Xavier Becerra talks to LAist about why he should be California's next governor (Transcript)

Here's a transcript of the conversation that took place Monday, April 13, on the campus of Loyola Marymount University in front of a live audience of students and other guests.

Xavier Becerra, 68, is running as a Democrat.

Larry Mantle: Xavier Becerra is running for governor. He served as President Biden's secretary of Health and Human Services following a turn as California attorney general. Secretary Becerra served 12 terms in the house representing east, northeast and downtown la. His undergrad and law degrees are from Stanford and he grew up in the Sacramento area. Mr. Becerra, welcome to AirTalk and LMU.

Xavier Becerra: Larry. Thank you. Thank you everyone. Great to be with you.

His position on health care

Larry Mantle: Let's start with health care. Given your most recent position, you've supported a single-payer governmental program and believe the state can take additional steps to move toward that goal, what would those specific steps be if you're governor?

Xavier Becerra: So, Larry, we have the most expensive health care in the country, and America has the most expensive health care in the world.

We spend more than any other place in this globe to provide health care, and we still have millions of people who don't have insurance. That's crazy. You can pay half the cost in Canada for the same kind of healthcare, and it is insane when we know what we need to do, we know because we already do it. It's called Medicare.

Medicare is essentially a single-payer healthcare system. It is essentially for those who are 65 and older who paid into it most of their working life. If you get a paycheck, when you see that FICA deduction, that’s what you're paying for. You're paying for your social security and you're paying for your Medicare, so when you turn 65, you have access.

No one can take it away from you. It is yours, guaranteed. Ask any senior in America today, “Will you give up your Medicare?” And they say, not over my dead body. And they shouldn't because that guarantees them for the rest of their life, they will have access to the doctor, hospital they need. That's what we need to do because we have a system with so many moving parts that it's so expensive that we spend billions of dollars of the dollars you pay and it never goes to pay a doctor or a nurse or even the hospital. It is used to pay the accountant, the attorneys, the pencil pushers who go through these administrative fights about how much should be billed and how much should be paid.

Larry Mantle: But, but how would you do that in California?

I understand the argument for doing this nationally, but if you're gonna do it in California and it's the outlier, Gov. Newsom has talked about the challenge of doing that, is that realistic?

Xavier Becerra: It is. Because you can. We know what we need to do to meet the moment.

You just have to get changes and so Larry, to your point, we cannot enact in California a system of single payer where you combine the Medicare program for seniors, the Medi-Cal program for the lower income Californians, the Affordable Care Act programs that we have along with the private, employer based insurance programs.

There are laws that underpin all of those, and many of those laws as Larry, you probably know, are federal laws. The state can't change federal law. So what we would need in order to enact a system of Medicare for all is to get harmony between what the feds do, what we do at the state, and what the local does along with the private sector.

And so can we do it? Yeah, it's just a matter of getting everyone to harmonize.

Larry Mantle: Well, if we've got a super majority of Democrats in the legislature and a Democratic governor, if it is that easy to do it, why do we not have that system?

Xavier Becerra: Well, if it were just up to the state of California, we'd probably have it already.

But it's not. It's up to the federal government. Congress has to help us harmonize. There's a law that governs how employers can provide health insurance coverage to you because they get a tax break. When your employer lets you have health insurance coverage, they get to write off some of the cost of giving you access to health care.

We'd have to change. That's called the ERISA Law. We'd have to change the ERISA laws so that they would conform. Essentially what we'd be asking the federal government to do is let us bring all of those different elements together into one, and instead of having so many moving parts. You have one law that governs and then you have one payer.

The state of California makes sure it pays the doctors and the hospitals. So can we? Yes, but we would need the help, and I don't think this federal government's gonna help us get to single payer.

What he'd do about healthcare fraud

Larry Mantle: While we're on the topic of health care, let's talk about fraud. We've had all these stories in the news, hundreds of millions of dollars we could be over a billion dollars when you total up all the hospice care, Medi-Cal, other forms of fraud that we have here in California. You've been criticized for not quickly responding to fraudulent use of federal COVID-19 funds when you were HHS secretary. If you're elected governor. What would you do to combat this size of fraud that, that is coming out?

Xavier Becerra: Larry, the federal government doesn't run the health care programs throughout the states. We made COVID vaccines, COVID treatments, PPE, ventilators, all those things available to the states when they requested them. How they got administered on the ground was based on how the states did it, not the federal government.

HHS is big, but we don't do it for 50 states. We provided the allocations, and so if there was fraud on the ground, it was being committed by the locals there on the ground. So when you mention fraud, for example, in the Medi-Cal program, in the nursing home programs, it's being done locally and the state and the federal government, because they're partners in these efforts, would go after that together.

When I was attorney general, we went after Medi-Cal fraud. We did that together with the federal government. If there's Medicare fraud, again, because it's federal law, Medicare, it would be the federal government that would go after them, not the state.

Larry Mantle: Has California, in your view, done enough to pursue fraud in the Medi-Cal and other programs?

Xavier Becerra: No. That's why when I was AG I, actually stood up a separate division to deal with Medi-Cal fraud because we know it goes on all the time. And why? Again, 'cause there's so many moving parts in our health care system that it's easy to hide the money, how it's spent. If we got rid of all those different moving parts and you didn't have to do so much accounting, it wouldn't be so difficult to figure out if the dollar from your pocket went to pay that doctor and it went into his or her pocket.

But there's so many other pockets in between that are taking some of that money.

California's deficit

Larry Mantle: We're looking according to the Newsom administration and the state legislative analyst office at structural multi-year budget deficits of $20 [billion] to $35 billion in California. This as revenue has, you know, gone through the roof because the stock market and taxes on those gains have been tremendous.

The economy's been doing well, generally in California. So what would you do if elected governor? When you've got this kind of a structural deficit, would you look at cuts or would you look at tax increases? How would you deal with this?

Xavier Becerra: Both. You can't do just one side. I tell you that having had to balance a budget larger than the budget of the state of California, the budget at the Department of Health and Human Services, the largest public health enterprise in the world, is by far bigger than the budget of the state of California. How much bigger? Well, you could take the budget of the state of California. You could add the budget of the Department of Defense, which is pretty big, and both combined are still smaller than the budget of the Department of Health and Human Services.

It's because we're providing healthcare services to the 50 states, for the 330 plus million Americans using Medicare, Medicaid, ACA, you name it. Everything falls under HHS. So we've got this massive budget every year. I had to balance it because the constitution doesn't let me spend a dollar that wasn't allocated by Congress.

So every year I had to go to the same routine with all my directors, NIH, CDC, FDA, CCM, all the different agencies that help HHS do all the work. And I had to tell them, we have to be ready. And I'd ask them for three scenarios. 2% cut, 4% cut, 6% cut, 'cause we didn't know at the end of the year where we would land.

So we had to be ready for that. At the same time, we also made sure that you never noticed. I guarantee you not a one of you can tell me where we made cuts. What we did was we protected the programs that provided direct services to people, but we did make our cuts and we did balance our budget larger than the budget of the state of California

Larry Mantle: So in your study of the California budget, you're prepped to run for this office, and as you familiarize yourself, what are the areas that you think cuts could be made? Where are those?

Xavier Becerra: Yeah, it's in all those different moving parts. We talked about it in health care, Google “healthcare coding.” Because every time you go see a physician or you go to a hospital when, when the hospital bills, they don't bill because you went and amend a broken arm or to get treatment for your diabetes or to deal with your hypertension.

It's all coded. Everything is coded. Everything has a code to it. And so when that doctor bills, he or she puts in a code, there's a game of coding that goes on. Providers try to go to the highest billable code. The payers, the insurers try to get you to the lowest billable code, and it's a food fight in between.

Billions of dollars are spent trying to beat the other side when it comes to coding. That doesn't provide anybody in this room a dime worth of or a minute worth of care. Get rid of that, and you get billions of dollars.

Larry Mantle: Is that something the state could do? For its reimbursement?

Xavier Becerra: Yeah. Because we can go in and say, “you are billing improperly. You are playing this game.”

Most people have heard of this thing called prior authorization. Insurance companies will deny you care that a doctor, your doctor, tells you that you need because they say, “Wait, you didn't get prior authorization from us.” Who's doing the prior authorization?

It's probably not a physician looking that over. It's some pencil pusher who says, wait a minute, I don't know if we need a bill. I don't know if we need to pay for that. So, because the doctor didn't get prior authorization, it's held up. Ultimately, you probably win because who's the medical expert? Not the pencil pusher.

Larry Mantle: I'm not understanding how that affects the state budget though. How does that enable California to cut its expenditures?

Xavier Becerra: Because prior authorization and the coding process is used in the Medi-Cal program. It's used in our Affordable Care Act in our covered California. The way people bill, the way we transact the dollars in health care is through this coding process.

Larry Mantle: So, you're saying the state would, would reimburse less to providers than it's providing now? That's where the savings would come?

Xavier Becerra: Less in some cases, maybe more in others. It depends, but what we would do is we would standardize it. So if the codes that cost us the most as taxpayers are the ones that are the most high skilled codes you can imagine.

If you need to get brain surgery, that's a very high billable expense. If you need to go in for an aspirin, that's a very low billable expense. But if an insurance company's gaming you all the time and say, “ah, you didn't get prior authorization to get that aspirin.” There's money in that the cost, the bureaucratic cost.

Larry Mantle: But we've, we've already had to deal with narrow physician networks under the Medi-Cal program because of the current levels of reimbursement. If you're looking at, on average, a cut in reimbursement, how are you gonna have docs willing to treat patients under Medi-Cal?

Xavier Becerra: So, I'm not talking about cutting the reimbursement.

A physician should be paid for providing a service. What we shouldn't have is some administrative bureaucrat saying that, that what the physician recommended for you should not be provided and spending millions of dollars in the fight to decide whether you get the coverage or not when the insurer finally says, “okay, you'll get the coverage.”

We spent a whole bunch of money, taxpayer money, to fight that administrative fight instead of giving you the health care. Cut out the administrative burden, the quickest way to do that, Larry, is to standardize some of the billing for the easy things.

Health care for undocumented residents

Larry Mantle: Can, can California continue to be able to pay for undocumented residents to be covered?

Xavier Becerra: Not only can it, it must, it'll otherwise cost us more money. You know this, you've heard it before. Pay me now or pay me later. Health care's not a commodity. If your child is sick, at some point you're gonna get care. If your child is sick and you don't have insurance, you're gonna wait 'cause you can't afford it and you hope that your child gets better and you wait and wait.

But when your child is finally so ill, such in pain that you cannot wait, you will go get health care. Here's the problem. When you finally do go get health care it, the problem is worse. When you enter into the healthcare system, you're entering through the most expensive doors in health care, the emergency room. We end up paying more money for people who are uninsured to walk in to get health care in the most expensive place in health care, the emergency room, because we didn't give them access early. So I'm gonna front load, I've already said this, as the health care governor for California, I'm gonna front load health care so that you get it early, upfront from a pediatrician, a family doc, an OB. So you don't have to wait till it's so severe that it costs us a lot of money 'cause they're not gonna pay for that. Those families, they don't have the money.

His position on working with unions

Larry Mantle: Secretary, labor unions staunchly support Democratic candidates in California, the same people with whom they negotiate public employee pay and benefits. Unions generally exert political pressure on Democrats over minimum wages, construction rules, worker benefits. What's your response to Californians who argue Democrats here are more beholden to unions than to the overall needs of the state?

Xavier Becerra: Larry, first I would say who in California should work a full day's work and not be able to afford to put food on the table? That you have to stop by some food pantry to pick up food after a full day's work because you didn't get paid enough?

Who thinks that making 15 bucks an hour? Actually, let me ask anybody here, do you think you could live on 15 bucks an hour in Los Angeles? So why should we believe that we should let people hire you and pay you only 15, and then put it on the taxpayer's dime to make sure that when that worker needs health care, they don't get health insurance from the employer. So guess what? They get it from us, the taxpayers. We're subsidizing that employment by not making that employer really pay a living wage for those workers.

Larry Mantle: So are you contending that labor unions essentially represent the totality of California. Is that the argument you're making, that their interests are the same as everybody else's?

Xavier Becerra: Uh, I certainly think, and I was a former member of a union, a labor, I was a construction worker in my younger years trying to help pay for my college. My father was a decades member of the Laborer's International Union as well in road construction.

Because of my father's work, my family, we had health insurance most of the time. I will fight very hard to make sure every Californian, if they wish, can join a union.

Larry Mantle: So it sounds like you don't feel like the legislature is overly beholden to unions. Is that what you're saying?

Xavier Becerra: Well, no, you read a lot into what I just said.

Larry Mantle: Well, that's what I asked you upfront though, is whether you feel like Democrats are beholden to labor unions? That's the question.

Xavier Becerra: Sure. The direct answer is I'm not beholden to anybody in particular. I believe I'm doing the right thing I'm fighting for.

Larry Mantle: But I'm asking you about the status quo. Are Democrats overly beholden to labor unions or you think they have it right?

Xavier Becerra: I think anyone who fights for workers to make sure that they get paid a fair wage, that they have access to benefits is doing what we would want to do for any working family. Now are, are some legislators overly helpful to particular interests? That could be, but what I'm saying if you ask me is, are we paying too much for a family that's making minimum wage? I ask whoever says we are to go work at that job for a minimum wage person.

The homelesness crisis

Larry Mantle: We're talking with candidate for governor Xavier Becerra. Secretary Becerra, California spent over $24 billion on homelessness services in the past five years, independent of the billions more cities and counties have spent.

Critics argue that there's minimal accountability. We have the legislative analyst audit that has been done. We have a criminal prosecution of a nonprofit that LAHSA here in Los Angeles sent millions of dollars to. None of the money ever got to homeless services. The nonprofits board, it's alleged ,didn't even have real people that were on the board.

So what would you do if governor to deal with how homelessness funds are being spent?

Xavier Becerra: Yeah, Larry, I'd do what I did when I was AG. I'd enforce against those folks after we've done the investigation. We need to have, you used the right word, accountability. When I was AG, it was my job to enforce the law.

We would do the oversight if we saw that there was misuse of funds. We went after those folks who did that, and we should do the same thing. There is no reason why any taxpayer in California should feel like their taxpayer dollars are not being used to help pull people off the streets, and we need to have the confidence of the public.

But I can tell you right now that most people will tell you that they don't think that we've used those billions of dollars in a way that really have addressed the issue of homelessness.

How he'd handle California's high gas prices

Larry Mantle: What would you do about the gas prices in California that we're experiencing? Would you suspend any of California's taxes or the environmental programs that capture some of the funds from gasoline?

Xavier Becerra: I’d get rid of President Donald Trump first, and that would help us reduce the prices. And -

Larry Mantle: But you don't have control over that.

Xavier Becerra: Yeah, I don't. But you asked me what I would do, and I'm telling you that what I can, and what I would do are two different things sometimes. What can I do to stabilize international market prices of gasoline when Donald Trump has unilaterally started an illegal war and as a result -

Larry Mantle: But, wait, wait, wait. You can blame President Trump for what's happening in the global price of oil, what's happening nationally. California has, next to Hawaii, the highest price of gas. Is that not a California issue?

Xavier Becerra: It is a California issue driven by Donald Trump. What was the price of gas a month ago, Larry?

Larry Mantle: Well, that's the latest. It was already higher than every state but Hawaii. So we feel it all the more when global events lead to an increase.

Xavier Becerra: Yes. Well, if you ask me specifically what can California do to try to help reduce the price of gas, what I would tell you is that we try to continue to produce as much gasoline in California that we can, so that we don't have to import it from the very expensive international markets that we see now. We continue to build out our infrastructure so we can move to clean energy, so we don't have to rely on fossil burning fuel vehicles, and that we do this in a way that brings the families that we need to afford those electric vehicles and those new energies with us.

Because oftentimes what happens is leaders get ahead of their skis and we propose these things that are well intentioned and really needed into the future. But if you've got a family that's barely paying the rent and driving a 15-year-old pickup, it's hard for them to conceive that they're gonna be able to purchase that electric vehicle tomorrow.

And so we have to do this in a way, if you're gonna be a leader, you gotta know that what you're proposing will bring the followers because if you don't have followers 'cause they can't afford to follow you, then you're really not a leader.

Larry Mantle: So if you're elected, how quickly do you think you could bring down gas prices, if you could do it?

Xavier Becerra: I think we could stabilize some of the prices in California by making sure we don't create instability in our local gasoline markets, that we make it make it clear that we're going to have a supply that's ready, readily available, so we can try to do what we can to stabilize. Donald Trump just took away the billions of dollars that, under the Biden administration, had been allocated to subsidize the move towards clean energy. Solar, wind, geothermal.

I will, as California governor, tell those industries, “we will support you. We will continue to provide some of those subsidies that the federal government has yanked away,” because we need to move in that direction so that that way we can have that transition. But while we're going in that transition, we can't make modest income, middle income families pay the price of our ambitions to get there faster.

How he'd handle another crisis like the pandemic

Larry Mantle: We have just two minutes left and I have so much left. I'm not gonna get to all of it, but let me introduce LMU student Aolanni Jimenez to ask a question of you, Secretary Becerra.

Aolanni Jimenez: Hi, my name is Aolanni Jimenez, and my question for you is, given your experience as Secretary of Health and Human Services under the Biden administration, how does that prepare you to be governor? And if something similar to the COVID-19 pandemic happened again, what would be your policy?

Xavier Becerra: Thank you. So when you have, as CEO, the responsibility for the health of an entire nation and making sure the 50 states can administer, whether it's the vaccines or the treatments, or to be able to move forward, to continue to improve the lives of the people, you need to know how to deploy your resources.

And so, as secretary of HHS, during the height of the pandemic, uh, we had to work every day, deliberatively with all the states. We were able to, at the end of four years, get some 400 million COVID vaccines in the, into the arms of each and every one of you and your fellow Americans. Uh, that has never been done in the history of the country.

And as a result, we pulled our way out of this COVID pandemic, but you had to be able to organize it. And so what it does demand of you as the CEO of that health enterprise, is to be able to bring everyone together. And that is something that I would do as governor is bring us together, deploy our resources.

I'm the only candidate for governor who can tell you that I've had to actually declare a state of national emergency, and when you do that, you have to be ready to deploy the resources and the personnel.

Immigration and the White House

Larry Mantle: We have one minute left. Real quickly, what would you do differently than the current governor when it comes to responding to the ICE raids?

Xavier Becerra: What I have said is that I would've used our law enforcement leadership at the beginning to tackle this with ice law enforcement leadership, because you see law enforcement works together all the time. When I was AG and my law, uh, a division of law enforcement, we worked day in, day out with ice.

While I, by the way, was suing ICE for trying to force us to engage in ICE raids along with ICE. And I sued saying, “we're not gonna do that.” I beat Trump, and ICE in court. And then at the same time, I was suing ice, I was working with ICE because every day we're going after drug cartels. So drug interdiction –

Larry Mantle: I’m sorry, we're coming up on time here. If you're elected governor and you're dealing, so this down the road at this point, what would you do early on if you were elected to respond to ICE's actions now?

Xavier Becerra: I would say to them, “you have jurisdiction to do only certain things. The moment you step over that line, our law enforcement can investigate the ice police, charge the ICE police, we can prosecute the ICE police and we can incarcerate the ice police if they violate our laws.”

ICE does not have jurisdiction to do public safety.

They have jurisdiction to do only immigration enforcement. I guarantee you. You look at some of those videos, it's clear they're not doing ICE enforcement. They're chasing citizens.

Why him

Larry Mantle: Final question for you. What is it about you as a person, not your previous job titles, not your education, but you temperamentally, who you are as a person that makes you suited to this job of governor?

Xavier Becerra: I just answered all your tough questions. I think really what it is, is that I've learned being the son of immigrants, being the first in my family to have a chance to actually go on and get a college degree. Watching as a sixth grade-educated construction worker and a mother who didn't come here till she was 18, how they survived and they did everything they could to give their kids, my sisters and I what they never had a chance to have. I take that with me everywhere I go because I know if I can provide this family today, the construction worker and clerical worker of today with that opportunity that my parents had, the California dream is alive, and it's on me to make sure that that continues forward.

Larry Mantle: Secretary Becerra, thank you for being with us here at LMU and on AirTalk.

Xavier Becerra: Thank you. Appreciate it.

This transcript has been edited for grammar and clarity.