Why Biden chose California's attorney general to be Health and Human Services secretary

Some Republicans are questioning President Biden’s nomination for secretary of Health and Human Services (HHS), Xavier Becerra, since he isn’t a doctor or someone with a robust health care background.

"I'm not sold yet," Senate HELP Ranking Richard Burr (R-NC) told Becerra on Tuesday. "I'm not sure you have the necessary experience or skills to do this job at this moment."

Only one HHS secretary in the 21st century has had an MD, Dr. Tom Price, (though Price is a member of a physicians group that is considered to put politics ahead of science), and several prominent experts told Yahoo Finance that Becerra is a high quality choice given his expertise of Affordable Care Act (ACA) aka Obamacare.

“He has been a leader on everything from expanded insurance coverage access to high-quality health care,” Kathleen Sebelius, HHS secretary from 2009 to 2014, told Yahoo Finance. “He is one of the foremost experts I would say in the country on the Affordable Care Act, both in its design features and then defending the law in court. But he’s also done lots of important work for children and families and immigrant children, which was one of the areas of great concern when he served in Congress.”

Becerra served in the House of Representatives from 1993 to 2017 before moving on to the role of California’s attorney general. His nomination comes at a time when the fate of Obamacare is up to the Supreme Court, which is debating the constitutionality of the landmark health care bill after a Texas judge declared it unconstitutional back in December 2018.

“His defense of the Affordable Care Act is the most notable item there, which likely means he’s going to continue to advocate for expansions of coverage,” Chris Meekins, Washington policy analyst at Raymond James, told Yahoo Finance. Meekins also noted that the choice of Becerra "regenerates a perception that most of the health care policy will likely be driven by the White House rather than the Department [of HHS].”

'So all-in on preserving and expanding the ACA'

Becerra served in Congress for 12 terms and was a senior member of the health subcommittee of the Ways and Means Committee. Upon being elected California's attorney general in 2017, he became a key defender of the ACA with his office frequently filing lawsuits (over 100) against the Trump administration, most notably the case of Texas v. California, which challenges the constitutionality of Obamacare.

“I would challenge the notion that he doesn’t have a health care background,” Sebelius said. “The policy work that he did for his constituents in his district often had to do with health care. He served on the Ways and Means Committee, which was one of the key jurisdiction areas over Health and Human Services. So he’s very familiar with the department and the budget.”

Larry Levitt, executive vice president for health care policy at the Kaiser Family Foundation, agreed with the assessment that Becerra's strength lies in his expertise related to Obamacare.

“It would be hard to find anyone in the country who has been so all-in on preserving and expanding the ACA,” Levitt told Yahoo Finance. “The setup as attorney general was the chief legal defender of efforts to overturn the ACA and the courts. So he’s well-steeped in all of the intricacies of the law, and it comes from a state that has been one of the most proactive in implementing the ACA from the start. So I think he’s certainly a good choice to reinvigorate the Affordable Care Act.”

Reinvigorating the ACA is a key part of Biden’s health care agenda, which some have dubbed “Bidencare.” Biden’s plan essentially builds upon Obamacare by filling holes in existing gaps like increasing subsidies, expanding Medicare eligibility, and potentially creating a public health care option.

Becerra “has been a leader on everything from expanded insurance coverage access to high-quality health care,” Sebelius said. “He is one of the foremost experts I would say in the country on the Affordable Care Act, both in its design features and then defending the law in court. But he’s also done lots of important work for children and families and immigrant children, which was one of the areas of great concern when he served in Congress.”

On his first day in office, President Biden signed an executive order opening a new “Special Enrollment Period,” which reopens access to the ACA marketplace but outside of open enrollment. His order gave Americans 90 days to find a health care plan.

“Bidencare is, in effect, a bigger and stronger ACA,” Levitt said. “There are some parts of Biden’s platform that are not part of the COVID relief discussions that will be controversial and probably hard to get passed, including a public option and lowering the age of Medicare eligibility to 60. But assuming Becerra gets confirmed, filling in the details of Biden’s larger health plan will probably be immediately on his to-do list.”

Priorities one, two, and three: COVID

The U.S. still isn’t out of the woods yet with the coronavirus pandemic, as the country just surpassed the 500,000 deaths threshold at the beginning of the week.

And while Becerra doesn’t come from a public health background, several experts agree that shouldn’t disqualify him from the HHS role. However, they concurred, addressing the pandemic should be among his main priorities upon being confirmed.

“COVID is certainly one, two, and three for President Biden and will be for Becerra if he’s confirmed as well,” Levitt said. “One area where President Biden has already placed some emphasis and could be a big priority for Becerra is addressing racial inequities in health care. There are some smaller programs within HHS targeted at racial disparities and there are some levers Becerra could use to push for a more equitable health care system. It’s already been a priority for the Biden administration and I would expect it to be for Becerra as well.”

The pandemic has revealed major disparities in the American health care system — the Black and Latino communities have been devastated by COVID-19. One study found that Black and Hispanic people accounted for nearly 60% of COVID-19 hospitalizations between January and July 2020.

Becerra hasn’t been shy about tackling health and racial inequities before. After he was revealed to be Biden’s HHS nominee, he tweeted: “As Secretary of Health and Human Services, I will build on our progress and ensure every American has access to quality, affordable health care — through this pandemic and beyond.”

“We’re in a unique time, a time when Latinos have been hit hard by the pandemic,” Levitt said. “Having the first Latino as secretary of HHS has important symbolic significance.”

Adriana is a reporter and editor covering politics and health care policy for Yahoo Finance. Follow her on Twitter @adrianambells.

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