tv Health Human Services Secretary Testifies on 2022 Budget CSPAN July 29, 2021 4:52am-8:05am EDT
including secretary becerra -- [inaudible] house resolution 8. i want to remind members of a few procedures to keep these proceedings running smoothly. first, consistent with regulations, the committee will keep microphones muted to limit background noise. members are responsible for unmuting themself when recognized for their five minutes. committee staff will mute members only in the event of inadvertent background noise. in addition -- [inaudible] they must have their cameras on. if you need to step away to attend another proceeding, please turn your camera off rather than logging out of the platform. finally, in the event that i experience technical difficulties or need to step away from the hearing, congresswoman delbene is
authorized to serve as chair. the topic of today's hearing, the d. of health and -- department of health and human services, secretary becerra. let me extend a warm welcome to you, mr. secretary, and i know i speak on behalf of all members of this committee as we offer that welcome. after nearly a year and a half of devastation, economic uncertainty and loss of more than half a million american lives, we meet today in a moment of renewed optimism as our nation continues to make significant strides in eradicating to covid-19. thanks to president biden's leadership, the diligence of public health officials, health workers and everyday americans, coronavirus hospitalizations and deaths have dropped dramatic clue. this progress is in no -- dramatically. this progress is in no small part due to the vaccine,
however, availability is different from vaccine administration, and there's still much more to be done to reduce hesitancy and combat misinformation regarding the vaccine. i'm impressed with the creative steps the administration is taking to encourage americans to get vaccinated as well as the efforts to eliminate barriers such as lack of childcare or transportation. another critical issue that threatens the health of all americans, it's also the target that we all understand of misinformation. and as it relates to climate change. climate change is real, it's a tremendous threat to our planet and to the health of our people. secretary becerra, i recently sent you a letter asking hhs to pursue a policy of regulatory changes that tackle climate change and promote sustainability. the health care sector can and must do more to reduce carbon emissions and make its infrastructure more sustainable. there are opportunities for this committee to work together in
this matter, and i certainly look guard to your partnership -- forward to your partnership. a topic that i know is near and dear to your heart is the affordable care act. in your short tenure at hhs, mr. secretary, you've already shown how the aca has continued to expand its reach and its positive impacts. 31 million americans now have health care coverage through the aca thanks to our accomplishments over these last 11 years, and more than a million additional people in our country gained coverage over the -- [inaudible] there's still more work to be done. for example, 12 states still have not adopted the law's medicaid expansion and leave vulnerable people without coverage for, in and ms. cases, truly political reasons. i'd like to hear your thoughts -- [inaudible] we recently improved the tax credit for people, but we need
to make these investments permanent. that's the kind of action -- the insured population and to help those who are covered thanks to the aca stay covered. while the affordable care act certainly has helped reduce american health care costs, many people still fall victim to surprise medical billing, unexpectedly facing exorbitantly high prices for their care. at the end of last year, congress acted to address this crisis with the passage of bipartisan legislation to protect patients from these surprise bills. i certainly want to thank ranking member brady as we've worked together to insure the solution that congress ultimately came up with was a balanced approach centered around strong consumer protections. now it is up to hhs to implement the law, and i know and hope you will work closely with us as you proceed. another area where your agency must take urgent action is nursing home safety and quality.
pandemic's ripping impacts on these facilities -- longstanding problems and challenges that exist within that industry. i spoke with your predecessor many times about this topic -- [inaudible] on the matter. fortunately, there was too little reform. i'm counting on you to make the necessary regulatory changes as congress legislates. the pandemic illuminated serious problems plaguing nursing homes, it also brought to the fore a variety of substantial challenges for working families in the united states for many, many years. the lack of inned adequate -- inadequate access to affordable childcare. democrats recently released the building the economy for families act, our draft proposal is to make sure the economy works for working families. hhs will be responsible for implementing many of the policies we put forward, and i know we can count on you to prioritize these changes that will make our economy stronger, more inclusive and more
resilient. and lastly, a definition that touches every single topic i've raised this morning is one that i know you and the president care deeply about. that topic is equity. the ways and means committee has become a leader in addressing these in the our society more broadly. we've done quite a bit of bipartisan work on this matter. i commend our committee members from both sides of the aisle who have led our health care task force as well as those who lead our racial equity initiative. i know that we want to raise the need to increase diversity in our work force. i'd like to get your commitment to support a pipeline to practice program that will grow the number of minority doctors in the united states. this issue requires urgent attention, and i plan to introduce legislation on this in the near future. i know my comments have covered a lot of ground, but in truth, they've only begun to scratch
the surface of the myriad challenges affecting our nation and your agency in march. i am pleasedded -- in particular. i am pleased -- [inaudible] head of hhs at this difficult time. i look forward to your pickup to improve the -- your partnership to improve the health and well-being of the american people. with that, let me recognize ranking member brady. >> thank you, chairman neal, for holding this important hearing. it's always good to welcome back a friend and former colleague of the house ways and means committee, secretary becerra. let's begin by taking a look at the health of the economy. even though president biden inherited a strong recovery, life-saving vaccines is and a reopening economy, he is sabotage the jobs recovery with upping tax increase proposals -- crippling tax increase proposals that slow hiring and drive u.s. jobs overseas. proof is in the april/may jobs report, the first of which was a
major economic setback, and the recent which fell far short of even dumbed-down jobs expectations. long-term unemployment is worse today than it was before the pandemic, and labor force participation has regressed to the 1970s. to put it in perspective, despite all the advantages he inherited including trillions of stimulus spending during his first five months, president biden is half a million jobs short of what president trump achieved in his last five months. most of which was during the height of the covid deaths. "the washington post" recently gave president biden two but knocke owes for his false claims -- pinocchios for his false claims about job creation. we don't need more stimulus, we need better economic powell. despite our differences, our committee's worked hard to find common ground, as the chairman said, in health care, foster care, medicare improvements, telehealth, covid aid, maternal
the mortality, helping the underserved and rural communities, and most recently leading the first-ever national -- on surprise medical bills. regrettably, though, this hearing reveals a budget that is truly partisan. president biden insists on putting washington in charge of americans' personal health decisions. even when it means canceling their private health insurance through medicare for all. fewer cures for devastating diseases through h.r. 3, imposing costly one-size-fits-all mandates on businesses, ignoring the looming insolvency of medicare, creating new entitlements that puts the irs in charge of your time off and doubling down on the fatally-flawed affordable care act. the fact is americans don't trust washington with their a to life and death medical decisions. they to oppose the socialist take over of their health care,
and they know the good paying jobs and growing wages do far. more for working families than one-size-fits-all washington mandates and permanently smaller paychecks. americans also don't want lower drug prices at the expense of future cures for alzheimer's, als, diabetes and cancer as democrats rushed through the house in h.r. 3. they want with congress to work together to deliver lower drug prices and more life-saving cures as republicans proposed in the bipartisan h.r. 19. president biden's budget ignores the looming insolvency of medicare without meaningful reforms to address the fact that this program is just five years away from going broke. instead, democrat make it worse by expanding the program beyond today's seniors, general. tizeing the medicare guarantee that seniors paid a lifetime into.
the possibility, the telehealth benefit may soon be stripped for those who relied on it to get through the covid pandemic is another problem ignored in the biden budget. this budget ignores the fall yours of the affordable care act and seems to acknowledge that obamacare has done little to address rising health care costs. that's why the biden budget spends another $160 billion over the next decade without addressing the real problem of continuing rising costs. the budget includes two new entitlement programs that will cost more than half a trillion dollars just in the first dad. and, oh, yes, for the first time puts the irs in charge of your time off from work while permanently shrinking the paychecks of every worker whether they use paid medical leave or not. ..
this crisis has made its way in communities across the country and it's making worse the challenges facing our foster care system. this last month nearly 300 children in texas had to seek shelter in the office, hotel or a church because there were no open beds in our current foster care system. i hope that you as we discuss can shed light on the agencies handling of the crisis ensuring the well-being of the more than 18,000 unaccompanied kids in your care. there is too much at stake to get this wrong.
i know we could agree on this here whether we're talking about foster kids come shelter, health care, medicare, or life-saving cures, president biden's budget in our view is the last thing americans need. we should and could go a different way. we can tackle in almost challenges by working together. and i hope that's what we do. secretary becerra, welcome back to the committee. chairman neal, hope we can take a step in that direction today. i yield back. >> thank you mr. brady pick with objects are members opening statement will be made part of the record. our witness it really needs no introduction. secretary becerra is the 25th secretary of the department of health and human services. k-12 terms as member of use house of representatives and was member of this committee in 1997 intel he was appointed attorney general for the state of california in 2017. mr. secretary, we appreciate your present you this morning. you received -- we received the
written testimony. we ask you some i should testimony of five minutes or less and help with that time please keep an eye on the clock which will be pinned to your screen. i will notify you when your time has expired. mr. secretary. >> chairman neal, ranking member brady, members of the committee thank you for the opportunity to be back with so many friends and familiar faces to discuss the president's 2022 budget for the department of health and human services. this department is at the center of many challenges facing our country. the covid-19 pandemic has shed light on how health inequities and inefficient federal funding can lead communities vulnerable to disease. now more than ever we must ensure hhs has resources to achieve its mission and build a healthier america. for age as the budget proposes $131.7 billion in discretionary budget authority and dollars in discretionary budget authority and 1.5 trillion and mandatory funding. this budget underscores the administration's commitment to prepare the nation for the next public health crisis to expand access to affordable healthcare,
to address health disparities, to tackle the awkward and other drug crises and to invest in other priority areas like maternal health, tribal health and early childhood education. of course the fight against covid-19 is not yet over but even as hhs works to beat this pandemic was also prepare for the next public crisis. to start the budget make significant investment in our preparedness and response capabilities including by investing in the strategic national stockpile and the public health workforce. it provides a mandatory, a new mandatory funding stream for the manufacture of medical countermeasures here at home to protect americans from future pandemic and to create u.s. jobs. the budget also includes the largest fiscal your investment in the cdc and almost two decades. the budget reflects the president's commitment to expanding access to quality affordable healthcare for all americans. it builds on the groundbreaking
reforms introduced in the american rescue plan by permanent extending the enhanced premium subsidies that put affordable health healthe within reach for millions more americans. the budget also expands access to home and community based services under medicaid. critical services that allow older americans and our loved ones with disabilities to live independently in their homes and communities. and the budget calls on congress to take additional steps this year to lower the cost of prescription drugs and further expand and improve health coverage through additional benefits and public coverage options. health care must be all right, not a privilege and i will work to ensure that families across the nation unable to secure the healthcare they need. as we work to expand access to affordable healthcare and address the challenges of covid-19 and future pandemics we need to address public health crises that are already here like violence in our communities and climate change. the president's budget increases funding to support domestic violence survivors. it addresses gun violence by
doubling funding for firearm violence prevention research and it allows hhs to play major role in the administration governmentwide efforts to tackle the climate crisis by supporting research and programs identified by human health impacts of climate change and establishing here at hhs and office of climate change and health equity. to ensure that hhs is equitably serving all americans the budget invest in reducing maternal mortality and morbidity the disproportionate impacts women of color. it builds on the american rescue plan state option to extend medicaid postpartum coverage. it finds a range of moral healthcare programs and expense the pipeline of rural health providers here and it includes internet extending increase and defense appropriations for the indian health service. it invest as well improving access to vital reproduction and preventive care services through title x. to support families and build the best possible future for our
children the budget makes major investments to ensure high-quality childcare is affordable for low and middle income families, and to provide high-quality pre-k pre-k e and four-year-olds. we know our experience as children shape adults we become. support in childhood leads to success in the future. to address covid-19's unprecedented acceleration of substance abuse and mental health disorders of the budget makes historic investments in sampson to support research, prevention, treatment and recovery support services to support innovation and research the budget increases funding for nih by $9 billion, 6.5 billion of which would go to establish the advanced research projects agency for health our age. with an initial focus in cancer and other diseases such as diabetes and alzheimer's. this major investment in federal research and development will leverage ambitious to built estimation of innovation through health research and application and implementation of health
breakthroughs. finally to ensure our funds or use properly the budget invest in programming that could he including efforts to combat fraud, waste, and abuse and medicare, medicaid and private insurance. mr. chairman, i would like like to be recognizing women and men at hhs for the outstanding and tireless work fighting covid-19 to protect the health of their fellow americans to build back to prosper smirk when it health america. we've taken important steps to be back this pandemic to expand access going healthcare and/or healthcare premiums and to protect women's health at home and abroad. president biden's budget builds on the progress and i thank you for this time. i think the chairman is muted.
-- institutions today. >> mr. chairman, i believe your muted. we didn't catch what you said. >> let's try it again. not yet? so without objection each member will be recognized for four minutes to question our witness so we made sure all members have the opportunity to inquire before the secretary is scheduled to leave. he has to be -- and sits with committee practices -- given to them will go in order to yorty between majority and minority members. i will begin by recognizing myself, and want to emphasize i will bring the gavel down in four minutes the secretaries as for the courtesy. we should extend it. i should the administration's commitment for addressing coverage gaps for low income people brought by some states who have refused to expand medicaid and you and i talked about the need to address this
issue. you and i know your answer but want to get on the record as well that these americans cannot wait any longer for coverage and the congress should find the most expeditious path to go forward. >> mr. chairman, we agree completely and we will compute expand health care. as know today 31 million americans have received healthcare to the affordable care act. that's in a a store number and over the last three months as result of the special enrollment period issued by the president more than 1 million americans were able to receive their healthcare coverage. so we will continue to expand that whether it's under medicaid, under the marketplace. we want to explore all the opportunities to continue to give all americans the opportunity to have healthcare as a right, not just a privileg privilege. >> mr. secretary, similar to our ways and means discussion draft of the building an economy femmes act the president budget
proposed historic investment in childcare to make it more affordable and available, upgrade childcare infrastructure to make it better and safer, , d raise wages for childcare workforce which we know predominantly is women of color. secretary becerra, we stand ready to work with you in this crucial part of the president's plan for strong economic recovery. could you tell us more about how making this long-term investment in childcare as well short-term rescue efforts in the arpa is ts the need to support workers and families? >> mr. chairman, firstly begin by thanking you in this committee for your work in building on, building an economy for families act which i know is crucial if were going to continue to move forward to help our children. our budget proposes $3.5 billion in budget authority for the childcare and act entitlement of 2022. it provides for further investment in our workforce in the childcare field. we want to make sure people can afford to work to take care of
our kids and want to continue to give americans the opportunity to explore any job opportunities they like because they know there will quality affordable childcare at their disposal. we look forward to working with you to continue to expand access to quality child care for all americans. >> mr. secretary, that covid-19 pandemic laid bare the long-standing inadequacy of our current protections for nursing home staff, residents and the families. the centers for medicare and medicaid services can take immediate actions to short existing protections and make long-term investments such as improved staffing, oversight and transparency. could you speak to the actions hhs is probably taking to improve conditions for residents and staff at these facilities? i know we can come count ao advance these issues to regulations while we work on legislation to get these issues. could you speak to that? >> absolutely, mr. chairman. we learn from covid-19 how much
we need to do a better job at being able to track what's going on in these various facilities. our oversight capabilities must increase their we need to work closer with congress so we know exactly how we can ensure that we're providing to our families the protections that they deserve and have safety as a paramount concern. the president budget request $75 million to increase to increase state survey agencies ability to address additional complaints that may be lodged by patients, to perform inspections can control service in nursing homes and provide an annual mandated survey in nursing homes. we intend to work with you to make sure we do the proper oversight and accountability of these various facilities that house our loved ones. >> thank you, mr. secretary. mr. secretary, thank you. now that they recognize mr. brady the ranking member for five minutes. >> thank you, chairman. would you a few minutes at this time to in her into brief --
>> yes. >> thank you, chairman. many patients in a film is the health problem were competent and expected out-of-network surprised medical bill. thanks to the tireless bipartisan work of this committee last congress this general practice will soon be no more. now it's up to the biden administration jewel movement this landmark bipartisan law and given the key role and the temptation want to reaffirm our shared priorities and those of the ways and means committee while we have secretary becerra before us. as leaders the ways and means committee came to protect patients access to providers in their area. we also sought to take patience out of the process and avoid tipping the scales in favor of one party over another in determining the right payment amount for out-of-network deals. this will enable independent arbiters to to weigh all the
relevant information in a given case and keeps the process from becoming a de facto ratesetting system. the integrity of the arbitration process should be protected in as many ways as possible including through robust transparency. i encourage of the administration to ensure timely resolution of billing disputes in accordance with the tight timeline we wrote into the bill. healthcare providers survey guarantee prompt payment upon resolution of these cases. finally i would encourage the administration not to neglect the bills important transparency measures with a particular focus on the historic advanced, honest and true bill, the explanation of benefits provision. giving patients information about the cost of the services ahead of time will help healthcare make sense. nobody fills up their tank without knowing how much the gas cost. the same should be true of healthcare. thankfully for patients and their families this changes for the better next year.
mr. chairman, i appreciate your indulging me while we have the secretary here before us and, of course, i look forward to continuing to work our partnership on this important the issue and they you back. >> i want to fully associate myself with the remarks and would at our shared priorities during implementation is that patients must be protected from out-of-network surprise bills. lawmakers did not design any intentional loopholes for sick patient to be a form when they are unconscious and subsequent get a bill that they supposedly agree to pay. the patient perspective be as tight as possible and we look forward to continue to engage with the administration as this law is rolled out. >> mr. chairman, if i may start with the secretary today. >> the gentleman is recognize. >> thank you. secretary becerra, i think there
are several areas of common agreement here including making america medically independent from china in crucial medicines, medical supplies and ingredients to build that. i hope we can work together on issues like underserved, the poor, the rural as well as ensuring that telehealth which is one of the saving graces in the covid can become permanent access and flexibility to connect our patients with their healthcare providers. house want to talk about an area that really concerns me and i think others in the country, this is unencumbered minors in hhs custody. unaccompanied minors have been coming across the board in unprecedented numbers for months now. i have been there. there is a real crisis at our southern border. i'm concerned the administration is in denial about this and certainly has no plan to address this. so why have written a two letters to you on this issue and
try to ask unanimous consent both these letters be entered into the record. >> so ordered. >> it is my understanding children will be unified with sponsors but a good number are not. and of what to focus on that. i believe it's roughly 10% of unaccompanied minors have no sponsors, need some sort of long-term foster care placement. the problem is our american foster system is already overwhelmed and, frankly, in some cases it is simply cruel. given the significant increase in kids coming across the border the last few months in the knowledge this is already hurting some of our u.s. foster kids as we try to get a roof over their head in foster parents, what is your plan to protect american foster kids with the system to anticipate and manage the increased need for long-term foster that?
>> great to see you and thank you for the question. very much looking forward to working with you. putting on this issue trying to help our foster kids. let me assure you that all the work we're doing with regard to the unaccompanied migrant children, and with responsibility for them to provide them with health and safety while they're in this country, for however long that might end up being, we will not let that impact the work that we all are doing to care for our foster children throughout the country. they run on two separate tracks that what we do with unencumbered minors, migrant children, and that which we do with regard to foster care. i went to assure you we will continue to keep those separate. >> thank you, mr. secretary. one, that's terrific to hear and i know you're sincere in this. so when from a timetable standpoint when might we see a plan on how we address this issue, one, when republicans and democrats can work together? >> mr. brady, i'm glad you're
asking that question because we are looking in the budget our budget essentially telegraphs that were looking to come up with long-term solutions. we know because previous administrations have gone through this that the phenomenon of seeing migrant children at the border unaccompanied is not new. and so we intend to try to come up with a solution that doesn't let us have to gyrate through the process in a in a yearp with long-term solutions. we look forward to working with you. it is expensive anytime you have custody and the need to provide health and safety to children. we look forward to working with you and coming up with some long-term solution. >> great, thank you, mr. secretary. thank you, chairman. >> thank you, mr. bertie. without many recognize the gentleman from texas, mr. doggett, to inquire for four minutes. >> thank you very much, mr. cha. secretary, for your important leadership. my home state of texas
unfortunate bears the disgraceful sanction of having more uninsured citizens can more uninsured children than any place in america. i was pleased to hear your comments earlier about your interest in addressing this problem. we've learned that as many as 2 million texans could get access to a family physician through extension of medicaid. unfortunately texas as is a true and 12 other states, ideology gets in the way of caring for citizens who are vulnerable and economically disadvantaged. you mentioned a couple of ideas already. i want to bring to your attention another one, and that is to authorize medicaid, cms, the contract directly with local governmental units in the states that a put ideology ahead of healthcare. this would be a way to have essentially a local option to protect vulnerable citizens and
extend medicaid to them on the same basis in a local area through a county, hospital district, a city that has occurred in most states that exercise a good judgment of taking 100 federal cents on the dollar to extend medicaid. have you considered this alternative, which i know his work previously in your home state of california and some of the places, and alternative that will be included in legislation that i'll be introducing with probably just about every democratic member from the 13 expansion states? [inaudible] >> i think we lost mr. doggett. jeremy, should we wait? will give it a couple minutes
and then come back to him or at least allow him to finish his question and you to give an answer. what will do is will come back to mr. doggett. why don't we recognize mr. nunes, the german from california. >> thank you, mr. chairman. i really appreciate the time today and taking mr. secretary for your attendance today. to be prepared for the next pandemic we must have robust domestic manufacturing of pharmaceuticals and death by topic here today if were going to continue to be the world's leader in innovation in numerous areas within the healthcare sector. we can't leave ourselves or our international partners vulnerable to china when it comes to this critical issue. this is why i introduced two bills in the last caucus to incentivize domestic manufacture. it is also what unconcerned about the biden administration
support for the trips waiver which would force american innovators of covid vaccines to share the proprietary information with foreign nations including china, russia, and other hostile regimes. because the waiver clearly jeopardizes the future development of vaccines and cures in the united states,, today i introduced another bill to require the administration can consult with congress, analyze all the implications and protect u.s. national security before waiving any intellectual property protections for vaccines. i recognize that ustr is leading the waiver negotiations but hhs should play a a central role n analyzing the waivers of facts. in both of the united states and globally. it's critical we assist the global distribution of covid vaccines but a trips waiver which is opposed allies like germany would take years before yielding large numbers of vaccine doses abroad here i'm
disappointed with the administration's announced support for this waiver without consulting congress but i will continue to press for the consultations robust analysis that are needed to justify the decision with such significant implications for our health and national security. with that, mr. secretary, what i'll do is i will ask two questions for the record and you can either answer the now if we run out of time or you can enter for the record for wins again i appreciate you being here. i have two questions that are fairly simple and straightforward. the first is, has hhs conducted any analysis of the impact of any waiver of intellectual property on domestic manufacturing or innovation? that's the first question. the second question is, has hhs conducted any analysis of how long it will take foreign nations to manufacture and distribute covid vaccines if this trips waiver is granted? that's my second question. with that, mr. chairman, i'm not sure how much time i have left
but secretaries time, is welcomed answer if not i'll take them for the record. >> go ahead, mr. secretary. >> great to see you and let me try to give you a response and i can always follow up if you would like. first on the trips waiver, please let's recognize the the president has said he is willing to open that to negotiation. there is no done deal, , nothing is set in stone. there still has to be negotiation to figure out textually that would look, it's what i can say to you and someone who as you have worked in the past on these issues involving intellectual property and the protection of her own rights as americans, will make sure we are protecting those property as we always have in the wto. what i will say to you is that whether we get to some negotiated language that allows us to move forward with vaccines will depend on the negotiations that have to take place on the trips language. secondly with regard to domestic
manufacturing i think there's a great deal of bipartisan support to move and enhancing our abilities to manufacture here at home and the american rescue plan provided $10 billion for us to do that come to increase that domestic capacity. we hope to work with congress to put that into fruition to make sure we have american manufacturers, whether it's for masks, ppe, vaccines, that we do it here at home. >> thank you. thank you, mr. secretary. let us return to mr. doggett here are you ready? you on mute. mr. doggett, you are on mute. okay, so we'll come back to you again, mr. doggett. >> mr. chairman -- >> go had. >> thank you very much. i was asking the secretary about
his reaction to allowing local governments to contract directly with cms as when one optioe this great gap of the uninsured. >> first, great to see you again and thank you for always pushing so hard on some of these matters. as a present as it were going to do everything we can to ban access to care. there are any number of great ideas to do that next to the work that you been doing you mention of states like california have taken advantage of these waiver opportunities. we look forward working with you because at the end of the day what we want to do is say that more americans are covered and doesn't mentioned in previous responses to some questions today 31 million americans have coverage through the affordable care act. some of them to the medicaid expansion of this that the marketplaces. we look forward to working with you to figure out a way to continue that growth. >> with regard to prescription drug pricing, is it important our legislation not discriminate against the uninsured, that we
provide benefits to them? >> again congressman doggett, thank you for being dogged in this, because you are right. like you like we want to make sure everyone has a chance to participate and to benefit from lower drug prices. >> thank you. >> thank you, mr. doggett. let me know recognize the gentleman from california mr. thompson to inquire. >> thank you, mr. chairman. thank you, mr. secretary, for joining us. it's good to see you back in the ways and means space. and i've got two questions and i'll give them both and you can respond. first i'd like to start talking about telemedicine. it's been one of the silver lining in the covid-19 pandemic. i'm proud to have founded the congressional telehealth caucus which is a bipartisan group and working to ensure high quality telehealth services are available to all americans. and it was bipartisan
legislation signed into law the start of covid that authorize medicare to expand telehealth for the duration of the pandemic. unfortunately the telehealth flexibility currently in place are going to expire once we get out of this public health emergency. i have introduced another piece of legislation along with my friend mr. schweikert on this committee that will ensure that patients can continue accessing telehealth services. so my first question would be good you talk about how you view the next steps for telehealth, now does the administration envisioned incorporating telehealth into the medicare program? and in second, we have got this just huge number of ongoing mental health challenges in our country. substance abuse, addiction, homelessness, suicide,
depression, the goes on and on and on. and we see the impacts of these cries all around us, in the homeless population, in prisons and jails come amongst our veteran population and amongst our teenagers. i've got legislation that would expand mental health services for seniors in medicare that is going to take a lot more than that. i do like to know how hhs is approaching this challenge? can you talk more about your efforts underway as secretary in your department to combat mental health? >> congressman thompson great to see you again. look for to visiting in your district and abiding in the refreshment such a bother that is so popular at some point. let me start with the second question first if i may. we recently announced $3 billion that we would be putting out as result of the american rescue
plan that you all helped push to the finish line. that will let us put money into mental health services with samhsa and also for substance use disorder services. major investment never would've been possible without your support and were going to put that work immediately. secondly to the question about telehealth. wow, do we get to learn things from covid-19, right? telehealth was one of the real benefits of seeing how we could adapt. so now it's a matter of figuring out how we can deploy some of that alone could because as you said some of the authorities will expire. we look forward to working with you because some of the authority will have to come through statute. some of that we can probably due to administrative regulation but what we do know is a cackle back to the old way doing business. we have to take advantage of telehealth. >> thank you, mr. secretary, and i just want to close by saying that so many of the problems that we face today are tied to mental health. you talk about homelessness in the addiction problems. if you can't get mental health care, you're going to turn to
whatever you can for relief, and sadly self-medication with drugs and alcohol is often what folks turn to. we really need in in a biparn way to redouble our efforts to do with a mental health challenge that faces every one of our communities on a daily basis. thank you and i yield back. >> thank the gentleman. let me recognize the gentleman from florida mr. buchanan to inquire. >> thank you, mr. chairman. welcome back, mr. secretary. i want to touch on the idea of affordability. you mention it. ten years ago we were talking about bending the curve. of a lot of people that have little or no insurance but it want to talk another group of folks, small businesses and many of them they have seen their costs go up over the last five or six years 20% a year. a lot of it not all of it gets
passed to the employees. historically for a summit has been business a long time i've always shared first 20 us myself a lot of companies paid anybody's insurance. the big corporations could afford to do that today. for many of their employees but a lot of the small businesses can't afford $1400 a month for a family of four back so they will pay six or 700. a gets pushed to the middle class, the working folks, and that's why they are so financially stressed out, borderline bankruptcy. i've seen it. i guess, mr. secretary, how can we all work together? i know you've got a lot of challenges, that this probably in this category 60 to 80 million people that are chipping in for many people in the past didn't have to as much as seven, $800 a month out of their own fate. it's very concerning. i was chairman of the florida chamber here it was a big issue back then. it's a more critical issue today. a lot of them are working in
restaurants or small businesses. they can't afford to absorb all the increases so lot of that is getting pushed to the working people in the middle class and i'm very concerned about many of them just financially going bankrupt or completely stressed out, or they don't take the interest because they can't afford the deductibility or their contribution. i know you touch on affordability. what's your thoughts? >> first, great to see you and thank you for always championing the cause of small businessmen and women. i know that's been a mantra of yours for a long time. and you're right because so many of the small business men and women don't have their own health insurance but work were hoping to do is make it more profitable for people to be able to afford it and have the choices here as i said, today more americans are using the affordable care act than ever before, 31 million, and the special moment period president biden initiated about three
months ago we've seen more than one main people to get vantage come so many of those folks author intros come so many worked for small businesses where it's tough to provide health care coverage. what i can tell he is i am absolutely interested in working with you and others especially if you try to get to the middle of america, that oftentimes gets squeezed and doesn't quite get the benefit from some of the proposals that are out there. look forward to working with you on that and continuing the growth as we've seen under president biden people in america who can get quality affordable health care. >> i appreciate. i'd like to work with you but i just want to just keep those folks in mind. a lot of the people that are employed with small businesses are stressed out in terms of trying to pay for the health care. it's a big issue. i see it. again looking back we used to beat everybody. now we are paying a little over half, our employees are paying the other half. my sons are running those businesses and i don't like it. because it's a money that they
can't afford to do so it's a big issue. i just want you to give them some consideration. i don't how much time i've got but but i did want to ask one quick question. in terms of your budget, you're looking at 23% increase. to make him run the math, 20 billion plus. what there's the majority of those dollars going to be focused in terms of the next year when you look at inflation at four or 5% come looking to get 23%? i'm just concerned everybody wants more spending but at some point you have to pay for this stuff. >> congressman, so much of the money that's coming in is going to be invested in some of the behavioral health issue that i previously spoke about, how we deal with mental health and substance use disorder issues. so much about going to need to do to recover from covid and also i should mention the fact the president is making sure those middle income americans, small business people who would fall off the cliff of coverage in terms of a subsidy come if we
are able to make this expanded support on the subsidy per minute, millions of americans who are in the middle, although small businessmen and women, are going to be able to keep their interest because they will no longer fall off the cliff when they get a certain income level and all of a sudden lose of those subsidies. much of the money is invested to improve healthcare and make sure we tackle all those health issues we're seen as result of covid. >> thank you mr. secretary. >> mr. blumenauer, the gentleman from oregon is recognized to inquire. >> thank you, mr. chairman. mr. secretary, at such a pleasure to welcome you back to the committee. we look forward to working with you and the administration in this critical time. the president's healthcare budget demonstrates his deep commitment to health and well-being of americans. our health care system faces significant challenges including
the coming exhaustion of the medicare trust fund and increasing cost of healthcare, lack of choices for individuals with serious illness, and at the end of life. i am the pleased to see the president's budget would make significant investments in the affordable care act insurance subsidies. however, making healthcare itself more affordable by increasing public subsidy does not reduce the cost of healthcare itself. without changing the payment model the cost will continue to increase forcing us to spend ever more money on medical care but undermining investments in the social determinants of health that are so critical ifor going to be able to deal with long-standing health disparities that disproportionately affect people of color. furthermore, governors even in medicare expansion states will be hard-pressed to maintain existing coverage without a way
to reduce the cost of care. given the constraints of reconciliation we difficult to address medical inflation through congressional action alone. the use facilitated 11, 15 and 1332 waivers offers a path for a carefully selected states to expand on the work really being pioneered in my home state of oregon and in maryland which are demonstrating innovative ways to reduce the total cost of care while maintaining access, benefits and quality. would you be willing to consider away for strategy as an administered koppelman for the legislative initiatives being pursued? >> congressman, as you know this administration is willing to look under every rock that any member of congress put before us to see if there's a better solution for healthcare. we want to continue expand coverage, continue tour cost. if you and your colleagues come up with good ideas when it comes
to prescription drugs, on better access, on innovation, on bending the curve we willing to listen. i know you're a number of good ideas in your pocket. i would love to continue to work with you on these things because at the end of day what president biden simply want wanted te americans don't have to worry about whether they should pay their rent or be able to send their child to see the doctor. we all have to have that piece of buying. we look forward to working with you on that. >> i appreciate that very much and would look forward to exploring what is happened with the waiver strategy as a way to deal with the total cost of care, and hope we could explore that together. one other thing, you recall from days on this committee when we would you do with the affordable care act i would you be concerned about end-of-life care and how we had problems, you remember with the phony controversy over death panels. but we finally got the
opportunity for the federal government to invest in those, in that end-of-life care but there is very low utilization right now. do you have any thoughts about what we might do to enhance the opportunity for american families to make sure they get the care they want in those vulnerable times? >> that's an issue near and dear to me, congressman, because my father who lived with me his last four years of his life had his family surround him the day he died about a year and half ago, and you would hope that i thought it would opportunity to be able to have more say in their healthcare especially towards the end of their life. those decisions are tough. my state has made as your status made advances in that regard. i look for to working with you to set we can do the federal level. >> thank the judgment. but you recognize the gentle than from pennsylvania mr. kelly
to inquire. >> thank you, mr. chairman. mr. secretary, good to see you again. you're looking quite well. hey, my question can we'll have four minutes but i sent a couple letters to you, going to ask, mr. chairman, bb submitted into the record. my big question, in erie, pennsylvania, we had a number of our unaccompanied children show up there. when i found out they were there i made a call and a window to see them and he told me you don't need to come up, they are already gone. my question comes down to, do we have any way we can look at what the contract is for people who are taking care of these children? it's a big operation. the kids at erie, pennsylvania, wonderful couple of days. after told they were not going to be there at all because the facility wasn't ready for them, 150 150 kids, about one and 75, 180 staff member to take care of them within two or three days they were all gone.
some of them had covid, and my question to you and i know you're busy and i know you're not going after the step because of her time, would you please get back to me at these emergency intake sites, what is the contract, i've been told is in with them seven and 50-$800 per day per child that is because opry. it's huge operation. i was down in texas, incredible job we did setting up a ten city to take care of these children or watch the implications of it but but i would really like to see going forward what is the policy going to be, what is the process going to be and what does the contact look like? i can get any information. i know you're busy. since you couple letters that i would really appreciate it. i don't expect you to enter this right now, okay? this is like jesus on holy thursday, you're getting hit from all sides. let's just do this. if you can get back to me as soon as possible i really appreciated. i know the people in pennsylvania did not understand what happened. they were very welcoming and
having those children but mr. secretary, there were only there a couple days and then they were all gone. going forward the policy, the process in the cost and what the contract looks like. >> congressman, wait to see you. you still have the same energy. it's great to see you. great to see an absolutely we will follow up picky were right, the folks in erie were very welcoming. we have an obligation to make sure we take care of these kids and provide them with the safety and health that's required. we work with our partners. we follow the federal acquisition regulations when it comes to contracting. rather than to try to get to deal because of time constraints let's follow up but what i can tell you is this. we make every effort to make sure that any site that we stand up will provide the safety and the health needs of those migrant children for however long they're going to be in this country. who knows what their status will end up being? we have an obligation to make sure they are cared for. we are going to the right way and we thank those communities
that will encompass. we have had a lot of folks come forward and donate supplies and toys and gifts and the folks in erie were very gracious as well. >> that's great. if you can get back to me on what that contract looks like, with the providers of the services. mr. secretary, good seeing you. stay healthy. i'm glad to work with you and i'm really looking forward on this issue to make sure we keep moving forward. mr. chairman, thank you. mr. secretary, thank you. >> thank the the gentleman. but he recognized the gentleman from new jersey mr. pascrell to inquire. >> morning mr. chairman and good morning, mr. secretary. good to see you. you look healthy. stay healthy. i appreciate your work in the biden administration's efforts to invest in public health and healthcare. many priorities in the budget like strengthening the aca and lowering drug costs and expanding medicare, they are long overdue.
so here are my questions. the fda supports unique device identification system, and we've been messing around with divisive for the last ten years and we're finally hopefully moving on it. references that identification system, references benefits and claims data to improve implant safety and reduce costs. however, the cms budget justification makes no mention of this change. please describe the administration's plan to utilize the unique device identifier information being collected for medicare and medicaid programs, and how the information will be used for quality measurement. and will you encourage the
adoption of new electronic claims standards under hipaa, that include unique device information? >> congressman, first, great to see you. secondly, thank you for being tenacious always. these are issues that often times most people don't know about get ignored but they are critical. especially when it comes to making sure that we properly are following the patient come making sure all the right information on them. the unique device identifier to mention, they're working their way through the process and my just any is at this stage right now there before the national committee, called vital and health statistics national committee on vital and health statistics. they are waiting to get through the process to get the recommendation from that committee to move forward. what i can do is follow up with you as we await to hear from this committee to find out where
that stands. but as you mentioned we have got to sure to these medicare claims the contract these things of that unique device identifier is one way to do that. >> examining examinee a, the device itself. there are many different devices, you know better than i do, and these devices need oversight in terms of what they do to the human body. we are finding more and more out, and a lot of other companies don't like the idea, a lot of companies. the second question was, wall street's tentacles and her health care system continues to grow. we talked about this a lot when you are around here. there are control is associated with surprise building, skyhigh nursing home, death rates. we can't accept that. the shuddering at safety net hospitals all in the name of profit, not patients.
the ways and means oversight subcommittee hearing revealed, not that long ago, a disturbing lack of transparency. we heard about declining standards and lower quality of care, a lot of those horror stories, from hospitals and nursing homes owned by private equity firms. i would like, not only nursing homes. i would like your take on that. >> what i'll tell you is i am prepared to work with you. i took this on as attorney general of california. our obligation has to be to the residence at first and foremost and drift of transparency and accountability in these facilities. >> thank you. thank you, mr. chairman. >> the gentleman from new york mr. reed is recognized to inquire. >> thank you, mr. chairman. it's great to see again, mr. secretary, here at the committee. mr. secretary, i just want to try to get two quick questions in. one is a very heavy concern about drug pricing takeover that
hr3 represents and what the the president has supported in his budget and one of the things i'm pretty concerned about is the corporations quality adjusted life years in setting drug prices from foreign countries in american drug pricing policy. i just wanted to see, secretary, if you commit today to us, to this committee, that hhs will not use wholly adjusted life years is that drug prices in u.s. either directly or by proxy during your tenure as secretary at hhs? >> congressman, first good to see you. i love your office. i love it. the thing that technology lets us do right now, have these calls is great. first let me just tell it forward to working with you. you know president biden has made very clear were going to definitely can to ring down the cost of prescription medicines and so we're going to look at everything but we'll actually work with you and your colleagues to make sure that
what we do is done right, that everyone feels it's there and it's accountable. let me just make sure we're in touch if you'd like to work on this issue. >> i definitely look forward to working with you. in energy and commerce we had a conversation with my colleague cathy mcmorris rodgers on this issue and just want to make sure that quality adjusted life years does not become the de facto or does your policy of your office in setting drug prices are nationally which would be i think a very difficult or very problematic policy for america to establish in regards to aids drug pricing policy. the other issue i wanted to get you and i have two minutes left ear, impacts or district. and that is the issue of critical access hospital reimbursement policy. you know i think in your confirmation testimony that there's a question of the mileage qualification for critical access hospital. we have a hospital soldiers and
sailors in cuny new york and/or district as well as i believe there's nine hospitals in new york state that it in impacted by the new mileage calculation if you would that hhs has been dealing with and has graciously been put on hold during the pandemic, and a just want to work with you and get recognition from you that these critical access hospitals are the backbone of rural hospitals in america, special in district like ours. changing the policy from pre-2015 determinations to future determinations is something i'm very sensitive to and in a many colleagues of mine are very sensitive to, and i just wanted to offer, what are your thoughts in regards to understand on that? can i get assurance we do no harm to these critical access hospitals in regards to their te reliance on this reimbursement policy? >> congressman, i think the thing with covid is that some of our communities that are distant from a provider really need to
have the support that makes it possible for all of us to get the care we need. what i can commit to you absolute best work which only sings but want to make sure we're not making it more difficult for more expensive for anyone especially someone in a row opportunity to get access to care the need. what i will do is, you, when you want to follow up and we will, because we have money in this budget that helps us address the needs of rural communities, make sure on telehealth or making sure those hospitals that were hit hard by covid have an opportunity to survive. there's money that was allocated specifically for rural communities. >> i've got eight seconds. just on the mileage if we can go to pre-2015 if you get that can mimic to meet today i would love that right now but i don't know if you position to do that. >> i sorely could commit to work with you to see where we can end up. >> you are a pro. thank you, mr. secretary. it's good to see again. >> thank you. let me recognize that children from wisconsin mr. kind to inquire. >> thank you, mr. chairman.
mr. secretary, it's so great welcome back our friend and former colleague on the committee, really enjoyed serving with you on the committee, look forward to partner with you now in your new capacity, so welcome home, so to speak. listen, a couple questions i have. i've been hearing from some of my providers that the provider relief fund money has to be spent by the end of this month and are still occurring some of the pandemic expenses that is or in consideration of extending the deadline giving them more time and spending the provider relief funds that's been allocated? >> congressman, i feel like i'm in in a family reunion, but great to see you. first, to the question, we are trying to provide some flexibility. we have seen having watched some of the provider relief fund was deployed originally some of the problems that occurred, were trying to make sure we don't make the mistakes of the past so we're trying to provide some flexibility. we can follow up with you but want to make sure everybody
keeps the deadline the best as possible. we understand any doubt some flexibility. we will soon this month will be coming out with some guidance to help people make sure they can apply for and make use, good use of their monies. >> i appreciate that. we will follow-up with you on that since we are just a few weeks away from that deadline. also just so you know i'm going to be introducing bipartisan legislation again with mr. kelly on the committee, medicare advantage quality payment relief grant and its of incentive bonus, bonus payments for plans that are hitting their benchmarks. unfortunately the payment levels are based on pre-ac and acls so it is excluding a lot of quality and in ma plans. i don't get answer from now, just want to lurch will be dropping that really tried work we did secret of success problem. as you know, with the leader of the affordable care act, i, you and others were championing all
the reform policy proposes that we could get into the legislation. i hope that now as secretary will be able to tap the et a little bit and go to alternate payment methods, emphasize quality health outcome, value -- [inaudible] with those altering the payment models with respect -- committed are you in trying to move, continue to move in that direction? >> congressman, music to my ears. i think we want to harness innovation everywhere we can. cnmi was a product of the work done on the affordable care act. arthur h is another example how president biden bully wanted to take this to the next level. would like you will take all that great research and that, just watch what if we see something that really exciting. talk it as a way that we think there's efficient private sector doing some things academia come we don't have -- in debt and the
h string upper we can see if we can accelerate the opportunity to provide that. >> we know with a shaves more than just extending quality affordable, accessible healthcare also cost-containment and something ranking member brady again race today if there's more work to be done on that front. finally as we emerge from this global pandemic is it any thought at hhs that doing a deeper dive on lessons learned come out of this pandemic, things we did do well, perhaps more poorly things we didn't do well that we were caught so flat-footed with all this? >> no doubt. we mention telehealth. clearly we learned how much people need telehealth and we also learned we've got gaps of those communities that are in the corners in the shadows and now we still lack the ability to sit every american that we're accurately going to provide you with health care, and so absolutely work on have a lot of lessons learned from covid. >> thanks, thanks, xavier. great seeing you.
>> thank the gentleman. let me recognize the gentleman from missouri mr. smith to inquire. >> thank you, mr. chairman. mr. secretary, i want to start by thank you for being here today to provide us with your come with more insight into the president's budget request. before i jump into the request, while i have you here, on april 21 senator lee and ant a letter to the cdc director requesting information on the cdc's mask guidance for children which i'm sure you know is the most strict in the world. this guidance makes no sense given current case numbers, evidence of lower transmission among children and the negative impact this guidance has on their daily lives we requested and reply to this letter by may 5. it is now over a month past the deadline and we received no response. in light of the summer heaping upon us and reports of some children be forced to wear masks
in sweltering temperatures i think the american people urgently need to know the full picture about how the cdc arrived at its decision that children over two should been asked. mr. chairman, will you commit to ensuring the cdc director provide a response myself and a 31 of the members of the house and senate who signed the letter by the end of this week? >> congressman, thank you for the question and it's in accord with. i committee will make sure that any letter that is directed at the department including cdc, you get a response it will try to make sure we do this as quickly as we can. ..
>> we do know that china is actively trying to hinder investigations into the virus' origins. and several prominent scientists who might otherwise be in a position to help us determine the virus origins like dr. fauci compromised because of conflict of interest. can you confirm none of the funds included in this budget would be used to provide aid to foreign laboratoies to deal with deadly or contagious viruses? >> congressman, this is something everybody has taken an interest in. we have to come to the bottom of the origins of covid-19.
i myself, probably a month ago when i had an opportunity to address the world's health assembly, i also said it was time for us to get to the bottom of this. we all want to make sure we do. addressing pandemics in the future requires us to know the origins of the source. so i can hereto look for partners to make sure we get to the bottom of some of these things and whether it's the authorities within nih or hhs, or the president himself working with the intelligence committee working to get michael terry totkus bomb of it and working one this. >> and can you tell us if there was anything in the budget to aid in the laboratories, any dollars in there. >> we have no dollars dedicated or earmarked for any foreign forces to do anything of the sort. >> and i appreciate it, mr. secretary.
if we do find that china is blamed for this virus, will you commit to holding the chinese government responsibility for this catastrophic irresponsibility. >> accountability is what we seek from everyone including hhs. >> thank you, recognize the gentleman from illinois, mr. davis, to inquire. >> thank you, mr. chairman and welcome, mr. secretary. i have serious concerns that social security and supplemental security income, benefits being paid to foster youth are not getting to them and are not even always being used for their benefit. so, mr. secretary, will you permit working with my subcommittee and with social security to find a remedy for this serious problem? >> i say it's great to see you
and thank you for always championing the cause of so many kids who are underserved, underprivileged and here, i look forward to working with you. we, too, are trying to do a better examination and we want to review the work being done by gao on this particular issue and as you know, it's complicated because here we have to work with our state and local partners who actually administer some of these programs. you're right, we have to make sure that these kids get the kind ever care that you and i would expect to give to our kids and we want to make sure that those kids have some-- they have their voice is included in this as well. >> thank you, mr. secretary. and millions of safety net hospitals in my district, hospitals like children's, loretta, mount sinai, region america, the new insight are all struggling just to keep their doors open because they serve this population big time,
where the money isn't really sufficient. i understand that there are $24 billion unallocated in the provider relief fund. would you share with us, plans, while that money or plan help these institutions that really need it right now? >> as you remember, when i was there in congress, i worked really hard with you and others to make sure that many of the safety net hospitals that care for our poorest and our sickest, don't go under for trying to do the right thing. and with the provider relief fund, you would hope that when any dollar is dispensed, it's because that institution, that provider has proven it deserves to get support from the taxpayers. we're taking a close look at the provider relief fund, we want to make sure that we're
transparent to do this and defunding for any accountable dollars that they receive, but without a doubt. we want to make sure that safety net hospitals that really were there in the front line helping some of our sickest americans during covid-19 get the support they deserve so we look forward working would you to make sure that we have transparency and accountability. >> thank you so much. and it's good to see you. >> thank you, thank you. >> thank you, gentlemen. let me recognize the gentleman from south carolina, mr. rice, to inquire. >> thank you, mr. chairman and thank you, mr. secretary for being here today. your testimony that you submitted, your written testimony didn't mention telehealth and i've got three very rural counties with majority, minority populations that are very much underserved in terms of health care facilities, telehealth has been a very big boon to them particularly in the time of covid. i'm glad to hear your testimony
live today where you'll support telehealth and do you believe that telehealth provides valuable resource particularly in some areas. >> easiest question, i've asked today. yes. i hope your further questions will be just the same. >> i have a bill out that would allow people to have direct access to audiologists because i've got very rural populations that are very much underserved by primary care physicians and the requirements they first have to go get a referral i think is onerous to them. i think that this is something that you channed while you were in congress as well. will you support a change in the process to allow people to go directly to audiologists rather than being referred under medicare? >> congressman, i look forward as you mentioned, i worked on a
number of these issues and now as secretary, my job, my role is a little different than as a member of congress, but absolutely look forward to it. you all try the solutions and please know we'll be there for assistance and perhaps be able to implement. we look forward to working with you. >> south carolina has faced a reduction in their grant because there's a requirement that you have 90% paternity establishment to qualify. and the reason that we're not able to meet that threshold is because of covid. because obviously the health care facilities and laboratories were overwhelmed and we're just now coming out of that, but i don't know how quickly we're going to be able to do it and we can't really afford to have our welfare recipients being docked because of this that was put on by
covid. would you waive the 90% paternity establishment requirement? >> congressman, i'm going to admit to you i don't know enough about this to be able to respond, but what i can do is ensure that i and my people get back to you and your staff so we can look into this further. but i appreciate you bringing this up. the lens from which i look at this is how are we providing accountability and equity. and at the same time doing it in a very transparent manner so everyone understands how hhs has moved forward. >> this will affect the -- it's not their fault, it's not south carolina's fault that we had covid, our facilities were overwhelmed. one last question, i know that your budget includes 6.5% increase in medicare spending, medicare trust fund is slated to go insolvent as soon as
2024. how do you propose to make up the difference in the medicare trust fund? do you propose additional payroll taxes? what's your plan? we've got to make this medicare plan golden, we've got to make it concrete for our seniors. how can we afford to spend more when we're going to be insolvent in three years? >> congressman, we're going to do what we can. i can follow up with you on that, congressman, i know time has expired. >> thank you. >> yield back, mr. chairman. thank you, let me recognize the gentle lady from california, ms. sanchez, to insquire. >> thank you, and i want to thank secretary becerra. i want to note how surprising it is my colleagues on the other side of the aisles have mysteriously become concerned about unaccompanied minors in hhs custody.
they weren't concerned during the last administration, they were taken from their parents ar forced to stay on squalid camps on the other side of the border and i wonder why it took so long for the other side of the aisle for the children. i couldn't leave that alone without commenting. secretary, the president's budget provides long overdue investments to help earn m families get back on their feet and it includes funding for democratic priorities that i have proudly supported for many years, and to make health insurance more affordable, access to child and elder care and many other things. but let's be clear, these investments are, you know, a critical first step as our nation rebuilds and recovers from the pandemic and that the covid-19 pandemic in various
ways in which our health center wasn't working and we had to address the gaps we've become aware of. for example, the pandemic shows that nursing home facilities were dangerously unprepared to help the residents in their care, according to the keiser family foundation on average, long-term care facilities account for 5% of covid cases, but over 30% of all covid deaths in the u.s. the previous administration raigtsed many proposals that have allowed nursing homes to steer clear of accountability at the expense of residents and their families. pre dispute binding arbitration agreements are just one example and i think that this is tragic. you know, i've been working for many years with the american association for justice and aarp, to try to correct this and just in april, congresswoman and i sent a letter with the necessary to rescind the trump era rule that
with the harmful use of the binding arbitration agreements. to mr. secretar mr. biden's-- president biden's budget looks at nursing homes, are you looking at additional measure to empower nurse being home residents and their families for their rights or hold nursing homes accountable when they fall short of the standard of care and rescind some of the trump policies to better protect our nursing home residents? >> congresswoman, thank you for your passion on this issue and we look forward to working with you. one of the areas i concentrated quite a bit with this area as well making sure we did better oversite and enforcement. we intend to do the same thing, and we were looking forward to working with you. and we have to do a better job of the avenue facilities and
correcting the data and we would look forward to working with you. as i mentioned in my opening testimony, we're going to do everything we can to hold people accountable and that means presented a lot of integrity work that's out there ap we fund the taxpayer dollars as the eyes of the american public on top of it. >> thank you, mr. secretary. and just quickly. the president includes robust funding for research, diagnosis and care, but one of the best ways to sort of set a baseline to track this disease early is through the medicare annual wellness visit. so i'm curious to know if you -- what you are doing within hhs and cms for detection and i'm running out of time so i'll take your answer in writing.
>> let me recognize the gentleman from arizona to inquire. >> thank you, mr. chairman. mr. secretary, first, this is my moment to also thank mr. thompson for his sort of dogged focus on telehealth and it worked. and we did something amusing a couple weeks ago, we looked at the couple previous years, memos and things about telemedicine and how skeptical many of our staff and brothers and sisters were. now that we've lived through it and realized what a plus it was, i desperately hope you'll join us in getting it so it's extended, it just doesn't come to an end, the expansion, once the pandemic is declared over. and mr. secretary, one other thing, this is sort of the big picture. both in reading your bugged over the weekend, but even just
our own conversation we're having today. many of us talk about health care and affordability in a light of who gets subsidized. who does not get subsidized, instead of what we pay. and i will beg of you, start thinking about what we pay because over the next 30 years, the 100 plus trillion dollars of u.s. sovereign debt that will be on the books in today's dollars, 67% of that is just from medicare. we need a revolution in what we pay. and something like diabetes is believed to be about 30% of that. i notice your budget, the president's budget does have a fairly substantial plus up in spending for diabetes research. i believe you'd find many of us on the republican side are willing to step up and oppose almost an operation warp speed to disrupt and finally take on diabetes because if you look at
health outcomes in rural america and urban america and put the charts of that outcome from covid and lined it up from the charts from diabetes. you'll find that comorbidity in many ways is responsible for much of the differential in outcome. those are my pitches to you, mr. secretary. what do you have to say? >> and i think wise words with regard to diabetes and heed the call to try to do the better job of addressing chronic illnesses that lead to death so quickly and i agree that covid exposed what we know about diabetes that it can kill, that it can kill quickly. and can i say on telehealth, absolutely agree that we're going to move forward with what we learned from covid. i would only-- i'd add two words. access, because you have to make sure that everyone has ak
access not just some parts of the country. you have to make sure that broadband extends everywhere so eastern has access and the second is accountability. let folks that do provide care further and further from the source. we just want to make sure it's accountable because taxpayer money is in there and we have to make sure we're getting the value for our dollar. >> mr. secretary, may i encourage you and your staff to look at one or two things. one, every inch of north america now hasbro band. it's called low earth satellite. being from arizona as you know, being from the west, my rural, my native american populations in the middle of nowhere where it would be irrational to run a line of fiber or copper, now with a small satellite dish, they have broadband. we need to start thinking in terms of this century. the second thing is, the ability to audit, monitor telehealth, and telehealth is more than facebook with a
doctor. telehealth is also the sensors i can wear on my body that monitor us and help us keep healthy and i believe week crash the cost of health care if we're willing to be disruptive with technology. thank you, mr. chairman. >> let me recognize the gentleman-- >> thank you, mr. chairman. thank you, mr. secretary, for being here. i just wanted to recognize how far we've come in the past 15 months. last year at this time the united states was the world leader in covid-19 deaths. today, we're the world leader in vaccination distribution and the administration. 42% of americans are fully vaccinated. that is an incredible, incredible accomplishment over a very short period of time. the science for these vaccines came from scientists within the national institutes of health.
and in the biomedical advance research development authority. mr. secretary, that comes under your jurisdiction. again, incredible, incredible accomplishment. messenger rna is the stuff that converts dna proteins, proteins are the active ingredient in the vaccine. moderna stock is up 10% today one of the manufacturers of the vaccine. moderna's pre-covid share price was $21 a share. today it's $209 a share. moderna, pre-covid, was valued about $6 billion. today they're valued at $32 billion. and projected to be 100 billion dollar company within the next 48 months. there's a 1980's law that keeps
the government from sharing in the commercial success of a taxpayer-funded research that made these vaccines possible. and my question is, you know, given the united states government's investments of $11 1/2 billion in vaccine development, in all of the years of research that pre-dated the actual manufacturing of that, don't you think it's time that the u.s. taxpayer share in some way, beyond the public good that it does, but share in the financial success that would not have been possible without the research, which is very expensive, and not profitable, financed by the american taxpayers? >> congressman, first, good to see you, always good to see you. secondly, you ask a really telling question and it's not one that i think in less than
five minutes or even in a hearing we'll be able to answer, but it is true, the taxpayers made major investments to make it possible for all of us, including people around the world to have a life saving vaccine. i think, one, it speaks to the innovation and the prowess of america, too, it speaks to our generosity, but three, it speaks to where we need to go, u.s. policy makers executing the policy to make sure that we're ready for the next pandemic. we're ready to provide the next generation of medicine. i am more than willing to engage in that conversation because we're going to count on our taxpayers to help make this work and at the same time our taxpayers expect us to be accountable so that they know that it's worth an investment, they have the confidence to continue to pay their taxes to make the kind of investments that made america so strong so i look forward to having that conversation, but you pose a really important question. >> and mr. secretary, i
represent communities along the u.s.-canadian border and we need to get more vaccines into canada so that we can get that u.s.-canadian border open. it doesn't require comment from you, but i want to make it clear, every time i get an opportunity to talk to someone from the administration i have to convey that message. thank you very much, sir. >> thank you, i just recently had conversations with prime minister on some of those with canada and working-- >> [inaudible] . >> thank you, mr. chairman, and thank you, secretary becerra for joining us today. right now i'm very concerned with president biden's border crisis and the such of unaccompanied minors we've heard, unaccompanied migrant children and the crisis at the border could have been avoided
if the biden administration hadn't had closed regulatory loopholes, secured agreements with mexico and central american countries and constructed biosecurity at the border wall. the previous administration's approach was a well-coordinated effort between agencies of foreign governments. mr. chairman i'd like to enter an article from the national review titled how trump got control of the border. >> in contrast, the current administration's rejected the common sense policies which were clearly working, not surprisingly the crisis is further than what we saw under president obama and president trump. and what we're seeing in the southern border is a crisis and the biden administration has a duty to address the downstream effects of the current crisis. we've seen local reports of
forcing their residents to make way for migrant children. and it's alarming with placement of foster children. and how has it burdened agencies to place foster children. has any child from foster care not for profit, and hhs to house unaccompanied minors. >> congresswoman, thank you for the question and let me as i said to congressman grady assure you we take every step necessary at hhs to make sure that the work we do with unaccompanied migrant children does not impact the ability of the domestic foster care system to care for our children who need that foster care service and we have done a tremendous amount of work to try to make sure that at the same time at
the border we are relieving the customs and border protection service for the need to try to care in what are essentially adult detention facilities for children. so we've been able to place those kids into our custody, keep them safe and healthy the way the law requires us to. >> thanks, mr. secretary, would you agree it's important for hhsa fda to report on drugs specifically for women so we can potentially understand risks and complications to women. >> we want to make sure that we follow the science and i think that fda tries to do that as we can it can. we're always going to try to make sure we put out the type of medicine that's proven to be safe and effective and that includes whether it's for women or men and we want to make sure what we can do is make sure that america can trust our health care system. >> thanks, and i think that we should prioritize better data
collection, and in addition to killing an unborn child, this drug can cause heavy bleeding and infection in women and yet as of 2016, providers are only require to report patient deaths, but not to report hospitalizations, transfusion or any other serious event. will you commit to prioritizing better data collection for the drug so it's clear for the potential risk it poses to women? >> congresswoman as you know, when the fda acts and when the-- take action with the medication, we follow the science and certainly make sure that everyone is accountable because we have to ensure the public has confidence in the system. >> the gentle lady, let me recognize the gentle lady from alabama to inquire. >> thank you, mr. chairman. i'd like to thank you and secretary becerra. welcome him back to this committee as a long time member of this committee.
secretary becerra it's good to see you. i'm encouraged president biden's budget aims to improve the health of all americans, addressing the needs of seniors and people with disabilities and expanding access to the aca health care tax credit and medicare benefits. however, the pandemic has laid bear the historic racial inequities, for so many americans. my constituency in the black belt of alabama is aware of the influence and contributing to the disparities in health care. a lot of the problems surround access to care and trust in the medical and scientific community. a specific area i'd like to focus on today is cancer, a disease that takes over 600,000 americans' lives every year. and one that minority and rural
populations are especially burdened by due to the higher rates of late stage diagnosis. experts tell us that one of the most important ways to beat cancer is to catch it early before it spreads. if you or your loved one is diagnosed with cancer, the very next words that you want to hear is, but we caught it early enough. i have sponsored last congress and this congress, a bipartisan bill called the medicare multiple cancer, early detection screening coverage act, a bill that i am pleased to be co-sponsoring with colleagues, representative arrington, and hudson. this seeks to modernize medicare coverage to enable access to a new test that use a simple blood draw to screen for over 50 types of cancer
including pancreatic cancer, and find them early while patients have a fighting chance. until now our tools have been limiteded, secretary becerra. we only have screening for five cancers covered by medicare and for this reason, pancreatic cancer and so many other cancers are not found early enough and the impact on medicare in terms of cost is staggering. catching cancer at its earliest stage in people without symptoms would be an amazing game changer. currently unknown cancers continue to spread often becoming metastatic and lives are lost because of that. for example, pancreatic cancer, the third leading cause of cancer in my home state of alabama has a very low survival rate in part because it's not caught early enough. only 80% of the cases with this disease have a survival rates.
rates for pancreatic cancer are six times higher when it's found earlier versus late. your committee, our friend, congressman john lewis passed away because of this cancer. fortunately, a new multi-cancer early screening pools for patients who are often at risk. i ask for your commit, secretary becerra in addressing this horrible cancer. all of these cancers by expanding the access to tools in the tool kit paid for by medicare so that we can catch this early on. in closing i'd like to ask a question regarding that, sirment i know you're committed to closing the equity gap that exists in health care. can you talk specifically about what your, this administration is doing about that and how we can work would you in order to make sure that we're saving lives? >> mr. chairman, why don't i
respond back to congresswoman-- >> the brief response, mr. secretary, that would be fine. >> absolutely. very briefly, we can follow up, congressman. the purpose of the affordable care act is to get people before they're too sick and we know from racial community we're always at the end of the stage when it manies could-- when it comes to getting that data. we need the data and learned from covid that we have to do better to reach the concerns of america and fl up. >> thank you, mr. chair. >> let me recognize from ohio to inquire. >> thank you, mr. chairman, thank you, mr. secretary, a pleasure to be with you today. health care, i'm a physician, health care is and should be a national priority. i'm encouraged to hear you talk about finding the origins of covid and identifying it. i served on our board of health
in cincinnati and you're exactly right. we can't address these issues if we can't get to the bottom. >> and going to the border quickly, when i visited back in april we saw many coming in with scabies, meningitis, chicken pox, of course covid-19. i think this is a very serious concern that we have for america with this coming in. i do want to work with you, and i'm encouraged by your concern, but let's work towards a healthy, legal immigration policy that's best for everyone. i want to go next to drug pricing and we need to address the cost of drugs in the united states. it's important for our patients and i think there's bipartisan room here and i believe that foreign price controls will not be for the next set of cures. so we have that balance between innovation and costs at the end of the day. let's lead the world on both
those things. and another thing we can work together on. i always talk about the health span of america. and you just kind of touched on it there a little bit. we always take a look at life span, but what about the health span of americans, health and cure is a cost and that's in the short-term, but we don't look at the long-term when we do this. it sound like you're on board with that. i want you to be aware we have a rural and underserved task force that the chairman put together. and it includes representative arrington, sewell, davis and me and i look forward to working with you to address the health disparate in these communities and you sound eager to want to engage in those, so i appreciate that. substance abuse, we can't ignore, it's a problem if you've read the book "dreamland", that's my district on the cover.
if you haven't read it. and on surprise billing, make sure we've done it right. and as a physician there isn't a part of me that doesn't want americans to have access to health care, and that's obviously extremely important. you know, we talk about medicaid, i'm proud to live in a country that has a safety net like that, that's there for people so we can maintain some help for those who have trouble affording it and for other reasons, but statistics have shown that that particular plan has the highest mortality and morbidity than any in the country and i think we're better if we start to look at solutions how fewer americans need the medicaid program because the fewer on it the better it is for those still in it, it's more, we want more of the best care for more americans so i'd like to continue to work with you on those issues. so i do have a lot there, but look forward to working with you and asking you one question, will you commit to work with congress and
particularly members of congress that have medical backgrounds? we met many times, our doctors caucus, we met many times with secretary azar and it was very productive and i think we could probably do the same with you, so i'm hoping as you work through payment rules and other issues that impact our health care providers and more so our patients that you'll be able to spend time with us as we have boots on the ground, so to speak. >> congressman, you put a lot out there, but i certainly look forward to working with you and working with you from the vantage point of a physician, your experiences are going to be immensely important and helpful. i absolutely look forward to working with you and your colleagues. >> thank you. >> thank you, the gentlemen. consistent with practice, we'll gibb with two to one questioning ratio, ms. benning. >> thank you, mr. chairman and thank you, mr. secretary, for
being with us. it's great to see you and thank you for the work that you and your staff have been doing already on so many important issues, and for preparing the team budget. i'm particularly pleased by the kidney x, a public-private partnership to accelerate intervention in prevention, diagnosis and treatment of kidney diseases. more than 37 million americans are living with kidney diseases and nearly 800,000 suffer from kidney failure, which is an incurable disease which requires dialysis every two days to stay alive and only cured by kidney transplant. kidney disease can be extremely debilitating, causing patients to leave the work force or die prematurely and the cost is medicare is substantial. nearly a quarter of all medicare spending is on kidney disease management.
sadly kidney disease disproportionately affect communities of color. 33% of americans living on dialysis, one striking example of the health disparities in our country. since roughly half of all patients hospitalized from covid-19 suffer kidney damage, we can expect these figures to worsen. when kidney x was conceived there was expectation of $250 million from the private sector and 125 million dollars from the federal government and given the remarkable success of this public-private partnership in the first two years, running for price competitions and innovators, the congressional district tackled long unmutt kidney patient needs and made inroads to artificial kidneys. what can we expect from the administration in the coming years? the private sector which has been led by the american
society of nephrology has 25 million annually to kidney x and i hope we can count on you to match that. >> congresswoman, good to see you. i know in our budget we include funding for the kidney innovation access rater. i don't have the comment, we can try to get that to you later. we can try to continue kidney x. it's important that we try to address these conditions as quickly and early as possible and as you mentioned, often times, it disproportionately impacts communities of color. so look forward to working with you on this. when i have a chance to visit your great state and maybe run into your husband curt again as i did the other day, we will have an opportunity to discuss the issues. >> thank you. and also, everyone knows that
we have so many areas of health care policy and opportunities to do better and one area is prioritization in medicare advantage. i partner with congressman kelly, we have garnered over welcoming bipartisan support to make prior authorizations fully electronic and streamlined. patients need care right away, and this is critically important that we have a system that works and also, look forward to working with you, to help us improve prior authorization for our providers, and our seniors who right now face necessary delays in care. look forward to working with you on that as well. >> absolutely look forward. >> thank you, mr. secretary. i yield back, mr. chairman. >> thank you, gentle lady. we recognize the gentle lady from california to inquire. >> secretary becerra, so wonderful to have you back with the committee today and always a pleasure to see a fellow
southern californian. as california's attorney general you led an amicus brief to defend the rights of immigration established by the florida settlements agreement. after visiting one of these unlicensed facilities in 2019 put together under the last administration, i was horrified and introduced the shut down child prison camps act to ensure no federal money would be allocated to emergency influx shelters that don't comply with standards which prevent children from being held in inhumane conditions. and how could you make sure they're compliant with the standards and treated by the department. >> congressman, thank you for your work op this, great to see you and to continue to see you in this position and i think if you've had a chance to visit the sites that we have, that you'll see not only do we care about following the law, but we
treat these kids as what they are, children. and we're going to provide them with the health and safety that's expected. it is not easy, it is a challenge. it's not inexpensive, but we believe we have an obligation to do it right. you know, there are a couple of sites there, local to you in long beach and in pomona, and if you have a chance to see the sites, you'll see something very, very interesting. in long beach, we were told a month ago when i was there, some 70,000 toys and gifts had been donated by folks in the community, southern california for these kids. obviously, we don't have 70,000 kids in the long beach site. that made it possible to send some of the new toys, new books to other children without the country where we have the sites. so, i think we look at this very importantly as something that we need to do because these are kids. >> thank you, and i did visit the pomona site and it was
impressive and very different from the last administration. secretary becerra, thank you, and president biden offering a budget without the harmful and discriminatory amendment. and the family planning program in your testimony. after years of president trump's harmful domestic gag rule i believe that we have to swiftly implement the biden rule to bring providers back into the program and provide quality family planning care to their patients. can you discuss how to do this as quickly as possible for the additional funding that congress provided in the rescue plan. how can we help you make sure more low income americans have access to the vital program. >> congresswoman, as you know, title 10 is one of the crucial programs to assure that we make access to many families that
otherwise would go without it. the and so we intend to try to move as quickly as we can to provide access to family planning services, by the way, not just services for women, men, children, receive services from are title 10 provided level. in california, as you know, we rely on a lot of our third parties to help make those programs work and what we're going to do is work as closely as we can to assure according to the law we provide services to anyone who needs those family planning services upfront. >> thank you, let me just say a word for disaggregation of data for pacific islanders. at the beginning of the pandemic, they were lumped into the other category on the c.d.c. website and that prevents us from knowing very crucial information, so, i just urge you to continue to de--.
>> thank the gentle lady. let me recognize the gentleman from nebraska, mr. smith, to inquire. >> thank you, mr. chairman. mr. secretary, for your appearance here today. i do want to kind of reflect on how, you know, the cares act came about at the beginning of the pandemic. it's gone on a very partisan basis and operation warp speed was done on a bipartisan basis and i'll be very direct and tell you, i am a concerned that things are being done without a spirit of negotiation and compromise. more specifically i want to talk about the cmmi, center for medicare and medicaid innovation and my underlying concern is that providers and patients aren't able to get the feedback or for feedback to be received. perhaps it can be given, i'm not sure if it's being received
as i think it can and should be. we've worked on a bipartisan basis on the committee here and beyond to move this forward in a way that can really move us towards value-based health care that i think is-- it's supported on both sides, shall we say on all sides. alternative, the pavement models, there's concern that the election stood in the way there and now things are being disregarded and overall, we're just kind of -- the alternative pavement model situation is getting set aside is my fear. so i was wondering if you had an update on that for that in general, but even where you think we're headed there and where we might be able to work
together. >> congressman, thank you for the question. cmmi, quite honestly, i think that cmmi is at the cutting edge and lets us know how to deal with health care moving forward. not only in terms of better health, but better costs when it comes to health care. so if there are some questions or any comments or concerns that folks want to raise, i hope they will because it's cmi is a small shop, but does important work. i hope we can say we're proceeding on a bipartisan basis when it comes to the work of innovation, no one has the concerns in market when it comes to innovation. there are a whole bunch of innovaors they just want to get something out there in practice and they look forward to working with you on that. i think that president biden has made it very clear, in fact, that he's talking about negotiating on the american jobs and american family plans and to try to see if we can
work something out with infrastructure and investments. i look forward to working with you and all of your colleagues on either side of the aisle because i think we can both agree that cmmi is one of the incubators of good ideas. >> well, i appreciate that. on another brief topic here. tell us how-- we have some telehealth measures that are due to expire at the end of the pandemic. i was wondering if you could touch briefly or just acknowledge perhaps the desire to utilize telehealth more or at least continue what we have been able to achieve throughout the pandemic. i mean, this is an issue that i worked on even before the pandemic, representing a very rural constituency and we have more than rural to utilize telehealth and i wondered if
you could reflect briefly on telehealth. >> you might want to unmute, i think. >> it looks like you're muted. >> mr. secretary, it looks like you're muted. >> there we go. >> mr. secretary, telehealth-- >> okay. [inaudible] we will do everything we can to try to implement-- are you getting the echo that i'm receiving? >> i do hear some feedback, but i think you're better, go ahead. >> well, we look forward to working with you on that
because that's crucial. telehealth a true value we just have to make sure that we can provide it critically and that we have accountability in its use so we can assure the american public-- >> thank you very much, i yield back. >> thank you. let me go to the gentle lady from wisconsin to inquire. >> thank you so much, mr. chairman, ranking member, all of my fellow colleagues. mr. secretary, i predicted that we'd be back here, you can't just lay in the sun on the beach forever. at a time like this, you're really, really needed. welcome back to washington. so many questions, so little time. let me just say that i gave up years of seniority to get on this committee, primarily to deal with the problem a permanent underclass that we've created comprising mostly women
who are underthe program and the minute they earn two cents over the minimum wage, they lose child care, they lose health, they are the primary employees in a low wage economy of restaurant workerseses 2.18 an hour, health care workers, cna's and so on. so you've committed a billion dollars towards an emergency relief for this group of folks. and then another 100 million dollars to make sure that people of color are not overrepresented in welfare programs. so number one, i am curious about how that money is being spebt and secondly, i'm curious about what have you relearned in terms of time limits, in terms of re quiring people, look, the time limits in a, you
know, counter cyclical economy and that we might inform as we reauthorize or welfare as we know it. and sort of going out of the door question, where is -- i am so happy to see that the administration has committed $400 million to the problems of maternal morbidity and maternal fatalities. and, but i am wondering, i'm hoping to work with you to make sure that there is some meat on these bones. i have a proposal. you know, we have the proposal, mama first to make sure that medicaid pays for doulas and midwives and people who are really expanding the health care work force to prevent some of these deaths.
also, signed into law under the former administration is a sunshine on sudden, unexpected death, you know, leading cause of infant deaths, but we need to know, i want to work with you to make sure we actually fund it now that it's law. it would provide research and best practices how to prevent the so-called sids death. so i will yield to you for your response, mr. secretary. >> congresswoman, great to be with you. i would say to you two things, one, we need to help those know are in most need. whether it's funds made available for those recipients. we're looking forward to working with you. on the issue on maternity mortality and morbidity, you
know as well it's communities of color the most, and the black community where you see so many women. and one of these that was done is provide the medicaid, a program that alo us women to receive postpartum care for more than 60 days, up to a full year. we hope you'll take advantage of it. >> thank the gentle woman, go to the gentleman from michigan, mr. kildee to inquire. >> thank you for seeing you, i never have to chance to see you on this committee, but i'm happy to see my friend. i'm really pleased to see the new hhs initiative, low income housing water assistance program which will make funding available to help low income
family's ford something as simple as their water bill. as you know, i've been advocating for a program like this for many years, you were right there with me fighting for the people of my home town when it was in a water crisis. access to clean drinking water is fundamentally a basic human right. some of the poorest communities in america pay the highest water rates. for example, just a few years ago it was found on average residents in my hometown of flint paid almost $900 a year for water service, many paying more than $1000 a year and a lot of systemic job loss, failing infrastructure. increased water rates shifting the burden again to some of the poorest rate payers in the country and i commend the hhs for moving forward on this
effort. and curious if you can share with us either now or in writing, what hhs is doing so that funding will be made available as soon as possible, the places, saginaw, bay city, and other places around the country where this is a really serious issue. >> congress mba, great to see you and waiting for you to take that seat behind you at those drums, maybe later. what i will tell you is that we have, i believe, the initial round of funding has gone out last week about $160 million. there's over a billion dollars to be made available, but without a doubt the sooner we can get this out the more people and families it's going to save so thank you for the work that you've always been so actively behind and we look forward to partnering with you. >> i appreciate that very much. we know, especially during the pandemic where people are
continually reminded to wash their hands and very often, the poorest people were having to make a decision whether they were going to turn that tap on, knowing that the bill is just going to run. we have a real problem in this country where we have a real disparate cost structures for something as fundamental as drinking water so this program has a opportunity to help correct some of that. it won't be until we have the investment that allow those that are structurally unsound and water systems structurally unsouped to correct some deficiencies and have a water delivery system that's more affordable long-term, but in the meantime, this program is really an important intervention and appreciate your work on it. thank you, good to see you and hope to see you in person sometime soon. with that, mr. chairman, i yield back the balance of my time. >> thank you, and the gentleman
from texas to inquire. >> thank you, mr. second. congrats on your appointment and thank you for your service to our country. i'll look high and low for a common ground and always think it's best when we can work together in a bipartisan fashion. i'm honored that the chairman and ranking member entrusted me to serve on the health care task force for ways and means. we've done a lot of good work on payment system reform and telehealth applications and improved access in rural communities and there's much more to do and i look forward to working with you on that. specifically. we all have a desired goal that i think that we degree upon with regard to the health care policies and rights to improve access and quality and to lower the cost. would i say that obamacare was an abject failure on all of the-- on every front in that regard.
i mean, it doubled the cost of care, people literally, millions paid a fine to get out of the program, and the one that stayed in it had very little choice so i think that doubling down on the experiment in government controlled health care is a real disaster exponentially and i do think it also, expanding or making permanent the temporary waivers that is a problem especially when you take away the percentage of poverty level and below whereby people receive subsidized care. so now people making millions of subsidized care. i think that's wrong headed and irresponsible. and i think that the dimension of climate crisis is-- i have a different opinion and definition of crisis. i do believe in the environment
for sure, but ask you asked seniors, for example, if you thought climate change was a crisis or five years medicare be insolvent in five years, and i see no plan to fix it, i see acceleration by expanding medicare from 65 to 50. and there's a crisis the at the border with the administration, and i'm not trying to play gotcha here, but as you go to the texas border, you will find out there is absolute chaos and there are threats to americans on many fronts. not the least of which is the spread of covid coming across the border. this administration's kept title 42 for which i'm grateful, but only partially implements it.
... why is that differentiation and why not fully enforce it during this pandemic and recovery? i yield the rest of the time to you. i thank you again for your service to our country. >> congressman, thank you for the question. what i can tell you is that title 42 is based on the actions by cdc aced on the science. the administration moves on title 42 days on the recommendations made by cdc, the implementation then and packs not just a chest but department of homeland security and others as well. what i can say to you is we use the best judgment we can based on science, take action.
i i can try to respond further n the future. >> thank you, mr. secretary. thank you, mr. chairman,. >> the gentleman from pennsylvania mr. welch regard. >> thank you, mr. chairman. it's great to see you again, mr. secretary. seven years ago when i first one literally the very first call that i i received from a futue colleague was some xavier becerra, , so he been a good friend of me and my family ever since. in just a few minutes available i wanted to try to quickly highlight two areas. the first is just a statement. i was excited to see in this budget a commitment to expanding medicare in dental, vision and hearing. in my view and in the view of many of my house colleagues that is a real missing gap in our current medicare system. one of many things i'm excited about with this budget proposal is the commitment to expansion there.
building upon the work that many of us have done on the side of the aisle. but let me shift to something different and try, i know you've talked about it already but o get further comments on. i am very alarmed about the dramatic spike we have seen in mental health issues and substance abuse over the last year and few months. governments, the 50 state governments and various municipalities and the federal government had to take dramatic action to try to best fight the pandemic even despite those efforts this is the third deadliest event in american history, but one of the many downsides of the actions that we had to take is the spike we've seen, for example, a 30% year over year increase in substance abuse deaths, overdose deaths not to mention the dramatic rise in mental health issues. i have seen in my own community and among people i know.
i was wondering, not just for this budget but if you were to take a step back what you think we could do together to attempt to address these twin but related crises? >> congressman, good to see, first, but secondly i hope we can work together on this on a bipartisan basis. i will say to you we have begun. a week or so ago i announced we were releasing $3 billion to help local governments, states and our community partners address both mental health and substance use disorders in our communities. we hope we can supplement that with your help to the american family plan to make sure we take this on. we really do need to get to the point where we treat mental health the same way we treat physical health in terms of
insurance and coverage. i'm looking forward to working with you on this because it's time. covid-19 has exposed the deficiencies we have in our system. >> just building up what you said very quickly, mr. secretary, covid-19 didn't create these problems but boy it is helped expose what already existed and then exacerbated those issues. unfortunately some of our friends out there in the private industry as much as we attempt to pass legislation mandating parity we so see time and again where in practice it is just not being carried out the same way. finally i would say one of the bright spots, one of the few bright spots out of the 2016 president election, was a real for the first time in in my lifetime was a focus on opioid addiction. i would point out to everyone overdoses were worse last year than even back for five years
ago when he was getting a lot more attention. this is something that requires us begin to focus on on a bipartisan basis and to solve. with that i say thank you and i yield back. >> thank the gentleman. but he recognized the gentleman from virginia mr. beyer to inquire. >> mr. chairman, thank you very much. mr. secretary, it's so good to see that alums of the ways and means quick internet okay so i'm encouraged for all of us. mr. secretary, while i was pleased to see the the press budget line for the suicide lifeline and the cdc climate program i am concerned about the underfunding of the agency for health research and quality, or for a president who once took a health inequities the agency is this rare entity that looks at our healthcare system and tries to address the geographic and the racial and ethnic disparities. thanks are paying attention to that in the days to come. mr. secretary, as you know the airlines have been pushing for digital health passes that can
store vaccine certificates as a result of the covid-19 and antibody test. they say will make it a lot easier to track doctrines, void the need to check physically airports not on that businesses like to see digital health passes for the reopening. it's starting to opening the eu gateway for the eu digital covid certificates up and running. the system allows to verify certificates in a secure and privacy friendly way. will the u.s. be joining this effort, mr. secretary? >> congressman, nice to see. what i can make and you is that i came back from a meeting of the g7 health ministers. this is one of the subjects discussed. i think what we've done is explained to our colleagues in europe and asia and africa and latin america and throughout, what we can to do is make sure our citizens will be able to meet whatever tasks for
authentication verification that the country is asking for, region might be asking for. although i think you're in this country we've taken the approach working with our private sector we will try to make sure that we leave it to our local communities decide what will be done to try to ensure the safety of all americans as we move forward. we believe we will have a solution that speaks to the acceptance of a method of verifying that will be useful for any american who wishes to travel to another country, and for those wishing to come into the u.s. >> great, thank you. at the beginning of the pandemic ireland sent the pamphlet to all the citizens explaining covid with a stoplight system, red yellow and green, the kinds of colored rank risk we use for air pollution forest fires. i'm amazed most americans were looking at bloomberg and the
"new york times" for data rather than the cdc. i'm not that there's this great site called covid act now, i was on it this morning, it's very intuitive and very accessible. even in virginia i can see in alexandria my wrist is very low. it would be a great thing for the cdc to model so we're turning not necessarily to a nonprofit but to the cdc to get that kind of data. i recommend this covid act now website for your information. >> congressman, i will take a look at and look forward to working with you on the subject. >> one small push back in the time love. i know my friend talked about title 42 but i know president trump did invoke that over the objections of senior scientists at the cdc who argued the band lacked and still lexington medical or scientific
justification. i would just ask that you use all due diligence to make sure it is still appropriate and was not inappropriate to revoke title 42. >> all right. >> i yield back. >> i think the gentleman. let me recognize the gentleman from georgia dr. ferguson to inquire. >> thank you, mr. chairman. thank you for being with us today. you said several times that you are very supportive of the administration's budget but one of the areas i want to talk about briefly is h.r. three. i'm very concerned about the impact that will have on innovation, very concerned about the impact that's going to have on ringing cheers for alzheimer's, diabetes, other things like that to the american people but i'm also concerned about the loss of pharmaceutical manufacturing jobs. could you briefly tell me which pharmaceutical manufacturing jobs you're willing to eliminate and sent to china?
>> congressman, thank you for the question. i think we are actually going to see the number of jobs in this country increased as a result of some of your proposals the president has. if you take a look at the pharmaceutical -- >> but mr. secretary, if you don't mind i'm talking specifically pharmaceutical manufacturing jobs. do you see with a lack of investment and innovation and impacts of h.r. three were going to lose those jobs. which jobs are willing to sacrifice and sent to china? >> congressman, as i was saying we are in the business of increasing the number of jobs including the pharmaceutical industry. in fact, some of the monies that were made available to the american rescue plan will make it possible for us to make that domestic commitment for manufacturing in the u.s. we look forward to working with you because we want any good -- >> so mr. secretary, am i hearing you correctly that if a piece of legislation would decrease manufacturing jobs in
the u.s. you would be opposed to that? >> we are looking for ways to increase the number of jobs. >> thank you. next i know we have on this briefly. you talked about the increase in funding for title x, particularly around family-planning between increase in funding for planned parenthood and the elimination of the hyde amendments, hide protection in the appropriations bill. do you think it will be an increase in access to abortions and is this the desired effect? >> congressman, i think what's most important is that we all have access to healthcare services that we need and i will tell you that will do everything we can to make sure that women or men or children do not get denied access to important care, and will continue to follow the law as we do the. >> finally, again you have supported the president's budget. one of those items would -- the biden administration would
prohibit fines being used or spent on stopping government networks from being able and government employees from being able to view, download or exchange for an auger fee. is that provision in the president's budget that you support? >> i think it's important given the amount of human trafficking at the border particularly and sex trafficking at the border. do you support the biden administration's push to prevent, i mean to allow government employees to work while they're at work to view pornography, download and exchange? >> i will certainly say to you that in this administration we will not only follow the law but will make sure it is in force. i of no provision in the budget that would allow anyone in the federal government to violate the law. no one has the authority to download information which is illegal in nature, and so if you have some information -- >> i'll be happy to make sure
that you get that information from the proposals that are in that budget. i worry about -- [inaudible] increase funding for abortions that would take the life of an unborn and making sure that we keep government employees from viewing pornography on the taxpayer dime. it sounds like you all got a lot of work to do and with that, mr. chairman, i just back. >> let me recognize the gentleman from pennsylvania mr. evans to inquire. >> thank you, mr. chairman. mr. secretary, welcome and congratulations to you. in recent years we have been an increase of private equity purging hospitals and nursing homes. one stark example of this is in philadelphia, and acquisition that eventual close behind him in hospital by the private equity firm which is described in detail in the current issue of the new yorker magazine. mr. chairman, i ask unanimous consent to include the article
entitled the death -- in the record. as this article details when private equity takes over it is almost the most vulnerable who bear the cost. so mr. secretary, how do you view the ever-expanding role of private equity in health care markets, and how can we incentivize medicare and medicaid to protect vulnerable safety net hospitals and people who serve and take over the? >> congressman, thank you for the question. what i can tell you is regardless of what your status come with your provider, whether you're the federal government, our first and foremost priority must be our patients. for that reason it is important that every program that utilizes medicare and medicaid funding follows total health and safety standards. when it comes to any federal facility, any facility that uses federal funds we are going to make sure they are accountable. we don't want to see them taking
advantage of safety net hospitals, stripping them of their assets and essentially leaving all those families behind. i look forward to working with you as the attorney general for the state of california i was very aggressive and i can show you the record i had in trying to make sure if anyone want to buy healthcare facility in my state, they better prove they're going to do it for the right reasons. >> mr. secretary, can you discuss the ways in which cms will improve marketplace services for consumers? how user fee across the marketplace functions and whether increase -- [inaudible] >> is the gentleman muted?
>> and how user fees are being allocated? >> i'm not able to hear mr. owens. >> mr. evans, would you try the question again please? >> okay. mr. secretary, -- [inaudible] >> i think you're having some technical difficulties in there so what we will do is will go to brad snyder and then come back to you. >> thank you, mr. chairman, and thank you, secretary becerra for becoming -- come before the committee today. countries in the midst of a long and difficult recovery. congress and the biden administration have made us work investments to improve our economy and are healthcare system. and at the same time as you noted in your opening statements we are not out of the woods yet.
president biden's budget builds on these achievements and provides the continued funding and planning new to realize the goals of the american rescue plan. in particular what you think your agency and the administration as a whole are not just your focus but your and administrations prioritization of supply chain management as relates to pandemic preparedness. i take note of the widest release today of its key finding an executive order 14017 american supply chains and i suggested creation of the supply chain disruption task force. as you may know i've introduced legislation to great and office-supply chain resiliency and i look forward to working with you and the administration to further advance this idea. along the same lines i remember back almost exactly 16 months ago when asked your predecessor secretary azar about our critical supply chains in the face of a looming pandemic, unfortunately my fears at the time were fully realize in the minds succeeding at, and our supply chains fail to deliver
vital proximity also protective equipment and testing supplies when our country needed them the most. fortunately since then the biden administration and congress have made incredible progress in chewing up our supply chains and we need continued planning and investment not just for covid but for the next pandemic as well. secretary becerra could you discussion were to increase domestic production supplies for the strategic national stockpile and what specifically we and punks can do to help you achieve that goal? >> congressman, great to see you and thank you for the question. this is an important one because we saw what happens when you're not prepared, and lasting with a do is make the mistakes of the past. our budget invests pretty dramatically and trying to make sure our stockpile it sit for the 21st century. were going to try to make sure we have those private and public partnerships that are essential to make this work. we can't just do this by ourselves as a fellow come. we need to turn to the private sector to make it happen and so
we look forward to working with congress because we know we have a lot of work still to do to make sure that supply chain is ready for the 21st century, ready for prime time. we look forward to working with you but we should use covid to give us the lessons that we can learn from to do this better. >> great and thank you. i look for to continue working with you on this in particular another bill that was -- with senator durbin which was specifically produced domestic ppe in testing supply production, promote predictable sustainable supply chains for the strategic national stockpile. is that something we can look to you to work together on? >> look forward to working with you on that. >> thank you. in the sake of time and respecting your visitor i appreciate you joining us and i yield the balance of my time back. >> i think the gentleman. let's return to mr. evans. >> thank you, mr. chairman. i recently reintroduced a bill
called the ipods. i'm very pleased president biden's request propose to work with congress on this. i look forward to working together. mr. secretary, can you explain what it is important to continue to expand the program? >> congressman, forgive me. please explain which program are we talking about. >> eight spots, the health professional opportunity grant program. >> i'm sorry, yes, health professions opportunity grant program. listen, here is going to try to the workforce at the healthcare system that we need for every community we have to do what we can to expand those opportunities to make sure our tanf recipients and other low-income individuals, education and training for occupations in the healthcare field can be out there for us. this is a way to make sure we're addressing not only our needs moving forward in terms of
workforce but is going to give opportunities to communities that oftentimes have been neglected. >> i thank you, mr. secretary, for that. appreciate that. thank you, mr. . thank you, mr. chairman. yield back. >> thank the gentleman. but he recognize the gentleman from kansas, mr. estes, to inquire. >> thank you, mr. chairman, and thank you, secretary becerra, for appearing before the committee. instead of setting our nation on path for fiscal stability i have concern that this wasteful $6 trillion budget which is the largest in our nation's history which set us on a course for higher spending, more taxes in runaway debt. it increases nondefense spending by 60% puts the annual deficit at an average of $1.3 trillion per year for the next decade, doubling the national debt over the next ten years. results of the debt owed by each american raised by 50% to $120,000. i used to say our children and grandchildren will be paying for our current lifestyle but,
unfortunately, it's its eqr great grandchildren that will bear the brunt of washington's out-of-control spending. instead of attending to find common ground that both parties can agree on the budget is about raising taxes on every american in order to pay for some of these democrat partisan socialist type policies. all that massive spending in the budget it's easy to overlook what the $6 trillion in spending doesn't address. basically safeguarding medicare for seniors. we know we are just five years away from medicare insolvency, frightening statistic by itself but even more so after a global pandemic. the trustee's report for 2021 is significantly delayed. was wholly unknowns regarding the true cost of covid-19 it possible insolvency accelerated significantly. instead of protecting our current promise to seniors and six in the insolvency issue this budget fundamental changes medicare and allows those 60-65 to start increasing medicare spending and proposes adding significant new benefits such as
vision and dental without any substantive and tangible changes to ensure that the look of current services. as we struggle to overcome and recover from the global pandemic it's more important than ever to help our families and small businesses recover and insure reckless spending in washington doesn't jeopardize the promises with me to seniors. secretary becerra, fiscal 2022 hhs budget would increase funding for nih programs by 21%. it's been mentioned before there wasn't any money going to grants for any of the gain of function, spending in the next budget but we are kind of concerned about the transparency and mischaracterizations about the prior funding was directed towards the moveon institute of neurology that, and we know they were involved in the gain of function research which fundamentally changes what a virus can do. what can we are hearing and
understanding his there was a direct of $600,000 and an additional $3.5 million nih funds. can you confirm how much and its bending went to the moveon institute of virology whether directly or through other companies? >> thank you for the question. i will simply aye what dr. fauci and dr. collins have said repeatedly, and that is that nih never approved funding for function research at the wuhan institute of virology. we're doing everything we can to make sure those who receive funding from an age are accountable for the fines pick as an agent previously the president has asked for an investigation about the source of the virus, the covid-19 virus. as i said as well i myself called for way before this beginner controversy recently for the world health organization to do a second stage of investigations into
this. i think, by the way i should also mention over the last several years some 100 scientists have been prevented, stopped from doing research with the nih over the course of time and in some cases we have prosecuted and convicted some of these individuals. >> thank you. i wish we had more time. i would put an echo in for some of the telehealth in making a permanent that i am at a time so i would yield back, mr. chairman. >> i think the gentleman. let me recognize the gentleman from new york to inquire. >> thank you, mr. chairman. i don't know if lloyd doggett is to love but i want to thank him for pointing out that his data is one of the highest rates of uninsured children in the united states of america, and our state and your guzzled the secretary of state have some of the highest rates of insured children in the united states of america and that's one of the reasons our state and local taxes are so high and why the salt deduction is so important. mr. secretary, thank you so much for joining us. let's remember you may be back
in 2016 when i was running for office and you should usually try to go a ways and means in committee. i never thought be so fortunate in this committee but are so grateful to be here and if so grateful for your service. thanks for everything you've done to defend the affordable care act and throughout your career. i want to bring up something people don't talk that much about the affordable care act. it's the consumer assistance programs, in the original affordable care act to provide money for state programs, state-based programs to help consumers navigate the bureaucracy of health insurance. over 40 million denials of health insurance claims in 2019. most people don't appeal that. my parents i remember them dealing with the medical health insurance issues, waiting on the phone trying to navigate. now we have this surprised of the protections that are chairman led the effort on along with the ranking member. people don't know they have those protections. i lead a letter earlier this
year with about 30 of my colleagues to the appropriations committee seeking $400 million to reinstate these consumer assistance programs that were defined it back in 2010. i want to know would you help us support the idea of finding consumer assistance programs? >> congressman, first, great to see you and congratulations on being on a great committee with so many good colleagues. absolutely we support that. this administration has made major investments. we have provided eight full funding for the navigator program which helps a lot of consumers know what kind of plan or policy to secure under the affordable care act. we've expanded the outreach and marketing of the affordable care act plans to consumers and the result is over 1 million americans in the last three months have signed up for new plants under the affordable care act exchanges. we will continue to do that because we want americans to be
good consumers and to do that they need good information. we will work with you to make sure that's done. >> so we want to try to get more money put in specific for these state programs, the state-based programs. i'm glad to see catch up and try to help get that done so thank you mr. secretary. really appreciate it thanks to good advice. it's proven to be very helpful. >> congratulation. >> thank the gentleman. let me recognize the german from california mr. panetta to inquire. >> hey, mr. secretary, thanks very much. text message of it. mr. secretary, thanks for being here is great to see you and obviously unfortunate that you left congress the same year that i got in but fortunate enough for all of us that your indisposition right now and we are in the position you in the last four years in california, fighting force you and i get to fight for everybody across our country estates of it comes to healthcare and so the other thing so thank you very much. as you know what i come from the central coast of california and being from california yourself you know how important
immigrants and farm workers are to our food security and who we are as as a culture. obviously throughout the pandemic they were on the front lines and literally met the definition of what it means to be an essential worker, an essential worker special ed came to our food security. unfortunately at that expense they were definitely susceptible to covid-19. that is why i believe and ensure you do to its critical we prioritize vaccinating our farm workers asked him to sit in recent "washington post" article on sunday that actually talked about what we've done here in the salinas valley, the soluble of the world. we came together, your help especially getting us vaccines you, my advocacy, the farm workers, the farmers, the federally qualified health clinics all came together and we did our own little mass vaccine sites that pretty much it make
sure our farm workers are vaccinated or significant amount of them are vaccinated right now. we need your continued help with that. so mr. secretary, could you please describe the steps that hhs is taking to get you to address the unique health needs of both immigrants and farming community? >> congressman, first great to see you and thank you for continuing the great panetta tradition, and what i can safely say is wind me up when it comes to what you just said. point also the best ideas i can tell you about are the ones you are coming up with back hope it would want to piggyback of what you are doing because you know where your families are that have been vaccinated. you know how to best reach them. you are one of most trusted voices whether it's the clergyman was wrestling coach of whether it's a neighborhood watch leader you know who has the confidence of the people who are haven't yet actually. we want to work with you. when it comes to farm workers my dad having been a farm worker at one point is a life that a you
if you got good ideas and how to reach them we are there. we are there. >> outstanding. thank yous mr. secretary. we do here and we do look forward to continue work with you. i big issue as we get out of this pandemic and get onto the road recovery is childcare and with the upcoming infrastructure package we want to make sure with certain infrastructure projects that address that. can you share more about what sorts of physical infrastructure projects are needed to make childcare facilities safe, affordable and more and poorly available to all families? >> there's some great ideas that are out there in our communities and would want to do at the federal level is not impose our idea. we want to support and fund the good ideas that are out there and so once again what i would sit is because you know your district we want to work with you so the resources we hope will become available some of them already available to the american rescue plan, but we hope investments that we do need for the american family plan to help so many families to make
sure kids have quality care so the parents can work, we want to work with you because you know what the successful models are out there and want to make sure we're piggybacking so they can grow. i was not long ago and ohio visiting a tremendously effective childcare center. they need to grow. they do with the right way. we want to build on what there is that can help on american families. >> thank you, mr. secretary. i yield back. >> let me recognize the gentleman from oklahoma mr. herns to inquire. >> thank you, mr. chairman. thank you for this important hearing today. one of the key and secretary becerra, congratulations. one of the key congressional responsibilities in the constitution is a power of the purse. every day americans -- [inaudible] have yet to do the full budget process since they take a majority in 2018. when the president's budget which relays i constituent were furious to learn during the the
bill to protect human life by removing the hyde amendment and spends more the hard-earned money to increase funding for abortion providers. this carelessness over taxpayer money comes on heels of congress appropriating nearly $4 trillion over the past year to fight the pandemic. now that my 130 million americans are fully vaccinated it's time for congress to assess the spin impact. one of the largest looming threats is exhaustion of the medicare trust funds expanding to accommodate the pandemic depleted funds but estimate 5.8 billion. the latest prediction show medicare funds will run out by 2024, two years earlier than previously expected. without changes, they would have two -- by some 26% or cut benefits by 16% to make the program solvent. in other words, according to the nonpartisan cbo if congress doesn't act and benefits will need to be cut by $1000 per
beneficiary and what if our kids and grandkids to access to the program that helps subsidize. i'm concerned we have no details about the administration so-called reforms of their popular medicare advantage program. my dear friend late senator tom coburn predicted logo each step the democrats take to be involved in healthcare wishes a long-term plot to take away choice and inform -- enforce government run healthcare. unfortunately fear we're gg closer to this reality every single play. not only does this but you get us closer to government run healthcare and fails to address looming debt crisis but this budget also does not reflect american priorities. last month i introduced a budget the nutley palaces and just five years or provide solutions for the issues americans care about like border security, social security and medicare solvency. infrastructure, police and local safety, all of this without raising taxes. americans are concerned about the economy and filling jobs
which president biden's budget makes mention of. it talks about abortion, climate control, price controls and government subsidies that continue to incentivize people to stay of the workforce. the bible budget continues to provide fully paid health care for america chooses not to go back to work. it also supports expanded aca's subsidies which will inevitably prolong absolute avoidable under the issued or as a business person i know what it is to compete against the government when it comes to of regulation on the business committee. i have witnessed how the democrat party believes the best and it to stick it to small businesses the backbone of our economy with their blood and spending bill. this is grossly misguided and will believe our kids and grandkids jobless and unable to pay the balance with zero benefits. meanwhile our jobs are for continually barrels that are employers are starting to fill jobs come drive dent in the main street and american use a help
wanted sign on edward. why would president biden continue with subsidies and cinemas a place to stay home? mr. secretary, the last week of survey realty unemployment for small businesses is that 40%, a 40 year high. yet yet your budget proposes to continue cobra subsidies and expense aca subsidies which makes it more appealing to go back to work. do you agree or disagree that americans -- mental health, yes or no? >> congressman, i know time is expired so i sent it will tell you we're in the business of creating more jobs and getting more people to healthcare neat and we could follow up. you look for to working with you since we never had a chance. i left and you came as hopefully will have chance to work together in the future. >> thank you. >> thank the generally. let me recognize the gentleman from california mr. gomez to inquire. >> thank you, mr. chairman. secretary becerra, good to see you. welcome back virtually to the committee. i don't really need to discuss
by district with you. you're very familiar with it. as you know the district is a very complex district. as the haves and have-nots pick as people from all walks of life from different backgrounds using different languages, getting around by different means. during the pandemic we saw the impact of covid-19 on the communities that i represent. that was disproportionate compared to others. when i first saw the data as you probably were aware, a lot of the covid-19 tests were not taking place on the side of los angeles but on the west side. you saw it on the infection rate. you saw it on death rate. i'm proud even able to turn the page but i believe it was foreseeable. our policymakers and our
institutions and programs for some reason froze when it needed to turn quickly and pivot towards a more equitable solution. we did that and a proud california now has the lowest infection rate of any state in the country. equity is key but it's very hard to do. very hard to do. no matter how much money you use it's all about how you invest, how you target and how you implement. it's not always a straight line. i like equity because it can index so many different people from so many different areas, and it impacts people of color but it also impacts working-class whites and rural areas as well. i know the health and human services budget focuses on advancing equity and reducing health disparities and all
healthcare programs. can you describe these programs and their intended goals and also how would you introduce programs work in practice? >> congressman, first great to see you. i see that those digs look really familiar to me, the office of yours pics i hope you're taking good care of not just the office and your workers but the district as well send to be able to come in and do a phenomenal job as a member of congress for the district after he left. >> somebody left me some nice furniture. >> hey, man. let me tell you, by the way thank you for all your work on equity, trying to make sure all communities are served as you said our district my former district on your current district it's a tale of two cities in many ways, right? from wealth to poverty but folks working together in many ways. i will tell you that president biden has spoken not just about equity that he's made it clear he wants to see results.
at hhs is easy for me as secretary to now say we are going to demand results as well from the people and the programs we have at health and human services. one of those things were doing, a couple quick examples, the emphasis and investment of real money into dealing with maternal mortality and morbidity. we can take for granted in the richest nation in the world that we have access to healthcare but you go do some communities and are women who are dying as a result of the pregnancy, and the women are having terrible outcomes as result of the pregnancy and it should surprise nor did note that happens once in communities of color. there are things were trying to do to address that the investment that the president, and i could follow-up but i apologize i see the time has expired. >> finish the thought, mr. secretary. >> in health services the kind of investment be made in inking health services, we are going to make sure we're out there reaching folks who for the most part have been in the shadows or
in the corners of america. thank you. >> thank the gentleman. let me recognize the gentleman from nevada mr. horsford to inquire. >> thank you very much, mr. cha. secretary becerra, it's great to see you. thank you for joining us today here i would be remiss if i did mention you have a great former staffer of mine, josie belinda way the press get. she has always done great work and in no she's going to do so with you and our behalf of the american people at health and human services, so please tell her i said hi. mr. secretary, for my time i would like to talk about the importance of data collection. they chairman, chairman neal, has designated the racial equity initiative working group within the committee which helps to ensure that policy proposals considered by the committee address economic and social inequities and advance racial justice, helping us create meaningful legislation that
improves the lives of the people we serve. that change though start with paying attention to the right metrics. we know the data collection and synthesis can change human behavior and the way that organizations operate. simply put if you want to improve something we need to be able to measure it accurately. and if we can measure equity accurately then we can clearly see the progress that we are making overtime. to do that we need to measure what matters. i'm talking about demographic data, collecting the right demographic metrics will help us better understand the effect of structural racism and discrimination on health and economic well-being. in your testimony, mr. secretary, you highlighted that covid-19 pandemic has also shown the importance of producing reliable data. this congress i reintroduced my bill for nursing facility
quality reporting act of 2021 which would require the centers for medicare and medicaid services to publish on the nursing home compare website certain demographic information aggregated by state with respect to covid-19 infections and deaths in such facilities. mr. secretary, in reference to the nursing home data bill it's my understanding that this could also be done administratively. i'm i am a strong advocate for ensuring we collect reliable race, ethnicity data particularly for most vulnerable population. and so given the administration's commitment to reducing health inequities this would seem like an important part of an overall agenda. so mr. secretary, can you talk about what hhs's plans are to move forward on this issue, and can you describe the administration's plan to improve the underlying data systems at hhs with respect to how we
collect race and ethnicity data and other file indicators to track health inequities? >> great to see you and thank you for the question. thanks for the work you're doing on this issue. as i have said i used to say this a lot when i was the attorney general of california, we depend on data to drive so much of what we did. bad outputs produces -- excuse me, that inputs produces bad outputs. if you're going to rely on the research that's been done but your data is flawed you're going to start issuing really flawed conclusions and recommendations. we need to have good data to have good outcomes, and that's going to permeate the work that we do at health and human services because we know how important it is to have data that can go beyond the generalized information that we often get. you and i could talk about any number of examples here diabetes. if we don't have clinical trials when we include all the
populations but especially the populations impacted by diabetes, and you know and i know african-americans, latinos oftentimes we are -- it affects us more than other commitments. but if you don't have clinical trial that includes surveys with those populations outputs, your results won't be very effective. we need to work together to make sure we do this right. >> thank the genuine. let me recognize the gentlelady from west virginia ms. miller to inquire. >> thank you, chairman neal and ranking member brady, and thank you, secretary becerra, for being here today. it's a nice to be able to meet you. we all can agree what the best healthcare outcomes for american and access for care for all those who need it the most at the most affordable price. however, we seem to have very different ways of accomplishing these goals and instead of a top-down government centered
approach outlined by the administration's budget, i think we should focus rather on the patients, pictures and ensuring long-term solvency for our healthcare system. within this budget the president has called on congress to cut prescription drug prices. the plan h.r. three would result in fewer cures, as many as 100 i've heard, from entering entering into the market. this legislation would completely shield american innovation actually raising prices on seniors and cost american lives. we cannot let such a disastrous piece of legislation reached the president's the president's desk. the republican solution of h.r. 19 would lower the cost of drugs, increase pricing transparency and further american innovation. the covid-19 pandemic has forever changed our healthcare landscape. within west virginia, who i represent, we saw many patients
with increased access to care through telehealth. given the extremely real nature of my state, patients sometimes had to travel hours just to see a doctor. and through telehealth are able to pick up the phone and meet with their provider. i heard from those providers who love it and they are able to see the patients more efficiently. i hope we can take the lessons learned from telehealth during the pandemic and to continue funding telehealth i think it's important. mr. secretary, can you commit to keeping this committee up-to-date with regular update on the status of the provider relief fund? specifically on how much money has yet to be distributed and how much has been returned from the hospitals and providers, please? >> congresswoman miller, first if i could just say i look forward to the chance to get to know you and work with you as you do your good work there in the house and i hope you feel
comfortable turning to me and to the people on my team to work with you to up the people of west virginia. on the provider relief fund we are going to do every thing we can to be as transparent and is accountable as they can be. much of the money has artie been released but what were going to do with the money for renate is trying to show you how it will be spent right, how would we allocated properly and hopefully we're working with the providers in line to get some of that relate to make sure they did in time and a document as well what they done with the money so you and i can both say that the taxpayers made a good investment in helping some of these providers who were there on the front lines helping americans recover from covid. >> thanks. west virginia is such an incredible real state. i don't know if you ever been there but it's beautiful. telehealth across all specialties has really played a crucial role during the pandemic and ensuring i timely and equality of access for us toe
care. given this increased access to care for our most poor, vulnerable and utterly patients what is the administration's plan to expand telehealth after the public health emergency ends? >> we are looking to take the lessons from covid that showed a telehealth became so important, and working with you provide more flexibility for more accountability so we can make sure we get the folks in america. want to make sure broadband is available to everyone. >> that's wonderful. i have another issue. the budget -- am i cut off? per you are not cut off but your time has expired. >> okay. i'll ask you more questions. maybe i'll send your letter. thank you. >> thank you. thank the gentlelady. let me recognize the gentlewoman from virgin island ms. plaskett to inquire. >> thank you so much, mr. chair. i'm so honored and excited to have the secretary with us as having had them as a mentor when
he was a member of the house, to see him in this position under the leadership that is going to bring to the agency is something i know we're all looking forward to. mr. secretary, i have a number of questions for you, and just wanted to surmise, summarize some of them related to the territories and hoping that you could give your commitment to work with our office and the other territories regarding healthcare disparities, as i'm sure you're aware of the territories are again in limbo as they face the upcoming fiscal cliff in medicaid programs at the end of this disco year. the administration has done a great deal and this congress has supported that the territon eliminating the disparities that we have not only in our funding caps as well as in the share of between the federal government
and hospitals and local governments as well. but also and one that we don't talk about as much is the exclusion of the american residence living in territories exclude from the income subsidies from medicare prescription drug benefits as well as to the disproportionate share for hospital dish program under medicare and medicaid in spite of the significant amount of uncompensated care and the number of individuals in rural areas in the territories. i was hoping you would look at some of these issues and make a commitment to work with my office as well as other territories in this committee to find permanent solutions to some of those disparities. >> congresswoman, first great to see you. secondly, it was great to see an person a couple weeks back and i look forward to getting to do that more often. let me tell you, i think you know from my work when i was a colleague, the territories
desert to our attention. you know the president's budget has support for eliminating the medicaid funding gaps for u.s. territories and tries to make sure we can align matching rates with states. and so i i look for to working with you. folks in a territories work very hard to . to match the work effort to make sure we can address these needs. >> thank you. the other question i have is with regard to temporary assistance for needy families, tanf. and in particular the national tanf issue. you believe that tanf funding levels are allocations of funds to states should be altered to account for change circumstances, inflation, poverty, population? what are your thoughts with regard to funding levels and allocations of tanf? >> congresswoman, tanf is a program that is supposed to meet the needs of our neediest families. we have to make sure whatever our statutory framework is or
anything we do through regulations, it's directed at trying to meet the needy families. every once in a while that means you probably have to make adjustments so that you refine your approach. we are more than willing to work with you and others every think there's a better way to do this because we want to make sure at the end of the day are resources are reaching the most dissident. >> i know this been an issue during the pandemic, as work requirements and time limits on age, should some tanf rules be suspended during the pandemic? but then once the pandemic ends should those changes be made to work requirements to prostates engage additional unemployment recipients and activities, or should the changes be made to alter the -- [inaudible] receiving assistance? do you have any policy ideas or thoughts for this congress on how we address the most neediest families in our country? >> i know time is expired so
i'll simply say this and we can follow up. we want to work with you. if you think there are ways we can move forward to address the needs of the families post covid-19, we are willing to work with you and we look forward to seeing if there's some good solutions. >> i think the gentlelady. let me recognize the gentleman from pennsylvania mr. smucker to inquire. with the gentleman unmute? >> and you hear me now? >> i can you. >> thank you, mr. chairman. secretary, thank you for testifying before us here today. i have some real concerns with president biden's budget. i think it manages to raise taxes on middle and lower income americans while simultaneously -- position by think we're headed toward not being able to make good in our promises on a path to bankruptcy. i really want to be sure the
american people are hearing this salcedo again. this budget raises taxes on all americans including those who the president said he wouldn't raise taxes on. we know even the money raised through this is still not enough to pay for all the proposals in the budget. this budget includes a provision to great a public option, coupled with the 163 billion in subsidies in the plan to try to make obamacare plans more affordable. both proposals do nothing to lower the actual cost of healthcare to boost innovation or to improve access. what's more, the budget includes promises to seniors by expanding medicare fee-for-service benefits without having the money to pay for those new benefits. i have a concern that will further erode medicare solvency and drive up premiums in the medicare advantage plans.
these ideas in the budget are bringing our nation one step closer to adopting healthcare model that using socialist countries. i believe socialist medicine means fewer cures and delayed or worse even denied care. coverage does not equal access. there's a lot we can do to improve access. by the way i want to mention telehealth has been mentioned many times in his hearing, and i want to share one unique use for my district i represent lancaster county, pennsylvania which is home to tens of thousands of amish constituents. i'm sure you're aware they don't typically use electronics, but even among the amish psalm dash seek necessary care during the pandemic and engage in what they do is audio only telehealth visits. so telehealth is helping to reach underserved communities throughout the nation, even populations like the amish in my area. if there's one area by partisan
work they can be accomplished this year i hope to work with the administration to make sure we can continue to provide access that telehealth has provided, at that that doesn't go away at the expiration of the public health emergency. but, a public option is really a partial government takeover offer healthcare system. as i mentioned i fear double underline the employer-sponsored market and threaten medicare solvency is. providers are already facing cuts to the reimbursement rates and they will be forced to charge the private market more just to make up for insufficient government payments. in turn, 157 million americans by the recurrently obtain their coverage through the private market. they will likely see their premiums rise including seniors on fixed income. in the meantime none of this makes a single improvement to the quality of care. we'll be praising physicians and
hospitals to do more for less and i for this will result in upheaval of the healthcare market. and, in fact, might be the intent purchase all in medicare for all. do you agree the underlying budget will let the tax cuts enacted under the tax cuts and jobs act for middle and low-income americans expire? >> congressman, thank you for the question. i do look forward to working with you in the future. please make sure you reached out to my team if we can be helpful on anything. the president's budget decreases opportunity -- i hope we have a chance since the time is its part to go into some of the in detail. >> thank you. thank you, mr. chairman. >> thank the gentleman. i want to thank secretary becerra for joining us today. i know he's on his way to the other chamber, but as an alarm you will be pleased to note we think he's better off staying over here with us. please be advised members have two weeks to submit written