President-elect Joe Biden has picked California Attorney General Xavier Becerra to be his health secretary, putting a defender of the Affordable Care Act in a leading role to oversee his administration’s coronavirus response.
Separately, Mr Biden picked a Harvard infectious disease expert, Dr Rochelle Walensky, to head the Centres for Disease Control and Prevention.
If confirmed by the Senate, Mr Becerra, 62, will be the first Latino to head the Department of Health and Human Services, an agency with 80,000 employees and a portfolio including drugs and vaccines, leading-edge medical research and health insurance programs covering more than 130 million Americans.
As California’s attorney general, Mr Becerra has led the coalition of Democratic states defending Obamacare from the Trump administration’s latest effort to overturn it, a legal case awaiting a Supreme Court decision next year.
A former senior House Democrat, Becerra played a role in steering the Obama health law through Congress in 2009 and 2010. At the time he would tell reporters that one of the primary motivations for him was having tens of thousands of uninsured people in his Southern California district.
Overseeing the coronavirus response will be the most complicated task Mr Becerra has ever contemplated.
By next year, the US will be engaged in a mass vaccination campaign, the groundwork for which has been laid under the Trump administration. Although the vaccines appear very promising, and no effort has been spared to plan for their distribution, it is impossible to tell yet how well things will go when it is time to administer the vaccine to millions of Americans.
The core components of HHS are the boots on the ground of the government’s coronavirus response. The Food and Drug Administration (FDA) oversees vaccines and treatments, while much of the underlying scientific and medical research comes from the National Institutes of Health (NIH). The Centres for Disease Control and Prevention (CDC) takes the lead in detecting and containing the spread of diseases. The Centres for Medicare and Medicaid Services provides insurance coverage for more than one in three Americans, including vulnerable seniors, as well as many children and low-income people.
Under President Donald Trump, CDC was relegated to a lesser role after agency scientists issued a stark early warning that contradicted Mr Trump’s assurances the virus was under control, rattling financial markets. The FDA was the target of repeated attacks from a president who suspected its scientists were politically motivated and who also wanted them to rubber-stamp unproven treatments.
As California’s attorney general, Mr Becerra jokingly became known in Democratic legal circles as the man who sued Mr Trump more than anyone else. Beyond health care, the lawsuits centred on issues from immigration to environmental policies.
Before he became California’s attorney general, Mr Becerra had served for more than a decade in Congress, representing parts of Los Angeles County. He had also served in the California state assembly after attending law school at Stanford.
His mother was born in Jalisco, Mexico, and emigrated to the US after marrying his father.
As CDC director, Ms Walensky would replace Dr Robert Redfield, who accurately told the public coronavirus vaccines would not be available for most people until next year, only to be disparaged by Mr Trump as “confused”.
Ms Walensky is a leading infectious disease specialist at Massachusetts General Hospital, and has devoted her career to combatting HIV/Aids.