Becerra Sets New Course as HHS Secretary After Senate Confirmation

Expanding access to health care is a top agenda item

Stephen Miller, CEBS By Stephen Miller, CEBS March 22, 2021
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Becerra Sets New Course as HHS Secretary After Senate Confirmation

​Xavier Becerra, former California attorney general, was sworn in as President Joe Biden's secretary of Health and Human Services (HHS) on March 19, a day after the U.S. Senate confirmed his appointment in a 50-49 vote. Sen. Susan Collins, R-Maine, was the only GOP senator to vote in favor of Becerra, who becomes the first Latino HHS secretary.

Prior to being California attorney general, Becerra served 12 terms in Congress representing downtown Los Angeles and was a member of the House Ways and Means Committee.

As HHS secretary, he will lead an agency with close to a $1.4 trillion annual budget. HHS is at the forefront of the administration's COVID-19 response and will pursue an agenda that includes expanding the scope of the Affordable Care Act (ACA) and taking regulatory actions to lower drug costs and reduce racial disparities in medical care.

A New Direction

"The Becerra-led HHS team will enact changes that advance its center-left philosophy," wrote Paul Keckley, editor of The Keckley Report, a health care industry newsletter.

Among the issues Keckley expects Becerra to tackle are:

  • Telehealth access, which expanded during the pandemic but "studies have shown limited access to telehealth services in low income and under-insured and rural populations," Keckley reported, "so policy solutions that address discriminatory access while mainstreaming telehealth and virtual care into coverage will be prominent in Becerra's HHS oversight."
  • Increasing access to affordable coverage, which "forces tension between private insurers and proponents of government run health care," Keckley wrote. "The Becerra HHS will execute a full-court press to expand Medicaid coverage while cautiously developing its public option plans." He added that "creating health insurance that's affordable [and] providing timely access to needed health and well-being services is the nut that has to be cracked by the Becerra team."

Biden's campaign had stated, "Whether you're covered through your employer, buying your insurance on your own, or going without coverage altogether, the Biden plan will give you the choice to purchase a public health insurance option like Medicare." The Democrats' narrow advantage in the Senate, however, may temper more ambitious efforts in favor of incremental regulatory change, at least for now, health industry experts believe.

Families USA, which advocates national and state efforts to expand health care coverage, supported Becerra, writing he had "dedicated his career to fighting for improved health equity … and ensuring every person in America has affordable access to high-quality health care." Among Becerra's critics, Sam Adolphsen, policy director at the Foundation for Government Accountability, which favors increasing consumer health coverage options, wrote that his appointment "seems to be more about his political prowess and determination to turn back the pages of President Trump's health care reforms."

Employer-Sponsored Coverage

The Society for Human Resource Management's (SHRM's) public policy priorities include workplace health care. As such, SHRM works with the agencies responsible for health care oversight including HHS and the Departments of Labor, Treasury and the IRS.

"SHRM and our members look forward to working with you and your agency to develop public policies to support employer-sponsored health coverage and to ensure Americans have access to affordable and quality care," wrote SHRM President and CEO Johnny C. Taylor, Jr., SHRM-SCP, and Emily M. Dickens, SHRM chief of staff, head of government affairs and corporate secretary, in a March 22 congratulatory letter to Becerra.

"Employer-sponsored coverage has been the backbone of our nation's health system for nearly eight decades, providing access to care to more than 181 million Americans," Taylor and Dickens wrote. "As HHS pursues health policy solutions and develops regulations to help our nation recover from the pandemic, SHRM and our members can serve as a resource to you and your team."

Regulatory Disputes

Below are positions Becerra has taken that could affect employer-provided health care.

Association Health Plans

Becerra joined a coalition of 12 attorneys general to block the previous administration's rule that, if implemented, would allow small businesses to band together through association health plans to provide large-group market health insurance to their employees, thereby avoiding some of the regulatory requirements that individual states and the ACA impose on small-group market plans. For instance, more factors are allowed to be considered in calculating large-group insurance rates than small-group rates.

Becerra charged that the regulations would remove critical consumer health care protections under the ACA.

In November 2018, the Society for Human Resource Management joined an amicus brief in support of the association health plan rule. The brief argued that the rule "promotes economies of scale and administrative efficiency for small businesses" that are seeking to offer health care coverage to their employees.

The Court of Appeals for the District of Columbia Circuit has not yet ruled on the validity of the rule.

Short-Term Health Plans

Becerra opposes allowing insurers to sell short-term, limited duration health plans that provide coverage for up to three years. These plans don't cover all services and treatments required by the ACA and cost less than ACA fully compliant plans.

Last year, a district court judge in Washington, D.C., dismissed a lawsuit challenging a Trump administration rule that expanded the scope of short-term health plans sold on the individual health insurance market from three months to three years.

Becerra said the rule "would flood the market with stripped-down, junk health insurance plans that don't provide the reliable, comprehensive coverage families need when an emergency occurs, leading to bankruptcy."

Some see short-term plans as a low-cost alternative to COBRA coverage for employees who find themselves between jobs.

"Short-term plans can be an affordable solution to fill gaps in coverage," said Jeff Smedsrud, CEO of Pivot Health, a provider of low-cost health insurance alternatives. "New employees typically have a 90-day waiting period before insurance coverage begins or have an extremely expensive COBRA option when they leave a job. That's when short-term health plans, which are structured like major medical health plans, can provide coverage and save consumers about 50 percent or more when compared to ACA plans."

Contraception and Abortion Coverage

Becerra opposed final rules issued by the Trump administration that exempt certain employers from the ACA's contraceptive mandate, which requires coverage of drugs some view as inducing abortion, if the employer's opposition is based on religious or moral grounds. "More than 62 million women have benefited from the Affordable Care Act's birth control coverage over the last decade," Becerra said. "We will continue to fight to keep health care decisions between women and their doctors, not their employers."

The Washington Post reported, "When the administration issued rules in fall 2017 to broaden exemptions to the ACA's requirement for employers to cover contraception, Becerra was one of several state officials and interest groups to swiftly file complaints in federal court."

In July 2020, the Supreme Court upheld the rules allowing private employers with moral or religious objections to deny women ACA-defined contraceptive coverage. The 7-2 decision was rendered in Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania.

Becerra also defended California's authority to require employers to cover abortion procedures.

Related SHRM Article:

What's Ahead for Health Care Under Biden?, SHRM Online, November 2020

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