Trump's HHS pick appears to be on track for confirmation

President Donald Trump’s nominee to run the Department of Health and Human Services appears on the brink of confirmation, which will usher in a new era of Republican efforts to remake major health care programs after legislative stumbles last year.

The expected confirmation of Alex Azar, who appeared before a Senate panel Tuesday, would put the conservative policy expert in charge of rewriting the rules of the U.S. health care system with a broad mandate to use the powers to the fullest. And following a tumultuous year marked by failed Obamacare repeal efforts and the abrupt resignation of Trump’s first HHS secretary, Republicans think Azar can ably get the Trump administration’s health agenda on track.


“Mr. Azar will be the administration’s primary policy driver,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said during Azar’s confirmation hearing. “I believe his record shows that he is more than capable of leading HHS through these next few consequential years.”

Azar, a former pharmaceutical executive and HHS official in George W. Bush’s administration, is expected to lead efforts to unwind the Affordable Care Act through regulation, pursue conservative change to entitlement programs long sought by Republicans and follow through on Trump’s unfulfilled pledge to tackle soaring drug prices. With many Republican lawmakers wary of waging another divisive health care fight during an election year, Azar will be charged with steering Trump’s health care legacy.

Skeptical Democrats point to a track record that includes a decade spent leading Eli Lilly’s U.S. operations, where Azar boosted prices for drugs. That was just standard industry practice, Azar testified Tuesday, as he pledged to leverage his industry insight to repair a convoluted system that he said perversely incentivizes higher and higher drug prices. Yet he’s largely rejected major government reforms on drug pricing, instead supporting policies typically backed by the industry.

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Still, he’s also won the respect of more centrist Democrats and health policy officials across the spectrum, who praised Azar as a level-headed and practical manager, capable of leading a department left in disarray by Tom Price’s resignation as HHS secretary in September.

“We know Alex to have the temperament, judgment, and necessary focus on practicality that is important to being a successful HHS secretary, even if we do not agree with him on every issue,” former Democratic Senate Majority Leader Tom Daschle wrote with former Republican Senate Majority Leader Bill Frist. So far, Joe Manchin of West Virginia is the only Democratic senator to publicly announce plans to vote for Azar when his nomination comes to the floor, possibly later this month.

Azar, who was previously general counsel and assistant secretary in HHS, has backed GOP proposals requiring able-bodied adult Medicaid enrollees to work as a condition of coverage. The idea, which several red states have asked HHS to approve, would amount to a significant restructuring of Medicaid that Democrats fiercely oppose. Azar also hinted at plans to overhaul insurance rules in a way that could undermine the fragile Obamacare marketplaces.

There needs to be “more choice of insurance,” Azar said during the hearing. “Insurance that fits [people’s] needs as opposed to what I happen to say they should have.” Azar said he would support allowing the sale of insurance plans across state lines, another GOP idea opposed by Democrats and many state insurance regulators.

While these ideas are popular with Republicans, critics say they would lead to patients having less robust health insurance. It could also further fracture the health insurance market, making coverage increasingly expensive for the sickest patients.

“The common thread to all the Republican talk is this: deep, draconian cuts to programs like Medicare and Medicaid, Social Security, anti-hunger programs, support for struggling families,” Sen. Ron Wyden (D-Ore.) said.

During Tuesday’s hearing, Azar cast himself as sympathetic to Democrats’ concerns, striking a conciliatory tone and pledging to solicit ideas from an array of lawmakers.

“I hope, if I’m confirmed, I can earn your trust,” he told Sen. Claire McCaskill (D-Mo.) following a contentious exchange over drug prices.

But once he is installed, Azar’s priorities are likely to fall firmly in line with Republican orthodoxy.

On drug prices, Azar rejected the idea of requiring Medicare to negotiate prices, a progressive idea that Trump at times has embraced. Azar largely declined to endorse specific measures as he expressed support for creating more transparency and competition among drugmakers.

The approaches Azar touted on drug prices, such as increasing competition, haven’t worked to bring down costs in the past. Another idea he cited, reducing the list price of drugs, would be difficult since HHS does not regulate how drug companies set prices.

On Obamacare, Azar endorsed stalled legislation from Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) that would replace the law’s funding with block grants to states, signaling his openness to ending Medicaid’s status as an open-ended entitlement.

“There are elements that are very positive, such as allowing states to run their own budgets,” Azar said. “Incentives can be reoriented in a very positive way for more state empowerment.”

That agenda won’t win many fans from across the aisle, Democrats warned Azar on Tuesday, prompting some testy exchanges with McCaskill and Sen. Sherrod Brown (D-Ohio). Brown said the administration’s support for Medicaid work requirements could hurt people receiving treatment for opioid addiction.

“You can understand our skepticism and concern that we hear top elected officials and appointed officials in this country talk about able-bodied adults and disqualifying them for Medicaid,” Brown said.

But for Republicans, Azar represents a second chance to advance the party’s sweeping health care priorities without the risk of another major legislative stumble.

“I’m glad someone with his experience is willing to step forward,” Sen. Rob Portman (R-Ohio) said. “Because frankly, we’ve got a lot of challenges.”

