Xavier Becerra Has Been Confirmed. What Does That Mean For Health Care In America?
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This story is part of a series on the new Biden administration and what Biden has planned for his first 100 days—and beyond.
Xavier Becerra, confirmed by the Senate on March 18 to serve as the Secretary of Health and Human Services, has long supported expanding health care in the U.S. But could he lead reform that gives America’s 28.9 million uninsured access to health care?
Becerra had a pivotal role in helping to draft the Affordable Care Act (ACA) during his 12 terms in the House of Representatives representing California. And as California’s attorney general, Becerra led a coalition of 20 states and the District of Columbia to protect the ACA against the Trump administration’s efforts to dismantle it.
Read more on Biden’s first 100 days:
However, while Becerra has fought to protect the ACA, he has expressed that he wants to see a single-payer health care system—commonly called Medicare for All—established in the U.S.
“For me, health care is a right,” he said. “I’ve been a single-payer advocate all my life,” Becerra told Kaiser Health News in Feb. 2019.
Becerra was narrowly approved by the Senate, in a 51-49 vote that was split along party lines. Those who approve of Becerra for the job say that his willingness to fight for a national health care system, combined with his extensive background working with lawmakers, is exactly the combination that can help advance Biden’s national health care plan.
However, critics of Becerra’s nomination have argued that he lacks the direct health care experience to do the job, and that Medicare for All isn’t the right path for American health care.
So What is Medicare for All?
At its core, Medicare for All is a single-payer health care system, run by the federal government. ProPublica defines it as “a system in which a government entity reimburses doctors and hospitals at a set rate.” It would eliminate all private health insurance.
The concept of a centralized government-funded health care system for all Americans isn’t a new idea. It first arrived in Congress in 2003, when Rep.
John Conyers (D-MI) introduced a single-payer health care bill called the Expanded and Improved Medicare For All Act.
However, the bill didn’t gain much traction with legislators, many of whom felt that the sweeping changes it proposed were too costly to implement.
In recent years, the Medicare for All idea has been resurrected, and has gained significant momentum.
The Kaiser Family Foundation, which has been tracking public opinion on single-payer national health care plans, found a notable increase in the number of people who support the idea of the government doing more to help provide medical insurance. In just two and a half years, support rose from 74% of those polled in Nov. 2016 to 85% in Jan. 2019.
Sen. Bernie Sanders (D-VT) has been the one of the most vocal recent proponents of Medicare for All, making it a central part of his two presidential campaigns (the Democratic primaries in 2016 and 2020).
In April 2019, Sanders introduced the Medicare For All Act.
It wasn’t broadly popular and didn’t have bipartisan support, but Sanders is often credited with pushing the Democratic party further left on health care—and his influence is visible in President Biden’s health care plans.
But Sanders and other Democrats didn’t push Becerra on Medicare for All at the nominee’s confirmation hearing last month, instead focusing on what Becerra would do to support Biden’s efforts to strengthen the ACA.
How Medicare for All Might Work
A Congressional Budget Office (CBO) analysis in 2020 found that Medicare for All would dramatically increase federal government spending—but health care providers and patients would pay less, and it would make health care coverage nearly universal. The government would ly have to raise taxes in order to pay for a Medicare for All-type program.
For-profit health care providers, your dentist or primary care physician, would ly take a substantial financial hit if all medical services in the U.S. were run by the government.
This is one of the reasons the American Medical Association, many of whose constituents may stand to lose some profits under a non-privatized system, has a long history of lobbying against a federally subsidized health care system.
However, Medicare for All is only one of the options being considered for health care coverage expansion; the public option is the other, and this appears to be the path Biden favors.
In late 2020, Biden proposed his own version of health care reform, called Bidencare, which aims to improve on the Affordable Care Act. Un Medicare for All, Bidencare aims to provide universal health care through a mix of public and private options rather than one centralized government entity.
Becerra’s progressive background means he’s well-versed in the minutiae of the policies that Biden seeks to iterate in his plan. And his legal battles to preserve the ACA from the Trump Administration’s attempts to dismantle it prove he knows the nuts and bolts of health care policy legislation.
“I think he has a lot of health care experience of a certain type and he’s shown himself to be a real advocate of cost containment,” says Katherine Hempstead, senior policy adviser for the Robert Wood Johnson Foundation, a nonprofit health care advocacy organization.
What Could Happen Under Becerra
As secretary of Health and Human Services, Becerra may use his position to influence health care legislation issues he has championed in the past, importing prescription drugs from countries where the price is lower and issuing waivers to states so they can create their own Medicare for All systems.
But with an evenly split Senate and fierce division between Democrats and Republicans in Congress, it’s uncertain how much progress the incoming secretary may be able to affect.
“What we could see from his role if [Becerra’s] confirmed is some change in the structure allowing the states to organize at the state level,” said Michael Urban, a senior lecturer and director of the Doctorate of Occupational Therapy Program at the University of New Haven, prior to Becerra’s confirmation hearing. “He’s a strong advocate of equality of access and trying to remove these inequities.”
Widespread and more affordable health care is a crucial issue now for millions of Americans who may require more medical oversight, or who have lost their jobs and subsequently their health insurance in the wake of the pandemic. Becerra’s history of successfully seeking to improve both the affordability of health care and expanded access may make it easier to get new legislation as Biden plans to expand Obamacare.