President-elect Joe Biden’s first round of selections for his health team clarified how the incoming administration will approach the COVID-19 pandemic and other health care issues, which were major themes of his campaign.
Biden introduced the team to the public at an event Tuesday, a day after formally announcing his selections. At the helm would be Xavier Becerra, the California attorney general who is the nominee for Health and Human Services secretary. Biden also said he would nominate Rochelle Walensky as director of the Centers for Disease Control and Prevention and Vivek Murthy as the surgeon general, as well as other officials who would focus on the pandemic from the White House.
Georges Benjamin, the executive director of the American Public Health Association, told CQ Roll Call that Biden’s selections reflect the array of issues a health secretary and other officials would need to address — not just COVID-19, but also opioid addiction, obesity, health insurance and gun violence, to name a few.
“The health system in the U.S. has enormous issues that have to be addressed,” he said. “What the president-elect has to do is put together a team that can deal with all those things comprehensively, but the most pressing issue right now is COVID.”
Benjamin said his organization has briefed the Biden transition team and urged them to clearly define each role and build a command structure so the different players all know how to work together efficiently.
Jeff Zients, whom Biden tapped as the coordinator of the COVID-19 response, addressed the need for coordination and efficiency, saying his role would focus on execution and empowering the other health officials to use their expertise.
At the event, Biden outlined three goals to slow the pandemic during the first 100 days of his term. He said he would sign an order mandating wearing a mask wherever he could, including in federal buildings and interstate travel on planes, trains and buses. He said the administration would ensure 100 million vaccine shots are given in that period, and prioritize reopening as many schools as possible and keeping them open.
Speaking separately at a Wall Street Journal CEO Summit on Tuesday, Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases who will also serve as Biden’s chief medical adviser on COVID-19, said he expects to advise Biden on vaccines and therapeutics and pandemic-related public health guidance, as well as continue to communicate that guidance to the public. Fauci also appeared via a pre-taped video at the Biden team event.
Biden has yet to announce his intent to nominate officials for other key health positions, such as the Centers for Medicare and Medicaid Services administrator and the Food and Drug Administration commissioner. He said he would also soon announce officials to oversee distribution of a vaccine, testing and the medical supply chain.
Becerra’s potential agenda
Speaking from California during the Biden transition team event Tuesday, Becerra noted the role that HHS played in President Lyndon B. Johnson’s Great Society, when the Medicare and Medicaid programs were established and civil rights were expanded.
“Now it’s our turn to discover the breathtaking opportunities before us in the midst of this hardship and pain,” he said.
“At HHS, tackling pandemics, saving lives, keeping us healthy should be our calling card. And we won’t forget that there is a second H in HHS: The human services. The work we do for our children, seniors and disabled,” he added.
Becerra has faced criticism from Republicans for his progressive positions and his decades of experience as a former congressman and an aggressive attorney general who led dozens of lawsuits against the Trump administration. Some physicians and health care professionals also were frustrated that Biden did not choose someone with medical training in the midst of a global pandemic.
Kathleen Sebelius, a former HHS secretary during the Obama administration, defended Becerra’s experience, saying at a separate event Tuesday that she’d put his background and health care portfolio up against any other HHS nominee’s. She said his time running the California attorney general’s office prepared him to oversee the sprawling network of agencies he would oversee as HHS secretary.
She noted that the last trained doctor to lead HHS, former Georgia Republican Rep. Tom Price, resigned over a scandal after less than a year.
“I don‘t think a medical background, per se, in the profession makes one an appropriate health secretary,” she said.
Becerra used his role as state attorney general to challenge many Trump administration policies in court, including defending the 2010 health care law when the administration took the rare stance of declining to defend a federal law. If confirmed, Becerra would be in charge of reversing several Trump administration policies and enacting policies that would expand health insurance coverage.
The Biden administration is likely to reverse several Trump administration policies, with some changes easier to enact than others. The administration could likely quickly expand outreach and consumer assistance under the 2010 health law and issue new guidance to states considering waivers in Medicaid and for the health law, said Larry Levitt, Kaiser Family Foundation executive vice president for health policy, in an interview.
Other changes would require new regulations and could be tricky politically. Democrats oppose a Trump administration rule expanding how long people can maintain short-term plans and call that type of insurance “junk plans.” But the administration may not want to kick people off those plans abruptly.
“Particularly when you think back to President Obama’s initial pledge with respect to the ACA of allowing people to keep their plans, it may be tough to end short-term coverage for people who have already bought those plans,” Levitt said, using the acronym for the health law.
Rep. Donna E. Shalala, D-Fla., a former HHS secretary, said the Biden transition team is already evaluating current policies to change.
“They’re identifying policies that need to be reversed immediately, both by the president as well as by the secretary,” she said.
Path to confirmation
Becerra could face a Republican-controlled Senate in his bid for confirmation, depending on the outcome of two Jan. 5 runoff elections in Georgia.
Sen. Tom Cotton, R-Ark., said in a Tuesday interview with Fox News that Becerra’s support for a single-payer Medicare for All system, his stance on abortion and his enforcement of pandemic lockdowns in California were reasons not to support the nomination.
“Xavier Becerra will be Joe Biden's nationwide lockdown enforcer. The Senate ought not to confirm him,” Cotton said.
Sen. Mike Braun, R-Ind., a Health, Education, Labor and Pensions Committee member, also questioned Becerra’s support for Medicare for All, as well as campaign donations the former congressman received from the health care industry and his abortion position. Sen. John Cornyn, R-Texas, said Republicans would give some deference to Biden to pick his cabinet, but called Becerra a “radical.”
Other Republicans, however, have been less hostile. Sen. Susan Collins, R-Maine, a moderate and HELP Committee member, said she did not know Becerra but did not say she opposed his nomination.
“I don’t know him at all. I was surprised that it wasn’t an individual that had a health care background,” she said. “I think he was a member of Congress before he was AG, but our paths just didn’t cross.”
Sen. Bill Cassidy, R-La., also a HELP Committee member and a Finance Committee member, also questioned Becerra's health care experience, telling CQ Roll Call "there's some advantage of somebody having some background in health care."
Still, he said he wouldn't fight the nomination and wouldn't commit to voting for or against Becerra's confirmation.
Shalala said she hoped that once Becerra began conversations on Capitol Hill, Republicans would soften on their initial opposition. She said when she was first announced as former President Bill Clinton’s pick for HHS, Republicans said she was unconfirmable, but ultimately she was confirmed nearly unanimously.
Sebelius said quickly confirming Biden’s pick for HHS secretary is “a life-or-death issue,” during the pandemic.
“To leave critical positions vacant over political piques makes no sense,” she said.