HHS secretary nominee Xavier Becerra on Tuesday threw his support behind efforts to improve access to care, aligning himself with President Joe Biden's healthcare agenda.
During his confirmation hearing before the Senate Committee on Health, Education, Labor and Pensions, the current California attorney general focused on issues affecting the healthcare industry, including coverage expansion, access to care and provider funding. He is also slated to appear before the full Senate and Senate finance committee on Wednesday.
Several senators asked Becerra how he planned to address provider shortages that have limited underserved communities' ability to get the care they need. Becerra leaned heavily on efforts to increase the pipeline of providers, including Congress' recent decision to fund 1,000 more graduate medical education slots. He said federal policies should reward providers for delivering primary care services. Becerra also supported the growth of Federally Qualified Community Health Centers and the National Health Service Corps to improve access to care.
But the HHS nominee never mentioned increasing the number of work visas for providers, expanding providers' scope of practice, relying more on non-physician providers like nurse practitioners or physicians' assistants for primary care and other services or other ways to boost provider access.
When it comes to insurance access, Becerra supported the new open enrollment period for healthcare exchanges as well as a Medicare buy-in program. He expressed concern about the lack of affordable coverage options for people without insurance who don't qualify for marketplace subsidies. He suggested more people should get larger tax credits to purchase coverage.
Becerra didn't answer how he would address the dwindling Medicare trust fund as HHS secretary but said general funds could be used to pay for Medicare expansion when Sen. Mitt Romney (R-Utah) asked Becerra about its effect on the trust fund.
Sen. Susan Collins (R-Maine) worried that many providers are struggling with the difficulty and costs of hiring additional staff, improving facilities and obtaining personal protective equipment during the pandemic.
"I was astonished that in a $1.9 trillion COVID package, the administration did not include any money for a provider relief fund," she said. Collins and Sen. Joe Manchin (D-W.V.) are calling for an additional $35 billion in provider relief funding.
Becerra said he would ensure that struggling providers get the money they need, whether through the provider relief fund or by redirecting other financial resources to the providers hardest hit by the pandemic.
He also embraced price transparency, which received widespread, bipartisan support from the committee. Becerra said that HHS would aggressively enforce price transparency under his leadership, suggesting that Congress should give the agency more power to create and enforce transparency rules.
"You have to be able to see how they're operating," he said.
Becerra also promised to get started on new surprise billing rules as soon as he could.
Biden's HHS nominee fielded a number of questions on prescription drug prices, especially the 340B drug discount program. Becerra called the program "indispensable" during his testimony, arguing that patients shouldn't have to worry about being able to access or afford healthcare as drugmakers and providers war over the program.
Sen. Bill Cassidy (R-La.) pressed Becerra on 340B, which has recently faced a series of high-profile challenges, asking whether the California attorney general thought Congress needed to update the law to address the problems. Becerra didn't answer the question directly, only saying that HHS should enforce the law and that the program had operated with few issues until recently. Cassidy disagreed with Becerra's characterization, arguing that problems in the 340B program date back at least a decade.
Becerra suggested that HHS could toss or significantly revise the Trump-era rebate rule, which would bar pharmacy middlemen from keeping rebates paid by drugmakers under Medicare Part D.
"Right now, we have a proposal that I believe was rushed out — that would take sides in this debate. I would simply say that we have to protect the Part D program for our seniors and do it the right way," he said.
The HHS nominee also spoke to the need to address health equity and the social determinants of health during his testimony. Becerra said HHS needed to collect more information to understand how and why many people aren't getting the care they need to develop and implement better policies.
He also promised to establish or reestablish national advisory panels on disaster preparedness for specific populations, including children, older adults and people with disabilities, as required by the 2019 Pandemic and All-Hazards Preparedness and Advancing Innovation Act.