Department of Health and Human Services (HHS) Secretary Xavier Becerra testified on May 12 before the House Energy and Commerce Health Subcommittee on President Joe Biden’s fiscal year (FY) 2022 HHS discretionary budget request, which proposes $131.7 billion in funding, an increase of $25 billion over FY 2021 [refer to Washington Highlights, April 16].
Throughout the hearing, subcommittee members raised a number of issues in their questions and comments, including the COVID-19 response and preparing for future public health crises, caring for unaccompanied children at the southern border, medical research, access to affordable health coverage, health equity, the 340B Drug Pricing Program, prescription drug pricing, maternal mortality, the opioid epidemic, telehealth coverage, and the Provider Relief Fund.
During his opening statement, Secretary Becerra noted, “HHS is at the center of many challenges facing our country today—the COVID-19 pandemic, safely caring for unaccompanied children, the opioid and substance use crisis, gun violence, racial inequality, and more—and we are rising to meet those challenges.” He continued to highlight specific priorities within the HHS budget proposal, including preparing for the next public health crisis by increasing funding for the Strategic National Stockpile and the Centers for Disease Control and Prevention.
Secretary Becerra also focused his comments on HHS efforts to reduce the maternal mortality rate, improve health outcomes and address health disparities, provide access to high-quality health care, combat the mental health and substance use crises, and promote biomedical research by establishing the Advanced Research Projects Agency for Health (ARPA-H) within the National Institutes of Health (NIH) to “speed transformational innovation in health research and speed application and implementation of health breakthroughs.”
Full Committee Chair Frank Pallone (D-N.J.) praised the FY 2022 HHS discretionary budget proposal in his opening statement, referring to it as “a breath of fresh air.” After stating his support for programs within the budget proposal, he added, “These investments are bold and necessary, but we must not stop there. The COVID-19 pandemic laid bare the impacts chronic underfunding of public health has had on our surveillance, preparedness, and response efforts.” Chairman Pallone urged the Biden Administration to include the rebuilding of the public health infrastructure in its jobs and infrastructure plans and also noted the need to reduce the cost of prescription drugs and permanently extend the tax credits included in the American Rescue Plan [refer to Washington Highlights, March 12].
Subcommittee Ranking Member Brett Guthrie (R-Ky.) expressed his concern about the level of spending included in the HHS budget proposal. He stated, “In total, the proposed budget is more than an 8% increase over the amount appropriated for fiscal year 2021. This increase would be on top of the nearly $4 trillion congress has already allocated for the COVID-19 pandemic in the first five COVID-19 relief bills.” He added, “I agree we need to improve our public infrastructure and better prepare for future public health emergencies; however, as we work on these improvements, we also have the responsibility to be good stewards of taxpayer dollars.”In her opening questions, Subcommittee Chair Anna Eshoo (D-Calif.) asked Becerra about the rationale for including the proposed ARPA-H program within the NIH, noting that the existing programs that ARPA-H would be modeled after are more independent. Becerra responded, “I think we have any number of places we could feel comfortable with it. But NIH continues to do the basic research. If we want to just lift that up and launch faster, we can discuss that. But the important thing is that we launch and not let issues about, bureaucratically, where we’re going to locate ARPA-H get in the way of a great idea.”
Rep. Fred Upton (R-Mich.) noted that he intends to include ARPA-H in an update to the 2016 law 21st Century Cures Act (P.L. 114-255), referred to as “Cures 2.0,” which he again is leading with Rep. Diana DeGette (D-Colo.). “We're all very excited about ARPA-H, and obviously we want to make sure that it doesn't interfere with the other functions that the NIH and others have. We have made the pledge as we look to the future, as we look to an update on 21st Century Cures, to in fact include ARPA-H to help that legislation get through,” Upton said during the hearing.
Eshoo also highlighted that the subcommittee was the first in congress to hold a hearing on “long COVID” [refer to Washington Highlights, April 30] and urged Becerra to have a dedicated person within HHS to lead a coordinated response from the government on this issue.
In response to a question from full committee Ranking Member Cathy McMorris Rodgers (R-Wash.) on whether the HHS budget would include a Medicare For All proposal that would take away employer-sponsored health insurance, Becerra stated, “I can assure you that the president has spoken with clarion voice on this issue. He campaigned on this and everything he's done so far makes it very clear. We're going to work to make sure that we can expand the Affordable Care Act, make it better. As a result of the American Rescue Plan, I think virtually every American can say it is actually much better. And certainly, the million people who have, in the last few weeks, signed up to get a plan under the Affordable Care Act are showing full proof that the ACA is working.”
Members from both sides of the aisle spoke about the need to reduce prescription drug prices and referred to recently re-introduced bills from each party to accomplish this goal [refer to Washington Highlights, April 23]. When asked directly by Chairman Pallone if he believes that empowering the HHS Secretary with the ability to negotiate drug prices is an essential tool to lower drug prices, Becerra responded, “Absolutely…If we want to lower drug prices, we have to have the ability to negotiate.”
Three members of the subcommittee – Reps. Doris Matsui (D-Calif.), Peter Welch (D-Vt.), and Angie Craig (D-Minn.) – urged Becerra to take actions against drug manufacturers that are not providing 340B discounts on eligible drugs purchased at contract or community pharmacies [refer to Washington Highlights, April 23]. Becerra responded, “We are on this one. We know that vulnerable populations are at risk…Everyone has to follow the law.”
Rep. Paul Tonko (D-N.Y.) praised Becerra for the recent practice guidelines that HHS issued to expand access to buprenorphine to enable more clinicians to prescribe treatment for opioid use disorder [refer to Washington Highlights, April 30]. Tonko submitted for the record a May 12 letter signed by the AAMC and 120 other organizations urging congressional leaders to pass the bipartisan Mainstreaming Addiction Treatment (MAT) Act of 2021 (H.R. 1384, S. 445), which would eliminate federal restrictions on prescribing buprenorphine. When Tonko asked Becerra if HHS would support a provision of the MAT Act that would authorize the HHS Secretary to conduct a national campaign to encourage providers to integrate evidence-based medication assistance treatment into their practices, Becerra responded, “We will absolutely be supportive of any congressional action to help us expand access.”