Biden picks Xavier Becerra to run HHS

No snarky headline here. After weeks of speculation, President-Elect Joe Biden made it official this morning:

President-elect Joseph R. Biden Jr. has selected Xavier Becerra, the Democratic attorney general of California, as his nominee for secretary of health and human services, tapping a former congressman who would be the first Latino to run the department as it battles the surging coronavirus pandemic.

Mr. Becerra became Mr. Biden’s clear choice only over the past few days, according to people familiar with the transition’s deliberations, and was a surprise. Mr. Becerra has carved out a profile on the issues of criminal justice and immigration, and he was long thought to be a candidate for attorney general.

But as attorney general in California, he has been at the forefront of legal efforts on health care, leading 20 states and the District of Columbia in a campaign to protect the Affordable Care Act from being dismantled by his Republican counterparts. He has also been vocal in the Democratic Party about fighting for women’s health.

As noted, Becerra was an unexpected choice for HHS Secretary; the names being tossed around included New Mexico Governor Michelle Lujan Grisham (also Latina) or Rhode Island Governor Gina Raimondo, both of whom apparently took themselves out of the running a week or so ago. However, he actually has more experience with healthcare-related matters than you might think:

Many may not realize how much health policy experience @AGBecerra has. He was very active in the #ACA's passage as part of House leadership & obviously took a lead defending the law in court. But as AG he's been active in on key health issues, from such prices to consolidation.

— Anthony Wright (@aewright) December 6, 2020

Wright, who's the Executive Director of Health Access California (a consumer healthcare reform advocacy organization) went on to explain:

Consumer advocates including @HealthAccess were pleased to work with him on putting conditions on hospital mergers, and on cracking down on "pay for delay" practices by prescription drug companies. He also won a major settlement with Sutter Health over anti-competitive practices.

Becerra has been a champion for reproductive health, and immigrant health, opposing the "public charge" regulations that discouraged legal immigrants from getting needed care. He stood up to hospitals who tried to wriggle out of charity care requirements. He's been an active AG.

So yes, @AGBecerra was most known for defending health care and many other protections, especially from the Trump Administration's attacks, but he pursued a pro-active consumer protection agenda as well, including on health care's cost, quality and equity.

The CA AG's authority was historically wide-ranging but dispersed in different silos, from computer protection to anti-trust law to oversight over charitable nonprofits & assets. Notably, @AGBecerra convened a task force within the CA DOJ to focus on health care as a portfolio.

Impressively, Becerra hasn't been afraid to take on big interests in health care, whether drug companies or hospitals. @HealthAccess worked with him on #SB977 this year in a tough fight to try to expand oversight on hospital takeovers by hedge funds and for-profit chains.

In addition:

And before the ACA he was a bulldog for Medicare, low income programs like Extra Help for Part D, and Medicare Savings Programs (e.g. MIPPA). Yes. He is a brilliant choice with the combination of health law and litigation— esp. with this SCOTUS.

— Heather Bates, MSW (@heatherjbates) December 7, 2020

Finally, via Larry Levitt of the Kaiser Family Foundation:

In Xavier Becerra, President-Elect Biden has selected a person who has been perhaps the biggest thorn in President Trump's side on the ACA, reproductive health, and immigrant rights. If confirmed, he will have an opportunity to overturn much of what Trump has done.

— Larry Levitt (@larry_levitt) December 6, 2020

Levitt goes on to note:

It's been more under the radar, but Xavier Becerra has also aggressively gone after anti-competitive practices in the hospital industry that keep prices high.

Becerra is not a health policy wonk, but wonks don't necessarily make the best cabinet secretaries. He's been around health care issues for years, as CA Attorney General and sitting on the Ways and Means Health Subcommittee in the House.

As Secretary of HHS, @AGBecerra will have a big to-do list that certainly includes, but is not limited to the pandemic:

  • Reinvigorating the ACA
  • Addressing Medicare trust fund insolvency
  • Curbing drug prices
  • Ending restrictions on family planning
  • Narrowing racial disparities

All of these are important, especially given the likely Congressional landscape. Democrats will hold a very narrow majority in the House (likely just 5 seats, possibly 6) and the Senate will either be narrowly controlled by Republicans or, at best, Democrats will have a bare 50/50 majority (with VP-Elect Harris as the tie-breaker).

This means that even if Democrats manage to flip both of the upcoming Georgia Senate runoff elections, the odds of any significantly progressive legislation passing is extremely slim, leaving it up to Biden & the HHS Secretary to make most changes via regulatory authority...which is pretty much what President Obama had to do for most of his time as President, as well as what Trump did for his single term.

As I've noted before, one of the strengths and weaknesses of the ACA is that many of the details are pretty much up to the whim of whoever the HHS Secretary (and the CMS Administrator) happens to be at the moment. This is what allowed Obama's second HHS Admin. Sylvia Burwell & Acting CMS Admin. Andy Slavitt to help shore up the law during his second term, and it's what allowed Trump's team (Tom Price/Alex Azar as HHS Secretary and Seema Verma as CMS Admin) to sabotage some elements of the ACA during his four years.

So, the odds are that Biden's HHS/CMS heads are going to spend an awful lot of time reversing stuff done by Trump, as alluded to by Levitt above.

With all that in mind--and the fact that these sorts of changes are subject to federal lawsuits--perhaps it's just as well that someone with an extensive knowledge of the legal system be in charge of the department.

Here's the official announcement, along with some of Biden's other top healthcare appointees (oddly missing: CMS Administrator):

Xavier Becerra currently serves as the 33rd Attorney General of California, the first Latino to hold the position in the 171 years of its existence. As the leader of the nation’s largest state-level Department of Justice, his work has focused on protecting underserved communities and fighting to safeguard the health and wellbeing of all Californians; in November 2020, he led the defense of the Affordable Care Act in the Supreme Court on behalf of twenty states and the District of Columbia.

Prior to his tenure as Attorney General, Becerra served twelve terms as a member of the U.S. House of Representatives, becoming a key fixture of the Committee on Ways and Means, Ranking Member of the Subcommittee on Social Security, and, ultimately, Chair of the House Democratic Caucus. The son of working-class parents who was the first member of his family to graduate from college, Becerra started his career as a legal aid attorney supporting clients contending with mental health issues before becoming a Deputy Attorney General in the California Department of Justice and serving one term in the State Assembly. Originally from Sacramento, Becerra received his bachelor of arts degree from Stanford and his JD from Stanford Law School.

  • Surgeon General: Dr. Vivek Murthy
    (yes, he's returning...he was President Obama's Surgeon General as well)
  • Chief Medical Adviser on COVID-19 to the President: Dr. Anthony Fauci
    (yes, he's sticking around)
  • Coordinator of the COVID-19 Response & Counselor to the President: Jeff Zients