Health and Human Services (HHS) Secretary Xavier Becerra, JD, testified before the House Ways and Means Committee on June 8; the Senate Appropriations Subcommittee on Labor, HHS, Education, and Related Agencies (Labor-HHS) on June 9; and the Senate Finance Committee on June 10 to discuss the Biden administration’s proposed fiscal year (FY) 2022 budget request for the HHS [refer to Washington Highlights, June 4].
Throughout the hearings, members from both parties focused their questions and comments on a variety of topics, including the COVID-19 response and preparation for future public health crises, how to care for unaccompanied children at the southern border, medical research funding, access to affordable health care, telehealth coverage, prescription drug pricing, the 340B Drug Pricing Program, maternal health, the opioid epidemic, and the Provider Relief Fund.
House Ways and Means Committee Chair Richard Neal (D-Mass.) praised Becerra for the administration’s efforts to expand access to care and address the coverage gaps for people with lower incomes, especially those in non-Medicaid expansion states. In response, Becerra noted that 31 million Americans have received care through the Affordable Care Act (ACA) and that the administration will work to continue to increase coverage through Medicaid and the ACA marketplaces. Additionally, Neal discussed the need to diversify the health workforce, noting that he plans on introducing legislation that will address the physician pipeline.
Ways and Means Committee members highlighted the important role that telehealth has played in expanding access to care during the pandemic and urged Becerra to maintain the current Medicare flexibilities beyond the end of the public health emergency. In response to a question from Rep. David Schweikert (R-Ariz.) during the June 8 hearing, Becerra stated, “Can I just say, on telehealth, I absolutely agree that we’re going to move forward with what we learned from COVID. I’d add two words. Access, because you have to make sure everyone has access — not just in some parts of the country, not just in some rural areas, but you have to make sure that broadband extends everywhere so everyone has access. And the second thing is accountability. … We just want to make sure it’s accountable because taxpayer money — whether Medicare or Medicaid — we have to make sure we’re getting the value for our dollar.”
In his opening statement before the Labor-HHS subcommittee, Becerra highlighted the budget’s proposed $9 billion increase for the National Institutes of Health (NIH), with $6.5 billion proposed for the new ARPA-H initiative. “This bold new approach will complement NIH’s existing research portfolio, which is a vital contributor to longer and healthier lives, supports and trains world-class scientists, and drives economic growth. Outside of ARPA-H, the remaining $2.5 billion increase will allow NIH to continue investing in basic research and translating research into clinical practice to address the most urgent challenges, such as HIV/AIDS and ending the opioid crisis,” Becerra said in his opening statement.
Ranking Member Roy Blunt (R-Mo.) reiterated his support for ARPA-H, adding that the initiative is “in the right place at the right time with the right focus. ... And I believe we can make it work in a way we wouldn't have envisioned before the last couple of years and the new things we did to step up to the pandemic.”
Several members of the Labor-HHS subcommittee focused on funding for the Strategic National Stockpile (SNS) and efforts to strengthen the domestic supply chain to better prepare for future pandemics. Sen. Tammy Baldwin (D-Wis.) asked why the subcommittee should prioritize the budget’s proposed increase of $200 million for the SNS “for distribution and oversight improvements.”
“We do want to increase the transport of supplies, the capabilities. We want to refine and modernize our inventory. We want to be able to track our supplies better, we want to be able to expand domestic manufacturing,” Becerra said. If the additional funds are provided, he added, “then we can really launch in ways that really let us make sure that we tell the American people we're stockpiling for what you need to get ready for the future.”
In his testimony before the Senate Labor-HHS subcommittee, Becerra noted, “The President’s Budget increase to workforce diversity programs, highlights HRSA’s commitment to supporting health care providers dedicated to working in underserved areas and building toward a workforce that reflects the communities it serves and is able to provide culturally relevant care.” The AAMC-led Health Professions and Nursing Education Coalition continues to advocate for doubling the funding of the HRSA Title VII and Title VIII programs, which includes the diversity workforce programs [refer to Washington Highlights, April 2].
In her questioning, Senate Labor-HHS Chair Patty Murray (D-Wash.) noted, “I was really pleased to see the budget focus on addressing systemic racism and health inequities, including an increase of $150 million for CDC's social determinants of health activities. Can you talk a little bit about what those initiatives will do to reduce health disparities?”
“Madam chair, the most important thing is that we're now recognizing — the fact that we're using the word ‘social determinants of health’ shows how far we have come as a nation and as a policymaking body that we recognize that, in so many ways, your health is determined by your background, too often by your ZIP code, and we have to change those things because there are people in America who are left out,” Becerra responded.
Labor-HHS subcommittee member Sen. Joe Manchin (D-W.Va.) asked Becerra about the next steps following recent letters that the Health Resources and Services Administration (HRSA) sent to six major drug manufacturers that have been withholding 340B discounts on eligible drugs purchased at contract pharmacies [refer to Washington Highlights, May 21]. Becerra responded, “We didn't just say it verbally; we put out in writing a clear message to these six manufacturers that we believe that they're violating the law. You violate the law, you pay the consequences.”
Members from both parties raised the need to lower the cost of prescription drug prices in each of the hearings. Senate Finance Committee Chair Ron Wyden (D-Ore.) began his remarks by referencing “out-of-control drug prices” and noting that he is working to update the committee’s drug pricing legislation from last Congress. He added, “I believe it’s long past time to give Medicare the authority to negotiate better prices for prescription drugs on behalf of more than 50 million seniors.” Meanwhile, several House Republicans, including Ways and Means Committee Ranking Member Kevin Brady (R-Texas), warned that the House Democratic-led Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3) would “lower drug prices at the expense of future cures for Alzheimer’s, Parkinson’s, ALS, diabetes, and cancer.” Instead, they voiced their support for the Lower Costs, More Cures Act of 2021 (H.R. 19).
During the Senate Finance Committee hearing, Sen. Bob Menendez (D-N.J.) raised the issue of graduate medical education (GME) and mentioned his legislation, the Resident Physician Shortage Reduction Act of 2021 (S. 834). Menendez asked Becerra how additional GME slots would help address the physician shortage, as well as how Becerra planned to ensure expeditious distribution of the slots should the legislation pass. Becerra responded that the HHS would “go out and talk to the provider community to make sure that we know exactly where there are shortages. We will try to encourage a lot of incoming physicians to consider working in those areas of shortage in rural areas and in low-income communities. We're going to try to make sure that the residency slots will be there to meet them when they're ready to come work in these areas that need new physicians.”
Additionally, during the Senate Labor-HHS hearing, Blunt asked Becerra about the importance of the HRSA Children’s Hospital GME (CHGME) program in increasing the supply of our physician workforce, especially for the health of children. Becerra responded, “GME programs are critical. … I absolutely agree with you; we have do everything we can to try to increase the number of and supply of these doctors.” Blunt also expressed an interest in working with Becerra to explore opportunities to provide a more reliable funding stream for the CHGME program than annual appropriations.