the American Association of Colleges of Osteopathic Medicine

PURPOSE
The purpose of this hearing was to examine the President’s proposed fiscal year (FY) 2024 budget for the Department of Health and Human Services (HHS).

MEMBERS PRESENT
Chairman Jason Smith, Ranking Member Neal, Reps. Buchanan, Adrian Smith, Kelly, Schweikert, LaHood, Wenstrup, Arrington, Ferguson, Estes, Smucker, Hern, Miller, Murphy, Kustoff, Fitzpatrick, Steube, Tenney, Fischbach, Blake Moore, Steel, Van Duyne, Feenstra, Malliotakis, Carey, Doggett, Thompson, Larson, Blumenauer, Pascrell, Davis, Sanchez, Higgins, DelBene, Chu, Gwen Moore, Kildee, Beyer, Evans, Schneider, Panetta.
WITNESSES
• Secretary Xavier Becerra, United States Secretary of HHS

KEY TAKEAWAYS
• Secretary Becerra justified the FY 2024 budget proposal of $144 billion in discretionary funding and $1.7 trillion in mandatory funding for HHS. He explained how these funds will allow HHS to extend the solvency of Medicare, address the growing mental health crisis, prepare for future emergencies, and build critical health infrastructure that prioritizes wellness care over illness care. The proposed budget also addressed closing the Medicaid coverage gap for over two million uninsured Americans through extended tax credits.
• There was bipartisan concern over HHS implementation of the No Surprises Act (NSA), HHS oversight of nursing homes and hospice care agencies, Medicare and Medicaid payment cuts, and the overdose and mental health crises. There was bipartisan support for the administration’s focus on expanding 9-8-8 hotline capacity and suicide prevention.
• Democratic members highlighted key successes of the Administration in expanding Affordable Care Act (ACA) subsidies, capping insulin prices, and Medicare price negotiations. However, Republicans focused on the impact of perceived Medicare Advantage (MA) reimbursement cuts, government drug price controls stifling innovation, and a lack of HHS program oversight.

OPENING STATEMENTS
Chairman Smith (R-MO) stated that the President’s FY 2024 budget proposal doubles down on harmful policies that will reduce access to and affordability of care. He claimed that the proposed budget funds government initiatives that will increase drug prices and stifle innovation. He also added that the proposal significantly impacts Medicare and Medicare Advantage (MA). He said that the budget proposes welfare for the wealthy through increased Affordable Care Act (ACA) subsidies. He urged the prioritization of health care access for rural Americans.

Ranking Member Neal (D-MA) discussed the successes and strengths of the ACA, including expanded coverage and lower drug costs. He stated that the budget responsibly invests in affordability and accessibility to care by permanently extending insurance subsidies, giving Medicare more power to negotiate drug prices, closing coverage gaps, addressing the mental health crisis, and building on American Rescue Plan (ARP) investments. He said that the Republican plan to repeal the ACA and cut Medicaid for millions would have a devastating impact. He also highlighted the role of Medicaid in paying for long-term care.

TESTIMONY
Secretary Becerra discussed how in the past year 16 million Americans gained coverage through marketplace subsidies, insulin prices were capped for seniors, and millions received free COVID-19 vaccinations. He outlined how the FY 2024 budget proposes $144 billion in discretionary funding and $1.7 trillion in mandatory funding for HHS. He explained that these funds were necessary for HHS to address the growing mental health crisis, prepare for future emergencies, and build critical health infrastructure that prioritizes wellness care over illness care. The FY 2024 budget proposed $30 billion to prepare for the next pandemic, including $1 billion to replenish the nation’s Strategic National Stockpile. He also discussed how funds will be used to increase access to mental health crisis care services, bolster the mental health workforce, and increase the patient capacity of the 9-8-8 crisis hotline. The proposed budget also addressed closing the Medicaid coverage gap for over two million uninsured Americans through extended tax credits. He highlighted the $600 billion proposed for childcare and preschool programs and the $150 proposed for home- and community-based services. He stated that these and other investments, such as the Cancer Moonshot initiative and the national strategy for hunger, demonstrate the President’s commitment to the nation’s health.

QUESTIONS AND ANSWERS
Chairman Smith (R-MO) asked about the agencies plan to use the $3 billion given to HHS by the Inflation Reduction Act (IRA) to implement a drug price setting scheme. He asked if Secretary Becerra will commit to keeping Ways and Means properly informed on this initiative by making HHS officials available for regular testimony to ensure effective oversight. Secretary Becerra answered that HHS is fully committed to transparency on the implementation of this law. Chairman Smith asked how HHS can ensure that the new revenue from small business taxes will go towards Medicare solvency when HHS’ own budget claims to be using these tax increases for deficit reduction. Secretary Becerra said that the President is committed to extending Medicare for the next generation and protecting current benefits. Chairman Smith said that the budget shows no plan to address $500 billion in Medicare pay go cuts. He asked what HHS will do to prevent these cuts from taking place. Secretary Becerra said that the President’s budget reduces the deficit in years to come while preserving Medicare benefits. He said within HHS, the budget protects every aspect of Medicare. Chairman Smith said that the Centers for Medicare and Medicaid Services (CMS) reports a projected 1% increase in MA payments for 2024, which includes the Risk Score Trend. He asked if the 3% Risk Score Trend projection for 2024 is forward-looking and is not factored into a plan’s base payment. Secretary Becerra said that there is data to project forward that shows companies have been overpaid in the Medicare system. He said these projections ensure that money is kept within the Medicare program. Chairman Smith asked if CMS approves MA insurance bids excluding this Risk Score Trend. He said that some groups are afraid that this proposal will cause MA insurers to increase premiums or decrease certain benefits, potentially impacting seniors. Secretary Becerra said they ensure they follow regulations set forth by the Medicare program. He said that their plan does not require plans to cut any services and that insurance companies will not be receiving a cut. Chairman Smith also asked about HHS plans to enforce the Hospital Price Transparency rule. Secretary Becerra said that HHS is trying to move quickly to enforce this law. He said an estimated 30% of providers are not in compliance. He said they want to work with Congress to ensure that enforcement does not disproportionately harm smaller businesses.
Ranking Member Neal (D-MA) discussed the successes of the IRA and the ACA. He said that bolstering the ACA would contribute to more savings for Americans. He said that the Republican health care agenda will increase out-of-pocket costs for drugs and care. He also congratulated North Carolina for expanding Medicaid. He stated that he hopes the No Surprises Act (NSA) will be implemented as the Committee intended. He called this legislation a bipartisan success and asked for commitment to consistency with what the Committee intended. Secretary Becerra said that he can guarantee that patients are taken out of the food fight between insurers and providers.
Rep. Buchanan (R-FL) asked about CMS’ decision to not cover the Alzheimer’s drug. He highlighted that the Department of Veterans Affairs (VA) decided to cover the drug. He asked if Secretary Becerra will commit to working with CMS to reconsider this decision. Secretary Becerra said that CMS is moving in a direction to get people access to the drugs they need. Rep. Buchanan said that MA is looking at a 2.3% cut that will negatively impact over 31 million people with MA. He asked if HHS would investigate that as well. Secretary Becerra said that these numbers are not true, as HHS is increasing its reimbursement to these companies.
Rep. Doggett (D-TX) asked for further comment on MA. He discussed the misleading commercials that constituents see that create false fear that the budget will cut money to MA. He asked to clarify that HHS is not decreasing payments to MA, but that the increase is just not as overly generous as the past. Secretary Becerra said that is correct and that HHS is increasing payments from FY 2023.
Rep. Smith (R-NE) expressed concern about the Office of Refugee Resettlement (ORR) at HHS. He said he hopes HHS will respond to his letter to address these issues. He added that there are several waivers that expire at the end of the public health emergency (PHE) that have vastly benefited patients. These expirations would have a disproportionate impact on rural and underserved patients. He asked if there should be concern that the expiration of many of these waivers will have an impact on patient access to care. Secretary Becerra said they should absolutely be concerned, and that HHS will give full support to make these changes through Congress. Rep. Smith asked about the lack of successful models coming out of the Center for Medicare and Medicaid Innovation (CMMI). He asked how simultaneously launching three models for the same solution is effective. Secretary Becerra said that CMMI is supposed to be a place to do small scale tests for new models. He said a failed model does not cost much and he thinks that CMMI innovation is important.
Rep. Thompson (D-CA) focused on mental health and telemedicine. He expressed concern that too much of the focus is on treating the symptoms of mental health issues as opposed to addressing and understanding the causes. He plugged his proposed legislation to provide tax incentives on brain research. Secretary Becerra said he would gladly provide comments on his legislation. Rep. Thompson discussed the extension of certain telehealth flexibilities beyond the pandemic. He highlighted his bill that would make telehealth a permanent part of Medicare. He asked Secretary Becerra’s opinion on the role of telehealth in the future of Medicare and health care overall. Secretary Becerra said that the results of telehealth in the behavioral health sector have been dramatic and greatly improved access. He expressed a need to continue these flexibilities.
Rep. Kelly (R-PA) asked how many HHS employees are working in-person. Secretary Becerra said that HHS provides flexibilities for their employees to work fully in-person or hybrid. Rep. Kelly showed a photo of an empty HHS parking lot and asked why the taxpayer should pay rent on a building that is not being used. He asked if HHS will ever make its employees come back to work. Secretary Becerra said that HHS’ employees work full time.
Rep. Larson (D-CT) asked about HHS’ progress in implementing the drug price reduction provisions of the IRA and how these provisions will benefit the American public. Secretary Becerra discussed the insulin price cap at $35 a month for Medicare. He also highlighted that Medicare beneficiaries are getting vaccines for free. He added that HHS will announce the first 10 drugs eligible for Medicare price negotiation.
Rep. Schweikert (R-AZ) asked what can be done to help folks in HHS innovation be more innovative in addressing Medicare solvency. Secretary Becerra said that there needs to be focus on prevention of chronic diseases and illnesses to reduce healthcare costs.
Rep. Blumenauer (D-OR) said that the federal government needs to catch up with most states as it relates to cannabis. He also discussed how Americans spend too much on drugs and applauded HHS’ efforts to implement price negotiations. He asked Secretary Becerra to speak on the $5.2 billion budgeted for nursing home program integrity and how that will ensure the taxpayer is getting full value. Secretary Becerra said that HHS wants to ensure they can do oversight of hospice and nursing homes to prevent waste and abuse.
Rep. LaHood (R-IL) discussed his bill, the Technical Reset to Advance the Instruction of Nurses (TRAIN) Act, that was passed last session. He said that it appears CMS is going against Congressional intent and stopping the recoupment of funds that are owed to hospital-based nursing schools that are essential to bolstering the health workforce. Secretary Becerra said he will help the Representative connect with CMS on this issue to ensure it is implemented correctly. Rep. LaHood expressed concern on the coverage with evidence development (CED) process and how CMS is making decisions on this issue. Secretary Becerra said that they are making sure they are getting diverse participation in trials, including from rural and underserved areas. He said he is prepared to work with Congress to further this issue.
Rep. Pascrell (D-NJ) welcomed the President’s bold goal to remake the nation’s 15,000 nursing homes, but he expressed anger at the results. He said Wall Street’s control over nursing homes grows and that there is a need for transparency. He asked what the Administration has done to increase transparency of ownership and management of skilled nursing facilities. Secretary Becerra said that HHS has required the disclosure of ownership interests in these facilities. He said that HHS is coming out with a rule to enforce minimum staffing levels at these facilities.
Rep. Wenstrup (R-OH) said that HHS ignored the NSA and implemented the law in a way that favors insurers over providers. He said this contributes to doctors closing and refusing to see patients. He asked if HHS would implement the NSA as written in statute. Secretary Becerra said that HHS is following guidance from the courts on how to implement the law.
Rep. Davis (D-IL) said that payment cuts to Medicare over the past two decades has impacted access to care. He said physicians are pushing for an annual Medicare payment update that is tied to inflation. He asked about the agency’s thinking about Medicare payments to physicians. Secretary Becerra said that the budget makes sure Medicare remains strong enough to offer benefits now and in the future. He said that the amount proposed in this year’s proposal increases physician payments from FY 2023.
Rep. Ferguson (R-GA) expressed concern about anti-microbial resistance, which costs the system $5 billion a year and causes thousands of deaths a year. He asked if Congressional action is needed to address this. Secretary Becerra said Congress must act to incentivize the market to address this problem. Rep. Ferguson urged the need to properly address the NSA. He also asked if any health sector has grown slower than inflation and if the costs of premiums have gone down. Secretary Becerra said that he would have to think hard to find one that has done that. He added that premiums across the country have gone down. Rep. Ferguson asked if people are healthier today than ten years ago but ran out of time for an answer.
Rep. Sanchez (D-CA) said that the IRA and drug cost reduction policies are saving beneficiaries $800 per year. She also highlighted the importance of the President’s plan to close the Medicaid coverage gap. She also discussed the plan to increase Medicaid payments for home- and community-based services. She asked what HHS is doing to address the predicted rise in long-term care needs and how it would suggest financing a system that does not solely rely on Medicaid. Secretary Becerra mentioned the work they are doing to improve existing services and the large investment in home- and community-based services. He said they are also working to increase the ability of states to do inspections themselves to ensure programs are certified.
Rep. Estes (R-KS) asked if HHS recognizes that the instability of the physician fee schedule disproportionately impacts rural and specialty care patients. Secretary Becerra said that ensuring that physicians are adequately compensated is a major challenge for Congress to address, and he committed to working with Congress to address this problem. Rep. Estes expressed concerns about an HHS rule to allow women to take mifepristone without the supervision of a provider. He asked if this rule puts women in danger. Secretary Becerra said that the Food and Drug Administration (FDA) has several years of evidence showing that the drug can be prescribed safely and effectively in this manner.
Rep. Smucker (R-PA) asked how states are being held responsible in implanting Temporary Assistance for Needy Families (TANF) work requirements. Secretary Becerra said he would love to work with Congress to ensure that TANF dollars are being spent as intended. Rep. Smucker asked if the President’s budget counts savings from increased taxes towards both Medicare solvency and deficit reduction. Secretary Becerra said that the Congressional Budget Office (CBO) score for the budget shows savings.
Rep. Higgins (D-NY) said that many nurses across the country have moved to travel nurse companies due to better pay and that these companies charge hospitals more for their services. He asked if HHS is aware of this problem and if there are efforts to address the shortage responsibly without relying on these expensive companies. Secretary Becerra said HHS is working to help states train more health workers and to also improve access to childcare to allow more women to come back to work.
Rep. Hern (R-OK) asked if Secretary Becerra supports the previous Administration’s policy to allow small businesses to cover the health insurance premiums of their employees through individual coverage reimbursement accounts (ICRAs). Secretary Becerra said that he does not support plans that do not satisfy ACA benefit requirements. Rep. Hern discussed the Orphan Drug Act’s work to spur the development of drugs for rare diseases. He said that the IRA threatens the success of the Orphan Drug Act and that two companies have already cited IRA as a reason to not pursue rare disease drug development. He asked if Secretary Becerra will commit to doing what he can to ensure that there is a strong pipeline for rare disease drugs. Secretary Becerra said he promises that HHS will do what they can to ensure access to these drugs.
Rep. Miller (R-WV) expressed concern about the health care workforce shortage and rural hospital closures. She cited the hospital vaccine mandate as a contributor to these shortages. She asked why HHS plans to keep this mandate in place until November 2024. Secretary Becerra said that COVID is still with the nation and that it is necessary to ensure health workers are protected. Rep. Miller asked if HHS would commit to ensuring the next round of graduate medical education (GME) slots are more equitably distributed to rural areas. Secretary Becerra said HHS would absolutely work with her to ensure an equitable distribution.
Rep. DelBene (D-WA) discussed HHS’ successes in addressing prior authorization. She turned to kidney disease and kidney failure. She said Medicare spent $150 billion on kidney diseases, yet the core technology to treat kidney failure has not advanced. She supports an initiative to increase funding for an artificial kidney, KidneyX, unlocking new treatments and saving money in the long run. She asked why HHS is not doing more to support this program. Secretary Becerra said that HHS would support what she said and that HHS would need more resources to address this.
Rep. Murphy (R-NC) commented on the improper implementation of the NSA. He also agreed that there is a need to address antimicrobial resistance. He said that pharmaceutical companies are disincentivized to work towards solutions to antimicrobial resistance due to the reduction of patent protections from 14 years to nine years. He asked how the IRA and the Moonshot fit, when innovation incentives are being cut for pharmaceutical prices. Secretary Becerra said that pharmaceutical companies make excessive profits off these drugs by gouging Americans for prices.
Rep. Kustoff (R-TN) discussed the increase of unaccompanied minors entering the United States. HHS is ensuring that these children are protected and not abused. However, data shows that HHS has lost contact with one-third of these children. Secretary Becerra said that this is not correct. He said HHS does a follow-up check by contacting these children and their sponsors. However, he explained that HHS does not have jurisdiction over these children once they are released from HHS custody and that the children and sponsors have no obligation to respond to HHS. Congress did not give HHS the authority to maintain contact with these children.
Rep. Chu (D-CA) discussed the lack of gun control laws as a source of gun violence in the country. She said the $50 million in suicide prevention funding to the CDC is important and asked how HHS plans to ensure that this important research and safety guidance will be available to people who do not speak English as their primary language. Secretary Becerra said HHS is working to ensure this guidance will be available to people in many languages. Rep. Chu asked about the importance of Title X and how HHS plans to protect those who will lose coverage during Medicaid Unwinding. Secretary Becerra said that HHS has been in contact with states to ensure they are prepared to handle the unwinding and manage the individuals who will lose their coverage to be connected to other options.
Rep. Van Duyne (R-TX) discussed the fraud in the hospice care industry. She asked if HHS is going to take this seriously and answer Congress’ questions. Secretary Becerra said that HHS is acting aggressively and that this budget asked for funds to be able to investigate this fraud. Rep. Van Duyne discussed clinics that perform gender-affirming treatment for children 11 years or younger. She asked if he is aware of any such clinics receiving federal dollars through Medicare, Medicaid, or grant funding. Secretary Becerra said they could receive funds for other services.
Rep. Fitzpatrick (R-PA) asked what HHS has to say to the patients who will not have access to FDA-approved Alzheimer’s drugs due to CMS’ refusal to cover these drugs. Secretary Becerra said that HHS will work to ensure that patients have access to safe and effective drugs and the care that they need.
Rep. Moore (D-WI) asked him to speak more on allowing community health workers to bill for select services to public insurance. Secretary Becerra said that this would be an important step to increase access to certain services that would otherwise not be available. Rep. Moore asked if there was a plan to ensure that foster youth that have aged out of foster care could still be eligible for Medicaid until age 26 according to a new provision. Secretary Becerra said that will be a challenge because those safety nets do not exist. Rep. Moore asked how HHS will ensure that mental health parity will be in the conversation. Secretary Becerra said that HHS will work to demonstrate the importance of mental health parity.
Rep. Steube (R-FL) discussed the Cochrane review study pointing to the inefficacy of masks in protecting from COVID. He said that the journal then released a statement retracting this conclusion. He asked if anyone in the Administration pushed the journal to release this retraction. Secretary Becerra said that he is not aware of any communication with Cochrane about this finding. Rep. Steube asked if HHS has had conversations with social media platforms about restricting certain information on these platforms. Secretary Becerra said that he has used social media platforms to put out information but that he has not had conversation on what information to restrict.
Rep. Tenney (R-NY) said that COVID vaccines no longer prevent transmission, but HHS refuses to drop the hospital vaccine mandate. She said that this is contributing to workforce shortages. She asked if HHS would be willing to overturn this mandate earlier to get people back to work. Secretary Becerra said that HHS’ actions are based on data and evidence.
Rep. Kildee (D-MI) asked how cuts to the Administration for Children and Families (ACF) would impact the department’s ability to protect children from exploitation. Secretary Becerra said that cuts to this department would limit the agency’s ability to provide the level of custody care that they need to provide. Rep. Kildee asked if HHS would support increased criminal and civil penalties against employers who take advantage of these children. Secretary Becerra said that he would support this action.
Rep. Moore (R-UT) said that 250,000 people die every year from medical error, but CMS failed to properly track how its spending is impacting this area. He asked Secretary Becerra if he could commit to answering the questions sent to him in a letter the day before on this topic by the end of April. Secretary Becerra said they will try to answer these questions as quickly as they can. Rep. Moore asked if Secretary Becerra can commit to making the outcome measure quality-oriented and transparent. Secretary Becerra said he looks forward to working with Congress on this issue. Rep. Moore asked if the President’s budget considers the added interest payments for Medicare. Secretary Becerra answered that the President’s budget extends the viability of Medicare and reduces deficits.
Rep. Steel (R-CA) expressed concern with CMS oversight of home health and hospice agencies. She explained that 443 California-based agencies were certified by Medicare despite likely being involved in fraud. Secretary Becerra said he is not aware of California’s moratorium and that CMS ensures that facilities are following their own criteria. He said that these programs must show that they are able to meet this criteria and CMS would not approve a program that is committing fraud. Rep. Steel asked what she should tell her constituents that are being denied access to clinically supported Alzheimer’s drugs. Secretary Becerra said that people must understand that CMS operates differently than FDA.
Rep. Beyer (D-VA) said he appreciates that the President’s budget takes suicide seriously. He asked why this is so important. Secretary Becerra said that everyone is impacted by suicide and drug overdose at some point. He explained that this hotline shows people that someone cares and wants to support them. Rep. Beyer said that a federal all-payers claims database (APCDs) is needed and asked what the benefits of this would be. Secretary Becerra said it would be possible to see what is working and what is not and spread these successes around the country.
Rep. Fischbach (R-MN) said that the President’s minimum staffing requirements would impact the number of patients that are able to receive nursing home care. She asked if Secretary Becerra agreed that nursing homes are facing a staffing shortage and would then be faced to close. Secretary Becerra said that the whole health care system is facing shortages, but that the most important thing is that nursing home facilities are providing quality care. He said enough nursing staff is necessary to effectively run these facilities. Rep. Fischbach asked if the President’s budget request includes Hyde Amendment language. Secretary Becerra said that the inclusion of the Hyde Amendment in the budget would be at Congress’ discretion.
Rep. Evans (D-PA) asked how insulin price caps help constituents across the country. Secretary Becerra said the benefits of this change are immediate. Constituents are seeing drastic differences in their insulin costs.
Rep. Feenstra (R-IA) asked if Secretary Becerra supports a single-payer system. Secretary Becerra said he worked for universal health care access as a Congressman. Rep. Feenstra said that cutting payments to health plans will cause cost shifting to the patient. He said benefits will either be reduced, or costs will go up. Secretary Becerra said that there is nothing in the President’s plan that will cause people to lose MA benefits.
Rep. Schneider (D-IL) highlighted some successes of the ACA and then discussed the impact of telehealth on health care access. He announced that he is going to introduce the Primary and Ritual Care Affordability Act, which will extend the provision that allows health savings account (HSA) eligible high deductible health plans (HDHPs) to waive the deductible for telehealth services. He added that he is a co-lead on the Telehealth Expansion Act, which makes telehealth provisions permanent. He asked Secretary Becerra to discuss other actions the Administration is taking to protect and expand telehealth. Secretary Becerra said that expanding broadband access is crucial to ensure access to telehealth. He said people must be trained to be able to use telehealth effectively, especially in the communities where it is most helpful.
Rep. Malliotakis (R-NY) said she is concerned that the three largest pharmacy benefit managers (PBMs) control 80% of the market and are crushing small mom and pop pharmacies. Secretary Becerra agreed that the lack of transparency around PBMs is a problem. Rep. Malliotakis asked why HHS has not launched its own investigation into these PBMs. Secretary Becerra said that HHS is working in this space. He said that HHS is working to create some rules on this area while avoiding the lawsuits that other agencies are facing. He noted that HHS is also working to ensure affordability for patients.
Rep. Carey (R-OH) discussed the high rates of fentanyl overdose in Ohio and the large amount of fentanyl captured at the border. He said Mexico needs to be held accountable. He noted the $40 million to combat fentanyl trafficking and asked what HHS is doing to prevent fentanyl trafficking and protect Americans. Secretary Becerra said that the drug-related activities at the border are out of HHS jurisdiction, but HHS is taking other steps to address the overdose crisis. Rep. Carey asked if HHS is working to combat fentanyl-laced drugs that are currently in the country. Secretary Becerra said that $11 billion of the budget is dedicated to drug overdose prevention. Rep. Carey asked about the benefits of the Treatment in Place waiver program that allows emergency personnel to be paid without bringing someone into the hospital. Secretary Becerra said that this waiver moves the nation more towards prevention and helps save money by avoiding the need to bring people to the emergency room.
Rep. Panetta (D-CA) discussed illicit xylazine that is cut with fentanyl to create a “zombie drug.” He introduced a bill today called the Combatting Illicit Xylazine Act that will allow enforcement of the illicit use of xylazine. He asked if HHS is responding to the xylazine threat in any way. Secretary Becerra said he will get back to the Congressmen about xylazine activities specifically but noted that HHS is working to address overdoses across the board. Rep. Panetta discussed the Medicare economic index (MEI). He noted that the cost of care has grown faster than Medicare reimbursement rates. He asked why the physician fee schedule has failed to adequately cover the cost of care and if tying the MEI to inflation is a necessary measure to mitigate this issue. Secretary Becerra said that Congress needs to take legislative action, because HHS must remain budget neutral in setting these reimbursement rates. Rep. Panetta asked if HHS is doing anything to address the fact that geographic adjustments have also not kept up with the cost of care. Secretary Becerra said that HHS ensures they adjust using the best evidence they have, but they are ultimately constrained by statute.
Rep. Arrington (R-TX) said that people making upwards of $200,000 a year, even $600,000 a year, are receiving ACA subsidies. He asked if Secretary Becerra is trying to move the country to a single payer system. Secretary Becerra said he does not know where the Representative got those numbers, as that is not reflected in the President’s budget. He said the President has reduced the deficit each year and the proposed budget continues to do so over ten years.
CLOSING STATEMENTS
Chairman Smith (R-MO) thanked Secretary Becerra for his time and adjourned the committee.

Watch the full hearing here.