The Senate narrowly confirmed President Joe Biden's nominee to lead HHS on Thursday, with all but one Republican voting against Xavier Becerra, California's attorney general.
Becerra's nomination was one of the most contested out of all the Biden nominees, with Republicans and conservative groups arguing he is an extremist that lacks the healthcare experience necessary to lead the agency during a pandemic.
Democrats and healthcare industry groups stood by Becerra, pointing to his experience as a member of Congress where he helped write the Affordable Care Act and later as attorney general, where he defended the healthcare law in court.
"In my view, AG Becerra proved in his nomination hearing that he is ready to lead HHS, and he knows health policy inside and out," said Sen. Ron Wyden (D-Ore.), chairman of the Senate Finance Committee. "That shouldn't have been any surprise, because he's got decades of valuable leadership and policy experience that will help him succeed in this job."
Becerra is also a supporter of abortion rights, making him a non-starter with most Senate Republicans. He was an ardent opponent of the Trump administration, filing more than 100 lawsuits against the former president's regulatory policies, including several involving healthcare and abortion. Republicans also noted that Becerra is not a doctor, though most HHS secretaries have not been. The last HHS secretary Alex Azar, nominated by President Donald Trump, had most recently worked for Eli Lilly, one of the world's largest drug companies.
"As a doctor, I'm deeply concerned President Biden has nominated someone with no medical or public health experience," said Sen. John Barrasso (R-Wyo.)on the Senate floor Thursday. "He's not a doctor, not a scientist, not a public health official. He's a trial lawyer and a career politician."
Becerra's record as attorney general shows a desire to hold powerful healthcare interests accountable, which could put him at odds with the industry as HHS secretary.
He filed legal challenges against hospital consolidations, which research shows lead to higher costs for patients, and sued pharmaceutical companies for allegedly fixing the prices of generic drugs.
Still, his nomination was supported by powerhouse groups including the American Medical Association, the American Hospital Association and America's Health Insurance Plans. PhRMA, a trade group that represents branded drug companies, has remained silent.
As HHS secretary, Becerra will play a large part in the COVID-19 response, including managing the Provider Relief Fund, a program passed by Congress that helps providers and hospitals weather the financial difficulties of the pandemic. HHS also recently reopened HealthCare.gov for a special enrollment period. Becerra is also likely to pursue regulations that address health equity, given the pandemic's disproportionate toll on communities of color.
HHS will also need to implement surprise billing legislation Congress passed last year. Becerra also indicated he will strictly enforce transparency rules issued by the Trump administration that requires hospitals publish the rates they negotiate with insurers.