Last week President Joe Biden unveiled his administration’s latest plan to combat Covid-19 at the National Institutes of Health. But the person who oversees the NIH and the entire agency that is tasked with fighting the pandemic was not in attendance: Health and Human Services Secretary Xavier Becerra.
Before Becerra was confirmed this year, he told senators that fighting the pandemic would be his top priority.
During Becerra’s Senate confirmation hearing in February, Ron Wyden, D-Ore., noted the dual challenges of a pandemic and a health care system strained “to the max,” telling Becerra, “There may not be a higher-stakes job in the executive branch outside the presidency.”
Becerra, a former attorney general of California and 12-term member of Congress, took office in late March. But since he was sworn in, he has yet to appear at a White House or Covid media briefing. His first visit to the NIH was eight months into the job, according to the online NIH newsletter.
Asked whether Becerra had been invited to the NIH event, White House spokesman Chris Meagher did not answer directly. He said: “Secretary Becerra is leading an agency handling some of the most critical issues our country is facing today, including tackling reproductive freedom, fighting to lower prescription drug prices and expanding access to high quality, affordable health care. The secretary has been a strong partner to the White House on a number of important issues, including to our Covid response team. We are stronger because of his leadership.”
Conversations with six former senior health policy officials from both Democratic and Republican administrations, as well as three people closely familiar with the agency’s activities, reveal that they are mystified about why Becerra’s leadership has been, as several of them put it, “invisible.”
Becerra pushed back against the accusation, saying in a phone interview that he is focused on the work and not on raising his profile.
“The best thing I can tell you,” he said, “is that it’s not profile, it’s results, that count, and so at the end of the day, if we do this right, if we’re mission-focused and if we are results-driven, we’re going to save lives. I suspect that’s going to help not just my profile, but HHS and this administration’s profile on tackling Covid.”
Becerra cited successes like the number of people vaccinated, the decline in the death rate from Covid compared to a year ago and the record number of people who have signed up for health insurance through the Affordable Care Act.
Becerra’s Twitter feed and public outings show a busy Cabinet member who has traveled to at least 20 states since March talking up the administration’s priorities, such as the American Rescue Plan, and answering questions from local reporters.
An HHS spokesperson said Becerra is focused on the following: “helping end the Covid-19 pandemic, reducing health care costs, expanding access to health care, tackling health disparities, strengthening behavioral health.”
Becerra has not held news briefings where the national media can ask questions about all subjects, according to a complaint sent to him late last month by the Association of Health Care Journalists. The letter says the agencies and the programs Becerra oversees, including the Centers for Disease Control and Prevention, the NIH and Medicare, make decisions “affecting the lives of virtually all Americans,” and they note that his predecessor, Alex Azar, held “regular press briefings.”
“You have yet to hold an open-ended press conference in Washington, D.C., in which you take questions on a variety of topics,” the letter says. “While our members appreciate that you have made yourself available on the road, not everyone has access to those events.”
In a news release accompanying the letter, Felice Freyer, the president of the journalists association, said, “It’s time for Secretary Becerra to come out of hiding.”
Becerra’s spokesperson, Sarah Lovenheim, the assistant secretary for public affairs, disputed the lack of media availabilities, saying Becerra “typically appears on national TV and/or radio weekly,” adding: “His last national radio appearance was this past Friday, with NPR’s ‘All Things Considered.’ Covid-19 was the focus, as it is for most of his media engagement.
"He has held at least one press call or press conference nearly every week since his first month in office,” Lovenheim said on Tuesday. “His last press call was six days ago on our global commitment to tackling the pandemic; his next press call is [Wednesday] tied to our overdose prevention strategy.”
Lovenheim said Becerra has roundtable conversations with state and local leaders, visits community health centers and has “invited media to join our Covid-19 surge response teams as they partnered with local public health teams in places like Las Vegas to slow the virus’s spread.”
When he was asked in the phone interview about holding briefings and making himself available to the national media, Becerra cited three television interviews he did Thursday on Telemundo, CNN en Español and Univision. “We’re constantly out there, [but], you know, with everything swirling, we don’t get all the attention,” he said. “That’s another story. That’s really up to you all what gets covered. But we’re out there. I can tell you that all this week I’ve been doing something on the press.”
Paul Mango, who was the deputy chief of staff to Azar, the Trump administration’s HHS secretary, said he was surprised that Becerra did not speak at the NIH event last week and introduce Biden. “It’s as if he’s in the witness protection program,” he said.
‘Wherever you need me on the field, I’m there’
Given that combatting Covid was Biden’s first priority on taking office, an architecture had already been established in the White House to address the pandemic by the time Becerra became secretary in March. The White House Covid response team, led by Jeffrey Zients, includes high-profile health experts like Dr. David Kessler, a former commissioner of the Food and Drug Administration.
Early in his tenure, Becerra discussed the Covid response in network interviews and emphasized the importance of wearing masks. But by May, he had taken a back seat to others when it came to Covid.
In response to a question about Becerra’s absence from Covid and White House briefings, an HHS official said: “At HHS, we follow the science and the guidance of our public health experts. This approach is critical, for the sake of saving as many lives as possible. The secretary told the president early on — wherever you need me on the field, I’m there.”
An agency official said HHS plays “a critical role in helping fight the pandemic — from deploying surge response teams in hot spots across the country to authorizing and distributing vaccines in the U.S. and around the world to educating the public about the vaccines’ safety and efficacy.”
“Not a day goes by where there isn’t an around-the-clock effort,” the official said.
A current senior administration official described Becerra’s role as largely “behind the scenes” and noted that he joined the administration later than some others, two months after Biden was inaugurated. When he did arrive, the official said, the White House had already scaled up its internal Covid team and Becerra was juggling the sudden influx of unaccompanied migrant children at the border, whose care is overseen by HHS.
In May, it was discovered that immigrant children were held on buses overnight outside an HHS facility before they were sent to their family members. NBC News has reported that the White House was “livid” about the situation.
The current senior official said Becerra has been increasingly engaged in the past three or four months. As far as Covid is concerned, the official said, the White House has intentionally chosen to have medical professionals be the faces of the response. The officials said Becerra’s lack of public profile is not an indication that there are problems. “He’s getting their ducks in a row before things make their way over here,” the official said.
A senior health official in the Obama administration who did not want to be named said, “The fact that he is not visible is very striking,” saying the public health community has faced unprecedented challenges this year and that the agency, which has 80,000 employees, could benefit from a larger public profile.
Another top Obama health policy official said Becerra’s low profile was “quite strange” and a “lost opportunity to communicate with the Hispanic community.” The official recalled that previous HHS secretaries Kathleen Sebelius and Sylvia Burwell maintained much higher profiles during the H1N1 flu and Ebola outbreaks, respectively, saying, “They were out there all the time.”
Another former Obama official said Becerra is well-liked by his staff, but the official said his absence from Covid events was unusual. “Normally you see a secretary who will push and push and drive the conversation,” the former official said.
NBC News requested Becerra’s calendar from the HHS press office, but the office deferred to the agency’s Freedom of Information staff. NBC News submitted a Freedom of Information Act request for Becerra’s schedule in early October. FOIA staff members responded that the schedule would be released in late November. Last week, the staff pushed the timeline back to late December.
An administration official said Becerra has been busy implementing many of the Covid policies that fall under the agency’s purview. “While the president articulates his vision, we are responsible for implementing much of it,” the official said. “If you ask him what our top priority is, it’s Covid.”
The job has changed
Some HHS veterans say that Becerra’s low profile is not his fault and that it is the job itself that has changed, with the agency’s power increasingly centered on one massive sub-agency, the Centers for Medicare & Medicaid Services, or CMS.
In Biden’s 2022 $1.7 trillion budget request for HHS, 80 percent is mandatory funding for Medicare and Medicaid, programs that touch the lives of almost half of all Americans. Once the Affordable Care Act passed, CMS grew in importance.
If Biden’s Build Back Better initiative is passed, CMS will take on an even more significant role in administering new health care investments that some view as the biggest expansion of health care in a decade.
“The department isn’t an operational role anymore, really. It’s a figurehead position. You go around and give speeches,” said a former senior Trump official, who added that it was “absurd” that the head of CMS had to run decisions past the secretary of HHS.