Mar 19, 2021 - Health

How the Biden administration made health policy without a health secretary

Picture of Xavier Becerra putting on a mask

Health and Human Services Secretary Xavier Becerra. Photo: Michael Reynolds-Pool/Getty Images

With Xavier Becerra's confirmation on Thursday as Health and Human Services secretary, the Biden administration's health care team is clicking into place — not that it's been sitting around waiting.

The big picture: Many of the most important health care jobs in the executive branch right now aren't the Senate-confirmed leadership roles, but the management advisers and rank-and-file civil servants in charge of the vaccination effort.

  • That effort has already yielded one new product and 100 million shots since Inauguration Day — and it will remain the most important part of Biden's health care agenda for months.

But it's not just vaccines. The stuff that fell under our pre-pandemic definition of health policy is also moving fast.

  • HHS has begun rolling back Medicaid work requirements — one of the most significant policy changes of the Trump administration. It revoked the waivers that allowed work requirements in Arkansas and New Hampshire, and the Supreme Court recently scrapped oral arguments over the policy at the Justice Department's request.
  • HHS and the IRS also will soon administer the expansion of Affordable Care Act subsidies included in Biden's coronavirus stimulus package.

The bottom line: This administration made an awful lot of health policy even before it had an HHS secretary, and more contentious debates over cost and coverage will be back on the front burner as the pandemic recedes.

Go deeper: We covered the policy fights awaiting the Biden administration — and the key personnel who will be fighting them — in our recent deep dive on health care in the new Washington.

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