Xavier Becerra, President-elect Joe Biden鈥檚 choice to head the Department of Health and Human Services, is set to be a pandemic-era secretary with no public health experience. Whether that matters depends on whom you ask.
Becerra built his career in the U.S. House of Representatives before becoming California鈥檚 attorney general, and some wonder whether his political and legal skills would be the right fit to steer HHS through a health catastrophe that鈥檚 killing thousands of Americans every day.
Although he would bring years of health politics and policy work to the role, none of it comes from front-line experience as an executive or administrator running public health programs, managing patient care or controlling the spread of disease.
Yet beyond the immediate COVID-19 crisis, many Democrats see Becerra as an important ally to undo what they view as years of damage from the Trump administration鈥檚 efforts to undermine the Affordable Care Act; the Medicaid program, which provides coverage for more than 70 million Americans; reproductive health; and more.
As California鈥檚 attorney general since 2017, Becerra has been a thorn in the side of the Trump administration, to overturn federal action on the Affordable Care Act, contraception, immigration, workers鈥 rights, LGBT rights, education, consumer protection, gun violence and the environment.
鈥淐OVID is the biggest issue on the table, but it is not the only issue on the table,鈥 said Dr. Georges Benjamin, executive director of the American Public Health Association. 鈥淚f you look at his body of work, he is not your traditional attorney. His body of work in the health area is substantial. And I think that counts.鈥
On Tuesday, Biden will formally introduce Becerra along with other candidates for top health jobs, many with deep public health experience.
They include Dr. Rochelle Walensky, an infectious disease expert at Harvard Medical School who practices at Massachusetts General Hospital in Boston, as the next director of the Centers for Disease Control and Prevention. Biden鈥檚 choice for COVID 鈥渃zar鈥 is Jeffrey Zients, a private equity executive and former Obama administration official who will steer the pandemic response from the White House. Dr. Vivek Murthy is the nominee for U.S. surgeon general, a position he held in the final Obama years.
Biden has said he will let the federal government鈥檚 longtime scientists guide his pandemic response, in particular those at the CDC, which is overseen by HHS. President Donald Trump sidelined the agency, damaging its reputation as the world鈥檚 most trusted public health institution.
That Becerra鈥檚 deepest experience is political makes some observers wary.
鈥淚 think there鈥檚 always a danger of letting that sort of cloud the scientific and medical judgment of how best to do things. I hope they can manage that well,鈥 said Jeffrey Morris, a biostatistics professor at the University of Pennsylvania who has worked on COVID issues. He said he had mixed feelings about the Becerra selection. 鈥淲hat is the leadership style, and is there going to be micromanaging from the top down into these organizations? To me, that’s the key aspect.鈥
Garry South, a Los Angeles-based Democratic strategist, called Becerra鈥檚 appointment 鈥渃urious.鈥
鈥淎 lot of people are raising eyebrows 鈥 even those who are pleased and proud that Biden picked another Californian to join his administration,鈥 South said. 鈥淚f Republicans are looking to target a few Biden appointees for rejection, you can expect them to make the case that there is no logical nexus between a state attorney general and serving as secretary of Health and Human Services.鈥
Still, Becerra, who as a member of Congress worked in the House Democratic leadership and was a member of the powerful Ways and Means Committee, has more health policy background and knowledge of U.S. health care finance and delivery systems than many previous heads of the sprawling HHS, which employs more than 80,000 people and has a $1.3 trillion budget.
For three years, Becerra has managed California鈥檚 Justice Department, with a $1.1 billion budget and 4,800 employees. As attorney general, he鈥檚 been deeply involved in crafting health policy. His office has gone after anti-competitive behavior from hospitals. And he鈥檚 sponsored legislation to take on drugmakers and pay-for-delay schemes.
鈥淗e鈥檚 gone after powerful health care interests,鈥 said Anthony Wright, executive director of the nonprofit Health Access California.
Antitrust enforcement is more commonly handled by the U.S. Department of Justice and the Federal Trade Commission. But Becerra made it a priority as California鈥檚 top cop. In May 2018, he brought an antitrust case against nonprofit health care giant Sutter Health, accusing the system of monopolistic practices that drove up the cost of medical care in Northern California.
“This is a big 鈥楩鈥 deal,鈥 Becerra said at a news conference unveiling the lawsuit. The case 鈥 which encompassed years of work by the department and his predecessors and millions of pages of documents 鈥 alleged that Sutter had aggressively bought up hospitals and physician practices across the region and illegally exploited that market power for profit. Health care costs in Northern California, where Sutter dominates with its 24 hospitals, are 20% to 30% higher than in Southern California, even after adjusting for Northern California鈥檚 higher cost of living, according to a from the Nicholas C. Petris Center at the University of California-Berkeley that was cited in the complaint.
In December 2019, Sutter agreed to pay $575 million to settle the case and promised to end a host of practices that Becerra alleged stifled competition.
Becerra channeled lessons learned from the Sutter case into an in the California legislature. The legislation ultimately failed, but it would have given the attorney general power to review private equity- or hedge fund-led mergers or acquisitions of a health care system or hospital.
鈥淭he Sutter case is a blueprint for a national policy that could start to restore competition for the health care system and save American health care consumers billions of dollars right away,鈥 said Glenn Melnick, a health care economist at the University of Southern California. He views Becerra as 鈥渁 real expert in some of the most important issues facing our health care system, not just in California but nationally.鈥
If confirmed by the Senate, Becerra supporters say, he will bring to the job a political acumen from his two decades-plus on Capitol Hill that鈥檚 likely to be an asset for the Biden administration as it negotiates pandemic relief bills and other health legislation with a politically divided Congress.
Former California Democratic member of Congress Henry Waxman worked with nearly a dozen HHS secretaries during his time on the House Energy and Commerce Committee. He said he鈥檚 not worried that Becerra lacks experience leading a vast health care bureaucracy. The HHS secretary job, he said, is one 鈥渨here you need political skills to see how far you can get with other people in a political context.鈥 That鈥檚 why most HHS secretaries, Republicans and Democrats, have had political backgrounds.
Becerra 鈥渦nderstands the policies and has a deep commitment to them,鈥 he said. 鈥淚 think he鈥檒l do well.鈥
Public health officials say the job before Becerra is gigantic.
Dr. Gary Pace, the health officer in rural Lake County, California, said Becerra would be tasked with rebuilding a broken public health system.
鈥淲e want a federal partner who can give us good guidance 鈥 we haven鈥檛 had that,鈥 Pace said. 鈥淔or him, I鈥檇 say what we need first is starting to get the CDC back into a flagship public health role, with trusted and timely evidence-based guidance.鈥
Born in Sacramento to Mexican immigrant parents, Becerra would be the first Latino HHS secretary. He was elected to Congress in his 30s and has been involved in national health legislation during the past two decades, even though he is more widely known for his involvement in immigration and tax issues. He joined the powerful House Ways and Means Committee, which oversees tax and health legislation, in the 1990s. The committee played a central role in the drafting of what would become the Affordable Care Act in 2010.
While HHS oversees major federal health agencies, including the CDC, the Centers for Medicare & Medicaid Services, the Food and Drug Administration and the National Institutes of Health, it also has a wide-ranging human services portfolio, including oversight of child care and welfare programs, Head Start, programs for seniors and refugee resettlement.
鈥淚t鈥檚 not like any one person is going to have everything,鈥 said Dan Mendelson, a former Clinton administration health official, who called Becerra an 鈥渋nspired choice.鈥 鈥淚 think that the most important point is that this is a leader of a team and not the be-all and end-all.鈥
California Healthline staff writers Rachel Bluth and Samantha Young contributed to this story.
This story was produced by , which publishes , an editorially independent service of the .
