If there was a long history of only prominent physicians being named secretary of the Department of Health and Human Services, then the nomination of lawyer/politician Xavier Becerra might look like the administration has a weak candidate is in line as HHS boss, especially during a pandemic.

But the fact is that among the 24 HHS Secretaries that came before Becerra, most were like him — major state politicians — not leaders in health, or medicine, or insurance, or at least not until they were in the top HHS job. And as attorney general of California, he has been running the country’s second-largest legal department and has been involved in HHS issues for years.

Among the past secretaries of HHS were such recognizable politicians as Elliott Richardson, Casper Weinberger, Joseph Califano, Patricia  Harris, Richard Schweiker, Donna Shalala, and Michael Leavitt. There’s no pattern of a medical degree for those who’ve run HHS in the past.

In the beginning, it was known as Health, Education, and Welfare (HEW), the first department secretary was former Army Col. Oveta Culp Hobby, who headed the  Women’s Army Auxiliary Corps or WAACs and later the Women’s Army Corps (WAC’s) during  World War II. She was first named to run the HEW department by President Eisenhower.

When Jimmy Carter spun off education into its own department, the 13th HEW Secretary, Patricia Roberts Harris, transitioned into the HHS Secretary. She was a former ambassador and law school dean.

Since 1980, HHS has grown rapidly, especially with its Medicare and Medicaid health insurance programs. Much of the government’s food safety program is also housed in the department including the U.S. Food and Drug Administration (FDA), the federal Centers for Disease Control and Prevention (CDC), and various other federal laboratories. 

HHS has a budget topping $1.23 trillion — for 2019 — for the spending of $9.640 for every household. It employs 72,000 in 520 programs.

Becerra’s nomination as HHS secretary is expected to be taken up by the full Senate in a few days. The Senate Finance Committee locked up on a tie 14-14 vote with Republican opponents insisting Becerra would need on-the-job training. But under Senate rules, Majority Leader Chuck Schumer, D-NY, may bring Becerra’s nomination to the Senate floor for a confirmation vote.

If there is a 50-50 partisan split in the Senate floor vote, Becerra is counting on Vice President Kamala Harris casting the deciding vote to confirm his appointment to run HHS.

MeanwhileRochelle P. Walensky, MD, MPH, is the 19th director of the Centers for Disease Control and Prevention and the ninth administrator of the Agency for Toxic Substances and Disease Registry. Dr. Walensky served as chief of the division of infectious diseases at Massachusetts General Hospital from 2017-2020 and professor of medicine at Harvard Medical School from 2012-2020. She served on the frontline of the COVID-19 pandemic and conducted research on vaccine delivery and strategies to reach underserved communities.

Walensky succeeds Dr. Robert R. Redfield who was CDC’s boss for the past three years.  She will report to Becerra upon his confirmation.

And since Jan. 20, 2021, Dr. Janet Woodcock has been serving as Acting Commissioner of Food and Drugs. She has served in many capacities at FDA  since joining the agency in 1986. Before her the FDA commissioner was Dr. Stephen M. Hahn, the 24th commissioner who served from Dec. 17, 2019, to Jan. 20, 2021.

Once confirmed, Becerra will likely have a significant say in who is named as the 25th FDA commissioner.

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