President Donald Trump’s pick for Health and Human Services (HHS) Secretary is a pharmaceutical executive familiar with the department which he is nominated to lead. On Wednesday, before a Senate committee on health, Alex Azar defended his past: law clerk for Justice Antonin Scalia, HHS General Counsel and Deputy Secretary under President George W. Bush, and executive to drug giant Eli Lilly.

Since Trump came to office, HHS has undermined the Affordable Care Act (ACA) and hindered reproductive rights — while also being shrouded in scandal since former Secretary Tom Price resigned over financial misconduct. While tax reform dominated the Senate halls, Azar gave further insight into how he would run a key department.

Here’s what you need to know where Azar stands on four key health issues:

Obamacare

If the ACA remains the law of the land, Azar commits to implementing it. Former Secretary Price undermined the current health law — a point Azar said he disagrees with. He also said the Trump administration wants to make statutory changes to the law, and Azar committed to implementing those once/if they become law. There is an executive order that’s currently making its way through the regulatory process, and it’s expected to hobble current health law.


But if the ACA remains, he wouldn’t want people to have a pointless insurance card. Any program HHS is responsible for, he wants to “run as efficient and effectively as possible,” he said.

Reimbursing insurance companies for subsidizing low-income people’s insurance is not a long term solution, said Azar. He said the Alexander-Murray bill is not a long term solution — which commits to paying cost sharing reductions, a subsidy that helps low-income people afford health insurance and which Trump last month said the White House would stop paying. The bill is expected to pass along side a tax bill that would repeal the individual mandate, but Azar said that it doesn’t address the ACA’s underlying problems. He didn’t get into the specifics of what the solutions to ACA’s underlying problems are.

HHS under Trump has undermined the current health law. The administration slashed ACA advertising and outreach funds. When asked whether this was a good idea, Azar said his view is do what works.

Reproductive Rights

Senator Patty Murray (D-WA) asked Azar to commit to science and access over ideology. Azar committed to running an agency that follows evidence-based research. He added that he supported the Trump administration’s decision to roll back the birth control mandate, which permits employers to seek federal exemptions by citing religious or moral objections. HHS under ousted Secretary Price used doubtful science to weaken this mandate.


“We have to balance a woman’s choice of insurance … with the conscience of the employer,” he said. He said he doesn’t think a lot of companies will take advantage of this exemption, although that is yet to be seen.

Azar also admitted he didn’t review the research released by health experts that the Obama administration’s used to make its decision that birth control is preventative health care.

Big Pharma

“Drug prices are too high,” said Azar, adding that the cost of insulin is too expensive. Senator Tammy Baldwin (D-WI) said that this starts with the manufacturers setting the list prices, a point Azar agreed with.

But when Azar was at Eli Lilly, the company tripled the price of insulin.

Azar deflected when Baldwin asked him who is responsible for the high costs. “It’s the system,” he said — pointing the finger to insurance companies, pharmacies, and drug distributes. As Axios notes, this is a recurrent refrain from the pharmaceutical industry.

Key hedge from Azar:"The system is not working for patients who pay out of pocket." That echoes a pharma perspective that the problem is really access, not overall spending. — Matthew Herper (@matthewherper) November 29, 2017

Azar says his main priority is lowering drug prices — a priority Trump touted during the campaign but has not acted on. Azar suggested increasing generic and brand competition and reviewing drug patents.

Opioid Crisis

When the Trump administration declared the opioid epidemic a public health emergency, the White House opened up a limited pot of money: $57,000, or just two cents for each person struggling with addiction. Sen. Maggie Hassan (D-NH) asked the secretary nominee to push Congress to allocate funds. He wouldn’t commit.


Bob Casey (D-PA) introduced a bill that would set aside $45 billion per fiscal year through 2027. Protesters championed this bill on Capitol Hill earlier this month as it has received minimal attention from lawmakers.

A health program that received no air time during Azar’s nomination hearing: the Children’s Health Insurance Program. Funding expired in September, and the funding for the program, that provides health insurance to low income children, is expected to deplete soon. Colorado has already warned parents that the state’s insurance program will end in next month if Congress doesn’t take action. It’s not up to HHS to renew these funds, it’s Congress’ — which is probably why it was avoided.