Department of Health and Human Services (HHS) Secretary-designate Xavier Becerra, JD, appeared before the Senate Health, Education, Labor, and Pensions (HELP) and Finance Committees on Feb. 23 and Feb. 24, respectively. Though both committees held hearings on the nominee, only the Senate Finance Committee will vote on whether to advance the nomination to the full Senate. AAMC President and CEO David J. Skorton, MD, sent a letter to the leadership of both committees on Feb. 19 supporting Secretary-designate Becerra’s nomination.
The letter emphasized Secretary-designate Becerra’s leadership experience, stating that it “will prove useful as he guides the many agencies of HHS as the department not only continues to respond to the COVID-19 pandemic, but also prepares for future public health emergencies and addresses other critical health care issues, including health coverage.” The letter also urged the Senate to quickly confirm him, “to ensure that HHS has leadership at the helm now to coordinate an effective response to COVID as well as proceed on the other pressing health care needs of the country.”
Throughout both committee hearings Secretary-designate Becerra was asked, and responded to, questions on topics relevant to academic medicine, including the federal COVID-19 response, health disparities, Medicare-supported graduate medical education (GME), physician workforce, Medicare, Medicaid, health coverage, telehealth, 340B, drug pricing, and the opioid epidemic.
In both the HELP and Finance hearings, several members asked Secretary-designate Becerra about the Biden administration’s goals to address COVID-19. In asking how he would ensure federal agencies worked in partnership to combat COVID-19, HELP Committee member Sen. Tammy Baldwin (D-Wisc.) cited her recently introduced bill that would provide additional funds to the Centers for Disease Control and Prevention (CDC) to support increased viral sequencing and surveillance [see Washington Highlights, Feb. 12]. Secretary-designate Becerra cited enhanced coordination between agencies and transparency with the public as key to improving the country’s response.
Finance Committee member Sen. Elizabeth Warren (D-Mass.) asked Secretary-designate Becerra to commit to collecting racial demographic data regarding COVID-19 infections, testing, and vaccinations, stating that, “[w]ithout this information, there would be no way to know if black, brown, and indigenous communities had the same access to tests as white communities, and it would be impossible for the federal government to allocate resources equitably.” Warren continued that “put plainly, you can't fix what you can't see.” Secretary-designate Becerra responded that, if confirmed, his department will work with local community leaders to learn the cultural health needs of different communities.
While testifying before both committees, Secretary-designate Becerra reiterated his commitment to addressing racial health disparities. When asked by Finance Committee Chairman Ron Wyden (D-Ore.) about maternal health outcomes, and what he would “do right out of the gate to address the significant racial, ethnic and geographic disparities in maternal health,” Secretary-designate Becerra emphasized data collection, community outreach, and training a “better workforce, a bigger workforce,” as well as making “sure they're competent in the cultural and linguistic differences that oftentimes we see.” He continued that “we have to tackle the social determinants of health” and that bipartisan congressional efforts on these issues should continue.
Secretary-designate Becerra was asked several questions in both hearings pertaining to the physician workforce including a question from Sen. John Hickenlooper (D-Colo.) about the nationwide shortage of physicians, and specifically, “what can we do to provide more support and increase the number of primary care practices especially in those rural and underserved areas?” Secretary-designate Becerra responded by referencing Congress’ recent expansion of Medicare-supported GME, which he called “a major investment in getting more doctors out there in the future.” He continued by noting that “it has become clear how indispensable our health care workers, especially our medical professionals, are and I hope what we find is that our medical schools, our nursing schools, [and] all our health care teaching institutions see a rise in the number of people who are applying to become the next generation of health caregivers who save lives.”
During the Senate Finance Committee hearing, Secretary-designate Becerra highlighted his strong support for the Medicaid program. “Medicaid is the lifeline. It is what’s kept so many American families from losing all hope…I am absolutely prepared to work with you and many of your colleagues to try to do what we can to strengthen Medicaid for so many – including seniors who have Medicare who oftentimes rely on Medicaid as well – we have to make sure that we don’t lose sight of how important Medicaid has become to the entire population.”
Secretary-designate Becerra received several questions about his views of the Affordable Care Act and vowed to help President Biden implement his vision related to the health care law. “And what I will tell you is I'm here at the pleasure of the President of the United States. He's made it very clear where he is. He wants to build on the Affordable Care Act. That will be my mission to achieve the goals that President Biden put forward to build on the Affordable Care Act.”
Senators on both committees also addressed the 340B Drug Pricing Program as well as drug pricing writ large. During the HELP Committee hearing, Sens. Bill Cassidy, MD, (R-La.) and Jerry Moran (R-Kan.) asked questions about the 340B Drug Pricing Program. Secretary-designate Becerra voiced his support, referring to it as an “indispensable program for some of our most underserved communities.” Sen. Moran specifically asked about a letter Secretary-designate Becerra led with 29 state attorneys general asking HHS to hold drug manufacturers accountable for refusing to provide 340B discounts to hospitals for eligible drugs dispensed at community pharmacies [see Washington Highlights, Dec. 18, 2020]. Secretary-designate Becerra reemphasized his support for this issue and noted that he would build on a recent HHS Advisory Opinion that stated that manufacturers were required to provide 340B discounts on covered outpatient drugs distributed at community pharmacies [see Washington Highlights, Jan. 13].
HELP Committee Ranking Member Richard Burr (R-N.C.) in his opening statement addressed Secretary-designate Becerra’s record of advocating for the use of “march-in” authority, or the ability for the government to require patent holders to license their patent rights to another applicant, to address high drug costs. Burr noted that misuse of march-in would discourage innovation, and that the Senators who authored the Bayh-Dole Act (P.L. 96-517), as well as the current director of the National Institutes of Health (NIH) [see Washington Highlights, July 10, 2020], have stated that the purpose of the march-in provision is not intended to interfere with drug pricing.
Secretary-designate Becerra also highlighted the importance of telehealth during both hearings. In the HELP Committee hearing, Secretary-designate Becerra stated, “wholeheartedly I believe that we’re going to be doing an expansion of telehealth.” In response to a question from Sen. Cardin (D-MD) in the Finance Committee hearing, he added, “We’ve learned so much from COVID and how indispensable telehealth has been, especially in our rural communities, but also to some of our inner-city communities. And here, it’s become obvious if you don’t have broadband accessibility, you’re in real trouble.”
Secretary-designate Becerra also cited his efforts to combat the opioid epidemic as evidence that he is prepared to take on the role of HHS Secretary. During the HELP Committee hearing, Sen. Hassan (D-N.H.) shared her support for an exemption for physicians to obtain an “x-waiver” to prescribe the opioid addiction medication buprenorphine, an exemption granted late in the Trump administration and recently revoked by President Biden [see Washington Highlights, Feb. 5]. Secretary-designate Becerra noted that while the Biden administration put a pause on several rules, he believed that there is, “a commitment on the part of this administration to make sure we're providing that treatment that is indispensable for so many families ... [and that] the President’s goal is to get it right.”
The Senate Finance Committee must now vote on whether to advance Secretary-designate Becerra’s nomination to the Senate floor.