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KHN’s ‘What the Health?’: Becerra Urges Congress to Expand Medicare, Address Rx Prices

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The Biden administration stands ready to work with Congress to address drug prices and expand Medicare, Health and Human Services Secretary Xavier Becerra said in a wide-ranging interview with “What the Health?” on Tuesday.

The former California attorney general also said his top priority while in office is to attack health disparities. “There are a whole bunch of Black and brown communities that have never had the kind of access to care that others have,” he said. “And when they come to the doctor, they come with the kind of conditions that show they didn’t have health care before.”

Becerra, who before coming to Washington successfully led a coalition of Democratic attorneys general in defending the Affordable Care Act from efforts to have it declared unconstitutional, said as secretary he’s looking forward to further expanding the 2010 health law.

“Now we’re playing offense,” he said. “We’ve got the ball and we’ve got to march it down the field, and we intend to because there are many Americans who still need good coverage.”

Here is a full transcript of the conversation.

Editor’s Note: If you are able, we encourage you to listen to the audio of KHN’s “What the Health.” This transcript was generated using a combination of speech recognition software and human transcribers and may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.

Rovner: Hello and welcome back to KHN’s “What the Health?” I’m Julie Rovner, chief Washington correspondent for Kaiser Health News. Usually I’m joined by some of the best and smartest health reporters in Washington. But today we have a special guest, Health and Human Services Secretary Xavier Becerra. We taped this interview at 10:30 a.m. [ET] on Tuesday, July 13th. As always, news happens fast, and things might have changed by the time you hear this. So without further ado, here’s my interview with the secretary.

Rovner: We are pleased to welcome to the podcast the 25th secretary of Health and Human Services, Xavier Becerra. Secretary Becerra, thanks for joining us and for having us in the studio here at HHS.

Becerra: Julie, great to be with you.

Rovner: Actually, this is a welcome back to the podcast because you joined us a couple of years ago in your previous role as attorney general of California, where you led the court fight to preserve the Affordable Care Act when the Trump administration would not. So let us start there. What’s the status of the ACA right now?

Becerra: It’s a great place to start because we’re launching. President Biden said when he was a candidate that he wanted to build on the Affordable Care Act. I was fortunate to get to lead the fight to defend the Affordable Care Act. We had a prevailing goal line stance against the attacks. And so now we’re playing offense, and we’ve got the ball. We’ve got to march down the field, and we intend to because there are many Americans who still need good coverage. So far, the president, through his special enrollment period that he announced, has been able to get more than a million, some 1.2 million, more Americans into coverage. More than a million Americans are finding that they are now paying less for the plans that they had as well, because a lot of folks went back into the website and found that they could get a better plan for less money. And so we’re going to continue to build on that and we’re going to go after that last crunch of America that is not yet insured.

Rovner: How are you going to do that? I know one of the big priorities is to fill in that gap for the people who don’t have Medicaid in the states that didn’t expand but aren’t eligible for help on the Affordable Care Act exchanges.

Becerra: Right. Well, you mentioned one really important way. And that’s a no-brainer because there are millions of Americans who could qualify for very good, very decent care. All the state has to do is take up the federal government’s offer to expand Medicaid to those populations. You’re talking 11 states now that haven’t done it. Well, actually 10, because [in] one state actually the people in the state voted for it. But now the legislature hasn’t yet adopted the Medicaid expansion.

Rovner: In Missouri.

Becerra: In Missouri. That’s right. So four out of every five states [have] already done this for their people and they’ve expanded health care to a lot of those citizens. The second way we want to do this is a very simple way. For example, maintaining the tax credits that the president passed in his American Rescue Plan that make it possible for sort of the working middle-class family that wants to buy insurance but doesn’t get the help that a lower-income American does through Medicaid and finds it really tough to continue a policy even under the Affordable Care Act. The subsidies that the president expanded and extended in the American Rescue Plan have made it possible for countless American families to stay on those affordable health care plans. And if we can do that, wow, we’re really getting close to chopping away at the final segment of uninsured America.

Rovner: I know on Capitol Hill, though, they’re talking about trying to have maybe a federal-only plan to get those people in that gap for those states that haven’t expanded. That’s something the administration is going to work for?

Becerra: The solutions, they’re coming hot and heavy and we’re willing to look at all of the above. We want Americans to know they’re getting better coverage at a better price for all Americans.

Rovner: So I’m not sure that a lot of people realize the breadth of what the Department of Health and Human Services oversees and the federal government, not just Medicare and Medicaid and the Affordable Care Act, but also the NIH and the FDA and the CDC and programs for seniors and children and refugees and health workforce training. Do you have two or three top priorities, things that you really want to leave your mark on as secretary?

Becerra: Wow! Well, as you just mentioned, it’s a huge agency. In fact, I like to tell folks — I mentioned it when I first was nominated, but I got to underscore it now that I’m actually here as secretary — just how mighty the second H in HHS is, the human, the human services side. People always forget, you know. Everyone remembers HHS — oh, health care, Affordable Care Act, Medicaid, Medicare. Human Services is big, especially after covid, the stress that Americans are under, our children, the suicidal ideation that we’re seeing, the high numbers of opioid deaths, probably higher than ever before. Last year, some 90,000 Americans probably OD’d based on opioids last year. We’d never seen those kinds of numbers. All of that, child care, data privacy in health care, that’s us. All those things are part of the second H in HHS. And in terms of priorities, I love that President Biden has said that he wants everyone to feel treated equally and so attacking disparities, the pockets of America that too often have been left behind. And that’s very personal for me. There are a whole bunch of Black and brown communities that have never had the kind of access to care that others have. And, by the way, when they come to the doctor, they present with the kind of conditions that show that they didn’t have health care before. All those things that we can address just by making health care more equitable are going to help all America and our economy be healthier. That’s a big one.

I’ll give you little ones. Indian health care services. It’s time we really put a focus on tribal communities and let Indian Country know we really are serious about being good partners, helping make sure that there’s health awareness in Indian Country. And I’ll mention one other because both my wife would kill me if I didn’t mention it and because it’s so severe. But in America, there are still women who die at childbirth in greater numbers than in developing countries. And that’s really affecting our Black community. African American mothers are dying at disproportionate rates, in some cases three or four times that of white mothers. And so a little thing like that is a big thing for that child that’s born without a mom. And so if we can do little things like that well, and then if we can continue to build on the Affordable Care Act, if we can finally get reasonable prescription drug prices and the president really wants to push on that, I’m going to be a happy camper.

Rovner: I’m getting to that. But first, as you may know, we at KHN have been tracking efforts to undo Trump administration policies here at HHS. I know the process has gotten started with efforts to end Medicaid work requirements and a lot of policies related to the Affordable Care Act. But there are a lot of other issues, including the Trump administration’s actions intended to reduce access not just to abortion, but to birth control, both under the Affordable Care Act and Medicaid and Title X. I know that was a priority for you as attorney general of California. How big a priority is it here at HHS to start to go after some of those policies?

Becerra: Huge. That word was overused a few years ago, but huge. And that’s because you can’t fulfill the president’s promise of better health at a better price for more people unless you really protect those types of services that some of our populations need and deserve. And so we’re going to go after any proposal or any program that undermines better health, better price, more people. And that’s sort of our mantra, is “What can we do to give you access to better-quality health care at a better price?” And for everyone, more people, we still have about 10% of the population that doesn’t have health insurance coverage and they use the emergency room as their point of entry. Where you and I would go to our family care physician, a primary care physician, others wouldn’t. And as I mentioned, something like maternal health, something very basic that everyone is for. And my wife as an OB-GYN, as I said before, she’d kill me if I didn’t have a focus on maternal health. It’s critical that we do those things because there are populations — we don’t think about it — but there are populations that are suffering from lack of that type of service.

Rovner: So, obviously, covid is still job one for this administration. We’re seeing the same sort of politicization about the vaccine this summer that we saw about masks last summer. We’re also seeing a spike in cases due to the spread of the delta variant. I know the administration has shied away from things like vaccine passports, but at some point, aren’t we going to need a universal way to know who’s vaccinated and who isn’t?

Becerra: We need a way to get America protected and America moving forward and open. President Biden has been very firm about that. We’re going to do what works best for America. This isn’t a cookie cutter-style approach where, if it worked in Europe or in Asia or somewhere else, we’re going to do it here. We’re going to do what works best for America. And what he is doing in a country with 50 states and several territories and a whole bunch of counties and thousands of cities is we want to work with our local and state partners. And so how we do this will be based on our partnerships with our state and local partners. And what the president has said is, we’re going to be your partner. We’re going to be right there with you. We’re not going to just say, “Here — we’re delivering the vaccines. Go to it. Bye.” No. “Here are the vaccines. How can we continue to help?” And that’s why we’re going to do outreach all the way to people’s door if we can get there, because we want you to know when we get a trusted volunteer from your community knocking, saying, “Please go get vaccinated,” we’re supporting that effort by that trusted volunteer. Whether it’s the pastor, whether it’s the teacher, whether it’s the wrestling coach, we want you to know and we want them to know that we are going to be helping to make sure we protect you and covid-19 doesn’t discriminate. So we’re going to go out there and help everyone.

Rovner: What do you do about politicians, including some governors, who are actually actively discouraging people from getting vaccinated?

Becerra: Look, 99% of Americans today who are dying — and hundreds are dying every day from covid — 99% of them, more than 99% of them, are unvaccinated. I don’t know how you can spin that any other way than to say that if you’re vaccinated, you’re probably going to live. And if you’re unvaccinated, you’ve done yourself and a lot of folks a disservice. We’re just going to go out there and work. We hope that everyone considers this an effort for Team America. And keeping our fellow citizens safe is a job for Team America. We’re part of that team. You want to help? We hope everyone will be part of that team.

Rovner: Is there going to be some sort of after-action review of what happened at HHS during the pandemic? I’m talking about things during the Trump administration. Obviously, many things could have gone better.

Becerra: I do a review virtually every day. I get briefed on covid, essentially every day. I have a meeting with our white coats, our experts on this, every week. And so we’re constantly doing that.

Rovner: But I’m talking about what happened, particularly at CDC and FDA, where things did not go well, as has been sort of documented.

Becerra: There’s always a need to make sure you’re learning from your past. And we’re certainly not going to be those who make the same mistakes in history. And so we are going to continue to learn. But I got to tell you that what this team has delivered for America — the vaccine, the more than 300 million shots in arms — it’s amazing. And we’re going to continue to improve because we know this isn’t the last pandemic America will face.

Rovner: So, drug prices, as you mentioned, are obviously a big political issue. But the president hasn’t proposed any specific drug price proposals of his own. He’s actually passed the task off to the Department of Health and Human Services. Can you give us a preview of what to expect to be in that comprehensive package that he’s asked you for?

Becerra: Actually, the president’s been pretty explicit. He is supportive of negotiation of drug prices so that when we get a price for our tens of millions of Medicare recipients and our tens of millions of Medicaid recipients, that it’s the best price we could have bargained for. So he’s for that. He has supported efforts to import the same drug that cost too much here from another country that costs less, if we can do it safely. He has supported every effort possible to try to get us to get a fair price for prescription medication. But what he has said, to your point, is “Congress, we need your help. We need statutory authority to do this. And so how you decide to do it, we’re going to be supportive, but do it.” And so he’s clear: Let’s do what we can to lower prescription drug prices. But he doesn’t have a vote in Congress. He has some sway. He’s going to use his authority as the leader of the country and as the man who carries a pen and signs things to try to get us there.

Rovner: Well, as you mentioned, I mean, there is some authority on importation if it can be declared safe. But obviously Canada, and even Canada and Europe, don’t have enough drugs to supply the United States. Is that a real viable solution? And are you really going to pursue it actively?

Becerra: It is a solution and we have to do it right. There are different lawsuits that have been filed on efforts to do some of these things. So it is critical. And, by the way, as someone who filed a whole bunch of lawsuits when I was attorney general, I understand how important it is to do it right.

Rovner: So, I want to turn to Medicare. As I’m sure you know, the Medicare hospital insurance trust fund is nearing insolvency, although how near it is we’re not sure because we haven’t seen a Medicare trustee report this year. You’re one of those trustees. Any idea when we will find out? And how serious a problem is this impending insolvency for the Biden administration?

Becerra: And, Julie, just as we’re looking at each other, I’ve  got to just tell you how cool it is to be a trustee for Medicare, having served in Congress for over 20 years, where we would always talk to the trustees about their report. Now I’m one of those trustees, so it’s, you know, it’s, well, you get tickled a little bit when you think about it. But it’s serious stuff. And so we have made it clear to Congress, we’re ready with some plans. We want to work with Congress because the heavy lifting really has to be done by Congress. But take, for example, the president’s budget. In his budget he introduces some proposals that would actually extend the life of the Medicare trust fund. And so we’re prepared to address solvency issues. Remember that [insolvency] doesn’t mean bankruptcy. [Insolvency] simply means that we’ll only have the money that comes in on an annual basis to provide services. What we don’t want is to have to reduce any services because Americans paid for their Medicare, and it’s been the lifeline for so many seniors. And so we want to continue it at the high standard and, quite honestly, improve it. And so President Biden has made it very clear, he’ll engage, he’s ready. He has no problem arm-wrestling anyone on Medicare and keeping it vibrant. So we’re ready.

Rovner: And when will we see that trustees report?

Becerra: Oh, I think you’ll see it pretty soon. I’m not the only trustee, so I don’t want to speak for all my fellow trustees, but it’ll come.

Rovner: On Capitol Hill there’s also a growing push to add both new benefits to Medicare, like hearing, vision and dental coverage, as well as to lower the eligibility age from 65 to 60, which was something the president advocated for on the campaign trail. Does the administration have a preference for one or the other of these proposals, or are you going to push for both?

Becerra: Our preferences to get it done? So, it’s a yes answer. Yes. And again, because we don’t have the vote, we can only hope that Congress works hard and gets it done. What’s the “it”? Well, we’ll take everything if we can get it all, but we’ll take something for sure. And Americans really need, have to have something. Whether it’s the hearing, dental and vision benefits included for a lot of seniors who don’t get that or whether it’s reducing the age for eligibility to Medicare from 65 to 60. There are any number of good ideas. By the way, some of them actually can save you some money. And so we hope that Congress is listening.

Rovner: So, Medicare Advantage, as you know, has grown explosively over the past decade or two. Now, more than 40% of the total Medicare population is in some sort of managed-care plan. Many experts expect that number to keep going up. Yet numerous government reports and whistleblower lawsuits, including at least two major cases at the Justice Department, have accused plans of overcharging Medicare by claiming their patients are sicker than they are. Do you think the federal government needs to crack down on these overpayments or seek changes to the risk adjustment payment system that was created by Congress? I think you were there when it was created. It’s often cited for triggering these overcharges.

Becerra: So, Julie, you’re asking all the right questions because you’re asking questions that, again, now I feel tickled that I get to do these. Before I was in Congress asking those questions that you’ve just asked, looking for results. Now, I’m actually the person who’s in charge of making sure our team does the right thing. And so what I can tell you is this: We’re going to look closely at all the programs because you can’t give better health at a better price for more people unless you’re getting the best bang for your dollar. And so we’re going to make sure that everyone who gets a taxpayer Medicare dollar is doing the right thing with the program. And because there are a whole lot of seniors who depend on it. So, we’re going to continue to do the oversight. We’re going to continue to ask questions. We’re going to look at the data and then we’ll act. But I will tell you this: Having served in Congress for more than 20 years trying to beat this one so we get to open the door to those hidden secrets, we’re going to do what we need to do to make sure that Americans are getting the best health care out of Medicare. Regardless of what the format is, we’re going to make sure that Americans are getting their dollar’s worth for their coverage.

Rovner: Are you going to let us see it, too? As you know, Kaiser Health News has filed a Freedom of Information lawsuit to be able to see the results of the risk adjustment data validation audits, which is how the government decides whether these companies are actually overcharging or not. Are we going to get to see those finally?

Becerra: Well, you know, I’ve said that at HHS one of our mantras is — I mentioned already — the equity issue, but transparency and accountability. And so transparency is big for us. But as you know, and as I mentioned before, we’ve got to make sure we’re following the rules, because if we don’t follow rules, someone’s going to sue us. And so with regard to that issue, we’re going to be transparent. But we’ve got to make sure in the process of putting information out there we do it the right way. It’s the right information, the right data, and we do it the right way. Because otherwise, as you know from the litigation that’s already been filed, we’ll find ourselves in court.

Rovner: From the other side.

Becerra: From the other side.

Rovner: Last question. One of the biggest controversies right now is over this Alzheimer’s drug, Aduhelm, which was approved by the FDA over the objections of its advisory committees. Now, Medicare has announced they’re going to do a national coverage determination to decide who should get it and whether Medicare should pay for it. Obviously, many Alzheimer’s patients are on Medicare because it tends to afflict people who are older. How hard is that sort of a tightrope for HHS to walk on, giving people potentially false hope or potentially a life-saving drug or a life-helping drug.

Becerra: Here’s the thing I mentioned: equity, transparency, accountability. Three of the pillars of what we hope to do at HHS while I’m here. Now you’re touching on accountability. And the beauty of HHS is that we’ve got some stellar agencies who are very independent and they rely on that scientific independence to be able to go out there and take steps approving vaccines for covid-19 and giving the public the confidence to know that it was done right. Because the moment you’re injecting yourself with that vaccine, you’re trusting that our experts got it right. And so with regard to Aduhelm, the American public has to know that we’re getting it right. And here you’re talking about two separate agencies within the same department. You’re talking about the FDA and then you’re talking about CMS. CMS is the agency that really oversees Medicare, Medicaid. FDA has already acted. CMS must now act. Two separate agencies, both within the same house. The beauty is that they each have independence to do things the way the facts and the science drive them. And so FDA has made a decision. Now CMS has to make a decision. Both will make the decision that they think best, based on the facts and the science. That’s the beauty of HHS, is that we operate as one agency, as one department, but we have experts in different fields and all of them can operate knowing that they have the independence to try to make the right decision without being influenced by anyone else.

Rovner: We’ll see how that turns out. Thank you so much for joining us. And I hope we can do this again, maybe a year in.

Becerra: I’m ready. I’m ready.

Rovner: So, that’s it for this bonus episode of “What the Health?” As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review that helps other people find us too. Special thanks as always to our ace producer, Francis Ying, who made sure this all got taped properly. And also, as always, you can email us your comments or questions. We’re at whatthehealth (all one word) @KFF.org or you can tweet me. I’m @jrovner. We’ll be back in your feed on Thursday with the rest of this week’s health policy news. In the meantime, be healthy.

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