Biden health nominee faces first Senate test

President Biden’s nominee to lead the massive federal health agency faced his first hearing in the Senate on Tuesday, with some Republicans indicating he doesn’t have the experience necessary for the job but others appearing to leave the door open to supporting him. 

Some Senate Republicans and outside conservative groups have ramped up criticism of Xavier Becerra in the days leading up to his confirmation hearing, arguing he is an extremist who has no health care experience, making him unqualified to lead the Department of Health and Human Services (HHS).

“I’m not sure that you have the necessary experience or skills to do this job at this moment,” said Sen. Richard Burr (N.C.), the top Republican on the Senate Committee on Health, Education, Labor and Pensions, adding that he would keep an open mind.

While the committee will not vote on Becerra’s confirmation — the Senate Finance committee will — some of the members’ support will be crucial for his nomination to pass the Senate. 

Becerra must win the support of all 50 Senate Democrats to be confirmed by the Senate if he doesn’t get any votes from Republicans and Vice President Harris breaks a tie.

But eyes are also on moderate Republicans who have supported some of Biden’s other nominees, given the tight majority Democrats have in the Senate. 

Sen. Mitt Romney (R-Utah) told Becerra on Tuesday, “I think we can reach common ground on many issues” except for abortion, but also didn’t indicate if he would support his nomination.

Democrats argue Becerra’s record is one of defending and protecting consumers as California’s attorney general by defending the Affordable Care Act (ACA) in court when the Trump administration refused to, challenging hospital consolidations that research shows lead to higher costs for patients, and suing pharmaceutical companies for allegedly fixing the prices of generic drugs.

“As California’s attorney general, he has proven himself as an executive leader by seeing one of the nation’s largest justice departments through one of the most challenging periods in recent history,” said Sen. Patty Murray (D-Wash.), chair of the committee. 

“As attorney general he has fought for patients, not pharmaceutical companies. … He has fought to defend families’ health care in court,” she added. “And as secretary he will work with Congress to make sure every patient can get quality, affordable care.”

Becerra appeared to respond to criticisms from Republicans that he doesn’t have the experience for the job, noting in his opening remarks that when he served in Congress he helped write and pass the ACA and as attorney general, he cracked down on Medicare and Medicaid fraud and sued opioid manufacturers for their role in the addiction and overdose crisis.

There is no requirement that HHS secretaries be medical professionals and most haven’t been. Only three physicians have led HHS since the agency was created in 1953 and the last one to serve — Trump nominee Tom Price — resigned in 2017 after being accused of misusing taxpayer dollars. 

But some Republicans used his record to argue Becerra is inexperienced, unqualified and overly aggressive with the health care industry.

Sens. Susan Collins (Maine) and Lisa Murkowski (Alaska), who both serve on the health committee and are among the most moderate Republicans, didn’t criticize Becerra or call him unqualified but did not indicate whether they plan to vote for him.

Murkowski said if Becerra is confirmed, she would encourage him to visit Alaska early on in his tenure.

Meanwhile, Sen. Bill Cassidy (R-La.), a physician, asked: “What would you as the attorney think if I — the physician — were nominated to be the United States Attorney General?”

“You would say ‘that guy’s not qualified’ … So you can imagine the kind of concerns I have regarding your nomination,” he said, but did not state if he would vote for Becerra.

Burr noted Becerra’s support for using march-in rights to withdraw exclusivity patents on drugs funded by the federal government if the drug company is deemed too expensive. 

“I’m not sure that you have the appropriate respect for the private sector and innovation and intellectual property needed to bring more exciting treatments and cures to save lives in this country,” Burr said.

Becerra didn’t shy away from his criticism of pharmaceutical companies, which have faced backlash in recent years for rising prices, especially for branded drugs. 

“I think, senator, we can all agree that the price that we’re paying for some of these prescription drugs is far higher than it should be,” Becerra told Sen. Bernie Sanders (I-Vt.)

He later added that the U.S. should support drugmakers and “spur innovation,” but that some drugs are priced too high and patients need to come first.  

More conservative members of the committee hammered Becerra on issues like abortion, but he largely steered away from that debate by saying he would follow the laws in place.

Sen. Roger Marshall (R-Kan.), an obstetrician, questioned Becerra about his support for deregulating Mifepristone, a pill used to end early pregnancies and treat miscarriages.

Becerra and others have called on the Food & Drug Administration to end requirements that Mifepristone be dispensed in person, particularly during a pandemic when people are staying home more to limit their exposure to COVID-19.

The American College of Obstetricians and Gynecologists has long called for the end of the requirement, clashing with Marshall’s view.

“I just hate to see those drugs, let alone birth control pills for that matter, handed out like candy,” Marshall said.

Republicans mostly had questions about health policy, from rural health care and drug prices to price transparency, organ donations, doctor shortages and telehealth.

Most of the criticism of Becerra came from Republicans who don’t serve on the committee.

Eleven Senate Republicans including Sens. Tom Cotton (Ark.) and Marsha Blackburn (Tenn.) announced their opposition to Biden’s nominee for health secretary Monday, citing “no meaningful experience in health care, public health, large-scale logistics, or any other areas critical to meeting our present challenges.”

-Updated 2:36 p.m.