I believe Biden is incompetent and insane. Facts speak for themselves.
White House officials have grown so frustrated with top health
official Xavier Becerra as the pandemic rages on that they have
openly mused about who might be better in the job, although
political considerations have stopped them from taking steps to
replace him, officials involved in the discussions said.
Top White House officials have had an uneasy relationship with
Becerra, the health and human services secretary, since early in
President Bidens term. But their dissatisfaction has escalated
in recent months as the omicron variant has sickened millions of
Americans in a fifth pandemic wave amid confusing and sometimes
conflicting messages from top health officials that brought
scrutiny to Bidens strategy, according to three senior
administration officials and two outside advisers with direct
knowledge of the conversations.
The frustration with Becerra comes as top White House and health
officials face growing criticism for health messaging missteps,
as well as controversial policies about coronavirus testing and
isolation. The administration has also struggled in the face of
a tsunami of cases that have overwhelmed hospitals and shuttered
some schools and businesses because so many workers became
infected.
White House and HHS officials denied such tensions and pointed
to the administrations work on delivering vaccines, as well as
new covid treatments and diagnostic tests, as proof of a
productive working relationship. Since day 1, the
administration has managed a strong, coordinated COVID-19
response thanks to Secretary Becerra and HHS officials at every
level of government, White House spokesman Kevin Munoz said in
a statement.
Becerra, a former California attorney general and longtime
congressman with no front-line health-care experience, was never
given a clear role in a response that is run out of the White
House, prompting defenders to say it is unfair to blame him for
recent stumbles. Still, his low profile has become more
confounding as the pandemic has worn on and health officials
have made statements that sometimes blindsided the president and
bewildered the public, some officials and outside experts say.
They also said the health secretary isnt fulfilling a core
responsibility of his job, which is to act as a de facto field
marshal coordinating the nations vast health bureaucracy to
achieve the White Houses strategy, even though he does not set
it. For instance, they cited officials airing of differences
over booster shots and covid-19 isolation guidance as confusing
and unnecessary. They said the tension between Becerra and the
White House has complicated the pandemic response at a time when
Americans are already exhausted and struggling to make sense of
ever-changing guidelines.
He hasnt shown up, said Eric Topol, director of the Scripps
Research Translational Institute and a prominent covid analyst,
adding that Becerra has been like a ghost during the pandemic.
An HHS secretary has so much authority and power to help. And
we have no evidence that any of it is being exerted.
Topol, who wrote an editorial in Science magazine this month,
saying Becerra had shirked responsibilities such as collecting
covid data and coordinating his deputies, said he had heard
similar concerns from people close to the White House. The
secretary has to step up or step aside, Topol said.
Several administration officials voiced similar displeasure with
Becerras leadership, although they would not do so on the
record because they were not authorized to speak with the media.
The health secretary is taking too passive a role in what may
be the most defining challenge to the administration, said one
senior administration official.
This story is based on interviews with 28 senior administration
officials, health agency officials, outside advisers and
experts, most of whom spoke on the condition of anonymity to
detail sensitive discussions.
As health secretary, Becerra oversees a $1.5 trillion agency
charged with responding to myriad national crises, including
disease outbreaks, extreme weather events and housing migrant
children at the border. He is responsible for coordinating
policy rollouts and communications among health agencies such as
the Food and Drug Administration, the National Institutes of
Health and the Centers for Disease Control and Prevention, a job
made particularly difficult by the pandemic. The nations most
prominent health officials, including CDC Director Rochelle
Walensky, Surgeon General Vivek H. Murthy and Anthony S. Fauci,
the director of the National Institute of Allergy and Infectious
Diseases, all report to Becerra or his deputies.
Bipartisan lawmakers have raised concerns about the agencys
persistent coordination difficulties, from collecting infectious-
disease data to clearly communicating health guidance. A
government watchdog last week echoed those criticisms, saying
such issues have plagued responses to emergencies across four
presidential administrations and, if left unaddressed, will
hamper the nations ability to be prepared for, and effectively
respond to, future threats.
Yet removing Becerra would likely draw the ire of the
Congressional Hispanic Caucus and other grass-roots groups that
pressed Biden to appoint more Latinos to his Cabinet. Officials
are also loath to take on a complicated staffing change with a
divided Senate as they prioritize confirmation of a new Supreme
Court justice and navigate election-year politics.
Biden is also averse to firing staffers and unlikely to make
major changes unless there are glaring reasons to do so, one
senior official said. As a result, the informal conversations
about replacing Becerra are unlikely to escalate to serious
deliberations in the near future.
Munoz, the White House spokesperson, dismissed the criticism of
Becerra as anonymous gossip, adding in a statement that HHS
is one of the most critical agencies in this fight and we have
built a coordinated operation that is working together day and
night, every single day of the week.
HHS officials also praised Becerras work on the pandemic and
said he deserved credit for other policy accomplishments, such
as record enrollment this year in the Affordable Care Acts
health insurance exchanges.
Hes been just a great thought partner, said Dawn OConnell,
assistant secretary for preparedness and response at HHS, citing
Becerras guidance on key priorities. For instance, OConnells
team on Jan. 1 took on direct oversight of distributing tests,
masks and other medical supplies across the nation, a
responsibility that previously rested with the team known as
Operation Warp Speed and was jointly managed with the Department
of Defense. While the Government Accountability Office warned it
was unclear whether HHS was ready for the transition,
OConnell said that Becerra had helped empower her team so it
could hit the ground running this month.
Weve got these vaccines out, weve got boosters available.
Tests are being delivered to American households, masks are
being handed out. And the secretary has just been there to
support that effort, she said.
Confusing chain of command
The White Houses frustration with the health secretary reflects
a complicated dynamic that has its origins in how the
administration set up the pandemic response.
From the start, the effort was run out of the White House and
led by presidential counselor Jeff Zients, a former Obama
economic adviser with extensive management experience known for
helping repair HealthCare.gov, the health insurance website that
struggled to launch in 2013, but no public health background. He
communicates directly with health leaders, including Fauci,
Walensky and Murthy, often referred to as the team of doctors.
Although all of those officials technically report to Becerra or
his deputies, the health secretary was never given a clear role
in the response and joined the administration in late March,
more than six months after Biden aides had begun to draw up a
detailed covid battle plan. And compared with senior officials
like Zients, Murthy, Fauci and others working on the covid
response team, Becerra had fewer ties to Biden or his inner
circle.
That chain of command is further complicated by the fact that
the White House has taken a hands-off approach to the CDC and
some other health agencies because it is sensitive to charges of
political interference after Biden repeatedly criticized the
Trump administrations meddling in scientific debates and
policies during his campaign. It is sometimes unclear who makes
final decisions or is in charge of carrying out initiatives,
with Zients absorbing much of the portfolio that would have gone
to an HHS secretary in previous administrations.
As a result, several officials described an often confusing
structure, with leaders like Fauci, Walensky and Murthy dealing
primarily with Zientss team, others reporting jointly to
Becerra and Zients, and some messages getting muddled or lost as
a result. Zients has faulted Becerra for not ensuring the White
House knows whats coming from the health agencies
particularly the CDC according to six people familiar with the
matter. Zients disputed that characterization through a White
House official.
Tensions have also grown as a result of the pandemics
persistence; many Biden officials thought the emergency phase of
the pandemic would end by last summer and the White House would
be able to turn to other issues.
Celine Gounder, an infectious-disease expert at New York
University and a member of Bidens covid transition task force,
said its unclear how much of [Becerras] role or non-role is
driven by him versus the White House.
Certainly whether its him or the White House itself, there
does need to be better coordination, she said. That isnt to
say there should be suppression of certain ideas but rather
coordination of different agencies. He is certainly one person
who could be doing that.
White House and HHS spokespeople said that Zients and Becerra
speak throughout the week and have a standing formal check-in.
The White House and HHS also set up omicron-specific working
groups on testing, vaccines, surge needs and other key issues, a
White House official said.
Senior officials also said they take every effort to be
transparent.
I keep two lines of communication open at all times, said
OConnell, the HHS emergency response chief, saying she first
relays information to Becerras office and then informs the
White House. Thats always my goal: never to surprise anybody.
Some officials say that Becerra has missed opportunities to be
more proactive while facing a steep learning curve to master a
sprawling, 80,000-person department responsible for the nations
food safety, most of the U.S. clinical medicine trials, and many
other health and social services programs, in addition to
overseeing sensitive issues such as housing unaccompanied
migrant children. While Becerra had years of experience as a
lawmaker and lawyer who worked on health-care issues, he now
faces a different set of challenges in trying to implement
programs like the Affordable Care Act, rather than defend them
in court.
The health secretary convenes a morning meeting most days where
he gets briefed by top health officials on work related to the
pandemic. But he mostly listens to updates without offering
input or asking probing questions, two people familiar with the
calls said.
The result, those people said, can be policy stumbles and
conflicts that are worked out in public view.
The battles and challenges between the agencies need to be
reconciled, and hes not doing it, said one outside adviser.
He has a $1.5 trillion budget. He has FDA, NIH, CDC. All of
those agencies need help, and they certainly need to be
rebuilding, and none of that is happening.
When the CDC announced in December, for instance, that it was
halving the isolation and quarantine times for those infected
with or exposed to the virus without requiring a negative test,
Walensky, Fauci and Murthy voiced conflicting messages about the
new guidance in public interviews. White House officials were
embarrassed by the rollout, which invited fierce public
blowback, and thought Becerra or one of his staffers should have
coordinated those messages ahead of time, according to two
senior administration officials.
Becerra is all their bosses. And could coordinate them. But he
doesnt, said a person involved in the covid response.
Sarah Lovenheim, HHSs chief spokesperson, disputed such
descriptions of Becerras style, writing in an email that
anyone who knows the Secretary knows that hes a good listener
and that he always asks questions. The purpose of his regular
meetings, she added, is usually to receive updates and
understand ongoing developments, not to make major policy
decisions. Major decisions require in-depth, focused discussion
for which separate time is reserved for the team to engage.
She also noted that Becerra wants to ensure that the
administrations doctors are able to speak freely, particularly
after the Trump administration sought to muzzle top experts.
The covid response is driven by the science and data,
Lovenheim wrote, adding that HHS informs the White House of any
high-level actions and decisions.
And, as the Secretary has often said, the quarterback on covid
strategy is in the White House, Lovenheim wrote. The Secretary
and the HHS team working on covid engage in constant
communication.
Inside HHS, Becerra has defenders who describe him as
approachable and thoughtful, while focused on issues like
lowering the rate of Americans without health insurance and
closing persistent racial and ethnic gaps in U.S. health
outcomes. He is well-liked by his staff, who feel empowered to
carry out their jobs.
Some administration and outside advisers say it is unfair to
blame Becerra for recent stumbles when the White House has
commanded the response.
Its very clear to me that the White House is not looking for
Becerra to be involved, said one outside adviser, who spoke on
the condition of anonymity to be candid. What you cant do is
say, Were going to run it out of the White House, but not be
involved with the agencies. Or if there is a role for Becerra,
they should articulate it to him.
A low profile
Becerra was a fallback choice for Biden and his team, who
struggled to agree on a health secretary during the presidential
transition and were turned down by other candidates.
But with the pandemic stretching into the second year of Bidens
presidency and officials worried about the potential for yet
another variant to pose problems Becerras relatively low
public profile has become more troublesome. It is also a stark
departure from his predecessors roles during health crises.
Alex Azar, who led HHS during the Trump administration, appeared
a dozen times during the first year of the pandemic on Sunday
morning television shows such as NBCs Meet the Press and its
counterparts on ABC, CBS, CNN and Fox News, where the White
House traditionally dispatches senior officials to put its
decisions in the best light. Obama-era health officials like HHS
Secretaries Kathleen Sebelius and Sylvia Mathews Burwell also
regularly appeared on the programs, and the Biden administration
has followed suit, having White House coronavirus coordinator
Zients and Fauci appear multiple times over the past year.
But since being sworn in as health secretary, Becerra has yet to
appear on a single Sunday morning TV show. The Association of
Health Care Journalists on Nov. 29 separately faulted the health
secretary for his low profile, calling on him to hold more
visible and frequent media briefings.
Its time for Secretary Becerra to come out of hiding, Felice
Freyer, the groups president, said in an accompanying
statement. Freyer this week said that the group had not received
a response and that Becerra was still failing to hold regular,
open-ended briefings.
Lovenheim, Becerras spokesperson, said that it was patently
false that Becerra keeps a lower profile than his predecessors,
citing his travel to more than 20 states and his frequent
appearances on TV and radio. She added that Becerra holds
briefings with the media at least once per week but suggested
that other matters took precedence.
Would you rather have a Secretary who prioritizes TV
appearances over getting tests, therapeutics and vaccines into
the hands of people who need them? Lovenheim wrote.
A proposal to boost vaccinations
Becerras role overseeing the federal governments health
bureaucracy means that some pandemic initiatives must go through
him. And he has sometimes pushed back on proposals championed by
officials leading the response.
In the spring, for instance, as administration officials
searched for ways to encourage more Americans to get vaccinated,
they coalesced around a plan to pay some doctors more if they
encouraged their patients to get the shots. The proposal would
have paid doctors through the government health insurance
programs Medicare and Medicaid, which fall under HHS and
collectively cover more than 100 million people.
But the plan came to a halt at one point because of Becerras
concerns that it lacked sufficient oversight and might lead to
fraud, according to two people with knowledge of the discussions.
Some White House and HHS officials were incensed by Becerras
opposition to the proposal, which drew on evidence that
Americans were skeptical of politicians recommendations on
vaccines but trusted the advice of their physicians.
He sees too many things like a former attorney general and
career congressman and not like the top health official during
a pandemic, said one of those involved in the discussions.
A scaled-back version of the plan did take effect last month,
when Medicaid began reimbursing doctors for talking to parents
about vaccinating their children, a move cheered by health-care
groups that sought the policy for months.
Lovenheim said the health secretary never opposed the plan
last spring but wanted to focus on Medicaid, which serves
children and younger adults who have far lower vaccination rates
than seniors in Medicare.
He raised serious reservations about efficacy and program
integrity tied to trying to do this through Medicare, Lovenheim
wrote, suggesting that Becerra deserved credit for what was
ultimately announced. The proposal successfully went where he
suggested it should go.
https://www.washingtonpost.com/politics/2022/01/31/becerra-hhs-
pandemic-response-leadership/