SACRAMENTO 鈥� President-elect Joe Biden didn鈥檛 back 鈥淢edicare for All鈥� during his campaign.
Yet his choice of California Attorney General Xavier Becerra to serve in the nation鈥檚 top health care post is fueling California lawmakers鈥� most progressive health care dreams, including pursuing a government-run single-payer system at the state level.
鈥淣ow it鈥檚 much more real, and it energizes me in terms of pushing for single-payer now,鈥� said state Assembly member Ash Kalra (D-San Jose), who is considering spearheading a new single-payer campaign next year 鈥� a move he argues is more plausible under the Biden-Harris administration, with Becerra at the helm of the U.S. Department of Health and Human Services.
鈥淚t鈥檚 not good enough to just say that we believe health care is a human right. We鈥檙e now obligated to act,鈥� Kalra said.
Across California, Democrats are changing their political calculus for what could be possible if Becerra, 62, is confirmed to the powerful position. After nearly four years of battling President Donald Trump and federal policies they view as unfriendly, Gov. Gavin Newsom and other Democratic leaders welcome a strong ally who could help make California a laboratory for progressive ideas. He would set the agenda for key federal health care agencies, which have broad authority to steer more money to states and approve their ambitious health care proposals.
Becerra, whose mother emigrated from Mexico, would be the first Latino to serve in the position. He would lead a massive federal health care apparatus that oversees agencies responsible for Medicare, Medicaid, vaccines, prescription drug approval and the U.S. public health response to the coronavirus pandemic.
鈥淚t鈥檚 a game changer for us 鈥� the stale era of normalcy versus the fresh era of progress,鈥� Newsom said Monday. 鈥淲e鈥檙e going to take advantage of this moment and these relationships 鈥� not unfairly.鈥�
A native Californian with 30 years of political experience, 24 of them in Congress, Becerra has long backed a progressive health care agenda, including single-payer, justice and protecting immigrants鈥� access to safety-net care. He has fiercely defended the Affordable Care Act and fought to preserve reproductive rights. He has gone after deep-pocketed pharmaceutical companies, and successfully sued a large health system in California for .
Newsom said he鈥檚 already spoken to Becerra about California鈥檚 health care priorities and is 鈥渁ccelerating鈥� a dramatic transformation of the state鈥檚 Medicaid program to better serve the chronically sick and those suffering from untreated mental illness.
Immigrant advocates, who are deploying a new strategy to expand the state鈥檚 Medicaid program to all income-eligible unauthorized immigrants, plan to lobby Becerra and the Biden administration for additional federal money that could help fast-track it. They also want Becerra to agree to allow young unauthorized immigrants known as 鈥淒reamers鈥� to purchase insurance through Covered California, the state exchange. And California Senate President Pro Tem Toni Atkins said she鈥檚 鈥渆xcited鈥� to seek renewed approval to use federal Medicaid dollars for nontraditional uses, such as combating homelessness and providing emergency housing assistance.
鈥淲e鈥檝e had a lot less money to bank on under Trump, but Becerra at HHS bodes well for us,鈥� said Cathy Senderling-McDonald, incoming executive director for the County Welfare Directors Association of California. 鈥淲e can rethink and possibly open up more federal funding.鈥�
Democrats are also seizing on Becerra鈥檚 past support for single-payer, which dates back to his early congressional career in the 1990s. He has as a lifelong single-payer advocate, and when a reporter asked him last year whether the idea is too costly and 鈥減ie in the sky,鈥� Becerra , 鈥淚 love pie.鈥�
A young XAVIER BECERRA, Biden鈥檚 pick to run HHS, lays out his health care principles as a congressman in 1994.
鈥淲e must have universal coverage. We must have portability. We must have choice of provider,鈥� Becerra says, endorsing single-payer.
鈥� Dan Diamond (@ddiamond)
But it鈥檚 unclear whether Becerra as HHS secretary would embrace progressive 鈥� and expensive 鈥� health care ideas like single-payer. In his first public remarks on his nomination Tuesday, he touted his work helping to pass the Affordable Care Act and said on Twitter he would 鈥渂uild on our progress to ensure every American has access to quality, affordable health care.鈥�
Some congressional Republicans are about Becerra鈥檚 nomination, which must be confirmed by the U.S. Senate. They cite his anti-Trump stance and opposition to some federal policies, such as a Trump-era Obamacare rule that allows private employers with religious objections to deny workers contraceptive coverage. Becerra has sued the Trump administration 107 times, including 13 times on health care.
Although Becerra has no direct health care experience, 鈥�the court has become the arbiter of health policy, and he certainly got experience there,鈥� said Trish Riley, executive director of the National Academy for State Health Policy.
In announcing Becerra as his Cabinet pick Tuesday, Biden described him as someone who is unafraid to take on special interests and has spent his career working to expand health care access and reduce racial health disparities. California, under Becerra鈥檚 leadership, led the defense of the federal health care law before the U.S. Supreme Court last month.
鈥淣o matter what happens in the Supreme Court, he鈥檒l lead our efforts to build on the Affordable Care Act, to work to dramatically expand coverage and take bold steps to lower health care prescription drug costs,鈥� Biden said at the news briefing.
In Congress, I helped pass the Affordable Care Act. As California鈥檚 Attorney General, I defended it. As Secretary of Health and Human Services, I will build on our progress and ensure every American has access to quality, affordable health care鈥攖hrough this pandemic and beyond.
鈥� Xavier Becerra (@XavierBecerra)
At the outset, however, Becerra would be consumed by managing the U.S. response to the coronavirus pandemic. In his new role, he would oversee the Centers for Disease Control and Prevention and the National Institutes of Health.
鈥淭he No. 1 task he鈥檚 going to be completely absorbed with is getting this pandemic under control. We need a consistent message,鈥� said Bruce Pomer, a public health expert and chief lobbyist for the California Association of Public Health Laboratory Directors. 鈥淚t鈥檚 going to be critical for the Biden administration to show people that it can be effective at keeping the American people safe.鈥�
Becerra鈥檚 public comments Tuesday indicated the pandemic would be his top priority. 鈥淭he COVID pandemic has never been as vital or as urgent as it is today,鈥� Becerra said, adding that the economic fallout has 鈥渢hrust families into crisis. Too many Americans are sick or have lost loved ones, too many have lost their jobs.鈥�
But liberal California lawmakers and advocates say the pandemic has made their ambitious health care goals all the more urgent. And should Becerra back a progressive health agenda in California, similar proposals could follow from other states, said Mark Peterson, a professor of public policy, political science and law at UCLA.
鈥淐alifornia has pushed the envelope on health care beyond where other states are,鈥� he said. 鈥淎nd that gives more capacity for California sensibilities and ideas to get into the mix in Washington.鈥�
This story was produced by聽, which publishes聽, an editorially independent service of the聽.