minutes because the time clock is not working. the subcommittee on health will now come to order. good morning colleagues, good morning mister secretary. welcome due to covid-19 today's hearing is being held remotely as well as in person. for members taking part remotely, microphones will be set on mutual emanate background noise. members will need to unmute their microphones when you wish to speak. since members are participating from different locations, at today's hearing recognition of members for questions will be in the order of sub committee seniority. documents for the record should be sent to meghan mullen at the email address we have provided to your staff. all documents will be entered into the record at the conclusion of the hearing. secretary becerra has a hard stop at 1:15, pm today. you will find that i will not be my usual generous self in terms of not lowering the gavel after five minutes is consumed. we want to have enough time for every member to question. the chair now recognizes herself for five minutes. for an opening statement mister secretary welcome to your first in-person hearing with our health subcommittee. what a difference a year makes. when you last testified at our subcommittee in may, 2021 our hearings were virtual. vaccine rollout was just beginning. congress had just passed the american rescue plan a few weeks before. today, over 218 million americans are fully vaccinated. covid hospitalizations in the icu admission are at the lowest they have been during the pandemic. premiums under the affordable care act are at an all-time low. enrollment is at an all-time high. nearly 6 million americans have newly gained health insurance coverage over the last year. american families have saved an average of 20 $400 on their aca health insurance premiums last year. president biden's fiscal 2023 budget request continues he's achievements by helping american families rebuild from the covid-19 crisis. healthier and safer than before. the budget invests 81.7 billion dollars over five years in pandemic preparedness, including 40 billion for the development and manufacturing of vaccines, tests and treatments, and 28 billion dollars to rebuild the cdc and the public housework fourth. these are incredible figures. importantly, the budget provides 11 billion dollars to address the overdose crisis. every member of this subcommittee, mister secretary, is engaged in cares deeply about this issue. president biden has called for a whole governmental approach to save lives. give people the evidence based care that they need, and go after drug traffickers, in order to stop overdose deaths. the president budget outlines a strategy to use 20.8 billion dollars to improve our nation's mental health, including increasing the availability of crisis care and achieving full parity, this is so, so, important. achieving full parity between physical and mental health care coverage. the budget continues to focus on addressing health disparities. it invests in quality maternal health care, especially for black and native women. while also increasing funding for the title ix family planning program. it takes the historic step of proposing 142 billion dollars over the next decade, in mandatory funding. this is a first! for the indian health services. importantly, the president request provides five billion dollars in the advanced research project agency for health, arpa h. which holds the potential for advanced by medical research to address diseases like alzheimer's, diabetes, cancer, and als. as the house sponsor as the authorizing legislation for arpa edge. i believe your decision to place arpa-h within nih, let's just put it this way, i don't agree! [laughs] that is in capital letters with exclamation points. there is still more to do! we still need a safe and effective vaccine for children under the age of five. we need to make sure that vulnerable americans health insurance coverage is not disrupted when the public health emergency expires. we have to continue the health insurance subsidies from the american rescue plan. we must finally allow medicare to directly negotiate drug prices so that prescription drugs are affordable. i look forward to working with you, to develop a budget and policies to improve our nation's health and well-being. we thank you for being here with us today, mister secretary. the chair now recognizes mr. got, our distinguished ranking member of our subcommittee for five minutes for his opening statement. >> thank, you thank you madam. thank you mister secretary for being here today today we are discussing the u.s. department of health and human services proposed 2023 budget. this also marks the second time that the secretary has been before the subcommittee. when the biden administration has extended the health crisis five times. we should hear more from our leaders of an agency that controls over one trillion dollars in spending. i call on my democratic colleagues to hold more age ss oversight hearings. it is one of the most important duties that we have members of congress have. our continuance deserve better. one stark example is the lack of oversight in covid-19 spending response. the last and the administration testified on covid-19 before this committee was in march of 2021. over one year ago. i know myself and other members of this committee have asked secretary because sarah to provide a detailed plan of handling the covid-19 emergency. particularly how agency intends on ensuring that there is no significant disruption as we transition from these blank waivers, as they expire. we have yet to receive a response. hopefully we will do so soon. oversight is importantly given the huge increases in spending requirements from the biden administration. calling for a 12% increase for discretionary spending for hhs in the fiscal year 2023. specifically giving six billion combined boost in the funding for disease control, the natural use of health. both of which have come under fire over controversial mask guidance, covid-19 research, funded by nih using american taxpayer dollars. we need to hold nih accountable. we need to ensure that taxpayer dollars is not going to labs going to risky research. and we have to make sure that labs are transparent to how they are spending taxpayer dollars from these funded grants. the budget even includes funding for climate change initiative. through the hundred and 74-page budget we have here, it mentions climate change more than fentanyl. i am increasingly concerned that the h hms has lost its way since biden took over. hhs has become increasingly more politicized. we saw the cdc school reopening with masking guidance. less transparent with congress, especially in the context of the use of covid-19 relief funding a recently released news article outlined. we also take a punitive, one side fits all approach to combatting covid-19 in respect to vaccine mandates. the biden administration has always failed the american people by planning to revoke title 42, which was used to prohibit migrants from entering the united states illegally to prevent the spread of covid-19. this poor decision comes despite the fact the biden administration extending the public health administration for another 90 days, in the same month without providing -- many expect it will be a massive influx of migrants attempting to endure the united states through our southern border. fentanyl related substances entering the country through our southern border coming in killing thousands of americans. between the 2020 in 2021 fiscal years combines u.s. customs and border control seized over 15,000 pounds of illicit fentanyl our southwest border. this coincided with the highest number of drug overdoses our country has ever experienced. reaching 160,000 in the 12 month period ending in 2021 we need to secure our borders and work to permanently schedule fentanyl related substances to keep our poisons up census out of our community. we can also do this while promoting public health programming. like the bill mr. taco and i hang nerd -- this legislation partners overcoming addiction with the resources to get back on their feet. like workforce or versus and peer support services. finally, i am concerned that the department has continued to restrict access to such as the first fda approved therapy to support alzheimer's disease in almost 20 years. swiftly supporting a new policy to allow patients, doctors and their families to make informed decision about their treatment. hhs must get back on track to use the resources for solutions that will drive down health care costs for americans, keep deadly drugs off our streets, and bring new breakthrough and potentially lifesaving cures to patients. thank, you i yield. back >> gentlemen yields back, chair now recognizes the chairman of the full committee, mr. -- for his five-minute opening. >> thank, you chairwoman. and let me thank our former colleague and secretary for being here today for this important hearing. i'm pleased to have you here to talk about the budget, because the budget is really an expression of our values and the annual budget process provides us an opportunity to review and consider the priorities of the administration. that's why i'm pleased this budget proposal has resources towards the agencies that help improve, lives prepares for the future and improve the health and well-being of all americans. the funding in this budget give us a roadmap to help let's get back in the wake of continuing to fight covid-19, continuing to make health care affordable for all americans, to improve our country's response to mental health challenges and to address deep and persistent health an equities. the impact an ongoing response to covid-19 can help to crystalize the funding of adequate health, and i'm pleased that it makes -- her infrastructure to make sure it has the resources it needs and the budget increases funding for each of the agencies within hhs that are involved in pandemic response. the work of these agencies has allowed americans to return to a semblance of normalcy. i'm immensely proud of the biden administration's work to undertake the largest free vaccine program in our country's history and, as a result of their efforts, three out of four american several deceived at least one dose of the vaccine. this has reduced hospitalizations and health care spending and, more importantly, save millions of lives. we're also in the midst of a mental health and substance use disorder crisis, and our country continues to be devastated by overdoses driven by the widespread availability of opioids and stimulant in the drug supply. such as fentanyl and methamphetamine. i'm glad to see that the budget prioritizes funding for programs and services to address this and acknowledge that connection between mental health and substance use. the budget increases access to prevention, harm reduction, treatment and recovery services. each of these are critical components to effectively address substance use. now, without question, the biden administration's actions have dramatically improved access to health insurance coverage. i want to commend secretary beshear on the progress that hhs has made in helping people get affordable, high quality health care. and a historic 2.5 million people enrolled in health care coverage. because of the success of the american rescue plan, families have seen lower premiums and the national uninsured rate is near historic lows. despite these, gains there's still significant gaps in the health care sector in the states that continue to refuse to expand medicaid. closing the gap for uninsured people remains a priority, and the house has taken action to ensure that low income americans and every state will have access to quality, affordable health care. i'm also pleased the budget prioritizes investments and health equity across hhs, including funding for a number of critical maternal health programs that will reduce inequities that have long persisted in maternal health occurrences. finally, the budget also reiterated the biden administration's commitment to reducing prescription drug prices and calls on congress to pass legislation that aligns with the principles included in the administration's comprehensive plan for addressing high drug prices. americans pay, on average, 3 to 4 times for the same drug as those and other countries, and we continue to watch drug prices increase year after year, as our constituents struggle to afford the medications they need to stay healthy. this house has taken action to give the secretary of hhs the ability to negotiate for lower drug prices, kept out of pocket costs in medicare part b, and stop drug price increases at the rate of inflation. so, it's imperative that these policies become laws soon as possible. when i plead the president biden shares our commitment to reducing drug costs and saving american consumers money. so, let me thank, you javier, for being here today. i look for the hearing for you on the administration's priorities and certainly appreciate you and hhs ongoing work to ensure the health of the american people. thanks again, i yield back, madam chair. >> the gentleman yields back. the chair is pleased to recognize the ranking member of our full committee, congresswoman kathy mcmorris rogers for your five-minute opening statement. >> thank, you madam chair. and mister secretary, welcome back. the energy and commerce committee. this is an important day, we have important questions that need to be answered. health and human services had been in the forefront of the covid-19 response. jurisdiction over cdc, nih and many other agencies. unfortunately, we've seen too many examples where health and human services seems to prioritize what is an extreme political agenda, rather than staying focused on mission. the mission is to improve the health and well-being of all americans. i'm very concerned about a lack of transparency, that is a routing peoples trust in public health. and eroding confidence. in health and human services. first, that is the administration's confusing response when it comes to the public health emergency. the administration's decision-making hasn't been based on science, but we see more and more is that it's based on power and politics. president biden wants to lift title 42 for a radical open border agenda. despite an overdose crisis that is killing more than 100,000 people a year, mainly because of illicit fentanyl coming across the southern border. according to president, biden there's no covid-19 emergency for illegal immigrants, but there is four toddlers in head start who are still forced to wear a mask. student loans are still being deferred, costing taxpayers 3.4 billion a month and making the inflation crisis worse. we see the administration fighting to keep the mask on for those that are traveling on airplanes. none of this appears to be rooted in common sense, science or and awareness of the crisis is in america today. people want their freedom back. this is the land of the free! they want to secure border, and healthier future for their children, safer communities and they want leadership that reflects its priorities. we are not in the same place we were two years ago, and that is why, in february, i asked for the administration's plan to properly unwind of the public health emergency. and i have yet to receive a response. i also want to discuss the centers for medicare and medicaid services unprecedented decision to restrict coverage for an fda approved alzheimer's treatment to only 1300 to 1500 people. fortunate enough to have been in the clinical trial. worse yet, this decision applies not only to the recently approved drug -- but an entire class of alzheimer's treatments. we should trust doctors and patients to decide if an fda approved drug is right for them. fda determined the drug is safe and effective, including for seniors in the medicare program. this decision is clear second guessing of ftas authority to determine drug safety. democrats may say that the drug would bankrupt medicare, but it's hard to take that concern seriously. when democrats voted for using savings from their government drug price control proposal to subsidize an in-flight health insurance premiums for people not on medicare. i urge that this proposal not be resurrected and that you rethink the national coverage decision. there's other examples of how the department is losing the public's trust. inflation from out of control government spending is making everything more expensive, including health care and for seniors on fixed income. seniors are now paying 15% more, the largest dollar increase in the program's history. yet, bipartisan law was signed by president trump to lower costs remain unemployment on implemented and an unforced. we're still waiting for the rules to make it easier for people to know what's doctors are in network, and we haven't seen enforcement against hospitals refusing to post the prices. yet, we've seen other top priorities. millions of dollars for a climate change office, forcing health care workers perform abortions on the band. policing speech with big tech companies. price controls for fear of cares, including with teachers unions to keep the schools closed in kids masked. undermining the rights of parents. avoiding oversight for how taxpayer dollars are spent. on risky research in china. and again, the open borders. instead of cracking down on fentanyl trafficking. these are not inspiring confidence. my message to health and human services today is to stop digging the hole. let's build trust. let's make sure that we are trusting people to make the best decisions for themselves and their families. our mission is to improve peoples well-being with. that, miss, madam chairman, i yield back. >> the gentlewoman yields back. i will now introduce our witness, secretary heavier becerra is the 25th the secretary of health and human services in our nation. previously, he served as the attorney general of the great, great, great state of california. very importantly, he served 12 terms in the house of representatives and we are classmates, we entered congress together. so, welcome back, mister secretary, to the subcommittee. you are now recognized for your time to provide your testimony to us. >> chairwoman eshoo, great to see you again. ranking member guthrie, good to see you also. thank you again for the time you've made available to have conversations in the past. to all members of the committee, thank you for this opportunity to discuss the presidents fy 2023 budget for the department of health and human services. today, more than 257 million americans have received at least one dose of a covid-19 vaccine. two thirds of adults over the age of 65 have gotten a booster shot. we've also closely glaring gap in vaccine rates we usually see for communities often left behind. it has paid dividends to search resources, including tests and treatments, to our hardest hit and highest risk communities. 340 million free covid-19 at home test ship across america. 270 million free and 95 masks. 100 million booster doses. almost 186 billion dollars and provided relief funds distributed through more than 800,000 payments to over 441,000 providers for covid losses and expenses. that's 441,000 hospitals, community health centers, doctors, pharmacies, nursing homes and so many other health care providers. real money, real relief, real results. beyond covid-19, today more americans have insurance for their health care than ever before in the history of our nation. that includes a record breaking 14 and a half million americans who secured health insurance through the affordable care act. many of those injured americans are paying less than $10 a month in premiums for that solid insurance company and the peace of mind that comes with it. in addition, we launched operation allies welcome, and hhs effort that is helped over 60,000 of our afghan brothers and sisters resettle as refugees in america. we have now begun to extend support to ukrainian refugees, fleeing the russian invasion of their homeland. we are coordinating with our 50 states, tribal governments and territories. nearly $300 million a nationwide support to prepare for the launch of the new three digit 988 suicide prevention lifeline this july. what's 9/11 is for local emergencies, who are working hard to make 98 a week the same for americans experience and mental health crises. -- closing holes in our health system including maternal health, where we've extended maternal coverage for postpartum care for a new mother and her baby from two months to 12 months. the presidents 2023 budget lets us build on that record investment in americans health, it proposes 127 billion dollars in discretionary budget authority and 1.7 trillion dollars in mandatory funding. including a standout and historic investment to transform the mental health infrastructure in our country. the priority i know you share. i also asked for 82 billion dollars for the presidents pandemic preparedness proposal, to get ready for whatever might come next after covid-19. considering that covid has cost our country more than four and a half trillion dollars and direct support from the federal government so far, this is a no-brainer to prepare for the next pandemic. the funding we are requesting will be end to end, meaning for research, development, approvals, employment and effective response. madam chairs and members of the committee, this turns hardship into hope, inclusion into opportunity. i look forward to working with you to make it a reality, and to continue our efforts to give our constituents real results, real peace of mind. with, that i'm more than willing to answer any questions you may have. >> thank, you mister secretary. we will now move to member questions. the chair recognizes herself for five minutes, to do so. first, mister secretary, we know that we don't agree, or i don't agree, with your decision related to arpa h. but here i would like to ask two questions very quickly on it. you've explained that, by placing it in nih, it was necessary to do so so that the administrative work of standing up the agency could take place. my question is, precisely how much time does our but age need and i ages administrative support to get set up? very quickly? madam chair, we are going to use nih to ensure that those ministerial duties. >> i know, how much time? >> we will wait to make sure that we get a director in place before we know exactly how much time that director. >> you do not know how much time? yet >> now, we have to make sure the new director has the ability to. >> is arpa h in your view a stand-alone agency once it is stood up? >> it will be an agency that has its own authorities and its own direction, and its own director. >> i think i just got the answer. political reports the fda may wait to receive both moderna and pfizer's vaccine application for children under five, before beginning the authorization process. but moderna's vaccine application may be ready before pfizer's. is it true that the fda plans to weigh for both applications? i mean, obviously parents across the country are, their patience is strained. >> the fda is waiting to receive that information from both of those manufacturers. as soon as it has that information, it will move through the process of trying to find out if it is safe or effective. >> the fda is waiting for both applications? >> it's still have not yet received the full application from either one. >> okay. the covid response, back to the budget, the covid response under the trump administration i think was really marked by a great deal of chaos. the strategic national stockpile is emptied, local public health department were over well and it took far too long to get tests and treatment to the public. in may of 2020, our subcommittee heard from former barr tick director rick bright on how he in his agency were marginalized and ignored when he pushed to develop critical covid treatment and push to increase the development of mass another equipment. under your leadership, b.a.r.d.a. is empowered to respond to covid and future pandemics. my question to you is, florida's budget is continually rated to fund other h hms efforts. if convent provides the new preplanned democrat fairness funding, will you commit that barred of will not see its funding transferred to other agencies. these are very important funds the strategic national stockpile has its own funding $975 million 828 billion dollars with an 80 million dollar increase to b.a.r.d.a.. if the figures are only markings on a sheet of paper, what's needs to benefit the american people is not going to take place. i think my overall, arching question mister secretary is the following, are you changing course? if so, how? in terms of pandemic preparedness. we have learned many lessons. it's so important for us to demonstrate that we have learned the lessons of the past. not just pile on more money to more programs. can you just spend a moment to describe where the changes are and also your commitment to b.a.r.d.a. >> madam chairman, thank you for the question. i won't speak for previous treatments of b.a.r.d.a. i will tell you in our budget we call for a 10% increase in our budget. b.a.r.d.a. will be one of the chief proponents of the pandemic moving forward. the work moving through h court, which is the operation that took over from operation warp speed. it relies on b.a.r.d.a.. from my perspective we can't get out of this pandemic without b.a.r.d.a. we are going to do everything we can to lift up b.a.r.d.a., it is the agency that congress created to navigate those minefields. >> i like your description of b.a.r.d.a., i'm very proud that it was my legislation that created it. i think at some point, mister secretary, that you give an overall view, perhaps today if not in writing, what is going to change. the new dollars that, that increase that are infused in the overall agency. >> >> with that the chair now recognizes the ranking member to question for five minutes. >> thank, you welcome back to the house mississippi terry. glad to have you here today. i was touring the border earlier in the year with dr. burgess. the border was overwhelmed. my focus on the subject of the committee was the illicit fentanyl coming across the border. we were talking to the border control and dr. burgess asked a question and they said, would if we rebel title 42. revoking. he said it will go from a crisis to a catastrophe. the concern is when cdc, hhs, recommended -- it is tied up in court but when they did recommend removing this may 23rd, did you consider the flow of illicit fentanyl coming into the country. you know that this will create another opportunity for you to come forward. why was a concern when you made that decision about fentanyl. 70% of kentuckians who died of overdose died of illicit fentanyl. i think that is typical for all of the states. how is the decision to revoke title 42, well were the factors you put into place for fentanyl or the other drugs coming over our border? >> congressman i think we all recognize we need to do everything when it comes to the drug enforcement policy when it comes to interdicting going when they come into the country. you are confusing health policy with migration and drug interdiction policy. title 42 would impact those immigrants who are actually crossing the border, not trying to clandestinely enter. they are trying to seek asylum. when they come in they present themselves. if they were carrying fentanyl, we will be able to discover it. >> we asked that question a border patrol. what they said was anything that doesn't discourage people from coming, the volume continues to increase. therefore we went through one of the processing centers. look at every person in here with a badge, and every person in here with a uniform. that someone that should be on the border. i understand title 42, i am not confusing it. i do know that it is a deterrent. if you're going to remove that deterrent, i know hhs has a different focus on homeland security. surely the administration has some kind of plan in place to keep -- to try to interdict this illicit flow offense no coming across the border. >> again, title 42 speaks to health conditions in the country. what you are speaking to are either migration challenges or drug interdiction challenges. >> it is still a country challenge. >> that is correct. but you would use migration laws or drug interdiction laws to try to deal with those challenges, not health care laws. >> so on illicit fentanyl, it is temporarily schedules. do you think it should be permanently scheduled? illicit fentanyl and subject to mandatory minimums. >> on fentanyl i would continue to say that fda and the different agencies within the hhs will be reviewing how they treat, whether it is fentanyl or any other drug will weather if we put it on any formula. >> you will not take the position on whether it should be scheduled. >> i would want to get ahead of the agencies that actually do this with science. >> we talked a little bit yesterday, remember last thanksgiving trying to go around town in bowling green kentucky trying to find test for my kids. trying to think they might have brought covid, not fentanyl thank goodness! >> hopefully they define. >> that they may have brought covid into our community. there was just a shortage. kentucky had to ration the monoclonal antibodies for delta. the vice president said we did not see delta coming, i think most scientists did not. whose advice or those we have did not see delta coming. when every time we saw dr. fauci he said, we don't know for candidates that. we never knew away was gonna come. it seemed like we were expecting where to come and we weren't prepared for. can you talk about, we were all the press conferences in april in may of 2020. the previous administration we're talking about testing, testing, all the other things. within three months, we were a year and a half into it and we weren't ready for a wave. >> congressman thank you for the question. as we discussed previously, we had millions of tests available. what's happened is, americans started to demand the at home tests. the test that we had available where the test that would take a week or two to get results because they go into laboratories, to give you the results. people wanted immediate results, they wanted to know if they could go visit their grandmother. but we did was really ramped up the availability of those instantaneous, at home tests. those are unfortunately less reliable than the pcr test. >> why aren't we ready in november of 2021? >> i'm sorry, i was? >> i understand what you're saying. the present where they could order these tests. why aren't we ready in november of 2021? we didn't know was gonna come that month? we knew away was coming. we knew we didn't have at home test. >> we had hundreds of millions of tests available for americans out of the summer. we had no tests available for the american public, a year ago. or february to march of last year. we ramped up dramatically. but the shift came when people wanted to be able to take the test solely home. very convenient. >> i know, we didn't have enough antibodies. i know time expired. i appreciate you being here. >> thank you. >> gentleman yields back the chair is pleased to recognize chairman of the floor committee, -- question for five minutes. >> thank you secretary becerra for your testimony. coronavirus response act in march of 2020. increasing federal medicaid funding if they agreed to keep everyone enrolled on medicaid during the public health emergency. every state took the deal. it has been a tremendous success to ensure that poor and disabled americans didn't lose a health insurance during the pandemic. when the public health emergency ends, states have to check that everyone on the role is still eligible for medicaid. i'm worried that people could be wrongly drop for medicaid simply because they make a procedural mistake during the application process. the center for medicare and medicaid services recent released guidelines for 12 month continues guideline for children on medicaid. 12 months plus postpartum medication on new moms on medicaid. and ship eligibility. these policies could help mitigate accident losses after the public emergency ends. i was glad to see the cdc and dorsey's policies. the bill better act would actually require all states to put instate all policies i just mentioned. -- my question after that long intro is, it seems critical that congress passes into law these policies to ensure that children and new mothers will keep their coverage. when the public health emergency ends. i just want you to say whether or not you agree. you don't have to say just yes or no, you can expand. >> chairman, the results are there. it is clear that by having, providing that kind of coverage, the extended coverage, we have kept americans from falling into the poverty clock. i hope that congress is able to work together to continue that support. today, as i mentioned, more americans have health care coverage. fewer americans are living in poverty, than before. >> thank you. the try caucus chairs recently sent a letter to the house and senate leadership asking for these policies to be included in the final reconciliation legislation. i want to thank representative louise and representative kelly for their leadership in for this letter. the letter states that by, latino, and certain asian american populations are disproportionately under represented by medicaid. it stands to reason that they would be therefore be at a greater risk for -- my second question given these concerns is, it seems the continuous coverage provisions in the build back better would help prevent disproportionate covered losses amongst minority groups and are important for health equity, do you agree with that? >> absolutely, we know that there are some 12 to perhaps 15 million americans who might lose their insurance coverage if we don't do the medicare expansion and continuous coverage the right way. we hope that in the process of an winding from the public health emergency, we won't lose all those americans who are currently getting covered. >> well thank, you finally medicaid covers about half of the children in the country now, paying for nearly half of all burst. these coverage provisions are not only far-reaching, they are affordable. as you know, we haven't paid out of the house legislation. given the cost of these policies and the huge number of children in new mothers that they would cover, it seems like they give us a tremendous bang for our buck. that is my final question, whether you agree? >> as my mother would say, [speaking spanish] . better to prevent then to remediate. you did a phenomenal job of helping us prevent illness and disease, which makes it possible for healthy's children in families, who can become healthier citizens contributing to our future. >> i appreciate that. i think everyone on this committee knows that prevention saves money. as you know, because you were on the ways and means committee, this is not the way the cbo works. whether it prevents further cost down the line. i think we have to constantly remind everyone that prevention does save money. i appreciate what you said, it just seems obvious to me if you we want to ensure that children a new mothers do not lose medicaid when the public health emergency and, we should include these policies in this legislation before the public health emergency. and thank you, i yield back. thank you madam chair. >> the gentleman yields back. the chair is pleased to recognize the ranking member of the full committee, representative mcmorris-rodgers for your five minutes to question. >> thank, you madam chair. mister secretary, in february i asked you on the president for a plan to help and the public health emergency. hoping to get information about how to transition to vaccines fully approved to commercial distribution, and how states can quickly and easily incorporate flexibilities from the pandemic into their medicaid programs. we didn't receive a response, or your plan, but we have received more requests for money. these requests have come with that information on how you and the state has been pandemic funds to inform needs today. i'll note the reports about covid-19 funds going to fund things like a high-end hotel, ballpark and ski slopes. you commit to following up near trumpeter inquest and also more funding request to include all assumptions about operations, cases and relevant, existing available funds to all members of congress in the public. >> congresswoman, we will continue to provide the information that outlines how we have used the covid money that we have received. we provided volumes of paper in response to questions. we have done numerous briefings, bipartisan briefings on the expenditures for covid. we'll continue to do that. the presidents plan to move us beyond covid-19 but stay prepared for any future pandemic at lines, in his budget, how he would use the money. we are more than ready to brief you as well in more detail, because we know we need to be ready. >> yes. well, it's pretty basic. we need to have those details. and, unfortunately, there's a lot of questions that have not been answered. do you anticipate the u.s. government being the sole purchaser of covid-19 vaccines for the rest of 2022? >> we know that there are others, whether it's nations or others who are looking to purchase. we will continue to make sure that we provide the american people with the supply that we need. and so, we will do everything possible -- to >> do you have a projected cost? >> i'm sorry? >> do you have a projected cost to the federal government? >> the pandemic preparedness plan does outline what we think we would need. remember that, if we're talking about getting further supplies of existing vaccines, that would be a different price than if we have to go towards a vaccine that deals with new variants or if we have to go toward a new vaccine altogether. >> do you have a plan to transition to commercial distribution for vaccines? >> that is part of the presidents pandemic preparedness plan. >> okay, thank you. i asked last year if there would be any proposals that would give you, as secretary, the ability to implement drug price controls using quality adjusted life years. qualities. qualities put a price on a person's life, and the department has requested against using it. i'm introducing a bill this week to ban the use of qualities. do any proposals in your budget rely on qualities to make decisions? >> congresswoman, best i could tell you is nothing we can propose would put any limits on the ability of american to get the best quality care that america can afford or prepare provide. >> does your department use qualities? >> i'm not aware of our particular agency using anything like that to make final determinations. >> well, i'm pleased to hear that. i hope you look at my legislation, i think it's very important that we clarify and banned the use of wally's. finally, because of inflation and surging prices americans are paying more for everything including health care. empowering them with information on the actual price of health care is more important than ever. your budget states that, quote, enforcement is necessary to drive compliance with price transparency. a recent survey found a majority of hospitals are not compliant with the hospital transparency rule. when will we start to see these enforcement actions? >> congresswoman, we have begun enforcing that law as of this year. we have issued numerous challenges to some of the providers, where we have evidence that they are not following through with the transparency requirements under the law. fortunately, most of those providers are responding in kind to make adjustments and we will continue to enforce that law. >> well, i appreciate your commitment to this. i believe it is so important that we're getting this information and, really, this is something that has been supported bipartisan. republicans and democrats coming together and making sure that we do have this transparency around prices. >> agree. >> finally, i just wanted to say, as it relates to the budget, it's been disappointing, we've been a bit frustrated that we haven't seen more details on how funds have been spent. i did notice that you had found the resources to a stab bush and office of climate change and health equity in august of 2021. i also just saw this past friday, he released an initiative to lower hospital emissions. i just hope that you will get back to the priorities that have been outlined in a bipartisan way. a yield back, adam. >> gentlewoman yields back. chairs pleased to recognize the gentleman from north carolina, mr. butterfield, for your five minutes to question. >> thank you very much, madam chair. and thank you secretary for your testimony today. it's good to see you, mister secretary. i have great memories of our work when you served here in congress, he would have great memories of our travel when you served with us we. i particularly remember when we accompanied president obama to charleston for the funeral of the charleston nine. i appreciate your friendship in appreciate or work. over the years, mister secretary, i've been really really alarmed by the growing mental health and substance abuse disorder crisis facing our families. i'm grateful that the administration has taken action to address the growing mental health and substance abuse disorders. in the midst of covid, congress provided nearly nine billion dollars to states into tribes and communities to respond to emergency mental health and substance use needs through the appropriations, through the cares act and the american rescue plan. the 23 budget would build on those efforts, providing 2.9 billion to mental health, 6.6 billion for prevention efforts within the substance abuse and mental health services administration. my question is, what activities and communities does the administration intend to target with these increased resources and why? >> congressman, first, thank you for the earlier mention of the friendship. i hope we continue to work with you on any number of these subjects. and certainly on this, one because the president had made it clear that he intends to deploy game changing resources and investments to make sure we tackle the mental health and behavior health crisis. i mentioned the 988 lifeline that we hope to launch in mid july, that will let anyone who is suffering a mental or behavioral health crisis to be able to reach to someone who can offer them health help. we're going to do much more when it comes to drug over those problems, over 100,000 americans are dying in one year from drug overdose, we know we have to tackle the opioid and drug overdose crisis. we're going to do everything we can to help children, because we know covid has exposed the belly of what we see as a true problem with mental health being experienced by our youngest americans. and, so we're going to do everything we can to focus on that. i'm a gate right now on a national tour, visiting state throughout the country to try and highlight what the president is hoping to do in his budget. >> thank, you mister secretary. let me just ask you this. let me ask you about the proposed crisis care set aside and the prevention and early intervention set aside in the mental health grant. as well as the proposed recovery and support services and the substance abuse -- why do you believe these programs are important, and can they have flexibility to meet the needs of the our citizens? >> congressman, as i said earlier, prevention is far better and more effective and better for the dollar then is remediation. if you wait until someone has a real crisis, it cost a lot more money, just like going into an emergency room, then it does in trying to prevent someone from getting to the point of suffering a crisis. so, we want to interdict where possible, we want to intervene where we can. what we want to do is let families know that we want to be their shoulder to shoulder with them, as they try to address these crises, especially for children. >> thank, you i have time for one more, mister secretary. since 2015 i have used on a bipartisan bill to work on access to disposable wound therapy for patients receiving health care. in 2015, we successfully created a new medicare benefit to this effect. unfortunately, the way this benefit was implemented makes it extremely difficult for patients to access this technology. to fix this, mr. mullen and i introduced -- would you be so kind to commit to work with us on this proposal, so that it can make it to the presidents desk before the end of this congress? >> you have my commitment, congressman, to work with you to see where we can go with the legislation. >> thank you, secretary becerra. i yield back. >> gentleman yields back. chair is pleased to recognize the gentleman from michigan, mr. upton, for your five minutes to question. >> thank you, madam chair. thank you mister secretary, we're glad to have you in person today. that is for sure. i want to thank you, chair, for holding this important meeting and your important leadership on arpa-h. i'd like to think we're moving close to bipartisan authorization of legislation through this committee. i would note that my partner again, i look forward to working with the advanced support legislation as well. we also look forward to working with you and chairman pallone and ranking members rogers a another important piece of legislation. here is two point oh, we continue to hear from patients, families, doctors, innovators, on how important it is to move forward. this committee works together and we do improve americas lives and i'm thankful to be a part of it, simply put. patients can't wait and we have no time to waste. so, mister secretary, drug resistant bacteria now kills more folks than hiv globally. statistic. cdc is reporting that both drug resistant bacteria and fungi are on the rise because of covid. past your act, the bipartisan bill that we included in the 20th century, urgent care is a needed solution to these growing threats. you agree, i think, with a need to address the am are and fungi threats. and i'd appreciate your thoughts on the past tour act as a solution. >> congressman, let me first say thank you for tackling this. because too many people are not aware of how rapidly we're losing the ability to use antibiotics to treat whatever pretty common diseases and illnesses. it's not affecting justice, it's worldwide. unfortunately, as you know, it is tough to get the manufacturing sector to jump on this, because there's not a lot of money they can make anymore. so, we have to work to provide the incentives. so, i am absolutely supportive of the efforts that you are making in this, because am our, antimicrobial resistance, it's a problem. not just in developing, countries but here in the u.s.. >> thank you. i'm also deeply concerned about the state of federal health insurance programs like medicare. in my view, medicare is antiquated approaches to coverage are not well suited for cutting edge technologies out of the potential to transform care. some have pointed to the issue of improving fda cms communications on innovative technologies that might house cms better cover and, more importantly, reimbursed for them. unfortunately, it seems like the administration might be moving in the wrong direction with its decision to pull the mc i t rule. can you share with me your thoughts on improving the cms fda communications, and what we might respect with regards to the mcit rule. >> once, again you ask a critical question because technology has taken us to a new place. there is a joint statement recently issued by both the heads of the fta and cms to make clear how it is important that these two distinct agencies work together where they can. but still proof fulfill their separate, distinct missions as well as possible. we're going to run into the circumstances, as we mentioned, more and more often because technology is taking us farther and farther towards getting new treatments and therapies. would i can tell you is, so long it's the mission of fda is to ensure that there is a safe and effective treatment of a drug to americans, that is critical. at the same time, we have to make sure that cms's role, which is different, more an issue of whether that particular therapy or drug is necessary, is a real issue that we have to confront. but i believe, that with that joint statement of the two heads of these agencies, they made it very clear that, where possible, we're going to make sure we're working together. >> thank you, i yield back. >> gentleman yields back. i want to reiterate, once again, as i have previously, my fullest support for cures two point oh. i believe that is a must for our subcommittee to advance in the full committee, as well as arpa-h authorizing language. i salute you and the congresswoman for the work you've done. we are all in your debt, because you've been working on this for three years. the combination of that will be what the subcommittee does with it. the chair is pleased to recognize the gentlewoman from florida, miss castor, for your five minutes to question. >> thank you, madam chair, and welcome secretary becerra, it's great to see you. i want to thank you and president biden for successfully lowering health care costs and premiums for millions of american families. that is what democrats and congress intended, through the american rescue plan. and now high quality coverage is more affordable and available to families at a time when they really needed to put money into their pocket. 14.5 million americans now rely on the affordable care act, and it has been a particular godsend in my home state of florida, where where the third largest state in the country but we have the highest in roman of any state. 2.8 million americans now, that's a 28% increase over the last year. largely because we were focused on lowering the cost through those enhanced tax credit. can you briefly discuss the impact of the american rescue plan, and what it has meant? what those enhanced tax credits have meant for affordable health care coverage? how many new individuals have signed up because of those tax credits, how many, what is the scope? what do you predict the future holds? >> congresswoman, thank you. by the way, thank you very much for the work you did to ensure the affordable care act could be there, we could have the american rescue plan, to make even better the results of good quality health care available to so many americans. you mentioned with with the numbers. americans are speaking with their feet, with their voices, applying for these health care plans the fact that today 40 million americans can rely on health care because of the affordable health care act. 6 million of them new to the program altogether. as you mentioned, several million in florida by itself, one of the 50 states. the fact that we can offer because a result of your work on the american rescue plan, americans a health insurance plan a quality, not a junk insurance plan, of quality. $10 or less a month in premiums, you can even go see a movie today for $10 or less, for one movie! let alone a full month of health insurance coverage. that is real piece of mine. >> it is! i, in the grocery store, in church, everywhere i go in my home state they really are grateful. this came at a time when we were dealing with a pandemic. in a time when costs were really hammering our families. thank you for everything that you have done. you must take great pride in the fact that you were here when we passed it, and you are here when you see the expanded coverage of these high quality plans. i also had some sad news from a friend last week, just diagnosed with and hpv related cancer. i am so grateful that president biden, and you, are there to help reinvigorate the cancer moon shot. what you have included in your budget, related to trying to find ways to save american lives, lower costs, by expanding the hpv vaccine, really deserves kudos. this is the first time it is shown up explicitly in the budget. i would say, when the vaccine, it wasn't around when we were younger but it is now for kids and adolescents. what i have learned back home is, when you asked parents if you could prevent your child from ever contracting cancer, would you? and of course they! would here we have this safe and effective vaccine that have been available since 2006, but the up tick rates are not high enough. talk to me about, you have committed to do more on hpv. how does the department plan to use what you have identified as $5 million to expand efforts to include coverage? what can congress be doing, we did pass a bipartisan bill out of this committee, by the way! and a bill through the house of representatives that will help. but what is your plan? >> congresswoman, one of the things we learned with the affordable care act and the enrollment, the record breaking enrollment numbers and with vaccines. reaching communities that are often left behind. today we have black americans, latino americans, who are vaccinated at essentially the same rate as white americans. a year ago there was a dramatically disparate difference. but i will tell you is what we found is, if you go to people instead of waiting for them to come to you, they will latch on. they take up the effort. when it comes to hpv vaccine, other treatments that we know are effective, we are going to go to those communities to let them know about this. as you said, if they know they will make sure these kids get these vaccines! >> thank you very much. i yield back my time. >> gentlewoman yields back. jerry is pleased to recognize former chairman of our subcommittee, one of our doctors dr. burgess of texas for year five minutes to question. >> i think the chair, let me just start by saying that i don't want to associate myself with the remarks of our ranking member of the full committee. i do feel one of the severe casualties of this pandemic has been the credibility in our public trust in our public health institutions. we really do need to work to regain that. you can see it almost daily. i guess on the good news front, doctor fauci was on judy woodruff last night and pronounced the pandemic over. congratulations! i somehow missed it in the headlines this morning. i'm glad that that, i hope that is true at least. i also want to associate myself with the remarks that the chairwoman of the subcommittee on our page. it is critically important authorization that this committee needs to undertake. i share concern that it is co-located with the campus of the national health. we spoke last time in our budget committee hearing, across the way. i was concerned about funding for data functioning research, particularly in adversarial countries. you disagreed with me, you said i think that question haven't answered before. you did not think it would be true. i still remain concerned about it. i have remained unconvinced that nih didn't not have some role in this funding. i promised you some articles, supporting my position. i have asked that madam chair make those part of the record today. and the conclusion of this hearing i will get those to you. even if we disagree about nih funding, data function research in adversarial countries, really the point has been made over and over again in those documents this is all done in a bsl to lab. the bio safety level of the wuhan lab was not a bio safety level three or four as i think it should have been. it's almost like it's asking for a lab leak if you are dealing with a pathogen such as this in a bsl to lab. i guess the question is, are we at a point now where we will be very careful about where we fund this type of research? it bothers me that it was in an adversarial country, and it really bothers me that it was in a bsl to lamb. >> dr. burgess let me just say, much of what he said i agree with. we should always be very cognizant about how any data function research is done. we should be very cognizant of where it's done, for all of the reasons that you just mentioned. i think that what i can do is assure you that, at the nih, at the department of health and human services we take those same concerns and ammunitions that you just stated, very seriously. i agree with you that we have to be very, very, careful. who knows what can surface at the result of some of this research that is being done? especially if it's done in a place that is not equipped to handle it. >> i really do hope that you will provide the committee with the official hhs policy directing the nih in this regard. we had a hearing on mental health, i appreciated your comments on mental health, a couple of weeks ago. i brought up, are you familiar with what is referred to as the imdb exclusion? the institute for mental disease exclusion to prevent medicaid from paying for coverage, hospital coverage. i brought up a concern about that. i asked the emit straighter if that was a barrier to getting care. she was not really -- she said, there are some challenges there. i did not get the impression that really, she put that as an obstacle to care. let me just ask you, do you think the imd exclusion is a barrier for patients getting the mental health treatment that they need? >> congressman, i think we are seeing that the growing need of health care, and medicaid have become a place where americans have been able to rely upon. to help them pay for their mental health care services. imdb does impose the restriction. i believe it is a statutory restriction, it makes it tough for medicaid to cover mental health services in many cases. we are more than willing to work with you and your colleagues to try to make sure that americans are able to secure the type of health care, even if it is for mental health, not just regular health, that we need. >> i tried to add that as an amendment when we were doing one of the reconciliation bills, i was defeated on the party line vote. i hope that i can look to your help when bringing that forward again, in legislative language. i agree with you, it is a legislative fix that is required. it is expensive. i grant that it is, it's the old saying about pay me now or pay me later. what is the cost of doing nothing? i think we found that it is extremely. hi thank you for your testimony. i will yield back. >> i look forward to working with. you >> gentlemen yield back. chair pleased to recognize the gentleman from maryland, mr. john sarbanes question for five minutes. >> thank you very much madam secretary, welcome. i appreciate the work that has gone into this budget patrol. it is very much, for the most part, a lessons learned budget. it really looks at what we have been through and tries to reposition us in a visionary way for the future. i thank you for your efforts, and the efforts of your stuff. the pandemic, as we know. it has taken a really heavy toll on health care providers, public health workers, that is obvious. these frontline hearings have been very stressed, very overburden, during this crisis. many have left the workforce, as we know. we also know that a strong, well trained workforce in the health field is critical to supporting a high quality delivery system. we have to make data driven decisions about how to prioritize the workforce. to that, and i know your agency is currently working on a number of initiatives on the health care workforce. excluding this work forth analysis. i support that. can you talk about this and how you see the fy 23 budget respondent responding to this need of collecting, analyzing, and ultimately acting on workforce when it and other related challenge ones? >> congressman, thank you for your interest. all the work that you've done over the years on these issues. i think a lot of work has been done in americans really appreciate what you're trying to do. the national center for health workforce analysis conduct research, it tries to help us determine if there is sufficient workforce throughout the country. geographic distribution, what the level of education for the workforce is, essentially tries to inform you, policy makers, about where the gaps are. where the deficiencies are, so you can better target your resources. if one region of the country lacks a certain type of health care professional, nurses for example, then we are able to target that appropriately. this way we spent every dollar that we have the most efficiently in order to boost up the workforce. >> i think it's gonna be very important to do the analysis carefully. in addition to there being a lot of competition among health care providers for those workforce positions, there is also going to be competition between health care industry and other folks who are looking for workers. there is a lot of teacher vacancies, for example, across the country. we've got a real labor workforce potential challenge coming at us, navigating that with some good, strong data review and analysis going to be important. i certainly support this center. i'm hoping that my colleagues in the house appropriation committee will even double the funding for the senate to make sure that we are in a position to handle this challenge, working together and moving forward. let me turn to another topic real quick, we talked about that the last time you are here, it is school based health centers. i think all of the evidence is when you have these resources in place with a captive audience, which is a school full of children that need support and help. health care, for themselves, and often time connected to their families in their communities, it makes a huge huge difference. i'm happy to see that hhs has been making strong investments in the health and well-being of our nations children. including, through recently announced joint initiatives between hhs and the department of education to expand health services. can you talk a little bit about the hhs commitment here to supporting school based health enters, and the students that they serve in this coming year, including through the initiative that i just mentioned? if i had my way, there would be a full hell suite in every school in america! it seems kind of like a no-brainer, when you think of all the good that could do. i would love to hear your thoughts about that. >> congress and maybe you are younger than me but i remember when i was going to school, in elementary school, there was a nurse at our school. today, you won't find a school with a nurse, if you do your very fortunate. it is one of the major losses we have seen over the years. trying to provide our children with as much access to health care, especially with kids you have parents who can't afford insurance. it is a big loss we have seen over the. years president has made a commitment to try to reach out to communities to provide those services to children, including at school based settings. we are providing $40 million for a new pilot program to integrate behavioral health support in a community setting. whether it's in a school, community center, whether it is -- somewhere accessible to families where they won't have to travel a long distance. i would like to continue to work with you and others to build programs like project aware, a program that helps us focus resources and attention into places like schools. two and sure that our children to have access to care. otherwise they don't have access otherwise. >> thanks very much, i look for to working with you and others in the department. i yield back. >> gentleman's time has expired. chair is pleased to recognize the gentleman from virginia, mr. griffith, for your five minister question. >> thank you very much madam chair, secretary becerra, ranking chairs. ranking member guthrie and myself have sent questions to nih. can you get them to answer, yes or no? >> i'm sorry, what's the question? >> will you get the nih nih to answer our questions in relation to covid origins? >> congressman, i know that the nih has answered many questions -- that >> okay. if you can give me more detailed answer later i would appreciate it. i've a lot of questions in a short time, as you are familiar. i visited the border and asked the acting secretary of children and families whether the office of refugee resettlement needed additional authority or resources from congress to improve the inadequate process of vetting potential sponsors of unaccompanied children. what they're telling the american people is there doing background checks. and what they're doing is they're doing a background check on a computer that's not part of the criminal background system in our country. they're just checking, you know, people finders or been verified, that kind of thing. not adequate. i have a written response saying, quote, o r is currently in conversations with our partners to determine what additional resources are needed from congress to improve the sponsor vetting process. but nothing further. in the meantime, unaccompanied children continue to arrive in the u.s., orr continues to place children with sponsors with no real background check. if we are doing this in a custody case, and i was practicing that kind of law, either the attorneys or the judge would be in front of somebody trying to figure out why they didn't do a proper background check. so, have you taken any action to improve the vetting process for unaccompanied minors and they're truly unvetted sponsors, yes or no? i understand you may have to get back to me, can you get back to me with a full written answer on that. because i'm very concerned on this. because, well i don't think they should be here, if they're going to be here let's make sure they're being put was safe people. i will continue with another question, and expect a full answer. can you get the answer, anything affirmative? >> i have to tell, you i don't agree with the way you pose the question. but i will provide you an answer to give you the best information i can. >> appreciate that. i'm stating a fact on whether or not they should be there, but the facts are they are doing a proper vetting process. if the court systems were doing this there would be people in trouble with the public. i'm going to go back to another question. >> the question of vetting, that's where i disagree with you. but we will respond to your questions. >> you're going to have to continue to disagree on that because it's just plain poor. yesterday you and i discussed that visit biden had discussed with agencies -- goods a material in the united states. i hope you're making plans to refill the national stockpile. manufacturer stand ready to provide supplies. will you commit to ensuring product that your industries used come from companies that operate in the u.s.. yes or no? >> 340 million free at home test kit, millions of n95 masks. we have done what we need to do to make sure there is a stockpile that -- >> are the american manufactured? we have lots of people who are saying they're going at a business because we're buying from the chinese again. >> because of the instruction given by congress, we have more authorities to make sure, domestically manufactured products are available. >> and we'll give you whatever you need on that, i'm sure. last, week i join my colleagues rodgers and got three to send you questions about troubling increase the deaths associated with substance use disorder. will you commit to getting us a timely response, a complete timely response, on those questions? i know you probably haven't seen it, but if you could give us a timely response would be greatly appreciated. say, june 1st, june 15th. >> congressman, we're committed to responding as quickly as we can. please be in touch if you haven't got the response. >> i appreciate, that we will be. in response to a march 8th letter i set to samhsa stating it does not and has no plans for conducting, collaborating or funding studies about the mental health impact of the pandemic. do you not agree that the institution responsible for aussie overseeing our nation's mental health should be involved in such work, yes or no? >> okay, i'm not sure i understood. because samsung is absolutely engaged in making sure we are addressing the needs for mental services. >> that's what you told me, i'll send you a copy of the letter. last but not least, when it comes to treating patients with substance use disorder is critical that 42 cfi part to be revised with hipaa regulations, the cares act instructed substance abuse and mental health services administration samhsa to do so with a deadline of march 2021. these regulations have yet to be published. earlier this month, i asked your colleague dr. delphin-rittmon for a status update. she was unable to provide it. can you? >> congressman, you through a lot of numbers and coach sections at me. without further reference it would be hard to respond. >> i do appreciate that, that's why i thought i had to move quickly as i've a lot of questions in a lot of big areas. these are not simple questions. i will get you a written question, but i really would like to have a response on that. because where you're behind where the law says y'all were supposed to do. i yield back. >> we will follow up. >> gentleman yields back, chair is pleased to recognize the gentleman from vermont. mr. welch. >> thank you very much. mister secretary, it is so good to see you. and welcome, it really is. i'm going to ask you about three different topics. the irc, it's drug pricing, which you have been a long time champion of, and also substance abuse treatment program in vermont that i think has brought applicability. first of all, on the dir fees, it's really brutal what's happening to the cost of drugs that gets passed on to seniors and also to our community pharmacies. i'm someone who thinks that the community pharmacies are an essential component in our health care system. i know your agency is looking at the dir rule in an effort to change it, it would save about 20 billion dollars out of pocket rug cause for folks who are on the part d program. my hope is that the rule will be finalized without delay for the year 2023. by the way, this has got a lot of bipartisan support here in this committee. so, my question is, where do we stand on that, mister secretary? and can we have confidence that we will get this done this year? >> congressman, good to see you. and thank you for the question, important question. we agree with, you it's an important rule. we are working it as quickly as we can. i can't give you a specific timeline, as i can't give you too many specifics. but we understand how important it is, because patients costs are at stake and we want to make sure that no is paying more than they should for the drugs and medicines and treatments that they need. >> let me just emphasize, this has been a tug of war for a number of years. the insurers are pushing back, pushing hard and this is about whether it's their profits or if we're going to get fair pricing. it's also about fairness to our community pharmacies. they really have this bizarre situation, as you know, where they sell the product at the stated price and they get a letter from the pharmacy benefit manager saying oh, by the way, that product you sold at the price we agreed on three months ago, we were just kidding and you owe us money. i mean, can that at all be justified as a business model? seriously. >> congressman, we are in the midst of the rulemaking. you know it would be inappropriate to respond to questions that go to the substance. >> well, i hope you heard my plea here. again, bipartisan. >> i remember hearing it for many, many years. it's a good message. >> drug pricing, again, i acknowledge the role you've played when you served here and of course in your role as attorney general in california. so, i know you're totally committed to doing everything you can to get price negotiations. i know the administration is, as part of build back better. where are we on this? i mean, folks are paying huge amounts for everything from insulin to lifesaving medications. and the drug industry is just unrelenting and using its pricing power and their increasing prices as we sit here. it has nothing to do with supply chains, it has to do with their infinite, unrestrained power to raise prices, to raise profits. where are we? >> congressman, we have some authority is, as you know, to take action to try and help keep drugs at the prices that are fair. but we need more authorities. that question, where are we, it's a question i know we are posing to congress. where are we, how close can you come to actually giving us the statutory authority we would need to actually be able to competitively drive down the price of prescription medication? so, we will do what we can with the authority we have. it certainly would help if congress passes a measure that enhances our ability to actually go toe to toe and negotiate for fair prices for americans. >> okay, thank you. my third topic, mister secretary, is on substance abuse. in vermont, we have this program that's working out, combining tele-health with a system where the medically assisted medication is in a wheel that can only open every 24 hours. a person can go on their app, in their home and, in the visual observation of the provider who maybe 100 miles away, take that pill. and there's insurance that there is no abuse. it's really a tremendous program, we have one person who said it saved her life because she didn't have the ability -- she had no card, she couldn't get to where she needed to be. so, is there any hope that we could have that sensible approach which we have on a pilot basis in vermont institutionalized? >> i think we've learned, as a result of covid, quite honestly, how much we can institutionalize when it comes to telehealth. but we need, again, statutory authority. because some of the prescriptions are written into law. we need congress to act to give us more discretion. but we have certainly learned how important telehealth can be. >> okay, i yield back. thank you to all the health care workers that have been sticking through it for over two years. thank you, madam chair. >> gentleman yields back. chairs pleased to recognize the gentleman from florida. mr. bill raucous for five minutes to question. >> thank you, madam chair. thank you secretary becerra. in your budget hearing last year i asked you about partial abortion or late term abortions, which are prohibited under law. you stated there is no, and i quote, there is no law that deal specifically with the term partial birth abortion. we know, of course, that this is incorrect. not only is there a federal law, but the biden administration and your department in particular has continually undermined these light protections in the years since we've seen you. mister secretary, let's try again. will you commit to working with attorney general garland to enforce the partial birth of barr's abortion ban act of 2003? which has sat on law and upheld in the supreme court in gonzalez versus car heart in 2007. will you commit to upholding the law, sir? in this case? >> congressman, thank you for the question, good to see you. i can absolutely commit to working with attorney general garland to make sure we are complying with the law and enforcing the law that we have, when it comes to the issue of abortion. >> thank you. next question, mister secretary. historically, questions about the safety and efficacy of drugs have been left to the fda. yet, in your tenure, hhs seems to have gone the opposite direction by significantly limiting the use of fda approved drugs that could potentially help millions of alzheimer's patients. and medicare's national coverage determination. again, through repealing the and said or the medicare coverage of innovation technology rule, which further limits the fda approved products. why do you seem intent, mister secretary, on adding an additional layer of red tape around your agencies? if that's not the case, please tell me. i think it undermines each other in the eyes of the public, especially with treatments and devices that may help alleviate suffering for patients. course, this is a very important issue, i have many seniors in my district that have been infected with this terrible disease, alzheimer's. so, if you could answer that question, sir, i'd appreciate it very much. >> thank you for the question. let me see if i can clarify, because it's an important question. there is no doubt that americans, whether it's because of alzheimer's or any other in illness or condition, are in search of anything that can help their loved ones. i have family that is done the same thing. but we have to remember is that fta and cms are two separate agencies with distinct authorities and distinct missions. the fda is the agency charged with telling us of a particular new drug will be safe and effective. it is cms's responsibility to tell us if that particular medicine is reasonable and necessary for the diagnosis or treatment of an illness or an injury. two different entities, two different missions, both based on science and data to give results i. we cannot confuse what's fda's mission and role is with that of cms. that's why you have distinct decision-making. as i've said, the heads of both agencies have come out with a joint statement talking about how it is important, where they're allowed to, to collaborate and work together so that what we can do is give the american people the best result that we can, when it comes to either therapies, drugs, treatments. and i think they're going to work as closely as they can, because as i mentioned mr. upton -- >> let's make sure that's the case. because there's a lot of people that are, again, early onset of alzheimer's that could be helped with this particular drug. so, i'd like to see it approved so that medicare would cover it for our seniors. mister secretary, this administration continues to stifle free speech under the guise of health information. despite your own cdc pushing up misleading information. i'm sure, from your days of secretary and, of course, state attorney general in the state of california, you understand the first amendment prohibits governments from pressing or pressuring private companies into censoring free speech, which has made recent actions by the surgeon general particularly troubling in my opinion. we are in the middle of an opioid and mental health crisis, as you know, with overdose deaths surging to all time highs. and yet, the surgeon general has instead prioritized policing speech online. did you direct the surgeon general to seek information about individuals on social media platforms? and is your aim to silence certain people? if you can answer that question, maybe, if you can't right now, because four out of time, i would like for you to submit the answer. thank, you mister secretary. thank you,. >> you're going to submit for the record? >> we can respond, later, for the record. >> all right, the gentleman yields back. the chair is pleased to recognize the gentleman from california, mr. cornice. >> thank you very much for holding this important hearing and giving us the opportunity to go through this budget. secretary becerra, it is great to see you enjoyed serving with you in congress you served our state in our country well. thank you for continuing here live to the service of all the people in this great country. i want to start today by focusing on an area of increased urgency in regard to the nine 80 mental health crisis line. as you know, 90-day will go live in july of this year. just a few short months from now. this program has the potential to revolutionize the way we respond to our neighbors in crisis, and will help us shift away from law enforcement responding to those having a mental health moment. i truly believe that 98 a will help save lives but it will only be meaningful if we continue to finance the program throughout -- i wonder what's your vision for 9-8-8's and, how does human services see nine 90 operating, and why is a 670 million requested for nine 98 so necessary in order for that vision to become a reality. >> congressman, nice to see you. please everyone i say hello when you get back home. 988 it is indispensable, we have to do it right. we have been dispensing some $300 million so far throughout the country to 50 states, territories, and travel governments to make sure that we are ready. remember we have a patchwork right now, this lifeline for suicide prevention. but it depends on different phone numbers, different entities to provide the services. this is the effort, through 988 to combine it all, to put the glue together to make it work for everyone under the rubric of a three digit phone number, instead of trying to remember a ten digit phone number. that's the first part! if someone decides to seek help, instead of going the wrong direction they get a voice that can support them right away. you make a really good rate point, we have to make sure the service follows through. that is where we want to work with the states, territories, and travel governments to make sure that that is available as well. it is a locally operated system. we are helping to glue it together. we will hope that you continue to support that. >> yes, thank you so much, mister secretary, for reminding us that 9-1-1 is a localized system but it is also a nationwide system. same thing with 988, it is a localized system. i want to thank you so much for the 300 plus million dollar rollout that we already engaged in. to make sure that we can, as best as possible, hitting the ground running when 988 goes live or later this year. it's also to ensure that when people make this phone call that people are linguistically incompetently competent to be able to help the people in the best way possible. with that, can you talk a little bit about the effort that is underway to ensure that folks who speak spanish, or other languages, can access this 988 line effectively. >> absolutely, fabulous question. it doesn't help if you make a call and you can't really communicate well with the person who is trying to help you. we are trying everything we can to encourage localities to have the work force in place you can provide the service directly. we are also helping to establish backup centers, in case a particular location is getting a lot of calls, then there is a another backup center that can take up some of that volume. we don't want someone to call, when they are making that decision to do something really drastically bad or get help. we don't want them when they call that 9-8-8 number to not be put on! hold or not get a busy signal. moore first and foremost we have to make sure that there is someone that can provide them with real help. first backing them up all throughout that process, it has to be culturally in wingless tickly sensitive so they are getting someone who can really help that person who's crying out for support. >> thank you so much. once again, i appreciate your proactive efforts. i want to go on to my question on hurts, the uninsured program. there are as many as 30 million uninsured americans who continue to face unique barriers especially when it comes to covid-19 treatment and care. unfortunately that money has run dry. what is the administration doing to address these needs now that this program has run out of money? what can congress do to help? >> congressman, we have requested of congress for the support for covid activities, including that uninsured fund that providers can seek relief fund. we hope that you are able to work through the process and get dissemination of resources. >> thank, you i yield back madam chair. madam secretary, please say hello to year better half, dr. kareena rhea, thank. you >> chairman yields back. just a comment on 9-8-8, i think members will recall that all of the contracting from hhs to the states went to the state department of health, not 20 yes. i don't know if that was the best design, but that is the design. just fingers crossed that it is going to work the way we all want to. it is really going to be an essential service in our country. the chair now is pleased to recognize the gentleman from missouri, mr. long for your five minutes to question. >> thank you madam chair. thank you for being here secretary becerra, when you leave congress. when you make parole from congress, they issue you a hyperbolic chamber? >> congressman, forgive me. you lost me, can you ask that question again? >> i have never met any congressman who has made parole around this place, gotten out a year or two later, who doesn't look a lot younger and a lot better than when they left. here [laughs] you are looking really good. i am just asking. >> i'm gonna take you home with me. >> do you have a hyperbolic chamber? >> i'm gonna test you're history a little bit. harriet truman, great missouri, and a one handed economist having tired of the dismal exponents of a -- proclaiming on the one hand, and on the other hand. that is why he wanted a one handed economist. on the one hand, and i think we need a one handed cdc director. on the one hand the cdc feels the public health emergency is still dire enough to want to extend mask mandates for air travelers and other public transportation. you are asking for tens of billions more dollars for emergency pandemic spending. on the other hand, title 42 may 23rd of this current wave, as if there is no pandemic at the southern border. there are more than 220,000 migrant encounters at the southern border, half returned away by title 42. i think it is still a necessary common solve policy in order to prevent the spread of covid. lifting footy 42 spends a clear message to illegal immigrants to come on in, and go on to lead to a huge migrant surge that the administration is not prepared for. the estimates from the border patrol, a population of springfield missouri is 169, 000, 176 folks according to the 2020 census. if this chapter 42 is lifted every nine days you could repopulate my hometown springfield, missouri with 169 176,000 people. as hhs secretary, and with the cdc, how can you square up the mess that the pandemic is essentially order at the border, by lifting title 42 but still not over enough to lift mask mandates for americans traveling on planes? are we in a public health emergency are not? >> congressman, thank you for the question. i know a lot of folks are asking the very questions you've asked. public health emergency declaration that eye issue is based on the data that we have on where we are in terms of this pandemic. title 42, is a separate measure in the statute that deals more specifically with things like quarantine. it is not the same to equate title 42 with the title health emergency. as you and i probably agree, there is still 300 or so americans dying every day of covid. there are still more than 1000 people being hospitalized every day because of covid. we are still in a condition of pandemic, much better circumstance than we have previously found ourselves. the situation at the border has presented a number of migration challenges. it is inappropriate to use a public health law, title 42, the deals principally with quarantines, to try to deal with a migration challenge that we face. cdc is required to look at the facts and the evidence based on health conditions, not on immigration or migration challenges that we face. >> we are even now, because you lost me on that one. it was issued due to a health pandemic, correct? >> title 42 was based on the health conditions that we are in at the time which have since changed, yes. >> okay, this issue should not be siloed. it counters are up 33% since february. i think lifting 42 directly affects what happens at the southern border. it's lifting sends a clear signal, to me, that illegal immigrants will not be turned away. we are seeing amassing surge at the border because of it, i found it very concerning. if the biden administration, not taking into account when looking over our overwhelm border? >> congressman, president biden presided over his first week in office a plan to fix the broken immigration system. what you are pointing to, verifies that we have a broken immigration system. we should be using immigration laws to deal with that border immigration challenge, not health care laws to try to deal with it. it's like using a knife to do work that you would use a screwdriver to do. you might have some success in some ways, but it is not the right tool. >> okay, thank you. i appreciate your being here. i yield back. >> okay, the gentleman yields back. the chair is now pleased to recognize the gentleman from oregon, mr. schroeder for your five minutes to question. >> thank you very much madam chair, thank the secretary for being here. always good to see a former colleague who has moved up the food chain and who is doing such great work, frankly. i would like to talk a little bit about health care. i am very pleased to see that the presidents budget have includes policy that i have sort of worked on for the past few years. two and some of the gaming of the generic drug application process and bring last costly, effective medication to the market sooner. if anything, my understanding is the proposal goes a step further. the president budget goes -- using marketing rather than filing as a time trigger. the blocking act that i have proposed has a slightly different mechanism. what concerns to the administration have around generic drug application? filing, marketing, all of those timelines? >> congressman, i think the president wants to make sure that generic drugs, safe and effective generic drugs are made available as quickly as possible for the american people. we know that within that sphere of the manufacturing industry for drugs, a lot goes on i can tell you about this i can tell you about the former attorney of california, how we can make this a more competitive marketplace. how we try to stop the gaming of deals that are done behind closed doors that limit accessibility to safe and effective generic drugs. the president has charged us to do everything possible in order to make the drug industry a more competitive place. that would mean that we would be able to put generic drugs out into the public hands, more quickly. >> totally agree, totally agree. we've also been working on a bio sin act, encouraging providers to you more of the bio similar's like they do in europe to reduce drug cost. so, we are totally in sync, i think. switching gears to mental health, youth mental and particular. how are the increases in the critical samhsa programs proposed in the presidents budget going to help meet the health needs of our he said there? >> thank you. well we're going to do is help concentrate some of those resources i hope you are able to get to us, get them to children whether through school, community settings, so they can access that mental health service faster. we find that too many families still don't have good mental health coverage in their health insurance plans. or trying to change that as well to make sure no one is denied health care because it's a mental health condition compared a more generalized his wealth condition. we'll continue to work with you, because if we get the game changing level of resources the president is asking for, we should be able to go to your community and communities around this country and make a difference in the lives of so many young people. >> i hear so much, certainly post pandemic and even a little pre-pandemic, about some of the trove ails of young america, dealing with lack of a social interaction in the traditional school environment. some of the program problems that are at home, they came exasperations -- they became exacerbated as a result of the covid pandemic in a lack of counselors, whatever, that are out there for these children to seek. like we had when i was a youngster, we actually had counselors in the school, every school. it's been very different. leads me into the last, question on provider workforce. i just got off a call a few moments ago with our hospital association. i've talked with our nursing providers, and that's in turmoil. the lack of workforce is legendary now, post covid. , well not quite post covid yet, we're still in covid, i don't agree with that. wet is hhs doing to evaluate conflicts abilities and programs during the covid-19 pandemic, to help get health care workers, the nays, whatever, to the workforce quicker not a more permanent basis? >> congressman, you hit it right on the nail. we're losing nurses, or having facilities fight for health professionals and they are paying major dollars to have these traveling health professionals come to their facilities. it's a difficult situation. we just recently, a couple months ago, put out a grant proposal of about 100 and $3 million to help with facilities that are trying to help their workforce cope. so, whether it is facing burnout, whether it is others who are trying to get trained up so they can move up a notch, or whether it is simply giving those workforces more time to rest. that money, we have made available so that providers could actually reward their workforce for everything they've done during covid. it's not enough, obviously, but it's something to try and help with the burnout that we're seeing in the industry. >> very good, very good. i look for the working with you, thank you very much. i yield back, madam chair. >> gentleman yields back, the chair is pleased to recognize the gentleman from indiana. one of our doctors on our subcommittee. doctor bucschon. >> secretary becerra, thank you for being here today, appreciate it. i want to start by talking about a topic that you have brought up frequently since you are confirmed. that's the no surprises act or the surprise billing legislation. as you, know the district court for the eastern district of texas recently ruled that presumption of a benchmark rate in the interim resolution process portion of your rule was not valid. the judge ruled that this provision conflicts, quote, conflicts with the unambiguous terms of the act. i in the majority of my colleagues, on both sides of the, aisle involved in writing the legislation have sent multiple letters to you and have been speaking frequently with your office, both before and after the incidents of the rule, stating that this provision, in our opinion, violated congressional intent and the delicate balance we struck in getting a deal that protects patients and is fair to both providers and plans. so, on behalf of the administration, can you commit to more closely following the will of congress and also the courts? and finalize a rule that does not include a rub audible presumption of a benchmark in the independent dispute process? >> congressman, thank you for the question. we are in the midst of trying to issued the final rule. we are heeding the ruling, the court ruling that came out recently. we are going to try to stay in communication with those of you who work very hard on this legislation. there is no doubt that the american people want to see this work well. they should not be blindsided with these medical bills that they were not expecting. so, we're going to do everything we can to continue to extract the patient from that food fight that occurs between the provider in the insurer, and working with you where hope we're able to issue, fairly soon, a final rule that puts it into effect in a meaningful way that new law. >> great, thank you. to your point, we all agree that the patient has to be taken out of this. we heard testimony of just some crazy cases, where people got these tens of thousands of dollars and bills and we just can't have that. we're in agreement. i look for the working together with you. as you know, the rollout of the federal portal for the payment disputes was delayed by almost a month and a half. so, there has been, that has continued. my understanding that, due to the delay, there are now hundreds of payment disputes where the 30-day business day open ago she asian period has already expired. that was in the law. there are many more disputes where the 30-day business days will be exhausted soon. this means that there is going to be a flood of disputes that will inundate the federal portal as well as the federal arbiters over the next couple weeks. i have two questions about that. what caused the delay, and will the federal portal be able to handle and resolve the flood of disputes that were created by the way? >> yeah, congressman, i think lawsuits have consequences. when we have to wait for a ruling to determine how we can move forward, it makes it difficult. we intend to move as quickly as we can because we want folks to believe that this is a law that they can count on. so, i will look forward to working with you. the sooner we get that final rule issued, i think the easier it'll be to try to prosecute these cases. >> great, thank you very much. another topic, the medicare accessed and chip reauthorization act or mascara, top of the congressional tent. you are on congress and the committee of jurisdiction when we work to pass macra, so i know you can appreciate me want to make sure the agencies are continuing to use their authority to maximize what congress intended to do. i still hear concerns about how physicians find it hard to enter into and participate in alternative payment models or that the incentive just isn't there to do so. i think we need to have more oversight hearings on macra, something i've called on this committee to do so that we can see why this is the case. in general, look at how we can build upon what is successful about macra in shifting to a value based health care system. not just have a fee for service, based on value. and alternative payment models. congress and hhs must find solutions to the existing physician shortage, and make sure we better value providers work is a great first step. as you know, adjusted for inflation, in practice cause physicians pay within medicare actually declined 20% from 2001 to 2021. given that the cost of running a medical practice has increased 39% of the same time, otherwise, reimbursement declined 29%, increase in practice caused up 39%. i know amount of time, so i will submit this for the record. but i'm going to read the question. what is hhs doing to stop the decline of physician reimbursement a medicare? and we will submit that for the record. thank you, i yield back. >> gentleman yields back. chairs pleased to recognize another one of the doctors on our subcommittee. mr. ruiz, for his five minutes to question. >> thank you, secretary becerra, it's good to see you my friend. thank you for being here today. i know that the administration as a whole, and you personally, hold health equity as a top priority. i appreciate all of the work that you have done on this front and i look forward to continuing to work together on policies that address this critical issue. as someone who grew up in coachella, and then practice medicine there in the coachella valley in the district i represent. i saw firsthand the very real effects that health access disparities, like physicians shortages, have a battle of underserved populations. i came to congress to fight for health equity and level the playing, field so that people have the same access to affordable health care regardless of where they live or how much money they make. a shortage of health care providers is one of the biggest challenges to health care access that we face, and the outlook is not good. according to research by the association of american medical colleges by 2034 we will have a shortage of up to 124,000 physicians. that shortage is most pronounced in the underserved areas, and that is why we need to make sure that we are increasing provider access in the areas that need it most. i recently met with regional leaders from eastern coachella valley and imperial county, two of the most underserved areas of california, to discuss health care challenges that our areas face. we must ensure that these areas do not get left behind. that is why i have been a long time advocate of the teaching health center program, which gets more providers in underserved areas. not only are physicians who are trained and community else and it is more likely to practice in underserved areas, it also generates a more diverse workforce in underserved areas. because of the program success, congress has allocated increased funding over the years to expand the program. however, one of the biggest challenges that the program is faced is uncertainty over funding, which relies on short term reauthorization from congress. them explaining difficult, which in turn makes it harder to expand and recoup residents. given the workforce shortages that we are facing across this country, we need to robustly support this program. this committee has shown bipartisan support over the years on this issue. i've worked with ranking member mcmorris-rodgers over several years to lead legislation on this issue, and i was thrilled when chairman pallone introduced legislation last year to permanently fund and expand the program. secretary becerra, do you support teaching health care center program parity with medicare genie, which is permanently authorized has funded? as well as the expansion of the program beyond what was authorized in the american rescue plan? >> congressman, first, great to see you. thank you for all your work. on this issue of community health centers and allowing them to be the teaching centers as well, you had me at hello. it is indispensable to allow these health centers, quality health centers that are providing care to some of the least able to afford it, with the capacity to build. and providing them with a workforce. the next generation of doctors. through the gma funding, but doing it specifically for these community health centers, is not only a smart thing to do but it's the right thing to do. so, absolutely, we look forward to working with you and others and you will see the president's budget, we make a commitment both in the mandatory allocation in the discretionary allocation to continue to grow the workforce through these community health centers. >> thank you, i fell in love with patient care at a community health center when i was a freshman premeditated in undergrad. now, i'm going to change gears a little. i want to ask about an issue that i'm hearing about, regarding workforce issues at cms call centers. specifically, that workers at two of the call centers that operates ems is customer service lines went on strike last month. we cannot be in a situation where these crucial services for seniors are disrupted. can you commit that cms will work with me, in good faith, to ensure that there are not work stoppages that will lead to service disruptions? >> congressman, we commit to work with you to try to address some of these issues. >> thank you. it's very important for the seniors in my district, it's very important to the workers that provide good services. we want to make sure that they have a fair shot and that our seniors get the best service that they can possibly get. and so, i appreciate your time, i appreciate the work that you've done. especially during the pandemic, we've seen access to vaccine disparities dissolve within hispanic communities, thanks to your excellent work. i commend you in the administration on the work that you are doing on health equity. thank you, i yield back. >> the gentleman's time is expired. chair is pleased to recognize the gentleman from florida. doctor dunn, for your five minutes to question. >> thank you very much, madam chair, and ranking member guthrie for holding this hearing today. and thank, you mister secretary, for being here today. i do have serious concerns about the presidents 2023 fiscal year budget, which calls for more spending on radical, progressive priorities that are frankly out of touch with what america is really interested in at this time. unfortunately, many of the issues we faced a year ago are even worse today. public confidence in our federal health edgy sees is at an all-time low. that is due to confuse messaging by both the cdc and the presidents covid response team. politics and policies that are encouraging school closures and unnecessary masking has failed our children, set them back tremendously. this failure is evidence by the cdc's own decision to lower the expected developmental milestones for children earlier this year. that outrage pediatricians, speech pathologists and parents. this is nothing new, i think this administration often changes covid rules on a whim to serve capricious political goals and interests. mister secretary, i want to suggest to you a commitment to transparency, just to get our public health agencies back on track. cdc needs to be more forthcoming about their data and who influenced that and who continues to influence their issued guidance. dunn nih, we have found, has actively suppressed information regarding sars-cov-2 and the circumstances of the research conducted in wuhan, china. american people deserve answers about the origin of covid. i also sincerely hope that you look into the issue internally, and ways to improve the public's confidence in federal health agencies. so, question. recently, more than 60 immunology expert on executives wrote to the fda took expressed concerns over the failure to incorporate cellular immunity into the vaccine studies. i, to, and worried about that oversight. congress actually included language in the appropriations bill, encouraging nih to you cellular i'm unity data on research on vaccines and requested and effort to incorporate that data. to underscore that, cellular immunity is an incredibly important part of the immune response and it's been well recognized for a number of years as the key mediator of long term immunity in coronaviruses. predates the pandemic. so, right now, the biden administration is talking about rolling out another round of booster shots for adults and booster shots for kids, 5 to 11. but yesterday, the cdc announced a three out of four children have already had covid. so, why are we looking at t cell amino response data to make covid vaccine decisions? >> congressman, i think i followed most of where you are going with your question. when i can tell you is that the cdc has continued to try and be as transparent as it can with the information that it has. and the nih, we coming up with those decisions on how to do research, has also tried to be as transparent as it can. >> i'm going to have to reclaim my time, just because it's short. everybody has told you that, unfortunately. but i will say, respectfully, i have not heard yet back my requests for information from the fiscal year 22 budget hearings. that's a year ago. we would really like -- you heard that from other members as well, they would like to hear back from your department when we submit written questions. the nih and cdc are notoriously poor about that, just for your information. i'll ask the guy on the other side. i'm my grandfather, i'm really concerned about the consequences of lockdown on kids. you're probably aware that governor ron desantis made in person learning a priority. i encourage you to review data from the state of florida and other states that kept the school doors open, to explore the advantages of that for our children. i have another question, regarding the status of therapeutics funding research funding. i know we're short on time, you will get this question in writing. the truth is, we only pursued monoclonal antibodies, we did not pursue the small molecules that we know are so effectively active against a lot of these pathways. we have really good science on this. i think that hhs, certainly nih, cdc and fda should be keenly interested and following the state, because it is outstanding. so, you look at those questions and writing from me. please, let's hear back this time. thank you very much mister secretary, madam chair, i yield back. >> gentleman yields back. i just want to make a quick comment, because there is a consistency, i think, in terms of a theme today at our hearing. about the loss of confidence in public health during the pandemic. i, for one, could not help but notice over a two-year period where the chipping away, in terms of attacks on some of the most revered people in public health, coming out of the congress. dr. fauci, being that person. i mean, here is the man that led the effort to cure hiv and a.i.d.s.. what are we doing to ourselves, when we do that? so, we all want confidence, the american people to have confidence, to have confidence in their institutions. but this institution, i think, can be found guilty on many fronts of diminishing those institutions. it damages our democracy. the chair is now pleased to recognize the gentlewoman from new hampshire, miss castor, for her five minutes to question. >> thank you so much, chairwoman eshoo. and i want to welcome our friend and former colleague, secretary becerra. i want to acknowledge at the outset might appreciate from the steps that the biden administration is taking to tackle the addiction and mental health crisis in this country, and the investments in this budget and adolescent mental health especially. as we look to the needs of communities across the country after covid-19, we must build on the work of this committee and ensure that americans struggling with mental health and addiction are supported through increased access to treatment and recovery. i want to thank you for that. secretary becerra, another constant concern i hear from my constituents in new hampshire is the rising cost of prescription drugs. i, myself, was surprised to pick up a medication the other day and might cope a was $182. drug costs in the united states are, on average, 3 to 4 times higher than in other countries with comparable economies. but in contrast with many other countries and, i might point out, in contrast with the veterans administration and other players within the united states, the medicare program lacks the ability to negotiate with drug manufacturers on a volume discount to lower the price of drugs. do you agree that allowing the secretary to negotiate to lower the price of certain medications in the medicaid or program is predictable to lowering overall drug costs? and is it fair to say that there are no other, as effective, tools to constrain drugs when a drug lacks competition? >> congresswoman, first, good to see you. secondly, easy answer, yes. absolutely agree. >> so, we've heard from opponents to these reforms who claim that provisions like drug price negotiations will -- innovation and delay the discovery of new cures. do you agree that it must be one or the other? lower cost or new cures? or, instead, can we protect patients while we also protect innovation? >> congresswoman, we are a society that relies on competition and the free market. it makes no sense to not be allowed to negotiate for the best price. you wouldn't except going into a car dealership and having to take sticker price for that vehicle, you wouldn't expect to just take any price from some mechanic if you have to get the vehicle repaired. it's a true untried provision, a part of our life in america, to be able to get the best price we can and negotiate for that best price. >> well, the presidents budget reiterate's your support and the administration support for a comprehensive drug prescription plan. how did the drug pricing reforms included in our build back better act, passed by the house, fulfill the administration's goal of lowering costs for consumers and patients? >> congresswoman, one, that provision would have allowed americans to have better insight into how drug manufacturers price their products. that transparency that the bill would have provided is wholly overdue, as they say, sunshine is the best disinfectant. we should get to see the types of prices that we would be charged. secondly, by being able to actually negotiate on behalf of medicare's 65 million or so beneficiaries to get the best price for all of them, that leverage allows us to get good prices not just for those seniors and those under medicare, but it would then set a trend for other pricing done in the private sector through the other private markets. whether it's through medicare, medicaid, the veterans administration or through health insurers. the more transparency you have, the more the right price will to hide that ball from the american public keeps prices very high. >> do you agree these policies, the transparency combined with negotiating discounts for the medication work in tandem to effectively lower drug costs and stop price increases? >> absolutely and at the same time i believe it helps promote innovation because you see where we need medicines and manufacturers go into that space to provide medicine where the demand is there. >> thank you, secretary xavier becerra. i'm pleased the administration is committed to lowering prescript and drug costs for my constituents and americans across the country. we have the solutions to lower drug costs and i look forward to seeing those enacted into law and i yield back. >> the chair is pleased to recognize the chairman from utah for your five minutes to question. >> thank you, ranking member, mr. secretary. last year i invited you out to utah. i will re-extend that invitation and -- we would very much enjoy that. i know how busy you are but you also know the sense in middle america we have for wanting to be part of the solution, partly answer and what we are doing utah, we would like to brainstorm what we can do better. we will make it happen. >> maybe the best question of the hearing. as we know, the budget, the president's budget is a reflection of priorities so i want to talk about one priority showing up in the budget that concerns me not because of what is on face value but budget out locates funding from $10 million-$110 million for studying potential impacts of climate and for context the budget has $97 million for nutrition research. i am the first here to say what is happening with the climate is important and we need to pay attention to it and it has impacts -- i think we've got somebody -- >> i think annie custer, you need to shut your microphone off. i recognize your voice. are interfering and i think you don't mean to. okay? >> sounds like she has got it. >> let me just emphasize, i attended the conservative climate caucus and i'm aware of the importance of this but 70% of americans are overweight, prioritizing climate over nutrition and diabetes in healthcare, the optics of this, would love to hear from you about the prioritization of this, realizing every dollar our people are hoping is spent on their issues and how we made a mistake by prioritizing climate in this budget. >> i thank you for the thoughtful way you posed the question. i hope i can convince you the investment we are making to deal with climate change is going to be critical to make sure americans stay healthy. you come from a state the state likely, california, where the warm temperatures, the high heat can oftentimes have major impacts. we are finding communities in california are running out of potable water. you cannot raise a family if you can't access potable water and can't afford to pay for bottled water and there are many ways the climate change we are seeing, is affecting families. we want to do everything we can. the kind of investment we are put into that office as opposed to food and nutrition, obesity doesn't compare. we have been engaged on nutrition, issues of obesity for a long time and we are committed. not putting one over the other but it is recognizing as climate change has become a major issue when it comes to the health of our country. >> your answer doesn't surprise merely. let me reemphasize from my district's perspective the optics of this, of all the things that are important. when you come to my district you will hear this. there is a fear that climate will be declared a public health emergency. could you comment on that, i can tell from your look -- do you intend to declare the climate of public health emergency? >> i think most people recognize the climate change has already become an emergency. >> the official declaration. >> as you know there are many elements that go into any kind of declaration of a public health emergency. >> to be clear, is that something we will see coming? >> when it comes to the public health emergency we will outline the different criteria we take a look at. for example we are in this pandemic and in a state of a public health emergency, it relies on the evidence, the science to guide us on that and we would do the same anytime we are ready to declare any form of public health emergency. >> i have a few seconds left. >> you have another 20 seconds. >> thanks, madam chair. we know that covid 19 exasperated healthcare problems. many are experiencing isolation, children's mental health is in crisis, the more time goes on the more data comes out, the decisions we have made, specifically in my district you are going to see exploding of drug and substance abuse, we took a few minutes the other day and sent a notice to my districts, i will have a chance to speak on this and these are the responses that came in, personal stories about problems with substance abuse, 250 americans every day tied to drug overdose, want to emphasize that, realizing at a time when we would love to talk to you about that. i yield my time. >> the gentleman yields back, it will be quite a visit. the chair is pleased to recognize the gentlewoman from illinois, miss kelly, for your five minutes to questions. >> good afternoon, good to see you again. thanks for being here today. a few weeks ago we observed a black maternal health week and we just discussed it last night, the issues around maternal mortality rates especially when it comes to black mothers who are three to four times more likely to die from her pregnancy-related death than white women and i was proud the american rescue plan included a policy that i pushed forward strong support from this committee to give states the option to cover mothers on medicaid. mr. secretary, how many states have the option to provide 12 months of continuing coverage, illinois was the first. >> thank you for what you did, working with your colleagues, it is crucial, we had five states, illinois being the first to come on board to take us up on the challenge to increase access to postpartum care for women up to 12 months instead of just 60 days, we are now talking with another 11 states, 12 states who have indicated a deep interest in moving in this direction as well. as a result of the american rescue plan we hope what we can do is get close to 800,000 women in america under full coverage for a year of postpartum care rather than having it drop off after 6 days. >> that's great news, talk about the benefits of providing 12 months of continuous eligibility postpartum in medicaid and how it will help address the maternal health crisis. >> i say this not just as secretary but as the spouse of an obstetrician gynecologist, i can tell you about many experiences with some patients, 60 days is helpful but you don't stop being a mother with all the stresses of the child doesn't tell us and get healthy after 60 days, there's a lot that happens after 60 days, want to continue that care so the child grows up healthy and strong, we want the mother to be healthy physically and mentally, going through that process of becoming a parent and it is important we continue to provide access to the different health services, whether mother or child will be needing for that course of time because you want to set them on the right track so this coverage you made possible is indispensable. >> thank you. i'm thrilled that so many states have decided to take this option but we know this policy will sunset in 5 years and what is worse, when i think some states have decided not to implement this policy at all leaving mothers without coverage at a very vulnerable time. we need to pass a mandatory and permanent medicaid postpartum extension policy, that was included in build back better but also i wanted to talk about how we are closing the medicaid coverage to help women who are seeking to help women who are seeking care earlier in their pregnancies. >> we hope more states will take up the opportunity to extend medicaid coverage. we hope congress succeeds to provide several million americans who are not in states where the expanded medicaid has been available and what we know is the results are that families get to get upfront preventative care early and it helps american taxpayers to spend more money whether it is an er visit or conditions get difficult. whether it is through congress and i hope you all have success in expanding access to coverage and medicaid were 12 states that have still not expanded medicaid coverage for their citizens will take that on and one way or another see more americans have access to quality healthcare. >> thank you so much. the democratic leadership and the president, sent a letter to outline the key medicaid policies that should be included in the final reconciliation bill. thank you for the work you do. great to see you and i yield back. >> the chairwoman yields back. thank you for your extraordinary leadership. this has been heralded, came from the far congress and we have an agency implementing and implementing well but i think were it not for congresswoman kelly and the work done of the subcommittee in support of the subcommittee going to the full committee we wouldn't be hailing what we are hailing today. this is such important progress for our country. the chair is pleased to recognize the gentleman from pennsylvania. another one of the doctors. >> thank you. mr. secretary. i would like to ask about healthcare access. since your department says that is a priority, the recent rfi on access to care and coverage in medicaid and chip, and that rfi cmi asked for feedback on ensuring access to timely providers and services so i would like to know do you think it would be in the interest of medicaid beneficiaries if a state were to restrict access to providers of mandatory services so that only hospital in their county or service area, in their region would be able to provide medicaid services? >> i want to make sure i understand the question. you are talking about a program where medicaid would compel the restricted access of services? >> compelled only to be with hospitals that had eligibility requirements by whether or not there hospitals were unionized. >> so if there is a requirement based on a level of care or criteria imposed before a hospital or other provider can make use of medicaid services it may be a result of an effort to make sure the care that will be provided is quality. i have to have more information to answer your question more directly but certainly medicaid is in the game of trying to increase access, not decrease access to care and if access was decreased because in rural areas throughout the commonwealth of pennsylvania hospitals are not unionized, and would not be able to accept medicaid patients and would then separate services that are available for those medicaid patients would that be unacceptable? >> we want to make sure medicaid is supporting hospitals or providers that offer quality care and we want to make sure that we keep americans and patients away from facilities, providers that don't offer that level of care that we would expect because not only would it be bad for the patient but it would be bad for taxpayers to privy providing care in that way. only the particulars would be helpful given the specific response to any particular provider. >> earlier you stated you are committed that americans stay healthy. i share that commitment. americans who rely on medicaid for healthcare need to have access to care. as you know for the letter i sent two weeks ago my home state of pennsylvania is preparing to prohibit mcos from contracting with hospitals and other providers that had a work stoppage in the past 5 years if the provider doesn't have a collective bargaining agreement or labor peace agreement in place. this provision would not only be inconsistent with your recently published rfi but would also be in violation of existing medicaid statutes including cfi, availability of services. 42 cfr 48214 provider selection, 42 cfr 438.12, provider just, nation prohibited. a large amount of regulations and guidance that flow from these laws notably time and distance standards, network adequacy in particular as well as state guide to cms criteria for medicaid management career contract. your agency just released in january of this year with that information i would ask you, would you be prepared to reject a contract amendment or a state plan amendment that undermines access to care by denying medicaid beneficiaries the access to only hospitals in their county or service area? >> let me commit to you, if you believe there is a state plan that is not working in the best interests of any medicaid patients we will take a close look at that. we are in the process of reviewing any number of requests on how to implement the medicaid program and try to make sure that we move towards increasing access to care, quality care for patients switching to medicaid. >> i look forward to working with you on that issue. it is important and beneficial that medicaid patients have access to more facilities regardless of the presence of qualifying relationships with organized labor. thank you for agreeing to address that with us. >> the gentleman yields back, the chair recognizes the gentlewoman from california for your 5 minutes of questions. >> thank you, madam chair, mister secretary, for being here today and your work to make sure your strong vaccination campaign against the vaccine across the country to people who are most vulnerable and we are continuing to fight covid as we see new variants come through. we are you testify about the difference between the fdi and cms and i just want to comment on the decision i disagree with with cms on finalizing coverage policy to tighten and restrict coverage of fda approved alzheimer's treatments for an entire class of drugs. i had a chance to speak to the administrator and to hear your response. there seems to be a disconnect, we are saying that the fda can say something is safe but cms will decide whether it is reasonably necessary. that to me seems like we are saying the fda can't judge clinical data but cms can. and sending me a message, this is about access. once the fda passes it, people who have money and can pay for it will get it. people under a cms program won't. that to me as an access issue that continues to trouble me and continued, something i continue to have an issue about. we talk about access to healthcare, this is access to healthcare, the decision should be between a patient and their doctor and so i will continue to speak out because i'm so disappointed. this is the first time we've had a drug that has been approved under the accelerated approval process that hasn't been covered by cms so that's the comment i have. i will move on to my question, those are on different topics, the first one is on the children's health insurance program, the children's health insurance program has been a remarkable success. reducing the uninsured rate for children by 68%. %. in 2021 chip in rome at averaged 7 million individuals per month making it an essential source of children's health coverage and during the pandemic chip help to ensure that children and pregnant women had free access to covid 19 testing and treatment. despite its success chip is the only federal insurance program that isn't permanently funded so every few years congress scrambled to prevent chip from running out of money. can you speak to the importance of chip and your thoughts on having it permanently funded? >> thank you for the work you've done on these issues. there would be many more children living in poverty if we didn't have the chip program. there would be many more children discover later in their life that they were suffering from illnesses that might be life-threatening but are able to get the care they need to prevent that from taking a life with the chip program and as i said earlier, my mom would tell me better to prevent than to remediate, chip is a program that lets families who are lower income prevent illness and their children from becoming life-threatening and we would be in disastrous shape if we did not reauthorize chip. >> i want to talk about the cancer moonshot and multiple myeloma. an important factor reducing the mortality of cancer, research and early detection of rare and aggressive forms of this disease, multiple melanoma is a fatalist answer - a cancer, all stages of the disease, african americans account for 20% of patients diagnosed with multiple myeloma. despite being only 12% of the us population. my own sister who's a year older than me was diagnosed and is now battling this and will have it for the rest of her life. there is no cure. barriers to treatment are also present. they have the lowest stem cell transplant for multiple myeloma. given the mortality associated with rare cancers and lack of treatment options could you discuss how the reignited cancer moonshot would expedite research to improve the lives of people with rare aggressive diseases such as my formal -- multiple myeloma? >> excellent question, one of the things we are doing to help launch the president's moonshot proposal is to start by getting people back into the doctors offices, their estimates that 9 to 10 million americans failed to make their screening appointments for cancer because of the pandemic. we are going to launch an effort to try to encourage americans to go back and get checked because the sooner you get checked for quicker you can address the cancers the can be preventable. we are also making every effort to make sure that we take equity into account, who participate in these clinical trials and the work that is done to make sure we have treatments for every one. >> gentlewoman yields back, the chair is pleased to recognize the gentleman from texas, mister crenshaw for your five minutes to question? >> thank you for holding this important hearing, thank you for joining us in person. seems like there is some bipartisan agreement, that's good to hear as well. i want to talk about title 42. i want to ask why do you want to end the expulsions at the border currently authorized under title 42. i want to understand that. >> let me try to explain. we don't base determinations about title 42, which is a healthcare law with quarantine activities, we don't base those on what is occurring in terms of the border on immigration. it is a healthcare measure that is rarely applied and when it is applied it is because the health conditions are such that cdc has recommended we use it to keep populations from intermingling in ways that could lead to worse results when something like over 19 hits us. >> i would take that as the answer if you didn't also support title 42 authority to continue the mask mandate on airplanes, to mask children in head start programs, to authorize the eviction moratorium. got to be consistent, you either believe title 42 is still a necessary thing to do because of covid or you don't which is it? >> in the various instances you raised you will see the guidance cdc has provided his change whether it is for cruise ships or for children in school settings, they have all been adapting to the facts, the medicine and the science tells us should be the case with regard -- >> i find it hard to believe the science tells us there still covid on airplanes even though that has been debunked loudly, many times when the filtration systems on airplanes, still pushing for that mandate there is no coven on the border with a thousand people crossing every single day, what title 42 rescinded all estimates, this isn't even a partisan estimate, all estimates point to 18,000 day. is covid still a problem or is it not? >> congress and, maybe you disagree but we are losing more than 300 americans a day, over a thousand americans hospitalized every day. >> it is a problem. why not keep title 42 at the border? why not allow those expulsions? >> as i explained, the law that i used to declare public health emergency is different from the law, title 42, that you are referencing that is used printer plant only infrequently to deal with things like quarantines. >> there is no consistency here and that is the problem. >> there's actually consistency what the cdc has done. the cdc has been using the facts in the science to drive what it does. cruise ships are different from schools which are different from the border. it's not a cookie-cutter approach to the use of our healthcare authorities. title 42 is not the same as the emergency declaration. >> we have failed to provide the scientific data and scientific backing for saying covid measures are still required for children over 2 years old and on airplanes when both of those things have been debunked many times versus the border with 18,000 people potentially crossing every day and by the way filling up our hospitals, filling up on buses, moving into the united states, getting tickets to wherever they want, this is a problem and to say hhs doesn't deal with immigration and you look at this separately is also not true because uco are which is the unaccompanied minors. how on earth can hhs deal with a tripling, quadrupling of unaccompanied minors coming through your system when you rescind title 42. >> once again, by law, we are the entity, the office of refugee resettlement which takes custody of a child that is unaccompanied by an adult found at the border. by law the department of homeland security cannot hold the child for more than 72 hours. we then provide accommodation. >> i understand what your job is. >> there's no way you can do under these conditions, don't care how much money we give you, you are not. it is impossible. letting people going vast quantities. >> you understand, congress and, title 42 does not apply to those children. >> here's what is happening. you have an excessive number of people crossing the border and along with that is more people that come in large groups, this will happen, in extraordinary numbers. time is expired. >> the gentleman's time is expired. the chair recognizes the gentlewoman from delaware. congresswoman blunt rochester for her 5 minutes to question. >> thank you, madam chairwoman, thank you for joining us today to discuss the president's fiscal year 2023 budget for the department of health and human services. i want to start off by saying that i applaud the administration's efforts to make sure that americans get healthcare coverage and to protect us from this historic pandemic. it is not lost that we have come a long way and we still have a ways to go but i would like to focus on an issue that is a priority for me and so many others, the pandemic has exacerbated it, social challenges have exacerbated this and i'm extremely pleased to see the administration's budget request include several important proposals to strengthen access to mental health and substance abuse care and services. my colleagues on this committee and i have let efforts to provide your department and the departments of treasury and labor with new tools to strengthen the enforcement of existing mental health parity law. the department's regionally released report found that insurance companies are failing, falling short of providing parity in mental health and substance abuse disorder benefits and the report documented numerous parity violations. can you briefly discuss the report's findings and why mental health parity is so essential for our constituents? >> thank you for the focus you've placed on this issue and for the work you have done. we can't say we are going to try to treat the healthcare needs of americans if we leave out mental health services especially at a time when because of the pandemic we have seen how dramatically the increase in the need for mental health service is out there and especially for our children and so we will do what we can to make it clear that the president is going to invest 50 billion over the next 10 years to change the way we deal with mental health services and we will start doing more work to aggressively enforce the law to make sure compliance with mental health parity we have in place. >> the fact that some insurance companies are still failing to deliver parity is unacceptable and that is why i'm pleased to see the budget request includes funding for grants to help states enforce mental-health parity requirements. can you briefly discuss the challenges states face in the enforcement and oversight of existing parity laws and why this funding is critical? >> as former attorney general in the state of california will tell you, it is tough when you have a good partner in the federal government helping you go out and do this, you can do more than the federal government by itself so i think many states will appreciate that congress provides us with this funding, the grant help that will provide states who want to be out there aggressively enforcing these parity laws. >> far too long frontline workers have lacked access to coverage for mental health and due to loopholes in the current law that allow state and local plans to opt out of mental health parity and the budget includes a request to finally close this loophole. discussed the imports of ensuring frontline workers are protected by mental health parity laws. >> that - isn't it tragic when you find out you are working hard, doing everything to keep someone else healthy and don't have access to the kind of care you need. we will do everything we can to a lemonade those barriers that don't belong in the 20 first century. >> medicaid and schip cover 40 million children, investments in access to needed mental health services are cortical to addressing the national child mental health emergency. what are you proposing to address children's mental health challenges under medicaid and chip? >> we try to make sure first medicaid is available to all families and we have some states that are not taking up the medicaid opportunity to provide families with that care. secondly we are trying to make sure we expand coverage in places and community settings but more and more conversation about the possibility that medicaid could be there in schools to provide mental health services many of our children need. -in conversation with secretary cardona, we will see if we can expand access to healthcare for our children including in our schools. >> thank you for this focus. we have experienced individual trauma and collective trauma as a country through all of this and your efforts will make a big difference and thank you for being here. i yield back. madam chair. >> the gentlewoman yields back. the chair recognizes the gentlewoman from minnesota for her five minutes. >> thank you, madam chair. thank you for being here today to testify for the committee. as a member of congress, one of my top priorities has been to lower the cost of healthcare for my constituents. a priority i'm happy to see reflected in the 2023 budget. when discussing the high cost of prescript and drugs, those who rely on influence specifically we understand why prescription drug reform is so critical. drug companies charge more for in seoul and in the united states than in 3 dozen other countries and the average price in america across all types of influence was ten times higher than the average price for all other countries combined. that is why any solution to reduce drug prices must include solutions to reduce the cost of insulin. i'm incredibly pleased at the house recently passed my bill, the affordable insulin now act, which would have the out-of-pocket cost of insulin at $35 for those with private health insurance coverage or medicare part d but we know tapping the cost, out-of-pocket cost alone is not enough. we must continue to work on solutions to lower the list price of life-saving medications like insulin including drug price negotiation so insulin has been available, the cost the patients face are increasing. in your view is there any justification? >> thank you for the work you are doing on this subject. it makes no sense that a drug that has become so readily available continues to increase in price. it shows how broken our system is for drug pricing in this country and why americans pay more than most people around the world for the same drug, a drug often times manufactured here in the us. i applaud your effort, i hope you succeed in making it clear that we have to corral these prices and have something that makes sense for the american people. i hope you can pass a measure that goes beyond one medicine because so many drugs being overpriced in this country and what i can tell you is no american should not be able to get the drugs they need that every american should be aware of the effort you're making to make those drugs more affordable. >> thank you so much. i want to dig in a little bit about your view here. how measures already passed by the house like the insulin bill, such as empowering medicare to negotiate drug prices, inflationary rebates, how to those things work together to lower influence costs and i will follow it up by saying any comments you have on other efforts is undergoing to address the cost of prescription drugs in america? >> by opening those curtains to how these drug manufacturers operate and how they price their costs, that transparency would give everyone insight on how this is being done, not in the best interest of innovations. we are in a country that believes in competition and it makes no sense that the biggest purchaser of drugs, the us government, whether for medicare or medicaid or the veterans administration cannot try to get the best price for all those patients and to americans who deserve to have that treatment. if we are able to get the best price we will save americans not just a lot of money but add years to their life because they will be able to afford their medication. one of every 3 americans tells us they skimp on their medications because they have to make it last longer because they don't have enough money to use it the way it is supposed to be used, that's not right and we need to tackle fat and that is where your efforts are indispensably making it possible. >> one last question around your directive to cms to evaluate the premium increase, anything you can share? >> that is underway. it is a cockaded process. cms is working to give an answer. >> thank you for being part of the committee today. appreciate the partnership and with that i yield back. >> the gentlewoman yields back, the chair is pleased to recognize the gentlewoman from washington state, question for 5 minutes. >> thank you, madam chair and secretary xavier becerra, for coming before the committee to talk about hhs budget and priorities. let me say as a pediatrician thank you for prioritizing children in your budget in so many ways. i'm especially pleased to be at the expansion of the vaccines for children program to cover chip enrollees. this aligns with provisions in the bipartisan bill i sponsored with representative butterfield and representative mckinley that strengthens excellent and important program. also happy to see the pros who to access the providers who participate in the vaccines for children program and this is important, seeing the drop in immunization rates because of covid. last week it was reported that hundreds of thousands of students, protected from common diseases, used to be common diseases like measles, mumps, this is particularly dangerous in middle school, those who are behind on their vaccines where we already see outbreaks of whooping cough. the pediatrician mom, i know the best way to help anxious parents feel comfortable about vaccinating their children, and empathetic, compassionate, trusted provider, these conversations take time and trust is not overnight. the medicaid program acknowledged this last summer, recognizing the time and effort it will take from a clinic visit. and make sure children get caught up on childhood vaccinations and make sure pediatricians take adequate time to have these conversations. >> you pointed out how important it is that those trusted voices get americans to take the lead, so essential in this effort and pediatricians are among the most trusted individuals, when it comes to take important safety measures. we will work with those trusted voices including folks like you and others who can reach out and connect with families in ways that others can't. we will provide state and local governments with capacity to do more screening, to get the type of information they need. they let those children be vaccinated. and the federal government helps administer medicaid in case of children and chip. and those families who have lower incomes include their kids when it comes to the protection the vaccine provides. >> i appreciate having multiple locations where kids get vaccinations. other important conversations we have with patients, have the ability to do a visit regarding vaccines. i want to highlight comments, access to affordable healthcare and with the help of the american rescue plan a dramatic drop in insurance premiums affecting my state, 60,000 washingtonians, 100,000, pay one hundred dollars or less a month thanks to these subsidies and emphasize how important it is to keep those cost-cutting subsidies and not let them expire at the end of the year. is there anything congress can do to work with you to keep healthcare affordable at the affordable care act plans? >> the most important things you can do, continue those subsidy to make quality healthcare, those plans people have to buy, they only pay upfront in premiums but they use the healthcare services, they pay a ton of money but as mentioned, $100 a month -- >> gentlewoman's time has expired. the chair recognizes the gentleman from georgia -- >> mr. secretary. >> along with 12 members of congress i sent a letter to you and the commissioner on february 16th about an important issue about blood testing and the policies for the american red cross. the method in question, sepsis and two patient deaths. in december, the fda, are you talking about this investigation? >> i don't know a final results but we can check back in and have the folks from the fda talk to you as well. >> three different methods used here, they are the primary supplier of blood. the most expensive of all of them. and resulted in loss of life. that is a concern for a number of reasons. in a district like mine where i have a large rural area. you don't have a long shelf life on these things, rural hospitals suffer. the longer shelf life, the better it is for them and the cost is a factor as well. i am concerned about the hospital's choices being limited, provided with one bacterial medication. with the american red cross requiring most expensive and shortest shelf life, indicated to call sepsis, the only choice they have, can you understand my concern. >> can we follow-up with you. >> a healthcare professional. i have been fighting for years to get rid of call back fees, put best on one of my colleagues, peter welsh. two years later, insurance companies say we should only pay $7, and and small pharmacies as well. 95% of our population, we need to keep pharmacies open. the department, they require price concessions in medicare part d program. not to the third party or the middleman. do you agree that your rules, actuary analysis seniors would save on $23 billion over the next several years. >> we stand by what we do so far. >> i hope this will go through and hope you will implement this rule. i heard some chatter, some noise that it may be delayed. an actual situation where we decrease prescription drugs costs per patient. without inhibiting research and develop an, discouraging research and development, having transparency and the drug pricing chain and making sure discounts are at the point of sale they go to the patient. >> if you permit me i would like to salute all the pharmacists who were heroes in this effort. >> i'm proud of the work my profession has done because as you mentioned and i mentioned earlier most successful healthcare professionals, that is why this issue -- i yield back. >> the chair recognizes the gentlewoman from massachusetts for five minutes, followed by the gentlewoman from texas followed by the secretary has agreed to this, the gentleman from alabama, that will conclude the hearing. you are recognized. >> thank you. mr. secretary, thank you for being here with us. the fy 23 budget, indicates this administration prioritizes affordable acceptable high-quality healthcare for all americans including those in underserved communities. in my district no one has been more to the underserved and under extremely challenging circumstances, the nurses, doctors and administrators, as you recall from your visit last august the hospital, 80,000 residents of a beautiful bustling, diverse and historic city, 80% of the city's residents are of hispanic or latino descent and the area was struck by natural gas explosions in december 2018 which devastated the community. just as the city was recovering, the pandemic struck setting progress back. on a per capita basis, the city suffered greater numbers of covid infections than any of the other 350 cities and towns in massachusetts. at one .3 quarters of the capacity was dedicated to recovering covid 19 patients. time and again lawrence general has come through for the 20% living in poverty. the patient publication is public payer, primarily medicare and medicaid. by caring for underserved and covid ravaged community, lawrence general inexperience -- covid force them to pause and postpone more lucrative services, lawrence generally struggling financially. the proposed budget does not include funding for safety net hospitals like lawrence general who are particularly hard-hit by covid 19 and financially unstable. i am curious how you see the fy 23 budget helping hospitals like lawrence general keep their doors open as they provide critical care to their communities through covid 19. >> thank you for the question and thank you for your constant consistent advocacy for the people in your district who use lawrence general hospital, for all the good work they do as well. we will do everything we can whether it is through the medicaid program or medicare program to provide services, resources to those providers who are providing services especially to our less well served families throughout the country. we had conversations regarding the provider relief fund that lawrence and other providers were utilizing to recover covid costs they had, we think it would be a phenomenal opportunity for congress to provide us additional resources to supplement the provider relief fund because it is essentially out of dollars so we could provide services and support to those providers who stepped up and as i explained before we do a distribution of the dollars in a very transparent way. can't speak for what was done before we came to office but anytime we distribute a dollar in the provider relief fund we will know how. >> i appreciate that. hhs didn't request additional funding for safety net hospitals or tighter relief in the covid supplemental. could you speak to the priorities reflected in the supplemental and how we work together to get safety net hospitals the funds they need to get through. >> if you look at the original request made for supplemental earlier this year it would include funds made available to the provider relief fund, that request was substantially more than what is being discussed in negotiations, were a supplement to package. we would love to see dollars included in the supplement a package and provide additional resources to the provider relief fund. we don't have a vote in that process. you and your colleagues make a decision. we hope in your wisdom you will include funding for the provider relief fund to provide services that those hospitals will suspend to the populations who need that support. >> thank you, i am out of time. i yield back. >> the gentlewoman yield back. the chair recognizes the gentlewoman from texas, miss fletcher, for her 5 minutes to question. >> thank you for coming today to discuss the president's fiscal year 2020 budget request for the department of health and human services. i have three issues i would like to raise with you in my time today. i'm thrilled that congress authorized the advanced research projects agency this year and recent advances in biomedical sciences or immunotherapy, highly effective covid 19 vaccine demonstrates the strength and success of the us medical care prize. such advances prevent an opportunity to revolutionize how we prevent treatment and cure rare diseases including cancer, alzheimer's and many others that affect a significant number of americans. in march you announced part of nih, the physical location would not be at the agency's campus and as my colleagues heard many times i represent many people who work in the texas medical center in houston, the largest medical center in the world, hunted the most innovative medical research in the world today, texas medical center is uniquely situated with existing infrastructure, research institutions and incredible people, the people who work there are willing to ensure this new agency. i want to ask when you plan on announcing the application and what you are taking into account when making the decision about its location. >> thank you for your interest and support. we are in the process of making those decisions. we would like to work as closely as we can with the inaugural director before we launch too far but i can tell you we wanted as much independence as possible, untethered from the previous ways we've done the research because this research we want to have the applicability as quickly as possible versus basic research we see, phenomenal research done, i will tell you i have duly noted, a great site in texas, whole bunch of folks reached out and told us the same thing. it is a fabulous opportunity for america to launch just as the department of defense was able to launch real innovation we hope arpa h will do the same. >> thank you. i want to touch on other issues affecting texas. and your insights, raising issues with you. i have raised the first issue with cms to use medicaid that is unable to access basic article reproductive health care services for almost the year because of the continued termination of planned parenthood from the texas medicaid program but a disastrous impact that is really just decreased access to care with violation of the medicare requirements. i saw your exchange with representative pugh and i look forward to swift action to support this requirement. the second issue i would like to talk to you about is a similar topic, incredibly important component to ensure reproductive economy is medication abortion, and effective option in early pregnancy and now that the evaluation mitigation requirements have been eliminated, what is used during that. i want to make sure hhs is empowered to protect where there are so many restrictions increasing every day. the reproductive health care task force, hoping you could update the committee on steps the task force is taking to make sure it is accessible. and how to facilitate the provision of care and the clinics and the pharmacies mail and telehealth and show me how to prioritize this issue. we would appreciate it. >> respecting the time left i can follow up with you more specifically but i can tell you when medication is made available because fda decided is safe and effective and we have a job to make sure we provide care to as many americans as possible we will do what we can to enforce the law to make sure everyone including abortion care get services and products medical products they need to exercise their rights. >> thank you, mister secretary. i have gone over my time. .. that they need to be able to exercise their rights. >> thank you so much mister secretary. i have gone over my time. madam chair, i yield back. thank you. >> gentleman yields back, mister secretary i want to ask you to do something. i know that you're ten minutes past where you want to be. mr. palmer is waving on, mr. >> the gentleman from alabama is recognized for five minutes to question. >> thank you, madam chair. i truly appreciate your indulgence. secretary becerra, i have expressedve this concern in othr hearings and i think we are facing a crisis of confidence in our nation, public confidence in many of our institutions. a lot ofnc it has borne out of e handling of covid. we have become more divided as a nation. impacting healthcare, and the trust in healthcare. what i want to ask you about, i hate to do this, but it just has just issued a medicare physicians peace schedule fun will that includes a provision that provide a financial incentive for doctors great and the bullet and antiracism plan. that's raising a lot of concerns onia people, and i just want to hear from you a little bit about how this is going to operate. i'll tell you my concerns. i think it undermines public confidence in two ways. it raises questions in the minds of minorities that if they see a physician who is not of the same race or color that they are not going to get quality care. it undermines the confidence of people who are white, that they are going to be discriminated against. how would you address that? >> congressman, i want to be as thoughtful and my answer as you were in the question. first, we don't have policy ases you described. our policy is to try to tackle the disparities that we see in wehealthcare access. i could tell you the number of stories i've heard from women, mostly black women, who go in to get care and they're not believed when they say they are in n pain. people who have experienced, because of sickle cell, experience deep, deep pain when they present an emergency room at ed o'keefe treatment. that should be provided a someone who suffer from sickle cell disease. t we know that this happens. to ignore it is to ignore a travesty in our system. we are simply trying to say that no one should be denied health care center because the disparities that exist present you from getting the care you need. >> we always have those rules and by the way one of my best friends, dr. tim downs one of the leading researchers in the world at the university of alabama birmingham on sickle cell research and he's white. he devoted his entire career to that. i want you to understand that there is a divide that is being created here. it's going to further undermine public confidence. and we have to be extremely, extremely careful about how we address this, all of us, not just the biden administration but all of us. and it creates serious concerns that, you know, if you go into a doctor's office and you think if you put down you are white you're going to be -- >> to that point if you will permit me, much of this is driven by the ms. and disinformation. i would challenge you to show me where in our policies we call anything we are doing antiracism policies. we're still trying to make sure everyone has equal access to health care. here is our doctors after discriminate against anybody for any reason they need to be dealt with in another manner. that is totally unacceptable, totally unacceptable. >> agree with you. i just want to raise that point, let you know that this is an leissue, there are people out there live raise concerns to me about it. i intend to address it further at the appropriate time, but i do appreciate very much you answering the question and your assurances that it is not the intent of hhs to discriminate againstmu anyone. i will hold you to that, and also again i sincerely appreciate you staying 30 minutes past the original time that you said you give us, and with that, madam chairwoman, i will yield the remainder of my time. >> gentleman yields back the remainder of his time. mr. secretary, thank you for accommodating the members and the members that have waived on and you would take the questions, very generous of you. thank you for being here today. we have covered a lot of ground. i would just quickly raise two points, mr. secretary. you're a former member of congress. you know that you wanted your questions answered when you addressed those that were representing agencies. i think the assistant secretary of legislation has some work to do, catch-up work year, because on both sides of the aisle members have made reference to writing but they haven't had their questions answered.. and secondly, i think that it's important as secretary of hhs to have a plan is, in fact, title 42 is lifted. you have responsibility for a plan, public health plan, so there's not any public health disaster relative to those at the border. so that is your responsibility. i know that 42 is kind of up for grabs right now because of a court case. but nonetheless, hhs have to have a plan. i don't know what that plan is, but i expect that you would come out with one and outline it. >> madam chair, on that point, if you're referring to the situation at the board of we do have plan to address the situation, post title 42. if you are speaking more generally in terms ofdo what happens to the country without title 42, we have been working on that as well and we can present that you and many members if you would like. >> no, it was a former, not the latter. >> remember, madam chair, that title 42 does not apply to the individual at the border that hhs has jurisdiction over come the children. we haven't had 42 apply to unaccompanied minor children since december 2020. >> anyone who comes into the country that is admitted into the country, there are public health issues there. we have had to deal with them before, and we might be presented with that case, i don't know. the courts of what the administration is going to do, but you always have to have a plan, and i don't think we can walk away from that. all right, i just have a unanimous consent request to enter two items into the record here does the -- >> nos objection. >> no objections. so without objection, sot ordered. members have ten business days to submit additional question for the record, and the witness, we ask that the secretary respond promptly to any questions that are received, ans at this time the subcommittee is adjourned. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] >> today on c-span, the house is back at 10 a.m. eastern for general speeches followed by legislative business at noon. members are considering a senate passed bill that expands the president's ability to send military aid to ukraine by waiving reimbursement requirements. on c-span2 the senate returns at 10 a.m. eastern. a vote expected in the afternoon on whether to start negotiations with the house to reach a final agreement on a semiconductor manufacturing bill. at 10 a.m. on c-span3, homeland security secretary alejandro mayorkas testifies about border policy and other dhs operations in front of the house judiciary committee. then at one p.m. the house foreign affairs committee here's some secretary of state antony blinken about budget priorities and the u.s. response to the crisis in ukraine. >> american history tv, saturdays on c-span2, exploring the people and events that tell the american story. 1 p.m. eastern a discussion on the advanced placement u.s. history exam with jason stacy and matthew wellington co-authors the fabric of a nation, a brief history with skills and sources for the ap u.s. history course. they will explain of this year's exam is structured, provide strategies for answering questions and analyze historical documents. at 2 p.m. eastern on the presidency, scholars and political expert at the bipartisan policy center look to see how the presidency change in the first two decades of the 21st century under presidents bush, obama, trump and biden, including a look at the late 20th century presidency of bill clinton. exploring the american story, watch american history tv saturday on c-span2 and find a full schedule on your program guide or watch online any time at c-span.org/history. >> c-span now is a free mobile app featuring or unfiltered view of what's happening in washington live and on-demand. keep up with the days biggest events with live streams of floor proceedings and hearings from the u.s. congress, white house events, the court, campaigns and more from the world of politics, all at your fingertips. you can also stay current with the latest episode of "washington journal" and find schedule information for c-span's tv networks in c-span radio plus a variety of compelling podcast. c-span networks available at the apple store and google play. downloaded for free today. c-span now, your front row seat to washington anytime anywhere. >> senator orrin hatch passed away last week after representing utah for more than 40 years. next, a treatment from a man who replaced him, mitt romney. this runs about ten minutes. >> i rise today to honor and celebrate the life and legacy of an extraordinary man, a giant

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