Secretary of Health and Human Services (HHS) Alex Azar March 15 testified before the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) for the first time since the Senate Jan. 24 confirmed his nomination, to discuss the president’s fiscal year (FY) 2019 budget request to Congress, released Feb. 12 [See Washington Highlights, Feb. 16].
In his opening statement, Secretary Azar discussed the opioid epidemic, health insurance and prescription drug prices, value-based care, and improving the nation’s biodefense and emergency preparedness, among other topics. The secretary’s written testimony also defended cuts proposed in the president’s FY 2019 request, saying, “When programs are not as effective as they can be, or cost more money than they ought to, or fail to deliver on their promise, change and reform are necessary.”
Subcommittee Chair Tom Cole (R-Okla.) opened the hearing by commending Secretary Azar for abandoning a proposal in the president’s FY 2018 budget request to restrict support from the National Institutes of Health (NIH) for facilities and administrative (F&A) research expenses, saying F&A support is “important to biomedical research.” Chair of the full House Appropriations Committee, Rodney Frelinghuysen (R-N.J.) also emphasized the widespread interest in the NIH, saying, “All of us are supporters of the National Institutes of Health” and noted that “Dr. Collins is doing an incredible job.”
Numerous committee members expressed concern, however, about the budget’s proposed funding level for NIH, including planned cuts that the administration reversed after enactment of the Bipartisan Budget Act [see Washington Highlights, Feb. 9]. Subcommittee Ranking Member Rosa DeLauro (D-Conn.) said the administration’s NIH proposal would “reverse the direction” of funding that many lawmakers have worked to increase over the years, saying “a breakthrough at NIH saves not just one life, but potentially millions of lives.” House Appropriations Committee Ranking Member Nita Lowey (D-N.Y.) also challenged Secretary Azar on the administration’s budget request saying that the investment in the NIH should be a national priority, later adding that “cuts to the NIH” and “level funding is not an option.”
Chairman Cole and Rep. Andy Harris, MD, (R-Md.) asked Secretary Azar about the administration’s plan to maintain or improve the nation’s pandemic preparedness. Secretary Azar shared that he was at HHS during 9/11 and the subsequent anthrax scare, underscoring his commitment to preparedness programs. Among other things, he highlighted that the administration “requested $2.8 billion, or an increase of $157 million for priority biodefense preparedness programs” to help address natural disasters, chemical, biological, radiological, nuclear, cyber threats, and infectious disease outbreaks. Secretary Azar stated that the majority of the increase is targeted to “pandemic influenza threats.”
The opioid epidemic was also a significant concern of committee members. Rep. Hal Rogers (R-Ky.) expressed his worry that the administration is focusing too heavily on enforcement and that prevention, treatment, and recovery need support. Secretary Azar noted that the budget includes a proposed $500 million investment in the NIH public-private partnership “to accelerate the development of new treatments for pain and addiction,” calling the NIH’s work “critical.”
Subcommittee members also criticized cuts to Health Resources and Services Administration (HRSA) workforce programs. Ranking Member DeLauro (D-Conn.) said the president’s proposal “decimates health care workforce programs,” which she characterized as shortsighted because “we are facing a shortage of more than 100 thousand doctors by 2030,” citing physician workforce projections commissioned by the AAMC. Chair Frelinghuysen added his concerns over cuts to the HRSA workforce programs that train nurses and physicians, saying “this is a huge investment that is historically important to our nation.”
Rep. Barbara Lee (D-Calif.) questioned Secretary Azar about the administration’s proposal to cut programs aimed at serving low income and minority individuals, asking the secretary about the proposed $70 million cut to the National Institute on Minority Health and Health Disparities and the $2 million proposed cut to the Office of Minority Health. In his response, Secretary Azar said, in a tight budget environment, the agency is “prioritizing direct care delivery” over infrastructure support or training programs.