HEALTH CARE BRIEFING: Biden Picks California AG Becerra for HHS

By Brandon Lee

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President-elect Joe Biden has chosen Xavier Becerra as his Health and Human Services secretary, tasking the California Attorney General with curbing the coronavirus pandemic and expanding the Affordable Care Act.

Becerra, a former congressman from the Los Angeles area, emerged as a candidate as others Biden had considered fell out of contention, including another candidate, New Mexico Governor Michelle Lujan Grisham, backed by the Congressional Hispanic Caucus.

His forthcoming nomination solves one of the highest-stakes selections outside of the traditional four top cabinet positions, in part because Biden has placed a heavy emphasis on the coronavirus outbreak, which has set records for new cases, daily deaths and current hospitalizations over the past week.

Becerra would have a long list of priorities in tackling the pandemic, including expanding testing, improving access to personal protective equipment and distributing a Covid-19 vaccine. He would also be responsible for another top goal of the Biden administration — strengthening and building up the Affordable Care Act.

Biden has made his decision, two people familiar with the matter say, but his transition team has not yet announced it. The Biden transition had no immediate comment.

While in Congress, Becerra was a supporter of a Medicare for All bill and as recently as 2017 spoke in favor of a single-payer health system.

As California attorney general, Becerra has led other states with Democratic attorneys general to file lawsuits defending the Affordable Care Act against the efforts of President Donald Trump’s administration to dismantle it. That includes a case currently before the Supreme Court.

He has also filed suit against the HHS for allowing health workers and hospitals to decline to provide medical treatment that conflicts with their religious and moral beliefs. He has also filed suits against broadening exemptions to the Affordable Care Act’s requirement that health insurance plans cover contraception without a copay, and removing LGBTQ people from the Affordable Care Act’s nondiscrimination protections. Read more from Jennifer Epstein, Shira Stein and Alex Ruoff.

Double Dose Vaccine Has Human Pitfalls

The new Covid-19 vaccines’ success hinges on getting people to come back for a second shot after the first dose. Historically, that’s been a challenge, and scientists fear people skipping a second jab will drag out the pandemic.

A significant portion of people have historically failed to follow through on vaccine schedules requiring multiple doses—sometimes fewer than half of participants returned for the second shot. And the two leading coronavirus vaccine candidates from Pfizer-BioNTech and Moderna both require double doses. That risks prolonging the pandemic.

Scientists aren’t certain how effective only one dose of either vaccine would be, said Matthew Laurens, a principal investigator for the phase 3 Moderna vaccine trial based out of the Center for Vaccine Development and Global Health at the University of Maryland School of Medicine. “You absolutely need both doses,” he said. “This ensures you get the full protective effect of the vaccine while minimizing potential side effects.”

Learning from history, it will be vital that states, which will organize most of the vaccinations, make the process as simple as possible so most people return for their second dose, Laurens said. Perfect public compliance isn’t realistic, according to Scott Knoer, CEO of the American Pharmacists Association.

The last time the U.S. vaccinated massive amounts of people in a short time was for polio. Part of the vaccination campaign was “Sabin Sundays,” named for Albert Sabin who developed the oral polio vaccine. On three consecutive Sundays in 1960, millions of Americans got their shots in local schools or churches, according to the University of Cincinnati Magazine.

Replicating that success means putting vaccination centers as close to people who need them most as states can—in particular, historically underserved communities where transportation can be an issue. Offering evening or weekend vaccinations is also key to protect those lacking the luxury of working at home during regular business hours. Jacquie Lee has more.

More on the Pandemic

Azar Sees Vaccine for All Americans by Second Quarter: All Americans who want to get a coronavirus vaccine should be able to do so by the second quarter of next year, Health and Human Services Alex Azar said yesterday. With the Food and Drug Administration set to decide as early as Thursday on emergency authorization for a shot developed by U.S.-based Pfizer and Germany-based BioNTech, Azar and Moncef Slaoui, the head of the federal government’s program to accelerate a vaccine, signaled confidence the FDA would clear the way. Read more from Susan Decker.

  • On Friday, BioNTech said it’s on track to produce 50 million doses of the vaccine, easing concerns they may miss their production targets. As of Friday, the companies had made the majority of the promised supply for this year, BioNTech said in a statement Friday to Bloomberg News. For next year, they’re looking for ways to increase production beyond a promised 1.3 billion doses. Naomi Kresge has more.
  • But weeks before states receive the first vaccine shipments, conflicting messaging from the federal government has clouded exactly how many doses may actually arrive. Some governors, including New York’s Andrew Cuomo (D) and California’s Gavin Newsom (D), have made splashy announcements about how much of Pfizer-BioNTech’s vaccines they expect. Others can’t offer a solid answer, given how quickly estimates change, Angelica LaVito, Margaret Newkirk, and John Tozzi report.

Biden Says He’ll Take Vaccine: Biden said he’ll take a Covid-19 vaccine to demonstrate its safety and will work to make sure the shot and any treatments for side effects are provided free to Americans. Speaking to reporters in Delaware Friday, he was asked about wariness among Americans, especially among African Americans, over a vaccine developed quickly and under a cloud of pressure from Trump administration. “I think that my taking the vaccine and people seeing me take that vaccine is going to give some confidence,” Biden said. “In the meantime I need to make sure that the vaccine is both free and available.” Read more from Josh Wingrove and Emma Kinery.

  • Also Friday, Biden said he expects to have a quieter-than-normal inauguration, without crowds filling the National Mall and a series of evening celebrations because of the risk of spreading the coronavirus. Biden said he will follow the advice of health experts who are asking people to stay away from crowds and indoor gatherings. The president-elect said festivities may look more like the nearly all virtual Democratic National Convention in August. Read more from Emma Kinery.

More on the Vaccine:

In First, CDC Says to Use Face Masks Indoors: Americans should be wearing a mask indoors whenever they are outside their own home, the Centers for Disease Control and Prevention is recommending for the first time as Covid-19 surges across the country. The recommendation on mask-wearing in all indoor sites came in the CDC’s Morbidity and Mortality Weekly report, which cited a higher-level transmission of the virus as the ongoing holiday season and colder weather have driven more people indoors. Read more from Anna Edney.

More on the Pandemic:

Happening on the Hill

This Week’s Health-Care Legislation: The House is scheduled to consider several health-related measures this week under expedited procedure.

  • Aid for Maternal and Child Malnutrition: The House would reaffirm that food security and good childhood nutrition “saves lives and lays the foundation for healthy physical and cognitive growth and development,” under H. Res. 189. The nonbinding resolution would call for “transformative” efforts by the U.S. Agency for International Development to accelerate progress to end child and maternal hunger. The Agriculture Committee approved the measure on March 10 by voice vote. the Foreign Affairs Committee also approved it on Oct. 30, 2019.
  • ALS & Disability Insurance: The waiting period for Social Security Disability Insurance would be eliminated for individuals with amyotrophic lateral scleoris, or ALS, under S. 578. The Senate passed the bill 96-1 on Dec. 2. For more, see the BGOV Bill Summary by Danielle Parnass.
  • Marijuana Research: Marijuana research regulations would be eased for researchers and manufacturers by a modified version of H.R. 3797. It also would allow researchers to study state-approved marijuana products. The House Energy and Commerce Committee approved the bill by voice vote on Sept. 9, 2020. For more, see the BGOV Bill Summary by Danielle Parnass.
  • Electronic Health Data Standards: The Health and Human Services Department inspector general’s authority to investigate technology developers and health-care providers that impede access to electronic health information would be clarified under a modified version of H.R. 7898. The measure also would require HHS to consider whether health-care entities have recognized cybersecurity practices in place when it makes determinations for fines and audits related to data standards. The House Energy and Commerce Committee hasn’t acted on the bill, which was introduced July 31 by Rep. Michael Burgess (R-Texas). For more, see the BGOV Bill Summary by Michael Smallberg.
  • Colonoscopy Cost Sharing and Drug Information: Medicare coinsurance would be waived for certain procedures done during a colon cancer screening test under a modified version of H.R. 1570, which also would require drugmakers to report certain pricing information to Medicare. Rep. Donald Payne Jr. (D-N.J.) introduced the bill on March 8.

Marijuana Legalization Measure Passes House: The House voted Friday for the first time to legalize marijuana at the federal level, but the bill has little chance of being considered in the Senate. The Marijuana Opportunity Reinvestment and Expungement Act would pull cannabis from federal schedules under the Controlled Substances Act, while expunging convictions for marijuana offenses. The bill would also put a 5% excise tax on cannabis and use the money to assist individuals who have been punished for drug offenses. Read more from Laura Davison.

Certain Hospitals Could See Medicare Hike: Dialysis centers, acute care hospitals, and long-term care hospitals—but no one else—would see Medicare payment rate increases in 2022 if Congress accepts the proposals approved Friday by an advisory panel. The Medicare Payment Advisory Commission’s preliminary recommendations to Congress would freeze rates in 2021 for physicians, nursing homes, hospices, and ambulatory surgery centers for 2022. Read more from Tony Pugh.

Hearings on the Hill:

  • Virus Outpatient Treatment: The Senate Homeland Security and Governmental Affairs Committee scheduled a hearing tomorrow on Covid-19 early outpatient treatment.
  • Abortion Cost: The House Appropriations Subcommittee on the Departments of Labor, Health and Human Services, Education, and Related Agencies plans a hearing tomorrow on women denied abortions over cost.
  • Veterans & Virus: The House Veterans’ Affairs Subcommittee on Economic Opportunity holds a hearing tomorrow on supporting veterans through the Covid-19 pandemic.
  • The Senate Veterans’ Affairs Committee meets for a hearing Wednesday on the VA’s response to Covid-19.
  • Opioid Crisis: The Senate Homeland Security and Governmental Affairs Permanent Subcommittee on Investigations holds a hearing Thursday on oversight of legislation implemented to combat the opioid crisis.
  • Vaccine Transportation: The Senate Commerce, Science and Transportation Subcommittee on Transportation and Safety meets Thursday to examine the logistics of transporting a Covid-19 vaccine.

Trump Signs Virus Education Program Bill: Trump Friday signed H.R. 8472, which passed the Senate in November. The bill revises the application processing data for local education agencies in the Impact Aid Program due to Covid-19 disruptions, and also directs the Department of Education to use pre-pandemic data when allocating funds to states under the Migrant Education Program
Related: Trump Signs Veterans Access to Care and Treatment Act Into Law

More Headlines:

What Else to Know Today

SCOTUS to Review Medicaid Work Requirements: The Supreme Court agreed Friday to look at whether the U.S. government can approve state programs that force Medicaid participants to work, go to school or volunteer to get benefits. Azar called on the high court to let his agency green-light Medicaid work requirement programs in Arkansas and New Hampshire the U.S. Court of Appeals for the D.C. Circuit struck down. Still, health law scholars doubt the court will actually hear the dispute. Read more from Lydia Wheeler.

International Drug Pricing Rule Gets First Challenge: A Trump administration rule that ties U.S. reimbursement for some drugs to cheaper foreign prices is unconstitutional and exceeds the authority of the federal Medicare agency, according to two lawsuits filed Friday by various trade groups. The cases mark the first legal challenges brought against the new policy, which culminated four years of presidential threats to companies in the drug supply chain to reduce prices or bow to regulation. The Trump administration released the policy as an “interim final rule,” meaning the public can still comment, but it is considered effective upon publication in the Federal Register. Read more from Alexis Kramer.

More Headlines:

To contact the reporter on this story: Brandon Lee in Washington at blee@bgov.com

To contact the editors responsible for this story: Zachary Sherwood at zsherwood@bgov.com; Giuseppe Macri at gmacri@bgov.com; Michaela Ross at mross@bgov.com

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