HHS Sec. Becerra’s Exclusive Interview With “Conversations on Health Care”

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Mark Masselli ( 00:05 ):
He leads a $1.7 trillion federal agency that touches on the most important and critical issues in
everyone's life, their health. We're honored to have the Secretary of the United States Department of
Health and Human Services join us today.
Xavier Becerra ( 00:19 ):
A woman is three times more likely to die of a complication during pregnancy if she happens to reside in
a state that restricts her access to abortion care services than if she lives in a state that gives her a full
set of the reproductive services that she needs. So we are seeing women and their health harmed
simply because of the politics in that state. So we at the federal level are doing everything we can to
continue to protect a woman's right to access the care she needs, including abortion care.
Margaret Flinter ( 00:50 ):
Xavier Becerra is the nation's top health official. He's overseeing the country's emergence from the
COVID pandemic, but the challenges remain great. He's dealing with everything from a low COVID
booster rate to abortion restrictions following the Supreme Court decision. Secretary Becerra is the 25th
person to lead HHS, and he is the first Latino in this role.
Xavier Becerra ( 01:12 ):
Just because we got the first vaccination, we're not done because just like the flu, just like the seasonal
cold, we could see a recurrence. The difficulty here is that COVID is different from the cold. COVID kills
you. The cold, we know how to deal with much better. And so if you want to stay healthy, you want to
stay alive, please do what we know is safe and effective, get vaccinated, be up to date.
Margaret Flinter ( 01:37 ):
And this is Conversations on Health Care.
Mark Masselli ( 01:48 ):
Well, welcome Secretary Becerra to Conversations on Health Care.
Xavier Becerra ( 01:52 ):
Thank you very much.
Mark Masselli ( 01:53 ):
You and the Biden Harris administration have announced a series of actions to protect consumers from
junk health plans, stop surprise medical bills, and limit excess costs that lead to medical debt. I wonder if
you could share with our listeners an overview of what's being done and why.
Xavier Becerra ( 02:12 ):
So maybe I can start by saying that it's hard to believe you're going to be healthy, have a sound mind if
you don't have peace of mind. If you can't believe that you're going to go to the doctor and come home
and afford to pay the bill, if you can't easily and freely believe that you could take your child to a
hospital when your child is sick, it's hard to believe you're going to have peace of mind.

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Xavier Becerra ( 02:37 ):
President Biden has wanted to make sure that not only do we have health insurance coverage, but that
that coverage is meaningful so that when you go and use that doctor or that hospital, you don't go
bankrupt by the bill that you get in the mail. So he wants to make sure that if you're going to have
insurance, it's not junk insurance so that when you try to use it, there's nothing there for you to get
covered with.

Xavier Becerra ( 03:00 ):
You end up paying everything out of pocket. That's what junk plans are all about. They offer you a plan
that says, "You only pay small amount out front and we'll cover you." What they don't tell you is the big
price comes once you try to utilize a doctor or hospital services. The president has also said, "Let's make
sure that no one gets a bill in the mail that they were not expecting. No surprise medical bills." And so
what the president has done is said, "Hey, we're going to seal off consumers, those patients." Once you
come back from using a medical service, you should not be getting a bill in the mail three weeks later
that you did not expect. That provider cannot do that to you by law anymore. And the president has
asked us to make sure we enforce that new law.

Margaret Flinter ( 03:44 ):
Well, that is incredibly important. We've all heard those stories from friends, neighbors and patients
about their experience. But secretary, we're nearing the immunization season. We recently interviewed
Dr. Fauci who really drove home the point that only 20% of Americans have received the COVID booster
and that we've got to get that to 50% to be effective. How can we do that?

Xavier Becerra ( 04:12 ):
Well, first we have to continue to reach out to Americans and let them know that just because we got
the first vaccination, we're not done because just like the flu, just like the seasonal cold, we could see a
recurrence. The difficulty here is that COVID is different from the cold. COVID kills you. The cold, we
know how to deal with much better. And so if you want to stay healthy, you want to stay alive, please do
what we know is safe and effective, get vaccinated, be up to date. And we know that the flu season is
coming and so we're encouraging everyone once again, please get vaccinated. Get that updated vaccine.

Xavier Becerra ( 04:44 ):
Today, the vaccine really targets the most aggressive of those COVID variants. And so if you want to stay
safe, if you want to be able to hug and kiss your grandmother without feeling that you might infect her,
please get vaccinated.

Mark Masselli ( 04:58 ):
Well, that's such an important message, secretary, and I know health centers across the country, private
providers are all giving that message and we remind people to listen to those that you trust. It may be
somebody from the religious community, it may be a family member, but it's so important to do this.
Secretary, I want to shift and talk a little bit about something that I know is important to you. 93 million
Americans are on Medicaid or CHIP, which is really an outstanding number, a real tribute to the
administration, but the end of the public health emergency, all of the patients now were being
redetermined for eligibility.

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Mark Masselli ( 05:34 ):
And yet in the last three months, 1.6 million Americans have lost that Medicaid coverage. And of that
group, about a third are children. I'm wondering what you and the department are doing and what's
your thoughts about is this too many losing that coverage?

Xavier Becerra ( 05:55 ):
Well, as you know, President Biden is all about making sure every American has access to healthcare.
That was one of his principle goals when he came to healthcare, more coverage. And in fact, we've
gotten there. For the first time in our history, more than 300 million Americans have access to a doctor
or a hospital because they're insured. President Biden really pushed hard for that and now he wants to
make sure that we don't lose people. And the Medicaid process requires that everyone fill out the forms
that show that they're eligible to receive Medicaid as their services.

Xavier Becerra ( 06:27 ):
So we want to make sure everyone does complete the process. For about three years, people didn't
have to worry about the process because during the pandemic, we essentially said by law, "We're not
going to require people to re - enroll every year. You get to stay on Medicaid." So that's why today so
many Americans have to fill out that process again. Please, when you get that form in the mail, fill it out.
If you get contacted by your Medicaid offices, please get back to them. Give them the information they
need.

Xavier Becerra ( 06:57 ):
And if you have kids, this is really important, if you have children, remember the chances are they
continue to qualify for Medicaid or CHIP, which is the Children's Health Insurance Program, even if you
may not qualify. And so please don't lose your insurance simply because you didn't connect the dots.

Mark Masselli ( 07:15 ):
Well, secretary, I think you said something important. It's three years that people haven't done it. It's a
muscle they hadn't exercised, and now is the time to exercise that muscle and go down there and get
those forms done.

Margaret Flinter ( 07:27 ):
Secretary, we recently marked the one year anniversary of the Dobbs abortion decision, and we note
that research in Texas is showing a sharp increase in unplanned and unsafe births under the strict
abortion law. What do you think the department can do? What more can the department do on
reproductive rights at this point?

Xavier Becerra ( 07:49 ):
Well, first we're going to do everything under the sun to protect the health of every American, certainly
a woman and her reproductive rights and access to abortion. You have to remember that a woman is
three times more likely to die of a complication during pregnancy if she happens to reside in a state that
restricts her access to abortion care services than if she lives in a state that gives her a full set of the
reproductive services that she needs. And so we are seeing women and their health harmed simply
because of the politics in that state.

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Xavier Becerra ( 08:24 ):
So we at the federal level are doing everything we can continue to protect a woman's right to access the
care she needs, including abortion care. That means if she's got an emergency under federal law, any
provider, a hospital has to give her the services she needs for that emergency, including abortion care.

Xavier Becerra ( 08:43 ):
We're going to make sure that we protect the privacy, not just of the patient, but of the providers as
well. They're entitled to privacy. We're going to make sure that if there's a medication that's available
for any American that's prescribed because it is safe and effective that a woman has access to it. So
medication abortion, Mifepristone. Everybody hears about the drug. That is safe and effective. We're
going to do everything we can to make sure every woman continues to have access to Medicaid
abortion.

Xavier Becerra ( 09:10 ):
So we're going to continue to work with those who are trying to protect a woman's rights as much as we
can because no American should have to go without their healthcare.

Mark Masselli ( 09:19 ):
Secretary, I think we're almost a year out, if I'm right from when President Biden signed the Inflation
Reduction Act into law. It's had a profound impact on many areas, but I wonder if you could just focus in
on what impact it's having on Medicare.

Xavier Becerra ( 09:37 ):
Here's the good news. Today, the cost of medicines for many Americans is going down. Today, the fact
that a senior on Medicare can find insulin for $35 and no more than $35 a month is a big deal because
it's real. It's hitting today. It's making that pocketbook feel a little more full every day for those
Americans who used to pay, I've been told $115 up to $200 for that insulin. So it's a great savings that's
acting today to put money in people's pockets, real money. What else? Today, that same person, if that
person needs a vaccine. Today, zero money comes out of their pocket to pay for that vaccine. That's
saving them a ton of money.

Xavier Becerra ( 10:28 ):
I hear about shingles. Maybe younger folks don't worry so much about shingles, but shingles is... You
don't want shingles, let's put it that way, because it is extremely painful. But it also is painful to pay for
it. 200, $300 for a shingles vaccine. A lot of folks on fixed incomes can't afford it. Today, zero cost for
that shingles vaccine. So Americans are saving a lot of money. Today, if a drug company tries to increase
the cost of its drug more than the rate of inflation, they have to give back the excess that they charge to
the Medicare program, which ultimately helps any pre - Medicare beneficiary.

Xavier Becerra ( 11:07 ):
And soon, get ready September 1st, we're going to announce the first 10 drugs under the president's
lower cost prescription drug law that can now be negotiated on their price. 10 drugs. We're going to
start to negotiate to get a better price for Americans on those drugs. That's as a result of the Inflation
Reduction Act. So much more as well. But it's helping Americans afford their healthcare and it's keeping
more Americans insured.

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Margaret Flinter ( 11:37 ):
Well, that is exciting. And we are certainly on the front lines hearing about this, particularly around the
insulin, and I'm sure that your offices are hearing about it positively as well. Secretary, you've also
announced an initiative that's very much on people's minds to strengthen the nation's health workforce.
We hear this in just about every discipline of the workforce and this time with equity as a key part of the
effort. Tell us how this initiative will operate.

Xavier Becerra ( 12:06 ):
Well, what's really important is that if we have a health professional, we keep them in the profession.
Many are burning out. Many are finding that it's just too difficult to continue. COVID really put a lot of
strain on families because not only did they have to worry about getting sick, but they were caring for
the sickest of our fellow Americans. What we want to do is if you went through the process of getting
trained and educated to be a health professional, we want to keep you there.

Xavier Becerra ( 12:34 ):
So we're working with states to try to feed that pipeline of new professionals. We're also trying to help
states provide to their workers the type of relief they might need. It may be to increase their pay. It may
mean giving them a little bit more time off. It may mean giving them a little more training so they can
move up the ladder. But whatever it is, we want to encourage states, and we're doing that by providing
them with some resources as well as some technical support to try to help build that workforce and
keep people in those professions because we know that we don't have enough of our professionals
already, especially I should mention, especially in the area of mental health. We're finding that we're
way behind in providing the behavioral health professionals that we need.

Xavier Becerra ( 13:21 ):
And so we're actually directing some monies in those areas. And we're also, for example, making sure
that slots that go for these medical residency programs that train up the next generation of doctors are
going to those areas that are less likely to have those professionals already. Rural communities for
communities. So if we can direct some of those medical education slots there, we might be able to keep
them there once they become full - fledged doctors and nurses and so forth.

Mark Masselli ( 13:52 ):
Well, that's such an important message. I know running school - based health centers across the state,
behavioral health clinicians are desperately needed, so we really appreciate all the work that's being
done.

Margaret Flinter ( 14:02 ):
Secretary Becerra, we appreciate your time, your service to our country. Thank you so much for joining
us today on Conversations on Health Care.

Xavier Becerra ( 14:10 ):
Great to be with you. Thank you so much. All right,

Mark Masselli ( 14:12 ):
Thank you so much, secretary. Continued success.

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Margaret Flinter ( 14:14 ):
Best wishes.

Xavier Becerra ( 14:14 ):
Bye - bye now.

Mark Masselli ( 14:16 ):
Bye.

Margaret Flinter ( 14:17 ):
Well, Mark, it was great to talk to the secretary. We had a chance to hear him speak and talk about his
work when we were out in Colorado at the Aspen Festival Health a few weeks ago. So great to have him
join us to that interview. I felt like his comments really gave us a sense of how enormous the
responsibilities he has and also how enormous the influence to be able to make the kinds of changes
that have been made. When we were in Colorado at Aspen, he was on a panel with the folks who served
in the role right before him, Secretary Kathleen Sebelius from the Obama administration and Secretary
Alex Azar from the Trump administration. It was really remarkable to hear their frank comments that
night.

Mark Masselli ( 15:03 ):
Well, it really was, Margaret. And first of all, it was great to have the secretary with us. And you're
absolutely right, that was a riveting conversation with the three secretaries, really sort of talking about a
wide range of issues. I was taken by something that Secretary Sebelius said at that time, talking about
the role that HHS has on the world stage. And it's such an important element of our diplomacy that
when things are tough and we see that now in the world, Margaret, where there's difficult situations.
Certainly the issue with Ukraine, the issue with China, but American scientists and the research that
they're doing are embraced around the world.

Mark Masselli ( 15:52 ):
We've heard on our own show a number of times from Dr. Fauci and others talking about the set of
relationships between scientists across the globe is so important. We've had folks on from the WHO.
We've had other people really talking about this global conversation that needs to happen and to keep
politics out. But it was a fascinating conversation that evening. And this is a very large organization, $1.7
trillion that they all had responsibilities for, and they all brought different energy and different focus to
their role.

Margaret Flinter ( 16:36 ):
I'm sure, I've heard the term soft diplomacy before, but I'd really never heard it used so eloquently is
when they spoke about the largest diplomatic corps being the soft diplomacy of the public health people
that are out there across the world. And I think it was the secretary who said, "It's one thing when you
bring a new piece of equipment into a community. It's another thing when you save the life of
somebody's child," as we've done with some of the vaccine campaigns and so forth, and made a big
impression on me just how powerfully that represents what we hope is the best of America.

Margaret Flinter ( 17:11 ):

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Secretary Becerra also made it clear that there are very few HHS employees who are political
appointees, very small percentage. Most people stay in their nonpartisan role through administrations
as they change. But I thought one of the biggest revelations was when Alex Azar said that in retrospect
he wished he'd taken the advice he heard that a cabinet secretary needs to be able to hire and fire who
he wants. Secretary Azar was in charge during COVID and certainly there were lots of reports. Everyone
heard them in the press about the turmoil the White House caused by trying to interfere and inject itself
in HHS personnel and policy matters during the pandemic.

Margaret Flinter ( 17:55 ):
So when he was asked what he was unprepared for when he started the job, he simply said the Trump
administration. And everyone seemed to understand respectfully what that meant.

Mark Masselli ( 18:06 ):
Yeah. A very, very difficult situation. I was impressed with our conversation today with the secretary and
his focus in on the work, and probably not well recognized of the Biden administration in a number of
fronts, particularly that Inflation Reduction Act, Margaret, really focusing on Medicare, really trying to
grapple with a very complicated issue. Though it seems simple to all of us about controlling price
because there's so many political factors that go into that issue in terms of what Congress will authorize
the administration to do.

Mark Masselli ( 18:43 ):
As we all know, the administration when this was passed was not allowed to negotiate with any of the
drug companies. Even though we were buying, we're the largest purchaser the United States
government, all of us are the largest purchaser of medicines probably in the globe, and we still did not
be able to do that. I'm interested what the 10 drugs, Margaret, that they'll choose. I think we all -

Margaret Flinter ( 19:11 ):
Absolutely.

Mark Masselli ( 19:11 ):
... probably have our own list of things, but really focusing on that. And then just some of the simple
things, making immunizations, really making sure there's no obstacle for people to get the type of
healthcare that they need. And then also his message about peace of mind I thought was nice, which is
so important is this. I think a lot of people worry about the cost of healthcare and all of its implications,
and if you're worried about anything in healthcare, you're worried about the cost of that medicine once
you get it prescribed and how you're going to pay for it.

Margaret Flinter ( 19:48 ):
Well, although we didn't have a chance to discuss it in our conversation with them, I was thinking about
the juxtaposition of the insulin been around for decades and decades, making that affordable, the 10
low cost drugs and let the negotiations begin. I'm sure that's going to be an interesting set of
negotiations. But at the same time, we're reading in the journals and in the press that we have approval
for a drug for Alzheimer's disease. It's going to be very expensive and Medicare has said that they will
pay for it given the right condition.

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Margaret Flinter ( 20:25 ):
So it's not like it's all tipped to the low cost and the generic. They're really interested, I think, in trying to
address the things that Americans are worrying about, the families worry about. And I thought that was
really important that they've made that decision.

Mark Masselli ( 20:40 ):
Yeah. Well, again, it was great to have the secretary, but it was also, as you started off, Margaret, a real
opportunity at the Aspen Institute Ideas health gathering that we joined to really meet so many engaged
people like the secretary. I know we have a couple of shows coming up with really some very bright and
talented people. Obviously, we've always already aired the conversation with Dr. Fauci, but I'm excited
to revisit our conversation with the ARPA - H folks who really, I thought have something that I think all
Americans will be excited to hear about, really trying to get some breakthrough discoveries in the area
of healthcare, a really a different approach, a different model, if you will, about how do you go out and
find these talented researchers, provide them the resources, and then really establish a set of KPIs that
they really have to meet. And if they're not successful, move on to the next.

Margaret Flinter ( 21:55 ):
Well, I loved the stories that we heard about Operation Warp Speed and this idea that when we need to
mobilize the entire country to get something done, as we did during the COVID pandemic, you can
command the military, the supply routes, the transportation routes, and you can make things happen in
a day. They described one operation in terms of distributing the COVID vaccines where they were
needed as soon as they were available to get them to those hard hit communities that were losing
hundreds of people every day and how they were able to do in a day, what would take months.

Margaret Flinter ( 22:29 ):
And that's, I think, a great message for the country that our military is not all about fighting wars against
enemies, it's about fighting for the health of people and bringing that same knowledge to bear. And I
think we're going to see a lot of speed with some of the initiatives coming out of the new projects.

Mark Masselli ( 22:49 ):
That's right. And we have Dr. John Torres coming up, medical reporter. I also found his backstory so
fascinating, a flight surgeon, somebody who's been in the military, somebody who continues to do
humanitarian work around the country. Not only is somebody we see on NBC News but really somebody
who's really very much engaged, very committed to many different communities, including work at the
South Pole. He has a really broad portfolio of interest and very fascinating. I know people will enjoy that
conversation as well, Margaret.

Margaret Flinter ( 23:31 ):
Absolutely. As we went from interviews back to attending the sessions, I also want to just recognize that
Secretary Becerra talked about how important it is that medical professionals and medical organizations
have stated and determined that gender - affirming care is value care, that it keeps people healthy, it
saves lives. He said that the Biden administration has included a writer in Medicare that says that any
provider who receives Medicare or Medicaid funding must be prepared to offer gender - affirming care.
That's a very interesting use of the power of the federal government to be able to make that kind of
requirement, will be interesting to see how this plays out in the coming year.

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Mark Masselli ( 24:17 ):
No, that's such an important piece of legislation. And also one that is top of mind I know to the people
who work here at the health center and to folks all around the country who working at community
health centers. We did talk Margaret recently about health centers and the valuable role that they play,
and yet they're not as well known as they should be across the country caring for 30 million Americans.
But our good friend, Senator Bernie Sanders, has really upset the apple cart down in Washington as he is
chairing the help committee and he has really basically said community health centers are underfunded
and really need to have the support of the federal government.

Mark Masselli ( 25:13 ):
He's been a real champion for many decades now, Margaret, in terms of his advocacy, not only for the
good health centers that are in Vermont, his home state, but for health centers all across the country.
And we're going to keep a close eye on that. We hope everybody who has the opportunity to listen to
Conversations on Health Care keeps eye on the work that's going on in health center. And we should say
rural health centers and behavioral health organizations and safety net hospitals all across the country
need America's support. They're really the front lines for so many people in need.

Margaret Flinter ( 25:52 ):
And he really, excuse me, understands that without the workforce training and the workforce retention,
you can have all the health centers, hospitals, clinics that you want, you still don't have care. And his
work on the Senate Health Committee has been very important in that leadership around supporting
health education, professional training, funding it, funding people as they come through the pipeline, all
very important initiatives.

Mark Masselli ( 26:20 ):
We've spent a lot of time, you and I, and the colleagues that we work with here at the Moses Weitzman
Health System thinking about workforce development. You are a national leader in the formation of the
first nurse practitioner residency program, and now through one of Moses Weitzman Health Systems
affiliates, the consortium is now engaged in accrediting nurse practitioner and PA programs. And in our
Colorado office, we run the National Institute for Medical Assistant Advancement. Such an important
program for that first rung on the ladder of making sure that there's a professional track for medical
assistance and make sure that we start to professionalize the work that they're doing.

Mark Masselli ( 27:09 ):
But I'd also say in our Weitzman Institute, in our echoes and other things, we're very much focused in on
this issue of trying to strengthen the health and safety net for all people across the country. Thoughts on
the work that goes on at the Weitzman Institute on this area as well, Margaret?

Margaret Flinter ( 27:31 ):
Every once in a while, I think that we're just so fortunate to have had this long arc to go from the
community organizing and the foundational pieces of care raised that up as advances in care became
available and then expanded out into research, education, training, policy. And to bring all that together,
not just for the benefit of one system, but for the benefit of everybody across the country. You talked
about the size of the health center movement. 30 million people get their care in a community health
center. So this is a huge opportunity, and the research that we've chosen to focus on are really the

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issues of concern to our patient population, which represents an awfully big chunk of America. People
who live with lower incomes are disproportionately members of racial and ethnic minority groups and
are really affected by the social determinants of health, whether that's climate change as we see it now,
or it's food insecurity, housing insecurity, unsafe neighborhoods, that whole range.
Margaret Flinter ( 28:33 ):
So providing care, learning from care, developing the research, not just focused, again internally, but by
partnering with organizations around the country, looking at social determinants of health and their
impact on people's health and how we then respond in the healthcare system at a community level and
at a clinical level. This is such important work. It addresses the issue, Mark, that you talked about in
terms of children and adolescents mental health. That's why we go to the schools -
Mark Masselli ( 29:04 ):
Absolutely.
Margaret Flinter ( 29:05 ):
... and then look to do the research and the policy work about does this work? Does it make a
difference? Does it improve children's behavioral health? Just critical.
Mark Masselli ( 29:14 ):
And we thank everybody for joining us today in Conversations on Health Care. Look forward to seeing
you soon. Peace and health.
Margaret Flinter ( 29:23 ):
This copyrighted program is produced by Conversations on Health Care and cannot be reproduced or
retransmitted in whole or in part without the expressed written consent from Community Health
Center, Inc. The views expressed by guests are their own, and they do not necessarily reflect the opinion
of Conversations on Health Care or its affiliated entities.

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