Health and Human Services Secretary Alex Azar defended the Trump administration's fiscal 2020 proposal to cut billions of dollars in funding from U.S. biomedical research and the nation's healthcare programs for seniors and low-income Americans, telling lawmakers the decreases were necessary to keep his agency afloat.
At the March 12 hearing of the Energy and Commerce Health Subcommittee, Azar was also questioned about why he has not responded to Democrats' repeated requests for documents, communications and answers to questions about the Trump administration's decision last year to not defend the Affordable Care Act in a challenge brought by Republican attorneys general and governors from 20 states.
A federal judge in Texas ruled in December 2018 that when congressional Republicans under their 2017 tax reform package zeroed out the ACA's tax penalty for the individual mandate, that action rendered the remainder of the healthcare law unconstitutional.
The decision is currently being appealed by a coalition of Democratic state attorneys general. The U.S. House also was permitted to intervene in the case.
Rep. Frank Pallone, D-N.J., chairman of the Energy and Commerce Committee, said his staff had communicated with Azar's office a dozen times since June 2018 but has so far not received the documents and other information the lawmaker has sought.
"I hope that this level of noncooperation doesn't continue," Pallone said, reminding Azar that the committee has legitimate oversight of HHS.
Azar pledged to work constructively and productively with the panel and said his staff was working on the matter, though he would not provide a timeline for a response.
Rep. Ben Ray Lujan, D-N.M., pressed Azar on whether he had been notified in advance last year when the Department of Justice decided to side with the Republican states in the lawsuit against the ACA.
"Yes, I knew the filing that was going to happen on behalf of the United States," Azar admitted, adding that he "did indeed" take part in conversations with other cabinet-level members about the administration's plan to be a party in the case.
Azar, however, said those cabinet-level deliberations were not ones he could discuss in public because they were "highly privileged, sensitive discussions."
Lujan reminded Azar that he had repeatedly vowed during his Senate confirmation hearings in 2017 and 2018 that he would enforce and uphold the ACA.
"And I absolutely and as long as it is the law of the land I will in my administrative authorities work to make it work for the American people in my judgment as best I can," Azar responded. "That is not a statement of whether something is constitutional or not."
The HHS secretary also insisted the administration was in favor of ensuring Americans with pre-existing conditions are protected against discrimination from insurers — safeguards granted by the ACA.
The Trump administration, however, specifically asked the Texas judge to strike down the ACA's pre-existing conditions protections.
Medicaid cuts, work requirement
At the March 12 hearing, Azar also defended the Trump administration's fiscal 2020 budget request to cut $1.5 trillion over 10 years from Medicaid, make it a block-grant program and to mandate work requirements across the board for all states.
Medicaid provides healthcare coverage to Americans with low incomes.
Rep. G.K. Butterfield, D-N.C., said any attempts by the Trump administration to go around Congress to implement any of those proposals would create a firestorm like none had ever been seen on Capitol Hill.
He noted similar proposals already have been rejected by U.S. lawmakers.
Rep. Joe Kennedy, D-Mass., noted that 20,000 low-income people in Arkansas lost their healthcare because of the work requirement waiver HHS had approved.
Azar acknowledged the administration does not yet have data on why those individuals "fell off the program," but suggested that many may have found employment that provided health coverage and no longer needed public assistance.
But Kennedy questioned why the administration would propose implementing mandatory work requirements without knowing what the impact would be on Medicaid beneficiaries.
He cited a June 2018 analysis by the nonpartisan Kaiser Family Foundation that found that upwards of 4 million Americans could lose access to healthcare if Medicaid work requirements were implemented across the U.S.
About 83% of those Americans "would only lose coverage because of onerous reporting requirements," Kennedy said.
"We believe it's fundamental aspect for able-bodied adults that if you are receiving free healthcare from the taxpayer, it's not too much to ask that you engage in some form of community activity engagement, work training," Azar responded.
But Kennedy pressed Azar for data to back up his claims.
"Can you point me to one study that says that work requirements make people healthier?" the Massachusetts congressman asked.
Azar said he would have to respond to Kennedy in writing "if we have that" data.
But Rep. Markwayne Mullin, R-Okla., commended the administration's work requirement proposal, saying: "We've got to put more people in the workforce or it's going to hold our economy back."
Cancer funding cuts
While Rep. Fred Upton, R-Mich., praised HHS' request for $500 million over 10 years, or $50 million per year, for childhood cancer research, he raised concerns about the Trump administration's plan to cut the National Cancer Institute's fiscal 2020 budget by nearly $900 million.
Azar noted the NCI decrease was proportional to the 12% cuts the administration was seeking overall for the National Institutes of Health, which would lose nearly $5 billion.
"I understand the pain. I understand the concern there," Azar said.
Upton said he was also concerned that Azar had redirected $385 million in fiscal 2019 funds that was supposed to go to the NIH and other health agencies but was instead being used to house the migrant children being detained by the Trump administration under its border policy.
Azar acknowledged that while the administration was seeking new funds for the immigrant refugee program, it also was again seeking authority to transfer funds from other programs, if needed.