Transcripts For CSPAN Sec. 20240704

Pharma. Big pharmas holy grail, what they cared abo prohibiting negotiation for a better deal on medicine. Look at wth going to court, trying to stop any negotiation. But we have it written in the law that there isation. On top of it, most americans have access to free vaccines. Osts 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 copies it. We have seen Real Progress in the private sector as well. We want every buddy in america to get that pricing relief but we are making Real Progress. We also created price gouging penalties ■7qfor the rst time to hold big pharma accountable for high drug costs. Those are benefiting patients and taxpayers. Plenty more to it is essential that finally, after all of this debate, we get pharmacy manager or Pharmacy Benefit Management and congress can finish this crucial change thats going to help all of these wonderful people in their white coats because they are here to keethen the lower drug costs for patients and protect Community Pharmacies. Thats on the first issue of drg 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 qqahone thoal, stated again and again, the number one goal, repeal the Affordable Care act. Get rid of the whole thing. On that one, he failed, fortunately, as well. Under President Bidens leadership, democrats osrance, f americans an average of 800 per year for coverage and access to care. When you look at President Bidens 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 and the 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 years after the efforts to repeal the aca crashed and burned, nothing has changed. Donald trump still says lets get rid of it. He still lacks a plan to take care of all of the people whose Health Care Coverage is doing thathes talked about gutting americans Social Security and health care nets. No plan to keep seniors out of poverty and illness, either. Thats the difference betwe demt 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 biden, Senate Democrats and donald trump, with respect to health care. The gap ee promises and biden action on health care, the difference on the actual records between■eo i. Democrats made promises to be american peoplm going to wrap g there is another issue today that is pending that is very impoant kids and health care. That is to get our bipartisan tax dealcongressman jason smith passed in the senate. It helps 16 million kids and immediaty kids out of poverty. Youll have to take my word for this. Here istherican academy of pediatrics had to say about this. In case anybody is interested, hes from oregon. Dr. Ben hoffman. Hes a doctor at oregons very own Oregon Health and science center. 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 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 th the child tax credits and their company and their research before the april 15 filing deadline. So, hearing from the American Academy of pediatrics, a■es we n, as far as i am concerned, its as good as it gets. We will have good input secretary becerra about how President Biden will continue to lower costs. First, we will hear from senator ÷crapo. There is one thing that you and i agree on. We have to control drug prices. You alreadyit. You see a number of folks in the audience in white coats. Those are pharmacists. We met onhe 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 do, which we need to do right now. Which is to get the pdm legislation, whichd this committee, 260, on the books. So that we can start one of the most significant things that can be done to help control drug prices 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. Im hopeful we can make progress on that right away. Back to my formal remarks. Thank you mr. Chairman and thank you, secretary becerra, for being here today. Over the course of the past year, the fince committee has taken bipartisan action to tackle a range of health care challenges, leveraging collaboration and consensus to advance commonsense solution for seniors and working families. Our Pharmacy Benefit Management reforms would modernize medicaresrescription drug benefits, driving down costs at the pharmacy counter and netting billions in savings for taxpayers. The would build on previous efforts to shore up Patient Access to critical servicesespecially in row communities. These policies received nearly unanimous support all through regular order. Yourartment 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, fu these ovt focused proposals must become an urgent priority. Not just for our committee, but we have a responsibility to patients, Community Pharmacies and Front Line Health Care providers to deliver on these commitmentregardless of policy s on other fronts. The president s budget request, unfortunaty,alon prescription de document makes virtually no mention of the robust partisan bicameral efforts. Instead, opting to double down on a price controlh chambers. Bipartisan bills in the senate and house would address unintended consequences spurred by the inflaon particularly for patients with rare diseases, who will likely see fewer Treatment Options under that l. Rather than embrace these avenues for viable reform, the budget seeks to expand the program sco w no attempt at improved transparency, certainty or mitigation. Further, the president s budget request conrms an overreaching mandate that would force Nursing Homes to close their doors and result in less access to home and communitybased services for mediideficiaries. This document highlights the visions and misses vital opportunities for productive, patientss. We will continue engaging with your 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 die recently 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 aligned e president s cancer moonshot, including by ensuring that seniors can access innovations like multicancer Early Detection screening. Those tests can be invaluable. Earlier, i joined senator bennett in reintroducing our bill to grant medicare coveragen both chambers. Bipartisan majorities in both chambers have joined asponsors e for this legislation. While the administration aired in rescinding regulations aimed at expediting access to medical breakthroughs, your department could take a range of steps to restore patients trust in reliable coverage for medical devices. Including byproposed pathway that cms published last year. Before closing, let me emphasize the importance of timn with reso 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 in unavoidable uncertainty. Already, financially vulnerable, providers with little to no cash reserves required immediate action by the administration to ensure payrolls could be met and se could be continued without interruption. In the coming days and weeks, hhs should continue to update efforts to limit further on disruption. We have an obligation to build on longstanding legacies of bipartisanship and bolster the clinician workforce, drive valuebased care, improve broken Payment Systems andwith these j, thank you again for being here, mr. Secretary. Irman. Thank you, senator crapo. Getting a 260 vote in major legislation involving enormous sums of money is just about impossible. Its hard to get a 26 vote on ordering soda pop. Thank you for your work on that. Secretary becerra. Sec. Becerra for the invitation. When President Biden took office in january of 2021, covid was ravaging our famils and our economy and americans were dying at a rate of 2 11s everyday. In january the number of americans with Health Insurance was, like our jobs and the economy, down and on the canvas. Prescription drug prices were skyrocketing with patients and their pocketbooks at the mercy of big pharma. Y, 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 u. gtodayn americans, a record number, can go to the doctor or hospital and not go bankrupt because they have tmore than 21 million of te americans can count on the Affordable Care marketplace for their insurance. Another record. Today, while big pharma is still big, the president s new Prescription Drug law has brought down the price of insulin for americans on medicare. As we speak, we are negotiating with Drug Companies to lower the prices of even more Prescription Drugs. Ev as the president s budget dod down on the investments that made the comeback of our jobs, economy and health possible. It fosters innovation and protects care she needs. This budget does not just strengthen medicare, it strengthens it beyond our lifetime. This budget coin 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. The budget provides medicaid like coverage to low income individuals in the outlier states that have notcaid under e care act. When that happens, another 1. 5 million americans will have Health Care Coverage and the peace of mind thatomes with it. This budget builds on the largest investment in a generation. It bolsters a crisis lifeline and gives young people support at home and school. That means boosting our Behavior Health workforce w12psychiatris, clinical social workers, marriage and family therapist, council lists and peer support specialists. Across hhs, they tackle the Maternal Health crisis by improving access to pranwe are e affordable for working families. Andthis budget will provide increased 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 nations 4 million fouryearoldand eventur threeyearolds as well. Our budget grows and strengthens the cerse and privacy and keep our hospitals and providers, especially smaller ones and those in Rural Communities, running and secure. Finally, this administration has made tremendous strides in preparedness capabilities since the pandemic. And we keep building. This budget invests in countermeasures to combat antimicrobial resistant drugs, to expand monitoring supply chains innovate 200 data sources across federal, state and local governments to improve information sharing. We cant reduce the health and ans to a line on a budget spreadsheet but we can transform the numbers on that Balance Sheet into invices that sustain health and promote wellness for all americans. President biden has presented a forward leaning budget. I look forward to taking your questi ons. 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 exam donald trump and i am quite certain, mr. Secretary, when you came i that had been actually accomplished. I described a president with a conversa after the election where he said he would stop the price gouging and cap outofpocket costs for seniors. A and he won. Not just talk, delivery. The secretaryvery involved in, s price gouging. Is it correct that some seniors are now saving 618 per do on a drug they get at the Doctors Office . Sec. Becerra senator, thats correct and its 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 a drn because there is a limit now on what they will pay with their cap spending. It might be 3500 this yea but next year, the limit on expenditures outofpocket for seniors is 2000. For the first time, in addition to the price gouging penalty and the outofpocket costs of these priorities that i mentioned, for the first time prices. As i say we beat pharma and took away their holy grailic negotia, i like to hear more about the high cost drugs that you are negotiating. How many people with medicare take the drugs that you are negotiating this year . I dont believe ive seen aggregate numbers on this. I think the American People would like to know how many people with medicare take these lower the prices on. Whats 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 lifesaving. In 2022, the cost of these 10 drugs for medicare, just the 66 million americans for medicare, the cost of those 10 drugs in 2020 was 46 billion. Outofpocket, about 3. 5 billion. It is big money for jt those 10 drugs. The next year, when we get to negotiate for 15 more drugs, we will get to save americans even more. Whats the ballpark number in terms of how many people with medicare are taking these drugs . Sec. Becerra i could not give you the specifics on all of the 10. I dont have that before me. But, they are very well known drugs. For seniors, they treat principled issues cancer, heart disease, kidney failure. Its the kind of chronic disease that we know a bit about. Why dont you get is that for the recd. Are saying the amountf money involved in this area, i thought i heard you say 46 billion. Sec. Becerra n x 46 billion for one year for 10 drugs. Ok. Lets talk about this cybersecurity breach, which is so serious. Im of the view that it also relates to the fact that these facilities are getting bigger and bigger and then i think they risk. And we have to get on top of this for a long time top of this. For a long time, private companies have been allowed to set their own standards and it does not seem surprising that neither the United Health group nor agencies were prepared for this and its fallout. My view is the Health Care Sector is a prime target for criminals and foreign adversar■ies. As these companies have become so large, it is creating a systemic Cyber Security risk. Today, there are no federal mandatory technical cybersecurity standards for tren though people have been talking about this for ages. Something like two decades. I want to make i clear that that has got to change now. I understand in your budget youre going to increase penalties for compliance violations and make the first actual concrete proposal to require a real, mandatory cybersecurity hospitals. Mandatory standards are a great first step but we have to do more and the nps have got to be accountability for negligent ceos, for example. Which will enable hhs to better protect patients and our national security. Will you work with me, mr. Secretary, to Start Holding theseg their jobs, complying wih the kind of Safety Standards the people have a right to expect on cyber, will you work with me so we Start Holding the negligent ceos accountable . Sec. Becerra mr. Chairman, we look forward to with you and every memory on these issues. Thank you, mr. Chairman. Mr. Secretary, last year, this Committee Voted Unanimously to pass two bipartisan support bills. These provisions would generate billions in taxpayer savings and bring down costs for seniors with chronthese bills reflect tt bipartisan and consensus driven Solutions Challenges raised by embers across both sides of the applicable spectrum. This ist in the president s budget. Sending a troubling signal to the patients and Community Pharmacy and Health Care Providers across■0he country. Secretary becerra, what concrete steps does the Administration Plan to take to support our effort to get this legislation moved expeditiously and put into law . Senator, we are prepared to work with you. A year, both in this chamber 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 non if te not going to provide health care. We look forward to working with you and we appreciate there is bipartisan support. I did say you have given very good Technical Support as we have given this legislation. Im asking theand use the pulpis legislation moved in this congress. I would ask you to please take that request back to him. Sec. Becerra youor, that we din event at the white house on this issue that highlighted it for the American People. When the ira past nearly two years ago, mr. Secretary american senio hthe consequencef the law. A growing number of Clinical Trials for medical breakthroughs have been canceled read particularly for rare disease part of these plans exclude more and more medications from coverage and subject others to prior authorization therapy for critically needed care. Payments skyrocket, often tied to sticker prices which excludec any rebates. Secretary becerra, can you commit to working with congress basis to remedy these issues and improve the program, rather than prioritizing ira expansion, ich 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 clear and is doubling down on the ira and making it work more effectively. We look forwar you on a bipartisan basis. It has been disappointing to hear but we received the president s message and im just asking you to help us try to find some Bipartisan Solutions to move forward. On telehealth, telehealth coverage has proven critical for our seniors and working families across idaho and the rest of the country. Unfortunately, without additional action, medicare beneciaries and ameran, deductie plans, risk access to losing risk losing access to■2 tellt fd uncertainty as we move closer to this coverageetary becerra, whas to your department and agencies plan to take in order to avert this unacceptable outcome as well allions of americans who rely on telehealth for coverage every day . Sec. Becerra we continue to work with your colleagues here and the house of representativef those flexibilities. Statutorily, we are constrained in being able to extend some of ies. We are working with our state and local partners because, as you know, many of those issues will involve state rules and laws. For exampl a practitioner practicing beyond state lines to improve telehealth has to be done with the concurrence of state doctor in your steak and practice in my state. We are working to extend these telehealth flexibilitys. 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 atttion to thwith that, thank you mr. Chairman. Thank you so much, mr. Chairman ranking member. Secretary becerra, welcome. It is always good 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 budget. This really does build on the and work we have done as democrats with the president for the last three years. I want to say, i want to correct one thing. Please. Forme resident that former President Trump didnt do anything her prescription jugs, i would say he didndo on 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 40 reduction in prices for the seniors in michigan or for anybody on medication in we have been focused, working with the president and with you on cutting Prescription Drug costs for americans who have been paying the highest prices in the world. The bills that we have been working on together improve and transform the way that we provide health care in this country, which is so and, as you know, its 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 insurancethat is including 400 0 michiganders. Many getting it for 10 a month, 20 a month. It has transformed families lives to be able to have that alth care. Care premiums have gone down hundreds of dollars for 271,000 michiganwho are usie care act and, of the 35 cap on insulin is lowering costs for seniors in michigan and across the country. Not counting the cap on outofpocket costs u or next year, when it comes to a permanent 2000. Its a big deal. Its a big deal. So, i want to just ask you a question and speakat i like to Call Health Care above the neck. We need to make sure health care 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. T, particularly in this budget, the president including significant investments in the future communicare, where we are helping through the health care syste■dm and t know, this is something that keeps people out of the hospital, out of the jail unnecessarily. People off theeets that have been homeless and gets 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 budget not only supports their expansion but making it permanent. I also want to give a shout out to you senator cornyn, thank you for being my partner and moving forward the definition to make sure they permanently part of medicare and medicaid. Thank you for partnering on that. Can you elaborate on your plans to make a Permanent Foundation for how we provide Behavior Health and communities across our country . Senator, first to you and senator cornyn, thank you for putting together something that has proven to be a Great Success and now that everyonwamental ht service between 9 00 and 5 00. They occur at any hour and any part of the day and you have to did in making Certified Community Behavioral Health Centers Available, Critical Care Centers Available 24 7 w 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 emerge■]y room twhat you hay establishing these centers that are specific for them, for Mental Health conditions, it gives them a cnce to see her fresh nose that could treat them right away. We are going to build that and the president s budget commits to that. Thank together on a bipartisan basis to address what nine in 10 americans say is a growing crisis in this country. Thank my colleague, neck to senator grassley. Im going to bring up a problem with your department. The same problem ive recently had with the environmentalnt just your depat this might be a problem with. But last month, i wrote 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 very dangerous situation. I want to know what these contractors are doing to ensure shin 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 grassleys office to hhss 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 do you accept the pt recipients of congressionally appropriated taxpayers money must respond directly to congressional oversight requests . And i hope you can positively that they should. If not, when will if you would agree with me, when would you direct your staff to clarify to recipients 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. 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,o7 t 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 followup, let me be very clear. 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 goita while, has been obstructing. Another question, if hhs receivesrequest for informationt to a childs trafficking investigation, doesheenforcemena subpoena . Sec. Becerra mr. Chairman, we work on an ongoing basis with Law Enforcement throughout the country. We care for and have custody for minors. We continue tot throughout the country. We follow the rules. In some cases, we are dealing with private, sensitive, confidential information and we make swt violate any individuas 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 make sure that we are complying with the law when it comes to providing information. Some information is more confidential than other pieces sure we are not violating any privacy rights or any protections in providing information whether it is to Law Enforcement or any other entity. This will have to be my last question and then i will submit for writing answers. At last years budget hearing, g Rural Health Care and the need for cms to utilize the rurgfal Community Hospital demonstration program. Right now, cms is only using 25 of its statutory 30 hospital for its program. You told me last year that hhs would do more to support rural hospitals in need. Following our discussion, i wrote cms administrator and but that is where the progress stalled. Cms explained that i 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 isnt in, you should be doing something about it. I realize you might hhs. But, why doesnt your department want to help hospitals throughout this program . Its budget neutral and congress has reauthorized it three times since 2003. Sec. Becerra may i respond . Briefly. Sec. Becerra lets follow up on this. But i will tell you if you take a look at the president san geto you with a number of the projects that we have undertaken in Rural America, we are doing a great deal. Especially with many facilits that are on the verge of closing. That would be worse for many parts of Rural America. Let me follow through with you on your particular concerns. Because we have quite a bit to talk about when it comes to our work in health care for Rural America and this budget, as you will makes Major Investments in Rural America. Senator menendez is next. Sec. Becerra for years, communities across the country have struggled to fill major provider workforce gaps and growing crisis exacerbated by the pandemic. Based on my legislation, congress authorized the creation of 1000 medicare slots in the consolidation of appropriations consolidated appropriations act5 of 2021. Cms has repeatedly included additional criterispecified in h unfairly disadvantages many states, including new jersey. E enacted, there have been two rounds of distribution for these slots which means we are 40 of the way through the program and new jersey continues to be completely shut out. Itbe and we still dont have an answer as to how we get uteaching hpitals in my state. The law states the secretary shall not made shall distribute residency positions to each of four specified categories and providers. So, what can you commit to doing to help insurers that states are no longer unfairly shut out of the program in contravention to the way the law is written . Sec. Becerra center, i appreciate the question because i know this is the one youve worked been trying to be responsive to your staff as well. As you know, new jersey, like california, the circumstances sometimes make it difficult for some regions to be able to qualify for some of the resources and in this case, gme slots. We are more than willing to work with your team. The resolution is not so simple because, as you try to resolve the issues that affect statesse, you create other issues for other states. Let me interrupt you. Its not so difficult. The law is clear. The kingdom of cms that has decided to add additional criteria that congress im sure when you are a member of the house and ways and means mitty, you appreciate it when federal agencies changed the law [6that you helped pass and enacd it in a way that was not your intention. Thats exactly whats happening here. I think you have the power to fulfill the law as it says the secretary shall distribute residency provisions in accordance with the law. This is not happening in accordance with the law. And so, the suggestion that the apartment is trying to be cooperative and helpful falls short on me. I hope we can find a better way forward. Month, your agencys Inspector General issued a concerning report, finding that over a few months period, 16 of unaccompanied Migrant Children files like any kind of sponsored background checks. It also found that nearly 20 of cases were unaccompanied minors released to sponsors, pending a background check. There was no documense checks we ever completed. Given the alarming pipeline of unaccompbeing released to situas where they are ruthlessly exploited for their labor, this is a blind spot that needs to be addressed. We are talking about p thousands of Migrant Children who are sent to unvented sponsors. As the report concludes, the failure to complete background checks increases c■nr being ree sponsors. What actions has your agency taken to the respond to the findings of the report . Sec. Becerra senator, i can assure you that most of the recommendations that were made by the Inspector General for incidents that you are referring to incidents that occurred in spring of 2021 over a two or three month period. I can assure you what was being observed by the Inspector General back then is not the case today. If you recallt that point, we had an infrastructure that have been virtually dismantled. We had to stand it up. We were dealing with an influx. Today, we wld find nethat i . Sec. Becerra you would find we are doing background checks and thorough assessment of anyone who is seeking to become a sponsor. I look forward to seeing that as a reality. A recent Supreme Court decision has upended vital protections o. A bill to■t■z amend that act and protect patients. Unfortunately, we are not able us. Get will you commit to cms, working with my staff and senator cassidys staff, to have the appropriate information we need to address this problem . Sec. Becerra i commit to make sure our staff is working with your and senator csidyf. I know weve been engaged with some of these folks on this particular issue. Thanks, mr. Chairman. In august, your department recommended the reclassification of marijuana to a scheduled three for the Drug Enforcement administration. Previous administrations used a five factor test to determi schg should be. This administration, your office has created a new two factor test to determine excepted medical use. Whats the reason for the change . Sec. Becerra senator, thank you for the question. As you will see from the report that has been made public, there has been a lot of science that has been collected over the years on cannabis. We have far more information now, as you know, throughout the country, many states have moved much farther than the federal government has, even in places like texas, you see where action has been taken on cannabis. We are reflecting what the science is showing. Youve compared it to heroin in terms of its potential for abuse. Why didnt you compare other types of drugs that were scheduled by your office . Sec. y not to speak directly for the fda because the fda did this independently from hhs. They are the agency that has been passed with that job. I wont try to speak for them. Rigorous work that was done to come to these conclusions was based on the science of the evidence they had before. Did they do Additional Research on Brain Development or Mental Health consequences or pact on pr im sure they took into consideration all the information out there on both the effects and the evidence that there is on cannabis use. You are saying that for a fact . Sec. Becerra im saying i dont want to try to speak for the fda and the scientists because i did not do the actual assessment. ■o but you announced a recommendation. I assumed you would take into accountt Brain Development and Mental Health consequences or pregnant women. Sec. Becerra as i said, im sure the fda wouldave taken into account all the different circumstances involved. I did not make the recommendation, it was made by the fda. I want to follow up on someye that senator menendez and senator grassley asked. Your department is responsible for the administration of the correct . Thats correct. That means any unaccompanied children who come to our border are basically tra care by the b, correct . Sec. Becerra thats correct. And you identify a sponsor for■l, in the interior of the United States. Correct . Sec. Becerra thats our obligation. And there are about 400,000 of these unaccompanied children that come to the United States during President Bidens term of office. Can you tell■ us where they are now . Sec. Becerra we can give you information on the vetting process. No, askthey are now . Sec. Becerra as i said to you, we can tell you who the vetted sponsors were that received thats not what i asked you. I know that you have interviewed sponsors to some extent although not adequately, i agree with bsenator nendez. Do you have any for their welfare as you sit here today . While they are in our provide e have im talking about now that they are in custody of your vetted sponsors. Sec. Becerra you did not give so that is not your responsibility is what you are saying . Sec becerra we dont have jurisdiction. You dont know if they are being traffic for sex, whether they are going to school or getting the health care that they need . You simply dont know. Sec becerra what they are in our care. Then they are transferred to their sponsors . Sec becerra you have not given us the authority to monitor. Whose responsibility is to ren . My understanding is this that the statute is that our jurisdiction ends after we have delivered them to a vetted sponsor and the communities where they reside will be a charge of providing for their services. Sec becerra result of the broken border policies they have been placed was sponsor. You dont know where they are. You dont ink that iyo responsibility and wrinkly, do not care. Sec becerra that is not accurate. This systemor more than 40 years. You and i have been in congress for quiteted back in 1993. Right now you have a one. 9 trillion budget and responsibility to care for these children and you simply hand them off to sponsors, in homes where you dont know the conditions they are living in, whether they are being sold for sex or forced into labor. You dontnothink its your resp. The time has expired. I am going to go to senator lankford but we just got information from the department of health and human services. The number of medire he beneficiaries because of negotiations is 9 million. Of seven Medicare Beneficiaries. Senator lankford, you are next. Excuse me senator carpeu are ne. You are before senator lankford. Ok we will go with senator lankford and come back. Let me do a quick followup on what he was just talking about. ■findividuals placed from custoy that are unaccompanied minors are they always placed in homes placed in the home with someone who is not legally present in know their legal status . Sec becerra our authority is to place them with someone we bet who will place them in a safe shelter. What percentage of people are placed in the home with someone who is not legally present in the country . Sec becerra i couldnt tell you at this time. These individuals are fed up and not for the status . Sec becerra our responsibility is the care and safety. Are individuals vetted, do we home was someone legally present . Sec becerra i dont want to evade the question but our question is what elements would this be safe . So legal residence is not on the list. Sec becerra im not saying it doesnt get considered. We don know which percentage . Thus not a consideration. There is a new rule on Nursing Homes that i completely concerned about. It will cause a closure overall Nursing Homes. What this is going to cause is a dramatic rise in prices our ende places. I would ask you to reconsider that rule. My state is half rural half urban. Those places that are roles they want to maintain their Nursing Homes on the world i did not vote on which is passed by hhs. I will challenge you to reconsider that so rural Nursing Homes can stay open. You know this is coming is because your office contacted us atlet me ask for clarity. Last year, you created a rule on title x funding in my state, if it does not put on our health pamphlets, brochures a way for people to get access to an abortion if they did not put that phone number we would lose title x funding. You follow through on our threat and took title x funding which takes away from aids testing, Cancer Screening and those things you too because my statet put a phone number in our health brochures of where people could get an abortion. That violates federal law because title 10 funding is not about abortion. You created something new with that. Why would you take away that funding and is that true . my state has lost that money fr aids testing and screening because of that. Sec becerra im not surprised by your question and you wont be surprised by my answer and i dont agree with the way you framed it. Ift would be in court losing. We are in court right now there is an appeal. Sec becerra we are able to enforce the law as it stands. Individuals going in for services should know the servicesa person should be infof the Services Available under title x. Ants to not abide by the law they understand the consequences. They wont get their money. If we dont put a one 800 number on where to get an abortion. Sec becerra thus not the case. That is if we added this one phone number does not fulfill its just a phone number to get an abortion. What has happened is testing, Cancer Screening thats a bully tactic to be able to say i will remove these things if you dont do what were asking you to do which is not in the statute. Sec becerra e expect those who follow the law who want federal funding. Sec becerra get your money . There is another decision coming up in the supreme hear al abortions. There has been rumors out there and individuals saying ie courtg about chemical abortions the fda should ignore it. We dont know the directi make e they make that decision will hhs stand by that decision. My colleagues time is up. It involves the United States constitution. Sec becerra we always follow the law. The time for the senator has expired. Welcome to finance committee. Lets see. I am so intrigued by this exchange. Here we go. When it comes to drug must lowen families, encourage innovation, curb rising costs for the government. For the past several years we pretty much accomplish those things. Last president signed into law the Inflation Reduction Act. Including provisions to end high cost of drugs. Cost, capped out Medicare Part d at authorized medicare to negotiate drug prices with manufacturers for high expenditure drugs. We made historicgress in making Health Care Accessible and more affordable. We are not done but we are heading in the right direction. E the high cost of health care by addressing theublic Health Crisis of obesity. Despite obesity is being classified as disease, the Economic Impact has risen 1. 7 trillion dollars per year. The cost of doing nothing is way too high. Way too high for the american me introduce the act was senator cassidy whiou coverage of intene behavior therapy for obesity it would authorize the medicare benefits to cover medication use for the treatment obesity. Ive been champion for the obeshow will your and your teamt hhs work with us to invest in this prevention and clinical obesity. We think this is one of those. We look forward to working with you because we know sophistication of science we will have opportunities to make the difference of the lives of americans so we look forward to some programs like medicare are at the forefront for americans to get thtreatment they nd. Covid19 taught us many lessons including we have■d is th waiver known as hospitals a home. We saw the demand fo homebased care when facilities were overcapacity and patience wanted to receive care at home. It was established under the Public Health emergency to meet this demand by allowing Medicare Beneficiaries to receive helwe t home program become a true success story. Proven to delive higher Patient Satisfaction along with positive Patient Outcomes and potential cost savings. To ensure patients and providers have access to hospital at home for two years beyond the covid19 emergency senator scott and i introduce the act a bill signed into law last year. What lessons have we learned from the success of the hospital at home program . Sec becerra i hope are able to report on all the lessons because the study required. The study we are going to be putting forward should help us undersndmove in a direction fors that need care in their home. We look forward to working with you on that. We look forward to working wih you and again, this legislation had bipartisan support and im grateful to senator cassidy, dr. Next to senator casey. You back here and thank you to your service of this country and i want to start with the issue of Prescription Drugs and grateful for your work in the work of the administration and the efforts to lower the cost of Prescription Drugs. We know Prescription Drug costs are significantly higher than so many of our competitor nations. I voted for the ;flation reduction act which had a provision for medicare to negotiate for lower the 35 a mn insulin for Medicare Part d beneficiaries. Im holding up here in the large version of a piece of paper i put out a couple of months ago now to summarize the benefits the Inflation Reduction Act Prescription Drugs just in pennsylvania. Insulin at 35 a month, 80,000 pennsylvanians will benefit from another one for highlight, we know less than a year from now the 2000 outofpocket cost cap will go into effect and that will impact 800 29,000 pennsylvanians. Big numbers just in one state. I wanted to ask you to give us a state of play. Whats already in effect and how is it working . ■ billion. We wby august and announcing the price come september. Those prices would then come into play at the beginning next year we will negotiate another 15 drugs. Money the Congressional Budget Office we will save 100 billion in just negotiating ■■r better prices in the first time drugs. You are aware, the cap on how meant she willave to spend out of your own pocket. The cap of 3500 for catastrophic cost but by next year, when people are paying for these drugs if they have cancer or kidney failure. Thousands of dollars because there cap id next year, the cap is 2000 overall. A game changer. And that goes into effect january 1. Sec becerra yes sir. Walk us through the proposals of proposed 15 more Prescription Drugs to be negotiated . Sec becerra works if the cbo is telling us just for these 10 drugs we save a 100 billion to taxpayers why do we limit it to 10 . You all helped us to negotiate 15 but why stop a good thing . List negotiate because were paying 2, 3 times the cost of drugs and people around the world. The second issue i wanted to note how grateful i was to the president s budget to allow states to provide continuous medicaid■ eligibility for children under the age of six. This will reduce coverage, ensuring kids have quality to health care which isne our number one priorities. I introduce legislation for all children tough the age of 18 on medicaid. How is hhs working to expand access to medicaid . Sec becerra you mentioned an important aspect that the president has in his budget. Moment of birthensure we provide because were focused on Maternal Health. Too many women in america are dying or their babies are dying within the first year. We offer a woman on medicaid not just 60 days of postpartum care but 365 days. So far 4550 states have adopted that. That will help kids moving forward to start off on the right track. Thank you so much appreciated. senator johnson a stacks. Secretary becerra will, welcome. I have written 60 oversight letters having to do with our response to covid, the vaccine injuries to your agency. Into your sub agencies. I want to talk about three of those. The origins of covid. And antho in june 2021 4000 emails were released under foia request. A week i have five members of Homeland Security signed a letter requesting nhose 4000 pages unredacted. You agree to the fact that foia those requests can be redacted for a host of reasons but congressional oversight were not subject to reductions . Sec becerra i dont want to speak out of turn but we continue to make sure we protect confidential information and privacy information and tried to do the best we can. Were not subject to the same reductions in u. S. Code5 section 29, 54 and requestaffail submit information requested of it. We went from 4000 pages to 400 pages unredacted over the course of a number of months, we are down to the last 50 pages of the 5g emails. I was hoping you would bring these unredacted because last year, and a similar hearing i asked you about these and you said, you are entitled to that information by law a member of the senate or house to■et. Why havent you turn those over tos rra i will try to make this as clear as i can because secretars before me have tried to answer this question in many senator house members have asked over the past. Make sure we fulfill the request without undermining national security, confidentiality and the if yog information from congress at a minimum you should be providing the reason for withholding this information. You said i was entitled to the information required by law. We have not gotten a response fr you or a privilege log, why not . Why arent you listing thenx hold these pages unredacted. What privilege are you claiming . Was the privilegeei i know yourf has been engaged with our team when it comes to trying to respond to their request that we tried to respond the best we can. You have responded you should have presented a list so we can understand what privilege is you are asserting for withholding this inrmlet me move on to two other things. There is Standard Operating Procedure shortly afteru he its emergency use authorization laying out an analysis that they would do on ant6 reporting since the first reporting ratio. I have written five or six oversight letters trying to obtain that analysis. I have gotten buckets. Bupkiss. Why are they withholding their analysis . Agencies and that data should be made available to the American Public . Why are you withholding that information . Sec becerra i will try make sure i can get back to you. I cant speak directlfor thereay to be responsive to any requests we have. Sec becerra your agencies have t been resnsanger. I request a phone call within a week or two. Ci have run out of time. I have significant questions that the agencies are ignoring. Over 5000 Adverse Reactions from e issues and the American Public deserves this information. I expect a phone call from you with the releasing the analysis on hot lots identified by outside researchers. The time has expired. First of all, thank you. The incredible work you and your team are doing around prescription negotiation as authorized by the Inflation Reduction Act is so important. So thank you. I also recognize big pharma is in court trying to challenge your authority under that legislationhich unfin addition n reduction enacted negotiation we also imposed spending for seniors for the first time. How was the initial out of pocket capital benefiting seniors right now and how will it change in full effect next year . Sec becerra yz■ thank you for r work. I know nevadans are able to keep extra money in their pocket because of the work you have done lower the cost of Prescription Drugs. Many americans have very high■us cost for medication. They are perhaps suffering from cancer. Maybe they have kidneytimes thee extremely high. While medicare pays for a lot of outofpocket costtens of thous. This year the catastrophic cost kicked in as a result of the cost Prescription Drug law. No senior today pays more than 3500 year, 2025, the most any senior will pay is 20. That is a lifesaving measure for many people. Ive heard from so many of our seniors. How did they become aware of it . Are they pushing out information . Sec becerra i had a senior, to me and say i went back to my pharmacist because when i saw what they charge me from my insulin i went back and no thus a new price. She was in the clouds because this was a senior on a fixed35. That makes a real difference. When we jump to Mental Health. Every single Nevada Health shortage area and 16 out of 17 are Mental Health sthe presides to extend the 10 incentive for physician services. This is passed a bipartisan package■n■f t and increase bonus for practicing. Should this shortage area become law they would receive medicare reimbursement. Nevadans may have access to a nursem practitioner or clinical social worker. Has hhs evaluated how expanding the range might impact our workforce challenges in a Rural Communities . Sec becerra you are as a result of covid, there are Health Professionals that may not be physicians that can do some of that work ththe licensee state level. Nurse practitioner to do things beyond what is provided by state law we have to have the states make amendments. Covidare ready to go they have to be free from those constraints. One thing i know working in my■bw at a federal level there is only so much jurisdiction you have it it does require state or local Community Partnership here. When it comes to looking out for the best interests of our kids Mental Health clinicians coming into this state there is a role for the state to play. I appreciate the work you and your staff are doing with that partnership. Senator cassidy . Thank you for being here. Senator menendezs and i requested coverage for dialysis patients. Protective mom act that allowed others at risk f problems during pregnancy to have stayed home monitoring. It has been outstanding for months. I know your staff is busy with lots of requests but this will save lives. Can i ask tt you ask your staff get these filled as quickly as possible. Sec becerra cms is besieged ths the latest being this change in health care and cybersecurity attack. Let me see i let me ask abot monitor. Is that an inor is it cloud . Sec becerra i will be honest with you i will get back to you. If you give us the name of who you person is nonstop we will get that to you. There was a recent finding by the National Association of i suggesting seven Fraudulent Companies stole 2 billion in medicare payments and they did that a Virtual Research data center. I would like cms to have been on p it and i would like to ask you about data monetization. Academics have use the data so thated upon cms to stream it. I was surprised to cms said it would discontinue sharing data with institutions begetting august the 19th of require researchers to move to the Virtual Research data center. I understand the per user prices quite high. I dont know if her get a lower thought price for academics or haveoue anmany researchers and s can access the data if you go to this . Sec becerra we are in the process of reviewing this. We haven to get responses back. This is a fairly new area and we want to get more aggressive forgetting everyone on bno one d with the Cyber Attacks occurring. If youre open to researchers having it at a discounted price. Sec becerra i will speak to where we go but we are open because were tryingo learn along with everyone else. Would you give me followup on that . Sec becerra absolutely. [p the researcher is incrediby helpful to our committee and the fight that she might not have it is deleterious. Sec becerra trying to get everyone to give us their best information. The big guys can afford to do these things but for the little ys is very expensive. Any information theyre getting we want to have it. What percentage of hhs employees are four days a week or more in office . Sec becerra at been working on day one and continue to have folks come into the office to work and i can tell Office Guidance when it comes to an office work levels. What is that requirement . Sec becerra its not a straightforward requirement because there areork schedules. Typical employee . One day a week, three days every month . Sec becerra ihs, every day. The hhs building. Sec becerra most of us, every day. What about nonpolitical appointees . Sec becerra there is flexibility for career staff. It could be three out of 5, 4 out of five. Was the least amount . Sec becerra there are some folks that are telework altogether. Are you monitoring vpn data. The systems we monitor it are from the 70s and 80s. It is difficult to get the dots connected. The time for my colleague has concluded. As you know oral health is critical to Overall Health and you have provided some addition medically necessary determinations in regards to medicare and medicaid. I would need to be able to ■cont t recognize that a lot of the services that are medically necessary bcan you tee using the authority you have to expand access to medical the necessary oral health . Sec becerra i know we are trying to expand access to in Rural Communities because we now see a contraction of what we are trying to do where you have given us flexibility in a way to how they operate. Sometimes is difficult because there are consequences when you have a minute neutral way of operating. We could choose your help to really reach we want to work wio evaluate Clinical Evidence for additional dental whether medicy necessary and we know sometimes it is a struggle and 2 tation and i know the senator and i are working on it but under the Affordable Care act you can deal with Necessary Services and use that to try to expand care. Let me askoucerning this commite with transplant issues. Can you tell us the status of sure we can have fair competition and quality in regards0] to related to transplant of organs . Sec becerra we are trying to move aggressively with the refos enacted which reflected the reforms we had proposed and regulatory channels. What we will need is resources because were trying to set up an independent board that will monitor the transplant activities. Were trying to create a robust system of competition and we need help to make sure we can possible because everyone agrees the resources we have to bring us uptodate or not there. Budget process were able to get those resources the president has proposed. Let me ask you about another g shortages. The wealthiest country in the world has spent the most by far on medicines that we have relatively inexpensive drugs that are in short supply. We have dealt with shelflife so drugs that are still effective but weind without some system of carrot and stick we will always have the and thats unacceptable. Can you tell me the strategy you are deploying so that americans have access to critical nes that are not difficult or expensive to produce but because the manner in which our market works, they are in short supply. Sec becerra our problem is current statutory authorities given site a stage at the retail level we see the shortage. People can find the truck on the and they cant get it from the pharmacy. ■twe are asking if we can see a shortage or constriction occurring at the early stages. Waiting until the retailer says i have enough is too late so were asking to have greater insight into what the the second thing we would like to do is make sure we bring home much of that manufacturing because we should not be dependent on china for the materi pharmaceutical medications. We would like to bring that manufacturing back home. The president included 95 million to have a possible to have manufacturers based in the u. S. In regards to what type of drugs are taking under the fda when life is short senator brow. Thank you chairman, mr. Secretary nice to see you again. We just as something in toledo, it better to people there i wa to thank you for your work on Prescription Drugs. 35 dollar insolent, 72,000senio0 ohioans who rely on the aca will benefit. We want to expand this as i know you do. We want expand the insolent cap not just Medicare Beneficiaries. The federal government lowering, better pricing for patients. We used to take buses to c and negotiate the price the way our own v. A. Does saving 50, 60, ■ 70 . Walk through it briefly, how this will all work and how hhs can work insulin into law to ensure lower prescription dg ive had conversations with seniors who rely on their Social Security check for their daytoday living when they hear 35 is all they will pay for their insulin were before they were paying 150, 200 is a godsend. Today we can yank back the extra profit making if they try to rae the price of the drug by the rate of inflation. Thats a great thing for on med. The outofpocket cost for a senior is being limited. Even if you have to use the expense of cancer drug you wont pay more than 3500 outofpocket. And that number comes down. Next year to 2000 total. Can you think aboutrestorings restored what the child tax credit. Dsdropping poverty rates by 40 , it affects huge numbers of people that need a little bit of help in their lives. I want to shift to East Palestine, the sitei make my nis week. The administration announced grants to get rk health monitoring. Thats a good first step. I am asking hhs to set up a disease registry for the residents of the community and i want you to commit to working with my office and surrounding this issuance of voluntary disease registry for longterm health monitoring. Sec becerra i think you for your leadership on this. East palestine, you are always on my behind to make sure we do something and im glad we got 50,000 to that local health out. We are glad we sent cdc to do in person surveys to figure out the health status. Ounce six grants that go out to help understand whats going on there and East Palestine and we are prepared to wo w you and state and local partners on registering these other matters. To oth commitment during last years hearing to use her project labor agreement. Niosh institute. To help understand workers illnesses and diseases and it matters. Thank you for that and we look forward to working with you to see this project through to completion and get that pla n. We spoke recently about financial issues, the train going through salem was on fire before it derailed. That Regional Medical center faces problems but because of medicares want to ensure we keep providi cares through the nter. Sec becerra we are prepared to work with the center. Senator braun i thought you would be intyears ago you were n creating that price gouging inflation and the secretary confirmed just one of those drugs is saving 600 per dose. I wanted to say thank you for your efforts on that. Thank you mr. Chairman. I wanted turned to the crisis of the southern border and how it is overwhelming our Health Care Centers news, hospitals and sanctuary cities. In new york city, chicago, boston tell us they are at risk of collapsing financially because of the overwhelming numbergal migrants who are getting free care, having the American People pay for their care. Chicago reported seeing 16,000 migrants last year. The cost of their care is over 30 million paid for by american taxpayers. Denver health was in the headlines reported over 20,000 hospital visits from migrants. The hospital is in financial distress. They are asking the federal government to il out and it is a completely democrat caused failure. Can you explain why it is the responsibility of american taxpayers to foot the bill for all of this care for 9 Million People from al world who flooded their way into the United States . Sec becerra what i can tell you is we have extended the resources and authorities we have it hhs to try to be there to help any Health Care Facility be supported. Ay we i dont know if a particular case, i know were prepared to be supportive at any facility where the authority you have given us i have gone into support. Is not hard to find stories about hospital sensation where he said same were overwhelmed by the number people we are to recover the cost. The federal government doesnt pay for the health care of every legal citizen. Why should american citizens be forced to pay for Illegal Migrants to receive the same care for you . Sec becerra ] as i said, i dont know howtisystems with regards e folks coming in. When we are proposed whether its a Medicare Program or those seeking other types of funds to help them we are ready to be responsive. When a hospital inundated with people not paying the shift the cost to people who are paying and thats happening all across t country. I want to talk to you about something senator lankford asked about and thushe nyour departmea rule on staffing ratios required a registered nurse be there, see hours per patient perhardship el communities who cant find people to hire is requiring much most would have to hire additional staffjust fill ■ out the paperwork that your department is requiring. We have concerns that we have express t■omnm and she said Medicare Medicaid has committed millions of dollars to support Nursing Homes. How will these funds reach Rural Communities . Only four out of five nursing home saying we cant comply with what the administration is forcing upon them . Sec becerra you packed mb respf funding and how it goes to Rural Communities. We have dollars into the communities that need it most to staff. If youre going to calyourself a nursing home you should have a nurse to provide care. Its embarrassing that nowhere near 60 Million People live in a nursing home one out of five who ed of covid dall we are seekinl Nursing Homes meet the snd or ia loved one. My times expired so i wont go into only one in five Nursing Homes could meet those requirements. They will be out of compliance with Administration Rules and you are saying, all of these Nursing Homes are incompetent to provide care. Your times expired, senator bennet. This is not the topic i came to address today butmy Dear Colleague gracie issue of in homeeafirst of all, denver heala national treasure. Disagree with that. It is a critical public assess hospital for the western United States. It has a massive problem because of the amount of uncompensated even without the current Immigration Crisis we are talking about because we unlike every other industrialist country in the world dont have unv end cover because no private Insurance Company will cover it or know what the hospital will cover it. There is Denver Health sitting there covering it and saying said many people who are uncompensated because we have a moralthe taxpayer covers that ce to. Its not like the is paying for that because of our broken Health Care System. Lets Work Together to fix our Health Care System so we dont have the immoral crisis we have because people are covered inth. Point number two, is not Denver Health responsibility or dare i say, denvers responsibility or even colorados reon fix the im. The Founding Fathers of this country understood congress woha fix the immigration system in this country and be responsible for it becausehe 18th century it wouldve made no sense to imagine this was something we would leave to the stateshospital in the middle of denver, colorado to address. We just had the opportunity to try to fix some of United States which i completely agree the American People are tired of, for good reason. I dont think we should be allowing transnational gangs to set the the United States. I think that is a mistake and because we have failed to act, who was running the immigration policy in some respects. Thats why so many people are showing up to the border and whe negotiation we have the opportunity to address this in a very incomplete way but we were going to address it in the other side walked away from their own even though it was the toughest portability agreed to and now theyDenver Health for uncompensd care they are providing because that is■m what honorable nurses and doctors do. That is what in an honorable community does. It is the responsibility of the nfederal vernment to deal with this. And not just point fingers at each other and i will say, i wanted to ask you about mental ■[health and the Mental Health epidemic that is raging among adolescents and young people in colorado and across the coy. Letg before my time has expired and that is two weeks ago, and the wall street journal, not the failing new york times. In the wall streetthey had a poland immigration and they asked eight policies for the American People support. Number one was 74 was a pathway for citizenship for 11 Million People who are undocumented. The American People have too much common sense to know thats not a good idea. The second was and third was the border. My point is well understood we can score political points but we have to fix the problem and did for health deserves the support of this committee and not a i know we have spoken about unaccompanied minors. Children have found themselves in the custody of hhs what we have seen during this search is the administrates inadequatecapacity of unaccompan children coming into this country. ■i the border which is what we wouldve wanted the president to do. D your staff to expedite the release of these children, prioritizing speed over due diligence. And assume call with your staff that i viewed you actually said and im going to quote■ you, if henry ford had seen this in his plans he wouldve never become famous and rich. You made that comment talking about Assembly Line process the country. Over due diligence, over sety ing them out. Your hhs oig reported your staff did not make timely safety and wellbeing calls if they made them at all. 22 were late months pass the time they were due an 18 never went out at all. ■p and it also found that the staff skipped essential safety steps, such as ensuring that the sponsors did not have a criminal record or that they were not sex offenders. It should be no surprise that we are continuing to hr reports sugg the existence of trafficking schemes preying on vulnerable individuals, allegations we are heangn of coercion of forced labor, and despite my persistent inquiry on this issue, your staff has stonewalled getting answers back to me. I have written twice and gotten responses that were not answers from your assistant secretary, one of them being over six months late week before this hearing. Mr. Secretary, this leads me to believe that you do not give a flip about what is happening to these vulnerable children. You answered senator cornyn about knowing where the children are and knowing who the sponsors are, but i havecaseworkers and y cannot ask if somebody is in the country legally or not. Oig said they have concerns. They have had 35 of the case files have legibility concerns over images, skins of photo ids, legal documents. T me ask you this. Can you sit in front of us today and say with full certainty that your department knows the identity of these children sponsors . Senator, let me make sure that i respond to the question in terms of the identity of sponsors. In our custody is released to a sponsor without having gone through a full vetting. A full vetting that you said, lets speed it up. Children are not widgets on an Assembly Line. They are human beings. Sir, i would say that oig digrees th y. They say you do no. Do you think you have a responsibility to followup with these children when they are placed . Senator, we not only believe it is our responsibility to take care of these children when they are in our responsibility. You have the authority. They shall be responsible for coordinating and implementing unaccompanied alien children. You have to do that. And then the nextcare providersa followup call with an unaccompanied child 30 days after the release date. Mr. Secretary, director marcos is failing in this. You are hesitant to move forward with giving us the information. My time is expired. Thank you. First, i take umbrage to the blackburn and i also want to make it clear that we have people who are working as hard as they can with the resources that we have. Your misrepresentations are it is unfortunate that you wish to mischaracterize what we are doing. We do everything with the authoritat you give us. I would like to submit the letters and statutes as evidence. Secretary, good to have you here. I want to move to a local issue. As you know, from the beginnings ofcy■l nbased care effort, i have been very involved, helping to set up■9 elsewhere, establishing what has been a success with the affordablearthd a bill today to improve and expand thegram. I first went to thank you all for the model that rhode island is applying to the cost of care model. It provides an avenue. So thank you for that. Cooperation and support as we pursue that process, i would be very appreciative of. So been trying to organize. Cmi was organized to be a trial pilot. That was the core. I have been trying to deal with le approaching end of life. When they are in that circumstance, the needs change. Are five that we have identified that are unhelpful in that phase of life. But at that point, they get in the way of familys ability to ta care of loved ones. Today is the third time i will raise this with you. I do not just raise it at hearings. We have had repeated hearings with staff and with the administrator. I have been meeting with directors through three different administrations. Every time one leaves, it is groundhogs day and i have to start all over again to get it moving. It has been the better part of the decade to get a very simple, very easy pilot launched in rhode island, that allows five rhode island, that allows five waivers that■ and over again in other circumstances. It is not that the waivers are unacceptable to anybody else. They have been granted inances. But it will not deal is to simply say yes to those waivers in rhode island for a population that we are willing to negotiate over. I would propose that the population be those identified by acos, patients of Accountable Care organizations to help the doctors provide better care. We can talk about others. Im open to working with you on what the population should be so that you can be comfortable that we had a m not put the health ce system at risk. I think we will prove to you that we will be improving the humanity of care, that you will be saving, if you let us go forward, to the extent that outcomes can be improved and t will be better. Please help me clear this logjam. ■3■oa9i do not want to hearhat s is the reason. This is an easy thing that i have pursued for nearly a decade, asking for waivershat have only been granted over and over again with a very simple and negotiablewe have been waits to get this done. I really need to get it done. You are invited to respond. Would be a great answer. We could be done. Senator, i know how hard you have been working on this. They understand the purpose. They understand all the different elements and appreciate the fact that you are lloped. They continued to raise concerns with the issue of having it stay focused. It is supposed to be an agency that comes up with models that can then be used nationwide. They have very limited resources. It will beppi am absolutely como getting back to you. I do not think it is as easy as you suggested, but i will see if we can move this. We absolutely need to move this. Here is what is going to happen. We have a number of senators in thebut we are just going to keep this going. Tor will be chairing and we will get everybody in. Thank you for this hearing and thank you, mr. Secretary for being here today. You and i spoke last weekthe img ew issue on monday. This includes four that have not received what amounts to 98 . Much for your quick attention. They are facing a long road ahead. Witty. And this meeting follo push to urge united to step up and provide more urgent aid to providers. We had a constructive conversation this morning. They made new commitments to provide a unfair or risky terms. What will the role be in the coming days to ensure that they are following up on commitments . Thank sure that others step up. We had a meeting with the payer and providers. We are now having a followup meeting on friday. But we are doing is saying, many of whom have already received their payment from medicare and medicaid, they are Holding Money and they are getting paid. B you have a you. I look forward to working with you. I want to turn to a different topic now. I was pleased that the budget included opioid response grants. Include improves response. Hdiscussed the programs impact. Our providers can really plan andmprehensive prevention treatment and recovery strategy. The most recent language requires to avoid a significant cliff for any state when allocating funds from yeartoyear. They have to h clarity. Will you commit to having your e sure that this information is communicated as soon as possible . Last set of funding bills included Addiction Treatment for those on medicaid. It permanently requires Medicaid Programs to put cover use disorder. The funding bill also included Bipartisan Legislation to expand access to treatment under medicaid. Canzeprovisions will be supportd expanded upon . You very much for your commitment to this issue and for pursuing real results for people. We will partner to make sure ■that they are aware that medicaid will be more helpful. We had to see how they structure thr medicaid once to be in the game. Scenario . o thank you, chairman. Welcome. Good to see you again. Hhs must e fori know that you agree, but te reality is that many medical technologies authorized face significant barriers and securing medicare coverage. Is provides access to key medical innovations. I am encouraged by the work last year. Transitional coverage for emerging technologies. This would establish criteria for an guided coverage patay to provide beneficiaries with faster access to beneficial technologies. We are waiting on a notice. I along with a number of my colleagues sent a letter asking for it to be finalized as soon as possible so that patients do not have to face barriers facing lifesaving technologies. Given that seven months has passed since the period ended, can you assure us that they will issue the final policy this spring or early summer . Senator, thank you for the question and the work that you have done on this particular issue. I hope we continue to work because we are talking aboobvios on these new proposals