Health and Human Services Secretary Xavier Becerra, the first Latino to head the powerful, sprawling bureaucracy, often quotes his mother: “It’s better to prevent than to remedy.” The former California attorney general and 12-term House member applies that philosophy when it comes to implementing and enforcing policy, while ensuring such efforts hold up to legal challenges.
During a sit-down with Modern Healthcare Thursday, the second anniversary of Becerra taking his Cabinet post and the 13th anniversary of the Affordable Care Act, he said his style is “pushing the envelope” as far as possible.
Becerra, 65, came to HHS amid the COVID-19 crisis and as the department and its agencies were gearing up to carry out President Joe Biden’s agenda and respond to significant new healthcare legislation. “It’s not just sitting there and watching the work happen. It’s making a difference and that’s what you want to have the chance to do,” he said.
What has your time leading the department been like, and what have you learned?
We didn’t have a choice but to jump into the swirling, raging waters of COVID in 2021. You absolutely hit the ground running … You had to learn how to run right away, because people were dying and we needed to save lives. Looking back at these two years: nearly 700 million shots in the arms of Americans from COVID vaccines. … Today, while COVID is still with us, we’re able to work, go to school, play, enjoy our families, because we know how to protect ourselves. In the process of not only managing COVID, we also found a way to increase the number of Americans who have health insurance coverage, so that they can go see a doctor or make it to the hospital without going bankrupt. And today, there are more than 300 million Americans—again, historic numbers—who have access to healthcare because they’re insured. The uninsured rate has dropped to a low of 8%. … That’s still 8% of the public that doesn’t have insurance, so that’s why we still have work to do. But you can see that in the midst of a pandemic, in the midst of real challenges, the president and his team—we’ve been able to do quite a bit when it comes to healthcare. We are expanding our reach when it comes to behavioral health. The president made it very clear: We have to do far more to deal with mental health and we need to deal with the scourge of drugs. There’s a lot that we’ve been doing. What I would say is: If I had to look back at these two years, we’ve been busy.
How does your experience as an attorney influence your approach to the job in terms of carrying out President Joe Biden’s agenda, and of balancing the need to enforce the rules while promoting access to care?
It helps to have that background in order to push the envelope, because passing the Affordable Care Act in 2010 was pushing the envelope. Implementing a $35 a month cap on insulin is pushing the envelope compared to where we were. That’s where I think it helps to have not just probably the best team around when it comes to healthcare knowledge and healthcare experience, because we have some of the best scientists, doctors [and] medical professionals working at HHS, but also then having had the experience as a legislator and knowing how to get a bill, a proposed law, across the finish line. And then, as an attorney, knowing how to protect that law in court. …
What’s coming up on the department’s regulatory agenda?
We want to continue to move towards mental health parity, so that mental health will be treated the same way as physical health, so that we can ensure that if you have insurance coverage, when you go get treated for depression, you will get the same type of access and coverage as if you were going in to care for a broken bone. …
We have to continue to work on the Medicare program because the president wants to keep it strong for the next generation. We constantly are working on regulations that will help make sure that we place every dollar that a taxpayer has paid through their FICA deductions to their paycheck, as much of that as possible, goes to actually provide care once they are in the Medicare program versus than just let middlemen skim off money off the top and make a profit.
We have work to do to ensure that the Medicaid program is working well for every state. One of our major undertakings now will be to ensure that with the wind-down of the public health emergency, that a lot of those folks who are receiving healthcare through the Medicaid program don’t lose their coverage and we help them find good coverage. That’s why we continue to work on the Affordable Care Act and extend the coverage. One of the things that we have done is, for example, we are maintaining a special open enrollment period for people who may end up losing their healthcare coverage, whether under Medicaid or some other reason because of the public health emergency wind-down. That way, they can enroll as soon as they find out versus having to wait until there’s an open enrollment at the end of the year.
Those are the kinds of things that we will continue to do. Certainly, we have to issue regulations to put into vigorous effect the No Surprises Act, which keeps Americans from getting surprise medical bills in the mail. We have to continue to implement provisions like our over-the-counter hearing aids, so that people know that they can get affordable hearing aids that are quality, instead of having to go through some kind of specialist to get those hearing aids. … We still have to continue to do the work to provide the care and protection that unaccompanied children who are coming across the border deserve—a child is a child. There have been recent stories about how certain companies are employing them at the unripe age of 12 and 13. What can we do as a government to ensure that no child is being exploited?
We have a lot to do. We will continue the work that the president has tasked us with and, most importantly, continue to thank the people day in, day out at HHS who continue to perform so admirably.
What made you decide to return to Washington after your time in the California government?
When you don’t grow up with a whole lot, you don’t mind pushing the envelope to see if you could get a little bit more. … I [was] the attorney for the largest state in the country. And now I get to be the secretary for health for the entire country, not just one state. The order of magnitude is so great, what you do. I thought I had a big budget when I was attorney general, and it was over a billion dollars. My budget at HHS is $1.8 trillion. Those dollars go into trying to provide healthcare, so you can make a big difference. The opportunity to make the biggest difference possible is what has always driven me. That’s why I left the state Assembly to go to Congress. That’s why I left Congress to become the attorney general and that’s why I left the attorney general’s office to become the secretary of health and human services.
What sort of drives me to want to do that? There’s so much that I know we still need to do. The beauty is, as secretary here, I’m getting to see us doing it. Not only did we break records in the number of people who are getting their healthcare insurance through the marketplaces and Obamacare, but we made sure that we reached out to communities that have often been left behind. …
What does being the first Latino HHS secretary mean to you?
I have the privilege of being the first in my family to get a four-year college degree. The first in my family to become a professional with a graduate degree, the first in my family to get elected to office, the first in my family to meet a president of the United States. … Why should I be the first and only one? What you want to do is open the door so others can go, and that’s what you do. The day I had an opportunity to introduce my parents to the president of the United States, that’s when you realize how important it is to make a difference because would a man with a sixth-grade education, who spent his life working with his hands, and a mother who didn’t come to this country until she was 18 from Guadalajara, Jalisco, Mexico—would they believe that they would have a chance to meet the president? … Maybe for some people it’s not that big of a deal, but for someone like my parents, it’s huge. …
My sense is that, when I get to be secretary or attorney general or congressman, there’s a kid that was just like me, who’s never had a family member go to college, who says, “Hey, that Xavier Becerra, I could be just like that.”
That’s what you want—to open those doors. But you don’t do that unless you push the envelope.