On the third day of his Capitol Hill road show to promote the Trump administration's fiscal 2020 budget request, Health and Human Services Secretary Alex Azar was quizzed by senators on a number of issues, though not all involving the funding proposals.
Azar spent his first two days being questioned by House lawmakers — first at the Energy and Commerce Health Subcommittee on March 12 and next at the Appropriations Labor, HHS, Education and Related Agencies Subcommittee on March 13.
At the HHS secretary's third hearing on March 14, Senate Finance Committee Chairman Chuck Grassley, R-Iowa, made it clear Congress holds the power of the purse and decides how much the government spends and how to allocate those resources — in other words, the White House proposal is essentially meaningless.
"A president proposes, but Congress disposes," Grassley said, though he acknowledged it was a "time-honored tradition" of having the heads of agencies testify at the committee on budget proposals and lawmakers were obligated to hear the officials out, despite the unlikelihood Capitol Hill would ever adopt a White House plan.
The panel's top Democrat, Sen. Ron Wyden of Oregon, grilled the health chief on a number of issues, particularly the administration's proposal to mandate work requirements for all able-bodied adults enrolled in Medicaid, the government's insurance program for low-income Americans.
Rather than improving employment and promoting health, the work requirement drowns beneficiaries in "mountains" of bureaucratic paperwork, with the intent of pushing them out of the program, Wyden said.
So far, HHS has approved seven state waivers for Medicaid work requirements, though only three have been implemented due to lawsuits or other delays. There are eight waiver applications pending.
Sen. Sherrod Brown, D-Ohio, pressed Azar to clearly state how the administration defines its criteria of "able-bodied."
"It is a common sense definition," Azar replied, noting the term had been used in the waiver applications approved by HHS.
But Brown dismissed that explanation as inadequate.
"This administration has made a conscious decision, the opposite of dignity of work, to kick hard-working able-bodied Americans off their insurance coverage when they're unable to meet the paperwork and bureaucratic requirements, not as a way to improve employment rates or promote health, but it's a way ultimately to pay for permanent tax cuts for the rich," the Ohio senator said. "That's the outcome of your policy."
Like a number of Democrats at the two House hearings, Wyden and Brown and some of their party colleagues on the committee, including Maggie Hassan of New Hampshire and Bob Casey of Pennsylvania, raised concerns about the administration's push to make Medicaid a block-grant program or impose per capita caps on funding.
Block-granting the program and imposing per capita caps would mean states would be given a fixed lump sum of federal funding they could use as they see fit.
Azar acknowledged HHS has had discussions with some states about block-granting Medicaid and per capita caps — conversations he said were instigated by those states and not by Trump officials.
The administration also wants to cut Medicaid by $1.5 trillion over 10 years and end the Affordable Care Act's expansion of the program, which extended coverage to about 17 million more Americans.
But such reductions would be "beyond disruptive for families," especially those with a child with a disability, Casey said. He said rural hospitals also would be compromised, with many likely closing their doors.
Hassan, whose state has been hit particularly hard by the opioid epidemic, said eliminating the Medicaid expansion would also leave many people with substance-use disorders unable to seek treatment.
Theft of U.S. data, intellectual property
At the hearing, Grassley expressed concern about an investigation by the HHS Office of Inspector General, or OIG, which uncovered security risks and failures in the protection of data generated by U.S. taxpayer-funded researchers.
In its February report, the inspector general found that the National Institutes of Health had permitted access to genomic data by for-profit entities, including companies from China, even though the FBI has identified those organizations as having ties to the Chinese government, Grassley noted.
In addition, the OIG found that the NIH did not consider national security risks when permitting and monitoring foreign principal investigators' access to U.S. citizens' genomic data.
"I'm very concerned about this OIG report," Grassley said.
The OIG opened its probe after the NIH reported in August 2018 that it had started its own internal investigation into foreign influence of data.
The OIG referred two cases to the U.S. Justice Department — one involving theft of intellectual property and one involving undisclosed foreign government funding.
"China in particular has been enormously aggressive, not only in terms of stealing intellectual property but trying to exploit vulnerabilities in our country," Sen. John Cornyn, R-Texas, said, calling it a "matter of grave concern."
"It's not just intellectual property, it's also data, and our adversaries are vacuuming up as much as they can get by any means available," the Texas lawmaker said.
Azar said HHS shared Congress' concerns and was working to safeguard taxpayer-funded intellectual property and sensitive data.
He noted the NIH recently established a working group of the director's advisory committee to evaluate ways to mitigate the situation.
"We are taking this very seriously. It is an immense challenge," Azar said.