Biden picks thorn in Trump’s side as new health secretary

California Attorney General Xavier Becerra would be taking over the Department of Health and Human Services (HHS) as secretary amid the worst pandemic in a century if confirmed by the Senate, but it’s his work on defending the Affordable Care Act from Trump administration attacks that may have won him the role.

As California attorney general, Becerra helped lead the legal fight to protect the health care law from a Trump-backed lawsuit against it. He also led a whole slew of lawsuits against the Trump administration’s regulatory changes to ObamaCare and abortion policy.   

If confirmed as President-elect Joe Biden’s top health official, Becerra, 62, would have a chance to dismantle the changes the Trump administration has made to the law from the inside.

He’d also be able to look for regulatory ways to further Biden’s health agenda without Congress, especially if Republicans control the Senate. 

“I don’t think you could find anyone who’s been a bigger thorn in Trump’s side when it comes to health care than Becerra,” said Larry Levitt, a health policy expert at the Kaiser Family Foundation. “Becerra spent years trying to stop Trump’s health agenda in court, and now he’ll have an opportunity to try to undo it directly.”

The former House Democrat is not a face of the progressive movement, but his nomination drew praise from the left, which pointed out that he is a supporter of “Medicare for All” and has taken some aggressive stands against the pharmaceutical and hospital industries. 

Republicans were much less thrilled, and his confirmation could be a battle.

“I think he’ll be controversial, to state the obvious,” Sen. John Cornyn (R-Texas) told reporters Monday. “I think most of us feel like there should be some deference in the president-elect’s choice for his Cabinet, but some of these folks are pretty radical.”

“He’s seen as very partisan,” said a Senate GOP aide. “The abortion stuff will be an issue. All the political lawsuits too.”

The aide added that Becerra’s support for Medicare for All is likely to “come up as part of a broader criticism that he’s too far left.”

Becerra, who would be the first Latino HHS secretary, is notably not a doctor or infectious disease expert.

Biden did announce a range of other positions on Monday more specifically aimed at fighting the pandemic, including Vivek Murthy, who would return to his previous role as surgeon general after advising Biden during the campaign, and Rochelle Walensky, chief of infectious diseases at Massachusetts General Hospital, to be director of the Centers for Disease Control and Prevention. Jeff Zients, who helped fix healthcare.gov in the Obama administration, will be coronavirus response coordinator. 

Rep. Judy Chu (D-Calif.), the chair of the Congressional Asian Pacific American Caucus, on Monday called on Biden to elevate Murthy’s role as surgeon general to a Cabinet-level post, saying there should be a doctor in the Cabinet.

“With the announcement this weekend that my friend and former colleague Xavier Becerra will be nominated to be Secretary of Health and Human Services, one thing is clear: there will not be a medical and public health expert in the cabinet during a pandemic that has left over 280,000 Americans dead and is still out of control,” Chu said in a statement. 

Progressive Rep. Ro Khanna (D-Calif.) praised the pick and put an emphasis on Medicare for All, tweeting that Becerra “supported Medicare for all, has stood up to pharmaceutical companies, and can work to give states federal waivers for single payer systems.”

“He is a strong choice and has always worked well with progressives,” Khanna added.

Becerra, who first joined the House in 1993 before leaving at the start of Trump’s term to become California attorney general, has long supported Medicare for All, something Biden opposes in favor of an optional government-run plan.   

“I’ve been a supporter of Medicare for All for the 24 years that I was in Congress,” Becerra told Fox News in a 2017 interview. 

Becerra could use waiver authority included in the Affordable Care Act to allow states to implement Medicare for All plans or a public option.

“I could certainly see Secretary Becerra and the Biden administration giving states flexibility to implement a single-payer plan, or even more likely, a public option,” Levitt said. 

Becerra has also given progressives something to cheer for by advocating that the federal government use a power known as “march-in rights” to break the patent on high-priced drugs and allow them to be produced by third-parties for a lower price, a drastic power to lower drug prices that even the Obama administration declined to use. 

Andy Slavitt, the former administrator of the Centers for Medicare and Medicaid Services (CMS) under former President Obama, downplayed Becerra’s support for Medicare for All and march-in rights to lower drug prices, noting he will still be serving under a President Biden. 

“He’s going to be working for Joe Biden,” Slavitt said. “Joe Biden’s policy views prevail.”

Slavitt said Becerra is a strong pick because the role does not necessarily need a health policy expert, but a good manager. 

“You don’t lack for expertise,” Slavitt said, pointing to the heads of a range of health agencies within the department. “You have to be able to manage very strong leaders.”

Slavitt said when he was CMS administrator, Becerra would often call him to check in and see what he needed help on. 

On a different front, Becerra has also helped lead litigation against abortion-related rules from the Trump administration, including a rule to cut off federal family planning funds under the Title X program from clinics that provide abortions or that refer patients for abortions. 

Susan B. Anthony List, an anti-abortion group influential on the right, called for Republican senators to “stand firm and stop this unacceptable nomination from going forward.”

Becerra has deep relationships with Congress given his years as a lawmaker. 

He had spent much of his time in Washington focused on climbing the House leadership ladder. He chaired the Congressional Hispanic Caucus, then later served as vice chairman and chairman of the House Democratic Caucus, where he burnished a reputation for cultivating colleagues and reporters alike.

But Speaker Nancy Pelosi’s (D-Calif.) decision to stay put after Democrats’ disastrous 2016 election cycle meant Becerra, like a lot of young, ambitious Democrats, had nowhere to rise in the House. So Becerra rolled the dice, accepting the attorney general appointment and trading Washington for Sacramento.

In addition to his tough stance on the pharmaceutical industry, Becerra as attorney general also took on another powerful industry, hospitals, suing and reaching a settlement with Sutter Health, a major California hospital system, for anti-competitive practices that he said drove up costs. 

“If I were hospitals or drug companies with high prices, this pick would not give me comfort,” Levitt said.

Jordain Carney and Scott Wong contributed.