What a Becerra HHS Administration Could Mean for the SLED Healthcare Market

Published: December 22, 2020

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California Attorney General Xavier Becerra is President-elect Joe Biden's pick to run the Department of Health and Human Services. Becerra is expected to focus on healthcare expansion, the opioid epidemic, and long-term care services.

President-elect Joe Biden recently announced he would nominate California Attorney General Xavier Becerra to lead the Department of Health and Human Services. The pick was surprising to many, as Becerra has never served as an executive or administrator running public health programs, managing patient care, or controlling the spread of disease. Before serving as California’s Attorney General, Becerra spent twelve years in the U.S. House of Representatives, representing Downtown Los Angeles.

Becerra was likely picked because of his legal background. As attorney general, he has filed over 100 lawsuits against the Trump administration, ranging from issues of healthcare to immigration to gun control. If the Biden administration is unable to work with Congress to make major healthcare policy changes, Becerra’s background could be helpful in making those changes through regulations instead.

As HHS Secretary, a major goal for Becerra will be to expand healthcare access and fortify the Affordable Care Act. During his time both in Congress and as attorney general, he has worked to uphold the 2010 healthcare law, including leading a coalition of states to defend it during its current Supreme Court battle. Becerra’s allies see his upcoming tenure as HHS Secretary as a crucial opportunity to reverse many of the Trump administration’s healthcare policies. One result of this approach would be to strengthen Obamacare’s insurance marketplaces. At the state and local level, this could lead to the expansion of state-based exchanges. In 2020, there were only 13 state-based exchanges, but potential new funding could lead to more states implementing this model.

Becerra is also expected to reverse other Trump administration policies on reproductive health, refugees, and safety net programs like Medicaid. Biden has supported Medicaid expansion under the Affordable Care Act and has proposed expanding the program to include more low-income Americans and immigrants, including those in states that have not expanded. Since Congressional action on this issue is unlikely, Biden and Becerra would need to implement a more targeted approach to expanding Medicaid coverage, such as revising waiver policies and extending the public health emergency. While these and other similar approaches could reduce the number of people uninsured, they could also increase state spending, placing more stress on already tight state budgets.

When it comes to expanding healthcare access, Becerra, like Biden, supports ‘Medicare for all’ and could use further waiver revisions to speed up such a transition. Under the new administration, it looks like states will have the opportunity to pursue more experimental and larger coverage expansions. But, the challenge will be how to pay for them, since the waiver process typically does not come with additional funding. Any extra dollars would need to come from states raising taxes or cutting something else in their budgets.

Becerra is also expected to carry out other Biden administration healthcare initiatives related to the opioid epidemic, the caregiving workforce, and nursing homes and long-term care facilities. During his campaign, Biden promised to end the opioid epidemic by expanding healthcare coverage and investing $75 million in flexible grants to states and localities for prevention, treatment, and recovery efforts. This funding could translate into business opportunities for providers and vendors in the healthcare market. Additionally, Biden has promised to support the caregiving workforce by immediately providing fiscal relief to state, tribal, and local governments to keep direct care and child care services running, and to keep workers employed. The president-elect has also promised to support nursing homes and long-term care facilities by providing them with resources to combat COVID-19 and by expanding access to home and community-based services for older Americans and people with disabilities.