Xavier Becerra’s future role in your family life
The California attorney general is expected to lead the Department of Health and Human Services, a massive department implementing policies affecting millions of families
His career has included providing legal services for low-income families, 24 years in Congress making law instead of applying it and, most recently, a stint as California’s attorney general, a role in which he often sued the Trump administration. Now Xavier Becerra is poised to take on a new challenge.
President Joe Biden has nominated Becerra, who turns 63 this month, to lead the U.S. Department of Health and Human Services. He would be the first Hispanic to head the department, particularly significant at a time when the coronavirus pandemic is hitting ethnic populations, including Hispanics, particularly hard. The role would put him atop a department that includes key federal health agencies, including the Centers for Disease Control and Prevention and the Food and Drug Administration.
Policy to end the pandemic and making sure Americans can be vaccinated quickly against COVID-19 are likely to capture a good share of Becerra’s attention following what is expected to be a quick confirmation.
Becerra was born in Sacramento, also his father’s birth place, though the senior Becerra was largely raised in Tijuana, Mexico. His mom was born in Mexico. After high school, Becerra studied abroad at a university in Spain for two years, then earned a bachelor’s degree in economics at Stanford, before earning his law degree there, according to his House of Representatives biography.
He married Carolina Reyes and they moved to Massachusetts so she could earn a medical degree at Harvard Medical School. She is a maternal-fetal specialist whose expertise includes complicated pregnancies and prenatal care. They have three daughters.
His family background is a thread running through many of the policies he’s championed during his long career in public service. He’s a champion of underserved populations and has a keen interest in immigration and health care policy. He also champions female reproductive rights, including access to birth control and abortion. From his earliest days in elected office, Becerra reportedly earned a reputation for listening to — and welcoming input from — those concerned about crime, health, taxes and education.
The book “Hispanic Americans in Congress 1822-2012,” produced by the U.S. House of Representatives, credits the fact he learned to play poker in high school for his ability to “read” people.
Becerra won a seat in the California Assembly at age 32. The Los Angeles Times at the time described him as “a quiet man with a boyishly sincere appearance.” In that role, he pushed successfully for longer sentences for gang crimes committed near schools.
He’s held powerful positions in Congress, including being the first Hispanic on the House Ways and Means Committee. He chaired the House Democratic Caucus. Becerra’s interest in economic issues, especially fiscal responsibility, served him well on the National Commission on Fiscal Responsibility and Reform and on the Joint Select Committee on Deficit Reduction.
He left Congress in 2017 for his current position as California’s attorney general. In that post, he’s sued the Trump administration on behalf of his state dozens of times over various policies. Ten different press releases came out of his attorney general office Jan. 19, the last full day of the Trump presidency, announcing California was joining or launching challenges of its own to Trump administration policies.
The New York Times called Becerra a surprise choice because he’d “carved out a profile” on criminal justice and immigration and was expected to be tasked as Biden’s attorney general — that nomination went to federal appellate court Judge Merrick Garland.
“I was surprised by his nomination, but he’s a great choice in my opinion,” said Shawn Fremstad, senior fellow at the Center for Economic and Policy Research. “My recollection is that he was generally very progressive on health care, welfare reform and other human services issues when he was in Congress.”
Fremstad predicts Becerra will be “much more activist/progressive than previous Democratic HHS secretaries — he’s a first-generation college grad, son of immigrant parents and California-style multicultural social Democrat, all of which strikes me as very different” from previous recent Democrats in the position. They include former Kansas Gov. Kathleen Sebelius under President Barack Obama and academic and later Congresswoman Donna Shalala under Bill Clinton.
The Biden administration says key issues it plans to address include health care access, establishing some control over drug prices, paid leave and child care assistance for low-income families. Becerra’s history suggests he largely agrees. But helping shape policy and directing its implementation is different than his experience in directly crafting legislation.
Health and Human Services is a massive department with close to a 100,000 employees, nearly a third of the national budget and more than 25 agency leaders that report directly to the secretary, said former Utah. Gov. Mike Leavitt, who was secretary of Health and Human Services when George W. Bush was president.
The position comes with some power and discretion, but the president is definitely the boss, he said. Just as he demanded loyalty of those he chose to serve as department heads when he was governor, Leavitt was expected to be loyal to the president and his priorities. But the position placed him in important discussions and allowed him to directly make a case for policies and ideas he thought important. He also shaped how things got done.
“I used to have a conversation with my cabinet members that went something like this: ‘I’m hiring you to run this department, but I want you to know that I expect you to be loyal. And I want you to know what I believe loyalty means,’” he said.
His definition? Using good judgment to run the department to the best of one’s ability while aligning with the administration’s philosophic underpinnings. Recognizing when decisions overlap departments and elevating discussions to include them. Speaking one’s view clearly but collaborating well when overlap occurs. And recognizing that the person who got elected — the president or governor — has final say.
Bush outlined his version of those points when he appointed Leavitt. It’s a sure bet Biden had that conversation with Becerra, Leavitt said.
He noted that anything substantial goes through a “significant process” involving multiple agencies and sometimes departments because of the nature of overlaps.
“The most scarce resource in government is presidential time,” said Leavitt. On important decisions, a lot of work goes into getting the issue to the point that the president would buy off on it.
Leavitt likens the White House to an air traffic control center with 50 planes in the air with emergencies, clamoring to land. “Unless there’s a way in which you can determine which ones really do need to land right now — or that are ready to land right now — you have chaos.”
Overlap is common. Paid medical and family leave fall under the Department of Labor, for instance, but strongly intersect with Health and Human Service work around early childhood and nutrition, among other connections, said Vicki Shabo, senior fellow for paid leave policy and strategy at New America. “So I think there’s also an important premium on interagency coordination and on making sure that policymaking doesn’t happen within silos, but really, you know, thinking holistically about whole people and whole families.”
Because of the sheer size of what must be managed, the most effective heads of this department have tended to be those who’ve managed large groups, said Tom Miller, a senior fellow at American Enterprise Institute. “The track record for HHS secretaries who’ve been governors or at least have some administrative background tends to be better.”
The incoming Biden/Harris administration announced “a very robust agenda around caregiving,” much of which will fall into Becerra’s jurisdiction, said Shabo — including a big investment in child care and long-term care and support, plus bolstering those work forces.
“I think that’s exciting because in Congress, Becerra was an advocate for children and for health care and has made very clear his commitment to both of those things. It will be exciting to see how (the department) meets the needs of millions of families across the country and deals with vast gender, racial and economic inequities,” said Shabo.
One Trump administration accomplishment was making paid parental leave a reality for many federal government employees. New priorities under Biden are predicted to include 12 weeks paid family leave for all American workers, funded by payroll tax. The time could also be used to care for an ill family member. That will overlap with policies and services under Becerra’s department and require him to join the conversations.
“I think that paid family and medical leave is at the top of everyone’s family policy list,” said Andrew Cherlin, sociologist and public policy professor at Johns Hopkins University. “Most federal workers have it now. Extending it to all workers is straightforward.”
Health looms large on the to-do list. Becerra has favored a public health option called Medicare for All, but Biden doesn’t. Predictions are that the administration will push to lower the age for Medicare to 60.
Other health priorities for Becerra will likely include strengthening the Affordable Care Act and adding a public option. A recent Gallup poll showed most Americans approve of the health care law. Kaiser Family Foundation said nearly 7 in 10 adults like the idea of a government-administered health plan option Americans could consider along with private insurance plans.
Efforts to curb drug prices and let people get prescriptions outside the country are likely, too.
“I don’t follow health care that closely, but getting something done on health care that is big and positive is going to be important to the Biden administration,” Fremstad said.
The welfare safety net may also get some repairs, he said. “Before his appointment, I would have expected very little to happen on Temporary Assistance for Needy Families, but he should be much more open/interested in making some fixes to what is now pretty obviously a badly broken program.”
Some experts hope for specific policy changes.
“Xavier Becerra should move to ensure that the government’s biggest program for low-income families, Medicaid, does not penalize marriage,” said W. Bradford Wilcox, Institute for Family Studies senior fellow. “Becerra should make sure that working families in America don’t have to choose between Medicaid and marriage.”
“Health equity is a critical cornerstone of people’s well-being, of children being able to thrive and to learn, of families having what they need to be able to have jobs. And so his commitment to that is important,” said Shabo, who’s anxious to see how Becerra and others tackle inequality.
“I also hope the administration continues to prioritize caregiving and caregiving infrastructure as a key pillar of economic recovery,” she said, noting studies suggest emergency paid leave during the pandemic, now expired, prevented many people from going to work and exposing others to COVID-19.
The administration will need to cross its fingers, too.
“At the start of every administration, people have big, broad agendas and think all things are possible,” said American Enterprise Institute’s Miller, who called the process of getting new policy or reversing existing policy or drawing up regulations “slow.” And it gets “jammed up with leftovers” like the pandemic and the challenge of trying to revive the economy and how to pay for it. “Those all fill the inbox,” he said. “And there’s more coming on that front, so this is not a time for massive decisive, bold action.”
It’s also tough to get legislation passed, even with Democrats holding slim majorities in both the House and the Senate, he added. And there’s existing legal challenges or those that might crop up.
“All that requires not only devotion of resources, but also people’s attention span,” said Miller, who predicts “more aggressive creativity on the regulatory-administrative side.
“I think what Becerra is going to learn is to get a good team around him,” Miller said, “who know how to work the process. ... The harder task is sorting through what’s most important to devote your time to, because not all things are possible.”