Becerra says government must reach people where they are to surmount vaccine inequities

By Amy Goldstein,

Health and Human Services Secretary Xavier Becerra said the federal campaign to vaccinate Americans against the coronavirus must “reach people where they are,” bringing vaccine-filled syringes into farm fields and onto construction sites to ease profound racial and ethnic disparities in who has been receiving the protective shots.

“We’re not going to say, ‘Now, just come get your vaccine,’ which is a very different model than we’ve done in the past,” Becerra said in his first interview since being sworn in as the nation’s top health official late last week. Too often, he said, Black and Latino Americans in low-wage jobs believe “their government thinks they are invisible.”

Becerra also said federal health officials will work more intensely to address behavioral health problems exacerbated by the year-old coronavirus pandemic. He said the problems include addictions, mental illnesses and a spike in suicides — all fostered by the isolation that has been a pandemic side effect and has, in turn, often lessened treatment for behavioral health issues.

In addition, the new health secretary foreshadowed steps the Biden administration is likely to take, reversing policies written by President Donald Trump’s health aides that weakened the Affordable Care Act.

Becerra noted that President Biden has ordered HHS to pause pending federal rules left by the previous administration, and to evaluate whether they would make health care more available and affordable. Already, he said, administration officials have reviewed completed Trump-era rules that made it easier for consumers to buy two types of skimpy, inexpensive health plans that can bypass the ACA’s insurance protections.

“In this particular case,” Becerra said, “we don’t want to undermine, especially in an era of pandemic, Americans’ ability to access the care they need. . . . Any policy that is going to make it tougher for Americans to afford health care, to access good health care, you can be assured we are going to take a look at.” The types of insurance are known as short-term health plans and association health plans.

Becerra, a Democratic congressman for 24 years and, most recently, California’s attorney general, gave the interview to The Washington Post on the evening of his first full day in office. The interview fell on the eve of the 11th anniversary of the ACA, a sprawling health-care law that he helped write when he was a member of the House Ways and Means Committee — and that he worked to preserve as leader of a coalition of Democratic state attorneys general fighting a Republican effort to invalidate the law in a case now before the Supreme Court.

Biden pointed to Becerra’s role in championing the ACA and other health-care legislation when nominating him in December to lead HHS, the largest federal department in terms of spending and the one at the core of the president’s most urgent priority of bringing the pandemic under control.

Biden emphasized his upbringing as the working-class son of Mexican immigrants. Becerra, 63, is the first Latino to be HHS secretary.

Public health experts had argued that, in the midst of the pandemic, the job should go to someone with on-the-ground medical or public health experience. For their part, congressional Republicans derided the fact that Becerra lacks medical training, even though few HHS secretaries over the years have been physicians. Several came from governorships, while Trump’s two HHS secretaries came from the House and the pharmaceutical industry, respectively.

Becerra won Senate confirmation Thursday by the closest margin of any Biden Cabinet member approved so far. The vote was 50 to 49, with a single Republican, Sen. Susan Collins (Maine), joining with every Democrat present. On and off Capitol Hill, conservatives castigated Becerra as a radical and a “culture warrior,” emphasizing his defense of abortion rights and his previous support — renounced since his nomination — of a single-payer health-care system for the United States.

In starting his new role, Becerra is joining a pandemic-fighting leadership at the White House and at HHS’s Centers for Disease Control and Prevention that has been in place for the two months since Biden became president. Asked how he regarded his niche within that group, Becerra said: “I sort of see myself as the weaver, the person who brings everything together to get things done.”

He said his legislative experience meshed with the substantive knowledge he acquired from his years on Capitol Hill and as attorney general since 2017 of the nation’s most populous state. “I’m not a stranger to the ACA, Medicaid or 1115 waivers,” he said, referring to the process by which states can request federal permission to experiment with Medicaid, the safety-net coverage that is the nation’s largest public insurance program.

“I’ve been there, done that,” he said.

Asked when the administration will fill a vacancy critical to combating the pandemic — commissioner of HHS’s Food and Drug Administration, which determines which coronavirus vaccines may be given to the public — Becerra chuckled and said he thought he would ask that question of the White House.

Without identifying possible candidates, he added, “I think you will see the administration try to move quickly. I’m glad I’m now in place to have input.”

In the interview, Becerra was careful not to get ahead of Biden’s public statements about the pandemic or access to insurance and health care. Like the longtime politician he has been, the secretary credited Biden and Congress for passing the American Rescue Plan. The $1.9 trillion coronavirus relief law contains substantial funding for the largest mass vaccination campaign in U.S. history, increased federal subsidies for consumers eligible to buy ACA health plans, and extra incentives for a dozen states that have not expanded Medicaid under the 2010 health-care law to change their minds.

“Obviously, covid-19 has made us really think hard now about what we do for health security,” he said.

Becerra praised the idea of a government insurance alternative that would compete against private health plans sold in ACA marketplaces, open to people who cannot get affordable health benefits through a job. He did not hint at when he or Biden, who made this public option part of his campaign’s health-care plan, might begin urging Congress to embrace the approach — a possibility that was considered when the ACA was adopted and rejected as too liberal at the time.

Becerra said a public option “will require a robust conversation” with state and local leaders, as well as members of Congress, to get a sense of how much receptivity exists to the approach now. “It’s all part of the menu of tools we have available to make health care more affordable and accessible,” he said.

For places where insurance options are scarce, he said, “the public option presents families another way to . . . know they have something in their reach.”

Becerra declined to say whether he favors asking Congress to make permanent the temporary increases in subsidies for ACA insurance premiums that are part of the coronavirus relief law. The subsidy changes, to take effect April 1, are the first since 2014, the year the ACA coverage began.

The changes will raise the tax credits for people already eligible for the subsidies and, for the first time, enable people to get some subsidy if their incomes are more than 400 percent of the federal poverty line — about $51,000 for an individual and $106,000 for a family of four. Until now, middle-class people ineligible for subsidies have been among the groups finding ACA health plans unaffordable.

The subsidy expansion “is going to be a blessing for some families” whose incomes excluded them from the tax credits, Becerra said.

In the campaign to vaccinate Americans against the coronavirus, Becerra said, “for African Americans and Latinos, the injection rate is far lower than it is for White Americans. We know that, in rural communities, it’s tougher to get vaccines to where we need them.”

A report last month by the CDC showed that, during the first month of the vaccine rollout, from mid-December to mid-January, 11.5 percent of the people nationally who received at least a first shot were categorized as Latino, while 6 percent were Asian, and 5 percent were Black. The CDC report found, however, that race and ethnicity data was missing from nearly half of the vaccination reports.

Becerra said federal plans will send vaccinators into disadvantaged communities, using mobile clinics and other means.

“All those people who do the domestic work in homes, all the people who have to go in and do the construction work or the farm work, they have never really been accustomed to having our government say, hey, we’re going to come to the fields to vaccinate you, we’re going to go to your work site,” the secretary said. For workers who need to take a bus — or three buses — to get to a job, he said, “we are going to make sure the driver is vaccinated, [so] you are safe.”

Becerra, who is working for now from both California and D.C., is making his first trip Tuesday as HHS secretary. He is visiting a Carson City, Nev., health center in the afternoon to talk up the ACA on its anniversary.