House Hearing on HHS Budget Looks at Grab Bag of Issues

WASHINGTON — COVID-19 provider relief money, surprise billing, and medication-assisted treatment were among the topics highlighted at Wednesday’s House hearing on the HHS budget request for fiscal year 2022.

“The COVID-19 pandemic has shed light on how health disparities, and the lack of national coordination and funding, can leave us vulnerable to crises,” HHS Secretary Xavier Becerra said in his opening statement before the House Energy and Commerce Health Subcommittee. “Now more than ever, we must ensure that HHS has the resources to achieve its vision and protect the health of our communities.”

More Money for Stockpile, Gun Violence Research

He outlined the priorities in the Biden administration’s $131 billion HHS budget proposal. “This $25 billion increase from fiscal year 2021 underscores the administration’s commitment to prepare the nation for the next public health crises, to address disparities in healthcare, and to support our state and local partners, and as well to invest meaningfully in behavioral health, among other very important priorities,” Becerra said.

He listed some of the budget’s line items, including $905 million for replenishing the Strategic National Stockpile, $489 million to support and protect domestic violence survivors, and $66 million to support victims of human trafficking, as well as increased funding for gun violence prevention research and $200 million to reduce maternal mortality and morbidity, “which disproportionately affects women of color,” he said. The request also includes a $2.2 billion increase for the Indian Health Service, and increased funding for Title X family planning programs.

Some items in the budget raised questions for committee members. Committee Chair Rep. Anna Eshoo (D-Calif.) liked the idea of the Advanced Research Projects Agency for Health (ARPA-H), which the budget allocates $6.5 billion to for working on cures to ailments such as cancer and heart disease. However, she wondered why it needed to be housed at NIH. “It doesn’t seem to me that the independence is really there,” said Eshoo.

“We know that NIH continues to do the basic research; we want to lift that up and launch it faster,” Becerra responded. “We can discuss that, but the important thing is we’re going to launch it and not let bureaucratic issues about where we’re going to locate ARPA-H get in the way of a great idea.”

Question on Provider Relief Fund

Rep. Frank Pallone (D-N.J.), chairman of the full House Energy and Commerce Committee, wanted to know about disbursing Provider Relief Fund money. “I just want to encourage the administration to permit providers who have received these critical funds to extend their availability to the end of 2021, as we continue to respond to COVID,” he said. “This Provider Relief Fund ensures that frontline workers can keep their doors open during this time,” he said. Becerra responded affirmatively. “We hear you loud and clear; I couldn’t agree more with what you just said,” he replied.

Rep. Fred Upton (R-Mich.) asked about something unrelated to the budget — the administration’s recently announced support of waiving intellectual property (IP) rights to vaccine patents, as a way of helping other countries ramp up vaccine production, which he warned could have a “chilling effect” on innovation in the drug industry. Upton noted that former FDA Commissioner Scott Gottlieb, MD, “argued that a much more effective means of helping other countries would be to ramp up production here in the U.S., and I’d like to ask the administration consider other options besides IP transfers.”

“When you have extraordinary circumstances, as we have with this pandemic, you have to apply extraordinary measures,” Becerra said. “And so we’re going to do everything under the sun — the ‘all of the above’ list — to try to see what we can do to try to help the global community recover.”

“At the same time we want to respect those that make those innovations possible … because we understand that this is a partnership, not just among countries, but with the private sector as well,” continued Becerra. The administration “has been having conversations with the industry, from the very beginning, and it continues to this day,” he added.

Rep. Ann Kuster (D-N.H.) asked about increasing physicians’ ability to prescribe medication-assisted treatment (MAT) for opioid use disorder. Becerra said that the Substance Abuse and Mental Health Services Administration “will take the lead, and we will try to supplement what we can with the resources that our state partners have; we’re going to try to be innovative. I will tell you that we’re going to try to make sure that we allow for those medically assisted treatment programs to get out there and do their job.”

Surprise Billing Law Implementation

Rep. Larry Bucshon, MD (R-Ind.) asked about the implementation of the No Surprises Act, which requires HHS to come up with rules for hospitals and physicians to take out-of-network billing disputes to arbitration. “Generally speaking, how do you intend to make sure the process is fair and balanced and doesn’t just revert to a benchmark [price]?” he asked.

“We’re not interested in favoring one side over the other in a dispute,” said Becerra. “We want to take the patient out of the dispute altogether, but we want to be evenhanded about the dispute itself, and we want to hear from everyone about how to have a balanced approach.”

Several Texas congressmen wanted to discuss another topic: the recent CMS rescission of a 10-year Medicaid waiver extension for their state. The rescission “has created a great deal of uncertainty — for patients, for doctors, and for hospitals,” said Rep. Michael Burgess, MD (R-Texas). He asked Becerra to explain how the decision to rescind the waiver was made.

Becerra emphasized that the state still has nearly 2 years left on its current waiver. “We wanted to make sure if there was an extension of the waiver, it complies with all aspects of the law,” he said, adding that there was no time allowed for notice and public comment on the decision. “We’re working with Texas to make sure we can move forward to extend their waiver.” Burgess didn’t appear to be satisfied with Becerra’s answers, saying that he felt HHS’s decision appeared to be “politically motivated.”