Senate Confirms Xavier Becerra as HHS Secretary

Members of the Senate voted 50-49 Thursday to confirm Xavier Becerra as the secretary of the U.S. Department of Health and Human Services (HHS).

Becerra will oversee a department that regulates activities that account for more than $4 trillion in annual U.S. spending and about 18% of the U.S. gross domestic product.

Becerra — who represented California from 1993 to 2017 in the U.S. House, and who has been California’s attorney general since 2017 — will now oversee the agencies that run Medicare, Medicaid, aging programs outside Medicaid, medical research programs and the U.S. response to the COVID-19 pandemic.

The Vote

The vote was split mostly along party lines, however, Sen. Susan Collins, R-Maine, crossed party lines to vote for Becerra. Sen. Mazie Hirono, D-Hawaii, was absent due to a family emergency.

Some Republicans accused Becerra of lacking the health policy experience to be the HHS secretary.

Sen. Bill Cassidy, R-La., a medical doctor, said during the Senate Health, Education, Labor and Pensions Committee hearing on the Becerra nomination that he believes Becerra has impeccable credentials as an attorney but not as an HHS official.

Not all votes have been split. On Wednesday, for example, all 49 Republicans voted yes on the nomination of Katherine Tai to be the U.S. trade representative.

Republican senators voted 32-17 Tuesday in favor of Isabella Casillas Guzman, Biden’s Small Business Administration administrator nominee,

The HHS Hierarchy

The last confirmed HHS secretary was Alex Azar II, who held that position under former President Donald Trump.

Norris Cochran, a career HHS employee, has been filling in as the acting HHS secretary since Azar left the post.

The last confirmed HHS secretary to serve under a Democratic president was Sylvia Mathews Burwell. Burwell is now the president of American University.

Becerra’s Background

Becerra was born in Sacramento, California, and grew up there. He has a bachelor’s degree in economics and a law degree from Stanford University.

Before Becerra began working as a government official, as a deputy attorney general in the California Department of Justice, he worked for a legal assistance organization in Massachusetts.

Now that he has been confirmed as HHS secretary, he will have to give up an interest in the New York Life Stable Value Guaranteed Interest Account, along with an interest in the T. Rowe Price Stable Value N common trust fund, according to an ethics agreement filed with the U.S. Office of Government Ethics.

Becerra’s Views

Becerra was known in California for efforts to create a government-run, single-payer health care system.

President Joe Biden said while he was campaigning that he intends to expand access to health care by building on the current Affordable Care Act framework, rather than by replacing the current framework with a single-payer system.

Becerra said during Senate confirmation hearings in February that his goal will be to achieve Biden’s goals, by strengthening the ACA system.

Industry Group Reactions

Insurance industry groups appeared to have had a cordial relationship with Kathleen Sebelius and Sylvia Burwell, the HHS secretaries while former President Barack Obama was in office, and with Azar.

Major groups expressed optimism about Becerra in statement’s about his confirmation.

Matt Eyles, president of America’s Health Insurance Plans, said AHIP shares the Biden administration’s commitment to the idea that every American deserves access to affordable, high-quality care.

While Becerra was in Congress, and serving as California’s attorney general, he “exhibited an unceasing dedication to protecting the health and well-being of all Americans,” Eyles said.

“Secretary Becerra will provide the strong leadership our nation needs as we work together to overcome the COVID-19 crisis. We look forward to working with him to protect and build upon the Affordable Care Act to expand health coverage for all Americans, address the underlying cost of health care, and eliminate racial and ethnic disparities in medical care,” he said.

Kim Keck, the president of the Blue Cross Blue Shield Association, also put out a statement congratulating Becerra on his confirmation.

The Blues “look forward to working with him to address longstanding racial health inequities, combat the COVID-19 pandemic and make health care work better for everyone,” Keck said.

“As California’s attorney general, Becerra was a key defender of the Affordable Care Act, expressing his support of the law and the protections it provides Americans. We agree that the ACA is the best path forward to achieve universal coverage and that we need to build on it to make health care more affordable and accessible for everyone,” Keck added.

In the past, some progressive Democrats have been opposed to the existence of Medicare Advantage program, which gives private insurers a chance to use a combination of Medicare program funding and enrollee premiums to provide an alternative to traditional Medicare coverage.

But Becerra said during his confirmation hearing that Medicare Advantage has turned out to be a good vehicle for getting people more services.

Allyson Schwartz, president of the Better Medicare Alliance, a group for Medicare Advantage program supporters, said her organization appreciates Becerra’s commitment to the protecting the 26 million Medicare enrollees who use the program.

Schwartz is a former House member, and she noted in her statement that she served alongside Becerra.

“I saw firsthand Secretary Becerra’s deep concern for improving health outcomes and reaching underserved communities,” Schwartz said.

The Better Medicare Alliance wants to show Becerra that Medicare Advantage plans are providing better care than traditional Medicare coverage is for enrollees who tend to have lower income levels and be more diverse than the people with traditional Medicare coverage are, Schwartz said.

Margaret Murray, the CEO of the Association for Community Affiliated Plans, leads a group of 78 nonprofit plans that focus on administering health coverage for people who qualify for Medicare, the Children’s Health Insurance Program and other government-sponsored health insurance programs.

“Secretary Becerra is unequivocally qualified to run HHS, as a longtime supporter of equitable access to comprehensive, affordable health coverage and care,” Murray said.

ACAP wants to work with Becerra on fighting the COVID-19 pandemic and eliminating racial disparities in health care access, Murray said.

ACAP also wants to work with Becerra on bringing back the old, pre-Trump administration rules for health insurance products that are exempt from the ACA rules that apply to major medical insurance, Murray said.

On Deck

Biden has nominated Chiquita Brooks-LaSure to be the administrator of the Centers for Medicare and Medicaid Services, the arm of HHS that’s directly in charge of overseeing Medicare, Medicaid and HealthCare.gov.

At press time, the Senate hearing calendar did not show a confirmation hearing listing for Brooks-LaSure.

The last hearing on the calendar was set for March 25.

Xavier Becerra (Photo: California Attorney General’s Office)