Transcripts For CSPAN3 Sec. 20240703

For joining us. I will start off with a little bit of history. Topic one, drug prices. In july of 2020, donald trump said since the day i took office, i have made reducing drug prices one of my highest priorities. For four straight years, donald trump complained about high drug prices, did lots of finger pointing at others about the problem and repeatedly talked about how he was the best friend of seniors best friend seniors who depend on medicare could have. What was actually accomplished over the last four years . Exactly nothing. Asked forward to the Biden Administration. From the time fastforward to the Biden Administration. From the time joe biden took office, he made it clear he was committed to lowering drug costs and Health Care Prices for families. I remember him having a conversation with me shortly after the election. He said the finance committee is a place where things happen. And everybody has been talking about doing something about drug prices forever. Now is the time to get something done. And to actually help seniors. Not just talk about it, because there has been plenty of talk. But actually get results and provide real pocketbook relief to seniors and consumers. Two years later, President Biden and many colleagues who are on this side of the aisle, worked very hard to get results. To lower prices on medicine and President Biden signed the Inflation Reduction Act into law. For the first time under the law, democrats and President Biden gave medicare the authority to negotiate better drug prices. Understand what that means. It means that seniors beat big pharma. Big pharmas holy grail, what they cared about more than anything, is prohibiting negotiation for a better deal on medicine. Look at what they are doing right now. Going to court, trying to stop any negotiation. But we have it written in the law that there is going to be negotiation. On top of it, most americans have access to free vaccines. Insolent costs for seniors were capped at 35 a month. As we said, when the government leads on these issues, particularly the showpiece of American Health care, medicare, almost always the private sector copies it. We have seen Real Progress in the private sector as well. We want every buddy in america to get that pricing relief but we are making Real Progress. We also created price gouging penalties for the first time to hold big pharma accountable for high drug costs. Those are benefiting patients and taxpayers. Plenty more to do. It is essential that finally, after all of this debate, we get pharmacy benefit manager or Pharmacy Benefit Management reforms across the finish line and congress can finish this crucial change thats going to help all of these wonderful people in their white coats because they are here to keep the small pharmacies going in the lower drug costs for patients and protect Community Pharmacies. Thats the difference, folks. On the first issue of drug prices. Donald trump, President Biden. Topic two. Health insurance. In march of 2019, donald trump said the Republican Party will become the party of health care. The Number One Health care goal, stated again and again, the number one goal, repeal the Affordable Care act. Get rid of the whole thing. On that one, he failed, fortunately, as well. Under President Bidens leadership, democrats boosted tax credits for Health Insurance, saving millions of americans an average of 800 per year for coverage and access to care. When you look at President Bidens budget, what you see is a clear focus which is to build on the progress the biden has made. With all of these Health Care Changes in mind, the next question is what do donald trump and the republicans have planned when they talk about health care . The American People are wondering, because not once during the aca repeal and replace crusades, not once did we see an actual replacement. Seven years after the efforts to repeal the aca crashed and burned, nothing has changed. Donald trump still says lets get rid of it. He still lacks a plan to take care of all of the people whose Health Care Coverage is doing that his doing that would actually rip away. Hes talked about gutting americans Social Security and health care benefits. No plan to keep seniors out of poverty and illness, either. Thats the difference between Senate Democrats and what President Biden is talking about and what donald trump and republicans are talking about. Republicans plan to shred the health care today that millions rely on and pretend everything is going to be fine. So, on these issues, i think it is clear that there is a gap between President Biden, Senate Democrats and donald trump, with respect to health care. The gap between those trump promises and biden action on health care, the difference on the actual records between the two is as deep as crater like. Democrats made promises to be American People and we got results and delivered. Im going to wrap up by saying there is another issue today that is pending that is very important for kids and health care. That is to get our bipartisan tax deal with congressman jason smith passed in the senate. It helps 16 million kids and immediately let 400,000 kids out of poverty. Youll have to take my word for this. Here is what the president of the American Academy of pediatrics had to say about this. In case anybody is interested, hes from oregon. Dr. Ben hoffman. Hes a doctor at oregons very own Oregon Health and science center. He has said there is an inexplicable link between poverty and inextricable link between poverty and child health. An inextricable link between poverty and child health. What we are trying to do that got 350 seven votes in the house of representatives, is help those 16 million kids be healthier. 400,000 of them would get out of poverty right away. So, we want everybody to know this morning that we are all in in terms of getting it done. We want to pass that bill for the child tax credits and their company and their research before the april 15 filing deadline. So, hearing from the American Academy of pediatrics, as we wrap up this discussion, as far as i am concerned, its as good as it gets. We will have good input from secretary becerra about how President Biden will continue to lower costs. First, we will hear from senator crapo. There is one thing that you and i agree on. We have to control drug prices. You already referenced it. You see a number of folks in the audience in white coats. Those are pharmacists. We met on the grass side in front of the capital today with hundreds and hundreds of them, to talk about one of the most important things we can do, which we need to do right now. Which is to get the pdm legislation, which passed this committee, 260, on the books. So that we can start one of the most significant things that can be done to help control drug prices. I want to focus on that. We have our disagreements on what we consider to be a Price Control Program and the impact of it. But we have places where we have agreement. Im hopeful we can make progress on that right away. Back to my formal remarks. Thank you mr. Chairman and thank you, secretary becerra, for being here today. Over the course of the past year, the finance committee has taken bipartisan action to tackle a range of health care challenges, leveraging collaboration and consensus to advance commonsense solution for seniors and working families. Our Pharmacy Benefit Management reforms would modernize medicares Prescription Drug benefits, driving down costs at the pharmacy counter and netting billions in savings for taxpayers. The committees Mental Health proposals would build on previous efforts to shore up Patient Access to critical services, especially in row communities. These policies received nearly unanimous support all through regular order. Your department and its sub agencies have offered essential Technical Assistance throughout these processes. That support has ensured alignment between our legislation and its intended goals. And i thank you for that. As we move forward, further action on these overdue patient focused proposals must become an urgent priority. Not just for our committee, but also for the administration. We have a responsibility to patients, Community Pharmacies and Front Line Health Care providers to deliver on these commitments. Regardless of policy differences on other fronts. The president s budget request, unfortunately, falls severely short of that aim. On Prescription Drugs, the document makes virtually no mention of the robust partisan bicameral efforts. Instead, opting to double down on a price control policy that polarizes members in both chambers. Bipartisan bills in the senate and house would address unintended consequences spurred by the Inflation Reduction Acts pricing provisions. Particularly for patients with rare diseases, who will likely see fewer Treatment Options under that law. Rather than embrace these avenues for viable reform, the budget seeks to expand the Program Scope with no attempt at improved transparency, certainty or mitigation. Further, the president s budget request confirms an overreaching mandate that would force Nursing Homes to close their doors and result in less access to home and communitybased services for medicaid beneficiaries. This document highlights the visions and misses vital opportunities for productive, patient driven partnerships with congress. We will continue engaging with your department on a host of Health Care Hurdles that demand policymakers attention. You have rightly raised concerns on around the ongoing surge in medication shortages, including for lifesaving therapies. The chairman to die recently and i recently released an outline of solutions to mitigate this crisis. And we look forward to working with hhs and cms to develop legislation designed to achieve these goals. We also stand ready to partner on proposals aligned with the president s cancer moonshot, including by ensuring that seniors can access innovations like multicancer Early Detection screening. Those tests can be invaluable. Earlier, i joined senator bennett in reintroducing our bill to grant Medicare Coverage with bipartisan majorities in both chambers. Bipartisan majorities in both chambers have joined as sponsors for this legislation. While the administration aired in rescinding regulations aimed at expediting access to medical breakthroughs, your department could take a range of steps to restore patients trust in reliable coverage for medical devices. Including by expanding and enhancing the proposed pathway that cms published last year. Before closing, let me emphasize the importance of timely communication with respect to the cyberattack on change health care. While you have taken important steps to issue guidance and flexibility to insurers, providers and contractors to mitigate the effects of this hack, over the the over two week delay resulted in unavoidable uncertainty. Already, financially vulnerable, rural hospitals and providers with little to no cash reserves required immediate action by the administration to ensure payrolls could be met and services could be continued without interruption. In the coming days and weeks, hhs should continue to update members and stakeholders on efforts to limit further disruption. We have an obligation to build on longstanding legacies of bipartisanship and bolster the clinician workforce, drive valuebased care, improve broken Payment Systems and ensure longterm access to telehealth. With these joint goals in mind, thank you again for being here, mr. Secretary. And thank you, mr. Chairman. Thank you, senator crapo. Getting a 260 vote in major legislation involving enormous sums of money is just about impossible. Its hard to get a 26 or 270 vote on ordering soda pop. Thank you for your work on that. Secretary becerra. Sec. Becerra thank you for the invitation. When President Biden took office in january of 2021, covid was ravaging our families and our economy and americans were dying at a rate of 23 9 11s everyday. In january of 2021, the number of americans with Health Insurance was, like our jobs and the economy, down and on the canvas. Prescription drug prices were skyrocketing with patients and their pocketbooks at the mercy of big pharma. Today, three years later, nearly 700 million shots of covid vaccines have gone into the arms of americans and we can now manage covid like the flu. Today, more than 300 million americans, a record number, can go to the doctor or hospital and not go bankrupt because they have their own Health Insurance. More than 21 million of those americans can count on the Affordable Care marketplace for their insurance. Another record. Today, while big pharma is still big, the president s new Prescription Drug law has brought down the price of insulin to 35 a month for americans on medicare. As we speak, we are negotiating with Drug Companies to lower the prices of even more Prescription Drugs. Even as they sue us to stop us. The president s budget doubled down on the investments that made the comeback of our jobs, economy and health possible. It fosters innovation and protects every americans access to the care she needs. This budget does not just strengthen medicare, it strengthens it beyond our lifetime. This budget continues our ship for our Health System that treats illness to one that sustains wellness. All told, fyi 2025 the fy 2025 budget provides 1. 7 showing dollars in mandatory funding to advance our mission and invest in key priorities. The budget provides medicaid like coverage to low income individuals in the outlier states that have not expended medicaid under the Affordable Care act. When that happens, another 1. 5 million americans will have Health Care Coverage and the peace of mind that comes with it. This budget builds on the largest investment in a generation. It bolsters a 988 suicide crisis lifeline and gives young people support at home and school. That means boosting our Behavior Health workforce with 12,000 new psychiatrists, psychologists, clinical social workers, marriage and family therapist, council lists and peer support specialists. Across hhs, they tackle the Maternal Health crisis by improving access to preand postnatal care. We are making child care more affordable for working families. And more available where families live and work. This budget will provide increased wages for Early Childhood education workers and it would fund more than 750,000 slots for children in head start. And, it funds universal preschool for our nations 4 million fouryearold children and eventually will include our threeyearolds as well. Our budget grows and strengthens the Cybersecurity Initiative to ensure safety and privacy and keep our hospitals and providers, especially smaller ones and those in Rural Communities, running and secure. Finally, this administration has made tremendous strides in preparedness capabilities since the pandemic. And we keep building. This budget invests in countermeasures to combat antimicrobial resistant drugs, to expand monitoring supply chains and innovate 200 data sources across federal, state and local governments to improve information sharing. We cant reduce the health and wellbeing of americans to a line on a budget spreadsheet but we can transform the numbers on that Balance Sheet into investment and services that sustain health and promote wellness for all americans. President biden has presented a forward leaning budget. I look forward to taking your questions. Thank you, secretary. Let me start with the lower Prescription Drug cost for seniors issued. I went through some of what former President Donald Trump said. He said Pharma Companies were cutting away with murder. He said that would change under his presidency and that he would create a fair and Competitive Bidding process and prices would come way, way down. They are exact quotes from donald trump and i am quite certain, mr. Secretary, when you came in, none of that had been actually accomplished. I described a president with a conversation with President Biden after the election where he said he would stop the price gouging and cap outofpocket costs for seniors. He took on big pharma and he won. Not just talk, delivery. The secretary, one, that i was very involved in, stop this price gouging. Is it correct that some seniors are now saving 618 per dose on a drug they get at the Doctors Office . Sec. Becerra senator, thats correct and its going to grow even more in terms of savings because, as we boost through the years, many of the provisions you passed are kicking in. Today, a senior will not have to worry about these enormous costs if they are on a drug medication because there is a limit now on what they will pay with their cap spending. It might be 3500 this year but next year, the limit on expenditures outofpocket for seniors is 2000. For the first time, in addition to the price gouging penalty and the outofpocket costs of these priorities that i mentioned, for the first time, medicare is negotiating drug prices. As i say we beat pharma and took away their holy grail, which is trying to prohibit negotiation, i like to hear more about the high cost drugs that you are negotiating. How many people with medicare take the drugs that you are negotiating this year . I dont believe ive seen aggregate numbers on this. I think the American People would like to know how many people with medicare take these drugs that they are fighting to lower the prices on. Whats the number . Sec. Becerra let me work down. We know there are 65 66 million americans who received health care through medicare. Not all of them were the 10 drugs that were negotiated. But for many, they are lifesaving. In 2022, the cost of these 10 drugs for medicare, just the 66 million americans for medicare, the cost of those 10 drugs in 2020 was 46 billion. Outofpocket, about 3. 5 billion. It is big money for just those 10 drugs. The next year, when we get to negotiate for 15 more drugs, we will get to save americans even more. Whats the ballpark number in terms of how many people with medicare are taking these drugs . Sec. Becerra i could not give you the specifics on all of the 10. I dont have that before me. But, they are very well known drugs. For seniors, they treat principled issues like cancer, heart disease, kidney failure. Its the kind of chronic disease that we know a bit about. Why dont you get is that for the record. But you are saying the amount of money involved in this area, i thought i heard you say 46 billion. Sec. Becerra 46 billion for one year for 10 drugs. Ok. Lets talk about this cybersecurity breach, which is so serious. Im of the view that it also relates to the fact that these facilities are getting bigger and bigger and then i think they become a systemic risk. And we have to get on top of this for a long time top of this. For a long time, private companies have been allowed to set their own standards and it does not seem surprising that neither the United Health group nor federal agencies were prepared for this and its fallout. My view is the Health Care Sector is a prime target for criminals and foreign adversaries. As these companies have become so large, it is creating a systemic Cyber Security risk. Today, there are no federal mandatory technical cybersecurity standards for the healthcare care industry, even though people have been talking about this for ages. Something like two decades. I want to make it clear that that has got to change now. I understand in your budget youre going to increase penalties for compliance violations and make the first actual concrete proposal to require a real, mandatory cybersecurity standard for hospitals. Mandatory standards are a great first step but we have to do more and the next steps have got to be accountability for negligent ceos, for example. Which will enable hhs to better protect patients and our national security. Will you work with me, mr. Secretary, to Start Holding these executives who are not doing their jobs, complying with the kind of Safety Standards the people have a right to expect on cyber, will you work with me so we Start Holding the negligent ceos accountable . Sec. Becerra mr. Chairman, we look forward to working with you and every memory on these issues. Thank you, mr. Chairman. Mr. Secretary, last year, this Committee Voted Unanimously to pass two bipartisan support bills. These provisions would generate billions in taxpayer savings and bring down costs for seniors with chronic conditions. These bills reflect the most bipartisan and consensus driven solutions to challenges raised by embers across both sides of the applicable spectrum. This issue is absent as i see it in the president s budget. Sending a troubling signal to the patients and Community Pharmacy and Health Care Providers across the country. Secretary becerra, what concrete steps does the Administration Plan to take to support our efforts to get this legislation moved expeditiously and put into law . Senator, we are prepared to work with you. I have said this for about over a year, both in this chamber and in the other chamber, that we are ready to work with you on reform. We want to find that there will be more transparency. We agree that there is no reason to have a middleman if they are not going to provide health care. We look forward to working with you and we appreciate there is bipartisan support. I did say you have given very good Technical Support as we have given this legislation. Im asking the president step up and use the pulpit to get this legislation moved in this congress. I would ask you to please take that request back to him. Sec. Becerra you are probably aware, senator, that we did in event at the white house on this issue that highlighted it for the American People. When the ira past nearly two years ago, mr. Secretary american seniors have experienced the consequences of the law. A growing number of Clinical Trials for medical breakthroughs have been canceled read particularly for rare disease drugs, part of these plans exclude more and more medications from coverage and subject others to prior authorization and therapy for critically needed care. Payments skyrocket, often tied to sticker prices which exclude any rebates. Secretary becerra, can you commit to working with congress on a bipartisan basis to remedy these issues and improve the program, rather than prioritizing ira expansion, which remains both a partisan and unrealistic endeavor . Sec. Becerra senator, we look forward to working with you on a bipartisan basis. I will say that the president is very clear and is doubling down on the ira and making it work more effectively. We look forward to working with you on a bipartisan basis. It has been disappointing to hear but we received the president s message and im just asking you to help us try to find some Bipartisan Solutions to move forward. On telehealth, telehealth coverage has proven critical for our seniors and working families across idaho and the rest of the country. Unfortunately, without additional action, Medicare Beneficiaries and americans with high, deductible health care plans, risk access to losing risk losing access to telehealth overnight. Patients face profound uncertainty as we move closer to this coverage cliff. Secretary becerra, what actions to your department and agencies plan to take in order to avert this unacceptable outcome as well as reassure millions of americans who rely on telehealth for coverage every day . Sec. Becerra we continue to work with your colleagues here and the house of representatives at the extensions of some of those flexibilities. Statutorily, we are constrained in being able to extend some of those flexibilities. We are working with our state and local partners because, as you know, many of those issues will involve state rules and laws. For example, a practitioner practicing beyond state lines to improve telehealth has to be done with the concurrence of state before a doctor in your steak and practice in my state. We are working to extend these telehealth flexibilitys. We understand part of that falls in our court. It helps when we have a mutual activity to try to get those kinds of resolutions to the finish line. Thank you for your attention to that. With that, thank you mr. Chairman. Thank you so much, mr. Chairman and ranking member. Secretary becerra, welcome. It is always good to see you. We appreciate the work you are doing, you and your department. I really appreciate the critical investments to expand Health Care Access and affordability for communities for families across the nation, that is proposed in the president s budget. This really does build on the investments and work we have done as democrats with the president for the last three years. I want to say, i want to correct one thing. Please. Former resident that former President Trump didnt do anything her prescription jugs, i would say he didnt do anything for people on Prescription Drugs. But President Trump did give a 40 tax cut to big pharma. A 40 tax cut and it did not translate to a 40 reduction in prices for the seniors in michigan or for anybody on medication in michigan. We have been focused, working with the president and with you on cutting Prescription Drug costs for americans who have been paying the highest prices in the world. The bills that we have been working on together improve access and transform the way that we provide health care in this country, which is so important. And, as you know, its something i care deeply about. We have over 21 Million People now receiving health care through the Affordable Care act. That is a record, over 21 Million People signed up for insurance, very, very affordable insurance. That is including 400 18,000 michiganders. Many getting it for 10 a month, 20 a month. It has transformed families lives to be able to have that health care. The Health Care Premiums have gone down hundreds of dollars for 271,000 michigan residents who are using the Affordable Care act and, of course, the 35 cap on insulin is lowering costs for seniors in michigan and across the country. Not counting the cap on outofpocket costs or next year, when it comes to a permanent 2000. Its a big deal. Its a big deal. So, i want to just ask you a question and speak to what i like to Call Health Care above the neck. We need to make sure health care above the neck is the same as health care below the neck for people. And we have made historic investments in Mental Health, on a bipartisan basis. It has been terrific to see that happen. I appreciate partnering with you and the president to lower costs and create more access as you have talked about. But, particularly in this budget, the president including significant investments in the future of communicare, where we are helping through the Health Care System and not through grants. As you know, this is something that keeps people out of the hospital, out of the jail unnecessarily. People off the streets that have been homeless and gets them the care that they need. So, we expanded nationwide through the bipartisan Safer Communities act. States are stepping up to participate. We have more states this spring that will be coming to be full program. I know that the budget not only supports their expansion but making it permanent. I also want to give a shout out to you senator cornyn, thank you for being my partner and moving forward the definition to make sure they are permanently part of medicare and medicaid. Thank you for partnering on that. Can you elaborate on your plans to make this a Permanent Foundation for how we provide Behavior Health and communities across our country . Senator, first to you and senator cornyn, thank you for putting together something that has proven to be a Great Success and now that Everyone Wants to do. Mental Health Conditions dont service between 9 00 and 5 00. They occur at any hour and any part of the day and you have to be ready. What you all did in making Certified Community Behavioral Health Centers Available, Critical Care Centers Available 24 7 was a god saving measure for so many people. Sec. Becerra we are going to try to encourage other states to buy in. Because the more we have these matters, the quicker we cut the cost for taxpayers. Many of these folks in up using the emergency room to get the care that they need. What you have done is, by establishing these centers that are specific for them, for Mental Health conditions, it gives them a chance to see her fresh nose that could treat them right away. We are going to build that and the president s budget commits to that. Thank god you came together on a bipartisan basis to address what nine in 10 americans say is a growing crisis in this country. Thank you. Thank my colleague, neck to senator grassley. Im going to bring up a problem with your department. The same problem ive recently had with the environmental e. P. A. Great it isnt just your department that this might be a problem with. But last month, i wrote oversight letters to 15 hhs contractors and grantees. Those 15 organizations received some of the largest contract awards for the care and placement of unaccompanied children. Many children have been placed in a very dangerous situation. I want to know what these contractors are doing to ensure shareholder safety. In response to my 15 letters, your department sent an email to contractors and grantees on february 20 that i want to quote. Kindly direct senator grassleys office to hhss office of assistant secretary for legislation for this request. My staff have been told by contractors that they are ready to respond to me. But hhs instruction has so far caused them not to. Do you accept the premise that recipients of congressionally appropriated taxpayers money must respond directly to congressional oversight requests . And i hope you can answer that positively that they should. If not, when will if you would agree with me, when would you direct your staff to clarify to recipients on my letter that they must respond to congress . We have had the epa say in these letters that i sent to other groups spending taxpayers money, that they could respond directly to me. Can you say that for your department . Sec. Becerra as a former member, i want to be able to conduct oversight from when i was in the house of representatives. These contractors, they give americans every right and opportunity to respond to you. We offer them guidance if they wish to have it. They are under no obligation to get it but you are within your rights and they are, as well, to be in communication. As a followup, let me be very clear. These folks have received together billions of dollars of taxpayers money. When i and my colleagues request for information, they have an obligation to respond and this administrations interference which evidently we are not going to have anymore, at least for a while, has been obstructing. Another question, if hhs receives a Law Enforcement request for information relevant to a childs trafficking investigation, does the hhs provide that information to Law Enforcement without requiring a subpoena . Sec. Becerra mr. Chairman, we work on an ongoing basis with Law Enforcement throughout the country. We care for and have custody for minors. We continue to work with Law Enforcement throughout the country. We follow the rules. In some cases, we are dealing with private, sensitive, confidential information and we make sure we follow the rules so we dont violate any individuals privacy. Are you saying in some cases, you direct to Law Enforcement without a subpoena . And are you saying in other cases you might need a subpoena . Sec. Becerra we tried to make sure that we are complying with the law when it comes to providing information. Some information is more confidential than other pieces of information. We make sure we are not violating any privacy rights or any protections in providing information whether it is to Law Enforcement or any other entity. This will have to be my last question and then i will submit for writing answers. At last years budget hearing, you and i discussed supporting Rural Health Care and the need for cms to utilize the Rural Community hospital demonstration program. Right now, cms is only using 25 of its statutory 30 hospital spots for its program. You told me last year that hhs would do more to support rural hospitals in need. Following our discussion, i wrote cms administrator and but that is where the progress stalled. Cms explained that in order to fill the open spot, it would require 12 months of work and too many hospitals would be interested. If cms has the tools to help one rural hospital and isnt in, you should be doing something about it. I realize you might not know about every program at hhs. But, why doesnt your department want to help rural hospitals throughout this program . Its budget neutral and congress has reauthorized it three times since 2003. Sec. Becerra may i respond . Briefly. Sec. Becerra lets follow up on this. But i will tell you if you take a look at the president s budget, and we can get back to you with a number of the projects that we have undertaken in Rural America, we are doing a great deal. Especially with many facilities that are on the verge of closing. That would be worse for many parts of Rural America. Let me follow through with you on your particular concerns. Because we have quite a bit to talk about when it comes to our work in health care for Rural America and this budget, as you will see, makes Major Investments in Rural America. Senator menendez is next. Sec. Becerra for years, communities across the country have struggled to fill major provider workforce gaps and growing crisis exacerbated by the pandemic. Based on my legislation, congress authorized the creation of 1000 new medicare slots in the consolidation of appropriations consolidated appropriations act of 2021. Cms has repeatedly included additional criteria, not specified in the law, which unfairly disadvantages many states, including new jersey. Since enacted, there have been two rounds of distribution for these slots which means we are 40 of the way through the program and new jersey continues to be completely shut out. Its been years and we still dont have an answer as to how we get Teaching Hospitals in my state. The law states the secretary shall not made shall distribute residency positions to each of four specified categories and providers. So, what can you commit to doing to help insurers that states are no longer unfairly shut out of the program in contravention to the way the law is written . Sec. Becerra center, i appreciate the question because i know this is the one youve worked on for quite some time and our team has been trying to be responsive to your staff as well. As you know, new jersey, like california, the circumstances sometimes make it difficult for some regions to be able to qualify for some of the resources and in this case, gme slots. We are more than willing to work with your team. The resolution is not so simple because, as you try to resolve the issues that affect states like new jersey or california, you create other issues for other states. Let me interrupt you. Its not so difficult. The law is clear. It is cms that the kingdom of cms that has decided to add additional criteria that congress did not stipulate. Im sure when you are a member of the house and ways and means mitty, you appreciate it when federal agencies changed the law that you helped pass and enacted it in a way that was not your intention. Thats exactly whats happening here. I think you have the power to fulfill the law as it says the secretary shall distribute residency provisions in accordance with the law. This is not happening in accordance with the law. And so, the suggestion that the apartment is trying to be cooperative and helpful falls short on me. I hope we can find a better way forward. Last month, your agencys Inspector General issued a concerning report, finding that over a few months period, 16 of unaccompanied Migrant Children files like any kind of sponsored background checks. It also found that nearly 20 of cases were unaccompanied minors released to sponsors, pending a background check. There was no documentation confirming those checks were ever completed. Given the alarming pipeline of unaccompanied Migrant Children being released to situations where they are ruthlessly exploited for their labor, this is a blind spot that needs to be addressed. We are talking about potentially thousands of Migrant Children who are sent to unvented sponsors. As the report concludes, the failure to complete background checks increases childrens risk of being released to unsafe sponsors. What actions has your agency taken to the finding respond to the findings of the report . Sec. Becerra senator, i can assure you that most of the recommendations that were made by the Inspector General for incidents that you are referring to incidents that occurred in spring of 2021 over a two or three month period. I can assure you that what was being observed by the Inspector General back then is not the case today. If you recall at that point, we had an infrastructure that have been virtually dismantled. We had to stand it up. We were dealing with an influx. Today, we would find none of that is what youre telling me . Sec. Becerra you would find we are doing background checks and thorough assessment of anyone who is seeking to become a sponsor. I look forward to seeing that as a reality. A recent Supreme Court decision has upended vital protections of patients, protections that Congress Passed 40 years ago. A bill to amend that act and protect patients. Unfortunately, we are not able to get your agency to work with us. Will you commit to cms, working with my staff and senator cassidys staff, to have the appropriate information we need to address this problem . Sec. Becerra i commit to make sure our staff is working with your and senator cassidys staff. I know weve been engaged with some of these folks on this particular issue. Thanks, mr. Chairman. In august, your department recommended the reclassification of marijuana to a scheduled three for the Drug Enforcement administration. Previous administrations used a five factor test to determine what the scheduling of a drug should be. This administration, your office has created a new two factor test to determine excepted medical use. Whats the reason for the change . Sec. Becerra senator, thank you for the question. As you will see from the report that has been made public, there has been a lot of science that has been collected over the years on cannabis. We have far more information now, as you know, throughout the country, many states have moved much farther than the federal government has, even in places like texas, you see where action has been taken on cannabis. We are reflecting what the science is showing. Youve compared it to heroin in terms of its potential for abuse. Why didnt you compare other types of drugs that were scheduled by your office . Sec. Becerra im going to try not to speak directly for the fda because the fda did this assessment analysis independently from hhs. They are the agency that has been passed with that job. I wont try to speak for them. I will say that the rigorous work that was done to come to these conclusions was based on the science of the evidence they had before. Did they do Additional Research on Brain Development or Mental Health consequences or impact on pregnant women . Sec. Becerra im sure they took into consideration all the information out there on both the effects and the evidence that there is on cannabis use. You are saying that for a fact . Sec. Becerra im saying i dont want to try to speak for the fda and the scientists because i did not do the actual assessment. But you announced a recommendation. I assumed you would take into account impact on adolescent Brain Development and Mental Health consequences or pregnant women. Sec. Becerra as i said, im sure the fda would have taken into account all the different circumstances involved. I did not make the recommendation, it was made by the fda. I want to follow up on some of the questions that senator menendez and senator grassley asked. Your department is responsible for the administration of the office of Refugee Resettlement, correct . Thats correct. That means any unaccompanied children who come to our border are basically transferred to your care by the border patrol, correct . Sec. Becerra thats correct. And you identify a sponsor for them, in the interior of the United States. Correct . Sec. Becerra thats our obligation. And there are about 400,000 of these unaccompanied children that come to the United States during President Bidens term of office. Can you tell us where they are now . Sec. Becerra we can give you information on the vetting process. No, i asked you do you know where they are now . Sec. Becerra as i said to you, we can tell you who the vetted sponsors were that received thats not what i asked you. I know that you have interviewed sponsors to some extent although not adequately, i agree with senator menendez. Do you have any response ability for their welfare as you sit here today . While they are in our custody, we have jurisdiction to provide im talking about now that they are in custody of your vetted sponsors. Sec. Becerra you did not give us so that is not your responsibility is what you are saying . Sec becerra we dont have jurisdiction. You dont know if they are being traffic for sex, whether they are going to school or getting the health care that they need . You simply dont know. Sec becerra what they are in our care. Then they are transferred to their sponsors . Sec becerra you have not given us the authority to monitor. Whose responsibility is to look after these children . My understanding is this that the statute is that our jurisdiction ends after we have delivered them to a vetted sponsor and the communities where they reside will be a charge of providing for their services. Sec becerra as a result of the broken border policies they have been placed was sponsor. You dont know where they are. You dont think that is your responsibility and wrinkly, do not care. Sec becerra that is not accurate. This system has been broken for more than 40 years. You and i have been in congress for quite some time. I started back in 1993. Right now you have a one. 9 trillion budget and responsibility to care for these children and you simply hand them off to sponsors, in homes where you dont know the conditions they are living in, whether they are being sold for sex or forced into labor. You dont know and you dont think its your responsibility. The time has expired. I am going to go to senator lankford but we just got information from the department of health and human services. The number of medicare he beneficiaries because of negotiations is 9 million. One out of seven Medicare Beneficiaries. Senator lankford, you are next. Excuse me senator carper just came in the room. You are next. You are before senator lankford but we did not see you come in. Ok we will go with senator lankford and come back. Let me do a quick followup on what he was just talking about. Individuals placed from custody that are unaccompanied minors are they always placed in homes placed in the home with someone who is not legally present in the country and we dont know their legal status . Sec becerra our authority is to place them with someone we bet who will place them in a safe shelter. What percentage of people are placed in the home with someone who is not legally present in the country . Sec becerra i couldnt tell you at this time. These individuals are fed up and not for the status . Sec becerra our responsibility is the care and safety. Are individuals vetted, do we know children are placed in the home was someone legally present . Sec becerra i dont want to evade the question but our question is what elements would this be safe . So legal residence is not on the list. Sec becerra im not saying it doesnt get considered. We dont know which percentage . Thus not a consideration. There is a new rule on Nursing Homes that i completely concerned about. It will cause a closure overall Nursing Homes. What this is going to cause is a dramatic rise in prices and a difficulty to get our end those places. I would ask you to reconsider that rule. My state is half rural half urban. Those places that are roles they want to maintain their Nursing Homes on the world i did not vote on which is passed by hhs. I will challenge you to reconsider that so rural Nursing Homes can stay open. You know this is coming is because your office contacted us at 11 00 p. M. To answer a question on this. Let me ask for clarity. Last year, you created a rule on title x funding in my state, if it does not put on our health pamphlets, brochures a way for people to get access to an abortion if they did not put that phone number we would lose title x funding. You follow through on our threat and took title x funding which takes away from aids testing, Cancer Screening and those things you took away from my state because my state would not put a phone number in our health brochures of where people could get an abortion. That violates federal law because title 10 funding is not about abortion. You created something new with that. Why would you take away that funding and is that true . My state has lost that money for aids testing and screening because of that. Sec becerra im not surprised by your question and you wont be surprised by my answer and i dont agree with the way you framed it. If it were as you framed it we would be in court losing. We are in court right now there is an appeal. Sec becerra we are able to enforce the law as it stands. Individuals going in for services should know the services they are entitled to. A person should be informed of the Services Available under title x. If a state wants to not abide by the law they understand the consequences. They wont get their money. If we dont put a one 800 number on where to get an abortion. Sec becerra thus not the case. That is the one issue if we added this one phone number does not fulfill its just a phone number to get an abortion. What has happened is aids testing, Cancer Screening thats a bully tactic to be able to say i will remove these things if you dont do what were asking you to do which is not in the statute. Sec becerra we expect those who follow the law who want federal funding. Sec becerra then you would get your money . There is another decision coming up in the Supreme Court as they hear about chemical abortions. There has been rumors out there and individuals saying if the Supreme Court says something about chemical abortions the fda should ignore it. We dont know the direction the Supreme Court will make once they make that decision will hhs stand by that decision. My colleagues time is up. It involves the United States constitution. Sec becerra we always follow the law. The time for the senator has expired. Welcome to finance committee. Lets see. I am so intrigued by this exchange. Here we go. When it comes to drug pricing, my principles are simple. We must lower costs for American Families, encourage innovation, curb rising costs for the government. For the past several years we pretty much accomplish those things. Last congress the president signed into law the Inflation Reduction Act. Including provisions to end high cost of drugs. Medicare beneficiaries made vaccinations available at no cost, capped out Medicare Part d at 2000 and authorized medicare to negotiate drug prices with manufacturers for high expenditure drugs. We made historic progress in making Health Care Accessible and more affordable. We are not done but we are heading in the right direction. I have the opportunity to tackle the high cost of health care by addressing the growing public Health Crisis of obesity. Despite obesity is being classified as disease, the Economic Impact has risen 1. 7 trillion dollars per year. The cost of doing nothing is way too high. Way too high for the american government. I introduce the act was senator cassidy which would expand Medicare Coverage of intensive behavior therapy for obesity it would authorize the medicare benefits to cover medication use for the treatment obesity. Ive been champion for the obesity act for decades. How will your and your team at hhs work with us to invest in this prevention and clinical obesity. We think this is one of those. We look forward to working with you because we know with sophistication of science we will have opportunities to make the difference of the lives of americans so we look forward to working with you some programs like medicare are at the forefront for americans to get the treatment they need. Covid19 taught us many lessons including we have is the acute hospital care at home waiver known as hospitals a home. We saw the demand for homebased care when facilities were overcapacity and patience wanted to receive care at home. It was established under the Public Health emergency to meet this demand by allowing Medicare Beneficiaries to receive help Care Services at their home. We have seen the hospital at home program become a true success story. Proven to deliver higher Patient Satisfaction along with positive Patient Outcomes and potential cost savings. To ensure patients and providers have access to hospital at home for two years beyond the covid19 emergency senator scott and i introduce the act a bill signed into law last year. What lessons have we learned from the success of the hospital at home program . Sec becerra i hope are able to report on all the lessons because the study required will give us an opportunity to see how to do this. The study we are going to be putting forward should help us understand how we can try to move in a direction for folks that need care in their home. We look forward to working with you on that. We look forward to it as well. We look forward to working with you and again, this legislation had bipartisan support and im grateful to senator cassidy, dr. Cassidy. Next to senator casey. Mr. Secretary its good to have you back here and thank you to your service of this country and i want to start with the issue of Prescription Drugs and grateful for your work in the work of the administration and the efforts to lower the cost of Prescription Drugs. We know Prescription Drug costs are significantly higher than so many of our competitor nations. I voted for the Inflation Reduction Act which had a provision for medicare to negotiate for lower prices and had the 35 a month pack on insulin for Medicare Part d beneficiaries. Im holding up here in the large version of a piece of paper i put out a couple of months ago now to summarize the benefits the Inflation Reduction Act Prescription Drugs just in pennsylvania. Just the capping of insulin at 35 a month, 80,000 pennsylvanians will benefit from that. Another one for highlight, we know less than a year from now the 2000 outofpocket cost cap will go into effect and that will impact 800 29,000 pennsylvanians. Big numbers just in one state. I wanted to ask you to give us a state of play. Whats already in effect and how is it working . What has he Administration Proposed in the budget to further expand policies and measures that will rush it down the cost of Prescription Drugs . Sec becerra we will want to ask you a copy of that document because we could use any index to help convey that to consumers. 35 insulin is lifesaving but people on fixed incomes you know how important that is for seniors who depend on their Social Security check. The fact that today a Pharmaceutical Company that raises the price of their drugs beyond the rate of inflation we can yank back the extra they are charging be on the rate of inflation. We are in the midst of negotiating for the 10 costliest drugs which in 2022 cost americans in medicare 46 billion. We will finish that negotiation by august and announcing the price come september. Those prices would then come into play at the beginning of 2020 six. Next year we will negotiate another 15 drugs. We will be saving a ton of money the Congressional Budget Office we will save 100 billion in just negotiating for better prices in the first time drugs. You are aware, the cap on how meant she will have to spend out of your own pocket. The cap of 3500 for catastrophic cost but by next year, when people are paying for these drugs if they have cancer or kidney failure. Thousands of dollars because there cap aside. Next year, the cap is 2000 overall. A game changer. And that goes into effect january 1. Sec becerra yes sir. Walk us through the proposals of this budget. You said the president proposed 15 more Prescription Drugs to be negotiated . Sec becerra we know it works if the cbo is telling us just for these 10 drugs we save a 100 billion to taxpayers why do we limit it to 10 . You all helped us to negotiate 15 but why stop a good thing . List negotiate more because were paying 2, 3 times the cost of drugs and people around the world. The second issue i wanted to note how grateful i was to the president s budget to allow states to provide continuous Medicaid Eligibility for children under the age of six. This will reduce coverage, ensuring kids have quality to health care which is one of our number one priorities. I introduce legislation for all children through the age of 18 on medicaid. How is hhs working to expand access to medicaid . Sec becerra you mentioned an important aspect that the president has in his budget. Were trying to ensure we provide care from the moment of birth because were focused on Maternal Health. Too many women in america are dying or their babies are dying within the first year. We offer a woman on medicaid not just 60 days of postpartum care but 365 days. So far 4550 states have adopted that. That will help kids moving forward to start off on the right track. Thank you so much appreciated. Senator johnson a stacks. Secretary becerra will, welcome. I have written 60 oversight letters having to do with our response to covid, the vaccine injuries to your agency. Into your sub agencies. I want to talk about three of those. The origins of covid. And anthonys file cheese emails. In june 2021 4000 emails were released under foia request. Under a week i have five members of Homeland Security signed a letter requesting those 4000 pages unredacted. You agree to the fact that foia those requests can be redacted for a host of reasons but congressional oversight were not subject to reductions . Sec becerra i dont want to speak out of turn but we continue to make sure we protect confidential information and privacy information and tried to do the best we can. Were not subject to the same reductions in u. S. Code5 section 29, 54 and request of the committee on Governmental Affairs 85 members there shall submit information requested of it. We went from 4000 pages to 400 pages unredacted over the course of a number of months, we are down to the last 50 pages of the 5g emails. I was hoping you would bring these unredacted because last year, and a similar hearing i asked you about these and you said, you are entitled to that information by law a member of the senate or house to get. Why havent you turn those over to us a year later . Sec becerra i will try to make this as clear as i can because secretaries before me have tried to answer this question in many senator house members have asked over the past. We try to make sure we fulfill the request without undermining national security, confidentiality and the interest if your withholding information from congress at a minimum you should be providing the reason for withholding this information. You said i was entitled to the information required by law. We have not gotten a response from you or a privilege log, why not . Why arent you listing the privilege or claiming to hold these pages unredacted. What privilege are you claiming . Was the privilege being claimed . Sec becerra i know your staff has been engaged with our team when it comes to trying to respond to their request that we tried to respond the best we can. You have responded you should have presented a privileged list so we can understand what privilege is you are asserting for withholding this information . Let me move on to two other things. There is Standard Operating Procedure shortly after the vaccine got its emergency use authorization laying out an analysis that they would do on the adverse reporting since the first reporting ratio. I have written five or six oversight letters trying to obtain that analysis. I have gotten buckets. Bupkiss. Why are they withholding their analysis . We found the agencies and that data should be made available to the American Public . Why are you withholding that information . Sec becerra i will try make sure i can get back to you. I cant speak directly for the reactions of the fda but we try to be responsive to any requests we have. Sec becerra your agencies have not been responsive at all if are giving me the middle anger. I request a phone call within a week or two. I have run out of time. I have significant questions that the agencies are ignoring. Over 5000 Adverse Reactions from one covid vaccine. These are serious issues and the American Public deserves this information. I expect a phone call from you with the privilege log and why you are not releasing the analysis on hot lots identified by outside researchers. The time has expired. Secretary, thank you for being here. First of all, thank you. The incredible work you and your team are doing around Prescription Drug negotiation as authorized by the Inflation Reduction Act is so important. So thank you. I also recognize big pharma is in court trying to challenge your authority under that legislation which unfortunately is happening. In addition to the inflation reduction enacted negotiation we also imposed caps on outofpocket spending for seniors for the first time. How was the initial out of pocket capital benefiting seniors right now and how will it change in full effect next year . Sec becerra thank you for your work. I know nevadans are able to keep extra money in their pocket because of the work you have done to lower the cost of Prescription Drugs. Many americans have very high cost for medication. They are perhaps suffering from cancer. Maybe they have kidney failure but often times their costs are extremely high. While medicare pays for a lot of outofpocket cost it could be tens of thousands of dollars. This year the catastrophic cost kicked in as a result of the lower cost Prescription Drug law. No senior today pays more than 3500 outofpocket and next year, 2025, the most any senior will pay is 2000. That is a lifesaving measure for many people. Ive heard from so many of our seniors. How did they become aware of it . Are they pushing out information . Sec becerra i had a senior, to me and say i went back to my pharmacist because when i saw what they charge me from my insulin i went back and said you under charge me and they said no thus a new price. She was in the clouds because this was a senior on a fixed income. 35 is real money in her pocket. That makes a real difference. When we jump to Mental Health. Every single Nevada County is a designated Mental Health shortage area and 16 out of 17 are Mental Health shortage areas. The president s budget proposes to extend the 10 incentive for physician services. This is passed a bipartisan package to receive and increase bonus for practicing. Should this shortage area become law they would receive medicare reimbursement. Nevadans may have access to a Nurse Practitioner or clinical social worker. Has hhs evaluated how expanding the range might impact our workforce challenges in a Rural Communities . Sec becerra you are right. As a result of covid, there are Health Professionals that may not be physicians that can do some of that work they are prohibited from doing. The licensee is she that at the state level. For certain practitioners, a Nurse Practitioner to do things beyond what is provided by state law we have to have the states make amendments. Covid taught us a lot of Health Professionals are ready to go they have to be free from those constraints. One thing i know working in my state at a federal level there is only so much jurisdiction you have it it does require state or local Community Partnership here. When it comes to looking out for the best interests of our kids or access to more physicians are Mental Health clinicians coming into this state there is a role for the state to play. I appreciate the work you and your staff are doing with that partnership. Senator cassidy . Thank you for being here. Senator menendezs and i requested coverage for dialysis patients. Protective mom act that allowed others at risk for problems during pregnancy to have stayed home monitoring. It has been outstanding for months. I know your staff is busy with lots of requests but this will save lives. Can i ask that you ask your staff get these filled as quickly as possible. Sec becerra cms is besieged with so many Different Things the latest being this change in health care and cybersecurity attack. Let me see if they can work with you at double speed. Let me next ask about monitor. Is that an inhouse . Or is it cloudbased . Sec becerra i will be honest with you i will get back to you. If you give us the name of who you person is nonstop we will get that to you. There was a recent finding by the National Association of acos published data suggesting seven Fraudulent Companies stole 2 billion in medicare payments and they did that using a Virtual Research data center. I would like cms to have been on top of it and i would like to ask you about data monetization. Academics have use the data so that they relied upon cms to stream it. I was surprised to cms said it would discontinue sharing data with institutions begetting august the 19th of require researchers to move to the Virtual Research data center. I understand the per user prices quite high. I dont know if her get a lower thought price for academics or have you done an analysis on how many researchers and students can access the data if you go to this . Sec becerra we are in the process of reviewing this. We have a solicitation for information to get responses back. This is a fairly new area and we want to get more aggressive forgetting everyone on board. No one can keep data unlocked with the Cyber Attacks occurring. If youre open to researchers having it at a discounted price. Sec becerra i will speak to where we go but we are open because were trying to learn along with everyone else. Would you give me followup on that . Sec becerra absolutely. The researcher is incredibly helpful to our committee and the fight that she might not have it is deleterious. Sec becerra were trying to get everyone to give us their best information. The big guys can afford to do these things but for the little guys is very expensive. Any information theyre getting we want to have it. What percentage of hhs employees are four days a week or more in office . Sec becerra at hhs, we have been working on day one and continue to have folks come into the office to work and i can tell you we are complying with the Office Guidance when it comes to an office work levels. What is that requirement . Sec becerra its not a straightforward requirement because there are different work schedules. Typical employee . One day a week, three days every month . Sec becerra every day. Ihs, every day. The hhs building. Sec becerra most of us, every day. What about nonpolitical appointees . Sec becerra there is flexibility for career staff. It could be three out of 5, 4 out of five. Was the least amount . Sec becerra there are some folks that are telework altogether. Are you monitoring vpn data. The systems we monitor it are from the 70s and 80s. It is difficult to get the dots connected. The time for my colleague has concluded. As you know oral health is critical to Overall Health and you have provided some addition medically necessary determinations in regards to medicare and medicaid. I would need to be able to continue to recognize that a lot of the services that are medically necessary but traditionally not covered under these programs. Can you tell us how you are using the authority you have to expand access to medical the necessary oral health . Sec becerra i know we are trying to expand access to health in Rural Communities because we now see a contraction of what we are trying to do where you have given us authority to provide flexibility in a way to how they operate. Sometimes is difficult because there are consequences when you have a minute neutral way of operating. We could choose your help to really reach Rural America with health care. We want to work with you to evaluate Clinical Evidence for additional dental services to determine whether medically necessary and we know sometimes it is a struggle and interpretation and i know the senator and i are working on it but under the Affordable Care act you can deal with Necessary Services and use that to try to expand care. Let me ask you in regards to the issues concerning this committee with transplant issues. Can you tell us the status of making sure we can have fair competition and quality in regards to the system reforms related to transplant of organs . Sec becerra we are trying to move aggressively with the Reforms Congress enacted which reflected the reforms we had proposed and regulatory channels. What we will need is resources because were trying to set up an independent board that will monitor the transplant activities. Were trying to create a robust system of competition and we need help to make sure we can get that as soon as possible because everyone agrees the resources we have to bring us uptodate or not there. I hope in this budget process were able to get those resources the president has proposed. Let me ask you about another subject dealing with drug shortages. The wealthiest country in the world has spent the most by far on medicines that we have relatively inexpensive drugs that are in short supply. I find that outrageous. We have dealt with shelflife so drugs that are still effective but we find without some system of carrot and stick we will always have the shortages and thats unacceptable. Can you tell me the strategy you are deploying so that americans have access to critical medicines that are not difficult or expensive to produce but because the manner in which our market works, they are in short supply. Sec becerra our problem is current statutory authorities given site at the in stage at the retail level we see the shortage. People can find the truck on the shelf and they cant get it from the pharmacy. We are asking if we can see a shortage or constriction occurring at the early stages. Waiting until the retailer says i have enough is too late so were asking to have greater insight into what the manufacturer sees. The second thing we would like to do is make sure we bring home much of that manufacturing because we should not be dependent on china for the materials it takes to create pharmaceutical medications. We would like to bring that manufacturing back home. The president included 95 million to have a possible to have manufacturers based in the u. S. In regards to what type of drugs are taking under the fda when life is short. Senator brown. Thank you chairman, mr. Secretary nice to see you again. We just as something in toledo, it better to people there. I want to thank you for your work on Prescription Drugs. 35 dollar insolent, 72,000 seniors will benefit, 219,000 ohioans who rely on the aca will benefit. We want to expand this as i know you do. We want expand the insolent cap not just Medicare Beneficiaries. The federal government lowering, better pricing for patients. We used to take buses to canada and negotiate the price the way our own v. A. Does saving 50, 60, 70 . Walk through it briefly, how this will all work and how hhs can work insulin into law to ensure lower Prescription Drug cost . Sec becerra ive had conversations with seniors who rely on their Social Security check for their daytoday living when they hear 35 is all they will pay for their insulin were before they were paying 150, 200 is a godsend. Today we can yank back the extra profit of Pharmaceutical Company is making if they try to raise the price of the drug by the rate of inflation. Thats a great thing for americans on medicare as well. The outofpocket cost for a senior is being limited. Even if you have to use the expense of cancer drug you wont pay more than 3500 outofpocket. And that number comes down. Sec becerra next year to 2000 total. Can you think about what this congress has done in terms of restoring 100,000 pensions restored what the child tax credit. Dropping poverty rates by 40 , it affects huge numbers of people that need a little bit of help in their lives. I want to shift to East Palestine, the site of eastern ohio. I make my ninth trip there this week. The administration announced grants to get work underway on health monitoring. Thats a good first step. I am asking hhs to set up a disease registry for the residents of the community and i want you to commit to working with my office and surrounding this issuance of voluntary disease registry for longterm health monitoring. Sec becerra i think you for your leadership on this. East palestine, you are always on my behind to make sure we do something and im glad we got 50,000 to that local Health Center to help them out. We are glad we sent cdc to do in person surveys to figure out the health status. We announce six grants that go out to help understand whats going on there and East Palestine and we are prepared to work with you and state and local partners on registering these other matters. To other quick things. I appreciate your commitment during last years hearing to use her project Labor Agreement on an irs institute. Niosh institute. To help understand workers illnesses and diseases and it matters. Thank you for that and we look forward to working with you to see this project through to completion and get that pla n. We spoke recently about financial issues, the train going through salem was on fire before it derailed. That Regional Medical center faces problems but because of medicares contract i want to ensure we keep providing care through the center. Sec becerra we are prepared to work with the center. Senator braun i thought you would be interested a couple of years ago you were helpful in creating that price gouging penalty where drugs were over inflation and the secretary confirmed just one of those drugs is saving 600 per dose. I wanted to say thank you for your efforts on that. Thank you mr. Chairman. I wanted turned to the crisis of the southern border and how it is overwhelming our Health Care Centers in the United States. What we have seen on the news, hospitals and sanctuary cities. In new york city, chicago, boston tell us they are at risk of collapsing financially because of the overwhelming number of Illegal Migrants who are getting free care, having the American People pay for their care. Chicago reported seeing 16,000 migrants last year. The cost of their care is over 30 million paid for by american taxpayers. Denver health was in the headlines reported over 20,000 hospital visits from migrants. The hospital is in financial distress. They are asking the federal government to bail them out and it is a completely democrat caused failure. Can you explain why it is the responsibility of american taxpayers to foot the bill for all of this care for 9 Million People from all across the world who flooded their way into the United States . Sec becerra what i can tell you is we have extended the resources and authorities we have it hhs to try to be there to help any Health Care Facility when there is a way we can go it be supported. I dont know if a particular case, i know we are prepared to be supportive at any facility where the authority you have given us i have gone into support. Is not hard to find stories about hospital sensation where he said same were overwhelmed by the number people we are treating in no way to recover the cost. The federal government doesnt pay for the health care of every legal citizen. Why should american citizens be forced to pay for Illegal Migrants to receive the same care for you . Sec becerra as i said, i dont know how particular states operate their Health Care Systems with regards to the folks coming in. When we are proposed whether its a Medicare Program or those seeking other types of funds to help them we are ready to be responsive. When a hospital inundated with people not paying the shift the cost to people who are paying and thats happening all across the country. I want to talk to you about something senator lankford asked about and thus the nursing home Staffing Ratio requirement. Your department is proposing a rule on Staffing Ratios required a registered nurse be there, see hours per patient per day and hardship exemption for Rural Communities who cant find people to hire is requiring much more paperwork. Most would have to hire additional staff to just fill out the paperwork that your department is requiring. We have concerns that we have express them and she said Medicare Medicaid has committed millions of dollars to support Nursing Homes. How will these funds reach Rural Communities . Only four out of five nursing home saying we cant comply with what the administration is forcing upon them . Sec becerra you packed a lot into the question. Mb respond to the issue of funding and how it goes to Rural Communities. We have made sure we get those dollars into the communities that need it most to staff. If youre going to call yourself a nursing home you should have a nurse to provide care. Its embarrassing that nowhere near 60 Million People live in a nursing home one out of five who died of covid died in a nursing home. All we are seeking is that all Nursing Homes meet the standards you or i would expect for a loved one. My times expired so i wont go into it, only one in five Nursing Homes could meet those requirements. They will be out of compliance with Administration Rules and you are saying, all of these Nursing Homes are incompetent to provide care. Your times expired, senator bennet. This is not the topic i came to address today but my Dear Colleague gracie issue of in home health. First of all, Denver Health is a national treasure. I dont think the doctor would disagree with that. It is a critical public assess hospital for the western United States. It has a massive problem because of the amount of uncompensated care even without the current Immigration Crisis we are talking about because we unlike every other industrialist country in the world dont have uncompensated care that no one else will cover because no private Insurance Company will cover it or know what the hospital will cover it. There is Denver Health sitting there covering it and saying said many people who are uncompensated because we have a moral obligation. The taxpayer covers that care to. Its not like the taxpayer is paying for that because of our broken Health Care System. Lets Work Together to fix our Health Care System so we dont have the immoral crisis we have because people are covered in this society. Those point number one. Point number two, is not Denver Health responsibility or dare i say, denvers responsibility or even colorados responsibility to fix the immigration system. The Founding Fathers of this country understood congress would have to fix the immigration system in this country and be responsible for it because even in the 18th century it wouldve made no sense to imagine this was something we would leave to the states or cities or a Public Hospital in the middle of denver, colorado to address. We just had the opportunity to try to fix some of the chaos at the southern border of the United States which i completely agree the American People are tired of, for good reason. I dont think we should be allowing transnational gangs to set the immigration policy of the United States. I think that is a mistake and because we have failed to act, that who was running the immigration policy in some respects. Thats why so many people are showing up to the border and why the border is overwhelmed. In the context of this ukraine negotiation we have the opportunity to address this in a very incomplete way but we were going to address it in the other side walked away from their own negotiation. Even though it was the toughest portability agreed to and now they come in here and be on Denver Health for uncompensated care they are providing because that is what honorable nurses and doctors do. That is what in an honorable community does. It is the responsibility of the federal government to deal with this. And not just point fingers at each other and i will say, i wanted to ask you about Mental Health and the Mental Health epidemic that is raging among adolescents and young people in colorado and across the country. Let me mention one last thing before my time has expired and that is two weeks ago, and the wall street journal, not the failing new york times. In the wall street journal, they had a poland immigration and they asked eight policies for the American People support. Number one was 74 was a pathway for citizenship for 11 Million People who are undocumented. The American People have too much common sense to know thats not a good idea. The second was dreamers and third was the border. My point is is well understood we can score political points but we have to fix the problem and did for health deserves the support of this committee and not a i know we have spoken about unaccompanied minors. These children have found themselves in the custody of hhs and what we have seen during this search is the administrates inadequate ability to handle the capacity of unaccompanied alien children coming into this country. Instead of fixing the border which is what we wouldve wanted the president to do. You pressured your staff to expedite the release of these children, prioritizing speed over due diligence. And assume call with your staff that i viewed you actually said and im going to quote you, if henry ford had seen this in his plans he wouldve never become famous and rich. You made that comment talking about Assembly Line process children that were coming into the country. Over due diligence, over safety you prioritize speed and moving them out. Your hhs oig reported your staff did not make timely safety and wellbeing calls if they made them at all. 22 were late months pass the time they were due an 18 never went out at all. And it also found that the staff skipped essential safety steps, such as ensuring that the sponsors did not have a criminal record or that they were not sex offenders. It should be no surprise that we are continuing to hear reports suggesting the existence of trafficking schemes preying on vulnerable individuals, allegations we are hearing of coercion of forced labor, and despite my persistent inquiry on this issue, your staff has stonewalled getting answers back to me. I have written twice and gotten responses that were not answers from your assistant secretary, one of them being over six months late. I got it just last week before this hearing. Mr. Secretary, this leads me to believe that you do not give a ripping flip about what is happening to these vulnerable children. You answered senator cornyn about knowing where the children are and knowing who the sponsors are, but i have talked to caseworkers and they say they cannot ask if somebody is in the country legally or not. Oig said they have concerns. They have had 35 of the case files have legibility concerns over images, skins of photo ids, legal documents. Let me ask you this. Can you sit in front of us today and say with full certainty that your department knows the identity of these children sponsors . Senator, let me make sure that i respond to the question in terms of the identity of sponsors. No child in our custody is released to a sponsor without having gone through a full vetting. A full vetting that you said, lets speed it up. Children are not widgets on an Assembly Line. They are human beings. Sir, i would say that oig disagrees with you. They say you do not know. Do you think you have a responsibility to followup with these children when they are placed . Senator, we not only believe it is our responsibility to take care of these children when they are in our responsibility. You have the authority. To do what . They shall be responsible for coordinating and implementing the care and placement of unaccompanied alien children. You have to do that. And then the next section. Care providers must produce a followup call with an unaccompanied child 30 days after the release date. Mr. Secretary, director marcos is failing in this. You are hesitant to move forward with giving us the information. My time is expired. Thank you. First, i take umbrage to the misrepresentation of the facts by senator blackburn and i also want to make it clear that we have people who are working as hard as they can with the resources that we have. Your misrepresentations are appalling. It is unfortunate that you wish to mischaracterize what we are doing. We do everything with the authority that you give us. I would like to submit the letters and statutes as evidence. Secretary, good to have you here. I want to move to a local issue. As you know, from the beginnings of the valuebased care effort, i have been very involved, helping to set up elsewhere, establishing what has been a success with the Affordable Care act. The senator and i Just Launched a bill today to improve and expand the program. I first went to thank you all for the model that rhode island is applying to the cost of care model. It provides an avenue. So thank you for that. Any cooperation and support as we pursue that process, i would be very appreciative of. So, i have been trying to organize. Cmi was organized to be a trial pilot. That was the core. I have been trying to deal with people who are approaching end of life. When they are in that circumstance, the needs change. There are five that we have identified that are unhelpful in that phase of life. But at that point, they get in the way of familys ability to take care of loved ones. Today is the third time i will raise this with you. I do not just raise it at hearings. We have had repeated hearings with staff and with the administrator. I have been meeting with directors through three different administrations. Every time one leaves, it is groundhogs day and i have to start all over again to get it moving. It has been the better part of the decade to get a very simple, very easy pilot launched in rhode island, that allows five waivers that you have given over and over again in other circumstances. It is not that the waivers are unacceptable to anybody else. They have been granted in many circumstances. But it will not deal is to simply say yes to those waivers in rhode island for a population that we are willing to negotiate over. I would propose that the population be those identified by acos, patients of Accountable Care organizations to help the doctors provide better care. We can talk about others. Im open to working with you on what the population should be so that you can be comfortable that we had a manageable pilot that will not put the Health Care System at risk. I think we will prove to you that we will be improving the humanity of care, that you will be saving money, if you let us go forward, to the extent that outcomes can be improved and the outcomes will be better. Please help me clear this logjam. I do not want to hear that this is the reason. This is an easy thing that i have pursued for nearly a decade, asking for waivers that have only been granted over and over again with a very simple and negotiable population. We have been waiting for years to get this done. I really need to get it done. You are invited to respond. Yes, that would be a great answer. We could be done. Senator, i know how hard you have been working on this. They understand the purpose. They understand all the different elements and appreciate the fact that you are willing to be flexible in how it has developed. They continued to raise concerns with the issue of having it stay focused. It is supposed to be an agency that comes up with models that can then be used nationwide. They have very limited resources. It will be applicable broadly. I am absolutely committed to getting back to you. I do not think it is as easy as you suggested, but i will see if we can move this. We absolutely need to move this. Here is what is going to happen. We have a number of senators in the room. But we are just going to keep this going. The senator will be chairing and we will get everybody in. Thank you for this hearing and thank you, mr. Secretary for being here today. You and i spoke last week. The impact that this is having in new hampshire. I raised this issue on monday. This includes four that have not received what amounts to 98 . Thank you very much for your quick attention. They are facing a long road ahead. I met with andrew witty. And this meeting follows my push to urge united to step up and provide more urgent aid to providers. We had a constructive conversation this morning. They made new commitments to provide aid to those who need it without any unfair or risky terms. What will the role be in the coming days to ensure that they are following up on commitments . Thank you for making sure that others step up. We had a meeting with the payers and providers. We are now having a followup meeting on friday. But we are doing is saying, many of whom have already received their payment from medicare and medicaid, they are Holding Money and they are getting paid. You have a general sense of what is providers bill you. I look forward to working with you. I want to turn to a different topic now. I was pleased that the budget included state opioid response grants. Include improves response. We have discussed the programs impact. Our providers can really plan and work towards a comprehensive prevention treatment and recovery strategy. The most recent language requires to avoid a significant cliff for any state when allocating funds from yeartoyear. They have to have clarity. Will you commit to having your staff work with mine to make sure that this information is communicated as soon as possible . And the last set of funding bills included Addiction Treatment for those on medicaid. It permanently requires Medicaid Programs to put cover opioid use disorder. The funding bill also included Bipartisan Legislation to expand access to treatment under medicaid. Can you discuss how these provisions will be supported and expanded upon . Thank you very much for your commitment to this issue and for pursuing real results for people. We will partner to make sure that they are aware that medicaid will be more helpful. We had to see how they structure their programs, but medicaid once to be in the game. Scenario . Thank you, chairman. Welcome. Good to see you again. Hhs must play a Critical Role for innovative technologies. I know that you agree, but the reality is that many medical technologies authorized face significant barriers and securing Medicare Coverage. This provides access to key medical innovations. I am encouraged by the work last year. Transitional coverage for emerging technologies. This would establish criteria for an guided coverage pathway to provide beneficiaries with faster access to beneficial technologies. We are waiting on a notice. I along with a number of my colleagues sent a letter asking for it to be finalized as soon as possible so that patients do not have to face barriers facing lifesaving technologies. Given that seven months has passed since the period ended, can you assure us that they will issue the final policy this spring or early summer . Senator, thank you for the question and the work that you have done on this particular issue. I hope we continue to work because we are talking about the new frontier. Obviously, there are many eyes on these new proposals. I can commit to you that we will get this out as soon as we can. When the u. S. The knee surely you have an estimate of the time period. I wish i could say yes. I want to be honest that the process is not always move as quickly. This is not a movie we have seen over and over again. For those who care a lot about this issue, what is the hold up . Why is this taking longer than they expected . What are you doing to try to manage some of those dynamics . Whatever we propose needs to fit within the prescription that you gave us. We cannot go outside of it and it cannot be too narrow. Sometimes you all give us specificity. Sometimes we have to interpret. We have to make sure that everything that we do will be done in the interest of the patients. We had to make sure that we can look around the corner to make sure what we are doing is not impacting Something Else and everything gets delayed because we are in court. How does hhs plan to address this perceived disconnect . I think that is always a dynamic, but closing that window will help improve and save lives. We are working with two different standards that are at play here. The fda has to say it is safe and effective. There is a different standard with medicare. They have to make a decision on if it is reasonable and necessary. It does not automatically mean Medicare Coverage. You have struck on the challenge. But from a management perspective, how are you trying to minimize that delay . We have to make sure that we are not overstepping our bounds, and we could use your help. More direct, the better we can move. If you have thoughts on how we can do that, because you have an army of experts. Surely they have some ideas about how we could optimize the process. I would welcome those. We look forward to working with you on that. As i comes in my time, i will ask you. There is a patient listening session and i get itemized some of the challenges associated. It would not surprise me if you anticipated a question about this but suffice to say it were not perceived by participants to be particularly helpful. It is because of their design that they were not intended to really gather a lot of information. What are your plans to approve the process . If you know of any particular concerns i will submit them to you. Our funds are limited. We are always looking for ways to get feedback. Thank you, mr. Secretary. Senator, thank you for being here. I want to resubmit some questions. I would really like to get a prompt response. I will not go through them now. It has to do with the facility down in greensboro. But i am a little bit concerned with the timeliness of it. I have been in and out. We can see how people have come in and out but nobody is behind me. I have spoken with the number of people and they have great things to say about you. I know some of the bipartisan work, but i do feel like there have been partisan decisions that you are responsible for commencing that i have a concern with. I will point drug pricing as one of them. No question that we can look at that and say, i think you mentioned 100 billion dollars. That is true, but what have we lost . I know that shortly after it was implemented, at least one shareholder call was shared with us that has a double digit drop in small Molecule Research because it has to come from somewhere. I would be interested, if you could submit further the record data that would refute the fact i worked in research and development, not in pharmaceuticals and hightech. The money has to come from somewhere. If you reduce the potential to be recombinant to be compensated, you have less money to spend. It looked in direct correlation to price controls and small Molecule Research. If you have information to refute that, i would be interested. You mentioned in response to someone else that we want to bring manufacturing back home. If you squeeze the margins, we have you produce fewer resources to make the case to bring manufacturing home when we know we are a more expensive jurisdiction. If you cannot reduce lower prices and try to get this industry to their shareholders, but you have to ring them home. We are not creating a hospitable environment in the u. S. For them to make these business decisions. Not to mention that they are making it more chilling on the pharmaceutical industry, in terms of having an actual property, being able to defend their intellectual Property Rights to recover the cost of an investment. If we do not figure out a bipartisan way to deal with this, we are going to lose the war. When we talk about drug pricing, the last time i checked, a therapy or drug im just going to give that a soapbox speech. There is a lot packed in there. This is a very dangerous game that we are playing of making this a purely partisan process. I also wanted to cover you get to hear a lot of other people talk. Another thing that we will meet with you separately on, number one, we have got to get telehealth authorized. Anybody asking for an extension does not understand how the free market works. I know that this is the operating standard from the perspective of the i am doing my part but you are not going to stimulate investment a bus it is permitted. It has been stress tested. They have been proven wrong. It is indisputable. We need to collectively work to input pressure. I have told my colleagues, do not tell be that telehealth is good except for a couple professions or except across certain territories. It is irrational. We need leadership to get it done right. We are going to go to the next. We have heard a lot about manufacturing and bringing it back from overseas. If we have partisan approaches, i will tell you later if i can catch you. 357 votes. Good to see you. You fear leadership. I wanted to talk about the frontal crisis. Fentanyl crisis. We have seen increased in overdoses. We are very impacted. One of the things we have had a lot of roundtables on this. 700 million in Substance Abuse and disorders. One of the innovations discussed is having basically Health Engagement hubs. You can do it by building capacity or you could build hubs that would be available for treatment. The one thing that is clear, not enough beds. All sorts of problems, but if you had engagement hubs and geographic, we also heard how they could be used in verbal areas. I would assume you think these are good ideas and we want to get help for Technical Assistance. We want to get some Technical Assistance. Could you help us speed up the process . It is critically important. I wanted to ask about the basic health plan, which you and i have talked about a number of times. I believe it has been a successful program. Oregon is rolling this out this summer, so they are finalizing the insurance providers. I we not seeing how this is driving down the cost of premiums and helping the government because it is driving more savings for us as well . The program because they are paying a reduced premium. Could you talk about why we should continue to expand . I know this has been a program that has worked well. I know other states are looking to adopt. We want to be supportive. We have been through quite a few authorities. We would love to see states take action. Because we think that there are real cost savings to be had. I think it is time, mr. Chairman. We went through and the challenges of the exchange got buried. But i think it is incumbent on us on where the exchange has been and driving a bargain for them. Allowing for better insurance. We have our own financial challenges. Why pay for federal tax dollars to pay for the plan would you could bundle up, just like you by in bulk and get a discount . I think it is time, given our financial priorities, to pay more attention to those. So we are not one of the states that successfully move forward on this, but i hope that we will be a future. Think its my colleague. Whatever you hear the senator talk about health care, you often come away saying, it may be too logical. The fact is that dollar for dollar, the concept that has been talked about for years. I am pleased the northwest is not just watching but getting the message out. Senator warren. President biden is working to lower drug prices for american. For the first time, look at the list. They faced penalties. Insulin copays were capped for seniors and people with disabilities. All outofpocket costs cap that 2000 for Medicare Beneficiaries beginning next year. Now President Biden is wanting to down by ensuring people that people have medicaid have the same relief. I am all for it. Especially when back shamir can taxpayers contribute dollars to the research and development of the same drugs. Do you know how much american taxpayers invest every year into researching and development . I can get that number to you, if you do not have it. Question 115 billion. Much is for biomedical research. I think this money is well spent. It supports the Scientific Research to develop new therapies and cures, the problem is that big pharma takes these discoveries, turns them into drugs they can market and charge americans nearly triple what they charge other nation, the very same drugs at the american taxpayers helped develop. Secretary, you think american should have to pay more for drugs, that their tax dollars help to develop, than other people around the world . In the spirit of competition, we should get prices that everybody else gets. If we put some skin in the game, we should get better prices. I like your approach on this. Charging americans this much for drugs when we are the ones who helped develop the is just greedy, pure and simple. The Biden Administration is wanting to do something about it. They released a proposal that would allow more companies to produce a drug that taxpayers helped to develop, if the original drug manufacturer jacked up the price of much that people cannot afford it. It would inject some competition into the market and lower drug prices for families. This law has been on the books for over 40 years, but it has never been used, in large part because big pharma has spent millions of dollars trying to convince policymakers that a drugs price has no impact on whether or not patients can access it. Any person who is forced to make difficult decisions between affording their medication and paying rent, or trying to put food on the table will tell you that argument is wrong. If you cannot afford to buy the drug, you do not have access to it. Sec. , if this framework the Biden Administration is working on right now is finalized, what impact would that have for American Families . Our belief is that this would make the pharmaceutical industry far more competitive and prevent the lockout of manufacturers who are actually willing to sell at competitive prices. It would unblock access to the crucial medications for many americans. On the whole, what we are trying to do is to fulfill the nature of this nation have competition drive what people can get. I appreciate your work on this. I sent a letter with my colleagues in the senate, urging the administration to strengthen and finalize this proposal that would have benefits that you described. It would stop pharmas price gouging and ensure that americans could access lifesaving drugs that their tax. The taxpayers helped create. Please get this done as quickly and efficiently as you can. We will try. Thank you. It has been a long morning, but i have a couple areas that i need to clean up. As you know, our colleagues from oklahoma senator langford was talking about women using dangerous chemicals for abortion. That was essentially the topic of conversation. I think he left most people confused about what he was talking about. I wanted to ask you. Senator warren has been a great advocate in for women in these areas as well. This topic is about the safe, effective alternative to surgical abortion and whether or not this medicine, which is now responsible for more than 50 of the abortions this country that this medicine will be available. That is what the court case is all about. It stems from the overturning of roe v. Wade. We are already seeing the consequences of that ruling playing out nationwide with women being denied the health care that they need and deserve. If the antiabortion activists get their way with this drug that is currently before the court, it would effectively be a nationwide abortion bid. Now, you and i served together in the other body, the house of representatives and quite some time before you came, i chaired the first congressional hearing on what seemed to be this drug back in 1990. The issue that we focused on then is still the issue of today. That is, are these decisions going to be made on the basis of science or are they going to be made on the basis of politics . I started arguing that first hearing that we ought to make the decisions based on science. The food and Drug Administration was activated and it has been available for years and years. We have evidence showing that it is safe as tylenol. I wanted to set the record straight because senator langford was talking about dangerous chemicals and it is contradicted by a lengthy data set developed by the food and Drug Administration. I wanted to ask you a question word two about this. If access to this drug is rolled back, which is what may happen this court decision, what would that do to access to health care for women all over the country in red and blue states . There was all this discussion about how the states would be able to proceed in own kind of fashion but now we have seen with respect to this drug, if the antiabortion activists get their way, they could put restrictions were completely make it impossible to get access to this drug at all and every quarter of the u. S. , but i would like to ask the secretary, give me your assessment about what a federal ban would do for a safe couple alternative for surgical abortion . First, i think it is important that when you say safe and effective, you are not just saying that because he believed it because science has shown that this drug for more than two decades has not only been safe but effective. If it were to be lost to americans who need it as medication, it would further reduce access to care. My daughters have fewer access to care that their mother had, they will these further access to the care that they need. Need that more women place themselves in further danger tried to get access to care that they need which would lead us to the scenarios that were common where women would die and that having consequences as a result of some of the action that were taken. It puts us in a place where we have regressed. I think the point that is often missed is it is not just this. It went through a process to be found safe and effective. Many other drugs and medications with through the same process of analysis. If the analysis were to be overturned, it would be difficult for anybody to conceive that the only result is that it be taken off the market and access to consumers because somebody other drugs went through the same process that would be subject to the same legal challenges affordability availability. Is important point to make is exactly the point that we need whether 30 years ago. In a drafty house hearing, we said the second you decide to start making decisions on the basis of politics rather than science we are talking about how the fda spent decades working through the scientific issues with respect to the safety. You are going back to the wild west. You are going to the days of politics and whoever has political strength will drive decision. I think people once had these decisions made. Scientists and policymakers who are about good science. I appreciate you bringing this up. We had to wrestle with putting science above politics. That is what we are facing now. Let me ask you about the officer Refugee Resettlement. We heard a lot of backandforth with charges leveled against you. This is an office that works with the company children. For years and years, these were the kids put in cages and Trump Administration even lost track of them, lost track of where they were, and my understanding is that the office of Refugee Resettlement is now working to improve the safeguards of these kids and as we wrap up, that seems to be the admission that she get the support of democrats and republicans. Your thoughts . As i tried to explain, when Congress Passed the law that placed children who did not have an adult with them that came from the border our responsibility was to provide temporary care the children until they were placed with a vetted sponsor. Once we place that child with a vetted sponsor, our authorities over that child ends. We tried to followup, even though there is no requirement that they get back to us, we tried to followup to make sure everything is moving the right way with that sponsorship. We are working with the department of labor because they are the ones to track any labor violations that might occur, especially with child labor. We try to make them make sure that we let them know about some of these children who might be trafficked or used for child labor, that they were one plate under our custody. But we provide care for any child. We do not deal with migration circumstances of the child. That is done by the department of Homeland Security. We make sure that the children are receiving the care that any child in this country should receive. About three hours ago, i tried to take the exact quotes from former President Trump, who claimed he was going to do so much to lower medicine and he was going to take on big pharma. And i compared it to the record which showed none of that. I contrasted it with President Biden and President Bidens conversation with e and 20 of other people after the election, talking about getting red getting rid of big pharmas holy grail where they could stop any negotiation and i remember walking off the floor of the u. S. Senate in 2022, late december and i said, we actually did it. This is not a debatable proposition. We passed this law. The president of the u. S. Is going to sign it. I think it is important, as we wrap up, to make clear that there are differences as deep as crater lake and what the differences are they are about value. The Previous Administration was sympathetic to the corporate interest in those corporate interest were driving up health care costs, particularly big pharma. And what President Biden said and what i support is that our northstar is getting a fair shake for people without power and clout, and all those years. 9 million americans. One out of every seven years are going to benefit because we are negotiating and working for a fair shake. You took a lot of hits this morning. I guess that goes with the turf. I want you to know that i think what you are doing and the values that support these action , i look forward to working with you the days ahead. The secretary, i look forward to talking with you soon. With that, this meeting is adjourned this hearing is adjourned. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] check