On March 28 and 29, Health and Human Services (HHS) Secretary Xavier Becerra testified, respectively, before the House Committee on Ways and Means and Energy and Commerce Health Subcommittee regarding the department’s fiscal year (FY) 2024 budget request, which was first released on March 9 [refer to Washington Highlights, March 10]. Theses appearances built upon last week’s testimony before the Senate Finance Committee, which featured discussion of the department’s efforts to reduce prescription drug prices and strengthen the physician workforce [refer to Washington Highlights, March 24].
In his testimony before each committee, Becerra provided highlights regarding the department’s budget, including investments in behavioral healthcare, pandemic preparedness, expanding the health care workforce, expanding coverage and access to care, and advancing science to improve health. The proposed department budget would provide $144 billion in discretionary funding and $1.7 trillion in mandatory funding.
In both hearings, Becerra faced concerns regarding the Centers for Medicare & Medicaid Services’ (CMS’) implementation of the No Surprises Act (P.L. 116-260). In the Ways and Means Committee hearing, Rep. Brad Wenstrup, DPM, (R-Ohio) criticized the agency’s implementation of the independent dispute resolution (IDR) process, which determines the amount paid to providers for out-of-network services. Interim final rules had originally instructed arbiters to proceed under the assumption that the appropriate out-of-network payment was the offer closest to the “qualifying payment amount.” Wenstrup stated, “You decided to implement the law in a manner that unfairly tips the scale in favor of insurers by placing undue weight on the qualified payment amount, which was just one component of arbitration and did not have weight over any others.” Becerra responded that the volume of disputes they have received — 164,000 in the first eight months — far exceeded initial estimates, thereby placing a burden on the agency and its staff. In the Energy and Commerce hearing, Rep. Michael Burgess, MD, (R-Texas) similarly criticized the implementation of the No Surprises Act, stating that “this process is a failure, and it's a failure because of poor planning on the part of HHS and mismanagement of the law passed by Congress.”
Members in both hearings also raised concerns about health care workforce shortages. In a key exchange during the Ways and Means hearing, Rep. Brian Higgins (D-N.Y.) raised concerns about travel nursing agencies, noting, “So many nurses across the country have left hospital-based positions and have gone to these traveling staffing agencies ... [that] charge hospitals a significant markup to employ their nurses.” Becerra responded that the FY 2024 budget includes key investments in the health care workforce, including a grant proposal to help recipients retain their workforce.
Rep. Carol Miller (R-W.Va.) questioned Becerra regarding the CMS’ methodology for distributing the 1,000 Medicare-supported graduate medical education (GME) slots provided by the Consolidated Appropriations Act, 2021 (CAA, P.L. 116-260), expressing concern at their perceived lack of distribution to rural areas [refer to Washington Highlights, Dec. 23, 2020]. Becerra emphasized the CMS’ commitment to ensuring that future slots are distributed to rural areas, stating, “We need to make sure we're directing some of these future doctors to communities like rural America where there is a shortage of them.”
Several members of the Energy and Commerce subcommittee also inquired about the budget’s proposed investments to strengthen the health care workforce. Rep. John Sarbanes (D-Md.) described the impact of workforce shortages in his community, noting, “In Maryland, for example, we are facing long emergency room wait times and a mental and behavioral health crisis that is particularly acute for pediatric patients.” Becerra responded that the HHS plans to leverage data from the National Center for Healthcare Workforce Analysis to understand where the shortages are the most severe, “not just geographically, but by profession.” Rep. Kim Schrier, MD, (D-Wash.) voiced concerns regarding rural communities’ ability to recruit and retain health care providers.
Several members of both committees expressed their support for ensuring Medicare beneficiaries continued access to telehealth services. The Consolidated Appropriations Act, 2023 (P.L. 117-328) extended certain flexibilities of Medicare reimbursement for telehealth services through December 2024 [refer to Washington Highlights, Jan. 4]. In a key exchange during the Ways and Means Committee hearing, Rep. Mike Thompson (D-Calif.) highlighted legislation with Rep. David Schweikert (R-Ariz.) to make telemedicine a permanent fixture of the Medicare program. Becerra affirmed his continued support for telehealth flexibilities, noting that the HHS “hope[s] to work with our states to figure out how we deal with the cross-state issues that are involved with the licensing of medical professionals.” Rep. Annie Kuster (D-N.H.) of the Energy and Commerce Committee asked Becerra how telehealth could be used beyond the public health emergency to “work across state lines, expanding access to rural and underserved areas.” Becerra responded acknowledging the importance of telehealth for these populations and highlighted the need to work with states to provide cross-state telehealth access.
During Becerra’s testimony before the House Energy and Commerce Committee, several members commented on the department’s implementation of the drug pricing provisions of the Inflation Reduction Act of 2022 (P.L. 117-169). Burgess criticized the legislation for reducing Medicare Part B reimbursement rates for certain physician-administered drugs. “I don't know that this administration realizes the circumstances that doctors are facing every day. It's not just that they've seen reimbursement cuts year over year over year. It's now that they've got 6 percent, 8 percent, 9 percent to deal with ... and they simply cannot afford to stay in practice,” he stated.
Rep. Larry Bucshon, MD, (R-Ind.) raised concerns about transparency and accountability in the 340B Drug Pricing Program. He inquired whether Becerra felt that covered entities should be accountable for how they use the savings generated by the program, to which he responded, “Absolutely.” Becerra continued, “There's little transparency in how money's being used, that 340B doesn't have the transparency we need.” He described the department’s efforts to reform the program asking for the committee’s help in providing the statutory authority to institute these changes.