tv HHS Secretary Nominee Xavier Becerra Testifies Before Senate Finance... CSPAN February 24, 2021 8:59pm-11:09pm EST
conferences as well as remarks from members of congress. use the interactive gallery of maps to follow cases in the u.s. and worldwide. go to c-span.org/coronavirus. >> happier becerra was on capitol hill for the second day of confirmation hearings. he faced questions from the senate finance committee about the coronavirus pandemic, women's health care, prescription drug costs and mental health services. mr. becerra previously served in the house of representatives until 2017 when he became california attorney general. this hearing runs just under three hours.
>> the finance committee will come to order. and colleagues, this is nominations week here in the senate finance committee. this is the second of three nomination hearings. we're very pleased to be able to welcome attorney general javier becerra, president biden's nominee, to lead the department of health and human services. with a pandemic raging so many americans are struggling to get by, and our health care system is strained to the max. there may not be a higher stakes job in the executive branch
outside the presidency. attorney general becerra brings more than 2 decades of experience in the congress. he was a senior member of the house ways and means committee, which overlaps with this committee on many important health issues. he was closely involved in major accomplishments on health care including the affordable care act. for four years he's led the second largest department of justice in america, overseeing thousands of employees and a billion dollar budget. anybody who discounts the experience of leading a california agency that large and influential to the fifth largest economy in the world is straining awfully hard to find something to critique.
the attorney general defended the affordable care act from absurd and dangerous far right attacks. when the pandemic hit he went to bat for californians by increasing access and affordability for covid treatments, protecting workers from exposure and securing key safe guards for front line health care workers. having started my career in legal aid for senior citizens as a co-founder of the panthers i appreciate the attorney general got his start in legal aid for the less fortunate. this is a nominee with the right policy experience, the right leadership experience and the right experience fighting for people without power. that's exactly what's needed at the department of health and human services after four years of management that took america in the wrong direction.
now, in this committee a special focus of our work is going to be tackling inequality in every form. in america inequality is a killer. if you didn't believe it before the pandemic there can be no questioning it today. people of modest means, people targeted by discrimination, people marginalized in society, they're the americans who suffered disproportionately in the pandemic. that's because they were vulnerable before the pandemic, and federal policies didn't do enough to protect them. i'll tick through a few examples. first, americans are getting clobbered every time they walk up to it pharmacy window to pick up their prescription drugs. in a country as wealthy as ours, it is shameful you still hear
about people rationing their own medicine and suffering terrible consequences because they can't afford their medicine. second, the pandemic has proven there needs to be a new focus on mental health in america. with so many lives lost and so many people out of work, it shouldn't be a surprise people in oregon and across the country are struggling when it comes to mental health care. compared to physical health care issues, mental health has gotten short tripped for far too long. now, the law says they're equally important. but i'll tell you that's often not the way it's handled in the real world. that needs to be changed. we're going to talk some more about it this afternoon. third, the pandemic hat shined a spotlight on many long running dace parities on health care in the country, many of them that stretched back generations. one of them is maternal health care. the american people want this to be a pro-family nation.
totally unacceptable childbirth in the postpartum period are so teenagers to american women particularly when you compare our country to wealthy nation. this is especially serious for black and native-american women, and it's getting worse as the years go by. in fact, here's a shocking statistic. women today are more likely to die in childbirth than their mothers were a generation ago. addressing this crisis goes hand in hand with the need to expand and improve womens health care overall since the last four years have been a womens health nightmare. i'm looking forward to working with the attorney general and the biden administration on these issues and more. it's been a difficult four years for too many vulnerable americans who struggle to pay for meldson and secure health care. if a.g. becerra and his team start every day in actually focusing on expanding health care and improve health services instead of limiting them,
they'll already be doing better than the last administration. this is a nominee who's highly qualified. he's got a valuable range of experience that will help him succeed in this job, and this is a historic nomination because the attorney general would be the first latino secretary of health and human services. finally, i want to congratulate him on a late breaking development. today he won in federal court defending california's net neutrality law. i see the chair of the commerce committee has done so much on that issue, and we're looking forward to seeing the attorney general score more wins for the american people. with that let me recognize our friend, ranking member senator. >> thank you. the department of human health and services is a sprawling department with over 80,000 employees and responsibility for
over $1 trillion in annual spending. hhs and its agencies directly affect every day life including running programs that provide health care coverage to nearly 150 million people. the hhs secretary will shape medicare, medicaid, obamacare and many other important programs in the finance committee's jurisdiction. these responsibilities are formidable in normal times. but the covid-19 pandemic has made the hhs mission even more critical as these programs will play a key role in the pandemic response. this hearing is important for us to understand how attorney general becerra will carry out these monumental responsibilities. a few weeks ago i outlined several issues in the health care space where i intend to focus my efforts as a health care member to making our health care system more efficient. the covid-19 pandemic has
threatened americans physical and economic health. but it has also reinforced and provided opportunities changes that foster it. hhs has used its authority under the public health emergency to waive numerous requirements to ensure medical beneficiaries and other patients receive care during the pandemic. patients have benefitted from expanded access to telehealth and expedited approval of covid vaccines, diagnostics and treatment. going forward medicare and medicaid patients should have the same access to those innovative items and services as those with commercial insurance. we must carefully evaluate our response to the pandemic and implement appropriate reforms based on the lessons we've learned. hhs should partner with this committee in that effort.
another long-term priority for many on this committee for many is to address the financial problems. medicare's financial stability was a key issue discussed by the bipartisan bull simpson commission on which i served with attorney general becerra a decade ago. although the commission's proposal did not reach the 14 out of 18 votes for adoption it did produce a constructive bipartisan blueprint to reform and secure our intitle programs. medicare's finances remain unsettled. the medicare trusties currently projecting that the hospital insurance trust fund will go broke in 2026. and unforeseen circumstances could move the solvency date even closer. the new administration should work with congress in a bipartisan way to ensure that medicare is able to serve current and future beneficiaries. in yesterday's hearing before
the health committee many of my colleagues raised concerns about the enforcement of california's restrictive actions related to covid-19 including the ban on indoor religious services rejected by the supreme court. they also raised questions about challenges to hhs' authority to provide a conscience exemption from the obamacare mandate. and mr. chairman, i ask that letter be included as part of the record. >> without objection so ordered. >> nearly a year ago the committee worked together to expand unemployment compensation. in response to the economic devastation caused to workers by shutdowns. as time has passed there's been substantial reportingf fraud perpetrated by california's insurance program. fraud centers including international criminal
organizations have siphoned off perhaps more than $11 billion. that raises questions what specific steps were taken to combat unemployment fraud and when those steps were taken. finally, attorney general becerra, you have long been an advocate for moving all americans to a government run medicare for all plan. raising concerns with me that your policy preferences could undermine the medicare programs that rely on private insurance. you and i have talked about this privately, and i will discuss it further with you during the question period. i strongly support private insurance so patients can choose the coverage option that best meet their need. popular coverage program must be allowed to continue to thrive. and the successful medicare part d. program must continue to serve. it number of issues i've raised
indicate the scope and importance of this position. and i look forward to hearing your testimony and your responses to questions. thank you. >> i thank my colleague, and we're going to have a big debate on that. but the department of labor of course handles unemployment, and we're going to talk through all of these issues, i'm sure. we've got the senior senator from california, senator feinstein, who is here for an introduction of the nominee, and we welcome her for her comments. >> thank you very much, mr. chairman. and ranking member crepeo, thank you for the opportunity to appear before the committee to introduce california's attorney general, javier becerra, as president biden's nominee to be secretary of health and human services. i am so proud to have known this
man for as both a friend and a colleague. he spent decades serving our state currently as the state's attorney general and previously as a 12-term congressman from los angeles. mr. becerra was the first in his family to receive a four-year college degree. earning his bachelor of arts in economics from a university we share. that's stanford. and later his jd from stanford law school. as a member of the house of representatives he was a strong advocate for the health care of his constituents, and he fought to make the affordable care act law. as california's attorney general he's been a staunch defender of the affordable care act. leading 20 states and the district of columbia in defense of the act before the supreme court. as part of his focus on protecting the health of americans mr. becerra worked
with nebraska attorney general doug peterson, a republican, to lead a pipartisan coalition of 43 attorneys general to reduce youth exposure to tobacco products like e-cigarettes, which we've all become derned about and continue to pose significant health risks to children. he's also worked on a bipartisan basis with multi-state coalitions of attorneys general on other health priorities that align with the work of this committee, which includes increasing access to covid-19 treatments as well as addressing the opioid epidemic and the considerable harm it has caused to families. as our states attorney general becerra led the nation's second largest department of justice behind only the u.s. department
of justice. so he is skilled and just extraordinarily good. as secretary he will lead the nation's top health agency charged with enhancing the health and well-being of all americans. in this global pandemic he will hopefully play a lead role in overseeing the implementation of president biden's national strategy of the covid-19 response which is int tegeral to defeating the virus that's plagued our country for far too long. his history making nomination as the first latino to manage this department comes at a time when this pandemic is affecting communities of color at much higher rates than americans. and those of us who know him personally know the level of his concern and the strength of his dedication to protecting the health and safety of all
hardworking americans and their families. i deeply believe, and i've had the privilege of making this statement to another committee as well -- that javier becerra is the right candidate to lead the department of health and human services at this time, and i would give him my strongest recommendation to this committee to approve his nomination. and mr. chairman, it's good to see you again after this morning's hearing and i'm grateful to be here. thank you so much. >> thank you very much, senator feinstein, and we're very pleased to have you here. and i would also like to note california now has 100% of their united states senators here for the launch of the nomination of the a.g., and we welcome our new colleague senator padilla. >> as we recognize in
yesterday's health committee hearing our nation is going through one of the toughest times we have faced in recent memory. the covid-19 pandemic has taken a incredible toll. covid-19 deaths in the united states just surpassed 500,000, a grim milestone for our country. as has been referenced the devastation has disproportionately impacted working class families and communities of color, very similar to the communities that both attorney general becerra and i grew up in. these communities are hurting and dying at alarming rates, and they desperately need someone who knows these communities at their core. the los angeles times published an article this past saturday documenting the disparity in
vaccination rates across in this particular case los angeles county where wealthy neighborhoods like beverly hills are receiving vaccines at five times the rate of predominantly minority communities such as south los angeles. and that's why i'm honored to introduce attorney general becerra today as the nominee for secretary of the department of health and human services. if confirmed attorney general becerra will be the first latino secretary of health and human services, an honor i know he will not take lightly. throughout his upbringing and time as a public servant javier has shown his passion for people and his commitment to improving the lives of those he represents. his parents immigrated from mexico just like my parents did with a dream of building a better life for themselves and their family.
as has been noted javier received his undergraduate and law degrees from stanford university. and while at stanford he met his wife, a widely respected obstetrician who helps care for women with high risk pregnancies in underserved communities. javier's first job out of law school was working with individuals with mental health disorders, a health issue that is too often overlooked especially in communities of color. he was elected to congress in 1972 where he quickly gained and maintained a reputation for being a strong supporter of reproductive health, protections for seniors, mental health parity and the childrens health insurance program also known as chip. javier was instrumental in both the drafting and passing of the affordable care act which has helped provide access to quality health care for millions of previously uninsured americans.
and his work did not stop there. as attorney general of california he's made it his mission to tackle structural inequalities within our health care system. he has been the leading force behind the lawsuit to protect the affordable care act and to maintain the protections for people with pre-existing conditions and for those suffering from a mental illness. over the past year attorney general becerra fought to protect front line health care workers from further exposure to covid-19, and he stood up for home owners struggling to meet their mortgage payments. now, while i understand the politic of the moment may compel some to try and paint a distorted picture of attorney general becerra, let me point out that many of you have worked with him for decades here in congress. republicans and democrats know javier becerra to be a thoughtful, open minded leader
and always willing to listen to both sides. it appears to me as it appears to many that he's being held to a much different standard than some of the nominees this senate has supported and confirmed over the last four years. let me say this both attorney general becerra and i throughout our careers have too often been the only latino in the room. sadly javier and i are not unfamiliar with being held to different standards, but he is a proven leader who is uniquely qualified to take on the challenges of this moment, and i urge the committee to support his nomination. thank you. >> senator, thank you very much. and we're very glad that you're here today. and i would say to you and
senator feinstein, thank you both for your statements. we know you have very busy schedules, and feel free to depart should you wish to. >> thank you. >> thank you both. let me also -- one other item of business before we turn to the nominee for his opening statement, we're going to take a quick moment to enter a number of letters of support into the hearing record for secretary designate sarah. as of thsk the finance committee has received 73 letters off support for mr. becerra from a wide range of groups. without objection i'd like to make those materials part of today's hearing and record. and with that attorney general becerra, we welcome you. we look forward to your opening statement. >> mr. chairman and ranking
member crepo and members of committee, thank you for this opportunity to speak to you. my good friends senator feinstein and padilla, i thank them as well for their gracious introduction. i want to thank my family if i may begin by doing that. she's been my long-term partner, i call her my north star, she's here with me. my three daughters. everything i do including this is a family affair. and i know i'm here because my parents who had only their health and their hope when they settled in sacramento, california, taught me to earn the american dream. the construction worker with a sixth grade education and a clerical worker who arrive from mexico, they never saw the inside of a college classroom,
but they cept other kids to one or to the military. we lost my dad last year on new year's day. and when the end came my dad knew we were there with him at his side in our home. sadly hundreds of thousands of americans haven't had that closure this past year. that, senator, is why i am here today. the covid pandemic has killed more than 500,000 americans, many of them alone without their families. millions more have lost their jobs and their health care. that is not the america my parents would believe possible. to meet this moment we need strong federal leadership. that's what president biden is demonstratingch and if i'm fortunate to be confirmed, i look forward to joining the president in this critical mission. i understand the enormous challenges before us and our solemn responsibility to be faithful stewards of an agency that touches almost every aspect of our lives. i'm humbled by the task, and i'm
ready for it. the mission of hhs to enhance the health and well-being of all americans is core to who i am. when i was a child my mom had a health scare. she was rushed to the hospital after hemorrhaging at home. the image is seared in my memory. we were lucky. my mom is now 87 years young. better put, we were blessed. my dad the laborer, he had insurance through his union. we didn't have much, but we didn't have to face the threat of unpaid medical bills or even bankruptcy. over two decades in congress i worked to ensure every family the same assurance my family had. i helped write and pass the affordable care act. from the ways and means committee i fought to strengthen and modernize medicare and how we finance it. as attorney general i created health care rights and access
task force, we cracked down on medicaid and medicare fraud. i hope to hold opioid manufacturers accountable for the addiction crisis. i've taken on hospital and drug makers who unfairly jack up prices on patients, and i've protect patients rights in privacy. if confirmed, i'll work with you to continue this type of work to address hhs' biggest challenges, and that of course starts with covid. the president has ambitious goals, 100 million vaccine shots in arms, increased access to testing, reopening schools and businesses. hhs has a central role in meeting these goals safely and equitably. as attorney general i saw the importance of this on the front lines. i worked with colleagues in other states both republicans and democrats to make covid treatments more available. i am ready to work with you with our state and local partners,
our tribal partners, our territorial partners and across government to get this right. next we must ensure people have access to the quality and affordable health care they need, to reduce the cost of health care and prescription drugs and ensure we are accountable, spending resources wisely and effectively. and i won't forget the other "h" in hhs, human services. i want to work with you supporting our vulnerable children, those in foster care, strengthening head start and expanding access to child care. finally, we must restore faith in our private health institutions. that starts with putting faith in the facts first. no one understands your state and your communities better than you. we may not always agree, but if i'm fortunate enough to be confirmed i will always listen to you and keep an open mind. i will look for common cause, and i will work with you to improve the health and dignity of the american people.
thank you, mr. chairman, ranking member crepeo and members for the opportunity to share my vision. >> mr. chairman, thank you. and there's some obligatory questions that we ask nominees before we get into questions. first, is there anything you're aware of in your background that might present a cop flict of interest to the duties of office which you've been nominated. >> no, mr. chairman. >> do you agree without reservation respond to any reasonable summons to appear and testify before any duly constituted committee of the congress before you're confirmed? >> yes, mr. chairman. finally, do you commit to provide a prompt response in writing to any questions addressed to you wii any senator of this committee? >> senator, mr. chairman. >> we'll now begin, attorney general, with five minute rounds of senators. i'll begin and then senator
crepeo. i think we all understand that the covid-19 pandemic has compounded the country's long-standing health disparities. the fact is america really has two health care systems. in the suburbs often affluent white families have all kinds of incredible health care. that's a stark difference to areas where many more black or latino families live. they really face in many instances health care deserts. for those communities long drives, long wait times or a lack of health providers are enormous constraints. this is especially true when it comes to mental health, where the united states has the worst record among similar countries. here's a statistic to remember. women today are more likely to die in childbirth than their mothers. women of color have borne the brunt of this tragedy. plaque, american, indian, alaska native women are three times more likely to die of pregnancy
related complications than their white counter parts. so our first question is do you agree that extending medicaid coverage from just 60 days to 12 months postpartum as the house covid-19 relief bill provides is a necessary step to reverse this rising mortality crisis? >> mr. chairman, absolutely. and if my wife were allowed to say a few words she'd probably say keep going, don't stop. >> good. if you're confirmed, mr. attorney general, what else would you do right out of the gate to address the significant racial, ethnic and geographic disparities in maternal health? >> we need better data. we have to be collecting information that lets us know where to go. if we collect that data we're going to have bad results, so one of first things we have to do is make sure we're collecting good data. we also have to reach out to the communities that know the people that were missing, go to the
civic and religious leaders back home where we know we're missing families. they are respected, trusted, they can help us reach out to those folk. we have to train a better work force, a bigger work force. and we have to make sure they're competent in the cultural linguistic differences that oftentimes we see. and of course we have to tackle the social determinance of health that i think i'm proud to say now watch what congress is doing, it's great to see how much it's a bipartisan effort now. >> mr. attorney general, let's return to the issue of mental health for a moment. and i think it would be fair to say from sea to shining sea communities are reporting gnat mental health demands for services have just soared into the stratosphere, and it is for schools, youngsters who have had challenges for learning are
reporting being in need of mental health services. and i want to say i think this mental health challenge right now is the public health equivalent of a four alarm fire. it is just that serious with the situation of care being too expensive or unavailable. and it's something i take very personally because my brother was a schizophrenic and for years there were nights in our household he'd be out on the streets and we were convinced he was going to hurt himself or someone else. so the question then is what do we do about it, and one of the solutions comes from my home state, and it deals with some of the challenges that we're facing on the streets. i talked to several of my colleagues here and senator crepo and i, and the question is do you look to a mental health counselor, and do you look to law enforcement to try to respond in the appropriate way?
and we've come up with a program in my home state called cahoots which is supported by both mental health counselors and law enforcement people. senator cortez is our lead sponsor, a number of other colleagues are for it as well. and our approach deploys medicaid, which would be under your jurisdiction to setup mobile crisis response teams that can dispatched when a person was experiencing mental health or substance disorder that would be appropriately handled from the mental health side rather than the law enforcement side. my time is short and i apologize for that. if you're confirmed would you be supportive of efforts like the cohoots program so we can expand in my home state of oregon but
expand it across the land. >> senator, count me in. i know law enforcement at home would say the same thing. as we watch a 911 call comes in and we're seeing a person usually in mental distress on the streets, it's our officers asked to respond. they're not trained professionals on mental health care, social services. they're trained to do public safety protection. and they would love to have people working with them so we can make sure the right professional is the first responder to these cases. >> okay. very good. thank you very much, mr. attorney general. senator crepo. >> thank you very much, senator widen. as we discussed i strongly support private insurance to allow consumers to choose health care coverage that best meet their needs, but your long-standing support for single payer government run health care seems hostile to our current system from my perspective.
what ashurnlss can you give to americans who currently have private insurance including through medicare advantage and are satisfied with their insurance provider that they will not lose their coverage in the future to some sort of medicare for all approach or other federal takeover of insurance, excuse me, of health care. >> senator, thank you for the chance to respond to the question and also the time you gave me to sit and chat. i will tell you we will both agree how important it is to give everyone in this country coverage, good coverage and i will tell you i'm here at the pleasure of the president of the united states. he's made it clear where he is. he wants to build on the affordable care act. that will be my mission to achieve the goals president biden put forward to build the affordable care act. >> i appreciate hearing that. could you go a little bit further? i'd like to know what your
feelings are about the program. that's i think one of the most successful parts of our system and the people who choose it who are increasingly dramaticically around the country are showing why their votes in support of it, why they think it's a program meeting their needs and helping them significantly. what is your perspective of the medicare advantage program? >> senator millions of americans depend on the advantage for our seniors. we see it gives it a chance to do what are called wraparound programs to reach out to people with more service. and i think we have to take every approach we can because at the end of day as i said at the beginning it's about getting more health care to people at an affordable price and good quality. whether it's in rural america or urban america, we have to see how we can make medicare for our seniors work better. >> thank you. and i want to move to the trust fund. i know you're aware the trust fund is in dire status.
most recent medicare trusties report projected the hi trust fund would be officially bankrupt in 2026. at which time it would no longer be able to pay full benefits for our nation's seniors and the disabled. that report didn't include any analysis on the trust fund. earlier this month the congressional budge office released its updated winter baseline and new baseline takes into account the increased tax revenue due to stronger economic forecast. but while cbo now also predicts that the hi trust fund will be involvant in 2026, there's substantial uncertainty behind their projections. given the recent medicare spending trends, it seems unlikely the trust fund could remain solvent to 2025. can you commit today if you're confirmed you'll immediately direct the centers for medicare and medicaid services, the chief
actuary taking into count the fiscal covid-19 pan dem snk. >> i can commit to you we absolutely look forward to working with you to give you and the this committee the information we need to make the right decisions when it comes to medicare moving forward. >> i appreciate that. grs has looked to reform to providers in order to extend the life of the hi trust fund. however, the last time congress enacted savings the money was used to finance spending. can you tell me -- we're now here a decade later and those savings are no longer available. what policies do you think congress should consider to extend the life of the hi trust fund? >> senator, i remember well our experiences, which i thought was a tremendous experience because it really bought some thoughtful minds together. heres what i can tell you off the bat.
i believe -- in fact you and i can agree that our seniors who paid into medicare should not be harmed by our need to come up with policy recommendations and solutions. so first and foremost our beneficiaries must come first and any discussion about this. secondly, as you know and as we worked and i know you've done since, there are short-term solutions and then there are longer-term solutions. and none are easy or otherwise we would have done them already. but here's what i would suggest to you. president biden is prepared to tackle this because our seniors depend on it. we've seen what medicare has done in pulling so many seniors out of poverty from the 1960s before it was enacted today. the team at hhs should i be frpt to be confirmed will be ready to sit down with you to discuss this and more on medicare's
future. >> i'll probably ask you to respond to this in writing afterward. but i'd like to know how soon we can expect that opportunity to develop a comprehensive legislative proposal from hhs that will extend the life of the trust fund. >> thank you. >> thank you very much, mr. chairman and ranking member. it's wonderful to have you in front of us, attorney general becerra. and it was wonderful to serve with you in the house of representatives and work on so many issues that related to health care and behavioral health. and as i told you i think when i called right after you were nominated, i was very excited to see that someone of your values and experience and competency would be nominated by president biden to lead this incredibly important agency. and i do say i know some have said they're concerned you're not a doctor. our former headquarter hs secretary was a drug company
executive, a ceo. and you've been on the other side as an attorney general and congressman fighting high drug prices. so that's the side i'm glad to have a hhs secretary on. so it's wonderful to have you here. and i have to say i'm so pleased this morning there's been so much focus on mental health and want to ask and thank mr. chairman about all these issues because i know you as well
some funding and the most recent hhs budget found these services led to a 63% decrease in emergency room visits for behavioral health and a 60% decrease in time spent in jails, which is why these comprehensive community services are so widely supported by law enforcement and decrease in homelessness. we have comprehensive community centers, 340 of them across 41 states. everyone wants to do this like we have federally qualified health centers with comprehensive funding. we have this model for behavioral health and it needs to be permanent and comprehensive. i wondered if you'd talk about some of your goals again about ensuring coverage, paying for behavioral health and can i count on you to work with us to
move forward to make this effect ive proven program permanent as a nationwide expansion of the behavioral health program? >> senator thank you the question and i have to first say thank you for the work you've done. if there's someone who has been the patron saint for this issue i think you are you get to qualify for the total. many folks feel no one cares. their esteem goes up when someone talks about the issues, the respect they deserve. i would say this. the money you all made available to help us expand some of the centers, most of it i think $500 million of the $600 million is on the ground trying to help. we have to be more effective and
reach out to indian health services folks and i think what we can do is elevate this issue because the laws as the chairman said is already there. we are supposed to treat mental health services with parity and provide the behavioral health service. the coordinator approach helps us do it bet per >> thank you. my time sup, mr. chair. i'll ask are to the record questions related to expanding access to home health services and alzheimer's, maternal, infant health, a lot we need to do together to make a real difference in the lives of americans across the country. >> senator grassley? >> i'll bet you're just waiting to talk about abortion. i'm going to start with something a fact. during the second trimester of fetal surgery, doctors may
administer anesthesia to reduce pain experienced by the unborn. so question, do you believe it should be routine to also give anesthesia to unborn children during late-term abortion to minimize the pain that they're capable of experiencing? >> senator, you're asking me i know an important question but a very technical question and you're moving into an area which i know carries with it very deeply-held beliefs where folks sometimes have differences. i respect that and want to make it clear that i respect the law and the science in my career working with men, women, young, old, what i've done as the
attorney general as of our state, follow the law and expect others to follow the law. while we may see it the same way on a particular issue, on health care, these challenges we have to confront for the american people so i would like forward to try to reach that common ground with you and others. >> i appreciate that. i think you made my question more complicated. i wasn't asking you were you for late term abortions or not. i was asking during the process, whether or not you thought the baby ought to have pain in the process of that pain killer in the process of that abortion, like we have a requirement for fetal surgery. i didn't mean to get into whether or not you support late term abortions. >> senator, let me try to address that, if i can, more directly. it still might not be enough for
you but i tried to make clear that i would rely on the science and the experts, as the secretary of hhs, to help us make decisions to the degree that the agency has any role in making some decisions related to that. i would rely on the science and the experts. >> thank you. now i want to go to something that the chairman, senator widen and i worked together on and good faith and arrived at quite a compromise and deals with the subject of prescription drugs. i believe congress must pass something like what he and i worked out last year in a bipartisan way. it might be difficult to get something through that would take 60 votes that some people in your political party are thinking about doing. and most of that deals with whether or not we're just going to put a cap on increase in drug
prices as the best way to get to solving the high cost of prescription drugs or whether the government will negotiate prices which basically the government dictates prices and also we have some letters from cbo over a long period of time that says it doesn't save money, where the widen-grassley bills saves about $95 billion. this is my question. dough you know in the biden administration would be interested in enacting drug pricing reform bill, like for instance what, along the lines what have widen and i worked out that saves the taxpayer dollars and can get 60 votes in the united states senate and will be a lot easier to get up under a
schumer majority leader position than it was under a mcconnell leadership position or do you think they want the alternative of trying to get something a lot stronger from the democrat point of view along the lines of what i suggested? >> senator you've asked a great question, would be easier to answer if i were still a house, senate member because those negotiations are really up to you all. there's no doubt president biden wants to see us lower the price of prescription medicine and if i'm fortunate to be part of that time will be working with you in a bipartisan fashion to reach a solution. i congratulate you and chairman widen for the work you've done in the past to try to bring members together. >> one second left. we passed a bill that i've been working on for six years and you will be in a position to get the regulations and get it under way. it sets up an alternative
program for rural hospitals, and it's called the rural emergency hospital program. and it would work this way. a critical access hospital would have the alternative. they wouldn't be forced to do this. if we want to give up their residential beds and preserve the other things that hospitals would do, then they could do that, and it's my way of keeping when there's only 4% occupancy in most of these critical access hospitals and it's a very expensive thing for them to operate, will maintain rural health services short of residence beds. i don't know whether you know enough about the bill that we passed but i think it's
critical. the american hospital association i'd like to get that up and running as fast as we could. >> senator, i know the time expired. we can follow up with this question that i am absolutely looking forward to working with you on this. people often forget, california as big as it is has large rural areas and i was trying to tackle hospitals gobbling each other up. in some of our rural communities there may be only one facility and they may not have any choice if they're going to survive but to have a major player come in and take them over and so please, make sure that you don't think that a rural facility, which is standing out there by itself is just like all these other places in urban america, and so -- >> colleagues, we're going to move on and i -- >> i will follow up, senator, i look forward to working with you. >> thank you. >> i thank the senator from iowa. senator cantwell?
>> thank you, mr. chairman. attorney general becerra i'm excited of your nomination and diverity and breadth of experience and your career. following up on senator grassley's drug questions, because it's topical of the moment, we had a chance to discuss drug shortage issues, the fact that the price of insulin is just too darned high and that shortages and issues, do you think there's more that the fda and the ftc should do in this area? >> absolutely. we cannot afford to see drug shortages continue. we have to plan ahead. we have to work on the supply chain. we have to make sure that we don't encounter a situation where americans one part of the country have the medication they need and other parts they don't. >> there's no reason to see the spikes we've seen in insulin, is
that correct? there are policies we could be putting place? >> in some cases we're finding these are artificially created, yes. >> thank you for saying that. i hope -- senator grassley lev the room but he and i worked on this and i plan to do a lot on this issue as it relates to the federal trade comission and its oversight. turning to the broaderish issues of afordability of health care, we also had a chance to talk about the basic health plan, something part of at fordable care act to take care of people above the medicaid rate but cost-effective way to bundle people who don't have access to insurance and make it a more interesting market, but still leave states in control of helping to negotiate on programs. the end result is 800,000 people in the state of new york buying insurance at basically $500 an annual supreme um and saving more than $1,000 from what we'd
save on the silver plan for those individuals. is this concept something we should continue to look at as a way to leverage and bundle up people who aren't quite as interesting to the market right above that medicaid rate. >> minnesota as well has done this and it's another innovation. especially for states that are willing to put skip in the game to make this happen, to try to get to the point where we're providing more coverage, better coverage, lower cost. >> well, i think you know my colleagues who talking about already who we don't want this, we don't want that, we've combined the best and the concept of allowing a state to still be in charge of that end product but to allow people to propose from the private provider, some sort of
discounted rate which i definitely think that we need to be getting more out of the providers on discount, not to say you can't have other public options. this one has been working and successful on that front. also, the issue of n 5 mask answer fraud. i personally think we need a task force between the fda and border and customs and doj and others to look at this issue again, we've given the ftc broad authority to find immediately on anybody who takes advantage of the covid pandemic to manipulate or to overcharge and we have health care workers and we're asking them to go into these situations and they're finding out big, vast amounts of supply of these masks don't meet the standards, so we need to be
aggressive here with the fda on a task force to make sure that we are looking at this. >> i couldn't agree more, senator. hhs would be more than willing to work. our jurisdiction comes more on the side of certifying what it takes to have a mask that works. we will work with our partners. state and local and tribal and territorial partners are important, too, because they're on the ground. i've had as the ag to in california work to go after the fraud, the gouging that's gone on with the products and pandemics and disasters. we're willing to work with you. i've had experience as a prosecutor doing this. if i'm fortunate to be confirpd as secretary of hhs we will partner with the different agencies to try to get to this. >> thank you. thank you, mr. chairman. >> i thank my colleague and just quickly, before we go to others, we have a bipartisan effort on insulin prices out of this committee, a report that we did. prices have gone up 12-fold in
recent years and the drug is not 12 times better. it's essentially a product of price gouging and senator grassley and i put together this report we'll put it into the record without objection after senator cantwell's good statement. >> thank you, mr. chairman. mr. becerra, welcome to the committee. you heard the chairman talk about a big range of public health issues that we have to deal with, starting with the pandemic. senator talked about medicare and medicaid and senator grassley will rural health. i'll come up with ihs in a minute. in exercising your record it does seem like as attorney general you spent an inordinate amount of time and effort suing pro-life organizations like little sisters of the poor, or trying to ease restrictions or expand abortion. you're going to have a big job as secretary of health and human services if confirmed. so how do you assure us, because i think the majority of the
american people would not want their secretary of health and human services focused or fixated on expanding abortion web we got all these public health issues to deal with. how do you assure us that's not something that continues over from your time as attorney general? >> senator, thank you very much for giving me a chance to answer the question and here, i think i tried to say to senator grassly, i understand americans have different deeply held beliefs on this particular issue and i absolutely respect that. i have never sued any nuns. i have taken on the federal government but i've never sued any affiliation of nuns, and my actions have always been directed at the federal agencies because they have trying to do things contrary to the law in california. it's my job to defend the rights
of my state and uphold the law. what i will say to you is this, as i try to uphold the law, i recognize that people will look at these things a little bit differently and here is where i think there's an opportunity and now as secretary of hhs if i'm fortunate to be confirmed working with all of you to try to see if we could find that common cause on how we move forward on this very, very difficult issue, but very important for so many americans. >> let me shift to, i mentioned indian health issues, in the great plains region, ihs lost accreditation for failure to comply with safety and quality measures and mum tipple health care providers exposed for abusing patients. we have to talk about the leadership and management failures that led to this
situation. it can't be blamed all on funding. had, hs has to be involved and active driving improvements from ihs. if confirmed, what specific actions would you take to hold ihs accountable to the patients it serves as well as to the congress who faces obstacles getting answers to important oversight questions? >> i know this one is important to you, senator, and so many who have a number of our tribal communities in their state. transparency. we must work better at providing you and others and those in these tribal communities with the information they need, better data but mostly it's accountability. that i commit to you. i say that as someone who represented more than 100 tribes in the state of california for many, many years that we owe it to our tribal governments and natives to be there, we have sovereign rights, we have a trust of responsibility. we'll work with you.
ihs works with tribal communities because they've had more success than many states putting vaccines in arms and we need to applaud them when they do something well. >> i have a bill that would improve management hiring practices at ihs and would like if you end up getting confirmed to work with you on that. you heard about 340b a few times yesterday. the key is it enables hospitals and covered entities to provide community benefits that otherwise may not be available. if confirmed would you commit to ensuring the strength of the 340b program and the community that it supports? >> absolutely. not just in your rural communities but i've got inner city communities i've had to represent who depend on 340b. >> one last quick question. this is probably the one bright spot of the pandemic has been telehealth, something that i've been working with this committee
on for a long time and as we continue to look at options for expanding telehealth, what will your approach be to taking administrative action at hhs and cms and what legislative approaches from the congress would you support? >> we've learned a lot from covid and seen how important it is to have broadband reach all our communities we're seep how we have to have flexibility. we can talk to the communities benefiting from it i don't think we're going back to the old days when it comes to telehealth. >> thanks. thank you, mr. chairman. >> senator menendez? >> thank you, i wish i could tape their conversations. >> could you all -- >> thank you. i have a hearing issue. mr. beis he rah, welcome, good to see you again. a few quick questions hopefully
you can glide through with me so i can get to other things. you were a member of the ways and means committee, the equivalent of the finance committee almost, of the house of representatives, is that correct? >> that's correct. >> were you there during the period of time when the affordable care act was instrumented? >> yes. >> were you there in the affordable care act? >> i was in those rooms. >> as part of that, you became familiar the affordable care act created the opportunity for millions to have health care. >> i was very active. >> to create affordability for millions who found it less affordable who created medicaid expansion? >> that's correct. >> and also dosed the hole for prescription drugs for seniors? >> that's fair to say. >> you had the experience during that whole period of time and created special provisions for women's health. is that fair to say? >> yes, it is. >> california has the fifth
largest economy in the world if it was an independent country? >> that is correct. >> as attorney general what was the size of the office? >> we were several thousand, over $1 billion budget. >> several thousand, over $1 billion budget. let me ask you, when you took an oath when you were chosen to be the attorney general of the state of california you took an oath? >> i did. >> in that oath i believe part of that preserve, protect and defend not only the constitution of the united states but the constitution of the state of california and the laws of california. >> that's correct. >> you don't pass the laws, you defend them. >> that's correct. >> let me ask you this. if you took, if you are successful and i believe you will be, being confirmed by the senate, you're going to defend the laws of the united states as they exist at the time? >> that's correct. >> i find it interesting many of my colleagues raised issues
about you being a lawyer and without sufficient experience. the reality is that thousands of employees under your direction experienced firsthand creating the most significant landmark legislation on health care and dealing with medicare and medicaid within the committee of ways and means jurisdiction seems to be a problem. the previous secretary of hhs was also a lawyer. he was a lawyer at a drug company that did a good job in fleecing insulin patients so i don't think we'd see that from you. a few specific policy questions, you and i had an opportunity to talk, will you work with us on improving diversity in clinical rise because this san area that we think lacks and i've written to all the companies that are engaged in clinical trials, most pretty responsive, but is something i think we need to do to make sure all of america is represented in the trials.
>> senator, absolutely. as i always say if you have bad inputs going in you produce bad outputs. if we have studies reflecting the american people we have to have good inputs. >> would you work with me and others to improve diagnoses of black and latino dementia patients as we begin to address alzheimer's disparities in communities of color? >> absolutely. >> one of the things with the pandemic it magnified the incredible disparities that exist in our society particularly in terms of the health care of minority communities. will you commit to working with me on ways to reduce the disparity for communities of color and the delivery of our health care system? >> yes, sir. >> let me ask you a question, we've had a bipartisan support here for mcveigh maternal infant early child home visiting program. i look forward to working with
others on the program. do you support an expansion of this valuable program? >> senator my wife is a maternal fetal medicine specialist and i've gotten the squeeze between you and her and the response is i absolutely look forward to working with you. >> finally, we were able, part of my work here was to ensure that we could include a thousand ugme slots that congress provided. i would like to get you to work with us to ensure that we quickly and efficiently implement that provision of the law. >> done. >> thank you very much. >> i thank my colleague. we'll move through this list of members. next is senator carper, who is available on the web. is that actually correct?
senator? >> hello? >> yes. we're waiting for you, senator carper. >> oh, good, good, good. first of all, general, how are you today? >> senator, i am well. >> have any of our republicans raised a question whether or not you have the ability to i would say the experience of leading a large organization? >> we've had some good discussions. >> no, i'm -- what i'm asking, has anybody raised a question like how could you lead an organization as big as hhs, what have you ever done that would suggest that you could do that? how would you respond to that?
>> how i would respond, sorry, say that question again, how i would respond to -- >> yes, like someone raised a question about your ability to lead an organization that is huge. what have you done in your life that suggests maybe i am up to that task. >> senator, for 30 years i've been working on health care, my first job -- >> more administrative side, running a huge organization. my recollection is talking with kamala harris is that the job you have right now is not a small job. >> second largest department of justice in the land, and i'd say over the four years that i was there, we outdid the largest department of justice in the land every time we were in court. we have continued to protect the largest state in the nation, and we are an operation that i think most people would love to see the size in their operation. we're over $1 billion and several thousand personnel and we do a really good job of protecting the rights and
opportunities for californians. >> that's a pretty good answer. thank you. we talk about the role of vaccination effort that's going on. can you talk to us about why that's important particularly why that's important with people of color? >> senator, as you know, too many people are missed. they fall through the cracks and community health clinics have been a godsend for many of these communities because oftentimes they're the only facility, the only available source for good health care, and with community clinics able to help provide the vaccines, it makes it more possible for many of our families who have often been left behind to actually get the care and the protection that they need and so they've been indispensable. thank you for the, that you and others have done to recognize how important they are, and especially now, during covid. >> i understand there was a hearing i think it was yesterday
in the house that focused on additional vaccines beyond pfizer andmoderna and discussion with respect to astrazeneca and johnson & johnson. have you had a chance to come up to speed on what was covered at that hearing? >> i wasn't at that hearing but it's been brought to my attention. certainly hhs will be on top of whatever happens with any future vaccines because it has to run the vaccines and trials would run through our different agencies. >> at the 30,000 foot level the process and next step approving, the approval for astrazeneca and
the johnson & johnson vaccines? >> so the fda plays a very crucial role along with cdc and there are several other subagencies within hhs will have roles that are critical as we try to continue to deal with the pandemic, and hhs if i'm fortunate to be confirmed will make sure it's working at reduced speed to make sure whenever is within our ability to handle we do is quickly because we know how important americans have a vaccine available. while we've seen success especially under president biden's tenure in reaching more and more americans and president biden announced that we have secured up to 600 million shots of the vaccine for americans that we will continue to work to make sure that we are on top of it and ahead of the game when it comes to making sure we're protecting all americans. >> how long did you serve in the
house? >> i was there for 24 years, sir. >> did you ever meet a guy named john carney? >> of course, your colleague and now your governor. >> yes. he used to be a member of my cabinet and enormously proud of him. when, usually our congressional delegation has a chance to catch up with him every couple of weeks and one of the comments we continue to hear is adequate supply of vaccine delivered in a timely way, and in accordance with expectations consistent with expectations. do you have any thoughts on that for us? >> and my response is going to be based as a leader in my state, and absolutely our states, our local partners, tribal communities, our territories they all want to know the same thing, we're going to be working in partnership with them, they'll coordinate with them and not going to blindside them because they have to prepare. they're doing most of this on the ground. they want to know there's a real
partnership so we're not doing this as if we're the federal government and we know everything so i would expect governor carney, who say champion for the people in the state and real fighter would make sure he's on top of it because he's working closely with the federal government. i would look forward if i'm fortunate to be confirmed to get the team to work with a former colleague. >> i understand the hearing yesterday johnson & johnson were close to getting emergency distribution approval from the ef ta and i understand there was also testimony that suggested astrazeneca could receive it about a month later, the beginning of april. folks at astrazeneca have the
ability to produce a lot of vaccine i'm told and i hope the same it true of johnson & johnson. we've been really starved for vaccine for the last several months and we could be in a position all of a sudden to get more vaccine than we know what to do with. that would be a good problem. i ask you think about that, because we've flooded with that and when it comes and flows in great quantities that we're ready to do something with it. >> senator carper is asking about an especially important issue. mr. tern general would you like to give a brief answer? or we can move on? >> i look forward to working with him. we want to be prepared and rather have more than less to make sure we're saving lives.
>> thank you, mr. chairman. >> senator carden and langford are next and colleagues, it is our intention after consultation with the minority and with senator crapo we'll see if we can complete the business of the hearing by 4:00, when we have the vote. my sense is we can't and it would be our intention to recess briefly between 4:00 and 4:5 and that is what we have talked about with senator crapo. we are at senator carden and senator langford. >> thank you to my good friend javier becerra. i very much remember the days of the affordable care act and the work that you did on that so thank you for your willingness to continue to serve our country.
>> thank you. >> one of the provisions included in the affordable care act set up the offices for minority health throughout hhs and established the national institute for minority health and disparities at the national institutes of help. chairman widen talked about meeting the needs of the underserved communities. you've talked about it, i have no question about your commitment to provide services to those left behind in health care in america. what strategy do you have to reinforce these offices that surntly exist so that the legacy of dealing with health disparities will be institutionalized within the department of health and national institutes of health to have an ongoing commitment to deal with the disparities in this country? >> senator, thank you for the question. it is great to see you again and brings back great memoies of our work together.
the office of minority health is a critical operation within hhs. i swend to make it a more important office than in the past because covid has exposed what many of us already knew, that we have failings when it comes to approaching all of our communities in america and giving them the same access and so the office of minority health prove indispensable if we want to tackle this beyond covid. i look forward to working with you and others interested in this because there are several office within hhs that deal with minority health and certainly the principle office i want to empower them. if i'm fortunate to be confirmed i think everyone in hhs has heard this that the office of minority health will have real program nens under my tenure if i'm frnt to be confirmed. >> thank you very much.
with covid-19 we recognized the importance of telehealth, made it easier for providers to provide telehealth services. what is your strategy to expand access to health care through telehealth which can easily make health more accessibility to communities today that are challenged with accessibilit >> we can't go back to the old days. we learned so much from covid and how indispensable telehealth is especially to rural communities but also to some of our inner city communities. here it's obvious. you don't have broadband accessibility, you're in real trouble. we're now into 2021 and is there there are still parts of america that don't have good access to broadband and covid explained why it was so essential we worked harder in the past.
the flexibility to make telehealth work for everyone. we're not going back to the old way of doing business. i look forward to working to see how to make telehealth accessible to everyone. >> thank you. we've made progress with pediatric dental care included under the affordable care act as an essential service but still our seniors lack access to certain dental care, private insurance not necessarily provides dental care for routine dental work so we still have a gap. do you have a strategy to try to expand access to dental care as you know good oral health care is essential to good general health. >> senator, who can forget the amte driver, a young resident of your state who died because his
parents didn't have the access to health care and in this case dental care they needed and what was an infection turned into an abscess and turned into a lost life and i will tell you dental health can be critical. you and i know this, and so i look forward to working with you to try to see us expand access to dental health, vision care, the times of things that sometimes we take for granted until we're in our later stages of life. it's so critical and the family of diamante driver could say that. >> the chief dental officer was left vacant by the previous administration. prescription drug costs is an issue to deal with but in america we have drug shortages of drugs that are inexpensive but not made because they don't make money on them. i urge you would make it a priority issue there should not be a shortage of drugs in
america necessary for health care because of the private pharmaceutical network doesn't feel it's profitable to make the drugs. >> profit shouldn't be the reason we come one life-saving medication. >> thank you. thank you, mr. chairman. >> senator langford? >> chairman, thank you. mr. becerra, it's a tough process to go through. you've been on the other side of this in the house of representatives, we've walked through a lot of the issues. i do need to get clarity on things we have not talked about so far. as california attorney general you sued the federal government over 100 times including multiple times dealing with issues about conscience protection that you would specifically have to now enforce on the other side of it. so i'm trying to get some clarity on this. there's a conscience and religious freedom division at hhs, they compiled 25 different conscience laws that already exist in statute that are law and to say that hhs in the past
wasn't always consistent in enforcing those laws but they were going to be consistent because they were laws on the books. may question, will you continue to enforce existing federal law on conscience issues when you get to hhs and what will you do with the conscience and religious freedom division? >> thank you for the chance to respond to the question. it's an important question and i believe deeply in religious freedom and i'll make sure as secretary of hhs you will know that i will not only respect the law when it comes to these issues of religion freedom but enforce them as secretary of hhs within my department. >> the challenge in processing through this, some of the history there. when you're attorney general, you had suits that went to the supreme court and were overturned, the fact act that came out of california requiring pro-life facilities have to post in their facility here is a way
to get an abortion, instead of having your child up for adoption which feels very much like promoting abortion, not providing abortion. you argued that case to the supreme court, ultimately lost because the supreme court said what's obvious. you can't require someone to say something they disagree with, the little sisters of the poor and other groups that said we don't want to participate in an abortion related health care and about 28,000 californians lost their health care that fit in with their conscience based on how you were xwagt. help me understand the disparity between those two? >> senator, again, it's important to provide clarity there. as you mentioned, i was in these cases my job as the attorney general is to defend the laws of our state in the first case, you referenced a law in our state which had been upheld in court,
ultimately overturned by the supreme court as you said, it was overturned which means up until the supreme court, i had been defending the law of our state. in the second case, the actions we took were against the federal government, and once again, we were defending our states laws and rights under the law. some cases we've lost, some cases we've won. where we have lost i can assure you right now california is following the rules that were provided to us by the supreme court and so we'll always abide by the law and it's my obligation to defend the laws. >> so you're going to be in this unique situation litigating against hhs in the areas and now have to flip and try to defend the areas and i'm trying to figure out how that's going to fit for you and if there's a conflict of interest in that. >> that's a great point, and i say this for everyone to hear. i will have to abide by ethics rules. i will be signing an ethics agreement. there are certain cases because i handled them as the attorney
general within california i'll have to recuse myself from certain cases where i was involved at the state level and certainly because of the ethics agreement that i will have, there will be always a check on what i'm doing to make sure that it doesn't somehow conflict with what i have been previously as attorney general. >> the conscience issue is important for a health care provider who believes a child is a child, whether they're in the womb or outside the womb, that's a child that got created and has value and worth. it's exceptionally important to be able to honor the convence rights of that individual and they not be compelled to be able to perform an abortion or to participate assisted suicide, something where they have a conscience issue with that and this is going to be a very significant issue that you're going to face that in previous times administrations just ignored and did not enforce. >> senator, i hear you, very clearly and as i said, i will respect the law as hhs secretary. >> there are multiple grants and aid that's out there, that there will have to be decisions made
faith-based entities can get grants or aid at the same level as nochb-faith-based entities. excuse me. here is the challenge. in some previous administrations if you're faith-based entity, you were not allowed to participate strictly because of your faith and the structure of that. supreme court made clear decisions over the last several years to make it clear you can't discriminate on the basis of faith. will you make sure the grant and aid proposals from hhs are equal for faith-based and non-faith based entities? >> you raise the the issue regardless of perspective, at the end of the day we've got to make sure, at least i do as, if i'm fortunate to be the secretary of had, hs, i have to follow the law and there i will tell you we will make sure that we are following the law. >> mr. chairman, i ask for four different letters entered into the record folks sent to me and other members of this committee.
>> without objection, that's so ordered. all right. senator brown is our next colleague on the web and senator daines is here, following senator brown. >> thank you, mr. chairman. general becerra, good to see you and thanks for your willingness to serve as secretary of hhs and thank you for your career, you've been reducing health disparities and prioritizing policies to address the social determinants of health. a number of communities in my state passed resolutions declaring racism as a public health crisis. i think it's important that we know that the history of institutional racism continues to impact health outcomes for communities and it's particularly important that you understand the emergent need to be intentional of your work and i know you will be so thank you
for that. cincinnati is home to two cdc niaf facilities. their focus is occupational repetitive injury, occupational repetitive health, toxins in the workplace, all of that generally. in 2015, secretary burwell announced hhs would dedicate $110 million to consolidate and upgrade the facilities, agreed to repair the way cdc was a half a generation ago. cdc and gao are undergoing site acquisition activities. a contract will be finalized in the spring for design. it's moved entirely too slowly from the previous administration. my request is simple to ask if you'd work with senator portman
and me and get the attention it deserves from hhs including the funding necessary to stay on track. >> you have my commitment to that. >> thank you. thank you, general. in recent years, congress and hhs expanded the scope of benefits available to those who enrolled in medicare advantage plans without doing the same thing for those individuals who choose to remain in traditional medicare. we've added benefits, vision, dental, we removed barriers to care like the three-day skill rule for skilled nursing medicare advantaged beneficiaries but failed to extend the more privatized medicare but failed to extend the same advantages to the seniors that stay in traditional medicare plans and those seniors typically are a little older and a little sicker and a little poorer generally. the growing imbalance between the programs concerns me greatly especially in the medicare programs, spending more money
per medicare advantaged plan enrollees than on people who choose traditional medicare, a relatively recent but inexorable move in that direction. my question general becerra, will you commit to using your authority to holding private insurers accountable in reining in those medicare advantage overpayments to ensure taxpayers in all medicare beneficiaries are getting their money's worth? >> senator, you have my commitment, in terms of dealing with medicare, you're right, we don't have the dollars to spare and to waste, and so in this process to try to strengthen and improve medicare we have to make sure we're doing oversight and keeping everyone accountable and so i absolutely agree that's one of the principle responsibilities we have. we have to be good stewards of the medicare program, taxpayer dollars and as you mentioned with this three-day rule for post acute care, there are ways that we have to make sure that we're keeping everyone honest and i will make sure that there
is a level playing field. >> good level playing field here is so, so important. in closing, one last point, mr. chair, general becerra. i'd like to, i want to bring forward to you the issue of the priority of bringing down the high cost of prescription drugs. let me share a story from a constituent in columbus area community called pickerington, someone named colton, diagnosed with ulcer ative colitis in 2014 and forced to pay $1200 every four weeks that kept the disease in remission. i want to read you his comments. at the time of this cost increase i was in college, was already feeling the financial burden, a student debt, budgets for students are already tight enough but the increase left me in a difficult position. unfortunately with the added financial burden for my infusions i had to choose between affording the cost of my
infusions or school. this decision wasn't a decision at all, since i needed the infusions to stay alive. yet a reasonable price of my prescriptions forced know leave college. my life path has been completely altered by expensive prescription drugs and drug company greed. i often feel i'm behind all of the people my age, even younger than i because i've had to focus my time and money on staying alive. we shouldn't have to give up on pursuing a college education because of critical medical debt, crippling medical debt and shouldn't have to make every financial decision with the cost of prescriptions and medical debt in the back of our minds. things could be better in our leaders rein in drug company greed and making the needs of patients like me the priority. that's the end of his letter. now is the time, general, for meaning for reforms to bring down drug prices. my question is simple. if confirmed, will you commit to working with me and other members of this committee
especially chair widen who has been so involved in this to deliver real change that will make american prescription drugs more affordable? >> you have that commitment. >> thank you, general. thank you chairman widen. >> thank you, senator brown. you will be working on that. senator daines? >> thank you, chairman widen. attorney general beer is camera, i want to be up front and tell you i've got serious concerns with the radical views that you've taken in the past on the issue of abortion as well as an important constitutional protection, religious linert and frankly a record to shows a disregard for that. our present challenges demand hhs secretary is prepared to combat the covid-19 pandemic and command a position of public trust. many montanians, pro-life groups written to say you've taken the most radical positions on this important issue of life and abortion. if you want to push back on that
impression, i think you have an opportunity here to try to gain some public trust, and to take a look at the record you've had in california and how you might govern if you are approved here in washington, d.c. could you name one abortion restriction that you might support? >> senator, let me try to respond this way. i have tried to make sure on this important issue for so many people, where oftentimes again we have different views, but deeply-held views that i have tried to make sure that i am abiding by the law, because whether it's a particular restriction or whether it's the whole idea of abortion, whether we agree or not, we have to come to some conclusion, and that's where the law gives -- >> but is there to be clear, is there any line you would draw? is there just one, just one
restriction as it relates to abortion that you might support? >> senator, you're talking to the spouse of an obgyn who for decades has practiced saving lives of women and babies, and i can tell you that, from the stories i've heard from my wife, i know how hard many women struggle just to save the life of their baby so what i will say to you and i know that right now, as i speak, my mother has blessed me this morning, as i got ready to come here and last night i know when she prayed the rosary as she does every day, every evening with my aunt that she said a prayer and included me in that prayer. >> well part of that is the battle for those who don't have a voice, the little babies. and you didn't answer the question but even one, even one restriction on abortion, i didn't get an answer from you. let me throw one, how about a ban on the lethal discrimination of babies who are diagnosed with down syndrome?
>> senator, once again, if i can simply say to you that i respect the different views that are out there, but what's important is that it makes sure -- >> you are going to, if confirmed, the head of hhs. that's a huge organization, profound impact on our society. how about a ban on sex selective abortion? where the little baby is a male or female, you can't have a sex selective abortion? >> i respect those who take a particular view. my job will be to make sure that i am following the law. >> there's a ban on partial birth aabortion. that question came up yesterday, yes or no, would you support a ban on partial birth abortion? >> again, senator, you're asking questions which will touch on aspects that i know have different views, and what i can say is that i will make sure that i'm respecting the law on those issues. >> you've repeatedly intervened in court to revoke an important
religious exemption to obama care's contraception mandate on catholic nuns that serve the poor and most vulnerable and they have won at the supreme court. as hhs secretary, would you commit to defend the existing or seek to eliminate the exemption protecting the little sisters of the poor from crippling government fines? >> the supreme court issued a ruling. if i'm fortunate to become secretary of hhs, we will abide by the law as it stands. >> you would defend the existing mandate then per the court? >> i will defend the law and support the law that's in place. >> according to cdc data, comparing states and territories, montana is ranked near the top for administration of vaccine but we fall near the bottom for first doses allocated by the federal government. that's why our congressional delegation wrote to president biden expressing frustration that montana isn't getting its fair share of vaccines.
i'm concerned hhs is neglecting to reward states like montana that could administer at least three times the number of doses being delivered currently. do you believe hhs should provide additional vaccines to states like montana, for example who have been able to quickly and efficiently get vaccines in the arms of people who want them? >> senator, we applaud states that are moving forward and being diligent in getting their people protected and i know president biden has made the commitment to have all the vaccines that we'll need throughout the country, and what i can commit to you is to make sure we're working with you and the folks in montana to make sure that the vaccines are there for the people of your state when they need them, and doing that for the same way for all the people in this country, we want to make sure we're not missing anyone and that's where the issue of pockets of populations -- >> thank you for that and appreciate that answer. last question, you're on record for pushing for allowing illegal immigrants to receive taxpayer funded health care and for decriminalizing illegal entry into the united states.
this coupled with president biden's radical plan for granting citizenship to those illegally would lead to hundreds of thousands if not potentially millions more people flooding into our country. in 2016, california passed a law requiring covered california to apply for section 1332 waiver to allow illegal immigrants to purchase health insurance through the marketplace. this waiver was withdrawn after president trump's election. my question is this. will you attempt to you attempt waiver authority contained in the affordable care act? >> senator, i can tell you that where the law as it stands now as i see it it does not allow those who are unauthorized in this country to receive taxpayer paid benefits except in very rare circumstances and it will be my job to make sure that we are following and enforcing the law. and i can commit to you that that's what we'll do. >> thank you. >> senator bennet?
>> thank you, mr. chairman. it's very nice to see you, mr. attorney general. welcome back to washington. and i want to turn to what was called a radical plan and that was the affordable care act which has made massive strides in providing health care to 20 million americans, protecting people with pre-existing conditions from discrimination. a lot of other things that have become the norm in this country like stay on your parent's health insurance until you're 26. something that you couldn't do before the affordable care act. i think we need to use the medicare system to provide a true public option and it's something that the president has talked about in the campaign. i believe in it when we passed the aca to begin with. the votes weren't here to do it. i think it's become very clear during the course of the pandemic that nobody is served by having people that don't have
primary access -- or access to primary health care because you can see in numbers in the pandemic what's happened tohis country versus some other places. last august, the president -- then candidate biden was speaking to one of my constituents from colorado, laura packard, who was told -- who told the vice president at the time that she was literally receiving chemotherapy on the day that there were some folks here trying to repeal the affordable care act. and she asked what he was going to do for people like her and for, you know, people in america and he told her, quote, we're going to provide a medicare like option as a public option. i'm going to protect you like i try to protect my own family and i promise you that. it was a powerful moment for all of us who were watching and yesterday senator tim kaine and i and some of my colleagues on this committee reintroduced the
medicare choice act to create a true public option, increasing choice for consumers starting in rural areas and increasing affordability of the haeld insurance. including fixing the family glitch and ensuring that the cap on premiums for everyone above 400% of the federal poverty level is 8.5% of their income. medicare finishes the work of the aca and aligns with the president's objectives. you are uniquely situated being a california attorney general to help us get this across the finish line and i want to ask what your thoughts are on the commitments the president made on a public option during the campaign and how we can get it across the finish line so we can
finally fulfill the promise that every single american has access to health care in this country? >> senator, you pointed out that now president biden stood as candidate biden and he was very strong about this. he made it very clear that affordable care act is a strong foundation from which we can build. you mentioned the public option. he made it very clear he's a supporter of moving forward on a public option. i will try to implement the agenda on health care so i will look forward to working with you and all of your colleagues to continue to see more americans access health care through their employer or through medicaid or through the marketplaces. we need to have those options and including the public option available if states want to move in that direction. we will try to be -- we'll work with them as best as we can. as you said the goal here has to be make things even better, more affordable for americans. >> mr. chairman, i came up with the idea of -- for this legislation after i was in a
meeting in jackson county, colorado to give you a sense of jackson county, my friend from indiana, i had to start the meeting by apologizing for how badly i had done in the election the last time because it is -- you know, there are very few democrats there. and somebody actually said oh, you actually won a few more democrats than there are. but it was grim but i was there and somebody said to me, michael, i moved back to this town, it's county with i think fewer than a thousand people in it. huge, i moved back to this town to take over the bowling alley that i loved to go to as a kid and i'm working 50 hours a week. my wife is working 50 hours a week, neither of us has health insurance. my -- i have got people that i want to hire but i can't hire people because they have to give up their welfare to come work for me. i said what do you mean their welfare? he said their medicaid. in other words, health care.
this is after the affordable care act was passed. here we have a situation where small business owner and his wife are working 50 hours a week, they can't afford health insurance. folks that would want to come work can't come work because they have to give up their insurance. how can we defend a system like that and we don't need to. i hope we look back at the history of all of that and find a way to put the partisanship aside and actually provide the american people with what this is. an option. they can choose all over rural and urban colorado it's a choice. if you want to stay with your private insurance, stay with it. if you want a public option administered by medicare you can have that too. and i think that's going to be a powerful argument for the american people coming out of the pandemic want more choices not fewer. i'm very glad you have been nominated and i look forward to supporting your nomination and working with you to deliver this for the american people. thank you, mr. chairman. >> thank you, senator bennet.
senator? >> mr. becerra, there are all sorts of concerns by my constituents and i think every american about getting shots in arms as quickly as possible. that is my foremost objective in trying to support the administration in furtherance of that goal. the biden administration just announced the launch of two new federal retail pharmacy program and the community health center vaccination program. this was an effort to speed up vaccinations across the country. these programs are in addition to an existing program which is the pharmacy partnership for long term care. unfortunately, these various programs are causing some confusion for the states. as the states aren't able to oversee and coordinate distribution of our already limited supply of vaccine with and these various entities. long term care facilities.
community health centers. retail pharmacies. and individual hoosiers are confused as well because they have to sign up in multiple places in order to become vaccinated. in fact, the national governor's association recently wrote to the administration highlighting this issue indicating, quote, if the federal government distributes independently of the states to the same entities without state coordination and consultation, redundancy and inefficiency may very well follow. unquote. i'd like to submit two letters for the record. one from the nga and one from my state home state of indiana. >> without objective so ordered. >> so i bring this to your attention because until adequate supply is available, mr. becerra, the administration should be working with states on vaccine distribution, especially
since retail pharmacies and federally qualified health centers are already part of many state's vaccine plans. in the state of indiana, it has been making great strides with the available vaccine to get into the arms of hoosiers. so do you commit to working with the states before announcing major program rollouts like the two i mentioned in the future? >> and senator, you'll understand why this is close to my gut more than my heart because i'm a state official right now and we have had to administer a lot -- i had to defend many of the programs in our state level in court and what i will say to you is that if we're not doing a good job of coordinating with our state and local and tribal and territorial partners then we're -- then we're not doing it as well as we can. i'm committed -- and president biden has made an effort to make
sure we have enough vaccines for everyone, we have to make sure that that shot gets in the arms. >> so that's an encouraging response. let me go further. >> sure. >> would you allow states like indiana who may well find these programs counterproductive to our shared goals of getting vaccine into arms, to opt out of the federal programs until there's adequate supply available? >> so let me -- i'm not yet there and i hope to be confirmed but it would be tough -- >> would you consider it? >> absolutely. we'll sit down and talk with you. the moment i'm on -- in that seat, i will make sure that we're setting together. we'll go to your office and we'll talk about this. >> can you conceive of a reason why wouldn't you allow a state like indiana to opt out of the programs? >> i will tell you the president's goals are ambitious and we want to move forward quickly. i want to make sure it's clear that the president's been very, very transparent in saying that
we want to make sure we're reaching everyone. we're doing it in a fair way. >> okay. >> we're doing it -- you know, it makes sense. >> i'm going to cut you off because you know how this goes. i've got limited time. >> yes. >> but i would hope you would allow states like indiana to opt out if that will help us get more vaccine in the arm of hoosiers. so 33 americans die every day waiting for a life saving organ transplant. we have an organ shortage in this country and it results from the severe lack of oversight and accountability among government monopoly contractors that run the organ donor systems. these are known as opos, and the senate finance committee recently noted that our organ donation system has been severely underperforming for decades. department of health and human
services finalized a rule last november that would allow the hhs to hold them accountable for first time in 40 year history and this rule is projected to save more than 7,000 additional lives every year. it will save money too over $1 billion annually to medicare. but because this rule was finalized in the last 60 days of the previous administration, you know where i'm headed with this, it's currently being subjected to the biden administration freeze on midnight regulations. so is hhs -- as hhs secretary, will you commit to implementing and enforcing the november 2020 opo final rules swiftly and forcefully as soon as the review period ends? >> first i have to say thank you for the role you have played on organ donation. it's critical. it's not a subject everyone wants to take on. secondly, the pause that the president put on a number of
these rules is something that most administrations do but i can guarantee you that the administration if i'm fortunate to be confirmed, hhs will work quickly to try to get back up to speed on some of these different rules. i can commit to you this. we all know we need to increase the supply. we know we have to be fair. we have to make sure we're doing in this a way that makes sense and we have to do the oversight. so i can commit to you to work with you to make sure that if i -- once i get in the chair if i'm fortunate enough to be concerned we'll talk about how to move forward with that rule and of course your legislation as well. >> thank you, mr. attorney general. let me also say to my colleague and to those following this. i think these are very important issues and we have had a bipartisan inquiry going on in this committee where our colleague has been very actively involved. we will be continuing that. it is really high priority matter and my colleague has laid out some of the problems and
we've going to want to get into the details i believe when the attorney general's confirmed and i was appreciative of his positive answer and i thank you. let's do this. if there are any senators waiting in the queue on the web, we will take one more before we go and vote. and then otherwise, per an agreement with both sides we'll take a 15 minute recess. mr. attorney general. are any of my colleagues waiting on the web to ask questions? all right. i gather not. so it is a little after 4:00. we'll take 15 minutes and we'll have a recess and we'll be back at that point. oh, senator casey, okay. senator casey, you're out there in cyberspace somewhere. >> i didn't think i'd have a chance. >> terrific. we will revise the state of play
here and we will hear in -- hear from senator casey and after he has completed his questions, then we will take a 15 minute break and that is in accord with the wishes of both the minority and the majority. senator casey? >> thank you, mr. chairman. i think i may have jumped ahead, so the attorney general -- this has never happened before. so let me use my time wisely. mr. attorney general, thank you again for your public service and your willingness to continue public service on behalf of the nation by running a major agency of our government that's so important these days and that's the department of health and human services. i also want to thank you for the commitment of your family which i know is a major commitment by any family when you're in public service like you have been all these years. and yours is a great american story. i wanted to start with the issue of home and community based services. we know that one of the real
tragedies within the larger tragedy of the pandemic now that we have reached that awful, awful number of 500,000 deaths is a high percentage of those deaths at last count more than 170,000 residents and workers dying of the virus who were in nursing homes, living or working in nursing homes or other long-term care settings. one way to protect these populations is with a responsive and robust support system that provides quality home and community-based services. we know that those who do this work in the home or home and community-based services are frontline workers. they're heroic. and the folks that do this work support older adults in our communities and they also support and provide care for
folks with disabilities who need that help. they are often paid about $12 an hour for this essential work. most of them -- a high especially of them are women of color and because the home and community based services are not required under medicaid under current law, there's over 8 hundred thousand people on waiting lists for the services. 16,000 of those in pennsylvania. so we need to invest in this option that we haven't really made part of medicaid in a substantial way other than the waiver program. we need to invest now, the house legislation, their covid-19 bill has over $9 billion. this is but a foot in the door, but a very important, unprecedented foot in the door. so i have two questions for you. first upon the passage -- i'm being optimistic here but i think it will happen, the passage of this emergency funding legislation, covid-19
legislation, as well as the funding for home and community based services, will you work to distribute it to the states as quickly as possible? >> you have got my commitment, senator. >> thank you. then secondly, as you know, the next matter for president biden and vice president harris is to work on the built back better plan and that's another opportunity i think for us to really focus on this issue but provide an even more substantial investment in home and community based services and i hope you will work with us to secure that funding. >> you've got my commitment again to work with you on that. >> the last issue in my remaining time is medicaid. i don't have to tell you because you have been a strong supporter in providing medicaid funding it isn't some program. it tells us who we are. it tells us who we are and tells
us whom we value. whether it's kids or seniors or people with disabilities. so many millions of americans, 70 million plus the last count, have the benefit of medicaid. you were familiar with when we sat down most recently and then in our last hearing in the health committee with my agenda for children. the five freedoms for america's children. if they don't have health care coverage they should be covered by medicaid and i want to ask you, how will you use your authority as hhs secretary to utilize waiver authority and other tools to strengthen medicaid and to help expand coverage to uninsured or underinsured americans? >> senator, i know you know this so i'm repeating what you have worked on so much and that is medicaid as a life line. it's what's kept so many american families from losing all hope and in many cases losing respect and so i am
absolutely prepared to work with you and many of your colleagues to try to do what we can to strengthen medicaid because 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 and with the president's commitment to continue to build on the affordable care act, medicaid as you know is indispensable. so ready to work with you on any issues especially for children and i know my wife is applauding everything you have just said to try to make sure our children have opportunities from the get go. >> thanks so much. we look forward to your confirmation. >> thank you, senator casey. >> thank you. >> we're calling some audibles here and with the consent of both sides we'll have all other senator whitehouse and then
we'll take a 15 minute break. >> welcome. great to see you and i wish you every success in the remaining days of your confirmation process. i want to mention two things to you that i put a lot of work into over time. one is delivery system reform in our health care system. macro, we hit the medicare trust fund in 2024. so we're going to have to deal with that issue between now and then. micro, rhode island has two of the best accountable care organizations in the country. these are primary care provider groups, doctors practices, that have got together early, signed up as acos under the affordable care act and have changed the way they practice and as a result their cost per patient is coming down. their patient satisfaction is through the roof. their outcomes are improving. and they're sending checks back
to the federal government out of the shared savings that they have been able to obtain. my staff person will hand you a little graph that i have got a big copy of right here which is something that i have worked on for a while as time has gone by. in the far left here, time begins around the time we passed obamacare. and at that point, cbo projected what federal health care spending was going to look like and their projection then is that top line. but in fact, with obamacare law we didn't follow that trajectory. costs were actually lower and as we have gone forward, we have experienced actual costs that are that bottom line. and the current projection matching that original one from
12 years ago i guess now pushes out -- from where we are right now ten years but if you took that same projection and put it on to where we were before, here's this gap between what was predicted and what we have achieved. in the next ten years, that gap is $6 trillion. something changed from what was anticipated at the time we passed obamacare and the savings and the next decade are going to be $6 trillion from whatever that thing was that changed. i think that what changed was getting away from fee for service. getting providers engaged in accountable care organizations and the emphasis on quality and reducing medical errors and dealing with patients better. so i have had my rows with the obama administration over how they were doing acos and i had my rows with the trump
administration and i want to work with you to make sure that these organizations that are basically breaking trail for the rest of the health care system, these leadership acos are getting the support and the encourage that they need because when they win, we win. and with medicare trust fund starting to hit its limit looming, we've got to get serious about that. and i don't need a long response from you now but i want to make sure you're aware of the opportunities for delivery system reform and i know you have some good acos in california as well. >> yes. senator, there's a response there, i'm looking forward to working with you on it. >> we will. because we've got work to do. it's also very likely a big political win-win.
i don't anyone on any side in washington who doesn't want better care producing lower costs with happier patients. last point, this is a bit of a personal thing. i have been working for a long time with having us treat people at the end of their lives better than that they do, making sure their capability to be at home is respected. making sure they're pulled out of the health hospital treadmill and they aren't dying in intensive care units that they don't want to be in and shouldn't be. in we have worked with cmmi a lot on that and i'm hoping we can close out under your leadership through the center for medicare and medicaid innovation a pilot program that will show that when you treat people at the end of their lives with more humanity, everybody's happier and it saves money. will you work with me on that? >> as someone who had his father
live with him for the last three years of his life and when he passed he passed in his home, absolutely. >> we have had the same experience. thank you, sir, and god speed in your confirmation. >> thank you. thank my colleague. mr. attorney general, take a 15-minute break. >> thank you. the weather hit, we were seeing a leveling off