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for joining us. i will start off with a little bit of history. topic one, drug prices. in july of 2020, donald trump said since the day i took office, i have made reducing drug prices one of my highest priorities. for four straight years, donald trump complained about high drug prices, did lots of finger pointing at others about the problem and repeatedly talked about how he was the best friend of seniors -- best friend

seniors who depend on medicare could have. what was actually accomplished ? exactly nothing. asked forward to the biden administration. from the time -- fast-forward to the biden administration. from the time joe biden took office, he made it clear he was committed to lowering drug costs and heal care prices for families. i remember him having a conversation with me shortly after the election. he said the finance committee is a place where things happen. been talking about doing something about drug prices forever. time to get something done. and to actually help seniors. not just talk about it, because there has been plenty of talk. but actuallyet results and provide real pocketbook relief to seniors and consumers. two years later, president biden

and many colleagues who are on this side of the aisle worked very hard to get results. to lower prices on medicine and president biden the inflation reduction act into law. for the first time under the law, democrats and presintegotir drug prices. understand what that means. it means that seniors beat big pharma. big pharma's holy grail, what they cared about more than anything, is prohibiting negotiation for a better deal on medicine. look at what they are doing right now. going to court, trying to stop any negotiation. but we have it written in the law that there is going to be negotiation. on top of it, most americans have access to free vaccines.

insolent costs for seniors were capped at $35 a month. as we said, when the government leads on these issues, particularly the showpiece of american health care, medicare, almost always the private sector cowe have seen real progress in the private sector as well. we want every buddy iama are ma. we also created price gouging penalties for the first time to b pharma accountable for high drug costs. those are benefiting patients and taxpayers. plenty more to do. it is essential that finally, after all of this debate, we get pharmacy benefit managerpharmact reforms across the finish line

and congress can finish this crucial change that's going to help all of these wonderful people in their white coats because they are here to keep thegoing in the lower drug costs for patients and protect community pharmacies. that's the difference, folks. on the first issue of drug prices. donald trump, president biden. topic two. health insurance. in march of 2019, donald trump said the republican party will become the party of health care. the number one health care goal, stated again and again, the number one goal, repeal the affordable care act. get rid of the whole thing. one, he failed, fortunately, as well. under president biden's leadership, democrats boosted tax credits for health insurance, saving millions of of $800 per year for coverage and access to

care. when you look at president biden's budget, what you see is a clear focus which is to build on the progress the biden has made. with all of these health care changes in mind, the next question is what do donald trump d republicans have planned when they talk about health care? the american people are wondering, because not once during the aca repeal and replace crusades, not once did we see an actual replacement. seven y the efforts to repeal the aca crashed and burned, nothing has changed. donald trump still says let's get rid of it. he still lacks a plan to take ca of all the people whose health care coverage is doing that -- his doing that would actually rip away. he's talked about gutting

americans social security and health care benefits. no plan to keep seniors out of poverty and illness, either. that's the difference between senate democrats and what president biden is talking about and what donald trump and republicans are talking about. republicans plan to shred the health care today that millions rely on and pretend everything is going to be fine. so, on these issues, i think it is clear that there is a gap between president biden, senate democrats and donald trump, with respect to health care. the gap between those trump promises and biden action on health care, the difference on the actual records between the two is as deep as crater like. democrats made promises to be

american people and we got results and delivered. i'm going to wrap up by saying there is another issue today that is pending that is very important for kids and health care. that is to get our bipartisan tax deal with congressman jason smith passed in the senate. it helps 16 million kids and immediately let 400,000 kids out overty. you'll have to take my word for this. here is what the president of the american academy of pediatcsy about this. in case anybody is interested, he's from oregon. dr. ben hoffman. he'sown oregon health and sciene center. he has said there is an inexplicable link between poverty and -- inextricable link

between poverty and child health. an inextricable link between poverty and child health. what we are trying to do that got 350 seven votes in the house of■ representatives, is help those 16 million kids be healthier. 400,000 of them would get out of poverty right away. so, we want everybody to know this morning that we are all in in terms of getting it done. we want to pass that bill for the child tax credits and their company and their research before the april 15 filing deadline. so, hearing om the american academy of pediatrics, as we wrap up this discussion, as far as it gets. we will have good input from secretary becerra about how president biden will continue to first, we will hear from senator

crapo. >> there is one thing that you and i agree on. we have to control drug prices. you already referenced it. you see a number of folks in the those are pharmacists. we met on the grass side in front of the capital today with hundreds and hundreds of them, to talk about one of the most important things we can d now. which is to get the pdm legislation, which passed this committee, 26-0, on thokso thate most significant things that can be done to help control drug prices. i want to focus on that. we have our disagreements on what we consider to be a price control program and the impact of it. but we have places where we have agreement. i'm hopeful we can make progress on that right away. back to my formal remarks.

thank you mr. chairman and thanr being here today. over the course of the past year, the finance committee has taken bipartisan actionchallengg collaboration and consensus to advance commonsense solution for seniors and working families. our pharmacy benefit management reforms would modernize medicare's prescription drug benefits, driving downthe pharmg billions in savings for taxpayers. the committee's mental health proposals would build on previous efforts to shore up patient access to critical services, especially in row communities. these policies received nearly unanimous support all through regular order. your department and its sub agencies have offered essential technical assistance throughout these processes.

that support has ensured alignment between our legislation and its intended goals. and i thank you for that. as we move forward, further action on these overdue patient focused proposals mu become an priority. not just for our committee, but also for the administration. we responsibility to patients, community pharmacies and front line health care providers to deliver on these commitments. regardless of policy differences oner fronts. the president's budget request, unfortunately, falls severely short of that aim. óon prescription drugs, the document makes virtually no mention of the robust partisan bicameral efforts. instead, opting to double down on a price control policy that polarizes members in both chambers. bipartisan bills in the senate and house would address unintended consequences spurred by the inflation reduction acts

pricing provisions. particularly for patients with rare diseases, who will likely see fewer treatment options under that law. embrace these avenues for viable reform, the budget seeks to expand the program scope with no attempt at improved transparency, certainty or mitigation. further, the president's budget request confirms an overreaching mandate that would force nursing their doors and result in less access to home and community-based services for medicaid beneficiaries. this document highlights the visis and■ misses vital opportunities for productive, patient driven partnerships with congress. we department on a host of health care hurdles that demand policymakers attention. you have rightly raised concerns on -- around the ongoing surge in medication shortages, including for lifesaving therapies. the chairman to dieecently --

and i recently released an outline of solutions to mitigate this crisis. and we look forward to working with hhs and cms to develop legislation designed to achieve these goals. we also stand ready to partner on proposals aligned with the ■presidt'including by ensuring t seniors can access innovations like multi-cancer early detection screening. those tests can be invaluable. earlier, i joined senator bennett in reintroducing our bill to grant medicare coverage with bipartisan majorities in bo bipartisan majorities in both chambers have joined as sponsors for this legislation. while the ainistration aired in rescinding regulations aimed at expediting access to medical breakthroughs, your department could take a range of steps to

reste devices. including by expanding and enhancing the proposed pathway that cms published last year. before closing, let me emphasize the importance of timely communication with respect to the cyberattack on change health care. while you have taken important steps to issue guidance and flexibility to insurers, providers and contractors to mitigate the effects of this hack, over the -- the over two week delay resulted financially, rural hospitals and providers with little to no cash reserves required immediate action by the administration to ensure payrolls could be met and services could be continued without interruption. in weeks, hhs should continue to update members and stakeholders on efforts to limit further disruption.

we have an obligation to build on long-standing legacies of bipartisanship and bolster the clinician workforce, drive value-based care, improve broken payment systems and ensure long-term access to telehealth. with these joint goals in mind, thank you again for being here, mr. secretary. and thank you, mr. chairman. >>getting a 26-0 vote■r in major legislation involving enormous sums of money is just about impossible. it's hard to get a 26 or 27-0 vote on ordering soda pop. thank you for your work on that. secretary becerra. sec. becerra: thank you for the

invitation. wh p of 2021, covid was ravaging our families and our economy and americans were dying at a rate of 2-3 9/11s everyday. in january of 2021, the number of americans with health insurance was, like our jobs and the economy, down and on the canvas. prescription drug prices were 6ocketing with patients and their pocketbooks at the mercy of big pharma. today, three years later, nearly 700 million shots of covid vaccines have gone into the arms of americans and we can now manage covid like the flu. today, more than 300 million americans, a record number, can go to the doctor or hospital and not go bankrupt because they have their own health insurance. more than 21 million of those

americans can count on the affordable care marketplace for their insurance. another record. today, while big pharma is still big, new prescription drug law has brought down the price of insulin to $35 a month for americans on medicare. as we speak, we are negotiating with drug companies to lower the prices of even more prescription drugs. even as they sue us to stop us. the president' budget doubled down on the investments that made the comeback of our jobs, economypossible. it fosters innovation and protects every americans access to the care she needs. this budget does not just strengthen medicare, it strengthens it beyond our lifetime. this budget continues our ship for our health system that treats illness to one that sustains wellness. all told, fyi 2025 -- the fy

2025 budget provides 1.7 showing dollars in mandatory funding to advance our mission and invest in key priorities. budget provides medicaid like coverage to low income individuals in the outlier states that have not expended medicaid under the affordable care act. when that happens, another 1.5 million americans will have health care coverage and the peace of mind that comes with it. this budget builds on the largest investment in a generation. it bolsters a 988 suicide crisis lifeline and gives young people support at home and school. that means boosting our behavior health workforce with 12,000 new psychiatrists, social workers, marriage and family therapist, council lists and peer support specialists. across hhs, they tackle the maternal health crisis by improving access to pre-and postnatal care.

we are making child care more affordable for working families. and more available where families live and work. this budget will providex creased wages for early childhood education workers and it would fund more than 750,000 slots for children in head start. and, it funds universal preschool for our nation's 4 million four-year-old children and eventually will include our budget grows and strengthens the cybersecurity initiative to ensure safety and privacy and keep our hospitals and providers, especially smaller ones and those in rural communities, running and secure. finally, this administrationmenn preparedness capabilities since the pandemic. and we keep building. this budgeinvests in■h countermeasures to combat antimicrobial resistant drugs, to expand monitoring supply chains and innovate 200 data sources across federal, state

and local governments to improve information sharing. we can't reduce the health and well-being of americanso a line on a budget spreadsheet but we can transform the numbers on that balance sheet into investment and services that sustain health and promote wellness for all americans. president biden has presented a forward leaning budget. i look forward to taking your questions. >> thank you, secretary. let me start with the lower prescription drug cost for seniors issued. i went through some of what former president donald trump said. he said pharma companies were cutting away with murder. he said that would change under his presidency and that he would create a fair and competitive bidding process and prices would come way, way down. they are exact quotes from donald trump and i am quite certain, mr. secretary, when you came in, none of that had been actuallyi described a presidenth

-- a conversation with president biden after the election where he said he wouldp out-of-pocket costs for seniors. he took on big pharma and he won . not just talk, delivery. the secretary, one, that i was very involved in, stop this price gouging. is it correct that some seniors are now saving $618 per dose on a drug they get at the doctor's office? sec. becerra: senator, that's correct and it's going to grow even more in terms of savings because, as we boost through the years, many of the provisions you passed are kicking in. today, a senior will not have to worry about these enormous costs if they are on a drug medication because there is a limit now on what they will pay with their cap spending. it might be $3500 this year but next year, the limit on expenditures out-of-pocket for

seniors is $2000. >> for the first time, in addition to the price gouging penalty and the out-ofcosts of i mentioned, for the first time, medicare is negotiating drug prices. as i say we beat pharma and took away their holy grail, which is trying to prohibit negotiation, i like to hear more about the high cost drugs that you are negotiating. how many people with medicare take the drugs that you e year? i don't believe i've seen aggregate numbers on this. i think the american people would like to know how many people with medicare take these drugs that they are fighting to lower the prices on. what's the number? sec. becerra: let me work down. we know there are 65 -- 66 million americans who received health care through medicare.

not all of them were the 10 drugs that were negotiated. but for many, they are lifesavingin 2022, the cost of 0 drugs for medicare, just the 66 million americans for medicare, the cost of those 10 drugs in 2020 was $46 billion. out-of-pocket, about $3.5 billion. it is big money for just those 10 drugs. the next year, when weeto for 1e will get to save americans even more. >> what's the ballpark number in terms of how many people with medicarere taking these drugs? sec. becerra: i could not give you the specifics on all of the 10. i don't have that before me. but, they are very well known drugs. for seniors, they treat principled issues like cancer, heart disease, kidney failure. it's the kind of chronic disease

that we know a bit about. >> why don't you get is that for the record. but you are saying the amount of money involved in this area, i thought i heard you say $46 billion. sec. becerra: $46 billion for one year for 10 drugs. >> ok. let's talk about this cybersecurity breach, which is so serious. i'm of the view that it also relates to the fact that these facilities are getting bigger and bigger and then i think they become a systemic risk. and we have to get on top of this for a long time -- top of this. for a long time, private mpanies have been allowed to set their own standards and it does not seem surprising that neither the united health group nor federal agencies were prepared for this and its fallout. my view is the health care sector is a prime target for criminals and foreign adversaries. become

so large, it is creating a systemic cyber security risk. today, there are federal mandatory technical cybersecurity standards for the health-care care industry, even though pt this for ages. something like two decades. i want to make it clear that that has got to change now. i understand in your budget you're going to increase penalties for compliance violations and make the first actual concrete proposal to require a real, mandatory cybersecurity standard for hospitals. maatory standards are a great first step but we have to do more and the next steps have got to accountability for negligent ceos, for example. which will enable hhs to better protect patiecurity.

will you work with me, mr. secretary, to start holding these executives who are not doing their jobs, complying with the kind of safety standards the people have a right to expect on cyber, will you work with me so weountable? sec. becerra: mr. chairman, we look forward to working with you and every memory on these thank you, mr. chairman. mr. secretary, last year, this committee voted unanius to pass two bipartisan support bills. these provisions would generate billions in taxpayer savings and bring down costs for seniors with chronic conditions. these most bipartisan and consensus driven solutions to challenges raised by embers across both sides of

the applicable spectrum. this issue is absent as i see it in the president's bu signal to the patients and community pharmacy and health care providers across the country. secretary becerra, what concrete steps does the administration plan to take to support our efforts to get this legislation moved expeditiously and put into #hw? >> senator, we are prepared to work with you. i have said this for about over a year,amber and in the other chamber, that we are ready to work with you on reform. we want to find that there will be more transparency. we agree that there is no reason to have a middleman if they are no provide health care. we look forward to working with you and we appreciate there is bipartisan support. >> i did say you have given as e

have given this legislation. i'm asking the president step up and use the pulpit to get this legislation moved in this congress. i would ask you to please take that request back to him. sec. becerra: you are probably aware, senator, that we did in event at the wte house on this issue that highlighted it for the american people. >> when the ira past nearly two years ago, mr. secretary -- american seniors have experienced the consequences of the law. a growingughs have been canceled read particularly for rare disease drugs, part of these plans and more medications from coverage and subject others to prior authorization and therapy for critical needed repayments skyrd to sticker prices which exclude anyebates.

secretary becerra, can you commit to working with congress on a bipartisan basis to remedy these issues and improve the program, rather than prioritizing ira expansion, which remains both a partisan and unrealistic endeavor? sec. becerra: senator, we look forward to working with you on a bipartisan basis. i will say that the president is very ira and making it work more effectively. we look forward to working with you on a bipartisan basis. >> it has been disappointing to hear but we received the president's message and i'm just asking you to help us try to find some bipartisan solutions to move rward.on telehealth, teh coverage has proven critical for our seniors and working families across idaho and rest of the country. unfortunately, without additional action, medicare beneficiaries and americans with high, deductible health care plans,■■a risk access to losing-

risk losing access to telehealth overnight. patients face profound uncertainty as we move closer to this coverage cliff. secretary becerra, what actions to your department and agencies o take in order to avert this unacceptable outcome as well as reassure millions of americans who rely onverage eve? sec. becerra: we continue to work with your colleagues here and the house of representatives at the extensions of some of those flexibilities. statutorily, we are constrained in being able to extend some of those flexibilities. we are workingand local partners you know, many of those issues will involve state rules and laws. for example, a practitioner practicing beyond state lines to improve telehealth has to be done with the concurrence of state before a doctor in your stea and practice in my state. we are working to extend these telehealth flexibility's.

>> we understand part of that falls in our court. it helps when we have a mutual activity to try to get those kinds of resolutions to the finish line. thank you for your attention to that. >> thank you so much, mr. chairman and ranking member. secretary becerra, welcome. it id to see you. we appreciate the work you are doing, you and your department. i really appreciate the critical investments to expand health care access and affordability for communities for families across the nation, that is proposed in the president's does build on the investments and work we have the last three years. i want to say, i want to correct one thing. >> please. >> former resident -- that former president trump didn't do anything her prescription jugs,

i would say he didn't do anything for people prescription drugs. but president trump did give a 40% tax cut to big pharma. a 40% tax cut and it did not translate to a■r 40% reduction n prices for the seniors in michigan or for anybody on medication in michigan. we he focused, working with the president and with you on cutting prescription drug costs for americans who have been paying the highest in the world. the bills that we have been working on together improve access and transform the way that we provide health care in this country, which is so important. and, as you know, it's something i care deeply about. we have over 21 million people

now receiving health care through the affordable care act. that is a record, over 21 million people signed up for insurance, very, very affordable insurance. that is including 400 18,000 michiganders. many getting it month, $20 a month. it has transformed families lives to be able to have that health care. the health care premiums have of dollars for 271,000 michigan residents who the affordable care act and, of course, the $35 cap o insulin is lowering costs for seniors in michigan and across the country. not counting the cap on

out-of-pocket costs or next year, when it comes to a permanent $2000. it's a big deal. it's a big deal. so, i want to just ask you a question and speak to what i like to call heah we need to mae above the neck is the same as health care below the neck for people. and we have made historic investments in mental health, on a bipartisan basis. it has been terrific to see that happen. i appreciate partnering with you and the president to lower costs and create more access as you have talked about. but, particularly in this budget, the president including significant investments in the future of communicare, where we are helping through the

health care system and not through grants. as you know, this is something that keeps people out of the hospital, out of the jail unnecessarily. people off the streets that have been them the care that they need. so, we expanded nationwide through the bipartisan safer communities act. =%states are stepping up to participate. we have more states this spring that will be coming to be full program. i know that the budg n only supports their expansion but making it permanent. i also want to give a shout out to you senator cornyn, thank ang forward the definition to make sure they are permanently part of medicare and medicaid. thank you for partnering on that. can you elaborate on your plans to make this a permanent fountion for how we provide behavior health and communities

across our country? >> senatorto you and senator cornyn, thank you for putting together something that has proven to be a great success and now that everyone wants to do. mental health conditions don't service between 9:00 and 5:00. they occur at any hour and any part of the day and you have to be ready. what you all did in making certified community behavioral health centers available, critical care centers available 24/7 was a god saving measure for so many people. sec. becerra: we are going to try to encourage other states to buy in. because the more we have these matters, the quicker we cut the cost for taxpayers. many of these folks in up using the emergency room to get the care that they need. what you have done is, by establishing these centers that are specific for them, for mental health conditions, it gives them a chance to see her fresh nose tt right away. we are going to build that and the president's budget commits to that.

thank god you came together on a bipartisan basis to address what nine in 10 americans say is a growing crisis in this country. >> thank you. >> thank my colleague, neck to senator grassley. >> i'm going to bring up a problem with your department. the same problem i've recently had with the environmental e.p.a. great it isn't just your department that this might be a problem with. but last month, i wrote oversight letters to 15 hhs contractors and grantees. those 15 organizations received some of the largest contract awards for the care and placement of unaccompanied children. many children have been placed in a vda want to know what these contractors are doing to ensure

shareholder safety. in response to my 15 letters, your department sent an email to contractors and grantees on february 20 that i want to quote. kindly direct senator grassley's office to hhs's office of assistant secretary for legislation for this request. my staff have been told by contractors that they are ready to respond to me. but hhs instruction has so far caused them not to. do you accept the premise that recipients of congressionally appropriated taxpayers money must respond directly to congressional oversight requests? and i hope you can answer that positively that they should. not, when will -- if you would agree with me, when would

you direct your staff to clarify toecipients on my letter that they must respond to congress? we have had the epa say in these letters that i sent to other groups spending taxpayers money, that they could respond directly to me. can you say that for your department? sec. becerra: as a former member, i want to be able to conduct oversight from when i was in the house of representatives. these contractors, they give americans every right and opportunity to respond to you. we offer them guidance if they wish to have it. they are under no obligation to get it but you are within your rights and they are, as well, to be in communication. >> as a follow-up, let me be very clear. these folks have received together billions of dollars of taxpayers money. when i and my colleagues request

for information, they have an obligation to respond and this administrations interference which evidently we are not going to have anymore, at least for a while, has been obstructing. another question, if hhs receives a law enforcement request for information relevant to a child's trafficking investigation, does the hhs provide that information to law enforcement without requiring a subpoena? sec. becerra: mr. chairman, we work on an ongoing basis with law enforcuntry. we care for and have custody for minors. we continue to work with law enforcement throughout the country. we follow the rules. in some cases, we are dealing with private, sensitive, confidential information and we make sure we follow the rules so we don't violate any individuals privacy. >> are you saying in some cases,

you direct to law enforcement without a subpoena? and are you saying in other cases you might need a subpoena? sec. becerra: we tried to complh the law when it comes to providing information. some information is more confidential than other pieces of information. we make sure we are not violating any privacy rights or any protections in where there is law enforcement or any other entity. >> this will have to be my last question i will submit for writing answers. last year's budget hearingcuss including need for cms to fully utilize rural community hospital demonstration program. with hospital spots for the program. you toldni me last year that h would, quote, do more to

support more hospitals in need. following our discussion, with rural hospitals interested in joining the program but that's where progress stall. cms expla to fill the open spot it would require 12 months of work and too many hospitals would be interested if cms has the tools to help one rural hospital and isn't, you should be doing something about it. i realized you[n0 might not kn every program at hhs but why doesn't your department want to help hospitals through this program? does budget neutral and congress has reauthorized it two times since 2003. respond? >> briefly. >> let's follow up on this. budget and we get back to you

with a number of projects we've undertaken in rural america, we do a great deal with many facilities that are on the verge of closing, and many parts of rural america. we he a bit to talk about rural america. and that makes major investments. >> we have to move on. senator menendez. >> communities have struggled to fill workforce gaps, a growing crisis exacerbated by the pandemic. based on my legislation congress authorized the creation of a thousand new medical education slot in the consolidated appropriations act of 2021 and my specific criteria for distribg slots. cms has repeatedly included

additional criteria not specified in the law which unfairly disadvantages many states including new jersey. since enactment, there have been meaning 40% of the way th the program and new jersey continues to be completely shut out. it has been years and weti an we get positions to teaching hospitals in our state. the law speci secretary shall,l distribute residency positions to each of four specified categories of profilers. what can you commit to doing to help ensure that states are no longer unfairly shut out of the program in contravention to the way the law is written. >> appreciate the question because this is the one you worked on for quite some time. our team has been trying to be responsive to your staff as well. as you know, new jersey, like

california the circumstances it difficult for some regions to qualify for some of the resources and slots. we are more than willing to work with your team but the resolution is not so simple because as you try to resolve the issues with new jse california you create other issues for other states. >> let me interrupt. it's not so difficult. the law is clear. it is cms that0s has decided t add additional criteria congress did not stipulate. the house ways and means committee, really appreciated when federal agencies changed the law that you helped pass and enacted it in a way that's not your intention. that's what is happening. i think you have the power to fulfill the law as the secretary shall distribute these provisions in accordance with the law. this isn't happening in accordance withp the law so th

suggestion the department's try to be cooperative and helpful fall short to me. i hope we can find a better way forward. last month your agency's inspector general issued a concerning report finding over a few months period, 16% of unaccompanied migrant children lacked any kind of sponsored background checks, also found in 20% of casesa unaccompanied minors were released to sponsors pending a background check there was no documentation confirming those given the unaccompanied children being put in situations where they are labor this is a glaring blind slop that needs to be addressed. extrapolating from the report we are talking ttíusands of migrant children who are sent to unvented sponsors. as the report concludes, failure to complete background checks increase children's risk

of being released to unsafe sponsors. what specific actions have your agency taken in response to the finding of the inspector general's reported how is your agency working to ensure that explicitly finding sponsors for unaccompanied migrant children does not come at the cost of their safety and well-being? >> i can assure you that most of the recommendations that were made by this inspector general for incidents you ares occurred in the spring of 2,020 one, two or three months period. i can assure you that what was being observed by the inspector general back then is not the case today. at that point we had an infrastructure that had been virtually dismantled, we had to stand it up and at that point we are dealing -- >> day we would find none of this? >> he would doing all the background checks, thorough assessment of anyone seeking to become a sponsor. >> i look forward to seeing

that. a recent supreme court decision appended vital protections congress passed 40 years ago, part of senator cassidy on a bill to amend that act and protect patients from discrimination by private health insurance plans but we are unable to get your agency to work with us. will you commit to cms working with my staff and senator cassidy's staff to have the information to address this pr? >> i commit to make sure our staff is working good with your and senator cassidy's staff. >> mr. secretary, in august, your department recommended

classification of marijuana for the drug enforcement previous administrations use the 5 factor test to determine what the scheduling of the drug should be, but this administration created a new two factor test to determine currently accepted medical use. what is he change? >> thank you for the question. as you will see from the repor there's been a lot of science collected over the years on cannabis. we have more information now states have moved farther than the federal government has even in places like texas where what we are doing is reflecting what the science is shown. >> you compared it to heroin in terms of its potential for abuse. why didn't you compare other types of drugs scheduled by your office?

>> i'm going to try not to speak directly for the fda because the fda did this assessment analysis independently from hhs. they are the agency that has been tasked with that job with their scientists and i won't try to speak for them but what these conclusions was based on the science of the evidence they had before them. >> didy development or mental health consequences or impact on pregnant women? >> i'm sure they took into consideration all the information out there on both of the facts and evidence that there is on cannabis use. >> you are saying that for a >> i don't want to try to speak for the fda scientists because i didn't do the actual assessment but i am pretty -- >> you announced the recommendation. i assumed you would take into account impact on adolesct egn.

>> i am sure fda would have taken into account all of the erent circumstances involved. i didn't make the recommendation was it was made by fda. >> i'm going to follow up on some of the questions senator meneez a s asked. your department is responsible for the administration of the office of refugee resettlementa correct? that means that any unaccompanied children who come to our border are basically transferred to your care by border patrol, correct? ■r and you identify a sponsor f them in the interior of the united states, correct? >> that is our obligation, yes. >> there have been 400,0 of these unaccompanied children that come to the united states during president biden's term

now? >> we can give you information on the vetting process -- >> i asked you, do you know where they are now? >> as i said to you, we can tell you who the fed sponsors were. >> that's not what i asked you. i know you have interviewed sponsors to some extent although not adequately. i agree with senator menendez. you have any response ability for your welfare as -- >> when they are in our custody we have jurisdiction to provide them -- >> i'm talking about now that they are in custody of your vetted sponsors. >> you and your colleagues did not give us jurisdiction to provide oversight of these children when they lef >> that's not your responsibly, is that when you're saying? >> we don't have jurisdiction but we can't spend money on things we don't have >> you do being trafficked for sex or forced into child dangerous child labor, you don't know whether they are going to he healthcare on't know whether

they need, use and please don't know, correct? >> when they are in our care, we know all those things. >> they are no longer in your care once you transfer them to the sponsors, right? >> as i said, the statutes you passed don't give us the >> so whose responsibility is it to look after the welfare of these children? >> my understanding is the statute that open for the communities where they enter. >> say that again. >> my understanding is the statute you enaed that said these kids and ends once we have delivered them to a vetted sponsor is that the communities where they reside are in charge of that. >> as a result of the broken border policies of the biden administrationseids have been placed with sponsors, you don't know where they are, don't know what's happening to them, you don't think that's your responsibility and you frankly /&■8don't care. >> that is not accurate.

these laws preceded president biden taking office. the system has been broken as you know and i know for more than 40 years are close to 40 years. you and i have been in congress for quite some time. i started ona job to do right now, you have $1.8 trillion budget and you have the response ability for taking care of these children simply hand them off to sponsors, to homes that you don't know the conditions they are living in -- whether they're being sold for sex or forced into labor, you don't know when you don't think it is your response ability, correct? >> pretty much what you just said. >> the time of the gentleman has expired. >> senator lankford in just a minute but some information from the department of health and human services. the number of medicare beneficiaries saved money

because of medicare negotiation, 9 million, that would be o excuse me. senator carper just came in the room a. senator carper, you are next. you are before senator lankford but we didn't see you come in. we will go with senator lankford and the come back. >> look at all this. a quick f this, what senator cornyn was talking about, individuals that are unaccompanied minors, are they always placed at home with someone who is legally present induals that are unaccompanied minors, could they be placed in a home with someone who is not legally present in the country and we do not know their legal status? >> are authorities to place

them with someone who we vet who will provide a safe shelter. >> any idea what rcentage of people, of children are placed in a home with someone who is not legally present in the country at the time? >> i couldn't tell you that. w■cow that. these are individuals that are vetted but not vetted for their legal status in the country. >> our responsibilities for >> just asking the question. are individuals vetted if they are legally present in the country, do we know children are placed in the home with someone legally present? >> i don't want to evade the question but i'm trying to tell you our focus is on the elemen t >> legally present on what's not safe. >> i wouldn't say to you that t mean it doesn't get considered. >> but we don't know what percentage of kids are placed there. about a lot of other questions but it is my understanding that

that's not a consideration. there is a new rule on nursing homes, nursing homes are concerned about, state is concerned about hhs creating a rule that will cause closure of a lot of our rural nursing homes. i understand the good intent to cause is dramatic rise in prices and difficulty getting our ends in those cations. i encourage you to reconsider that rule. my state is half rural, half urban and for those areas that are rural they still want to maintain their nursing homes. a rule that i didn't vote on that was created b about to clg homes, that is significant for so i challenge you to reconsider that so rural nursing homes can be staying open in the days ahead. you know this is coming because your office contacted us on this.

last year cr which my state currently has laws to protect the lives of every child born and unborn that if my state does not put on our health pamphlet whatever it may be, a way for people to get access to an abortion, if they did not put that one 800 phone number on their we would lose title x funding, you follow through on your threat, you took away title x funding fromy state which takes away from my rural counties, aids testing, and cancer screenings, all those things you took away from my state becausee would not put a phone number in our health brochures where people could get an abortion. first of all, let me start, that violates federal law because title x funding is not about abortion.d something ent

new with that. why would you take away that funding and is that true? of funding has taken away my state is lost that money for aids testing and cancer screenings in county health department because of that? not surprised by your question you will not be surprised by my answer, i don't agree with the way you framed this. if it were as you framed it, w losing. >> there is an appeal going on. >> so far we are able to enforce the law as it stands. the law says individuals going in for services should know what services they are entitled to. we are not saying anything about abortion but a person should be informed of services that could be available to them under title x. if a state wants to not abide by t law they understand the consequences. they won't get their money. >> the specific law is up we d to get an abortion --

>> that's not the case. >> that is the case, we verified this and walked through the process, that's the one issue when we asked if we added this one phone number to brochures -- that would fulfill everything. it is just a phone number where to get an abortion. what happened is aids testing goes away, cancer screening goes away, that's a big bully tacticdon't do what we are asking you to do which is not in the statute. >> we follow the law, we waw. >> we are also following the law. >> than they will get their money. >> we are being withheld from i would ask a quick yes or no question because there's another decision from the supreme court next week as they hear about chemical abortions, there's been rumors and individuals saying if the supreme court determined something about chemical abortions that hhs and fda should just ignore it.

my yes or no question, we don't know what direction the supreme court will make oat decision but when the supreme court make the decision will hhs abide by the decision? >> my colleague's time is up. >> we are going to follow the supreme court of the united states constitution. as a member of congress and a member of the exec a branch.■■, >> the time of the gentleman has expired. >> thanks, mr. chairman. welcome. to the finance committee. let's see. i am so intrigued by this exchange between the two of you. here we go. when it comes to drug pricing reforms my principles are

pretty simple. we must lower costs for american families to approve rising cost for the federal government. the past several years we've accomplished those things. last congress we passed, the president signed into law the inflation reduction act, this landmark legislation meeting provisions to lower the high cost of prescription drugs. the ira, cost insulin at $35 a month for medicare beneficiaries, regimented vaccinations available at no cost, out-of-pocket expending for medicare part d beneficiaries at $2000 annually negotiate with manufacturers for hikes budget cuts. we made i think historic progress in making healthcare accessible and more affordable. we are not done but we are headed in the right direction. an opportunity to tackle rising

costs of healthcare by addressing growingubc health crisis of obesity. despite obesity being recognized as a disease with access to medical treatment is lid, the economic and social impact of obesity has risen to almost $1.7 trillion, per year. the cost of doing nothing is too high for families and the federal government as we wrestle with deficits. that is why i reintroduced the obesity act with senator cassidy in this congress, this legislation would expand medicare coverage of intensive behavior therapy for obesity and authorize medicare prescript and drug benefits to cover medications user besity. i've championed this for a decade. investments in obesity are long

overdue. how are you and your team at hhs work with us to invest in this prevention of obesity? since solutions are lasting solutions this is one of those. >> we look forward to working with you because we know more and sophistication of technology and science that we will have opportunities to make a difference in the lives of a forward to working with you so programs like medicare and medicaid are at the forefront of making sure have access to the people they need. lessons, one is we now have the opportunity to learn from and grow upon the acute hospital care at home waiver known as hospitals at home. we saw demand for home-based care rise during the pandemic went hospitals and healthcare facilities were overcapacity and patients preferred to

receive their care at home. under the public health emergency to meet this demand by allowing medicare beneficiaries to receive hospital level hlt since it is an enactment, we've seen the hospital at home program with a true success pr higher reported patient satisfaction and positive patient outcomes and potential cost savings to ensure oipaties and providers have access to that for two years beyond duration of covid 19 public health emergency. last congress tim scott and i introduced the hospital and patient service modernization act, it was signed in year. what lessons have we learned from the success of the soon on all the lessons because

what was required by the legislation will give us an opportunity to see how we can do ts but no doubt i share your interest in making sure people in america can receive the care they need where they need it. and when they need it. studies we are putting forward should help us understand how to move in a good direction for folks who need care. we look forward to working with you on that. >> my colleagues often hear me say what works, we think this is something that works and we look forward to working with you. this is one of those pieces of legislation i support and i'm grateful to senator cassidy, doctor cassidy, thank you so much to everyone ith room. >> my colleague next to senator casey. >> good to have you back thank country at a difficult time and i want to start with the issue

of prescription drugs. i'm grateful for your work and the work of the administration efforts to lower the cost of prescription drugs. we all know prescription drug costs in this country are higher than so many of our competitor nations. i voted for the inflation reduction act which has provision to allow medicare to negotiate for lower prices and $35 a month on insulin for beneficiaries. i am enlarged version of a piece of paper i put out a couple months ago now. to summarize the benefits of the inflation reduction act prescript and drug provisions just in pennsylvania to give an example why you can't see from where you are sitting,g of ins month. 80,200 pennsylvanians will

benefit from that and another e highlights, we know less than a year from now out-of-pocket cost capital going to affect, that will impact 829,000 pennsylvanians. big numbers in one state. i want to ask you to give us a state of play. what is in effect and how is it working and what's the administration proposed in the budget to further expand policies that ratchet down prescription drugs? >> the copy of the document that help convey information for in solon. for folks on fixed income yo t seniors who depend on social security checks to pay for things.

th pharmaceutical company rais the price of the drugs. >> they are noted negotiating for the medicare program, 65 million on medicare, $46 billion. they announce what the price would be. and next year, they would like to negotiate 15 but another 50? the congressional budget office has said $100 billion in nego of that you are

throughout the country, the of catastrophic costs but next year, the drugs on cancer or kidney failure, tens of >> >> walk-throughthe president proposed 15 more prescription drugs to be negotiated. >> we know what works. of the congressional budget office is telling us these 10 drugs will save one hundred billion dollars to taxpayers, why limit it to 10? if you were good enough to make t is 15, the president is

saying let's negotiate more of these because we know -- the cost of these drugs, other people around the world. >> i appreciate that. the second issue i wanted to ■7 the president's budget includes a provision to allow states to provide continuous eli for children under the age of six. this eligible he will reduce gaps in coverage and interrupt access to central care service for kids such as preventive care, ensuring high access affordable healthcare, one of our number one priorities. i introduced legislation that would enroll all children to the age of 18 in medicare and medicaid. >> you mentioned an aspect, ato

many women in america, they -- their babies year. and postpartum care, 365 days, unfortunately 45 of the 50 states adopted that. that will help kids moving forward to track. >> thank my colleague, senator johnson is next. >> welcome. i have written over 60 oversight letters having to do with our response to covid cup

clean injuries and your sub agencies. i want to talk about three of those primary quest s, first on the origins of covid and e-ma june 2021, 4000 emails were within a week of that i had five members of the governmental affairs committee, 4,000 pages unredacted. let me ask the question, you agree to the fact that foia requests can be redirected for a host of reasons. we are not subject to those reductions, correct? >> we continue to make sure pr information, privacy information and do the best we can. >> we are not subject to the

same read actions. us code 5 usc section 2954 states on request of the coittee on governmental affairs, 85 members shall submit the information request so as an accommodation we went from 4000 pages requested, 4000 unredacted. over number of months we got 350 pages to look at them, couldn't take copies, couldn't take notes. back to the last 50 pages of ■g you would bring these unredacted codes last year and a similar hearing, i asked you, you are absolutely entitled to the information by law a member of the senator house should it is 2954, you will turn those over to us.

why not turn them over a year later? >> the secretary for me and a many centers and house numbers have asked in the past. it's an accommodation process where we try to make sure we can without undermining national security, confidentiality and the interests. i you are withholding information from congress under law, at a minimum you should be the reason you are withholding this information. this has been a year since you said that i was entitled to the information required by law. we have not gotten a response from you. we've not gotten a privilege. why are you not sting the privilege you are claiming get

unredacted what privilege is it you are claiming to withhold this information from congress, from the american public? >> i know that your staff has been engaged with our team when it comes to responding to the requests. we continue to respond the best we can. >> you haven't responded. you should have provided a privileged list. what privileges are you asserting withholding this information from the american public? i am expecting that privilege law posthaste. leme move on to two other things, there is standard operating procedure in 2021 after the vaccine got its use authorization laying out the analysis on the vacci■odverse event recording system, the first reporting ratio you got

that says empirical basing analysis. i have written 5 or 6 oversight letters trying to obtain that analysis. i've gotten buckets. i haven't gotten anything on this whatsoever. why are they withholding their analysis of their vaccine rep? we fund the agency's, paid a salary, that data should be available to the american public. why isn't it? why are your agencies pulling that infti >> i will try to get back to you. i can't speak to the actions o requests we get -- >> you haven't been responsive at all. they are giving me the middle finger for years. mister secretary, i would request a phone call within a week or two. you check into i've gotten some significant -- the agencies are completely

ignoring angles like over thousand investors of a covered vaccine versus the most at risk, one hundred 37. these are serious issues and the american public deserves this information so i expect a phone call from you with a privilege log and responding, analysis on their is. why can i not get a legitimate response in terms of what is idened >> the time of the judgment has expired. secretary cortez masto. >> secretary, i appreciate it. thank you. incredible work you and your team a doing around prescription drug negotiations it is still important to so many. thank you. i also recognize the department is in support trying to challenge your authority under

that legislation which unfortunately is happening. in addition to the inflation reduction act negotiation we also have caps on out-of-pocket spending for seniors. house the initial out-of-pocket playing in january of this year benefiting seniors and how that might change when it is in full effect next year? >> thank you for the question and your work. nevadans like to keep money in their pocket because of the work your colleagues have done to lower the cost of prescription drugs. many americans especially those in medicare who are getting older have high cost of medication, perhaps suffering from cancer, maybe having kidney failure but often times costs are extremely high and medicare provides a lot of support and pays for a lot. out-of-pocket costs can be

dollars. today, this year the catastrophic costs kicked in as a result of the president, drugs which means no senior today for the catastrophic costs paid more than $3500 out--pear in 2025, the most for those medications any senior will pay out-of-pocket will be $2000. that is a lifesaving measure. >> i heard from seniors, how do they become aware of it? is your agency putting information out? >> we are trying to get that information out. i had a senior come up to me and say i went back to my pharmacist because when i saw what they charged for my insulin i felt guilty and went back to the promised a sense that you under charge me in the pharmacist said that's the price, $35, she was in the clouds because this is a senior

on fixed income. $35 extra money in her pocket. >> makes a difference to so many of my seniors as well. every one of nevada's 17 counties is designated a health professional shortage area. also known as h psa. all 17 counties are primary care and 16 of them in nevada county are designated as menta■ health shortage areas. the president's budget proposes to extend the 10% incentive, provided ige of emissions and behavior. the committee testified artisan baggage to help providers to for practicing and shortage areas. should this increase in shortage areas becomewould see reimbursement. many shortage areas lack a physician but nevadans may have access to a nurse practitioner

or clinicasocial worker. so has hhs elevated the beauty of extending the range of clinicians for the bonuses that might impact our workers in rural communities? >> great question because you are right. the results of covid, we learned there are health professionals that may not be physicians who can use some of this. we are working with states because of a licensing issue that is at the state level. for certain practitioners, nurse pracú■rtitioner for exam, to do things beyond what is currently provided by state law, we wanted states to make amendments. covid taught us a lot of health professionals are ready too. they just have to have strength. >> i appreciate that. one thing i know, us former attorney general recognize at a federal level, there's only so much jurisdiction you may have and it require state or local community governments when it

comes to looking at our kids or whether it comes to access to most physicians doctors or health clinicians into the state, there's a role for the states to play as well and i appreciate the work you are doing. >> thank you. thank you for being here. first, senatori requested ta for coverage analysis patients for connected moms act to allow mothers at risk for problems of pregnancyx for stay-at-home monitoring and i know your staffers are busy but this will save lives. can i ask that you ask your

staff to get these filled asap? >> i agree it is important. things, the latest being to change healthcare, cybersecurity, but let me get to the man say this is important and see if they can work with you double speed. >> i appreciate that. let me ask about hhs modernization. is that an in-house data platform that hhs is using? or do you somebody like that? >> i want to get back to you misinformation but if you give us the name after this hearing who your person is on staff we will work in communication to get you that. >> there was a recent finding by an acronym, the national

hcos with published data suggesting seven fraudulent companies fill $2 billion in medicare payments for 2023 and they did thatlr using a virtual research datastream and that is all good. for cms to be on top of it, i wa■$ to talk about data modernization. i'm also told academics have used this data. they don't have the ability to purchase into they relied on cms to stream it. the last one, it would discontinue shar with institutions beginning august 19th and require all researchers to move to the virtual research data team. so i understand the price for that is quite high. so i don't know if you will lower the price or if you continue, have you done an

analysis to access the data if you go to this etc. ? >> senator, we are in the process of revealing this. we have a solicitation for information to get responses back. this is a fairly new area. we want to be more aggressive at getting everyone on board, every sector within healthcare to get into this because no one can keep their data doors with cyber attacks that are occurring. we■ç■i information we can to know how to proceed. >> i think you are open to allowing researchers to have their finger in a place somewhere. >> i won't speak to where we will go. we are open because we are trying to do something else.fo. >> absolute. >> the researcher has been helpful to this committee.

she extended into our office and the fact that she might not have it would be deleterious. >> i invite your team because we are trying to get everyone to giver best information because we don't want to miss anything especially for the little guys. the big guys can afford to these things but the little c any information you are getting we would love to have it. >> i've been interested in return to work. tell me what percentage of hhs employees are currently four days a week or more in the office? >> we have been working from day one and continue to have folks come into the office to work. we office of management and budget guidance when it comes to in office work levels. >> what is that right now? what is that requirement? >> the requirement is not a straightforward requirement because there are aot of er

>> typical employee, one day a week? three days every month? four days a week? >> nih researcher every day. caregiver every day. >> hhs, not the 1 down the street. >> most of us probably almost >> political appointees, what about non-political appointees? >> you have flex abilities for the career staff. it could be a three of five days a week. >> the least amount it could be. >> some folks get to telework altogether because their job is in front of a computer. what we are trying to do -- >> your anything else that is measured? >> we could use your help to get the system to monitor in the 1970s and 80s difficult to get the dots connected. >> the time of my colleague has expired. >>erful to have you and the committee.

i want to ask in regards to actions you've taken in regards to oral health. oral health is critical to overall health and■r you have provided some additional medically necessary determinations in regards to coverage under medicaid and medicare. i want you to continue to recognize a lot of the services are medically necessary that traditionally have not been covered under these programs but tell us how you are using the authorities you have to expand access to medically necessary oral health? >> i know that we are trying to expand access in rural communities because we see a contraction. what we are trying to do, you've given authority to

actually provide flexibility to do so, it is difficult because there are consequences especially if you have a net neutral system of funding to make those resources available but we try to stretch where we can. we can use your help in making sure the authorities we have allow us the flexibility to reach rural america wheitare. >> we want to work with you in a process within cms to evaluate clinical evidence for addition determine whether the medically necessary for beneficiaries, sometimes it is a struggle in interpretation. we have been working on this issue and we will be glad to give you the additional the affordable care act you have certain abilities to deal with medically necessary services and you can use in order to expand care.

let me ask in regards to the transplant issues and quality issues the status of making sure we can have fair competition and quality in regards to the system reforms related to transplanting organs? >> we are trying to move aggressively with the reforms congress enacted which reflected the reforms we had proposed in regulatory channels. we need resources. we are trying to set up a new independent board to monitor activities to create a robust system of competition to see who will operate the system and we need help to get it in as quickly as possible because everyone agrees the resources

we have to bring us up to date are not there and i hope in this budget process we are able to get the resources the president proposed in his budget. >> another subject i been raising dealing with drug shortages, the wealthiest country in the world has spent themedicines, inexpensive drugs in short supply compromising healthcare in america. we try to deal wit and complex ability to drugs that are still effective that shortages but we find without some system of karen and stick that we will always have these shortages and that's unacceptable. the strategy are deploying in order that americansith access to critical medicines that are not difficult or

expensive to produce but the manner in which our market e w been doing on this subject. the current statutory authorities only give us the enstage when at the retailer level we start to see this shortage. people can't get it from the we see a shortage or a constriction occurring at the early stage when the medicine is being manufactured. waiting for the retail to say i don't have enough is waiting too late. we want greater insight to what the manufacturer sees. if the manufacturer has to alert government about shortages at their stage the second we would like■■k to do make sure we bring home the manufacturing because we should not be dependent on china and other countries for the materials it takes to create these pharmaceutical

medications so we would like to bring that manufacturing home. million to make it possible to have manufacturers base their operations in the us. >> question in regard to drugs that are taking a long time under fda where life expectancy is short. i have a question for the record. work on the drug shortage issue. senator brown. >> thank you. nice to see you again, thank you. thanks, this matters in people's lives. in tow lido another subject that mattered for your work on prescription drugs, $35 in solon, insulin,2,00 seniors will benefit, 219,000 ohioans

will benefit. senator whitehouse and i expanded on this. and you -- people wou bable fir negotiated price, 60, seventy%. we cur work on that. another topic, how this will all work and how implement the law to lower prescription drug loss? >> with insulin, i had any number of conversations with a lot of seniors who rely on social security chk today liv. when they hear $35 is all they

will pay for in the solon where before they were paying 152 it is a godsend. the fact that today we can yank back the extra profits pharmaceutical companies are making if they raise the price of the drug by more than the rate of a great thing for americans on medicare. the fact that today out-of-pocket costs for senior are now being limited so even of cancer drug you won't pay more than $3,500 out-of-pocket, still a lot of money. >> the number comes down. >> next year it comes down to 2,000 total. for folks paying tens of thousands that is real money. >> think about what this congress and the laste done in terms of restoring 500,000 union workers, pensions the child tax credit did temporarily. what we are doing and drug prices.

it affects huge numbers of people who need help in their palestine, the sight of the in pennsylvania, i made my ninth trip there is this week. thegrants to get underway on health monitoring. that's a good first step. i asked hhs to set up a disease re0@gi for residents of that community. i want you to commit to working with us and surrounding communities including senator casey with voluntary disease registry and additional resources for health monitoring. >> thank you for your leadership on east palestine. you are always nipping at my behind on that.

to help them out, we are glad on in person surveys to find out and ih, 6 grants to help prepared to work with you and state and local partners on this issue. >> thank you. two other quick things. appreciate the commitment you made when we talked, using a project labor agreement during construction of a cdc facility. the occupational safety and health, unlike any in the world,rkers studying and understanding workers illness and diseases and injuries. it matters. thank you for that. look forward to working with you and make sure we have the

resources to see this through to completion as quickly as possible. the other thing is we spoke about financial issues. happens to be the same county where east palestine is. 8 miles later in east palestine, that regio dide by medicare regional contractors which i need your commitment to work with me to make sure we deliver timely >> we are prepared to work with you. >> thank you. >> senator brown. ■t interested, a couple years ago you were enormously helpful in our creating the price gouging penalty when drugs were way over inflation. the secretary confirmed just

one of those drugs, medicare saving $600, more than $600 per dose. thank you for your efforts on that. >> thanks, mister chairman, tt the southern border and how it is overwhelming our healthcare system in the united states. reported, written on video and television and hospitals and sanctuary cities right now, new york city, denver, san diego, chicago, boston, tell us they are at risk of collapsing financially due to the overwhelming number of illegal migrants floodin their emergency rooms and clinics getting freaked care having the american people pay for their care. clinic in chicago reported seeing nearly 16,000 migrants last year, illegal guns, the cost of their care american taxpayers. denver health was in the

headlines in 2,023, reported over 20,000 hospital visits for migrants, the hospital is now not surprisingly in financial distress. these hospitals are asking the federal government to bail them out and it is democrat caused failure to enforce the law at the southern border. can you please explain why it is t responsibly of hard-working american taxpayers to foot the bill for all of this care for people 9 million world who have flooded their way to the united states. >> i appreciate the question was what i can tell you is we have and authorities we have at hhs to try to be there to help any healthcare facility when there is

saying were overwhelmed with the number of people we're treating and have no way to recover the costs other than to turn to the american taxpayers. the federal government doesn't pay for health care of every legal u.s. citizen. seems like it's in the position of having to do for all these illegal immigrants. why should american citizens be forced to pay for illegal migrants to receive the same care for free? >> because that's what's >> senator, as i said i don't know how particular states operate their systems, with regard to the folks that are coming in. what i can tell he is that when we are approached whether it's the medicaid program or simply those who seeking out other types of authorities and funds that could help them. we are ready to try to be responsive. >> you are aware of what with pe who are not think they have to shift the cost of the people who are paying and that's what's

happening now. all the cost to crunch a specific the sage something you asked about, the nursing home staffing ratio requirements. specifically your department is proposing a rule of nursing home staffing ratios required a registered nurse be present only four hoursz a day, curly and his record eight hours. cna hours per patient per day increasing and the hardsp commus who can't find people to hire even though they tried very hard is required much more paperwork. most of the wyoming nsing homes i i talked to would havo hire additional staff, not in addition to taking care of the patients but to just fill out the paperwork that your department is requiring them. we had concerned and expressed them to the director of medicare, medicaid. the center r medicare and medicaid have committed $75 million to support

to support nursing staff in nursing homes here how do you plan for these funds to reach these rural communities that are really getting hammered by these additional roles? only four out of five nursing homes say we can't comply with what the administration is now forcing upon the all across the country. >> senator, packed a lot into the that may respond first to the issue of the funny how we can make sure it gets into the rural communities. one of the things we've done is make sure we try to get those dollars into the trinity that need it most to be able to staff up. i must tell you if you're going to call yourself a nursing you should have a nurse is present to provide care to the films that are leaving their loved ones there. it is embarrassing that while not one of every five americans visit the nursing home, know when you're 60 million people in a nursing home, one of five people who die from covid died in nursing all. we need to momes have for the people that we love and even in the custody will be the right

care. and it will be withrol we are se sure all nursing homes many already do this but all nursing homes meet the standard you or i would expect if we leave o is t. >> mr. chairman, let me say to my time as expats i won't go into additional, only one of five nursing homes to meet the proposed requirement even the strength i people can't find people to fill it so for at a five nursing homes are going to be out of compliance with administration will and apparently what y'r all of the nursing homes are right now incompetent to provide care. still providing pretty good care today thank you, mr. chairman. >> the time of the gentlans, mr. this is not the topic i was going to come to address today, but my dear neighbor from wyoming raised and i feel like it's really important for me to respond. want to make sure i do that be of all, denver health is a national treasure. i don't think the doctor would

disagree with that. it i a critical public access hospital for the western unitedd states, not just denver. serves the entire metro region. it has a a massive problem bee of the amount of uncompensated care. it covers even without the current immigration crisis, because we like every other industrialized country in the world don't have a system of healthcare where people know they have insurance, where people know they can get care. and so the doctorst denver health are left to cover the uncompensated care that no one else will cecause no private insurance company will cover it or no other hospital will cover it. there is denver health sitting there in the middle of dve not just covering it but saying send me the people that uncompensated, because we have a moral obligation to cover it.

by the way, the taxpayer covers of that care, too. it's not like the taxpayer sma off the hook. we are paying our broken healthe system. so what i would say to my colleague from wyoming is let's work together to fix our health ca s don't have the immoral crisis that we have because people are not covered in this society number two, it is not denver health responsibility, or dare i say i think the sector would agree with this, then first responsibility or even colorado's responsibility to fix immigration system in the united america. the founding fathers of this country understood that congress would have to fix the this country and be responsible for it, because even in the 18th

century it would made no sense to imagine that this was something we would lead to the states or to cities or to a public hospital in the middle of denver, colorado, to address ito try to fix some of the chaos at the southern border of the unit states, which i completely agree, the american people are tired of, for good ason. i don't think we should be allowing transnational gangs to set the immigration policy of the united states of america. i think that is a mistake. and because we have failed to act, that's who's running the ts country in some respects. that's why so many people are showing up to the border. that's why the border is

overwhelmed. and in the context of this negotiation, we had the opportunity to try to address this in a, in my opinion, a very incomplete way, but we're going to address it. and the other side walk away from the own negotiation, even though it was the quote-unquote toughest border bill ever had been agreed to. now they're coming here and beating on denver■1 health for uncompensated care that they are providing because that's what honorable nurses and doctorso. that's what an honorable community does. it's the responsibility of the federal government to deal with this, and not just to point fingers at each other. and i'll say, i wanted to ask you about mental health, mr.

secretary, the epidemic that is raging among adolescents, young people in colorado and across this country come something we have to address as well but let me last thing before my time is expired, and that's this. two weeks ago in the "wall streetkay? not the failing "new york times," not proper to but in the "wall street journal" -- prop to -- interpolnd and asked eight policies of the people who took the poll in the "wall street journal" for the american■ñ people support, numbr one with 74% was a pathway to citizenship for the 11 main people in this country that are undocumented. the people who have spent 30 years in oregon and in colorado picking fruits and vegetables. the american people have too much common sense not to know that's a good idea. second was the dreamers.

third was dealing with the border. my point and i will stop, mr. chairman, is that we need a comprehensive solution to this problem. it was understood we can come here and score political points. we have to fix the problem, and denver health deserves the support of thismi an attack on the work they're doing. >> as much as agree with senator bennet, since we have to move on to senat b thank you, mr. chair. and secretary, thank you for being with us today. i know we've talked some about the unaccompaniedinors that have traversed that southern border. a big part of the solution is to secure that southern border. themselves in the custody of hhs and office of refugee resettlement. and what we've seen during thisn adequate ability to actually handle the cac

unaccompanied alien children that come into this country. and instead of fixing the what e would've liked for the president to do, you pressured your staff to expedite the release of these children, prioritizing feed over due diligence. in fact, in the video and a call with your staff that i viewed, you actually said this, and i'm going to quote you. if hrys, he was have never become famous and rich. and a quote. you made that comment talking about how to assembly line process children never coming into the c■ntry. and over due diligence, over safety, you prioritized feet and moving them out.

now, the oig, your hhs oig recently reported that your staff make timely safety and well-being calls, if the make them at all. 22% late months past the time they were due, and 18% never went out at all. at and it also found that the staff skip essential safety steps such as ensuring that the sponsors did not have a criminal record or that they were not sex offenders. so it should be no surprise that were continuing to hear reports suggesting the existence of trafficking schemes that are preying on these vulnerable individuals. allegations that we heard of coercionorced labor, and

despite my persistent inquiry on this issue, your staff has stonewalled getting answers back. i've written you twice. i got responses that werem yourm secretary. one of them being over six months late, and i got it just last week before this hearing. mr. secretary, this leads me to believe that you don't give a rippg is happening to these vulnerable children. now, you answered senator cornyn about knowing where the children are and knowing who the sponsors are, but i talked to caseworkers in some places and can't ask if somebody is in the country legally or not. and oig said theyad concerns,

they had 35%, 35% of the case files haveility concerns over images, stanza photo ids, birth certificates, legal documents. so let me ask you this. can you send her to do of us and say with full certainty that your department knows identity of these children's sponsors? >> senator, let me make sure i respond to the question in terms of the identity of sponsors. no child in our custody is released to sponsor without having gone through a full vetting. so speedy all full vetting that you said let's speed it up because henry ford couldn't have been rich and famous if you work at the slow process you all are. children are not rigid on an assembly line. they are human beings.

>> if that's exactly what i said. >> well, sir, i would say oig disagrees with you because they say you do not knoéw. you think you have a responsibility to follow up with these children when they are placed? >> senator, we not only believe it's our responsibility to take care of these children while their inner custody, we make efforts even though you and your colleagues did not give us the ry to follow -- >> you have the authority, six >> to do what? >> orr shall be responsible for coordinating and elevating the care and placement of unaccompanied alien children. s. >> correct. that is a sponsorship of the vetting process. >> care providers must conduct a safety and well-being follow-up call with an unaccompanied child with his or her sponsor 30 days

after the release of the day. mr. secretary, director marco's is failing in this here there are 85,000 children that we know of that you will cannot find and you are hesitant to move forward time is expired.ed informati. thank you, mr. chairman. >> very briefly. s, i take umbrage to the miscalculation in some cases misrepresentation of the facts by senator blackburn. i also want to clear that we are people at orr who are working as hard as with the resources we have. your mr. position on the authority, we at orr are calling, it is a force that you wish to mischaracteri we're doing and we do everything we can with the authority you give us to provide the care that these kidsn, i would ask to

submit the letters and the statute speeded without objection, so ordered. senator whitehouse. >> thanks very much,q÷ chairman. mr. secretary, good to have you here. i want to move to a much more lo you know from the very beginnings of the value-based care effort, i have been very, very involved, hel+■pingo set up the accountable care organization, a success in rhode island and elsewhere in the affordable car act, establishing large event success in the affordable care act. and i want barrasso and i just launched a bill today to improve and expand the aco program. i first want to thank you all for the ahead model which rhode island is applying to, the state

total cost of care model provides a very important potential avenue to get off the fee for service treadmill which a service of badly so thank you for that. and any cooperation and support to rhode islanders, we pursue the process, would come to what i would hope would be very happy conclusion, i of. so, cmmi, i have beenry to organize -- cmmi was decided to go to try out pilots. i've been trying to get a pilot in rhode island to do with people who are approaching end-of-life, and when they're in that circumstance they need to change. so there are a bunch of waivers, there are five of them we've

identified, that are unhelpful, that interfere with care in humaneness in that phase of life. they may make sense in the larger world, but at that point they really stop making sense and they get in the way of families ability to take care of their loved ones. today is the third time that i raise this with you in hearings when you have come before us. i don't just raise it in hearings. we've had repeated meetings with h staff, , we had multiple big with cms administrator and ivey meeting with cmmi directors now through three different administrations, and every time that one leads, it's groundhog day and i've got to start all the help over again to try to get this moving. it has not now been the bett of aec very

simple, very easy pilot launched in that allows from you five waivers that you have given over and over again int te for some reason unacceptable to cms or to medicare or two cmmi or to anybody else. the waivers have been granted in many circumstances. what you will not do or what cmmi will not do is simply say yes to those waivers in rhode island for ahat they are very willing to negotiate over. i would propose that the population be those identified by aco's,■h accountable care organizations

who are nearing the end of life or whose waivers would be appropriate and to help the doctor to provide better and savewe can talk but others fedel health qualified health care centers. i'm open to working with you on what the population should be so that cmmi and cms and you can be comfortable that we have a manageable pilot that is not going to put the■b feral health care system at risk. i believe we will prove to you that you will be improving the humanitygj the end-of-life if you let this go forward, that you will be saving money if you let this go forward, and that to the extent that outcomes can be improved for dying patients, that outcomes and experience will be, please help me clear this logjam. this is not a difficult thing. i don't want not

invented here is the reason. i don't want to be told no, we've a differentan go there. this is an easy thing that i pursued for nearly a decade asking only for waivers that are already been granted over and over again, and narrowed to a very simple and negotiable population in the state of rhode island. we have been waiting for years to get this done, and it really need to get it done. >> yes, you are invited to >> senator, einar -- >> really briefly would be y gr. a decade of obstruction. >> senator, i know how hard you been working on this and in my conversation with her team at cmmi they understand the purpose. they understand all of the different elements of proposal.

the appreciate the fact that you're you are willing to be somewhat flexible and how it is developed.rns with the issue of having a state focused. we supposed to be an agency that comes up with models that can then be used nationwide, i know they're trying to move in a direction to make that we do through cmmi which is very little limited resources as you and authorities are some limited, that it would be applicable probably. so i'm absolutely committed to getting back to you. i don't think it's as easy as you suggested but i certainly believe that i.o.u. at l conversation to see if we can move this. >> we absolutely do need to move this. >> the time of the gentleman has expired. next is ssan. colleagues, here's what's going to happen. we've got a number of senators in the room. we want to have questions, senator cantwell chair for a few minutes so i c and at

this point if senator hassan next and then senator cantwell will be chairing and will get everybody in. >> thank you very much, chair widen. i want to thank you and the ranking member for the searing , for being here today. you and i spoke last week about cyber attack on change health, the payment processor for hospitals and doctors all the cost country and, in fact, that this hack is having in new hampshire. i raise the issue with the president on you and i discusses hack is having a really outsize impact on small and rural hospitals including four access, critical access hospitals which is not received what amounts to 98% of their expected payments for the last three weeks. after you and i spoke a least one of our hospitals seek approval from medicare program so thank you very much for your

quick attention. while this has been some progress our providers are facing a long road ahead. this morning i met andrew witty, the ceo of united health group which owns change healthcare and following, this meeting followed my by push s week to urge united to step up and provide more urgent aid to provide it. so we had what i had a constructive conversation your p is make new commitments to provide cash aid today to the providers in my state who need it without any■5nfair or risky terms. what will it as role be in the coming days to ensure that united health group is following up on these commitments? >> senator, first thank you for the work you're doing to make sure not just in new hampshire but generallyha step up. we have a meeting earlier this week with the payers with jeanette health group and providers. we a n follow-up meeting was specifically with the payers on friday.

what we're doing is essentially saying to the payers, man of whom have already received their payment from medicare and medicaid, they are holding money and providers are not getting paid. we are saying to them while what you may not receive the actual bill, you have a general sense on a monthly basis what these providers billiards so there's no reason to not work out an advance payment to these hospitals and other doctors and other providers. >> i look forward to continued to work with you and your and making sure united healthcare payers generally are doing what they need to do a special with our critical access hospitals. io turn to a different topic now. i was really please the department's proposed budget includes $1.6 billion for state opioid response grants. these grants have helped new hampshire and prove its response to the fentanyl crisis. in the past we discussed the programs impact andof continuit. our providers can really plan

and really work towards an overall comprehensive prevention treatment and recoverytrategy. the most recent appropriations language requires hhs two, a quote, avoid a significant clip close quote for any state when allocating funds from year-to-year. states have to have clarity from the administration regarding fue calculated over the next two years. what you commit to having doorstep work with mine to ensure this information is clearly communicated to states as soon as possible. >> with you absolutely have the commitment. >> thank you. finally, last weeks set of government funding bills contained multiple provisions to support addiction treatment for those on medicaid. one of these bipartisan measures which i worked on with senator blackburn permanently requires medicaid programs to cover all medications to treat opioid disorder. i'm quithe funding will also ine bipartisan legislation which i

worked on with others to expand access to short-term residential addiction treatment under medicaid. mr. secretary, can you discuss how these provisions now sx&cigd into law will be supported and expanded upon by the program in the president's budget? >> senator, first thank you vers issue and for being so dogged in pursuing real results for folks. we are going to try to make sure we're parting with states and communities to make sure they are aware that medicaid can be more helpful. we have to wait to see how they structure their programs because they're the ones that operate themcaid wants to be indicated. >> thank you very much and they use my time. >> senator young chairman. mr. becerra, welcome. it's good to see you aga mr. secretary, hhs can and must play a critical role in

advancing access to individual medical technologies. i know you agree, but the reality today is that many medical technologies authorized by the fda face significant barriers in securing medicare coverage. this prevents access to key medical innovations. i'm encouraged by year on releasing a long-awaited proposal transitional coverage for emerging. this would establish criteria for expedited coverage pathway to provide medicare beneficiaries with faster access to innovative and beneficial technologies. we are now waiting on a final notice which we thought would finalized by the end of last year. i along with a number of my senate colleagues sent a letter to cms asking for tcet to be finalized as soon as possible so

that patients don't have to continue expensing delays in barriers in accessing innovative and often life-saving medical technologies. secretary becerra, given that roughly seven month hasse the td ended, can you assure us cms will issue a final tcet policy yet this spring or early summer? >> senator, thank you for the question and for the work you've done on this particular issue. and by the way, i hope that we continue to work this because we are talking about the new frontier when it comes to medicine. so c sure we do it the right way. obviously there are many eyes better place on these new proposals. what i can commit to you is to make sur we get this out as quickly as we can. we got to get it right because we want to make sure people have access to the medicines. >> when do you estimate, surely have the time? would spring be realistic or

early summer? >> i wish, honestly i wish i could say yes, but be honest with you that the process doesn't move always as quickly again, this is not dealing with a movie this is not a movie we've seen over and over again. this is new stuff and we g to get it right. >> for those who are watching care a lot about this issue, as many of my■g constituents, whats the hold up, so to speak? wisest taking longer than baby they had expected? because business people and innovators require certainty, and what are you doing to try and manage some of those dynamic? >> first, went to make sure whatever we propose fits within the statutory prescription you gave us. so we can't go outside of it and we don't want to be so narrow that it doesn't asking us to do. that takes a lot because sometimes you all give a

specificity in the legislation. sometimes it leads aomewt open and we have to interpret. secondly, we have to make sure everything we do at the end of the day will be done in the interest of the patients who will be receiving the medication therapies. and finally we have to make sure whatever we do we have to be able to look around the corner to make sure what we're doing is anmplse we might up in court and everything gets delayed because we are in court. >> thank you. so stepping back, how does hhs a broader, at least perceived disconnect between the pace of■lknnovation and updated outdated pa? i think that's always the dynamic are going to begin with some extent, that closing the window will save lives and improve lives immeasurably. so what are your thoughts? >> remember as you know we are working with two different st fda has a standard before a drug and hit the market, fda has to

say it's safe and it's effective. you have a different standard with medicare and cms has to make a determination, not safe and effective but reasonable and necessary. two different standards. a drug it up because fda says it safe and effective, doesn't automatically mean medicare covers it. >> so you struck uncertainty inherent going to be getting with probably on a going forward basis unless we change the standard stutorily, that from a management perspective how are you trying to minimize that delay? >> that's where we get into the rule, why have they come like oo make sure we're not overstepping bounds. we could use your help. the more you all direct us the better we can move and faster. >> if you have thoughts on how we can do that, because you have an army of internal experts, surely they have some ideas about how we might consider optimizing the process. i would welcome this.

>> we will tak invitation. >> okay. fantastic. i look forward to working with you on that, and as i come to the end of my time i will just you, there's a patient listening sessions, i can i do my some challenges associated with inflation reduction act, cms held a number of patient listening sessions come wouldn't surprise me if you anticipated question about this in your hearing but suffice it to say that they were not proceed by participants to have been particularly helpful. in fact, they the impression because of their design ty would buy a car so what are your plans to improve the process so that the patient concerns with the ira changes fully heard and

address? >> senator,■p here again i overtake your defines picketing of any particular concerns being raised we would love to hear them. >> i will submit themo. there's a itemization. time doesn't permit the ability to unpack the concert. >> we try to reach out to our funds are limited doing that type of outreach. most of her money has to be spent by doing something that we are always looking for ways to get feedback from patients. >> thank you, mr. secretary. >> thank you, senator. senator tillising here. i want to get some housekeeping out-of-the-way. out of the way. i want to read, submit some question for the record intted n november 2 director marcos. i really would like to get a prompt response. and i can go through them now. it has to do barge with the silly down in greensboro that i don't think i'll have time to

talk about today. but i am a bit concerned with the timeliness of it. i've been in and out because i've tried to get in the order here as you can see how people come in and out, but this is beautiful, nobody is behind me. >> i remember those days. >> yeah,nd actually i spoke with a number of people who assert with your that great thing to say that you kind of some of the bipartisan work that you have worked on. but i do feel like there have been some partisan decisions that you are more or less responsie implementing that have concerned with. i am going to point to drug pricing or price controls and the ira is one of them.■( no question that we can look at that and say that we say i think you mention that what you mentioned a response? that's true. but what if we lost? i know that shortly after the

ira was implanted that there was a least one shareholder call or one call that was shared with us that has a double-digit drop in small molecule research because it's got to come from somewhere. and so i would be interested if you could maybe submit for the record, unless your detailed information now, dated that would refute the fact that if

you take down -- i worked in research and development not in pharmaceuticals and high-tech. the margin has got to come from somewhere. the money is got to reduce the potential to get compensated for your product then you just do, you have less money to spend in r&d. looks lik there's a direct correlation to ira's price controls and a big dip in small molecule research. if you have to refute that, we've got to get smarter without we tried to drive down drug o someone else that we want to bring manufacturing back home. well, if you squeeze the margins

for pharmaceutical manufacturer, we have a lot in north carolina, then he produced fewer resources to■añ) makheng manufacturing home when we know we are in a more expensive jurisdiction. so all these things are interrelated. you can't on the one hand, black this ind and say reduce, lower prices, and then cut to get this industry who has a fiduciary responsibility to their shareholders to say but you do, manufacture home. maybe we can get them out of china but we're not creating hospitable environment in the these business decisions if we continue to whack them, not to mention that the presi even mak, making them more chilling on the pharmaceutical industry in terms of having anellectual property, being able to defend their intellectual property

rights over time to recover the cost and investment they made in the drug. if we don't figure out a bipartisan way to deal with this i will guarantee you we can have people thrilled about winning the battle but we are going to lose of the war. when we talk about drug pricing the last time i checked, brought to market cost zero, but so did the human consequences. i'm just going to give that a soapbox speech gives as you said to senator barrasso there's a lot packed in there. we've got to get the right way to do this. this is a very are playing of jt making purely partisan progress on this issue might arguably the ira was. wasn't a single republican vote. also wanted to cover, one of the advantages of being the startup of the dice to get you a lot of other people talk. it's another thing that think we will probably maybe meet with you separately. one, we have got

telehealth permanently authorized. period picked . another extension doesn't know how the free market works. the free market works this way. i know that this is a new operatingd from the perspective of the federal government, and also know there are state impediments we need to work on. i'm doing my part in north carolina. but you are not going to get, you are not going to stimulate investment and innovation in telehealth unless they know permanent. businesses that operate on to your horizons. and it has been stress tested -- two year horizon. all the naysayers before covid have been proven wrong. it works. it works at skill. its efficacy is indisputable. so we need to collectively work on the federal layer andhe the .

i have told my colleagues do not come to meet in this state and tell me telehealth is good except for a couple of professions, or except across their territories. it is irrational and i rejected before you even walked in my door. but we need leadership from the administration i think to get it done right. >> the time of the gentleman has expired. we're going to go right to senator cantwell in the minute but just come back, i heard my friend has done ag and bringingt back from overseas, if we have of issues like r&d.es in terms i will tell you later if i can catch you, i know is such an example. it got 357 vot in representatives. kidding aside, i want to work with my colleagues. >> thank you, mr. chairman. secretary becerra, good to see

you. thank 90 so much for your lp on many fronts. wanted to talk about the fentanyl crisis which has claim 1000 people who died king county, washington, in 2023 from an overdose and we seen a 425% increase in fentanyl relator overdoses since 2020-2022. we are very impacted. one ofhings come with lots of roundtables on this and in of disorders, , mental health treatment so thank you for that. one of the innovations that is been discussed of universal havy health engagement hubs you can do this either by building capacity and existing health clinic or you could build hubs i would be available for treatment. obviously when we held a roundtables around the state one thing that truly clear clear,

not enough beds. i can then you've also to problems of wind when you t people back in treatment but if you had engagement hubs that were clinics based in big geographic locations people could access daily the kind of treatments t t needed and help us in addressing this issue. issue. we've heard from law enforcement humble wood units could be used in rural areas■;nd help rural jurisdictions. the long and short of it is i would assume you think is a good ideas and innovations, and we want to get cms's help in some technical assistance on this legislation. we've had it over with your shop since january and we want■>■x tt technical assistance. could you help us speed up this process progressed we are on board. >> thank you. thank you. critically, critically important. i want to also ask about the basic health plan which as you know you and i talkedbout this

many times. but i believe it is a very successful program where it exists. my that oregon is rolling this out this summer so they are finalizing the providers, but are we not seeing how this is driving down the cost of premiums and out-of-pocket eenses and helping the government because it's driving more savings for us as well? i think the new york program is paying zero, , well, they reduci think they're up to a million in beneficiaries and the program. could you speak to why y think we should continue to expand from new york and minnesota and oregon? >> senator, i know this has been

orked well in your state. i know that other states are looking to adopt. we are interested in having states inne.o be supportive. we have been granting quite a few waiver authorities within the medicaid program. what we're interested in is seeing how states test these different operations. we would love to see any number of states take action to try to do what your state, washington is doing, what oregon has done. because we think a real cost savings that could be had and we would love to be able to keep some of those cost savings as we save so many of the federal level to the various federal programs we have medicare, medicaid ahdnd so forth. >> i think it's time, mr. chairman, we went to the pandemic and i think the challenges of■u the exchange may have gotten buried in the capacity to just deal with the pandemic. but i think it's incumbent upon us now to look back at where the

exchanges has been driving down costs and where bundling of lower end about the medicaid rate customers to drive a bargain for them in premiums this is winning today, or at least allowing for those who are not insured to get better insurance at a cheaper rate. and also we obviously know here we have our own financial challenges. and doing, why pay for an expensive silver plan? why use federal tax dollars to pay for an expensive silver plan when you can bundle up a population above the medicaid rate just like when you buy in bulk at costco and you get a discount? so i think it's time given all our financial priorities here t pay more attention to those states. to be clear, our state was the

first before the affordable care act so we are not one of the states that is, he successfully move forward on this but am hoping that we will in the near chairman. >> thank my colleagues for the pacific northwest or whenever your store capital talk about healthcare you often come away saying, it may be too logical for washington, was. the fact is that dollar for dollar, the concept senator cantwell has been talking about for years in terms of washington states health plan, the concept and coordinating the nuts and bolts of rewarding and all this, i'm very pleased notches russian state is coming around and getting the message out. i look forward to working with her. senator moran. >> thank you, mr. chairman. so president biden is working to lower drug prices for americans, and now for the first time look at the list. medicare to negotiate the price of prescription drugs. drug companies face penalties when the

inflation. insulin co-pays were capped at $35 for seniors and people with disabilities. and all out-of-pocket costs for prescription drugs will be capped at $2000 for medicare beneficiaries beginning next year. now president bid■ wants to double down on this progress by ensuring that people who don't have medicare feel the same relief, a i'm all for it. there is no reason why americans should have to pay more for a prescription drug than anywhere else in the world, especially when america taxpars of dollars to the research and development for those same drugs. secretary becerra, do you knowws invest in medical research and development every year? >> senator, number. i know it's a big amount but i can get it to you if you don't have it. >> that's okay. i actually do have it. it's about $115 billion of which

54 billion is for biomedical research. that's in a single year. i think this money is well spent. i'm a big fan. it supports the scientific research that we need to develop new therapies and new cures but the problem isha big pharma takes these discoveries, turns them into drugs that they can market, and then charges americans nearly triple what they charge other nations, access the very same drugs that the american taxpayers helped develop. so secretary becerra, do you think that americans should have to pay more for drugs, that their tax dollars helped develop that of the people around the world? >> senator, first in the spirit of competition we should be able gets it secondly if we put some skin and again we should probably be able to get far better prices. >> i like your approach on this. you know, charging americans

miss much for drugs when we are the ones who help pay to develop the drugs greed, pure and simple. the biden administration wants to do something about it. so in december it released a proposal that would allow more mp a drug that taxpayers helped develop, if the original drug manufacturer jacked up the pri a much that people can't afford. as you know this is called march in rights and would inject some competition into the markets and lower drug prices for families. now this law has been on the books for over 40 years but it ever, never been used. in large part because big pharma has spent millions of dollars trying to convince policymakers they drugs price has no impact on whether or not patients can't access it. s forced to make

difficult decisions between a 40 their medication paying rent or kind of put food on the table will tell you that argument is wrong. but if you cannot afford to buy the drug, and you don't have access to it. so secretary becerra, if this draft framework that the biden administration is working on right now is finalized, what impact with the have for american families? >> senator, i believe is this ee competitive. it would also prevent the lockout of manufacturers who are willing to actually sell for mp it would probably unlock access to some very crucial medication from work americans, and so on the whole i thinkt dol the character of this nation to have competition drives what people get. >> all right. i would like, i very much appreciate your work onebruary h

over 70 of my colleagues in the house a senate urging the administration to strengthen and to quickly finalize this proposal that would have the benefits that you describe. it would stop big phrma's price gouging and ensure that americans can access the life-sin tax dollars helped discover. so please get this done as quickly and effectively as you can. >> we will try. do i >> thank my colleagues. mr. secretary, it's been a long moing but've got a couple of areas that just need to clean up with you. one, as you know, our colleague from oklahoma, senator lankford, was talking about women using dangerous chemicals abortion. that was essentially the topic of his conversation.

and i think he left most people kind of confused about what he was talking about. i just wan to ask you, and senator warren has been a great advocate for women in these areas as well, about what thi this topic is all about the safe, effective alternative to surgical abortion and whether or not this medicine, which is now responsible for more than 2%e a, are going, this medicine is going to be available. that's what the court case is really all about. it stems from of course the overturning of roeçq.e. we are already seeing the consequences of that ruling playing out nationwide with women being denied healthcare they need and des

and if, and to emphasize if, the antiabortion activists get with mifepristone which is currently before the court, it would effectively be a nationwide abortion ban. now, you and i served together and the other body, the house of representatives, and quite sometime i think before you came i chaired the first congressional what came to be mifepristone. this was back in 1990. the issue that we focus on then is still the issue of today. and that is are these decisions going to be made on theis of science or are they going to be made on the basis of politics? and i started arguing in that first drink, i believe it was

1990, that we ought to make the decisions on the basis of science, the f activated, and it's now been available for years and years. with evidence showinghat it's as safe as tylenol. i just wanted to set the record straight, because what senator lankford was talking about the e is contradicted by a set, data set developed by the fda. i wanted to ask you a question or two onhis. if access to mifepristone is rolled back, which is what may happen with this court decision, what would that do to access to health care for women all over e

states? you know, it was all this discussion about how the would basically be able to proceed in their own kind of fashion. now, we have seen with respect to mifepristone that the antiabortion at the various get their way, they could put restrictns that antiabortion activist -- make it impossible to get access to drug had all come in every corner in the united states to me, but i would like to ask health and human services since he had senator lankford my colleagues talk about getting your a federal ban, the courts would do to access to a safe, effective alternative for surgical abortion. >> mr. chairman, well first i you say safe and effective, you are not just saying that because

you believe it. it's because the science has shown that mepristone f only been safe but it has been effective. to americans who need it as medication, it would further reduce access to care. my daughters who today have fewer rights to access to health care that their mother had, would lose eventh to the care that they need. it would also mean that more women would probably place themselves in further danger trying to access the care that they need, which would likely delays to the scenario that were very common pre-roe omen would end up having life consequences as a result of some of surgeries or actions that regrettable action that would take it and it puts us in a place where we have

regressed. but i think, mr. chairman, the point that too often dismissed his just not mifepristone your mifepristone went to a process within the fda to be found safe and effective. many of the drugs, many o the medications that americans rely on went through essentially the same process of analysis. if the analysis that was done with mifepristone were to be overturned, it would be very difficult for anyone to see that the only result is that mifepristone is taken off of the market because there's so many of the drugs that went through the same process that would then the same legal challenges on their accessibility throughout american for americans. >> it's an important point to make and it■ñ is exactly the pot that we made more than 30 years ago. i remember in a drafty house small business hearing room when i was chairing this hearing, we

said the second you decide to start making these decisions onr than science, and we were talking about how literally decades working through the scientific issues with respect to the back to the wild west. you are going back to the days of basically politics and who's got political strength is goingk the american people by an overwhelming majority want to have made and other policymakers who are not about ours in these, , about god site and appreciate you bringing is up. let me continue dash if i can surely struck by the issues way to wrestle with more than 30 years ago, putting sle politics is exact with the challenge is now respect to

mifepristone. let me ask you about the office of refugee resettlement where we heard lots of back and forth and charges leveled you. this is an office that works with unaccompanied children. that's their responsibility. and for years, years and years these were the kids put cages, and the top administration, source i could even lost track of them. .. that the office of refugee resettlement is now working to improve the safeguards of these kids and as we wrap upn that she get the support of democrats and republic

>> as i tried to explain, when congress passed the placed children who did not have an adult with them that came from the responsibility under the statute that congress passed were to provide the temporary care of these children until they were placed wit vetted sponsor. once we placed that child with a vetted sponsor, our au that child ends. that child doesn't need to communicate with us. the sponsor doesn't need to communicate with us. we do everything we can, including after we discharge the child to try to follow up, even though there's no requirement that the child or the s to us. we do try to do follow up to make sure that everything is moving the right way with that sponsorship. what we're doing is working th because they are the ones that track any labor violations that might occur, especially with

child labor and we're trying to work with them to make surethat know about any kids in the event that some of these children that might be trafficked or usedvq for exploitive child labor. we're trying to do everything with the authority and resources that congress gives us to provide the care that any child would receive. we don't deal with the immigration status of the child, that's done by the department of homeland se8]curity under law as we're required to make sure that the children are receiving the care to this country would receive. >> so, i guess about three hours ago what i did was tried to take the exact quotes from former president trump who claimed that he was going to do so much to lower medicine and he was going to take o big pharma and he was going to be for more competition and compared it to the record,

which showed none of that. and i contrasted it with president biden and president biden's conversation with me and i'm sure plenty of other election and we talked about getting rid of big pharma's holy grail where they could justtop any negotiations. we talked about price gouging and we talked about out of pocket, you know, caps andén i of the united states senate in 2022, late in the summer, and i said we actually did this is not a debatable proposition, we passed this law. the president of the united states is going sign it. and i just think it's important as we wrap up to make clear that as deep as crater lake, as i said,

three hours ago and what values the previous administration was sympathetic to the corporate interests and those corporate interests were driving up health care costs, particularly big pharma and president biden said and what i support is our north star is getting a fair shake for people without power and without clout and all of those seniors. your people got it to us. nine million americans, one out of every seven seniors are going to benefit in medicare from the fact that we're negotiating, working to get ash so, you took a lot of hits this morning, i guess that goes with the■c■ turf, but i want you to know that i think that what you're doing and the values

that support these acons, what the american people want, i look forward to working with you closely in the days ahead for senators, questions for the record and due next thursda 21s mr. secretary, looks forward to talking to you soon. with that the finance committee is adjourned. [inaudible conversations] [inaudible conversations]

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