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

Picture of Xavier Becerra, President Joe Biden's nominee to be Secretary of Health and Human Services
California Attorney General and nominee for Secretary of Health and Human Services Xavier Becerra. (Photo courtesy of California Department of Justice)

The Basics

  • Served as California Attorney General since 2017
  • Represented Los Angeles-area district in Congress from 1993-2017
  • Grew up in Sacramento, California, as the son of Mexican immigrants
  • Would be first Latino HHS Secretary

  • Health Policy Record in Congress

  • Longtime supporter of single-payer health care
  • Helped craft and pass the Affordable Care Act as member of House Ways and Means Committee
  • Received $2.3 million in campaign contributions from health care interests, the second most he received from any sector
  • Health Policy Record as California AG

  • Led a coalition of 21 states in suit defending the ACA to the Supreme Court, as well as other ACA-related suits over birth control coverage exemptions, cost-sharing payments and nondiscrimination protections for transgender patients
  • Sued pharmaceutical companies over the opioid crisis and "pay-for-delay" practices
  • Actively enforced nonprofit hospital charity care requirements and sought to limit anti-competitive consolidation, including joining a lawsuit against Sutter Health (more in next column)
  • Taking on Sutter Health as AG

  • Sued Sutter Health in 2018 alleging the hospital giant illegally inflated prices after decades of buying up hospitals across Northern California
  • Brokered a 2019 settlement in which Sutter agreed to pay $575 million and stop using several anti-competitive practices
  • Settlement is a rare antitrust health care win for a state and is likely to influence other state actions on consolidation
  • Sought legislation to increase AG office oversight of health care mergers
  • 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


    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!