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WASHINGTON -- Tuesday's Senate confirmation hearing for Health and Human Services Secretary nominee Xavier Becerra, who is currently California's attorney general, struck a note similar to other confirmation hearings, with a mix of praise from Democrats, tough questions from Republicans, and vague replies from the nominee himself.

Some senators made their positions on the nominee clear early on. "While the Trump Administration ignored crises that impact public health like this pandemic, climate change, and systemic racism, Attorney General Becerra has taken them on," said Sen. Patty Murray (D-Wash.), chairman of the Senate Health, Education, Labor, & Pensions (HELP) Committee, which was holding the hearing. "He has held companies accountable for flouting COVID-19 safety rules and putting workers at risk ... And he has worked throughout his career to advocate on behalf of communities of color across health, immigration, education and more. Overall, his record tells a story that is clear, compelling, and persuasive."

"While the days of President Trump's head-in-the-sand approach to crisis management are thankfully over -- this pandemic isn't," she added. "Given the urgency of this crisis, I'm hopeful that after today's hearing -- and the Finance Committee hearing tomorrow -- the Senate will move quickly to confirm Attorney General Becerra."

Questions on Abortion

Ranking member Richard Burr (R-N.C.) was more negative. "As the attorney general sits before us I'll say what I've said to him privately -- I'm not sold yet," said Burr. "I'm not sure that you have the necessary experience or skills to do this job at this moment. I'm not sure that you have the appropriate respect for the private sector, and innovation, and intellectual property needed to bring more exciting treatments and cures to save lives in this country."

Sen. Mike Braun (R-Ind.) asked Becerra about his views on abortion; as California's attorney general, Becerra has maintained a pro-choice position. "For many of us, your record has been very extreme on abortion issues. Other prolife groups have put a lot of information out there that you've been against prolife on the record," said Braun. "If you're the HHS secretary and will be representing everyone, will you commit to not using taxpayer money to fund abortions and abortion providers?"

Becerra responded that if he is confirmed, his department "will follow the law when it comes to the use of federal resources. There I can make that commitment." Braun seemed dissatisfied with that response, saying it was "not really the particular answer I was looking for."

Sen. Bill Cassidy, MD (R-La.), asked about the 340B program, which is designed to provide drug discounts to safety-net hospitals. Recent disputes over how the program should work involve "big stakeholders, all claiming they're totally righteous and the truth being somewhere in between," Cassidy said. "Do we need a statutory definition for contract pharmacy and a statutory definition for patient and, if yes, what would those definitions be?"

Becerra dodged the question, calling 340B "an indispensable program for some of our most underserved communities" and adding that "I think the first thing we have to do is enforce the law that we have in place. I'm more than willing to work with you and members of Congress -- if I'm fortunate to be confirmed -- to see if we have to move in that direction," i.e., new legislation.

Qualifications at Issue

Cassidy also pointed out that Becerra was a lawyer and not a physician; he seemed to suggest that this made Becerra unqualified for the job. "What would you as the attorney think if I, the physician, were nominated to be the United States Attorney General?" said Cassidy. "You'd say, 'Eh! The guy's not qualified. Maybe HHS secretary -- maybe not -- but certainly not Attorney General.' So you can imagine the kind of concerns I have regarding your nomination." Cassidy added that he nonetheless had "an open mind" about Becerra.

Sen. Tim Kaine (D-Va.) defended Becerra on that point. "I've worked with 6 HHS secretaries -- five have been attorneys or businesspeople and had multi-year tenures; one was a physician and his tenure was measured in a matter of a few months," Kaine said, referring to Tom Price, MD, who was 8 months into his tenure as HHS secretary after controversy erupted over his use of private jets for government business. "That's not to say a physician couldn't be a good HHS secretary, but we've had plenty of good business folks and lawyers who've been strong HHS secretaries."

Kaine also asked what Becerra would do to improve the mental healthcare for clinicians. "One, we have to make sure we provide them with the resources," Becerra said. "Two, they should know they're essential and they will be priority one when it comes to vaccines. Three, we have to make sure they're rewarded; they should not have to worry about whether they have enough money coming home to feed the family."

"We also have to make sure we don't give stigma to getting mental health services," he said. "I face this a lot in law enforcement with peace officers who are afraid oftentimes to get mental health services because they're afraid it will go on their permanent record and deprive them of opportunities to continue forward. We have to make providing mental health services something that's part of life. Just like you get an annual checkup, mental health should be part of it as well."

More Funding for Providers

Sen. Susan Collins (R-Maine) asked Becerra what he thought of the fact that the $1.9-trillion COVID relief package currently being championed by President Biden didn't include provider relief fund money for nursing homes. "It would be a top priority to make sure we're providing the resources necessary," he said.

"We've seen how many of these assisted living facilities and nursing homes that care for aged and disabled Americans haven't had resources; they're short on workers ... so we have to provide the help. I believe President Biden will be there to provide support, whether through the Provider Relief Fund or or simply by making sure we're providing resources already allocated to make sure we're working closely with those facilities that have been hit the hardest."

Sen. Bernie Sanders (I-Vt.) sought Becerra's views on the need for more healthcare providers -- including community health centers -- in underserved areas. "Our primary healthcare system is awful, in the sense that even those with insurance can't find a medical home, can't find a doctor when they need to," said Sanders. "Are you supportive of significant growth in federally qualified health centers around this country so we can make sure every American, regardless of income, has access to decent quality healthcare? "

"Absolutely," replied Becerra, who was formerly a House member representing a district in the Los Angeles area. "That is one of the ways we were able to reduce by almost one-half the uninsured rate in my former congressional district after the implementation of the Affordable Care Act, because our community health centers were there to be supportive of people who didn't have access to doctors and hospitals previously."

Sen. Jacky Rosen (D-Nev.) pointed out that her state was in dire need of more doctors; it ranks last in per-capita numbers of general surgeons, 48th for primary care, and 45th for physicians overall. "We have to increase our graduate medical education slots; these are critical to addressing our provider shortages," she said. In response, Becerra thanked Congress for recently adding about 1,000 graduate medical education slots. "President Biden has made a commitment; he wants to put 100,000 new public health workers out there to help states like Nevada ... We just have to be there long term."

Sen. Maggie Hassan (D-N.H.) wanted to get Becerra's view on how HHS should handle the new COVID variants. "Sequencing is so critical," said Becerra. "We have to have scientists tell us what the next iteration of that virus may look like. We have to stay ahead of the game... If variant takes off, we don't want to go back to square one. We need to do sequencing, we need to provide scientists with what they need."

Tuesday's hearing was considered a "courtesy hearing" because the HELP Committee does not actually vote on whether to send Becerra's nomination to the Senate floor. That is the task of the Senate Finance Committee, which is slated to hold its own hearing with Becerra on Wednesday.

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