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House Democrats, Republicans Square Off on HHS Budget Proposal

WASHINGTON — Defenders and critics of the Trump administration’s healthcare priorities squared off against each other at Wednesday’s House Budget Committee hearing on the administration’s proposed Health and Human Services (HHS) budget for fiscal year 2021.

Committee Chairman John Yarmuth (D-Ky.) had harsh words for the administration’s proposal, noting that at a time with a deadly virus outbreak, “strategic investments in public health systems, research into a vaccine and treatments, availability of accurate testing, and access to high-quality care are critically important. But the contrast between those needs and the Trump administration’s budget could not be more stark.”

“Instead of proposing a realistic budget for HHS and taking the health and well-being of Americans seriously, the president has called for draconian cuts, mounted consistent attacks on our healthcare, undermined the agencies charged with keeping us safe, and starved our communities of critical resources,” Yarmuth continued. “President Trump has proposed a nearly $10 billion cut to HHS’ discretionary budget, including debilitating cuts to the CDC and NIH. He slashes mandatory health care spending by $1.6 trillion over 10 years, including a $900 billion cut to Medicaid, a half a trillion-dollar cut to Medicare, and a $200 billion cut to other health programs.”

Rep. Steve Womack (R-Ark.), the committee’s ranking member, had a different take. “Healthcare spending is growing faster than any other sector of our economy,” he said, noting that healthcare spending in 2018 was $3.6 trillion. “Congress has to pay attention to the factors fueling this growth,” namely increasing costs of care and longer life expectancy, he said. “Unfortunately, the laws that govern how healthcare programs work have not kept place with these realities. As an example, Medicare Part A is expected to be insolvent by 2026, threatening the health benefits people expect to see in the future.”

“The president’s budget takes important steps to do that,” Womack continued. “It invests in the health of the American people while advancing proposals to rein in healthcare spending.” He lauded the proposed budget’s resources for expanding opioid response grants and its commitment to decreasing the number of people infected by HIV, as well as provisions aimed at lowering drug prices and decreasing patients’ out-of-pocket healthcare costs.

Several Republicans also faulted Democrats for not having presented their own budget. “I’m frustrated that this committee has once again convened a hearing to discuss the president’s budget when my Democrat colleagues refuse to produce a budget proposal of their own,” said Rep. Bill Johnson (R-Ohio). “It’s the job of this committee to produce a budget, and ensure that our government’s finite resources are helping grow the economy, create jobs, and raise wages for all.”

But Rep. Steven Horsford (D-Nev.) disputed the idea that the committee hadn’t produced any budget. “There are budget cap agreements in place through 2021 that have been agreed to with the Senate,” he said. “Many members on the other side voted for those budget caps. I know we get a lot of misinformation from the White House, but I wish we wouldn’t bring it into the committee setting.”

Committee members also asked the hearing’s lone witness, HHS Deputy Secretary Eric Hargan, about specific areas of interest. Rep. Pramila Jayapal (D-Wash.) noted that in her home state, “coronavirus response efforts resulted in $200,000 a week of unexpected costs in Seattle and King County alone. People on the front lines, including health workers and emergency service personnel, were not provided with adequate personal protective equipment in advance. And the initial botched test kits and slow response from the administration on testing protocols were incredibly detrimental to our efforts.”

She added that “calling this a hoax, as President Trump did in the early days of this virus, was extremely damaging … It is time, Mr. Deputy Secretary, to stop playing politics with this.”

Jayapal asked whether it was a public health priority to have symptomatic people come get a test if they’ve been in contact with an infected person. Hargan did not answer the question directly, saying, “I will defer to clinicians on exactly what’s done with testing, but to repeat what health professionals said … People who need medical care should come to a healthcare facility.”

Horsford asked about a $52-billion cut to GME funding, something he had also asked HHS Secretary Alex Azar about during a previous House hearing on the same topic. “These cuts would have detrimental impacts on my home state of Nevada, where we need more physicians, not drastic cuts to a program that trains and retains doctors, particularly with the coronavirus,” he said. Hargan, like Azar, responded that several GME funding programs were being combined into a single program to give states more flexibility.

Horsford cut him off, noting that Azar had told him the same thing and that it would benefit Nevada. “That’s simply not true,” Horsford said. “We’re a growing state; putting us into a block grant program and calling it flexibility doesn’t work. How does that help constituents have access to more doctors?” Hargan agreed to work with Horsford to address the need to diversify revenue for GME programs and train more physicians.

Rep. Ralph Norman (R-N.C.) raised an issue unconnected to COVID-19: drug pricing, including the high cost of insulin, and the role of pharmacy benefit managers. “As you know, the president made bringing down the cost of pharmaceuticals one of the keystones of what we’re trying to do at HHS,” Hargan responded. “One of the things we’ve done internally is the fact that generic drug approval rates have gone up to record levels, and we’ve had high rates of innovator drugs approved … That’s produced lower costs for Americans.”