WASHINGTON — U.S. Department of Health and Human Services Secretary Xavier Becerra on Tuesday defended access to health care for transgender people, as well as his agency’s actions in connection with unaccompanied migrant children.

Republicans at a U.S. House Education and the Workforce Committee hearing grilled Becerra about gender-affirming care for transgender minors, including puberty blockers. They also pressed him about an investigation from the New York Times that reported HHS lost contact with 85,000 unaccompanied migrant children and hundreds of those children were found working dangerous jobs in violation of child labor laws.

Becerra appeared before the panel to advocate for President Joe Biden’s HHS budget request for fiscal 2024 proposing $144 billion in discretionary funding and $1.7 trillion in mandatory funding for health care, child care, mental health services, Medicare expansion and more.

“Our country faces numerous health care challenges — and HHS is at the center of addressing many of these issues,” Becerra said in his opening statement.

But the chair of the panel, Rep. Virginia Foxx, said she was not pleased with the budget request.

“Each dollar matters when wallets are stretched thin, so the enormous HHS budget requires a critical eye,” the North Carolina Republican said in her opening statement. “Budgets calling for more money and reckless spending are crushing everyday Americans.”

Democrats raised concerns about maternal mortality, lack of access to reproductive care for pregnant patients, the rise in child labor violations for unaccompanied migrant children and health care access for transgender people.

“The nation is witnessing the harsh restrictions and criminalization of women’s access to abortions, jeopardizing the health of women and families across the country,” ranking member Rep. Bobby Scott, a Virginia Democrat, said in his opening statement. “We are all bearing witness to the baseless villainization of the necessary care that supports transgender individuals.”

The GOP-controlled House recently passed legislation to ban transgender girls from competing in the sports that align with their gender identity.

Gender-affirming health care

Several states with Republican-controlled state legislatures have moved to ban transgender children from accessing gender-affirming care, and Republicans at the hearing zeroed in on the topic.

Republican Rep. Mary Miller of Illinois asked Becerra if puberty blockers were dangerous and what risks come with using them.

“No drug would be on the market if it was not safe,” he said.

Miller asked Becerra what “your own FDA says about the risk,” referring to the Food and Drug Administration.

Puberty blockers were first approved by the FDA in 1993 to temporarily pause puberty in children who were going through it too early. Transgender adolescents can choose to start hormone therapy, in which they receive either estrogen or testosterone treatments, whichever one that aligns with their gender identity.

Republican Rep. Jim Banks of Indiana took issue with a report HHS published in March about gender-affirming care, in which the agency recommended cutting federal funding for hospitals that deny access to health care for transgender people.

“Does this mean that HHS is seriously threatening to withhold hospital grants from states like my own if they refuse to go along with surgeries … or puberty blockers for kids?” he asked.

Becerra said that the agency is going to “protect the rights of any American to get the health care they’re entitled to, and if someone tries to stop them from that, that’s a violation of the law.”

Democratic Rep. Mark Takano of California said Republicans on the committee were trying to cause a “moral panic.”

“This line of questioning I think is meant to inflame Americans sensibilities about transgender people and stigmatize them,” he said.

Takano asked Becerra how often transgender youth receive gender-affirming surgeries.

Becerra said that any surgeries that transgender minors receive are very rare and that they are performed on adolescents, not young kids. It’s a decision that is made on the individual level between a patient and medical provider, he added.

“What we know at HHS is that many of the transgender youth that are having very difficult, traumatic times find that getting gender-affirming care has been helpful in stabilizing their lives,” Becerra said.

Child labor

Both Democrats and Republicans asked Becerra about The New York Times investigation into child labor.

Becerra pushed back on those criticisms, arguing that the agency did not “lose” contact with any children because those children were not in HHS jurisdiction.

“Once we place those children (with a sponsor), we lose jurisdiction over those kids,” he said. “So we can’t lose people we don’t have jurisdiction over.”

Becerra mostly placed the blame on companies that the Department of Labor has investigated and cited for exploiting migrant children.

“I don’t believe that these children are receiving the oversight protections when an employer or company is violating their labor rights,” he said.

Republican Rep. Tim Walberg of Michigan told Becerra that he found the lack of coordination between HHS, the U.S. Department of Homeland Security and the U.S. Department of Labor alarming.

“It appears as though many of these children were placed with human traffickers and were forced to work in dangerous jobs,” Walberg said.

He asked Becerra if the Labor Department had informed his agency in 2021 and 2022 that those unaccompanied children were being exploited.

Becerra said that HHS does not have jurisdiction over the unaccompanied children that the agency releases to sponsors, but that HHS is coordinating with the Labor Department to notice any patterns that companies are violating child labor laws.

House Democrats last week lobbied?Foxx to hold a hearing on the uptick in child labor violations overall, but she argued that Tuesday’s hearing would provide the committee with an opportunity to address the issue.

“We do feel like there was a betrayal of trust for our most vulnerable kids in this country,” Republican Rep. Lori Chavez-DeRemer of Oregon said to Becerra about the reports of migrant children working in dangerous work conditions.

Reproductive health care

Following the first-year mark since the U.S. Supreme Court struck down the constitutional right to abortion access, Democrats raised concerns about access to reproductive care, especially for pregnant patients who live in states that have banned abortion.

Democratic Rep. Suzanne Bonamici of Oregon told Becerra she was concerned about reports of pregnant patients who need to travel to other states to access care because of abortion bans. She also cited reports about medical staff waiting until their patients get dangerously ill before being able to provide treatment.

She asked Becerra if the agency expects to see maternal mortality rates increase or decrease in states that pass bans and restrictions on access to abortion.

“Pregnant women in states with abortion bans are nearly three times more likely to die during the process of bringing a child into their family,” Becerra said.

He added that the Biden administration is aiming to reduce maternal mortality rates with a budget request of $1.9 billion for the Health Resources and Services Administration Maternal and Child Health programs. HHS is asking for $276 million to be directed “toward reducing maternal mortality and morbidity and $185 million to the Healthy Start program to reduce racial disparities in maternal and infant health outcomes.”

The current maternal mortality rate?in the U.S. is 17.4 deaths per 100,000 live births, according to the Centers for Disease Control and Prevention.

There are also racial disparities in maternal mortality rates: Black mothers are 2.5 times more likely to die from pregnancy or childbirth causes than white mothers.

Democratic Rep. Jahana Hayes of Connecticut said she was concerned about the Black mortality rate, pointing to the recent death of American track and field champion Tori Bowie due to complications of childbirth. Bowie was 32.

She asked Becerra how the president’s budget would address the high mortality rates of Black mothers.

He said the agency is planning to continue expanding access to the doula program “so we can make sure that women are receiving care, not just at the point of delivery, but before that, so they’re preparing for that delivery and having good health outcomes.” Doulas are trained professionals who provide support to new mothers before and after birth.

“So we’re going to continue to work with community health centers, with those programs that reach out to do community health service work, to try to make sure we’re getting to people early,” Becerra said. “Someone who’s an athlete at a young age of 32 should not be dying in her home alone because she’s pregnant.”