Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2024

Floor Speech

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Mr. HARRIS. Mr. Chair, I rise today to offer amendment No. 5 included in the en bloc, to increase our investment in the health workforce and to decrease spending for the Office of the Secretary of HHS, who has driven this historic health workforce shortage.

In December of 2020, Congress passed the No Surprises Act, which was the result of a yearslong effort to ban surprise medical bills in a way that both takes the patient out of the middle and sets up a fair process for the provider and payer to negotiate the resulting bill.

Unfortunately, the administration has implemented the policy in such a way that has tilted the scales in favor of the big insurance companies at every possible turn.

Historically, Medicare has reimbursed physicians for their services at a lower rate than private insurance, which is why many providers don't even accept Medicare. In fact, 42 percent of psychiatrists don't accept Medicare patients. Most providers rely on private insurance to keep their practices open.

Now, due to the botched implementation of the No Surprises Act, private insurance companies are paying the same or less than Medicare, which, as we unfortunately predicted, is forcing doctors to close their practices and decreases access to patient care.

Someone told me a long time ago, if you are losing money on every patient, you can't make up for it on volume. The fact of the matter is that the Secretary is not enforcing the No Surprises Act as written.

Once an out-of-network bill is generated, we set up a 30-30-30-day timeline. The doctor and insurance company have 30 days to agree on a payment amount, or else either side can initiate the arbitration process. The arbiter has 30 days to determine the appropriate payment, and then the insurance company has 30 days to pay the provider.

This timeline is simply not happening in a majority of cases. On average, it takes 236 days for a payment dispute to be resolved and paid. A recent survey found that after arbitration, 52 percent of the insurance companies aren't making payments at all.

Unfortunately, the Secretary has implemented this policy poorly and without serious enforcement. As a result, doctors are leaving the workforce in droves. Forcing doctors to provide care for which they may never receive payment is unsustainable.

Because the Secretary is perpetuating the healthcare workforce shortage, this amendment would decrease the Office of the Secretary of HHS and increase the top line of the HRSA Health Workforce accounts.

Mr. Chair, I urge all Members to support this amendment, which would penalize the Secretary for driving the health workforce shortage.
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Mr. HARRIS. Mr. Chairman, I rise today to offer an amendment to increase funding for Project BioShield from $820 million to $870 million, with the funds coming from taking money from the recurring expense fund for buildings and facilities at HHS.

Mr. Chairman, medical countermeasures are important. We know that the chemical, biological, radiological, and nuclear threats are real in this world and that there is no natural market incentive for private industry to invest in developing countermeasures despite their critical importance to national security. That is exactly why Congress authorized Project BioShield almost 20 years ago, in 2004, which incentivizes industry to invest in these products despite the fact that there is no natural market incentive.

The program provides multiyear funding to support advanced research, clinical development, manufacturing, and procurement. BioShield responds to national security threats identified by the Department of Homeland Security's material threat determination process.

According to the Public Health Emergency Medical Countermeasures Enterprise, or PHEMCE, their multiyear budget, BARDA's Project BioShield would need $1.7 billion in fiscal year 2024 to develop and support the candidates in the smallpox, radiological, nuclear, broad- spectrum antimicrobials, Ebola, and chemical countermeasure portfolios. That is in contrast to the $820 million that is in the underlying bill. Again, the experts have said we need $1.7 billion.

Additionally, last year, the House included report language in the fiscal year 2023 omnibus that asked BARDA to compile a procurement strategy for novel antimicrobials. BARDA then included this objective in their 5-year strategic plan, but it was, of course, way underfunded. This amendment would allow them to move forward with these activities to provide additional funding, which could be used for the procurement of new antimicrobials.

Mr. Chair, I urge all Members to support this amendment, which would increase funding for Project BioShield to $870 million, and I reserve the balance of my time.

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Mr. HARRIS. Mr. Chair, to pay for this, we take money from the NIH buildings and facilities. That is true. However, Mr. Chairman, you know that the way CBO works is that we had to take it from that fund because we expect that money to be replaced from the nonrecurring expense fund at HHS. The CBO won't score it as a savings, but they will score it as a savings if you take it from NIH.

Mr. Chair, I get it. Nobody understands how CBO works. It makes no sense. Nevertheless, that money could be backfilled easily because, Mr. Chair, that nonrecurring expense fund at HHS is a slush fund with $1.8 billion in it unspent with moneys each year authorized in the bills to be rolled over to the next year, so there is $1.8 billion sitting at HHS.

Mr. Chair, that money would be much better spent on countermeasures.
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Mr. HARRIS. Mr. Chair, the dangers in the world are immense. China and North Korea both, obviously, are nuclear and nonconventional weapons threats. We are looking at a war in Israel right now with the possibility that Iran could make a dirty bomb. There are nuclear threats. We need countermeasures. We need to spend money on countermeasures.

Just as we are spending $880 billion on what I call kinetic defense, we need to spend money on nonkinetic defense. One of the things we need to do is fund Project BioShield because that is where we develop these countermeasures.

Mr. Chair, I urge adoption of this amendment. It would take $59 million that HHS would transfer out of a $1.8 billion fund that they have unspent and use that money for countermeasures.

Mr. Chair, I yield back the balance of my time.
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Mr. HARRIS. Mr. Chairman, this amendment is similar to the last one. It takes money from the NIH buildings and facilities funds, which, under authorization of law, can be transferred back from HHS' nonrecurring expense fund and transfers $100 million of that to the Strategic National Stockpile.

The Strategic National Stockpile is the only program dedicated to having civilian medical countermeasures on hand to respond to chemical, biological, radiological, and nuclear threats that may occur on U.S. soil.

From what we are seeing in Israel now to the current Marburg virus outbreak in Equatorial Guinea, these threats are real and growing.

Again, according to the PHEMCE multiyear budget, in fiscal year 2024, the stockpile would need $1.96 billion, almost $2 billion, to meet current stockpiling needs. Yet, in the bill is less than $1 billion.

The sharp increase that they feel is necessary--again, these are the experts in these countermeasures--is largely due to needed investment in the anthrax, Ebola, and smallpox portfolios. When we underfund that stockpile, then risky decisions have to be made. A prior annual review proposed reducing anthrax vaccine and antibiotic holdings. This amendment provides funds that will help meet the goals that have been identified by these experts.

I appreciate the Appropriations Committee including my requested report language directing the Assistant Secretary for Preparedness and Readiness in coordination with the intelligence community to provide annual classified threat briefings to Members of Congress.

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Mr. HARRIS. Mr. Chair, I agree with the gentlewoman from Connecticut when she said we need to fund the SNS. That is the bottom line. Mr. Chair, you read the Constitution like I read it. National Defense is one of the things outlined for Congress in the Constitution.

We don't have adequate defense stockpiles in the Strategic National Stockpile.

Let's talk smallpox, for example. We had 200 million doses back in 2018. A lot of those have expired. The bottom line is that anthrax has a 30 percent mortality rate. We need a vaccine for every American, everyone living in the United States.

It is that simple, because anthrax, Mr. Chair, is not something you have to develop in the Wuhan Institute of Virology. God knows they can develop dangerous weaponry. It can be stolen from somewhere and duplicated. It doesn't take a First World country to be an anthrax threat.

Now with regard to the buildings at NIH, as I explained before, Mr. Chair, there is a $1.8 billion building slush fund over at HHS. They have accumulated $1.8 billion in what they call their nonrecurring expense fund.

Mr. Chair, I will remind you, because of Bidenomics and a 5 percent interest rate, that is $90 million a year we are paying on interest on their slush fund.

Mr. Chair, what I am proposing is we take the money out of NIH--and I will join with the gentlewoman from Connecticut in writing a letter to Secretary Becerra asking him to backfill that money from his slush fund.

Enough with slush funds--$22 billion in Commerce, the Commodity Credit Corp, in USDA; $1.8 billion slush fund, nonrecurring expense fund in HHS.

Mr. Chair, we can't afford it. We also can't afford to be without a Strategic National Stockpile. We need to make sure that we have the antimicrobials, that we have the vaccines in there that are necessary to protect against the next threat from China, North Korea, Russia, or Iran.

Mr. Chair, I urge my colleagues to support this commonsense amendment, and I yield back the balance of my time.

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