President Donald 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.
In announcing that he is nominating Azar to be secretary of the government's largest civilian department, the president turned to a health policy insider and conservative thinker. Azar spent a decade at Eli Lilly and Co., including five years as president of Lilly USA, its biggest affiliate, before stepping down in January to work as a health-care consultant. He previously was HHS general counsel, then served for two years as the department's second in command.
Republicans predicted that, if confirmed, Azar would pursue Trump's goals to tilt health-care policies in a more conservative direction through executive action. Leading Democratic health policy experts, while not sharing Azar's views, said he is well qualified for the post. His ties to the drug industry drew some rapid criticism, however.
In announcing his decision on Monday, 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 Mike Pence.
Azar has been highly critical of the Affordable Care Act, saying in interviews in recent months that the law was "certainly circling the drain" and that many of its problems "were entirely predictable as a matter of economic and individual behavior."
In a June interview on Bloomberg Television, Azar said the administration could alter the implementation of the health-care law even if congressional Republicans failed to repeal much of it. "One of the nice things in it is it does give tremendous amount of authority to the secretary of HHS," he said.
He also supports converting Medicaid from an entitlement program covering everyone who is eligible into block grants, a polarizing and long-standing GOP goal. He opposed expansion of the program under Obamacare to people with slightly higher incomes, something most states chose to pursue.
Azar boasts sterling conservative credentials, having clerked 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 and Democrats alike expect he could work more deftly with competing health-care interests and politicians than his predecessor, Tom Price. Revelations that Price racked up more than $1 million in expenses by making official trips on noncommercial aircraft forced his departure.
The White House plans to send the official nomination to the Senate on Tuesday, according to deputy press secretary Hogan Gidley.
As expected, Azar's selection was 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." As a former HHS official and private-sector executive, "Alex Azar has the qualifications and experience to get results," Alexander added.
Senate Democrats have begun preparing for Azar's confirmation proceedings. They intend to focus on his ties to the pharmaceutical industry, his position on high drug prices and the way he would continue implementing Obamacare. On Monday, they used Azar's selection as an occasion to bash anew the Trump administration's health policies. "It's time to turn over a new leaf at HHS," Senate Minority Leader Charles E. Schumer (N.Y.) said in a statement.
Sen. Patty Murray of Washington, the top Democrat on the health 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."
And Sen. Ron Wyden of Oregon, the senior Democrat on the Senate Finance Committee, which will hold the official confirmation hearing on the nomination, said he would "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."
On the opposite end of the political spectrum, anti-abortion groups praised Azar's work for Scalia and another conservative jurist and said they will listen for his commitment to reversing Obama administration policies on the issue.
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 department's turmoil under Price, "he will bring stability to this agency. He really understands the mechanisms of HHS."
Azar's ties to Pence date to his days at Lilly, an Indiana-based pharmaceutical firm, when Pence was Indiana 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. During his tenure as deputy secretary, 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, Rhode Island, in 2007.
In recent weeks, Azar was seen as the only likely choice to be nominated to become the next secretary of HHS, a sprawling department that encompasses 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.
While Azar led Lilly USA, the U.S. list price of its Humalog insulin more than doubled - from $123 per vial in January 2012 to $255 per vial when he left the company five years later. But a spokesman said the net amount Lilly receives has declined since 2009 because of rebates to middlemen in the drug-supply chain.
Critics said Monday that Azar's leadership at a company that repeatedly raised prices on existing drugs makes him ill-suited to lower drug prices. Supporters countered that his understanding of the complex dynamics behind pharmaceutical pricing will give him an advantage in striving to make drugs more affordable.