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Source: United States House of Representatives – Congresswoman Rosa DeLauro (CT-03)

WASHINGTON, D.C.(February 26, 2020) Today, Congresswoman Rosa DeLauro (CT-03), Chair of the House Appropriations Subcommittee on Labor, Health and Human Services, and Education, held a hearing with HHS Secretary Alex Azar on the President’s budget request for Fiscal Year 2021. DeLauro and Azar discussed the federal government’s response to the coronavirus, the $10.1 billion in proposed cuts to HHS, HHS’s handling of information on unaccompanied children, and much more.

A video and transcript of DeLauro’s opening remarks, as prepared for delivery, can be found here and here, respectively. Links to full videos of their exchanges can be found below, along with transcripts of each exchange:

Questions (First Round)

Rep. DeLauro: I have a question for you Mr. Secretary, just before you testified yesterday morning for Senate Appropriations, OMB finally submitted a supplemental funding request. And Chairwoman Lowey mentioned that we both asked you to submit such a request three weeks ago and while we’re glad the Administration has finally done so what has been provided to date is unacceptable. It lacks the fundamental components of a supplement request including proposed bill language, supplemental documentation, and OMB did not transmit a budget table with programmatic details until last night.

To be clear: we want to be supportive. We realize the situation is evolving and you are adjusting to shifting circumstances. But it is important for the committee to better understand the needs going forward. One, can you tell us how much of the Infectious Diseases Rapid Response Reserve Fund has been used for this emergency response? Has the $105 million that was available from that fund been exhausted?

Sec. Azar: We are at the point now where we have used or where we have either committed or obligated the monies in that $105 million Rapid Response Fund. And that’s why I sent you the notice last night about the reprogramming and transfer on the $136 (million) so that for future obligations we can continue our work. 

Rep. DeLauro: So that the $105M is gone? 

Sec. Azar: It is.. In budget speak..

Rep. DeLauro: …thereby being spent committed or obligated.

Sec. Azar: it is committed or obligated. Exactly. Right. 

Rep. DeLauro: It’s not there. Ok. And are you going to, how quickly are you expending the funds? 

Sec. Azar: The actual run rate of the money going out the door I don’t know. I believe we were at about $20 million the last update we had given to the subcommittee but, I want to defer to staff if we can check with you on that. I do want to make sure you are getting information on spend rate as quickly as OMB will authorize the release of that. Basically, we’re out of the $105 (million) for which we’re very greatly that you all funded. It has proven to be vitally, vitally important. So, thank you. 

Rep. DeLauro: Let me ask you to provide additional details of the supplemental request for the subcommittee. I’ve only seen the two-page letter from OMB and a one page budget table. You know I was around when the Obama Administration submitted a supplemental request for Ebola. They sent a twenty-eight page document outlining the intended purpose of each component of the request, and that was demanded by this Committee. I was there, every time they came was much more information. So, let me ask you these several questions. How do you intend to reimburse state and local agencies for their expenditures on the ground?

Sec. Azar: So we’ve got—I appreciate your frustration with the two-page letter being the documentation. We’ve been working with your staff to provide detail…

Rep. DeLauro: By the way this is the Obama submission. 

Sec. Azar: Sob we’ve been working with your staff. We actually do, we do have plans that we are going to work with your teams to make sure we educate on and work together to flesh out. It’s a very fast moving process as I’m sure you understand. So, within the $2.5 billion dollar, at least $2.5 billion dollar request we would have the CDC have a major fund which would be through the Public Health Emergency Fund to allow them to work with state and local governments to reimburse for expenses around contact tracing, laboratory work, lab testing… 

Rep. DeLauro: We are going to reimburse state and local agencies? 

Sec. Azar: Yes, that is the goal to have a fund that would enable—the feedback we’ve gotten from state and locals whether through grants or actual reimbursement. And we’d work with the committee on the appropriate structure of how you think that should be done. 

Rep. DeLauro: Ok, and I would just like to know what we think that is going to be, how much money is involved, etc., so that we can also respond. 

Sec. Azar: Absolutely. 

Rep. DeLauro: We’re all getting those questions. 

Sec. Azar: So, that’s in the table. So there are five key areas that didn’t work quite transparent in the letter if I could mention that the key strategic investments…

Rep. DeLauro: Quickly, my time is going to run out. I got the five areas. How much of the funding is designated for international activities versus domestic preparedness?

Sec. Azar: So, I believe in the most recent document that I saw, the table that I believe you have access to there is a $200 million dollars in their of USAID funding that may be from existing sources I don’t know if that’s new money or not, that may be existing monies that would be dedicated on that. We have focused our $2.5 billion dollar requested at HHS frankly on U.S. preparedness and response. And I would say compared to the Ebola response where getting that stopped in West Africa, where now in East DRC is the critical element. 

Rep. DeLauro: Yes. 

Sec. Azar: Here our activities are really mitigation, containment and mitigation preparation in the homeland, because we’re not going to help the Chinese stop this in China—China’s going to do that or not be able to do that. 

Rep. DeLauro: Does the supplemental request include funding to replenish the Infectious Disease Rapid Response Reserve Fund? Yes or no? 

Sec. Azar: I don’t believe we use the Rapid Response Fund but what we would do is work with you on the 2021 appropriation to ensure that it is appropriately funded in light of this. The funding request of course was locked in December before any of this happened, so we want to be flexible on 2021 funding to respond to this. 

Rep. DeLauro: Did OMB rejects any of your requests for emergency supplemental funding to respond to the coronavirus?

Sec. Azar: Well, I’m not going to get into back and forth with the White House or OMB discussions but I want to let you know, this $2.5 billion dollar request; it has my complete and full support. It attacks the five critical success factors that I made clear I needed to invest in and it supports that. It’s at levels that I think are appropriate. And if not, if it doesn’t fund enough we’ll come back to you and work with you. And again, we’re trying to be flexible, we said at least $2.5 (billion). We want to work with you both funding sources as well as top line amounts. 

Rep. DeLauro: Well, the Chair pointed, we will put together a supplemental that will address this issue.

Questions (Second Round)

Rep. DeLauro:  A second round in asking people to do three minutes, so everybody has a chance to say or do what they need to do and then we will wrap up. I would just mention that the White House is weighing whether to appoint a coronavirus czar to coordinate responses to the spreading epidemic.

Sec. Azar: I don’t put much stock in anonymous sources in Politico.

Rep. DeLauro: Well, anyways we will see what happens.

Sec. Azar: I should hope you wouldn’t either.

Rep. DeLauro: Well, let’s see what happens. But let me move to a different area, I’m told the DHS can still be given significant incident reports, which may include a child’s past accounts of trauma or witnessed activity. You know, the vast majority of children that end up in ORR’s care are there as a result of fleeing unimaginable violence, gang activity, poverty, desperate situations. What is ORR’s policy with regards to sharing information, sharing significant incident reports collected by case managers or clinicians with ICE? It’s my understanding that you have said, Secretary Azar, that you have talked about consent. How are children capable of giving consent to sharing notes from there confidential therapy sessions with ICE?

Sec. Azar: So, as we have discussed the transmission of the clinical notes should not have happened—that was under the Obama guidance in 2016 that led to a misunderstanding where providers were putting their clinical notes either completely into the serious incident reports or they were being transmitted by ORR incorrectly over to DHS. That should not have happened when we learned of it in August of 2019, that practice stopped, and we’ve corrected the understanding of providers. It is important that a serious incident report must be completed if a child evidences harm to self or harm to others, and that goes into the SIR, which does get transmitted to DHS as important information about the child. But that should be minimal information, not including, we believe in respecting that psychiatrist or mental health professional relationship.

In terms of consent, our children who are not tender age of course, are in our care, and they have to consent for medical treatment for any other things all the time. This is part of how ORR has to operate these are kids who don’t have parents, left their parents, parents abandoned them, whose parents sent them here, and they consent and that is what they do for whether they are getting vaccines or whether they are getting medical treatment. We try to keep in touch with parents as best as we can, as you know.

Rep. DeLauro: But, again, that requires probably to have legal counsel in order to be able to provide the child with recommendations depending on obviously the age. I don’t know whether not you require legal counsel if a child is asked to consent to sending their clinical notes or significant incident reports to DHS.

Sec. Azar: Well as you know, we do provide legal counsel, you fund it. So kids are offered legal counsel, but we serve as the guardian for these individuals, they do not seek legal counsel for every interaction.

Rep. DeLauro: I understand that, but the guardianship has—there’s been some changes made, but  guardianship hasn’t been really that substantial, as we have found out over the last two years about how we guard these children private rights, etc. It hasn’t been the case. I would hope we would get to direct representation, legal representation of children.

What guidance have you given case managers, clinicians to distinguish in a child’s file or in their report that a child has witnessed gang activity or violence without forever associating that child as a gang member? There is a important distinction, if that’s what justifies sharing child’s information with law enforcement.

Sec. Azar: We’d be happy to work with you. The guidance that went out in August of 2019, I don’t know about the divide between witnessing versus participation and we’d be happy to share that with you.

Rep. DeLauro: I would like to see that guidance and would like to sit down and figure out what your oversight is of DHS, with regards to this transmittal of this information.

Closing Questions and Remarks

Rep. DeLauro: The issue of suicide makes me—and the commentary on that—makes me view that you need to review whether or not you want to cut $25 million dollars from gun violence prevention research where the basic focus is on suicides. It’s mostly suicides with veterans and I don’t care how good the hotline is, we need to find out what is going on in the minds of veterans and others in order to be able to plumb why they are taking their lives.

The issue of, we’re not going to talk influx facilities today my colleague mentioned this. But, we are, very flat out and I will just tell you it is my goal that empty facility and millions of dollars being spent and the numbers declining as they are and we are nowhere near capacity at the state licensed shelters, we ought to shut them down. Because we can deal with the issues in other ways.

I might also add the issue came up with regard to cuts, “…determining whether a federal budget proposal counts as a budget cut is simple, if the proposal would reduce funding for a program’s benefit or services or reduce the number of people who qualify for benefits relative to levels that would occur under covered law, it’s a cut.” We’re (the President’s budget) cutting $920 billion over ten years to Medicaid, $756 billion over ten for Medicare.

I want to get, let me just do this, you mentioned this Mr. Secretary and I thought it was very clear, you stated that infectious disease, global health and preparedness, were prioritized in the CDC budget request. The following the essential programs were proposed for cuts which makes the commentary quite frankly inconsistent. Cutting CDC $693 million or 9%. We’re cutting Infectious Disease Rapid Response Fund by $35 million, 41%, and you’re not replenishing it in your supplemental. The Public Health Data Initiative, $20 million, a 40% cut, specifically asked by the Director Redfield in order for us to modernize our efforts to transform public health data into analysis so that we can move more quickly. The Public Health Workforce which we talked about today, $6 million or 12%. And the Epidemiology and Laboratory Capacity Program by $40 million is a cut, 18%. This flies in the face of what you have talked about in terms of what your goals are.

Lastly, about information sharing with DHS, is this ORR sharing information about rejected sponsor applicants with ICE, DHS?

Sec. Azar: So, we have shared the names and addresses of 141 individuals who were denied sponsorship due to criminal histories or due to fraudulent representations or that they have a bonafide relationship with the child, no parents were included in that group. Whenever we have, sorry…

Rep. DeLauro: You are prohibited by law from detaining sponsors based on information that HHS collects on potential sponsors during the vetting process. 

Sec. Azar: Again, I don’t detain sponsors, but also the Department of Homeland Security is complying with the legal restraints in the Act but this is not parents, this is, this is individuals denied sponsorship due to criminal histories or due to fraudulent representations to ORR that they have a bonafide relationship with the child, no parents being included in that group is what I’m informed.

Rep. DeLauro: Can you tell me, also is ORR sharing information with DHS on any adult who does not fall into the categories included in the DHS rider? The prohibition on the use of funds to detain a sponsor unless they have a certain specific criminal criteria. 

Sec. Azar: I’d want to get back to you on the details there—we certainly are complying with the rider. But if there’s anything beyond the rider, I do not have that detail. 

Rep. DeLauro: I would like the information. What kind of firewall exists between ORR’s information about potential sponsors and ICE given that information sharing for enforcement actions is prohibited?

Sec. Azar: A use of it for enforcement may be prohibited, but there’s no firewall that’s required, and so information is shared and it’s been shared, frankly for, I think, for quite some time. For instance, we share information on sponsors within twenty-four hours of discharge and that’s part of also, there’s couple things; one, the sponsor actually has to certify to us and the DHS that if they move the child that that will be reported, remember this is a child who is not legally in the country and subject to proceedings; and second, that the sponsor isn’t, for instance, illegally in the country and subject to a deportation or a removal order and about to be deported. That wouldn’t be a safe environment for us to then place the child, so there’s that last minute check and information sharing. I think that is gone on for a over a decade I believe.

Rep. DeLauro: But, we need to get a very, very detailed view of the current information that is being shared and whether or not in contravention of the writer in the bill and at further to that is that we need—because ICE walks into a state license facilities and fingerprints and you may or may not know about it. ICE is transmitting, ORR is transmitting clinical notes. There are all kinds of avenues here which are being breached in terms of the privacy and the care of these children and the intimidation of these children. We need to get to a point where that’s no longer the case and that ORR and DHS have only their concern about the welfare of these children. And yes, I understand criminal activity, I understand human trafficking. But we have seen over the last year and a half or more that we are moving into what is really unbelievable mental health issues are arising out of intimidation of children that are in our care—they’re in your care, but they are in our care while they are here. And we are not going to continue to put up with that.

Thank you for being here this morning. Thank you for being upfront with us on issues and as my colleagues said, we want to be ahead of this crisis on the coronavirus, we do not want to be behind the curve. So, thank you.