President Trump has selected Alex Azar, a former pharmaceutical executive and a top health official during the George W. Bush administration, to lead the Health and Human Services Department.
The decision to enlist the 50-year-old Azar — who served as president of Lilly USA, the biggest affiliate of Eli Lilly and Co., before stepping down in January to work as a health-care consultant — represents a pragmatic pick. An establishment figure with a reputation as a conservative thinker and methodical lawyer, Azar would be expected to use his experience as HHS general counsel and deputy secretary to pursue Trump’s goals through executive action.
In announcing the nomination Monday morning, Trump tweeted that Azar “will be a star for better healthcare and lower drug prices!” He has a close rapport with the department’s top political appointees as well as Vice President Pence.
Azar has been highly critical of the Affordable Care Act, telling Fox Business in May that the law was “certainly circling the drain” and saying in a speech two months ago that many of its problems “were entirely predictable as a matter of economic and individual behavior.”
In a June interview on Bloomberg Television, Azar made it clear he thought the administration could shift the ACA in a more conservative direction even if congressional Republicans failed to repeal much of it. “I’m not one to say many good things about Obamacare, but one of the nice things in it is it does give tremendous amount of authority to the secretary of HHS,” he said.
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He also supports converting Medicaid from an entitlement program covering everyone who is eligible into block grants, a long-standing GOP goal that has sparked opposition from Democrats as well as some centrist Republicans. He has opposed expanding the program under the ACA to people with slightly higher incomes.
The nominee boasts sterling conservative credentials, clerking for the late Supreme Court Justice Antonin Scalia before working under special counsel Kenneth Starr to investigate Bill Clinton’s failed Whitewater real estate investments. Still, administration officials think he could work more deftly with competing health-care interests and politicians than his predecessor, Tom Price.
As expected, Azar’s selection was quickly and widely praised by congressional Republicans. Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-Tenn.) said he plans to schedule a courtesy hearing on the nomination “promptly,” adding that as a former top HHS official and private-sector executive, “Alex Azar has the qualifications and experience to get results.”
Anticipating his selection, Senate Democrats had already begun preparing for his confirmation hearings. They intend to focus on his ties to the pharmaceutical industry, his position on high drug prices and the way he would continue implementing the ACA.
Oregon Sen. Ron Wyden, the senior Democrat on the Senate Finance Committee, which will hold the official confirmation hearing on the nomination, issued a statement Monday about the issues likely to come up when the Senate Finance Committee meets. “I will closely scrutinize Mr. Azar’s record and ask for his commitment to faithfully implement the Affordable Care Act and take decisive, meaningful action to curtail the runaway train of prescription drug costs,” Wyden said.
He added: “The Trump administration’s track record on health care to date is objectively abysmal . . . Price abused the public trust on multiple occasions, led efforts to sabotage the Affordable Care Act, and enabled congressional Republicans’ disastrous attempts to pass Trumpcare.”
Washington Sen. Patty Murray, the top Democrat on the HELP Committee, said in a statement that she wants “to understand whether [Azar] is willing to stand up to President Trump and his Administration to ensure the needs of all patients and families are put first, whether science or ideology will drive his decision-making, and whether he plans to continue the Administration’s ongoing and unprecedented attack on women’s constitutionally protected health care rights.”
Price, the former secretary did little to foster better relations between the administration and Capitol Hill despite his dozen years as a Georgia congressman. He stepped down in September after revelations that he had racked up more than $1 million in expenses this year by making official trips on noncommercial aircraft.
On the opposite end of the political spectrum, antiabortion groups said they will be scrutinizing his stance on abortion to ensure that he will continue the push to scale back Obama administration policies.
Students for Life of America President Kristan Hawkins said in an email she “is pleased” to see that he clerked for Scalia and J. Michael Luttig, a conservative judge who served on the Fourth Circuit, “but we will be looking not at his history but at his agenda as head of an organization that controls so much of American healthcare.”
Tevi Troy, who succeeded Azar as HHS deputy secretary under Bush, recalled in an interview that the two of them were part of a small group who gathered on the campus of Cornell University for a Federalist Society meeting in the fall of 1988. It was a freezing weekend in Ithaca, N.Y., and the fact that Azar drove up from Yale Law School was a testament to his conservative ideals, Troy quipped. “There were probably only about 30 people there,” he said.
Dan Mendelson, president of the Washington consulting firm Avalere Health, said that, conservative as Azar is, “he is well accepted by [Democratic] policy people by having good policy wonk credentials.” Mendelson, who has known Azar for two decades, said that after the turmoil and rival factions within the department under Price, “he will bring stability to this agency. He really understands the mechanisms of HHS . . . He’s not going to be getting on little planes. He’s got a humility about him. He kind of understands how government works”
Azar’s ties to Pence date to his days at Lilly, an Indiana-based pharmaceutical firm, when Pence was the state’s governor.
While Azar initially backed Jeb Bush for president in 2016 and served on his Indiana steering committee, he later donated $2,700 to a “Trump Victory” committee. Since 2008, records show, he has donated more than $96,000 to GOP candidates.
In an undated Yale Law School alumni profile, Azar said that he “wrestled with the question” as to whether he should take his first job at HHS but that it set him on the career path he has followed ever since.
“I realized I had found my life’s calling: to help people around the world live longer, healthier, and happier lives,” he said.
As HHS general counsel, Azar worked on the administration’s response to the 9/11 terrorist attacks and the ensuing anthrax attacks, stem-cell policy and the advent of the Medicare prescription drug benefits. He then served two years as deputy secretary, during which he pushed for greater disclosure of prices associated with medical services to help foster competition and contain costs. He also backed converting medical records to electronic form.
“It is absurd to me that one of the largest sectors of the economy is run in a way where consumers don’t have a way to find out about price or quality,” Azar said at an event in Providence, R.I., in 2007. “We will not continue to be the dominant power in the world if we continue to spend so much more on health care than other economies.”
In recent weeks, Azar was seen as the only likely choice to be nominated to become the next secretary of HHS, the government’s largest civilian agency, encompassing the National Institutes of Health, the Centers for Disease Control and Prevention, the Food and Drug Administration and the Centers for Medicare and Medicaid Services, among other branches.
His selection comes even as Trump has repeatedly attacked U.S. drug companies for profiting too much, suggesting the federal government should negotiate with them to get lower prices.
“The drug companies, frankly, are getting away with murder, and we want to bring our prices down to what other countries are paying, or at least close and let the other countries pay more,” the president told reporters in October. “Because they’re setting such low prices that we’re actually subsidizing other countries, and that’s just not going to happen anymore.”