Xavier Becerra: Get to Know Biden's Pick to Lead HHS
January 28, 2021
Photo by Gage Skidmore licensed under CC BY-SA 2.0
Joe Biden has nominated California Attorney General Xavier Becerra to lead the Department of Health and Human Services (HHS). We explore Becerra’s health policy record, what drives his views and what he could do about the country’s health care consolidation problem.
Listen to the full episode below, read the transcript or scroll down for more information.
Get to Know Him: Xavier Becerra
The Basics
Health Policy Record in Congress
Health Policy Record as California AG
Taking on Sutter Health as AG
What Can HHS Do About Consolidation and Competition?
As California’s attorney general, Becerra took a particular interest in addressing anti-competitive consequences of consolidation in health care, including his influential suit and settlement with Sutter Health.
Consolidation is a nationwide problem. Seventy percent of cities have highly concentrated hospital markets, according to the Health Care Cost Institute, and a large body of research has shown this kind of concentration raises prices without necessarily improving quality. The relatively few efforts to address this issue have come through antitrust lawsuits from states — including California, Pennsylvania, North Carolina and Washington — as well as the U.S. Department of Justice and Federal Trade Commission.
If confirmed to lead HHS, Becerra will not be able to file antitrust lawsuits, but experts say he will have other tools at his disposal to tackle the issue.
Rulemaking and Regulations
HHS is responsible for writing many of the rules that govern the U.S. health care system. Department veterans say HHS could use that authority to produce more pro-competition regulations around things like telehealth, site-neutral payments, price transparency and information sharing. HHS also runs Medicare, and the department could require hospitals to drop anti-competitive clauses from their contracts if they want to participate in Medicare. These kinds of changes would likely face pushback from industry as well as possible legal challenges.
Research and Analysis
The HHS secretary can use the department's Office of the Assistant Secretary for Planning and Evaluation (ASPE) to assess the competitive impact of proposed polices and produce external reports on the impacts of consolidation and market concentration on the health care system. The department can also share its research and knowledge of health care markets with the U.S. Department of Justice and Federal Trade Commission to assist their antitrust enforcement efforts.
Bully Pulpit
An HHS secretary focused on consolidation and competition could encourage the president to prioritize the issue, testify before Congress, submit briefs on relevant cases to the Supreme Court, provide guidance to states and speak directly to the American people about the topic. Scrutinizing consolidation and enhancing competition in health care are also tenets of conservative health policy, which could make the issue more likely to gain bipartisan support, especially compared to other administration health care priorities such as building on the ACA and expanding reproductive rights.
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Episode Resources
Select Reporting on Xavier Becerra:
Three cases show Becerra’s range of expertise in health policy (Richard M. Scheffler and Surina A. Khurana, CalMatters, 1/25/2021)
In Becerra, an HHS Nominee With Political Skill But No Front-Line Health Experience (Rachana Pradhan, Angela Hart, Julie Rovner and Jenny Gold; Kaiser Health News; 12/8/2020)
HHS role gives Xavier Becerra new tools to challenge healthcare consolidation (Tara Bannow and Rachel Cohrs, Modern Healthcare, 12/7/2020)
Becerra Supports ‘Medicare for All,’ and Could Help States Get There (Sarah Kliff, New York Times, 12/10/2020)
Select Research and Reporting on Hospital Consolidation:
The Train Has Left the Station (Tradeoffs, 10/30/2019)
Addressing Consolidation in Health Care Markets (Leemore Dafny, 1/28/2021, JAMA)
Provider Consolidation Drives Up Health Care Costs: Policy Recommendations to Curb Abuses of Market Power and Protect Patients (Emily Gee and Ethan Gurwitz, Center for American Progress, 12/5/2018)
California’s Sutter Health Settlement: What States Can Learn About Protecting Residents from the Effects of Health Care Provider Consolidation (Rob Waters, Millbank Memorial Fund, 9/23/2020)
Hospital Concentration Index (Health Care Cost Institute)
Examining the Impact of Health Care Consolidation (Martin Gaynor, Testimony Before U.S. House Committee on Energy and Commerce Oversight and Investigations Subcommittee, 2/14/2018)
Episode Credits
Guests:
Peter Lee, JD, Executive Director, Covered California
Richard Scheffler, PhD, Director, Nicholas C. Petris Center
Aditi Sen, PhD, Assistant Professor of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
Lanhee Chen, PhD, David and Diane Steffy Fellow in American Public Policy Studies, Hoover Institution
The Tradeoffs theme song was composed by Ty Citerman, with additional music this episode by Blue Dot Sessions.
This episode was reported, produced and mixed by Ryan Levi.
Additional thanks to:
Richard Frank, Meredith Rosenthal, Jaime King, Matt Fiedler, Martin Gaynor, Matthew Cantor, Anthony Wright, Glenn Melnick, Jane Delgado, Tim Gronniger, Jonathan Morse, the Pennsylvania Attorney General’s Office, Niall Brennan, Bill Johnson, Kevin Kennedy, Emily Gee, Joanne Adams, Melanie Fontes-Rainer, Renuka George, the Tradeoffs Advisory Board and our stellar staff!