Xavier Becerra, a staunch defender of reproductive health care access and transgender rights, will be the nation’s next Health and Human Services secretary, after being confirmed by the Senate in a 50-49 vote.

Becerra, the current California attorney general, will be the first Latinx person to head the massive agency, which oversees health care, disability programs, foster care and many other social service programs. Previously, Becerra served for more than 20 years as a member of Congress. As a member of the House Ways and Means Committee, he helped draft the law that ultimately became the Affordable Care Act and was an early supporter of marriage equality.

Becerra’s nomination won early accolades from reproductive health supporters and transgender rights organizers, who cited his work in California to support access to health care. 

But conservatives campaigned heavily against Becerra’s confirmation, pointing in particular to his history defending abortion rights. The right-wing Heritage Foundation spent $500,000 on ads in West Virginia and Arizona — home to the two most conservative Democrats, Joe Manchin and Kyrsten Sinema — highlighting abortion, guns and immigration. 

Becerra was also the first of President Joe Biden’s cabinet nominees not to be favorably reported out of his committee. While all 14 Democrats on the Senate Finance Committee backed his nomination, none of the committee’s 14 Republicans did. 

As secretary, Becerra has indicated he would prioritize health care issues that disproportionately affect women of color and LGBTQ+ people. 

In his confirmation hearings, Becerra pledged to prioritize the nation’s pregnancy-related mortality crisis. The United States ranks at the bottom of wealthy countries for pregnancy-related health outcomes, and Black and Native American people are significantly more likely to die because of pregnancy than White people. 

Addressing that crisis — which experts argue will require a comprehensive, multifaceted approach — is one of the few health policy areas where political observers argue there is a strong chance for bipartisan legislation.

In confirmation hearings, Becerra also spoke about the need for improving the government’s data collection to better capture racial disparities in COVID-19. Even though Black, Latinx and Native American people are more likely to have died of the coronavirus, almost half of the government’s current data on COVID-19 test results does not have any information about the person’s race or ethnicity. The federal vaccination data has similar shortcomings.

As California’s attorney general, Becerra drew the ire of conservatives for his regular lawsuits against President Donald Trump’s administration. California led other states in suing over the administration’s efforts to limit contraceptive coverage and block Planned Parenthood from receiving federal funds.  

In the ongoing criminal case against Chelsea Becker of California, who was charged with murder after delivering a stillborn baby, Becerra, then attorney general, filed an amicus brief arguing that prosecutors cannot treat pregnancy loss as murder. Becker had been jailed on $2 million bail since November 2019. She was released in March to enter a drug treatment center, as prosecutors alleged Becker’s use of methamphetamine caused the stillbirth.

Becerra also defended the Affordable Care Act — which extended health coverage and major new insurance protections to women and LGBTQ+ people — as part of California v. Texas, a pending Supreme Court case that could undo the 2010 law. As secretary, Becerra will be charged with overseeing and likely undoing many Trump-era regulations that weakened the landmark health law, and in potentially developing regulations that could expand its benefits. 

While serving in Congress, Becerra suggested he supported Medicare for all — a universal health care model favored by progressives that would in theory provide far more generous coverage than what the ACA covers — though he acknowledged in his confirmation hearings that Biden does not prefer that model. 

Becerra’s reversals from the past administration could include undoing the former administration’s efforts to weaken the law’s protections for people with preexisting medical conditions. Those are protections that disproportionately benefited women and transgender people in particular. 

Becerra would also be in charge of walking back Trump’s efforts to weaken the ACA’s specific health care protections for transgender people. Under former President Barack Obama, the federal government interpreted the health law to prohibit health discrimination against transgender people, a protection the Trump administration reversed. 

The Trump administration also sought to protect health care providers who did not want to treat transgender people, people with HIV/AIDS and people seeking abortions. Though that regulation never took effect, it is also one that Becerra could step in to undo.  

Ko Bragg contributed to this report.