today Hon. Xavier Becerra, the 
Secretary of the U.S. Department of Health and Human Services, 
and as Mr. Scott mentioned, a former member of this Committee. 
We thank you for being here today and look forward to your 
testimony.
    I remind the witness that we have read your written 
statement, and it will appear in full in the hearing record. 
Pursuant to Committee Rule 8(d) and Committee practices, I ask 
that you limit your oral presentation to a 5-minute summary of 
your written statement.
    I would also like to remind the witness to be aware of his 
responsibility to provide accurate information to the 
Committee. With that Mr. Secretary, I recognize you for 5 
minutes.

STATEMENT OF HON. XAVIER BECERRA, SECRETARY, U.S. DEPARTMENT OF 
                   HEALTH AND HUMAN SERVICES

    Secretary Becerra. Chairwoman Foxx, Ranking Member Scott, 
and members, thank you very much for this opportunity to 
testify. I understand that CDC Director Dr. Rochelle Walensky 
is also testifying at an oversight hearing this morning. Dr. 
Walensky helped lead our unprecedented whole of government 
response during this historic pandemic.
    We are living our lives again, and the American people are 
safer now because of her leadership. Under her direction, we 
began the critically important work of modernizing our public 
health infrastructure. She leaves the CDC better positioned to 
respond to future threats. Working alongside Dr. Walensky as a 
partner and friend has been an immense honor. As she prepares 
to leave later this month, I wish to publicly thank her for 
restoring, in no small measure, the health of America.
    Now, let me offer a few data points as we prepare to 
discuss the President's 2024 budget and investments. Today, 
under the President's watch, more Americans have access to a 
doctor or a hospital through their own insurance than ever 
before. More than 300 million. 16 million, another all-time 
high, have it through the Affordable Care Act.
    The President's new lower cost prescription drug law is 
already working. Today insulin costs only $35.00 per month, and 
preventative vaccines like those for the flu, COVID and 
shingles are free under Medicare. Soon, we will finally begin 
to negotiate to lower prescription drug costs. We have 
effectively implemented the largest adult vaccination program 
in U.S. history, achieving close to 700 million shots in arms 
to tackle COVID.
    Finally, HHS has successfully launched and expanded 988, 
the three-digit suicide and mental health crisis lifeline. We 
have added text and chat capabilities, lines that are dedicated 
for our veterans. We have added language support options. 
Millions of Americans have since reached out for life-saving 
help using 988.
    Our aim is to build a healthier America by moving the 
Nation from an illness care system to a wellness care system. 
An illness care system leaves our most vulnerable families 
behind. A wellness care system invests in providing the full 
spectrum of healthcare to all Americans.
    Illness care allows the price of prescription drugs to 
skyrocket. Wellness care would seek to negotiate for the best 
price for prescription drugs and treat nutritious foods as 
medicine. Illness care requires you to get a referral to a 
specialist from your own family physician in order to secure 
mental health support.
    Wellness care lets you get that support the minute you walk 
through the door of your family physician's office. Illness 
care, well it forces hardworking Americans to deplete their 
life savings in their later years in order to afford the long-
term care and support they need.
    Wellness care advances long-term care, and invests in in-
home care, so older adults and Americans with disabilities can 
thrive at home in their communities. The President's Fiscal 
Year 202024 budget builds on our successes and moves us closer 
to a wellness care model. The budget invests in better 
preparing America to tackle the next public health crisis and 
keeps us in a ready position to confront a COVID resurgence.
    On mental health and substance abuse, we build support for 
crisis care services. We invest in growing the behavioral 
health workforce, and we dedicate resources to combat fentanyl 
and opioid addiction. The President's budget strengthens 
Medicare for the next generation. We also take care of our 
family members in this budget by investing in childcare and 
preschool programs, and by strengthening Medicaid home and 
community-based services.
    Americans will appreciate that the President drives forward 
funding for the cancer moonshot, and ARPA-H's investments in 
cutting edge medical innovation. His budget protects and 
bolsters Title X family planning programs so essential to so 
many of our families, and it honors our responsibilities to 
Indian country.
    Through his Fiscal Year 202024 budget, President Biden once 
again delivers on his promise to the American people to lower 
healthcare costs for more Americans with better benefits. I am 
very much looking forward to working with every member of this 
Committee, and I look forward to your questions today. Thank 
you.
    [The prepared statement of Secretary Becerra follows:]
    [GRAPHIC] [TIFF OMITTED] T5561.009
    
    [GRAPHIC] [TIFF OMITTED] T5561.010
    
    [GRAPHIC] [TIFF OMITTED] T5561.011
    
    [GRAPHIC] [TIFF OMITTED] T5561.012
    
    [GRAPHIC] [TIFF OMITTED] T5561.013
    
    [GRAPHIC] [TIFF OMITTED] T5561.014
    
    [GRAPHIC] [TIFF OMITTED] T5561.015
    
    [GRAPHIC] [TIFF OMITTED] T5561.016
    
    [GRAPHIC] [TIFF OMITTED] T5561.017
    
    Chairwoman Foxx. Thank you, Mr. Becerra. Under Committee 
Rule 9, we will now question the witness under the 5-minute 
rule, and I recognize myself for 5 minutes. Change of plans. I 
recognize Mr. Walberg for 5 minutes.
    Mr. Walberg. Madam Chairman, thank you for that 
opportunity. Secretary, welcome back to the Committee room. We 
had the opportunity to serve together on this Committee and 
appreciate you coming back. However, before I go on to my main 
questions, I would be remiss in not at least letting you know 
my concern as the position you are in, given that position by 
the President, confirmed to be in the position.
    I would have to say that what is going on with our 
children, regardless of the adults, what is going on with our 
children right now, I would believe contrary to science, and we 
have been told for the past several years to the science, 
follow the science, follow the science on many things.
    What is being foisted on our kids these days, relative to 
things we would not have countenanced just three, four, 5 years 
ago. Suggestions about their sexuality, and gender, et cetera 
is gravely concerning to me, and we probably can talk about 
that some other day.
    It is a great concern. A great concern to many parents, and 
adults who care about kids. Their lives now, and for the 
future, and so your position has much to do with that in making 
sure a generation moves to what will be productive, healthy for 
the future, and living according to science and nature itself.
    Mr. Secretary, in April the New York Times published an 
article detailing the horrifying reality that unaccompanied 
migrant children were being released from HHS custody to 
sponsors who are exploiting them. The lack of coordination 
between the Department of Labor, the Department of Health and 
Human Services, and Department of Homeland Security described 
in the New York Times piece is alarming.
    It is the responsibility of HHS to ensure that these 
children are placed with responsible caregivers after they 
leave HHS, yet it appears as though many of these children were 
placed with human traffickers, and were forced to work in 
dangerous jobs. Did the Department of Labor warn HHS that these 
children were at risk for human labor trafficking at any point 
in 2021 and 2022?
    Secretary Becerra. Congressman, first on your earlier 
remarks, I appreciate the way you posed that, and at some 
point, perhaps we will have opportunity to discuss that type of 
care that Americans are receiving and need.
    On this particular question, let me again thank you for the 
way you posed the question. First, to point out that we are 
working closely with the Department of Labor to try to 
coordinate where we can. We do not have jurisdiction over the 
kids that are in the hands of sponsors. What we can do is work 
with Labor if they find that there are some markers, signs that 
perhaps there are certain employers or companies that are 
violating child labor laws.
    What we do is we try to work with them, but this is not one 
of those cases where we are able to monitor a child who has 
been placed with a sponsor.
    Mr. Walberg. Do you think--I understand it is your 
responsibility to vet sponsors. Do you think they were properly 
vetted? These unaccompanied minors who were eventually found to 
be exploited by human traffickers.
    Secretary Becerra. Congressman, yes. Let me tell you why 
the answer is affirmative. Virtually all of these--well, the 
vast majority of these children are placed with either the 
parent or a close family relative. They all go through 
background checks. We continue to do the checks that you would 
expect to make sure that if you are going to place a child in a 
particular home, that they will be safe.
    Mr. Walberg. How did this happen then? If that is the 
policy. How did this happen that they ended up being human 
trafficked?
    Secretary Becerra. Yes. What I would tell you is that what 
I think the evidence points to is that we have unfortunately 
unscrupulous employers and companies that are willing to take 
advantage of some of these kids. Not all of them are migrant 
kids by the way, there are some U.S. citizen kids. Clearly, 
migrant children are more vulnerable, and what we see is that 
they are being taken advantage of by some of these employers.
    I hope that we all work together to try to get to the 
bottom of this.
    Mr. Walberg. Well, I would hope so, because it appears that 
you had the opportunity to return these children to immediate 
relative, or an original sponsor, and ultimately the vetting 
was not done, and they ended up being human trafficked. That 
was under your watch.
    Secretary Becerra. Congressman, we did the vetting that 
showed that whether it was a parent, or an older brother or 
sister, or an aunt or an uncle, if we cannot place them with a 
close relative like that, then it would be very, very 
difficult. There are far fewer a number who are assigned to 
someone who is not an immediate or close relative.
    Mr. Walberg. They ended up being human trafficked. That is 
my concern, and we are expecting you, your agency, to make sure 
that that does not happen. This was the New York Times bringing 
out this issue, so please, please help us on that one.
    Secretary Becerra. We will look forward to working with 
you.
    Mr. Walberg. I yield back.
    Chairwoman Foxx. I want to ask members to not start 
questions in the last few seconds or to continue speaking. If 
the witness is speaking, I am tolerant of that. I do not think 
members should keep speaking, so we can get through the hearing 
as quickly as possible. Mr. Courtney, you are recognized for 5 
minutes.
    Mr. Courtney. Thank you, Madam Chair. Mr. Secretary, good 
to see you here again today, and you know, I would just begin 
by just saying that you know, for all the talk that our friends 
on the other side, in the majority, about you know, the problem 
of inflation, which is real, for the American people over the 
last five and a half months, in the majority they have actually 
contributed absolutely nothing in terms of real policy that 
could make a difference.
    Just a few minutes ago, the Bureau of Labor Statistics just 
announced their latest inflation numbers. It shows that 
inflation dropped to 4 percent. That is the lowest number in 2 
years, 11 straight months. Again, we have got more work to do, 
and one thing that this Congress could do is to follow on the 
work of the Inflation Reduction Act regarding prescription 
drugs.
    As we all know, starting on January 1, because of the 
Inflation Reduction Act, the cost of insulin was cut by two 
thirds for people on Medicare, which was authorized by that 
law. What is not maybe as well known is that just a week ago 
you announced more savings with the provision in the law 
requiring drug manufacturers to pay rebates to Medicare if the 
price of the product rises faster than inflation in part B and 
part D.
    HHS last week released a list of drugs in the Medicare Part 
B system for which drug manufacturers increased prices against 
the law, and that means that those drug companies have to pay 
rebates, which according to your statement could mean, for 
patients and seniors, up to $449.00 per dose of savings for 43 
drugs.
    Now, if we wanted to do something about inflation in this 
Committee, we could extend the benefits of those price 
negotiation rebates and insulin reductions to employer-based 
health plans, which we passed in the House when the Inflation 
Reduction Act came out of the House. Unfortunately, that was 
stripped from the Senate.
    Could you talk a little bit about the rebate savings, and 
again about there is a golden opportunity for us to extend 
those savings to working age Americans through their employer 
sponsored health plans.
    Secretary Becerra. Congressman, absolutely. Everyone is now 
familiar with the $35.00 for a month's supply of insulin. Great 
news. Great news. By the way, I hear more from seniors about 
the shingles vaccine, that is now free, than about anything 
else because the shingles vaccine could cost you 200 or 300 
hundred dollars. For a lot of seniors on fixed income, that is 
not doable.
    Worry about getting shingles because it is not fun. It is 
very painful, and so it is great that it is zero cost. What we 
just announced is that we found that there were 43 drugs that 
pharmaceutical companies were putting out there where these 
companies had actually increased the new price more than the 
rate of inflation, and because of the new law that you all 
passed, we now have the ability to go back and say you cannot 
do that.
    If you try to increase the price beyond the rate of 
inflation, we get to pull back the excess, and put it back into 
Medicare so it provides savings to those Medicare 
beneficiaries.
    Mr. Courtney. Again, to the point about our ERISA 
jurisdiction in this Committee. I mean there is nothing that 
really justifies not extending that same benefit to people who 
are not in Medicare. Is that correct?
    Secretary Becerra. That is right. In fact, we saw that 
companies because the President pressured them said you should 
be able to do $35.00 insulin not just for those on Medicare, 
but for every American and today that is what we are seeing.
    Mr. Courtney. I am glad you mentioned that because you are 
right. A couple of the large drug manufacturers who produce 
insulin were almost shamed into again, matching the $35.00 cost 
for seniors under Medicare. Again, this was a drug that had 
been off patent for over 100 years, and there was no 
justification for the overpricing that took place.
    Again, I hope again, as the fruits of this law begins to 
again become more and more apparent to my colleagues, that we 
will revisit this issue of again extending this benefit, so 
that again, private health plans that provide insurance for 
people of working age, in employer sponsored settings, will 
again also benefit from lower costs helping reduce inflation, 
in a really critical area, which people depend on for life 
saving medications.
    I want to congratulate the Department for their successful 
and swift, implementation of the Inflation Reduction Act rebate 
program, and with that, I yield back.
    Chairwoman Foxx. Thank you, Mr. Courtney. Mr. Grothman, you 
are recognized for 5 minutes.
    Mr. Grothman. First thing I would like to submit for the 
record Administration for Children and Families, or Field 
Guidance Number 10, and Field Guidance Number 11.
    Chairwoman Foxx. Without objection.
    [The information of Mr. Grothman follows:]
    [GRAPHIC] [TIFF OMITTED] T5561.018
    
    [GRAPHIC] [TIFF OMITTED] T5561.019
    
    [GRAPHIC] [TIFF OMITTED] T5561.020
    
    [GRAPHIC] [TIFF OMITTED] T5561.021
    
    [GRAPHIC] [TIFF OMITTED] T5561.022
    
    Mr. Grothman. Thank you. Last week I met with a young gal 
15 years old who unfortunately, let herself get tied up with 
what is quickly becoming the medical establishment. She had 
been on testosterone and puberty blockers, and wound up getting 
her breasts cutoff at age 15.
    Now she just feels horrible about that to a degree she 
feels she has made fundamental changes in her life, and she is 
never going to be able to live a normal life. I have also read 
a book When Harry Became Sally, by a guy of the name Ryan 
Anderson, which talks about the horrific long-term effects of 
these type of gender, what I guess you guys would refer to, as 
gender affirming healthcare.
    Mr. Secretary, what are puberty blockers?
    Secretary Becerra. I am sorry, Congressman?
    Mr. Grothman. What are puberty blockers?
    Secretary Becerra. Congressman, there are a number of 
medical treatments and services that are provided to Americans 
to fulfill their healthcare needs.
    Mr. Grothman. Yes. What do they--what effect do they have 
on brain development? Do we know that?
    Secretary Becerra. Well based on the recommendations of a 
physician, an individual would be recommended for these types 
of medicine.
    Mr. Grothman. Yes. I know. Have we done, like, studies over 
a period of 20 or 30 years, so we know the long-term effects of 
puberty blockers on kids? It seems to me a very significant 
thing that I would never allow anybody who was asking for my 
advice ever to take. What is the long-term effect of 20 or 30 
years?
    Secretary Becerra. Well, there is scientific and medical 
evidence regarding the practice of some of these medicines. 
These are treatments.
    Mr. Grothman. Where is that evidence?
    Secretary Becerra. There are a number of medical journals 
that we could cite you to. There are a number of physicians who 
have been providing gender affirming care for quite some time. 
Most every major national medical association supports gender 
affirming care, and so it is not new. It has been around.
    Mr. Grothman. Is it true that on some of this stuff, 
Scandinavian countries, Dutch countries, at one time 
recommended this, and they do not recommend it anymore?
    Secretary Becerra. I am sorry. Who did not?
    Mr. Grothman. Scandinavian countries and the Dutch.
    Secretary Becerra. Congressman, I could tell you about 
America. I would be out of my lane if I tried to tell you about 
Scandinavia.
    Mr. Grothman. Does it bother you that European countries at 
one time used these and now are backing off?
    Secretary Becerra. I think we have some of the best medical 
professionals in the world. We do some of the best research. I 
trust the medical judgment of those who are experts in this 
field.
    Mr. Grothman. I guess I would ask you to familiarize 
yourself with what is going on in other countries and see why 
they are backing off this sort of treatment. Next, are you 
familiar with studies that show increased levels of suicide, 
depression going with people who take these puberty blockers, 
and much less people who have surgeries when they are 15 years 
old?
    Secretary Becerra. Congressman, we could talk about a lot 
of the research and the data. I will tell you that what we know 
at HHS is that many of the transgender youth that are having 
very difficult, traumatic times find that getting gender 
affirming care has been helpful in stabilizing their lives.
    Mr. Grothman. You stand behind the idea of a 15-year-old 
girl having her organs removed? You think that is under any 
circumstance appropriate? 15?
    Secretary Becerra. Congressman, you are asking questions 
that are issues that are made or judgments that are made by 
that individual patient with that patient's physician, a 
medical expert, not a politician.
    Mr. Grothman. She is 15. I know she is making the decision, 
and she was 15. Does that mean anything to you? Do you think 
this is appropriate for a 15-year-old?
    Secretary Becerra. It means a lot to me that a medical 
professional is the one guiding that patient's decisions, not a 
politician, not a bureaucrat.
    Mr. Grothman. Okay. I want to switch really quickly to ORR, 
and the type of people who are becoming sponsors. Do you--
frequently these people are becoming sponsors, claim to be 
relatives of some nature. Do you ever do DNA tests on these 
people to assure that they are related? If they claim they are 
related?
    Secretary Becerra. We do a number of background checks. We 
include fingerprinting.
    Mr. Grothman. Do you do DNA tests?
    Secretary Becerra. We do background checks, and we do 
them----
    Mr. Grothman. That means no?
    Secretary Becerra. I could tell you what we do.
    Mr. Grothman. That is what I want to know. Do you do DNA 
tests?
    Secretary Becerra. We do background checks that include 
fingerprinting. We check----
    Mr. Grothman. It is a yes or no question. Okay? I know that 
at the southern border, the border patrol does DNA tests 
sometimes when somebody says. I gave you a yes or no question. 
You have the capability of doing DNA tests. Do you do them or 
not?
    Chairwoman Foxx. Mr. Grothman, I think the witness answered 
your question.
    Mr. Grothman. He did not answer the question.
    Chairwoman Foxx. He did. He did not answer it, so he 
answered it. Ms. Wilson, you are recognized for 5 minutes.
    Ms. Wilson. Thank you. Thank you, Chair Foxx, and Ranking 
Member Scott for today's hearing. Secretary Becerra, my friend, 
we miss you, but it is great to see you today. Congressional 
Democrats, with the help of HHS, have been working to expand 
access to quality and affordable healthcare. Florida led the 
Nation in Obamacare enrollment for 2023.
    More recently, I have successfully fought and gotten 
resources to build new clinics, and expand access to primary 
care and dental care for children in my district. I have 
proposed legislation that places a registered nurse in every 
school, and provide additional resources for HIV and AIDS 
patients in Florida.
    These actions all demonstrate Democrats' dedication to 
accessible healthcare. I look forward to working with you, Mr. 
Secretary, to working to address health disparities, a woman's 
right to choose, the nurse shortage, COVID services to our 
underserved minority communities, and I want to extend an 
invitation to you to come visit Miami, so that we can work 
closely together.
    I would love to have you, so that is on the record. With 
that, I have a few questions. I have so many questions that I 
am going to ask them all, and let you answer.
    Secretary Becerra. Okay.
    Ms. Wilson. Okay, so how about that. How are you working to 
protect 340 B programs to ensure community health centers can 
continue to serve our communities with the end of the COVID 
funding? Medicaid redetermination, can you work with our State 
to improve the process and address the Floridians who lost 
coverage because of their redetermination?
    COVID funding. We have a group in Miami led by Dr. Dwight 
Reynolds, it is called Centers for Health Promotion. How can 
HHS help this coalition continue their work to provide COVID-19 
vaccinations, treatment, and education to the African American 
community in South Florida?
    Gun violence. Gun violence has been the No. 1 killer of 
black men and boys between the ages of 15 and 44. In 2006, gun 
violence became the No. 1 killer of black children, and now gun 
violence is the No. 1 killer of all children. What is HHS doing 
to address gun violence and health disparities in black men?
    What is HHS doing to address these preventable health 
issues of black men, heart disease, stroke, and other 
preventable illnesses? Also, in 1978, there were 1,410 black 
men in medical school. Now there are 690. Has your agency 
worked with the American Medical Association and NMA to address 
this disparity? Thank you. I have some more, but I will run 
out.
    Secretary Becerra. Congresswoman, let me do the best I can 
to try to respond to as many of those questions as possible. 
First, I will respond to your comment, and I publicly can say 
to you I look forward to being in your district, and meeting 
with folks who are desperate to make sure that we continue to 
offer them affordable healthcare quality, and affordable 
healthcare, so I look forward to the invitation to come visit 
in your congressional district.
    340 B, as you know, it is a critical discount, drug 
discount program for safety net providers. Without the 340 B 
program, a lot of those community health centers that offer 
tremendous services would not be able to make reasonably priced 
pharmaceutical drugs available to so many people, and so we 
understand the importance of it.
    It is a big tug of war right now. I know you know this. We 
are going to do everything we can to enhance transparency in 
the way those middlemen operate. We want to make sure that 
those who are operating these 340 B programs and determining 
which health centers are able to get access to the 340 B 
program, are doing so in a way that complies with current law.
    We also want to make sure that any of the savings that are 
being generated by the drug discount program, are actually 
going back to the American people. Through lower priced drugs, 
and so there is a lot of work we need to do there, but as you 
know many of those who operate in this space use the courts to 
try to protect themselves from full disclosure and 
transparency.
    We are going to do what we can. The president's budget does 
propose an increase, 17 million dollars, so about a 5 million 
dollar increase, to be able to actually strengthen the 
program's operation.
    Redeterminations on Medicaid, I hope we can all work--every 
member in here can work with us. We just sent out a letter to 
every Governor in this country saying we need to work on 
redeterminations.
    Chairwoman Foxx. Thank you, Mr. Secretary. Thank you, Mr. 
Secretary, and thank you, Ms. Wilson. Mr. Allen, you are 
recognized for 5 minutes.
    Mr. Allen. Thank you, Madam Chairwoman, and thank you Mr. 
Secretary, for being here this morning. I have got a lot to get 
through here. Right now, private health insurance in this 
country is virtually non-existent, as the government is 
currently driving all healthcare decisions, as a large part 
because Democrats have been working for years to move Americans 
from the small group market to the Obamacare exchanges.
    Even though according to Congressional Budget Office 
estimates, Obamacare plans, per enrollee, are three times more 
expensive for taxpayers than employer sponsored insurance. In 
fact, in a reported article in Forbes December 22, 2013, the 
Obama administration provided special carveouts for labor 
unions when they realized the increased cost provisions like, 
you know, like the reinsurance tax.
    How is HHS working to help remove barriers of access to 
employer sponsored markets for Americans?
    Secretary Becerra. Congressman, we work closely with all 
those stakeholders in the insurance market for healthcare. We 
try to compliment what is being done by employer health 
insurance providers. For example, on Medicaid redetermination 
as some individuals who are currently on Medicaid in your 
State, may end up losing coverage through Medicaid, we work 
with the employer sponsored insurance companies.
    Mr. Allen. Why would you give waivers to employee sponsored 
plans, so that they could go out into the private markets 
without the assistance of the government? In other words, have 
a system where we can actually compare costs in the private 
sector, versus this government run system?
    Secretary Becerra. Well, Congressman, remember the----
    Mr. Allen. I mean why would you give those waivers? Yes, or 
no? I mean.
    Secretary Becerra. The marketplace plans that people 
receive under Obamacare are private sector plans. They are not 
government run plans.
    Mr. Allen. No, sir. That is not correct. The private 
insurers have to, I mean, they have to abide by the providers 
have to abide by all of the requirements in Obamacare.
    Secretary Becerra. Well, of course, you want to have 
minimum standards.
    Mr. Allen. It is not in private plans. That is wrong. That 
is wrong.
    Secretary Becerra. If you want to have minimum standards.
    Mr. Allen. Do you believe Americans from government 
sponsored plans under Obamacare to the private employer 
sponsored market would be beneficial? Do you believe we could 
save money in the Federal Government if we allow these folks to 
go totally private? The association plans?
    Secretary Becerra. We would love to continue to work with 
anyone who can come up with a lower cost prescription drug 
plan, or any kind of plan for healthcare.
    Mr. Allen. Well, I guarantee you if you will give them the 
waivers, they will do it. Mr. Secretary, prescription drug 
middlemen like pharmacy benefit managers are raking in profits 
while evading congressional scrutiny. An executive for one of 
the big PBMs recently told investors to not worry about 
Congress, that it would find ways to maintain its level of 
profit if those reforms to things like drug rebates went into 
effect.
    Earlier this Congress, I joined my colleagues from Georgia, 
my colleague from Georgia, Buddy Carter, who is a pharmacist, 
in introducing the Drug Price Transparency and Medicaid Act to 
establish oversight and accountability for PBM's taking part in 
the spread of price practices in Medicaid programs that often 
leads to low reimbursement rates for pharmacies, and 
artificially raises healthcare costs.
    What other actions can Congress take to increase oversight 
and accountability on PBMs?
    Secretary Becerra. Congressman, great question, because we 
know that PBM's should get more scrutiny. We hope that you will 
engage with your colleagues to change some of the statutory 
rules because we think we need to get more transparency in that 
system. I would agree with you.
    Mr. Allen. Good.
    Secretary Becerra. The PBMs are raking in more money than 
they should.
    Mr. Allen. Thank you very much. Mr. Secretary, as you are 
aware this Nation was founded on religious freedom when it was 
adopted as the First Amendment to the Constitution, that is why 
the Center for Medicare/Medicaid Services framework for health 
equity declares each person CMS serves should receive care that 
was responsive to their cultural health benefits and practiced 
traditions, and other communication needs.
    In light of that, why does CMS reject an appeal from St. 
Francis Hospital in Oklahoma, which was threatened with 
termination from Medicare for having a lit candle behind two 
layers of glass, in the hospital chapel?
    Secretary Becerra. Congressman, I am not familiar with that 
case.
    Mr. Allen. Yes. If you will get back with me on that. How 
did this threat ensure Medicaid/Medicare beneficiaries are 
receiving care that is responsive to them?
    Secretary Becerra. Congressman, I could try to get back to 
you, but I would tell you that we do everything we can to 
protect religious conscience. We have rights in this country. 
We want to make sure no one is discriminated against, and so if 
someone believes that they are being discriminated against 
because of their religious beliefs, we would want to know that 
because we would try to protect those rights.
    Mr. Allen. That is interesting, because CMS finally agreed 
to a compromise, which incidentally coincided with the story 
hitting the media. You might better abide by the Constitution 
before you put out these rules, or deny the reimbursement. 
Thank you, and I yield back.
    Chairwoman Foxx. Thank you, Mr. Allen. Ms. Bonamici, you 
are recognized for 5 minutes.
    Ms. Bonamici. Thank you. Secretary Becerra, welcome to the 
Committee, and thank you for your leadership. It has been 
nearly a year since extremist justices on the Supreme Court 
overturned 50 years of precedent that protected reproductive 
healthcare in this country.
    Since then, we have seen the devastating, and really wide 
ranging effects of this decision, especially on the 
approximately 22 million people of reproductive age, who now 
live in states where abortion access is restrictive or banned, 
and it also affects their families as well. Many have made 
harrowing journeys to another State to receive needed medical 
care.
    I just heard about a young woman who was experiencing an 
ectopic pregnancy, which as you know, can be life threatening 
if not treated. She was denied care because of the State law. 
She had to travel to another State. I am sure this is not the 
only case like that. I have heard from doctors.
    Some doctors have had to watch their patients' health 
deteriorate significantly before providing care because of life 
of the mother exceptions, putting those doctors at risk. 
Stories of people being turned away, the sort of, leave until 
you are closer to death approach, which is incredibly dangerous 
and concerning.
    Even before the Dobbs decision, maternal death rates in 
2020 were 62 percent higher in states that ban or restrict 
abortion, than in states where abortion is accessible. With the 
kind of restrictions that many of these Republican-controlled 
states are imposing, do you expect maternal mortality rates to 
increase or decrease in this country?
    Secretary Becerra. Congresswoman, the signs are pretty 
clear that we would expect to see mortality increase as a 
result of what is now in place under the Dobbs decision.
    Ms. Bonamici. Well, that is serious. That is very 
concerning, my Republican colleagues like to call themselves 
pro-life, Mr. Secretary. Does enacting laws that increase 
maternal mortality rates sound pro-life to you?
    Secretary Becerra. All I can tell you, Congresswoman, is 
that pregnant women in states with abortion bans are nearly 
three times more likely to die during the process of bringing a 
child into their family.
    Ms. Bonamici. Well, we have some work to do, and I thank 
you for your leadership on this issue. I want to talk about 
childcare. Your budget reflects that you understand, and the 
administration understands fortunately, the importance of 
childcare for families, children for the economy. As you noted 
in your testimony, we get a return of up to $9.00 for every 
dollar we spend on early childhood education.
    I fought hard for the nearly 40 billion dollars in 
childcare stabilization grants that help providers keep their 
doors open during the pandemic. Providers across the country 
are now facing a sort of fiscal cliff when the American Rescue 
Plan's stabilization grants end.
    How can we work together to prevent a wave of childcare 
provider closures in September, and for the budget request we 
are discussing today is fully funded, which I submit should 
happen, will that fully close the childcare gap, or where there 
still be childcare deserts?
    Then also, in response to that, will you talk a little bit 
about the workforce? There is a tremendous need, as you know, 
to grow the workforce, and I know you have a workforce center 
designed to attract approximately 100,000 childcare workers 
lost during the pandemic.
    What more can we do to meet these workforce needs and care?
    Secretary Becerra. Congresswoman, the president's budget 
outlines a great proposal to try to move us forward on 
childcare. We know that we do not have a large enough 
workforce. We are never going to get it to be where we need to 
be, so long as you can go flip burgers at a hamburger shop, and 
probably make more money than caring for our children in 
childcare programs. We need to try to expand services.
    The president's budget proposal actually works with states 
to increase and expand access to childcare services. The 
president has been trying to get through a robust proposal for 
childcare programs, and Head Start, and we look forward to 
support there.
    Ms. Bonamici. Absolutely. It is such a good investment in 
our children. I am going to go back to reproductive healthcare 
because I have been concerned for years since my time at the 
State legislature, about so-called crisis pregnancy centers. 
Many of these centers regularly provide inaccurate, incomplete, 
and injurious information to people who are seeking guidance, 
and actually fact based reproductive healthcare.
    Recently, I reintroduced my Stop Anti-Abortion 
Disinformation Act to direct the Federal Trade Commission to 
prohibit unfair or deceptive advertising of abortion services. 
What dangers do crisis pregnancy centers pose for patients, and 
what is the Department doing to help regular the spread of 
reproductive health misinformation?
    Secretary Becerra. Congresswoman, every American deserves 
to get accurate, complete information about healthcare because 
when you make very important healthcare decisions, you need to 
make sure that you are making the right decision. We are going 
to do everything we can to make sure that if you are out there 
providing services, that you give to every American the 
information that they are entitled to when it comes to the 
services that they are about to take.
    Ms. Bonamici. Accurate healthcare information.
    Secretary Becerra. Absolutely.
    Ms. Bonamici. Is what is needed. Well, I am proud to be 
from a State that respects the right of people to make their 
own reproductive healthcare decisions, and thank you for 
visiting Oregon, where we talked about the 988 service that is 
being provided out there, especially for our youth. It was a 
great visit, and I appreciate that. I yield back my time. Thank 
you, Madam Chair.
    Chairwoman Foxx. Thank you, Ms. Bonamici. Mr. Banks, you 
are recognized for 5 minutes.
    Mr. Banks. Mr. Secretary, when you were the Attorney 
General in California your State expanded its ban on 18 to 20-
year-olds owning hand-guns, including rifles, and shotguns as 
well, and I am just curious. What do you think--why do you 
think that 18 to 20-year-olds cannot be trusted with a firearm?
    Secretary Becerra. Congressman, let me try to take you back 
a little bit when I was Attorney General in California, by 
first by saying for us here at HHS, gun violence is a 
healthcare crisis in this country, and we have to do everything 
we can. I am proud that my State has tried to undertake 
measures that would try to keep individuals from using, 
especially assault weapons, for purposes that never should be 
deployed in a civilian society, and so.
    Mr. Banks. You supported these policy changes. I am just 
curious, what was it about 18 to 20-year-old's that you focused 
on to take away their gun rights to own rifles, or hunting 
shotguns, and other firearms? What was it about that age 18 to 
20-year-old?
    Secretary Becerra. Yes. We could go back to the legislative 
record. I was not the legislator--a legislator who voted for 
that legislation, but I was the AG who defended our state's 
laws.
    Mr. Banks. You did not believe that an 18-year-old should 
be allowed to own a hunting rifle. Is that--I mean that is what 
you supported then? Do you still believe that today?
    Secretary Becerra. My job as the Attorney General was to 
defend the laws that the State of California has enacted.
    Mr. Banks. You do think that an 18-year-old should be 
allowed to own a hunting rifle?
    Secretary Becerra. Congressman, when you are the Attorney 
General, you have an obligation to support and defend the laws 
of your State. I happened to believe in many of those laws that 
help us not only protect Americans from gun violence, but also 
keep weapons of destruction out of the hands of Americans when 
it is not necessary.
    Mr. Banks. Okay. An interesting way to dodge the question. 
I mean back then, you clearly defended and supported changes in 
the law to stop 18 to 20-year-olds from being able to own a 
firearm. I just want to ask this question. Why do you think 
that children much, much younger than 18 years old, 9, 10, 11-
year-old's are mature enough to make a decision to have a sex 
reassignment surgery because you support those policies too, so 
can you defend that for the Committee?
    Why do you believe that a 9, 10, or 11-year-old should be 
allowed to change their sex?
    Secretary Becerra. Let me be clear. My position, my views, 
have not changed with regard to gun violence, and what we 
should do to try to control that mass killing that is 
occurring. Whatever my views were when I was Attorney General 
on those issues, are still probably the views that I have now.
    Again, I am not the Attorney General of California anymore. 
With regard to the healthcare of any----
    Mr. Banks. Let me just be really clear, then you believed 
that an 18-year-old should not be allowed to own a hunting 
rifle. Today you believe that a 9, 10 or 11-year-old should be 
able to change their sex, and have an irreversible surgery to 
do that. Just help us explain the logic.
    Secretary Becerra. Yes. Congressman, I would appreciate it 
if you let me characterize what I believe, and we can have a 
good conversation, rather than you characterize what I believe. 
What I would say to you is, with regard to gun violence, I 
think it is important that we take actions to protect our 
communities and our neighborhoods. With regard to----
    Mr. Banks. I do not think you want to explain it, because 
you realize how crazy it is, and that is why you are dodging 
the question.
    Secretary Becerra. No. That is not the case.
    Mr. Banks. Let me move on.
    Secretary Becerra. No. That is not the case.
    Mr. Banks. This spring, HHS released a 112-page report 
claiming that gender affirmation, including social transition, 
changing one's name pronoun, and/or appearance, is appropriate 
and beneficial for gender minority children and adolescents, 
according to this report.
    The report recommends cutting Federal funds from states 
with ``policies that stigmatize transgender children, including 
by denying them access to medically necessary healthcare.'' Mr. 
Secretary, does this mean that HHS is seriously threatening to 
withhold hospital grants from states like my own if they refuse 
to go along with surgeries, or puberty blockers for kids?
    Secretary Becerr. Congressman, we are going to protect the 
rights of any American to get the healthcare they are entitled 
to, and if someone tries to stop them from that, that is a 
violation of the law.
    Mr. Banks. You would withhold hospital grants from states 
like mine that ban transgender sex reassignment surgeries for 
minors? I mean that is what the report says clearly.
    Secretary Becerra. We will protect the rights of any 
individual to receive the healthcare that they are entitled to, 
and we will take action against anyone who tries to 
discriminate against that person.
    Mr. Banks. That is a yes. I want to ask you the same 
question that I asked Secretary Cardona the other week. Do you 
support pulling Federal funds, Federal school lunch benefits, 
from schools that refuse to comply with your definition of 
gender identity? Withholding school lunches from kids in 
schools that will not recognize the definitions that you do?
    Secretary Becerra. Congressman, I would not hold anyone to 
the standard of having to uphold my definitions. I would hold 
them to a standard that protects what the rights of Americans 
are under the law.
    Mr. Banks. It is pretty clear what you believe. The report 
says so. Madam Chair, I hope and pray 1 day that the history 
books look back and realize just how crazy the policies of this 
administration are, and Mr. Secretary, your photo with the 
President is going to be in those history books, as history 
will not look back fondly on your policies. I yield back.
    Chairwoman Foxx. Thank you. Mr. Takano, you are recognized 
for 5 minutes.
    Mr. Takano. Thank you, Madam Chair. Mr. Secretary, my 
colleagues on the other side of the aisle want to create some 
sort of moral panic over gender affirming surgeries. I have 
heard from the transgender community that I do not know if 
any--that surgeries for minor children are hardly ever, if 
ever, performed in this country. Is that your understanding of 
the current State of affairs?
    Secretary Becerra. I am sorry, ask the question again, 
Congressman?
    Mr. Takano. My question is gender affirming surgeries for 
minor children, those below 18 years old, are hardly ever, if 
ever performed in our country.
    Secretary Becerra. That is right. It is very rare, and it 
is always done through the consultation with the medical 
experts.
    Mr. Takano. It is extremely rare, and so this moral panic 
being created by this line of questioning, and I think is meant 
to inflame Americans' sensibilities about transgender people 
and stigmatize them. That is my sense of it.
    I want to turn to your role, Mr. Secretary, as you have 
responsibility over the Office of Refugee Resettlement and the 
Administration for Children and Families, correct?
    Secretary Becerra. Correct.
    Mr. Takano. The responsibility of vetting sponsors to host 
unaccompanied minors falls within ORR. That is right?
    Secretary Becerra. To have custody, temporary custody, yes.
    Mr. Takano. Temporary custody?
    Secretary Becerra. Yes.
    Mr. Takano. When you took office in March 2021, there was a 
surge of unaccompanied minors presenting themselves in the 
United States. Is that right?
    Secretary Becerra. That is correct.
    Mr. Takano. It was a significant surge, above what had been 
occurring the year prior?
    Secretary Becerra. Yes.
    Mr. Takano. I imagine your concern was to keep these 
children safe. Is that correct?
    Secretary Becerra. That is the primary concern.
    Mr. Takano. The previous administration was criticized, 
rightfully so, for keeping children locked up in cages, and was 
it your intention to avoid this scenario repeating itself?
    Secretary Becerra. Absolutely.
    Mr. Takano. I imagine you were looking to respond to the 
situation differently than was handled by the administration 
before. I am looking at a recent audit conducted by your 
department, which revealed that the Office of ORR adhered to 
its program policies and procedures designed to meet or exceed 
statutory requirements in the placement of unaccompanied 
children, with a vetted sponsor.
    Mr. Secretary, do you believe that the current statutory 
requirements provide you with enough authority to protect our 
unaccompanied minors effectively?
    Secretary Becerra. Congressman, the authority is sufficient 
for the work of protecting these children while they are in our 
custody. The moment we are able to place them with a vetted 
sponsor we lose custody. What happens after that? Well we have 
seen some of these reports, New York Times and others, that 
show in some cases, some of these kids have been exploited by 
employers and companies.
    That is where I think we have to really focus. We do not 
have that jurisdiction. Not even the Department of Labor has 
sufficient jurisdiction, but if we want to have a better sight 
of what is going on with kids after they leave our care, I 
would urge Congress to consider that.
    Mr. Takano. Thank you. Thank you. You see a room for 
whether it is giving you more authority, Labor more authority, 
or some entity more authority. Would you say that our current 
Federal--so the current Federal statutory environment, whether 
in regard to Department of Labor, or your department, or how 
you relate to State and local agencies that there are 
definitely holes of authority, and kids are falling--these 
unaccompanied minors are falling through the gaps in terms of 
protection.
    Secretary Becerra. Without a doubt. I suspect that the 
Department of Labor has come and testified how they lack the 
number of inspectors they need to do the oversight of violators 
of child labor laws, employers, and companies. Certainly, there 
is a gap when it comes to how we protect children, make sure 
they are going to school, versus going to the workplace.
    Those are the kinds of authorities that we do not have 
existing right now.
    Mr. Takano. You do not have the authority, nor say the 
funding, or the staffing to do case management after you have 
placed these children, because you have temporary custody. You 
have handed the custody over to these vetted sponsors, but as 
far as monitoring what goes on with those families, monitoring 
whether or not they are adhering to sending those kids to 
school, as required by law, you do not have the resources or 
authority to deal with that, do you?
    Secretary Becerra. You struck the--you hit the nail on the 
money because what you have pointed out is that unlike foster 
care in America, where a foster child may go to a home, but the 
foster care agency still has custody over that child. We do not 
maintain custody once that child is placed with a vetted 
sponsor.
    Mr. Takano. You do not have any--there are no resources 
going to that host family, like in a foster family.
    Secretary Becerra. That is correct.
    Mr. Takano. They are given some money to take care of that 
kid.
    Secretary Becerra. That is correct.
    Mr. Takano. There is no ability for you to do case 
management post?
    Secretary Becerra. The link is not there.
    Mr. Takano. Thank you. I yield back, Mr. Chairman.
    Chairwoman Foxx. Thank you, Mr. Takano. Mr. Comer, you are 
recognized for 5 minutes.
    Mr. Comer. Thank you, Madam Chair. Mr. Secretary, thank you 
for being here today. During your testimony before the Senate 
Appropriations Committee on the Department's Fiscal Year 2024 
budget request, you were asked about the role of pharmacy 
benefit managers they play in rising drug costs.
    I know those questions have been addressed earlier, but 
this is something that the House Oversight Committee is taking 
a lead on and investigating. You responded, and I quote, ``I 
think we know that there are some folks who are very clever and 
creative in how they do this work.
    Middlemen have always skimmed money off the top, and it is 
a matter of how we can try to keep the resources where they are 
most needed, with consumers, not with the middleman.''
    Now, we have recently seen this idea stated directly from 
the Chief Financial Officer of CVS Caremark, AETNA, who was 
quoted on May 31st at an industry conference when asked about 
the potential reforms proposed in Congress saying and I quote, 
``There's other ways in the economic model that we can adjust 
if one of those things changes,'' and advises his peers not to 
worry about Congress.
    Now this blatant admission by PBM's of behind the scenes 
control of cost to patients and pharmacies, allude to the 
factors in evidence that have led the House Oversight Committee 
to examine how these middlemen weaponize their access to 
patient information at the expense of those they were intended 
to benefit.
    Today, every major PBM is owned by a major health insurer, 
and owns or is owned by specialty, mail order, or retail 
pharmacy, or all three. Mr. Secretary, PBM's were found to have 
overcharged State Medicaid programs millions of dollars by 
claiming they paid competing pharmacies higher reimbursements 
than they actually did.
    Kentucky, my home State for example, was overcharged 123 
and a half million dollars. Are you familiar with these 
instances?
    Secretary Becerra. I am familiar with the general 
proposition that you are stating, yes.
    Mr. Comer. Would you say that PBM's engage in self-serving 
practices at the expense of patients and taxpayers?
    Secretary Becerra. Clearly, something is going on where 
consumers are not benefiting the way they should, and many 
providers are paying more than they should.
    Mr. Comer. Do you believe this is evidence of vertical and 
horizontal manipulation of the pharmaceutical market?
    Secretary Becerra. Mr. Chairman, you are going to where I 
used to be when I was Attorney General in California, but I 
will tell you that we need to look closely at these programs, 
because PBM's should not be able to game the system.
    Mr. Comer. I agree. My criticism of the whole PBM saga is 
that Congress has been looking at it for a long time. It is 
well past time for Congress to do something.
    Secretary Becerra. I agree.
    Mr. Comer. We want, you know, the question I have for you 
is there anything as Secretary, you would advise Congress to do 
to cut out this unnecessary middleman that is costing 
consumers, and it is costing Medicare and Medicaid a fortune?
    Secretary Becerra. Yes. Congressman, transparency. As they 
say sunshine is the best disinfectant. We need to go behind the 
curtains to see what they are doing. No one is saying that we 
do not need someone who can make sure that from the 
pharmaceutical company to the consumer, the medicine gets to 
them.
    It is just how it is getting there. Are these middlemen 
taking advantage? We need to be able to get behind the curtain, 
so whatever you can do to help us have the transparency.
    Mr. Comer. Well, let me ask you this, Mr. Secretary, would 
you be supportive of reforms or limitations to the pharmacy 
benefit manager model, including preventing PBM's from owning 
the pharmacies, insurers, and clinics for which they are 
expected to negotiate?
    Secretary Becerra. Yes. Very interested in exploring all 
those ideas with you because we do need to make some progress, 
and we do need Congress to act.
    Mr. Comer. If you keep up with much that the House 
Oversight Committee, which I am honored to serve with our 
distinguished Chairwoman, Ms. Foxx, very, very active member on 
the House Oversight Committee. We do not agree on a lot in that 
Committee. When I say we, the Republicans and Democrats. There 
is 100 percent agreement, and 100 percent bipartisan support to 
act on these PBM's and do more than requiring them to be 
transparent.
    That is a political talking point. That does not do 
anything. One of the suggestions, and there are bills. I know 
we mentioned a couple of the bills in Energy and Commerce, but 
I think there is support on that Oversight Committee, 
bipartisan support, and I know Representative Porter, 
Representative Ocasio-Cortez, Raja Krishnamoorthi, there are 
many Democrats that agree with my school of thought, that we 
should break these PBMs up.
    Because you cannot be vertically integrated. I mean, what 
the PBM's were created to do, and by all accounts there needs 
to be someone negotiating these drug prices. What they were 
created to do and what they are doing is they have gone so far 
off the reservation. I am a Republican. I am all about making 
money, but this is ridiculous what they are doing.
    This is costing consumers and taxpayers, so if we are going 
to have a serious conversation about reducing drug costs in 
America, and we do not mention the PBM, then no one is serious 
about reducing drug costs. We have to do it with the PBM's, and 
we have to do more than require transparency.
    Secretary Becerra. Our team is ready to work with you, Mr. 
Comer.
    Chairwoman Foxx. Thank you, Mr. Comer.
    Mr. Comer. I yield back.
    Chairwoman Foxx. Dr. Adams, you are recognized for 5 
minutes.
    Ms. Adams. Thank you, Madam Chair, and thank you, Secretary 
Becerra, for coming to the Committee, it is good to see you 
again, and I appreciate you coming into my district, and all 
the great things that you are doing. Thank you for your 
leadership. I have to agree with Mr. Courtney, who talked about 
the $35.00, and I agree that certainly you should not have to 
be old, as I am, or some of the others, to get that benefit.
    We have young children who also have diabetes and so forth, 
but anyway, thank you for doing that.
    There have been a series of reports, and I think one was 
referred to earlier, in terms of a--and I will just say there 
was a video that was leaked, and as a result, talking about the 
children, and migrant children and processing them.
    I wanted to just give you an opportunity to speak to that, 
but you have also--HHS announced some initiatives to address 
some of those problems, and if you could just speak to a couple 
of those, I would appreciate that.
    Secretary Becerra. Congresswoman, thank you very much, and 
I look forward to a visit again when it is accommodating for 
you. Our foremost priority is the health and safety of these 
children while they are temporarily in our custody. We have 
then an obligation to find a more appropriate setting for them 
while they are awaiting their immigration proceedings to 
conclude.
    Rather than stay in a Federal congregate care setting, with 
a lot of other kids where they are not getting that more 
individualized care, we seek to find sponsors who will protect 
them, will take care of them. Typically, that means a parent, 
or a very close relative for most of these children.
    We go through the process of providing them while they are 
temporarily in our custody, with healthcare, medical checks, 
mental health services, in some cases educational services. We 
try to provide everything that a licensed care facility for 
someone, for example, who is a foster youth might get.
    We do it temporarily. Typically, a child will stay with us 
from 3 weeks to four or 5 weeks. Some stay longer, some stay 
less. What we try to do is make sure we work efficiently, 
because some of these kids have come with a lot of trauma. It 
is all the medical experts, all the child welfare experts will 
tell you, all the migrant children, advocates will tell you, it 
is best to try to get that child with someone that child knows 
and loves and is a close family relative.
    That is our goal. It is tough because in 2021 we had a 
large number of these kids, today it is much more manageable, 
but we continue to try to make improvements as we go along.
    Ms. Adams. Thank you. Let me ask you a question about the 
whistleblowers issue, and that has been in the news a lot, and 
retaliation against whistleblowers. There was an article in the 
New York Times that you were aware that staff in the agency 
were raising concerns about the safety of unaccompanied migrant 
children who were being placed with unrelated adults.
    To the best of your knowledge, did the Department demote, 
transfer, or terminate staff because they raised concerns about 
the safety of children in the care of the Office of Refugee 
Resettlement?
    Secretary Becerra. Absolutely not. ORR did not demote 
anyone because they raised concerns. In fact, we encourage our 
ORR staff, Office of Refugee Resettlement staff, to report, and 
we urge the contractors that we work with to provide care to 
report. In fact, they are obligated to report any instance of 
abuse of a child.
    Ms. Adams. Okay. Let me ask you, I have been very involved 
with the issue around domestic violence, and I know that you 
have been concerned about this issue as well. Could you just 
speak to the importance of reauthorization, and how delaying 
the reauthorization of when the House passed the Family 
Violence Prevention and Services Improvement Act, can you speak 
to how delaying the reauthorization would hinder the efforts to 
prevent intimate partner violence, and support the victims?
    Secretary Becerra. Congresswoman, first let me just say I 
hope you and your colleagues have success in getting us to 
reauthorize the Family Violence Protection and Services Act 
because it is indispensable. We know for example, that during 
COVID, when people were in their homes and afraid to come out, 
that there was a rise of domestic violence.
    We know that Americans are being injured, in some cases 
killed, because we're not there to provide the services. 
Whether it is the victim who needs the services, or the 
perpetrator who might need the services. We are hopeful that we 
could continue to make the investments that let us reach people 
before the violence occurs, because most of the time, as you 
know, it is violence between people who know each other very 
well.
    Ms. Adams. Right. Proactivity is what we need. Thank you 
very much, Mr. Secretary. Madam Chair.
    Chairwoman Foxx. Thank you, Dr. Adams. Mr. Good, you are 
recognized for 5 minutes.
    Mr. Good. Thank you, Madam Chairman. Thank you, Mr. 
Secretary, for being with us once again. There is a story that 
just came out today that Open-the-Books.com, as you know, a 
watchdog group who tracks governments reports, of payment 
reports I should say, and is reporting that the Federal 
Government made nearly three trillion improper payments over 
the last 20 years.
    We reached a record level last year, with about 250 billion 
dollars in bogus payments. It cited HHS as being No. 1. I guess 
it is great to be first, or No. 1 in something maybe, but HHS 
was the worst agency of all, and it reported that Medicaid had 
about 80 billion in improper payments, and Medicare had about 
46 billion, so combined together it was right at 127 billion 
dollars.
    Can you just share some thoughts on that?
    Secretary Becerra. I have not seen those reports, but I 
will tell you that we know that there are people who are always 
trying to game the system. Medicaid and Medicare, some of the 
largest programs in the country certainly are ripe for that. 
That is why our budget calls for more money for program 
integrity, so we can go after those fraudsters.
    We know that for every dollar----
    Mr. Good. Why would we give more money to manage something 
when we have got 127 billion dollars in bogus payments last 
year? Why would the answer be to spend more money?
    Secretary Becerra. Well the Inspector General, our 
oversight and law enforcement agencies would need to do 
oversight in order to recoup some of that money from 
fraudsters.
    Mr. Good. 127 billion dollars in improper payments, and 
your solution is to spend more money. Let me ask about the 
border.
    Secretary Becerra. It is to make sure we do the oversight.
    Mr. Good. Let me ask about the border sir, I am reclaiming 
my time. Do you think the United States has operational control 
of the border?
    Secretary Becerra. Youn are asking me a question that is 
outside of HHS's jurisdiction.
    Mr. Good. Do you believe the United States has operational 
control of the border?
    Secretary Becerra. I think the U.S. Government has done a 
yeoman's work of trying to make sure that we can protect 
Americans.
    Mr. Good. Do you think that the United States has 
operational control of the border?
    Secretary Becerra. I think the Federal Government is 
proving that we can manage a border.
    Mr. Good. What would a loss of operational control of the 
border look like?
    Secretary Becerra. I am sorry?
    Mr. Good. What would a loss of operational control at the 
border look like? How would you define a loss of control if 
this is control?
    Secretary Becerra. If we are leaning to something relating 
to the jurisdiction in my department, HHS, I am more than 
willing to try to answer, otherwise I think you are more 
appropriately----
    Mr. Good. Well, HHS is more involved with the border than 
they ever have been under this administration, so what would a 
loss of operational control of the border look like if this is 
control of the border?
    Secretary Becerra. Again Congressman, I could talk to you 
about my personal views, but if you wish to know what the 
Federal Government should be doing with regard to the border, I 
would urge you to continue to ask questions of the Department 
of Homeland Security.
    Mr. Good. The ORR, or Office of Refugee Resettlement, has 
lost contact with more than 85,000 migrant children in the last 
2 years.
    Secretary Becerra. That is not true sir. That is not true.
    Mr. Good. Well, what is accurate?
    Secretary Becerra. We have not lost contact with kids. Once 
we place those children, we lose jurisdiction over those kids, 
and so we cannolt lose people we do not have jurisdiction over.
    Mr. Good. Well, so what percentage of the 85,000 would you 
say that your department has followed up with in the last 2 
years?
    Secretary Becerra. We try to followup with every child that 
we have placed in the custody of a vetted sponsor. Whether the 
child or the sponsor choose to reply, or respond to our efforts 
to reach them, is another matter because Congress did not give 
us the authority to make them respond to us. We reach out to 
every child.
    We try to contact the child. We try to contact the sponsor. 
It is no guarantee that we are going to get that child or 
sponsor to respond to our overtures.
    Mr. Good. There are reports that migrant children have been 
found working in slaughter houses, operating machinery, doing 
other hard labor jobs.
    Secretary Becerra. Yes.
    Mr. Good. Do you believe your department is adequately 
screening UACs?
    Secretary Becerra. I do not believe that these children are 
receiving the oversight protections when an employer, a 
company, is violating their labor rights, but we do not have 
jurisdiction to try to enforce against violations of child 
labor laws. That is not within our jurisdiction. Even the 
Department of Labor will tell you they do not have enough 
resources and personnel to go out there and inspect all these 
work sites the way they should.
    Mr. Good. In a recent Oversight Committee hearing, the ORR 
Director admitted that only a third, or 37 percent of UACs 
ended up with a parent. Do you agree with that assessment?
    Secretary Becerra. I think that number is pretty accurate. 
About a third of the kids that we place are placed directly 
with the parent. If those kids are not placed with the parent, 
the chances are they will be placed with a close relative of 
that child.
    Mr. Good. Biden plans to rescind the Trump rule exempting 
individuals and entities from the contraception mandate on 
moral convictions. Given that the District Court of the 
District of Columbia decision in March for Life vs. Burrell, 
how does your department's proposed rescission not violate the 
Constitution of religious liberties?
    Secretary Becerra. I am sorry, can you State the question 
again?
    Mr. Good. I am out of time. I will yield back, Chairman.
    Chairwoman Foxx. The gentleman can submit his question, and 
we could ask for a response in writing from the Secretary. Ms. 
McBath, you are recognized for 5 minutes.
    Mrs. McBath. Thank you.
    Secretary Becerra. Your microphone is not on.
    Mrs. McBath. Thank you, Secretary Becerra, and Chairwoman 
Foxx, Ranking Member Scott, and to all the staff that have put 
together today's hearing. I am a two-time breast cancer 
survivor, and the daughter of two healthcare professionals, so 
healthcare is very, very personal to me.
    I am so excited to finally see a budget that truly puts 
working families, and their healthcare needs first. As I said, 
I am a two-time breast cancer survivor, and I have personally 
benefited from the protection afforded by the Affordable Care 
Act.
    Because of the ACA, and the work of the congressional 
Democrats, folks with pre-existing conditions like me will not 
be denied coverage simply because we are more likely to have to 
use that coverage for our healthcare needs.
    When going through physically draining treatments like 
surgeries, radiation, and chemotherapy, and they are very, very 
draining, Americans and their families should be able to focus 
on getting better, and rebuilding their lives, not on trying to 
avoid having to declare bankruptcy because of an unpaid medical 
bill, which is the No. 1 cause of personal bankruptcies that 
have been filed in this country.
    I often hear my Republican colleagues discussing the high 
cost of healthcare after the passage of the ACA, but they 
consistently fail to recognize how much higher the financial 
and health related costs would be for working families without 
these critical protections and programs.
    Sadly, the proposals that have been put forth by my 
Republican colleagues, will do nothing to lower the prices, or 
increase access to this care. The percentage of Americans 
without health insurance is down to the lowest level in our 
Nation's history.
    Medicare can finally negotiate directly with drug companies 
to ensure that American seniors are not paying more than they 
need to pay for their prescriptions. The fact of the matter is 
that the price of insulin would already be limited to $35.00 a 
month for working families on private insurance, as well as 
Medicare, if my Republican colleagues had not intentionally 
gone out of the way to block this from being signed into law.
    Because of President Biden, congressional Democrats, and 
your really important work at HHS, out of pocket insulin costs 
for people on Medicare are now capped at $35.00 per month, and 
many private drug companies are following suit, and taking 
action to lower their costs of insulin, of the drugs that they 
sell.
    We know Congress definitely has to do more. That is not 
enough. I am very proud to be a co-lead of the Affordable 
Insulin Now Act, which ensures that no American ever pays more 
than $35.00 out of their pocket per month for their life-saving 
insulin drug, and lowering the cost of insulin for Medicare 
beneficiaries is phenomenal.
    It is a phenomenal victory in the fight to make healthcare 
and prescription drugs far more affordable for working 
families. As Americans with diabetes below the age of 65 know 
full well, this simply is not enough. It does not go far 
enough. The budget put forward by you and the President would 
ensure that Americans in group, and also individual market 
plans also have access to these lifesaving drugs at prices that 
they can afford, and that their families can afford.
    Secretary Becerra, can you talk about who the additional 
folks are that would be helped by this expansion, and why it is 
so vitally important that we get this done for the American 
people?
    Secretary Becerra. Congresswoman, everything you said I 
agree with, and I applaud you for your courage in fighting past 
the cancer that you have had. We should give everyone that 
opportunity, the way you have just marshalled through that. And 
if we were to expand care, we would find that more Americans 
would stay healthier longer, live better lives, and be able to 
rest, have peace of mind.
    The expansion of healthcare gives everyone the chance to 
really pursue what they are best at, but if you have to worry 
whether or not you will have insurance if you try to change 
jobs, or if you worry if you will be able to get the care you 
need for cancer, if you change jobs, those are the kinds of 
things that really panic Americans.
    Expanding healthcare so that not just those on Medicare for 
example, get $35.00 a month insulin, but every American gets 
that, is crucial because you want to know that you are saving 
some money. You can do other things, even if it is something as 
basic as giving your grandchild a birthday gift now that you 
can afford it.
    Mrs. McBath. Well, thank you so very much. We really 
appreciate all the work that you have done and keep up the good 
work.
    Secretary Becerra. Thank you.
    Chairwoman Foxx. Thank you, Ms. McBath. Ms. McClain, you 
are recognized for 5 minutes.
    Mrs. McClain. Thank you, Madam Chair, and thank you for 
being here. I know there has been a lot of talk today about the 
unaccompanied minors and the children and whatnot, so I want to 
try and clarify it, and just get some simple answers.
    You vet the sponsors who you place the unaccompanied minors 
with, right?
    Secretary Becerra. That is correct.
    Mrs. McClain. Okay. How many total unaccompanied minor 
children do you think you deal with every year?
    Secretary Becerra. Every year? I believe, and I could try 
to get you the accurate numbers, but I believe in 2021 it was 
something over 120,000 children. Yes.
    Mrs. McClain. Okay. Roughly 120 give or take.
    Secretary Becerra. Yes. In 2022, close to that as well.
    Mrs. McClain. I have heard, you know, I know the New York 
Times obtained data from your office, and your department 
saying that your agency had failed to reach more than 85,000 
unaccompanied minors. Is that inaccurate?
    Secretary Becerra. Completely inaccurate.
    Mrs. McClain. Okay. Do you know who they contacted from 
your office? This is just a bogus story that the Times put out?
    Secretary Becerra. It is that they use statistics in the 
wrong way.
    Mrs. McClain. Okay.
    Secretary Becerra. We try to track children, and as I 
mentioned in a previous exchange, we reach out to these 
children, to the children, and to the sponsors.
    Mrs. McClain. If they do not respond, they get checked as 
they have not responded. Okay.
    Secretary Becerra. We make note all the time.
    Mrs. McClain. How many unaccompanied minor children are 
actually unaccounted for?
    Secretary Becerra. Are what?
    Mrs. McClain. Are unaccounted for?
    Secretary Becerra. We----
    Mrs. McClain. Let me give you an answer, example. We vet 
and place 120,000.
    Secretary Becerra. Yes, correct.
    Mrs. McClain. Give or take, right? Of those, how many are 
not accounted for? How many of those people do not respond?
    Secretary Becerra. When you say accounted for, are you 
saying how many do we try to check on their status?
    Mrs. McClain. I am going to say you try and check all of 
them.
    Secretary Becerra. Correct.
    Mrs. McClain. Right? Okay.
    Secretary Becerra. Correct.
    Mrs. McClain. Okay. How many of those people do not 
respond, and we are not able to track?
    Secretary Becerra. The vast majority, I think it is over 80 
percent we have been able to reach either the child, or the 
sponsor, and we make an effort three times for each child.
    Mrs. McClain. Okay. So roughly 20 percent.
    Secretary Becerra. Did not respond.
    Mrs. McClain. We are unaccounted for?
    Secretary Becerra. Not unaccounted for, because they are 
with their sponsor likely.
    Mrs. McClain. Well how do you know they are with their 
sponsor if you have not been able to contact the child, or you 
have not been able to contact the sponsor?
    Secretary Becerra. When we placed them there with the 
sponsor.
    Mrs. McClain. Okay. I place you today, but if you do not 
respond right, the sponsor does not respond, or the child does 
not respond, how do you still know they are with the sponsor?
    Secretary Becerra. Well HHS does not have the jurisdiction 
to try to follow those children, and so when you say they are 
unaccounted for, you are implying that we should be able to 
account for them. Once they are placed----
    Mrs. McClain. You are.
    Secretary Becerra. I am sorry?
    Mrs. McClain. You are. My point is let us just say you 
placed 120, right?
    Secretary Becerra. Correct.
    Mrs. McClain. There is a whole batch of unaccounted 
children that we do not know. We do not know if they are being 
trafficked, right, because we know human trafficking is a 
problem. We do not know if they are in child labor, right? In 
my State of Michigan, we had this issue with child labor. We do 
not know what is happening to these children.
    We are making some pretty broad assumptions, that is all I 
am saying. Are you disputing that fact?
    Secretary Becerra. No. I am not. Can I clarify?
    Mrs. McClain. Sure.
    Secretary Becerra. This is not like a foster care program 
where the agency----
    Mrs. McClain. No. It is worse.
    Secretary Becerra. In many respects you are right because 
there is no connection.
    Mrs. McClain. Right.
    Secretary Becerra. Saying their unaccounted implies that 
there is a way to account for them, and Congress never gave us 
the----
    Mrs. McClain. Well there is a way.
    Secretary Becerra. How?
    Mrs. McClain. There is a way. You just told me that you are 
accountable for----
    Secretary Becerra. No. I cannot account for them because I 
do not have jurisdiction. I do not have jurisdiction.
    Mrs. McClain. Let me just go back then. Then why are you 
tracking them anyway if you don't have any jurisdiction, you 
should not be following them anyway, is that what you're 
telling me?
    Secretary Becerra. Congresswoman, because we----
    Mrs. McClain. Is that what you are telling me?
    Secretary Becerra. We believe it is important.
    Mrs. McClain. You do have jurisdiction?
    Secretary Becerra. No.
    Mrs. McClain. Then why are you doing it?
    Secretary Becerra. We believe it is in the best interests 
of the child.
    Mrs. McClain. I believe it is in the best interest of the 
child, so would you agree with me that there is 20 percent of 
the people, children that are just twisting in the wind that we 
are making a bunch of assumptions on?
    Secretary Becerra. Absolutely not.
    Mrs. McClain. I think it is very convenient that you say 
oh, we care so much about the kids, the ones we account for, 
the ones that we cannot account for, eh that is really not my, 
you know, that is not my jurisdiction.
    Secretary Becerra. No. Congresswoman, remember we try to 
reach every child.
    Mrs. McClain. Let us just use the same context and go. Are 
you accountable or not accountable?
    Secretary Becerra. Do you--if you give us the authority.
    Mrs. McClain. I am asking you the questions. Are you 
accountable or not accountable, yes or no?
    Secretary Becerra. We do not have the authority from 
Congress to try to keep account of these children once they are 
placed.
    Mrs. McClain. That is not your job is to----
    Secretary Becerra. That is not what we are saying.
    Mrs. McClain. Your job is to vet them?
    Secretary Becerra. That is not what we are saying.
    Mrs. McClain. Then let them go.
    Secretary Becerra. That is why we try to reach out to these 
kids.
    Mrs. McClain. I do not think you know what you are saying 
because you use the laws that are convenient for you, when if 
we really truly care about the children, we would care about it 
when it is convenient, and when it is not convenient, and we 
would begin to fix a problem that we know we have as opposed to 
try and cover our butts. I yield back, thank you.
    Secretary Becerra. If Congress gives us the jurisdiction to 
try to account for these kids.
    Chairwoman Foxx. Thank you, Mr. Secretary, thank you, Ms. 
McClain. Mr. DeSaulnier, you are recognized for 5 minutes.
    Mr. DeSaulnier. Thank you, Madam Chair. Mr. Secretary, nice 
to see you. The pride of McClatchy High School. I want to talk 
to you about kids' mental health. What the Surgeon General has 
said, what the American Psychology and Psychiatric Association 
has said. The urgency, and as fellow Californians are well 
aware of the benefits of social media, and technology, but also 
the challenges, particularly around young people.
    Surgeon General said that a third of young girls in this 
country, American girls, have contemplated suicide. 10 percent 
of young people in the United States have attempted suicide. We 
know this connection now. The amazing investments we have made 
in behavioral health, and when we look at Johns Hopkins, UCSF, 
Stanford, you are alma mater. I was just there 2 weeks ago to 
visit their center for youth mental health and social media.
    These connections, my own view is the private sector is 
using what we have learned from neuroscience, particularly in 
cognitive development, to addict young people, and it goes 
right to some of the more unpleasant parts of human nature. So 
can you talk a little bit about what we can do to get on top of 
this?
    We are losing a generation according to the Surgeon 
General, and the professionals, about how young people are 
spending three and half hours a day on social media and media. 
We know what they are doing. We know with these amazing 
investments.
    We have probably learned more than in the last 50 years on 
cognitive development because of imaging, and the investments 
at NIH and on behavioral health, on how this is affecting 
people. It is frustrating to see what is happening literally 
every day in this country. What can we do to partner with you, 
and it should in my view, and Madam Chair, we have had these 
discussions.
    This should be a nonpartisan issue of great urgency, is to 
putting some guardrails on ``innovation'' to make sure that we 
are doing no harm to future generations of Americans.
    Secretary Becerra. Congressman, as you know, technology is 
outpacing our ability to keep up with it, and so once we come 
up with a way to try to help these children survive, and 
improve their mental health status, something else comes up 
that is new in social media and so forth. It becomes very 
difficult.
    We are trying to partner with many of the institutions and 
agencies that are trying to help kids, to try to improve 
opportunities to get to them before social media takes them 
down the wrong path. We are for example, trying to do far more 
mental health in our schools, and we are encouraging school 
districts to work with us to see if they could qualify to get 
Medicaid dollars directly, so they can provide behavioral 
health services at their school sites for kids.
    We will try to do what we can to expand access to 
healthcare. I will tell you one of the most important things we 
can do is finally treat mental health on parity with physical 
health because we still have insurers who are not reimbursing 
for mental health services, when they would reimburse for other 
physical health services, so we have to do more to really put 
mental health on par with physical health.
    Mr. DeSaulnier. I appreciate that. A sense of urgency, that 
word I think is imperative. I look forward to working with you. 
On a different subject, as a survivor of cancer with a form of 
Leukemia that is chronic, I was just told again at your alma 
mater, I do not spend a lot of time on the peninsula, but I 
did. Some of the work they are doing they now think again, 
because of public investment, that you can cure what 
historically my form of Leukemia is chronic.
    I was asked to go speak to the head of UCSF's cancer 
program, who spent years running London's cancer programs. He 
talked about the difference in the cultures. He wanted to talk 
to me in frustration about all the amazing diagnoses and 
treatments they have, but the disparity that they cannot get. 
He told me with quite a lot of passion, there are people within 
an hour of this institution that I can save their lives, but 
they cannot access that treatment.
    What can we do about disparity specifically in cancer? Then 
secondarily, I just want to mention the drug that keeps me 
alive in my pocket, when I started taking it was $500.00 a day. 
It is now less than $100.00, but it is still in Australia, it 
is a little over $25.00 a day.
    Executives, when I ask them, they say that is part of our 
business model. Americans pay to subsidize lower care. In the 
30 seconds that we have left could you talk a little bit about 
the disparities.
    Secretary Becerra. Just generally. This is what happens 
when you treat healthcare as a commodity, that you game the 
price. It is a matter of whether you can afford the price, not 
whether you can get the healthcare you need. That has got to 
change. We have to do more to make sure that we are reaching 
people at the beginning.
    Health--cancer screenings went down some 9 million 
Americans missed their health screening during COVID. We need 
to get back to doing the basics of prevention, so we can try to 
keep people from ever catching cancer.
    Chairwoman Foxx. Thank you, Mr. DeSaulnier. Ms. Miller, you 
are recognized for 5 minutes.
    Mrs. Miller. Thank you. Mr. Secretary, do puberty blockers 
pose a health risk to children and teenagers?
    Secretary Becerra. Congresswoman, if a medical professional 
has been recommending healthcare for an individual, then I 
would believe that that healthcare professional had the best 
interests of that individual in mind in prescribing or 
recommending certain treatment or medicines.
    Mrs. Miller. What does your own FDA say are the risks of 
these chemical castration drugs and puberty blockers to young 
people?
    Secretary Becerra. Well, no drug would be on the market if 
it were not considered safe and effective by the FDA. Therefore 
those drugs----
    Mrs. Miller. Right. What does the FDA--what is your own FDA 
saying the risks are?
    Secretary Becerra. Well, with any drug there will be some 
level of risk.
    Mrs. Miller. Yes. You are not answering my question. What 
does your FDA say the risks are because people want to know the 
risks?
    Secretary Becerra. I am--Congresswoman, I am trying to 
answer you the question. If the Food and Drug Administration 
has put a drug out for the market, for consumers to use, it is 
because they have found that drug, after doing research and 
looking at the evidence, they have found that drug to be safe 
and effective for its use.
    Mrs. Miller. Okay. Well, I will answer the question. Your 
own FDA has admitted these puberty blockers cause brain 
swelling, brain tumors, vision loss, even blindness. Why is the 
Biden administration and your agency continuing to promote 
these blockers when you know that they are harmful to children 
and young adults?
    Secretary Becerra. Congresswoman, as I said, you have 
proven me--shown me nothing that says that the FDA did not go 
through a process to ensure that a particular drug was safe and 
effective. It would not be on the market if it were not. We 
would find FDA in court for having put a drug out there into 
the market.
    Mrs. Miller. I would like to enter into the record the 
FDA's warnings, which I have up here also.
    Chairwoman Foxx. Without objection.
    [The information of Mrs. Miller follows:]
    [GRAPHIC] [TIFF OMITTED] T5561.023
    
    [GRAPHIC] [TIFF OMITTED] T5561.024
    

    Mrs. Miller. In a written answer to me after the last 
hearing you wrote that taxpayer dollars should be used to pay 
for sex reassignment surgeries and chemical castration. Drugs 
for children. Do you still hold that taxpayers should be paying 
for this?
    Secretary Becerra. Congresswoman, maybe you should read 
what I actually said.
    Mrs. Miller. I did.
    Secretary Becerra. That is not what I said.
    Mrs. Miller. Yes. You believe that taxpayers should pay for 
this, and why are you going around parents and medical 
professionals and putting out guidance directed toward children 
and young adults, promoting the use of chemical castration 
drugs and puberty blockers that cause significant health risks?
    Secretary Becerra. Congresswoman, I assure you I did not 
say what you just said.
    Mrs. Miller. Your own agency, the CDC, has directed toward 
young people guidance using these dangerous drugs with the 
potential serious, life altering side effects. I would like to 
know did the second dose of the COVID mRNA vaccine cause 
increased--caused myocarditis in young people and teenage boys? 
Young adult men, and teenage boys?
    Secretary Becerra. Congresswoman, again those drugs that 
the FDA found safe and effective have helped save millions of 
lives, and today we are able to go about our business in a far 
safer way, even though COVID is still with us.
    Mrs. Miller. Well, how did the risk of myocarditis and 
health complications from the second dose of the mRNA vaccine 
compares to the risk of serious complications from COVID in 
young men and teenage boys? How did that compare?
    Secretary Becerra. The fact that the FDA and the CDC have 
recommended the vaccine shows that the evidence is there to 
make it clear to Americans that it is safer to use the vaccine 
and protect yourself against COVID than the risks of other type 
of health effects.
    Mrs. Miller. Your agency, the CDC, has put this out. I 
would like everybody to notice the alarming red line. That is 
the increase in myocarditis among young men and teenage boys 
after they received the COVID vaccine. I would like to know why 
the Biden administration continues to push this on our young 
men and teenage boys?
    Even pregnant women and babies to receive this vaccine, but 
especially our young men and teenage boys who, we can see, are 
at increased risks for myocarditis. I would just like to say 
that you do not follow the science, you ignore medical 
evidence, and you are pushing a political narrative and agenda, 
by pushing puberty blockers and chemical castration on 
children, and pushing a second dose of the COVID mRNA vaccine 
on young boys, when you knew it was causing myocarditis. Thank 
you, and I yield back.
    Chairwoman Foxx. Thank you. Ms. Hayes, you are recognized 
for 5 minutes.
    Mrs. Hayes. Thank you. Wow. We are hitting all the points 
this morning. I guess I have got to tighten up my chart game. I 
will also just say what I am hearing, just completely separate 
from the questions I am going to ask, is some opportunities for 
bipartisan support.
    When it comes to unaccompanied migrant children. Congress 
is actually the body that makes the laws and has the ability to 
give HHS the jurisdiction and the funding and resources to do 
exactly what I am hearing so many of my colleagues say is 
critically important to them.
    I welcome a partnership with anyone on the other side to do 
just that, to make sure that these kids are safe, and not 
twisting in the wind, as we have heard this morning, so I am 
here. 2458 Rayburn.
    Moving on to my questions, which seem even more relevant 
today. I want to talk to you a little bit about black maternal 
mortality. We just heard this week that Olympic track and field 
champion Tori Bowie died from childbirth complications in this 
country. I was never more aware of the risk to black women and 
their maternal health as I am now that I am in Congress.
    American moms are dying at the highest rate in the 
developed world with black moms experiencing pregnancy related 
deaths three times higher than white women. Long-standing 
variations in access to quality healthcare, underlying chronic 
conditions, structural racism, and implicit bias contribute to 
these extreme disparities.
    According to the CDC, social determinants of health prevent 
many minority groups from having fair economic, physical, and 
emotional health opportunities. To close these long-standing 
disparities, I recently led the Social Determinants for Moms 
Act, included in the Black Maternal Health Momnibus Act, which 
was introduced by Representatives Underwood and Adams.
    The Social Determinants for Moms Act establishes a whole of 
government task force to develop comprehensive strategies to 
eliminate preventable maternal morbidity, and maternal health 
disparities. President Biden's budget includes 937 million for 
the maternal and child health block grants, an increase of 122 
million from Fiscal Year 2023 enacted rates.
    Approximately--I am sorry, approximately 145 million will 
support investments to address disparities in maternal 
mortality and morbidity, including proposals to address social 
determinants of maternal health.
    Secretary Becerra, how does the Department of Health and 
Human Services plan to invest the 145 million dollars to ensure 
the most underserved communities are reached, and additionally, 
would a task force dedicated to eliminating preventable 
maternal mortality and maternal health disparities be a 
resource to HHS?
    Secretary Becerra. Congresswoman, thank you very much for 
the question, and all the work that you have done on this. We 
hope that the president's budget can be fulfilled, because that 
would let us reach many communities. We would use some of that 
money to not wait for folks to come to us, but to go to them 
where they live.
    For example, we are planning to continue to expand our 
access to women who are planning pregnancy, through the doula 
program, so we can make sure that women are receiving care. Not 
just at the point of delivery, but before that so they are 
preparing for that delivery, and having good health outcomes.
    We are going to continue to work with community health 
centers, with those programs to reach out to do community 
health service work, to try to make sure we are getting to 
people early because someone who is an athlete at a young age, 
of I think 32, should not be dying in her home alone because 
she is pregnant.
    Mrs. Hayes. Yes.
    Secretary Becerra. That is where we are. People are not 
being reached. We intend to use the resources to reach them.
    Mrs. Hayes. Thank you. Rightfully, that should not be 
happening in the United States of America. My next question, 
12.5 million children currently are potentially eligible for 
childcare subsidies under Federal rules, but only 16 percent 
receive subsidies in Fiscal Year 2019.
    Last Congress, Democrats in the House passed the Build Back 
Better Act, which included programs for the expansion of high-
quality childcare. Unfortunately, this failed in the Senate, 
but we know that we definitely need to update our childcare 
system. What would it mean to expand childcare, not only 
access, but accessibility to American families, so that they 
are able to afford care?
    Secretary Becerra. Well, as you just said, we would be able 
to get to more than one in seven children who need that 
childcare. We would be able to expand that dramatically. We 
also would be able to increase the wages of those workers that 
we depend on to care for those kids because right now I believe 
the average wage of a childcare worker is a little over $13.00 
an hour.
    You can flip burgers and make more money. We hope that you 
are able to secure some of the funding. I believe we are 
calling for some 400 billion dollars in new investments, and 
childcare services and Head Start, in the President's budget. 
We hope you can get us there as far as you can.
    Mrs. Hayes. Thank you. I yield back.
    Chairwoman Foxx. Thank you, Ms. Hayes. Mr. Kiley, you are 
recognized for 5 minutes.
    Mr. Kiley. Good morning, Mr. Secretary. You have been asked 
about the huge increase in illegal child labor by migrant 
children. Here is the New York Times story headline, as migrant 
children were put to work, U.S. ignored warnings. Sub-headline, 
the White House and Federal agencies were repeatedly alerted to 
signs of children at risk. The warnings were ignored, or 
missed.
    Now you have testified that these children are being 
exploited by unscrupulous employers, is the term that you have 
used. You also mentioned that some of this is outside your 
jurisdiction, which is fair enough. Maybe as a point of common 
ground could we agree that we have not done enough, or 
specifically, the Department of Labor needs to do more to crack 
down on these unscrupulous employers? Do you agree with that?
    Secretary Becerra. I am certain the Department of Labor 
would tell you that they would love more resources to go out 
and do the oversight, and enforcement work to make sure kids 
are not being abused.
    Mr. Kiley. As it is they have not done enough. You would 
agree with that?
    Secretary Becerra. I am sorry?
    Mr. Kiley. You would agree they have not done enough as it 
is?
    Secretary Becerra. They have done a great deal with the 
resources they have.
    Mr. Kiley. I see. There has been a 70 percent increase in 
illegal child labor. Does that mean there has been--is there 70 
percent less staff right now at the Department of Labor? I am 
trying to understand why this is a resource question?
    Secretary Becerra. My suspicion is if you look at their 
budget to do the oversight and enforcement, it has not grown to 
meet the needs.
    Mr. Kiley. I see. Thank you. Mr. Secretary, did forcing 2-
year-olds to wear masks save lives?
    Secretary Becerra. Do what now?
    Mr. Kiley. Did forcing 2-year-olds to wear masks save 
lives?
    Secretary Becerra. Making sure people wore masks when it 
was appropriate was essential to make sure that we would be 
able to get out of this pandemic.
    Mr. Kiley. Sure. That was not my question. Could you answer 
the question that I asked?
    Secretary Becerra. Which is?
    Mr. Kiley. Did forcing 2-year-olds to wear masks save 
lives?
    Secretary Becerra. Who did the forcing?
    Mr. Kiley. Well, your department, or the Head Start which 
is under your department, had a mask mandate until late last 
year for 2-year-olds and above, even outdoors. Can you point to 
any public health benefit of that policy?
    Secretary Becerra. We never forced anyone to do anything 
because we do not have the jurisdiction or authority to do 
that. What we did was provide guidance on what would be the 
policy.
    Mr. Kiley. Mr. Secretary, did Head Start have a mask 
mandate?
    Secretary Becerra. We provide a mask mandate, a requirement 
for jurisdictions that wish to receive money to provide 
particular services.
    Mr. Kiley. Head Start did have a mask mandate for kids. 
Yes?
    Secretary Becerra. We had a mask mandate for jurisdiction, 
excuse me, for agencies that wish to get Federal dollars to 
provide services.
    Mr. Kiley. That is a yes. Can you point to any benefit.
    Secretary Becerra. It is not a yes, to your question.
    Mr. Kiley. Any public health benefit from that policy, 
whether it was recommended, or enforced, or forced, of 
requiring young children to wear masks?
    Secretary Becerra. Did families benefit from the policy of 
using all protection, all precautions to avoid contracting 
COVID? Yes.
    Mr. Kiley. I am not asking you to rephrase my question to 
some abstract question that you would rather answer. I am 
asking that you, as the person who is the Secretary of Health 
and Human Services, right now can you point to any evidence 
that there was a public health benefit to forcing young 
children to wear masks?
    Secretary Becerra. Well, the fact that today we are not 
losing lives the way we lost them when we first got into this 
pandemic is a clear sign.
    Mr. Kiley. You think that was because you forced 2-year-
olds to wear masks?
    Secretary Becerra. That is your interpretation. What I am 
saying to you is that using good policies that give us the 
precautions to keep our families from contracting COVID are 
helping save lives.
    Mr. Kiley. I want to quote you from an article from NPR on 
January 2022. It says the United States is an outlier and 
recommending masks from the age of 2 years old. The World 
Health Organization does not recommend masks for children under 
age five, while the European equivalent of the CDC doesn't 
recommend them for children under age 12.
    In retrospect, was it a mistake for the United States to 
defy the international norm on child masking?
    Secretary Becerra. The U.S. had been working closely with 
our international partners, and we have done more than any 
other country to try to help our country, our partner 
countries.
    Mr. Kiley. That is not what I asked you. I asked you, was 
it a mistake to defy the international norm on the issue of 
child masking?
    Secretary Becerra. We continued to use all the best 
practices when it comes to making sure people take the 
precautions.
    Mr. Kiley. Is there a reason you are not answering my 
question, Mr. Secretary?
    Secretary Becerra. I am answering the question the best I 
can because you keep phrasing questions that are already geared 
to get a particular answer.
    Mr. Kiley. Mr. Secretary, a few weeks ago we had the 
testimony from your counterpart, the Secretary of Education, 
who gave false testimony to this Committee. He claimed that he 
did not encourage states to adopt student vaccine mandates. I 
wanted to ask your own recollection of your own advocacy. Did 
you encourage or support the adoption of student vaccine 
mandates by states, or school districts?
    Secretary Becerra. We have encouraged states to use all the 
precautions necessary to protect their populations, including 
students.
    Mr. Kiley. Did you--including student vaccine mandates?
    Secretary Becerra. All the precautions to help states 
protect their populations.
    Mr. Kiley. Right, but specifically did you support student 
vaccine mandates?
    Secretary Becerra. We have supported all the policies that 
showed that they help save lives.
    Mr. Kiley. Did you support student vaccine mandates? Yes, 
or no?
    Secretary Becerra. We have supported all policies that 
helped states make sure people's lives are saved.
    Mr. Kiley. Mr. Secretary, Madam Chair, I think we had an 
opening from you asking for the witness to give frank and 
honest answers, and we are just not getting that today I am 
afraid, and that is very unfortunate. I yield back.
    Secretary Becerra. Congressman, if pose questions in a way 
that I could respond to them I would.
    Chairwoman Foxx. Thank you, Mr. Kiley. Ms. Stevens, you are 
recognized for 5 minutes.
    Ms. Stevens. Thank you, Madam Chair, and just as a point of 
record and reference, COVID killed a million people in this 
country and some of us were in Congress. Some of us were taking 
the calls, like I did, on behalf of Michigan, when we did not 
have the ventilators, and we had a twice impeached president 
who was laughing at supply chain disruptions.
    Some of us were here on January 6th, when a president twice 
impeached now was eating popcorn as the Capitol was being 
attacked. We are here with the Secretary of Health and Human 
Services, a member, a former member of this body, someone who 
is dedicated to the health outcomes of this Nation.
    Now, I only wish that the other side of the aisle could 
care just as much about the things that they are making up as 
they do about the real problems impacting Americans. My 
colleague from Connecticut spoke about a maternal mortality 
crisis in this Nation, the highest in the industrial world.
    Mr. Secretary, we salute the Biden administration for your 
commitment to expanding access to quality, affordable health 
care, a very basic thing. You were here when we passed the 
Affordable Care Act and we have been expanding on that and 
trying to improve outcomes for people, in the middle of a 
health crisis, a Supreme Court overturned Roe v. Wade, adding 
and doubling to the challenge of women.
    Some of us have the physical reality of what it is like to 
get pregnant and to be fighting for the access to care, not 
cheering when Roe v. Wade is overturned and now 14 states 
passing extreme abortion bans with no exceptions for rape, 
incest, or the life of the mother. Say that again, for the life 
of the mother, a human being.
    Secretary Becerra, what steps has HHS taken to ensure that 
women continue to have access to comprehensive reproductive 
health care in the wake of this almost 1 year later horrible 
ruling from the Supreme Court to overturn Roe v. Wade?
    Secretary Becerra. Congresswoman, we are engaged in a 
number of activities. We have taken actions against health care 
providers that have deprived women of the health care they need 
at the time during their pregnancy. We are making sure we 
defend women's access to Mifepristone, a medication abortion 
medication, an abortion medication that has been in use for 
more than 20 years.
    We are continuing to work with family planning programs to 
make sure women get the right information about the care that 
they are entitled to. We have taken actions to defend any 
individual whose rights to health care have been discriminated 
against and violated, and we continue to make every effort to 
work with our State and local partners, to make sure a woman 
has access to the care she needs wherever she may have to go to 
get it.
    Ms. Stevens. Well, thank you so much for that response, and 
I know my good colleague, Ms. Manning from the great State of 
North Carolina, has played a leading role in making sure that 
women have continued access to Mifepristone. Women bear a 
disproportionate burden of autoimmune disease, thyroid disease 
and other gynecological diseases like endometriosis, certainly 
compared to male counterparts.
    I just want to take this moment to continue to implore your 
office, with the great role that you play at HHS, to continue 
prioritizing research to improve understanding of the 
mechanisms, diagnoses, and treatment of diseases that 
disproportionately impact women.
    You can go on the NIH site and this condition, that 
condition, is not researched enough because it is only 
impacting 50 percent of the population, except for of course 
for our colleagues on the other side of the aisle, who are 
possessed about reproductive care and stripping it away from 
women. Thank you for utilizing your role in that regard.
    Along the theme of equal access to health care for all 
people, I would just like to inquire about continued support 
for disabled Americans, a group of workers whose rights and 
opportunities are so often stifled in the workplace. Essential 
laws like Section 504 of the IDEA work together to protect 
children and adults with disabilities from exclusion and 
unequal treatment in schools, jobs, and the community.
    Secretary Becerra, what can HHS do to strengthen 
enforcement of civil rights mandates, including Section 504 of 
the Rehabilitation Act, to ensure that the 64 million people 
with disabilities in this country have adequate and equal 
access to health care?
    Secretary Becerra. Congresswoman, thank you for the 
question. We are continuing to try to reform and improve the 
regulations that we have that let us enforce Section 504 or 
Section 1557 of the Affordable Care Act when it comes to anti-
discrimination provisions.
    We hope that Congress will provide us with the resources 
our Office for Civil Rights requires in order to be able to do 
the work to enforce the law when we get reports of violations.
    Ms. Stevens. Thank you. I yield back, thanks.
    Chairwoman Foxx. Mr. Bean, you are recognized for 5 
minutes.
    Mr. Bean. Thank you very much, Madam Chair. Good afternoon 
to you, good afternoon, Mr. Secretary. Welcome. We are glad to 
have you here. You say the 85,000 number of child--of children 
that you have lost is incorrect. You say that it is more like 
20 percent of the 120,000 that we--that are unreachable. Is 
that a better number to use, the 20 percent of 120,000 that we 
cannot find?
    Secretary Becerra. Let me correct you. We have not lost any 
children. All the children that are within our care stay in-
house. When we assign them, after vetting a custodian that 
placement, then we relinquish, or we lose the jurisdiction to 
do more with that child.
    We cannot lose someone we do not have--we do not keep track 
of or have the jurisdiction to keep track of.
    Mr. Bean. You said that your agency tries to contact them 
afterwards just to check in, but you do not have contact with 
them. You call them unreachable. Is that----
    Secretary Becerra. Those efforts that we make are beyond 
the statutory requirements that Congress has imposed on us. We 
do that because we think it is good practice to try to reach 
those children after we place them. They are not obligated to 
respond back to us.
    Mr. Bean. Losing 20 percent is not that--that is a horrible 
record, but you are not excited about that record.
    Secretary Becerra. It is not that we have lost them.
    Mr. Bean. You do not know where they are? I mean they are 
unreachable if you do not know where they are.
    Secretary Becerra. We do not have jurisdiction to keep tabs 
on them. As I said, this is not like a foster care program----
    Mr. Bean. You are working with--but you are the one, you 
are the one that placed them there.
    Secretary Becerra. That is right. We are the parent; we are 
the parent----
    Mr. Bean. Are you concerned? I mean, if I lost a kid, I 
would be really worried about it, and now that reports that 
these kids are coming up, they are working in slaughterhouses, 
and we do not know where the others are. They could be doing 
far worse things. I mean, you do not seem too concerned. I want 
your concern about it.
    Secretary Becerra. Oh, we are very concerned, and I hope 
you find that compelling enough that you will act to change the 
law to give the Federal Government jurisdiction, more 
jurisdiction to keep account of these kids.
    Mr. Bean. What are you doing differently? Your track record 
is losing 20 percent of them. What are you doing differently 
going forward to say that you could have 100 percent? Is there 
anything less than 100 percent that you would be happy with?
    Secretary Becerra. If you would require that the child or 
the sponsor to stay in touch with us, that would help us. We do 
not have the authority to require that. We cannot lose kids 
that we do not have jurisdiction to keep tabs of.
    Mr. Bean. What are you doing differently, now that you are 
only having 80 percent? What are you changing? What are we 
doing differently?
    Secretary Becerra. That is a great question. We are trying 
to work closer with the Department of Labor, because they may 
spot some trends, and they could say to us, by the way, it 
looks like in this part of the country----
    Mr. Bean. Are you doubling down? Do you give a sponsor more 
than one kid if they cannot--are we doing more than one kid to 
a sponsor who does not check in and let us know that the child 
is okay?
    Secretary Becerra. We vet every potential sponsor, have 
them go through all the background checks, make sure they 
understand their responsibilities before they place that 
child----
    Mr. Bean. I would check that out, because evidently, it is 
not working if you are only doing 80 percent that are checking 
back in with you.
    Secretary Becerra. You are conflating two different things. 
You are conflating different things. The vetting process has 
nothing to do with our post-release checks. Those post-release 
checks are things that we do because we think it is a good 
thing to do.
    Mr. Bean. What number are you going to say that when you 
lose kids, how many is too many and say you know, we cannot 
take any more? We have just got too many. We have got so many 
things going on at HHS that we just cannot keep track anymore. 
Let us let somebody do this or let us just--let us say that we 
just cannot take any more kids? Is there a number that you 
would say we cannot do anymore?
    Secretary Becerra. Well first, we do not have the privilege 
to say we cannot take any more kids. We have to take a child 
that has been----
    Mr. Bean. Not batting 80 percent and losing 20 percent.
    Secretary Becerra. We do not--we have assigned those kids 
and once they are assigned, they are the responsibility of 
those sponsors.
    Mr. Bean. Do COVID vaccines prevent--do COVID vaccines 
prevent COVID? Does that prevent COVID?
    Secretary Becerra. Does COVID--do COVID vaccines help keep 
people out of the hospital. They help prevent severe COVID.
    Mr. Bean. Okay, but they do not prevent COVID? They do not 
prevent COVID.
    Secretary Becerra. They help prevent----
    Mr. Bean. Penn State University says you are seven times 
more likely to get myocarditis after taking the vaccine than 
not taking the vaccine, seven times, especially if you are a 
young man.
    That does not seem to bother HHS. We are still full 
throttle on telling everybody to get the--get these vaccines. 
What number or what multiplier will you say enough is enough, 
and we need to give warnings to young men who are being still 
urged to take these vaccines? What number will you say enough 
is enough?
    Secretary Becerra. More than a million Americans have died, 
many of those young men who have died. How many men have died 
from myocarditis? Is there a number.
    Mr. Bean. It is a big number. If you got--I know them. They 
call my office.
    Secretary Becerra. Is it a million?
    Mr. Bean. There is a number that you would say enough is 
enough, I want to follow the science. You have seen the 
dramatic rise, the surge, the skyrocketing myocarditis, but you 
are okay with that.
    Secretary Becerra. Young men are dying from COVID in 
numbers that are far greater than anything that could happen 
with any of the side effects----
    Mr. Bean. I wish you could talk to some of these families 
that have myocarditis and deal with that. With that, I yield 
back, Madam Chair.
    Chairwoman Foxx. Thank you very much. Ms. Wild, you are 
recognized for 5 minutes.
    Ms. Wild. Thank you, Madam Chairman, Chairwoman. Secretary, 
thank you so much for being here. I want to shift gears 
entirely, to a subject that I find of great interest, mostly 
because it is something that has been highlighted to me for--by 
my constituents on so many occasions, and that is the issue of 
postpartum mental health.
    I know that the National Maternal Mental Health hotline 
recently updated its number to 1-833-TLC-MAMA, which is great, 
and as I said, I have heard from so many women about postpartum 
experiences that have been very, very difficult. I am happy 
that there is now a 24/7 free telephone line that connects 
these mothers with professional counselors who can provide 
emotional support and so forth.
    For any mother who might be listening in today or might see 
this hearing in the future, is there anything that they should 
know about this important resource that your department has 
provided?
    Secretary Becerra. Congresswoman, thank you for the 
question. Absolutely, that they should know that if they reach 
out and call that number, there is a good chance that we will 
be able to direct them to services that they can utilize, to 
make sure that they are taking not just good care of 
themselves, but of any family member as well. We encourage them 
to use the hotline to find out what services are available to 
them.
    Ms. Wild. Well, I promise you my office will make sure that 
we are pushing the availability of that number out. It is 
something that I was not very aware of prior to this.
    I also--and then I just want to switch gears to the Low 
Income Home Energy Assistance Program, otherwise known as 
LIHEAP, which for those who are watching provides federally 
funded assistance in managing costs associated with home energy 
bills and weatherization and that kind of thing.
    It is something that in Pennsylvania, many families are 
relying on these investments to lower the cost of staying warm 
or in fact to receive heat at all in the winter or staying cool 
in the summer. The president's proposed budget would allow 
LIHEAP grantees, those funds to assist low-income households 
with their water and wastewater utility bills, which would be 
something new.
    Can you talk about why that would be important and about 
LIHEAP generally and its successes?
    Secretary Becerra. Congresswoman, first I have to thank you 
and many of your colleagues for giving us the additional 
resources in LIHEAP to actually reach out and now expand the 
scope of services. What we are finding is that many Americans 
are suffering, in some cases dying, because of heat or in some 
cases because of cold.
    What we want to do is make sure that the LIHEAP program is 
there to help them as best possible in the way they need it. 
For some, it will be the issue of heat, some it will be an 
issue of air conditioning during the summer. Some will be 
making sure they can stay warm and get the type of heating that 
they need.
    For other folks, it may be something different, as you 
mentioned, now water. We are trying to make sure that we do not 
forget that people have to have access to potable water that is 
safe to drink, and if you cannot drink safe, potable water, you 
are in really big trouble.
    We want LIHEAP to work for families where they are, and we 
will let those on the ground that actually administer the 
programs determine how best to utilize those LIHEAP resources.
    Ms. Wild. Well, it would seem to make a lot of sense. Most 
people are aware that the energy cost, whether it is gas or 
electric to help with air conditioning and particularly heating 
in the winter, is incredibly important. A lot of people do not 
think about the necessity of water to every single human being, 
and how expensive it can be.
    Can you talk, again getting back to my interest in maternal 
health and postpartum health, we know that maternal exposure to 
heat is associated with an increased risk of preterm and early 
term birth, low and decreased birth weight, stillbirth and 
other--and harmful newborn stress. Can you talk about the 
importance of continuing and expanding the LIHEAP programs 
generally, especially as it relates to vulnerable populations, 
and if you could focus particularly on expectant mothers and 
children?
    Secretary Becerra. I know you know this. My wife, who is an 
OB/GYN, can tell you this as well, that a woman goes through 
significant stress during pregnancy, and the last thing you 
need is to have that stress compounded by a lack of heating or 
a lack of air conditioning and hot temperatures, or lack of 
access to potable water.
    LIHEAP should be there to help, and again let those on the 
ground who know how best to use the resources with families in 
their jurisdiction determine how best to use those LIHEAP 
dollars, and certainly when it comes to maternal health, the 
last thing you would want is to have a woman who is stressed 
because she is already pregnant, now have to stress more 
because she does not know how she is going to----
    Ms. Wild. It is not just emotional stress. We are also 
talking about physical health during pregnancy, right?
    Secretary Becerra. Absolutely, both, both.
    Ms. Wild. Okay. Thank you very much, Mr. Secretary. I yield 
back.
    Chairwoman Foxx. Thank you, Ms. Wild. Mr. Burlison, you are 
recognized for 5 minutes.
    Mr. Burlison. Thank you, Madam Chair. In 2018, you were the 
California Attorney General, correct?
    Secretary Becerra. Yes sir, yes sir.
    Mr. Burlison. At that time, you investigated, I believe it 
is called Humboldt County? I am not from California so--the 
Department of Health?
    Secretary Becerra. I believe so. You would have to--you are 
making me go back a bit in history, but I believe you are 
right.
    Mr. Burlison. You investigated them because of systematic 
issues related to the care of children, correct?
    Secretary Becerra. Yes.
    Mr. Burlison. Okay. You obtained in a stipulated judgment 
against that agency; correct?
    Secretary Becerra. Okay. My recollection is yes. Sorry.
    Mr. Burlison. Okay. In your press release, when you 
announced the judgment, you stated, and I am going to quote 
``The institutions of Humboldt County entrusted to protect 
children failed them. What can be more important than public 
agencies performing their duties to safeguard the security and 
welfare of our kids?'' Do you still agree with that statement?
    Secretary Becerra. It sounds like you were reading 
verbatim, so I would say yes, if it is a quote.
    Mr. Burlison. I think anybody should agree with this 
statement. This is where it comes to the crux of this hearing, 
which is why so many of my colleagues are asking this question. 
We have a whistleblower that appeared before the Judiciary, who 
stated that 85,000 minors are missing from your agency. Now you 
say it is not 85; you say that it is somewhere around 25.
    Secretary Becerra. Well, that is completely inaccurate. 
They are not missing from our agency. We no longer have 
jurisdiction over those children.
    Mr. Burlison. You cannot get ahold of these children.
    Secretary Becerra. We do not have jurisdiction to get ahold 
of the children.
    Mr. Burlison. Okay. Let me--let me ask you this question. 
You say you do not have jurisdiction, but you have bent the law 
to get jurisdiction to call these families. You are willing to 
go beyond what your authority is in order to make phone calls. 
You just stated that in testimony.
    Secretary Becerra. Yes. We did not bend the law; we went 
beyond the law to try to see if we could reach these kids.
    Mr. Burlison. What you are saying is that it is not 
important enough to go beyond the law to find out what happened 
to these children?
    Secretary Becerra. No, because we do go beyond the law.
    Mr. Burlison. Okay. Let me ask this. Within the law, what 
your authority is, what authority do you have to place the 
children with a sponsor?
    Secretary Becerra. We do have authority to place the child.
    Mr. Burlison. You place the children with the sponsor?
    Secretary Becerra. Correct.
    Mr. Burlison. What do you do--how do you decide who they 
can be placed with?
    Secretary Becerra. We usually work with the parents if they 
are in the home country. We work with the child, especially if 
they are older, and we try to work to find out who they know or 
who they consider to be a close and could be protective of the 
child. Many, about one in three of our placements are with the 
actual parent of the child.
    Mr. Burlison. Do you not think that there could be 
something that you could do in the perimeter of the law that 
you have purview over, to reduce the number of children that 
you lose track of?
    Secretary Becerra. Okay, Congressman, let me--we go beyond 
the law to try to reach out to them. We do not lose any child 
because we no longer have jurisdiction over them.
    Mr. Burlison. You do not know where they are.
    Secretary Becerra. The problem is, you have not given us 
jurisdiction for us or any other agency to find out where they 
are.
    Mr. Burlison. What I am saying is on the front end, why can 
you not come up with a solution on the front end to keep track 
of the children that you placed?
    Secretary Becerra. Well, we--we have tried to do what we 
can through the post-release service calls, to try to see if we 
can find out if they are doing okay, to check in with them. As 
I said, they have no obligation to answer the phone or speak to 
us once they are placed with their sponsor.
    Congressman, if you wish to change the authorities and give 
us more jurisdiction or give more jurisdiction to the 
Department of Labor, I think we would be more than willing to 
talk to you about that.
    Mr. Burlison. Let me ask you this.
    Secretary Becerra. You cannot keep saying we lose kids when 
we do not have jurisdiction over them.
    Mr. Burlison. Okay, take my time back. Let me ask you this. 
I am going to move on, because this is--this is disturbing to 
me. In 2022 last year, you issued new guidance direction to the 
Office of Refugee Resettlement, to make ``all reasonable 
efforts to facilitate access to abortion services if requested 
by the unaccompanied child''; correct?
    Secretary Becerra. Yes, correct.
    Mr. Burlison. Okay. My question is, when you are handling 
these unaccompanied children, what efforts are you taking to 
ensure that they are separated from the individual that, you 
know, if they were involved in an assault of any kind or they 
are being used for sex trafficking, do you not see that the 
impacts that you are having, that you could have to a child who 
is basically captive in sex trafficking, and you are enabling 
their captors to be able to get--to help them get an abortion 
so they can get back to work?
    Secretary Becerra. Again Congressman, you are conflating 
two different things and coming up with a question that----
    Mr. Burlison. My question is if you are keeping track of 
these children, you would know.
    Secretary Becerra. We are not. If they are in our care, we 
do keep track of them because they are in our custody. Once 
they are placed with a vetted sponsor, we no longer have 
custody. We cannot keep track of them, because they have no 
obligation to stay in touch with us.
    Mr. Burlison. Turn a blind eye?
    Secretary Becerra. No.
    Mr. Burlison. You do not know. You do not have the 
authority. You do not----
    Secretary Becerra. We do not have the authority.
    Mr. Burlison. You are going to make sure that they have 
access to abortion services.
    Secretary Becerra. We do not turn a blind eye, but we do 
not have the authority.
    Mr. Burlison. Okay, thank you. I yield back.
    Secretary Becerra. Appreciate that.
    Chairwoman Foxx. Thank you. Ms. Leger Fernandez, you are 
recognized for 5 minutes.
    Ms. Leger Fernandez. Thank you, Madam Chair. Thank you so 
much, Secretary Becerra, for joining us here today. I truly 
appreciated, as we opened our hearing today, your summary of 
how both congressional Democrats and President Biden's 
administration have worked to actually bring down the cost of 
prescription drugs, have worked to make sure that more people 
have access to health care.
    While we have been doing that and so much more for American 
families, American families, rural communities, and just this 
country in general, we have done so much. We have also been 
doing it at the same time that we have been reducing the 
Federal deficit, by $1.7 trillion in 2 years.
    The Biden administration, Democrats in the Senate and 
House, leads to both fiscal responsibility and paying attention 
to what our families need. I represent rural communities, you 
have been out to my district, and there is a huge need for 
better health care and better access to resources.
    I want to talk about one of the little problems, and that 
is that it is often very difficult for these smaller 
communities, these smaller organizations, to actually apply for 
competitive grants for alcoholism, substance use disorder and 
treatment, and those kinds of things. We have people, we have 
organizations that say I have to pass up this, because I do not 
have the capacity.
    I am constantly asking what can the administration, what 
can HHS do to provide the assistance so we get those kinds of 
projects and programs actually operating in our smaller, rural, 
and frontier communities?
    Secretary Becerra. Congresswoman, thank you for the 
question because you are right. It is difficult to compete 
against the big guys, especially when you are in a distant 
location. We are trying to work closer with rural America to 
try to make some of these resources available. Some grants are 
designated to go into rural America.
    We are working very hard to try to keep some of the 
authorities and services that have really helped rural America. 
For example, telehealth, which was one of the greatest godsends 
for men and women, families in America, rural America who 
during COVID could not really go visit, physically, their 
health care provider.
    Telehealth has been instrumental in helping a lot of these 
families stay in better health. We are going to do everything 
we can to try to help and in that regard. You are right, when 
it is a competitive grant, Congress, you all determine how that 
grant is administered. We try to make sure everyone can be 
competitive.
    We do, for example, offer training and assistance for those 
who wish to compete for some of those grants, so they can try 
to compete against the big guys.
    Ms. Leger Fernandez. Right, and the more assistance you can 
provide, sort of from the executive on, that would really be 
helpful, so that we can have more of the rural areas. I mean 
this administration and Congress last cycle did so much for 
rural America.
    I put together pamphlets so that I could go out into my 
district and say look at everything we have done in rural 
America. Part of the problem that we still need to look at is 
rural hospitals. Like too many hospitals in rural America are 
closing their OB/GYN or cutting their hours. I know we have the 
new rural emergency hospital designation, which is going to be 
very helpful, as it increases Medicare reimbursement.
    I would love to brainstorm with you a bit about what else 
can we do, because hospitals that provide inpatient care are 
ineligible for 340(b), which is a major source of funding. Do 
you have some ideas on how we could increase the success of our 
rural hospitals?
    Secretary Becerra. We have already had plenty of discussion 
about 340(b) and how we have to try to preserve it but take 
away the elements that keep prices from coming down and being 
utilized by more providers.
    What I would say to you is one thing. I would love any 
Member who would take me up on this offer, and that is to try 
to make sure that our graduate medical education slots, the 
residency slots that are used to train upcoming physicians, 
that we are able to place more of these in places like rural 
America, inner city America.
    What we are finding is that if a budding doctor goes 
through his or her training in a particular location, after two 
or 3 years of that residency, there is a good chance that they 
like where they have been working, and they will stay. You have 
created a new resource for those communities in rural America, 
for example.
    We are trying to direct where we can a focus on under-
served areas, to place some of these graduate medical education 
slots. We are also, for example, trying to beef up the number 
of slots we have in our Public Health Service Corps, where if 
you commit to provide 5 years of service as a doctor after you 
graduate from medical school and residency, we will pay for 
your medical education.
    My son-in-law is right now practicing in Salinas, 
California as a pediatrician. He got 4 years of medical school 
paid for by the Federal Government, but now he is committed to 
serve in that under-served area of Salinas, California for 5 
years.
    Ms. Leger Fernandez. Thank you very much, Mr. Secretary, 
and I really do appreciate how we are having a rural focus with 
this administration. Thank you.
    Chairwoman Foxx. Mr. Williams, you are recognized for 5 
minutes.
    Mr. Williams. Thank you, Madam Chairman. Mr. Secretary, I 
am very disappointed in the evasive nature of your answers here 
today, particularly on our side of the aisle. In reviewing your 
background, I see that you spent 24 years in this chamber and 
serving in the House, and also that you are a lawyer.
    The fact that you bring politics and law into this 
conversation instead of medical background and medical 
expertise, I think, explains very much the nature and lack of 
answers in your questions. I am an engineer. I come from a very 
different sort of background, very new to this whole 
environment of politics.
    I find it astounding that this charade of answers and--is 
allowed to continue. I will just give you a few examples from 
your testimony today, and again this could only be crafted by 
the expertise of someone with your background, where quite 
often you talk about that your Department goes beyond the law 
to provide these heroic services, and in the same breath you 
will say you do not have jurisdiction.
    Which is it? What I have noticed when I go back home and 
talk to ordinary Americans, that they are incredibly frustrated 
with people that do not answer directly. There are real issues 
that the American people want to know.
    For example, the learning loss and emotional harm done to 
children as young as two forced to wear a mask by your 
department, under your leadership, and yet you will not provide 
an answer. These are parents of small children that are dealing 
with the fallout, and yet you choose to play games and you 
choose to evade direct questions.
    This is what frustrates America about this town, and about 
an administration that puts politicians and lawyers in charge 
of health care. That is not the kind of leadership that the 
American people expect, and I find it shameful, and frankly I 
find it shameful because I come from a different discipline.
    On a nuclear submarine, you do not have that option. There 
are no sea lawyers on submarines. They do not send us out. I 
understand that the Soviet Union did, that they sent political 
officers out with their submarines, not necessary on 
Americans--on American ships because we are always interested 
in getting the job done.
    That is exactly what the American people expect, and that 
is nothing similar to the nature of your answers sir, or your 
disregard for this body, where you served for 24 years. I do 
want to point out that the American people are watching, and 
they expect answers. Why did you continue a policy of requiring 
2-year-olds to wear masks in the classroom and out on the 
playground, and what medical benefit did that provide?
    Secretary Becerra. I hear a question, so you want me to 
answer the question about----
    Mr. Williams. That is a question.
    Secretary Becerra. As I have said before Congressman, what 
we try to do at the Department of Health and Human Services, 
because we don not operate childcare programs, we don not 
operate school classrooms, we try to----
    Mr. Williams. This evasiveness of Head Start funding, that 
if you do not require children to wear these masks and comply 
with our principles, you will cutoff funding, you are saying 
that is not coercive? You are saying that you, on the one hand, 
do not have jurisdiction? This is exactly what I am talking 
about.
    Then on the other hand, that you have this stick that you 
use with funding? That is so disingenuous sir, and I will tell 
you sir the American people see through it and they are sick of 
it. Do you care to answer the question? What medical benefit 
was there to masking children, 2 years old, in the classroom 
and on the playground? A medical answer, not a legal answer.
    Secretary Becerra. I will give you, Congressman, the answer 
that we got from the medical experts that guided the policies 
that HHS put forward, and that is that the best precautions 
that we can take to prevent COVID infection are things like 
masking, distancing, making sure you are washing your hands, 
getting vaccinated.
    Mr. Williams. Two-year-olds? Two-year-olds.
    Secretary Becerra. Every American can benefit----
    Mr. Williams. Everyone equally.
    Secretary Becerra. Every American can benefit from these 
precautions.
    Mr. Williams. That is scientific, sir?
    Secretary Becerra. There I would agree with you. There are 
studies that show that some benefit more than others. 
Obviously, if you are in the----
    Mr. Williams. Are you paid, sir, to have the judgment in 
your area of leadership, to provide that kind of counsel, that 
hey, maybe the children under five, that is not necessary? Is 
that your purview, or is that maybe, what did you say, not in 
your jurisdiction? My time has expired, sir. I hope you will be 
more forthright in the future, thank you.
    Chairwoman Foxx. Ms. Manning, you are recognized for 5 
minutes.
    Ms. Manning. Secretary Becerra, I want to thank you for 
your service to our country. I want to thank you for your 
valiant attempt to answer actual questions in the hearing 
today, and I also want to thank you for trying your best to 
save lives during the global pandemic, with all the information 
and you and all medical professionals had at the time, for your 
attempt to save young lives and old lives and everybody in 
between.
    I also want to thank you for visiting my district, where 
you attended a roundtable with my constituents to talk about--
to listen to them talk about the importance of Federal funding 
for federally qualified health centers, which provide critical 
health care to the most vulnerable among us.
    I want to thank you for attending a roundtable on the 
devastating impact of the Dobbs decision on reproductive health 
care for women. Not only on the freedom of women to decide 
whether, when, and with whom to have children, but also the 
negative effect on women seeking care for miscarriages, and 
hearing from physicians in my district about how they are 
handicapped in their ability to provide the best care to their 
patients, because of confusing and restrictive legislation 
passed by extreme State legislators in the absence of Federal 
legislation that is so dearly needed to protect women's health 
care.
    As you stated to my colleague, Ms. Bonamici, pregnant women 
are more than three times more likely to die during pregnancy 
in states that enact abortion restrictions. This is an 
appalling outcome, and this Congress should be taking action to 
protect the health of women and girls in this country, not 
standing by while women and girls' lives are being put at risk 
by extreme politicians.
    Secretary Becerra, even before the Dobbs decision, the 
Trump administration took many harmful steps to undermine 
access to reproductive care, by allowing employers to evade the 
Affordable Care Act's requirement to cover contraception 
without imposing cost sharing on individuals.
    Earlier this year, HHS, DOL and the Treasury proposed rules 
to roll back these harmful actions, while creating a new 
pathway for women to receive contraception when their employers 
seek religious exemptions. Can you talk about how the proposed 
rules will expand access to contraception, and also tell us 
what HHS can do to ensure that insurers comply with Federal law 
and cover contraceptives?
    Secretary Becerra. Congresswoman, there is no doubt that 
without contraception services, we would have far more 
difficult pregnancies, we would have many more cases of 
families that are in dire need, and what we find is that 
contraceptive services, which are usually undertaken by a woman 
after consultation with her medical provider, an expert, and in 
consultation with those who are trusted advisors help us make 
sure that when we see a family ready to grow, it is because 
they have really been working to plan that. We are going to do 
everything we can to make sure that contraceptive services are 
available, that the information and counseling that a woman 
should have so she can make the right decision is provided to 
her, and certainly we will do everything we can to protect the 
rights of that woman to receive those services.
    If anyone attempts to prevent that and discriminates 
against that woman, we will take whatever action we can to 
enforce her rights to be protected against discrimination.
    Ms. Manning. Thank you. I am going to change topics here. 
You said earlier to Mr. DeSaulnier that mental health should be 
put on par with physical health.
    You were talking about the mental health crisis in our 
schools, and I just want to mention that I am trying to do that 
with my Mental Health Wellness in Schools bill, which would put 
mental health services information on par with physical health 
and health care and services.
    The most recent CDC report did outline a severe decline in 
students' mental health after the pandemic, and particularly 
mental health issues faced by teenaged girls. In the 
president's budget, HHS requested $90 million for school 
behavioral health program, what works in schools.
    Can you walk us through this program and talk about how it 
will help combat youth mental health problems?
    Secretary Becerra. Congresswoman, as you are aware, the 
mental health challenges facing our young people are growing 
dramatically. The closer we can get to providing that care 
where they are on a daily basis would help them. We are going 
to try to work with schools as much as we can, to make those 
mental health services available to all those young people.
    Ms. Manning. Thank you. My time is about to expire, so I 
will yield back. Thank you so much for your service.
    Secretary Becerra. Thank you.
    Chairwoman Foxx. Thank you, Ms. Manning. Ms. Houchin, you 
are recognized for 5 minutes.
    Ms. Houchin. Thank you, Madam Chair. Thank you, Mr. 
Secretary, for coming to testify before us today. Nearly 3 
months ago, I sent a letter to the Center for Medicare and 
Medicaid Services concerning your department's intent to impose 
a minimum staffing ratio on nursing homes in the coming months.
    This administration chooses not to cooperate with 
congressional communication. I would like to take the 
opportunity to discuss that issue with you today. As you know, 
long-term care facilities are still recovering from the COVID-
19 pandemic as they try to backfill open practitioner positions 
during the national workforce shortage.
    According to the Bureau of Labor Statistics, Indiana's 
long-term care facilities had over 46,000 practitioners in 
February 2020. As of 2022, that number fell below 40,000. Now 
just last week, I had constituents in my office explaining to 
me their concern on how this rule will hinder their ability to 
care for patients.
    Mr. Secretary, why I am still hearing from providers that 
HHS and CMS are unwilling to consider and discuss their 
concerns?
    Secretary Becerra. Congresswoman, please if there are 
particular providers, I believe that we, HHS and CMS have not 
been willing to speak to them, please let me know who they are 
because we have reached out to providers throughout the country 
to talk about the staffing levels of nursing homes.
    Ms. Houchin. Okay, we will do that.
    Secretary Becerra. Great.
    Ms. Houchin. If this rule is to be introduced, the 
providers in my district have made it clear that long-term and 
post-acute nursing care facilities will be unable to provide 
continued care in rural areas such as the district that I 
serve, and that is quite frankly unacceptable.
    It will push patients to unnecessarily higher levels of 
care, costing already high-cost programs, driving those costs 
even higher, not to mention the fact that the higher levels of 
care are not always optimal for these patients.
    Instead of implementing a top-down rule that will force 
providers to increase their staffing minimums, I encourage your 
department to take time to meet with these providers and 
consider how we can best support their success, particularly as 
they are still recovering from the pandemic.
    I would like to discuss another example, moving on, where 
your department is, in my view, just not listening to the 
providers. Of more than 6.7 million patients with Alzheimer's 
across the country, more than 110,000 of them are Hoosiers.
    As you know, the FDA has approved monoclonal antibody 
treatment created in Indiana that has demonstrated it can slow 
down Alzheimer's for individuals with mild cognitive 
impairment. Medicare has traditionally covered all FDA approved 
drugs, yet it has continuously chosen to not allow for 
unencumbered access to Alzheimer's treatment. Why is this, Mr. 
Secretary?
    Secretary Becerra. Congresswoman, I have tried many times 
to explain this, because I myself, my wife, we have all gone 
through this, I suspect maybe you have as well, where someone 
in your family may have been afflicted by Alzheimer's or some 
other form of dementia.
    It is very difficult, and I appreciate and applaud all 
those people who are trying to push this through aggressively 
as possible to get the kind of care that would help their 
family members get better. Where I think I have to try to 
explain this constantly is that once the Federal Food and Drug 
Administration takes action and says a particular medicine can 
be put out for consumption because it will be safe and 
effective, the decision then becomes on the Medicare side 
whether or not that drug will be listed as----
    Ms. Houchin. What is the answer? Why is that not available 
to those patients?
    Secretary Becerra. The standards are different between what 
the Food and Drug Administration uses to put out a drug, and 
what CMS determines whether or not to include it within 
Medicare.
    Ms. Houchin. Why is that?
    Secretary Becerra. By law, Congress passed a statute that 
says FDA treats its work, with a different standard than CMS. 
FDA has done its work does not mean that CMS automatically then 
takes what FDA did and uses it for Medicare.
    Ms. Houchin. Those living in rural districts such as mine 
are more likely to be affected by this if the CMS policy for 
coverage with evidence development moves forward. The 
logistical challenges for patients and caregivers alike, as 
well as health care providers in these rural areas, will make 
it increasingly challenging to meet the needs of those 
patients.
    Are you willing to consider that CMS could reevaluate the 
current policy of requiring coverage with evidence development 
for this class of therapeutics?
    Secretary Becerra. CMS, as we are speaking, is doing an 
ongoing reevaluation because once the information that they get 
is sufficient for them to say, ``we now have passed the bar to 
include that drug within coverage within Medicare,'' they will 
announce it. It is an ongoing process within CMS.
    Ms. Houchin. I urge you to allow for immediate access to 
FDA-approved treatments for patients that would benefit from 
these important therapeutics, just as it does for all other 
classes of FDA-approved medicines. I will not stop advocating 
for improved health care in rural areas.
    I worry that continued suboptimal performance will continue 
if HHS leadership does not make meaningful to those affected in 
rural districts. Madam Chairman, I yield back.
    Chairwoman Foxx. Thank you. Ms. Omar, you are recognized 
for 5 minutes.
    Ms. Omar. Thank you. Secretary Becerra, it is really good 
to see you. My daughter, who welcomed you to her school the 
other day, sent her greetings when I told her that you will be 
coming to testify.
    I wanted to talk to you about drug pricing. I know that we 
did an incredible job with the Inflation Reduction Act. It was 
a historic effort to reform and improve the affordability of 
health care, and many of my constituents and seniors are 
particularly excited about the fact that there are--there is a 
law that would also place an out-of-pocket limit on senior drug 
pricing, and require drug companies to provide rebate when they 
raise their list prices faster than the rate of inflation.
    Many of them are also excited that you now have the ability 
to negotiate prescription drug prices. I wanted to ask you how 
are these tools, these new tools that we provided, going to 
help you do just that, lower the cost for people on Medicaid?
    Secretary Becerra. Within the Medicare program, it is 
working tremendously well. It is going to help us if we can get 
people to understand what benefits they now have. Some people 
still do not recognize that they are not obligated to pay more 
than $35 for their month's supply of insulin. Many people are 
not aware that they will not pay a penny anymore for a vaccine 
for say shingles, which could cost between two and three 
hundred dollars.
    One of the things we are really working on is communicating 
more, reaching people, going to districts of Members of 
Congress so we can work with you to make sure people understand 
what these new benefits are in the president's new prescription 
drug law.
    Ms. Omar. As you know, the Administration for Child and 
Families hosted its annual tribal consultation, and they were 
able to look at policies and priorities in June. Can you talk 
to us a little bit about this important gathering?
    Secretary Becerra. At the Department of Health and Human 
Services, we do consultation with our tribal partners. We 
believe that sovereignty is an important pillar of tribal 
governance, and we work closely with our tribal governments to 
make sure that we know where they would like to see HHS go, our 
Indian Health services.
    We engage in very robust consultation with tribal 
leadership, to make sure that when we are putting out policy, 
it is with the understanding that Indian country is supportive 
and on board.
    Ms. Omar. As you know, approximately 7 percent of all 
American Indians and Alaska Natives live in urban and suburban 
areas. Can you also speak to the importance for the Department 
as they do this consultation, and what are they willing to do 
in order to communicate with urban Indian communities and 
organizations?
    Secretary Becerra. We consider very important the voice of 
tribal members who live in urban communities, and may not live 
on tribal land, and we have mechanisms to make sure that their 
voice is included in all of these consultations, because we 
want to make sure that when we say ``Indian country,'' we 
include every member of a tribal community, whether or not they 
live on tribal territory.
    Ms. Omar. As someone who represents the largest Native 
urban communities, I really do appreciate that. That is 
important. I wanted to switch gears and talk to you about this 
report that came out from HHS Inspector General's Office about 
the failures of the State child welfare agencies to properly 
report missing children to the National Center for Missing and 
Exploited Children.
    It was shockingly 69 percent of the missing children were 
not being reported in accordance with Federal requirements. Of 
the 69 percent, 47 percent of the missing children during the 
audit period were never reported to NCMEC at all.
    The IG recommended the Administration for Children and 
Families work with the State agencies to ensure proper 
compliance. It looks like ACF agreed. Can you give us an update 
on the agencies and how they are dealing to address this issue?
    Secretary Becerra. Thank you for the question, 
Congresswoman. We are trying to move forward by adopting many 
of the recommendations by the Inspector General. We would like 
to be able to work as closely as possible with the local 
agencies that are the enforcers of child welfare laws. We want 
to make sure that every tool that we have, that we can put at 
their disposal, resources as well, we advise them of.
    I suspect you will find that many of these local agencies 
are very stressed, understaffed. We will do everything we can 
and with your support, we might be able to get the resources 
and authorities to work closer with these agencies, to make 
sure all children are protected.
    Ms. Omar. I will be following up with you on that. Thank 
you, and I yield back.
    Chairwoman Foxx. Thank you. Ms. Chavez-Deremer, you are 
recognized for 5 minutes.
    Ms. Chavez-DeRemer. Thank you, Madam Chairwoman. Secretary 
Becerra, thank you for coming today. As some of my colleagues 
have mentioned, your impatience to place undocumented children 
with sponsors at a faster rate than your caseworkers could 
handle placed thousands of kids in dangerous conditions, where 
they were exploited for labor, kids as young as 12, some even 
died.
    These are chilling--this is a chilling failure of 
leadership. President Biden has decided to keep you on board, 
as we have an obligation to the American people to work 
together. Let us make sure this never happens again. Yes or no, 
do you commit yourself and your staff to working with me and 
the Committee staff on this issue, that includes providing us 
materials which can educate us as to how the sponsorship 
process has been abused?
    Secretary Becerra. Congresswoman, thank you for the 
question, and we have been working directly with the Committee 
and members on this committee in the past. We look forward to 
working with you to make sure that we are doing everything 
possible to protect the children who are in our care.
    Ms. Chavez-DeRemer. Have you reviewed how to improve the 
vetting process for sponsors since the New York Times story, 
and what improvements have you made to date?
    Secretary Becerra. Congresswoman, we have been reviewing 
the vetting process since--well since I became Secretary, 
because it is an ongoing process. The circumstances have 
changed, as you would know, very dramatically. In 2021, there 
were large numbers of children in our care. Today, the number 
is greatly smaller.
    What we are trying to do is constantly be on top of what it 
takes to make sure that we care for the kids who are in our 
temporary custody well, but we also make the right placements 
once they are able to go out into the community.
    Ms. Chavez-DeRemer. Okay. With that being said, you have 
concluded--which areas of Congress, which areas do you think 
Congress needs to address, and aside from comprehensive 
immigration reform, which we are already doing that with the 
Dignity Act, tell me, where can Congress help you?
    Secretary Becerra. I appreciate the question, and there is 
a very simple answer to that, because many of the questions 
many of your colleagues have asked are why are we not 
accounting for children? I keep trying to explain that we only 
have jurisdiction based on what Congress has given us.
    Someone has to be able to account for these kids in a 
better way, these migrant children who are ending up working in 
these exploitive conditions. We do not have the authority to 
check up on them, to followup and require them to check in with 
us a foster care program might have with a U.S. citizen child.
    If you want to help us, make sure that someone in the 
Federal Government, maybe it is not HHS; maybe you decide it is 
Department of Labor; maybe you decide it is done through the 
states. There is a gap. When we have the kids in our custody, 
they are not exploited in the labor workplace.
    Once we place them with a parent or a close relative, we do 
not have jurisdiction. Who will make sure that they are 
accounted for or taken care of? There is the gap, and I would 
hope that rather than make accusations, Members would try to 
work with us to make sure that if they really care about kids, 
we are making sure that they are accounted for who has 
jurisdiction.
    Ms. Chavez-DeRemer. Let me add onto that. Talk to me a 
little bit about the child labor space. Within your 
department's jurisdiction, what areas would you be willing to 
partner with me and the Committee to strengthen those 
guardrails needed to protect these kids?
    Secretary Becerra. We can work with you--right now, we are 
working with the Department of Labor. They are trying to give 
us any signals.
    If there are some signs that a particular person who might 
want to sponsor a child, or in particular areas of the country 
we see that type of exploitive behavior, if we get that 
information early, we can have then the red flag go off if 
someone is seeking to sponsor a child who fits that profile or 
lives in that area.
    We can work with you if it happens to be your congressional 
district, or if you are interested in helping us merge and 
better tie the work that the different agencies can do, and 
then where you can really help us, get the local agencies, the 
State and local agencies, the licensing care facilities at a 
State level, the community organizations that work with 
families, migrant kids, to work closely with you and with us to 
make sure that we are all trying to do this seamlessly so there 
is no gap in who is accounting for these children.
    Ms. Chavez-DeRemer. Thank you. I think there is little 
words that can describe the anger that we all felt when we read 
the New York Times story and when it broke. We do feel like 
there was a betrayal of trust for our most vulnerable kids in 
this country, and you know, they are surrounded by those 
strange faces, and I just can't imagine that for my own kids or 
anybody else's kids.
    I do expect that I will work with you, but I do expect that 
you will honor those commitments that you have made to me today 
and with that, Madam Chair, I yield back.
    Secretary Becerra. I look forward to it.
    Chairwoman Foxx. Thank you. Ms. Jayapal, you are recognized 
for 5 minutes.
    Ms. Jayapal. Thank you, Madam Chair. Thank you so much, 
Secretary Becerra, for joining us today. Your work to promote 
health affordability and health equity from your time here in 
Congress as a Member of the House, to your tenure as Attorney 
General of California, to your current work leading the 
Department of Health and Human Services for the administration 
has just been vital to our progress, and I am deeply grateful 
to you.
    The contrast between the priorities of my colleagues across 
the aisle and Democrats could not be clearer. When Democrats 
controlled the House, we passed bills that gave people the 
freedom to get the health care they need, by expanding coverage 
and lowering costs. Now, this Majority is pushing bills that 
continue to take away the right to health care, including 
gender-affirming care and abortion, while doing absolutely 
nothing to lower costs for patients.
    Secretary Becerra, my Republican colleagues have proposed 
Federal bans on gender-affirming care, and more than 19 states 
have passed bills restricting care. What do medical experts say 
about the importance of access to gender-affirming care for 
transgender people?
    Secretary Becerra. Congresswoman, it is long-standing 
medical practice to offer gender-affirming care. It has been 
shown to not only provide for the physical health care needs of 
an individual, but the mental health care needs of individuals.
    Whether it is because the science has shown us that it 
works or whether it is because through practice we have 
professionals, doctors who can tell you how it is worked, we 
know that gender-affirming care has helped us bring some level 
of comfort and a better life for so many Americans, who are in 
search of gender-affirming care.
    Ms. Jayapal. In fact, is it true that there is a long list 
of medical associations that endorse gender-affirming care, and 
the positive health effects that gender-affirming care has for 
people with gender dysphoria?
    Secretary Becerra. That is correct.
    Ms. Jayapal. There has been an increase in violent rhetoric 
and threats against transgender people and their doctors, 
including at children's hospitals, that provide gender-
affirming care. For example, Boston Children's Hospital 
received a bomb threat resulting in a lockdown.
    Secretary Becerra, how do you predict that this will impact 
children's mental health and safety?
    Secretary Becerra. Congresswoman, I think it is very 
obvious. If you see on the news that there are bomb threats, 
there are attacks, there is violence committed against those 
who are trying to help an individual who needs gender-affirming 
care, you take on the burden of saying it is because of me that 
that person may have been attacked or harmed, and you also 
recognize that that could be me next, because they are 
attacking that person because of the care I need.
    The kind of stress that imposes on any individual, 
including a young person, we can only imagine.
    Ms. Jayapal. I know that HHS has taken action to address 
and increase critical care for trans youth. I want to thank you 
for that. Can you tell me a bit about your efforts to improve 
access to quality mental health care for trans people and trans 
youth, and why this has better outcomes for trans youth in 
removing their right to medical care?
    Secretary Becerra. Well first and foremost, every American 
is entitled to get the health care that they need, and so 
transgender Americans are no different. We are doing what we 
are doing because it is their right, and we have an obligation 
to defend their rights and protect their health care interests.
    At the same time, we know that the closer we can get to 
providing them with that care, for example in a school, the 
more likely that that child will have good outcomes, not just 
in terms of health but in school and moving forward in life. We 
are going to try to put that care as close to that individual 
as we can.
    Ms. Jayapal. Well, I really want to thank you, Mr. 
Secretary. I think you know I am the proud mother of an 
incredible trans daughter, and I have watched the role that 
good medicine has played in her life and good care, health 
care, has played in her life.
    My heart breaks for parents that are in states that have 
banned this evidence-based life-saving medical care that kids 
need, and for those who face these coinciding increases in 
violent rhetoric against trans people. I am deeply concerned 
that this Republican Majority continues to make this a priority 
for their time leading the House, restricting the freedom of 
families to make health care decisions, overtaking real action 
to tackle our health care crisis.
    Seems to me that if we did a poll across the country and 
asked Americans what they would want us to focus on, it would 
be on lowering the cost of prescription drugs, on lowering the 
cost of basic health care, making sure that seniors can get 
dental, vision and hearing, other things that are critically 
important, not banning gender-affirming care for so many young 
people and trans people across this country.
    I want to thank you for your leadership. I yield back, 
Madam Chair.
    Chairwoman Foxx. Thank you, Ms. Jayapal. Mr. Scott, you are 
recognized for 5 minutes.
    Mr. Scott. Thank you, and thank you Secretary Becerra for 
being with us today. It is been a long day. First, a quick 
assurance.
    Can we count on you to continue to follow the science and 
CDC recommendations in response to COVID-19 and any future 
pandemic, in terms of vaccines, masks and other 
recommendations, including how they might affect children 2 
years old or under and ignore the politics and misinformation?
    Secretary Becerra. We will follow the science and we will 
try not to let the politics get in the way.
    Mr. Scott. Thank you. Notwithstanding the court situation, 
are prevention services still available under the Affordable 
Care Act?
    Secretary Becerra. Yes, they are.
    Mr. Scott. We have heard a lot about religious 
discrimination. Some view the victim of discrimination as I do, 
if you apply for services that a provider will not provide you 
services because of your religion, you are the victim of 
discrimination.
    Others have kind of turned it around, that if a provider 
has to provide you the services if he does not want to because 
of your religion, the provider becomes the victim of 
discrimination. Can we count on the patients who are seeking 
benefits under HHS-funded programs, to the extent possible 
under the law, to be free from discrimination?
    Secretary Becerra. Absolutely. If you are entitled to 
receive a health care service, we are going to defend your 
right to get it. At the same time, whether it is because of 
your ethnicity, your race, your religion, your religious values 
that someone is trying to deprive you of your rights, we will 
try to defend that as well.
    Mr. Scott. Thank you. We have signed up over 16 million 
people under the Affordable Care Act. Are there any ongoing 
barriers to signing up that we need to address?
    Secretary Becerra. Congressman, there is always some 
impediment. Rural America, tough to get to people everywhere. 
In urban areas, we still have a lot of disinformation and not 
enough information about what the benefits are. We are going to 
continue to go where people are, instead of waiting for folks 
to come to us. That is how we were able to have such success in 
getting more than 60 million Americans enrolled in Obamacare.
    Mr. Scott. Thank you. We have had a lot of discussion about 
unaccompanied children, excuse me. First, you have identified 
sponsors. What do the sponsors promise to do?
    Secretary Becerra. In order to sponsor a child, they must 
commit to protecting the health and welfare of that child. They 
must provide for the safe housing of that child, and make sure 
that the interests of the child are promoted. If the child is 
of school age, the child has an opportunity to go to school.
    They are essentially committing to be the guardians, the 
custodians of that child during this temporary status while 
they're going through their immigration proceedings.
    Mr. Scott. That is a temporary placement while they are 
going through the proceedings?
    Secretary Becerra. That is correct.
    Mr. Scott. Does the Department provide any services during 
this time?
    Secretary Becerra. By law and by statute, we lose 
jurisdiction over these children once they are placed with a 
vetted sponsor. We do try to followup with phone calls to the 
child and to the sponsor, and as I have continued to point out, 
they do not have an obligation to respond to us because we do 
not have jurisdiction. We try to make an effort to at least 
followup to see how the placement is going.
    Mr. Scott. Well, you have described this as a gap. What 
agency would be the appropriate agency to have continuing 
jurisdiction?
    Secretary Becerra. Well, that is a great question, because 
remember, this is not like a foster care program where the 
State has custody of a child and places that child with a 
foster parent or home, where the State continues to hold 
jurisdiction over the child. If things do not go well, the 
State can take action.
    These children are here under a temporary status while they 
are undergoing their immigration proceedings, and because they 
have come in without an adult guardian, we are caring for them 
temporary until we find a sponsor who says we will take over 
that responsibility.
    The gap exists because there is nobody then who oversees 
that sponsor, and there is where Congress would have given us, 
us or someone else, authorities.
    Mr. Scott. If we gave you that responsibility, would we 
have to provide some funding so that you can actually fulfill 
your responsibility?
    Secretary Becerra. Without a doubt.
    Mr. Scott. Thank you. Madam Chair, I ask unanimous consent 
to submit for the record a letter from the Centers for Medicare 
and Medicaid Services regarding the waiver it afforded to St. 
Francis Health System, to maintain its chapel candle, so long 
as it took reasonable measures to mitigate fire risks. This 
letter corrects the mischaracterization of my colleagues 
concerning this issue.
    Chairwoman Foxx. Without objection.
    [The letter follows:]
    [GRAPHIC] [TIFF OMITTED] T5561.025
    
    Chairwoman Foxx. Thank you, Mr. Scott. Mr. Secretary, I 
wrote to you on December 22, 2022 about our concerns about HHS 
policies about children who identify as a gender that is not 
their biological gender. Specifically, I expressed my concerns 
about parental rights not being respected in basic 
decisionmaking about life-changing treatments and surgeries.
    You failed to respond timely or completely. I again wrote 
to you on January 12th, 2023, to request you provide timely and 
complete responses. You responded but Mr. Secretary, you 
neither fully nor completely responded to my questions, and 
particularly my document request.
    Will you commit to providing timely and complete responses 
to my questions and documented requests to my letters of 
December 22, 2022, and January 12, 2023, yes or no?
    Secretary Becerra. Madam Chair, we will work in good faith 
with you to try to address any requests that you make in your 
oversight capacity.
    Chairwoman Foxx. Will you commit to providing timely and 
complete responses to all letters I send you henceforth?
    Secretary Becerra. Congresswoman, we will again work with 
you closely and certainly in good faith to try to address any 
request. As you know, the long-standing practice in the 
executive branch is to try to respond to the requests of the 
Chairs of the Committee, so we can make sure that you have that 
information.
    Chairwoman Foxx. Well, you are going to need to work just a 
tad harder to comply. Mr. Secretary, in my earlier letters to 
you, I noted how the family is the most basic unit of society, 
and parents have the inalienable right and responsibility to 
educate and rear their children.
    There are examples around the country where Child 
Protective Services has taken children from the homes of loving 
parents because parents do not support life-altering surgeries 
or other medical interventions on their children who have been 
diagnosed with gender dysphoria.
    In California, one parent lost custody of her daughter and 
the court permitted only 1 hour of visitation each week, 
because the mother did not want her daughter to receive gender 
interventions. In Ohio, a husband and wife lost custody of 
their 17 year-old daughter because they would not consent to 
cross-sex hormones.
    Instead of standing up for parents, the Biden 
administration has pushed to make it easier for children with 
healthy bodies to access puberty blockers, cross-sex hormones, 
and life-altering irreversible surgeries. I am saying children.
    HHS has even weaponized its Office for Civil Rights to 
threaten providers and health plans that refuse to assess 
children diagnosed with gender dysphoria in receiving surgical 
or hormonal medical interventions.
    What planned regulations and guidance documents do you have 
under consideration for the Child Abuse Prevention and 
Treatment Act, Family Violence Prevention and Services Act, and 
childcare programs that will discuss policies related to gender 
diverse, gender minority, or transgender issues?
    Secretary Becerra. Congresswoman, that was either a very 
long question or I missed the actual question in the comments.
    Chairwoman Foxx. What regulations and guidance do you have 
planned under the legislation Child Abuse Prevention and 
Treatment Act, Family Violence Prevention and Services Act, and 
childcare programs?
    Secretary Becerra. We will do everything through regulation 
that we can to make sure we can enforce the statutory 
provisions in those acts, to make sure that we are protecting 
every individual that is entitled to those protections under 
those new laws. We will do everything for a transgender child 
that we would do for any child, because they have the same 
rights to access care that they need.
    Chairwoman Foxx. You mean you are going to protect children 
who have one biological sex and may think that they have a 
different biological sex. What is your estimated timing for 
such regulations and guidance?
    Secretary Becerra. Congresswoman, I can get back to you on 
that, because I cannot say that there is a particular 
timeframe. I would say that gender-affirming care is a standard 
of care that is recognized by every major medical association 
in this country, and that means that you are talking over a 
million providers who have been part of that process of 
affirming that type of care.
    What we are going to do is make sure that when it comes to 
implementing the laws that you and your colleagues have passed, 
that we do it without discriminating against any group, and we 
protect every individual.
    Chairwoman Foxx. It is unfortunate that you do not have the 
same feeling about protecting the lives of unborn children, so 
that they would have the chance to be born and live life. Mr. 
James, you are recognized for 5 minutes.
    Mr. James. Thank you, Madam Chairwoman. Good morning, Mr. 
Secretary, how are you? Well, I guess it is afternoon now. Good 
afternoon, Mr. Secretary.
    Secretary Becerra. Good afternoon.
    Mr. James. Secretary Becerra, in the State of the Union 
this year, the President of the United States of America stood 
on the House floor and lied to the American people. He stood on 
the floor and said that the Republicans wanted to take away 
your Social Security and Medicare.
    In reaction to these lies, I proposed H.R. 875, divorce the 
debt negotiation proceedings from health care, so that our 
seniors were not used as pawns in that negotiation. As a result 
of these lies, I get comments back from my constituents, one 
from Rochester Hills who writes ``Rep. James, I am concerned 
about the debt negotiations that were underway in Congress, and 
they could jeopardize current and future Social Security and 
Medicare benefits, which I rely on.''
    Another of my constituents from Sterling Heights wrote in 
saying ``It is outrageous that some are suggesting cutting 
Social Security and Medicare in the debt debate.'' I have heard 
a lot about misinformation in this hearing today, but the 
greatest purveyor of misinformation in the past few months has 
been the Biden administration.
    There is been a lot of fearmongering, and to establish the 
trend, the White House also lied about cuts to VA benefits. I 
am a combat veteran. I have felt the sting of not only the 
physical wounds of war but the unseen wounds of war.
    The increase above the President's budget of over $18 
billion that went to the VA has invalidated that misinformation 
from this administration. Mr. Secretary, what also concerns me 
in addition to this misinformation of the Biden administration 
is that it seems to be more concerned with expanding government 
run programs when free market options exist to bring down the 
cost of health care.
    Many of my constituents ask me why must the government 
continue to spend more and more and more to force them, to make 
them beneficial, rather than supporting free market 
alternatives that could at least alleviate a little bit of 
pressure on the taxpayers to foot the bill, while also 
increasing quality and choice?
    Right now, my understanding is Medicare Part A is expected 
to go insolvent in 2031. Is that also your understanding?
    Secretary Becerra. Medicare Part A will face a challenge 
unless Congress--you all act to provide it with more resources, 
yes.
    Mr. James. Do you believe that Congress should act to 
maintain the long-term stability, security, and sustainability 
of Medicare?
    Secretary Becerra. Yes, of course, and the President 
provides a proposal to do so.
    Mr. James. Would you agree that increasing expenditures has 
put us in this mess in the first place? I will even credit you, 
both administrations, Democrat and Republican, spending without 
controls, without checks, and without commiserate attention to 
the nutritious and environments that we are putting our people 
in.
    Do you believe that spending, in Democrats and Republicans, 
have put us in a situation, where Social Security and Medicare 
could go insolvent within our lifetimes?
    Secretary Becerra. Well Congressman, as you know, Social 
Security and Medicare do not rely on what the budget that you 
pass on a yearly basis does, because Social Security and 
Medicare operate on their own terms.
    Mr. James. Okay. Irresponsible fiscal policies. Do you 
believe that irresponsible fiscal policies have put us in the 
position where our seniors now and in the future are at risk, 
and do you believe that Congress and the administration have a 
responsibility to fix that?
    Secretary Becerra. Fiscal policies must be enacted that 
keep the interests of our families in mind. Social Security and 
Medicare operate on their own terms.
    Mr. James. Sir, do you believe that Congress and the 
administration have a short-and long-term responsibility to get 
Social Security and Medicare back on the right track?
    Secretary Becerra. I would hope that you would act to make 
sure that we get Social Security and Medicare working----
    Mr. James. Okay. I am going to assume that is a no, unless 
it is a yes. I do not want to put words in your mouth. OK. I am 
going to assume that is a no. Madam Chair, before I conclude, I 
do not want seniors to lose their benefits, and I am going to 
do everything I can to protect seniors' benefits. With that, I 
yield.
    Chairwoman Foxx. Thank you. I would like to thank the 
Secretary again for taking the time to testify before the 
Committee today, and without objection, there being no further 
business, the Committee stands adjourned.


[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] 



    [Whereupon at 1:21 p.m., the Committee was adjourned.]