When people talk about the US Department of Health leader, they usually start with a title. Secretary of Health and Human Services. It sounds incredibly stiff. It’s the kind of job title that makes you think of endless beige hallways and stacks of paperwork that never end. But the reality of Xavier Becerra’s role is actually much more of a political tightrope walk than most folks realize.
He isn't just a doctor-in-chief. He isn't a doctor at all, actually. That’s usually the first thing that gets people fired up.
Think about it. You have a department with a budget that rivals the GDP of some mid-sized countries—we are talking about roughly $1.7 trillion. That’s a staggering amount of money. It covers everything from the pills your grandma takes for her heart to the safety of the spinach in your fridge. Becerra sits at the top of that mountain, yet his background is in law and litigation.
The legal mind in a medical world
Choosing a lawyer to be the US Department of Health leader was a deliberate, if controversial, move by the Biden administration. If you look at his track record as the Attorney General of California, it starts to make more sense. He spent years suing the federal government to protect the Affordable Care Act (ACA). He knows the legal plumbing of the healthcare system better than almost anyone.
That matters because healthcare in America is basically one giant legal battle.
It’s about who pays, how much they pay, and who gets sued when things go sideways. Becerra’s job isn't to perform surgery; it’s to make sure the legal framework holding up the ACA doesn't crumble under the weight of constant court challenges. Honestly, the HHS is less of a hospital and more of a massive insurance and regulatory conglomerate.
Why the critics are so loud
There’s been no shortage of heat directed at Becerra since he took the oath in March 2021.
🔗 Read more: Why Your Feet Itch: What It Really Means and When to Worry
Critics often point to the handling of the migrant children crisis at the border or the perceived slowness during certain phases of the COVID-19 response. During his confirmation, Republicans hammered him on his lack of medical experience. Senator Mitt Romney notably questioned his qualifications, arguing that the US Department of Health leader should be a health professional, especially during a once-in-a-century pandemic.
But here’s the thing: HHS is a sprawling beast.
It contains the CDC, the FDA, and the NIH. Each of those has its own specialized director. The Secretary is the conductor, not the lead violinist. If the FDA is arguing with the CDC about booster shots—which happened quite a bit—the Secretary is the one who has to mediate that mess.
The hidden power of the HHS Secretary
Most people focus on the big headlines, like drug pricing or reproductive rights. Those are huge, obviously. But the US Department of Health leader exerts influence in ways that don't always make the evening news.
Take the "Inflation Reduction Act" (IRA) for example.
Becerra is currently overseeing the first-ever negotiations between Medicare and pharmaceutical companies over the price of ten high-cost drugs. This is a massive shift in American policy. For decades, Medicare was literally forbidden by law from negotiating these prices. Now, the HHS is building the machinery to haggle with Big Pharma. It’s a grind. It involves thousands of pages of regulations and likely years of lawsuits.
If you want to understand what Becerra is doing right now, look at the technical implementation of these price caps. It’s not flashy, but it affects the bank accounts of millions of seniors.
Navigating the post-Roe landscape
The landscape changed overnight when the Supreme Court overturned Roe v. Wade. Suddenly, the US Department of Health leader became the frontline defender of reproductive health access at the federal level.
It’s a weird position to be in.
Federal law (EMTALA) requires hospitals to provide stabilizing care to patients in emergencies. The HHS under Becerra has argued that this includes abortion if the mother’s life is at risk, even in states with bans. This has set up a massive legal collision between state capitals and Washington D.C. Becerra has been traveling the country, basically acting as a megaphone for the administration’s stance, trying to find "workarounds" within the limits of federal authority.
What most people get wrong about the budget
People see the $1.7 trillion figure and assume Becerra has a giant "spend" button on his desk.
In reality, about 90% of that money is "mandatory spending." That’s Medicare and Medicaid. It’s already spoken for by law. The US Department of Health leader only has direct control over a relatively small "discretionary" slice. This is where the funding for mental health initiatives, the opioid crisis response, and rural health clinics comes from.
Becerra has pushed hard for "health equity"—a term that gets used a lot in D.C. but basically means trying to make sure zip codes don't determine life expectancy. It's a tall order.
Whether it’s expanding Medicaid in holdout states or trying to lower the maternal mortality rate for Black women, the focus is on the gaps in the system. These aren't quick fixes. They are generational shifts that require moving a bureaucracy that is notoriously slow.
The reality of the "Bully Pulpit"
Being the US Department of Health leader is as much about messaging as it is about policy.
🔗 Read more: Why Alone and Depressed Quotes Actually Help When Life Feels Heavy
When Becerra goes on TV, he’s trying to build public trust in institutions that have taken a beating lately. Trust in the CDC hit record lows during the pandemic. Part of his job is trying to restore that credibility while also managing the political expectations of the White House. It’s a thankless gig in many ways. You get blamed when a new variant pops up, and you get blamed when the price of insulin stays too high, even if the holdup is in a court case 2,000 miles away.
He’s often described as "low-key" or "cautious."
Some see this as a lack of leadership; others see it as a seasoned politician knowing when to stay out of the line of fire. Unlike some of his predecessors who were very "out front," Becerra seems to prefer the legal and administrative trenches.
Actionable insights for following HHS policy
If you want to stay ahead of how the US Department of Health leader impacts your life or business, stop looking at the press releases and start looking at the "Proposed Rules."
- Monitor the Federal Register: This is where the real changes happen. When HHS wants to change how a hospital is reimbursed or how your health data is protected, they have to post it there first.
- Follow the Medicare Negotiation Timeline: The prices for those first ten drugs won’t actually take effect until 2026. Keep an eye on the legal challenges from Merck and Bristol Myers Squibb; those will determine if the HHS actually has the teeth it claims to have.
- State vs. Federal Dynamics: Watch how Becerra uses "Section 1115 waivers." These allow states to test new ways to deliver Medicaid. It’s a huge indicator of where healthcare is heading, especially regarding social determinants of health like housing and food security.
The role of the US Department of Health leader is currently defined by the tension between legal authority and public health necessity. Xavier Becerra isn't a doctor, but he's acting as the lead attorney for the nation's health. Whether that's the right approach depends entirely on whether you think the healthcare system's biggest problems are medical or structural.
Moving forward, the focus will likely stay on the cost of living. Healthcare is the biggest expense for most American families. The success or failure of this department won't be measured in clinical trials, but in the "out of pocket" column of a standard family budget.