President Trump on Monday said he would nominate Alex Azar as his next health secretary, setting off a battle with some Democrats who promised to make the former pharmaceutical executive’s work with drugmakers an issue in his confirmation.

Azar seems unlikely to see his nomination blocked, given the GOP’s 52-seat margin and a simple majority needed to confirm. Several Democrats didn’t outright oppose his nomination to lead the Department of Health and Human Services, but said they would rigorously question him over prescription drug prices and repealing ObamaCare.

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The skirmish will likely renew arguments from Democrats that the Trump administration is determined to roll back ObamaCare’s benefits, a message that proved effective in last week’s off-year elections.

Senate Minority Leader Charles Schumer Chuck SchumerVideo of Lindsey Graham arguing against nominating a Supreme Court justice in an election year goes viral Graham signals support for confirming a Supreme Court nominee this year Pelosi orders Capitol flags at half-staff to honor Ginsburg MORE (D-N.Y.) said the confirmation process “will be a referendum on the Trump administration’s repeated efforts to sabotage our health care system and raise premiums on millions of Americans.”

“It’s time to turn over a new leaf at HHS,” Schumer said in a statement. “The next Health and Human Services Secretary must demonstrate a commitment to lowering Americans’ health care premiums, not sabotaging the Affordable Care Act and our health care system with reckless actions that hurt families. I look forward to reviewing the nomination of Mr. Azar.”

Azar previously worked at HHS, serving as general counsel from 2001 to 2005 and as deputy secretary for two years under former President George W. Bush.

He’s deeply familiar with the regulatory process, his former co-workers said, which could come in handy as the Trump administration looks to change ObamaCare in ways that do not need Congress’s permission.

Trump is attempting to replace Tom Price Thomas (Tom) Edmunds PriceConspicuous by their absence from the Republican Convention Coronavirus Report: The Hill's Steve Clemons interviews Chris Christie Trump flails as audience dwindles and ratings plummet MORE, who resigned after Politico detailed his repeated trips on private and government jets that cost taxpayers more than $1 million.

Price’s confirmation in the Senate was a hard-fought battle. Democrats on the Senate Finance Committee boycotted a vote to send his nomination to the full chamber, forcing the panel’s chairman — Sen. Orrin Hatch Orrin Grant HatchBottom line Bottom line Senate GOP divided over whether they'd fill Supreme Court vacancy MORE (R-Utah) — to temporarily suspend committee rules to pass it.

It’s unclear if that move will be repeated, and the panel’s top Democrat, Sen. Ron Wyden Ronald (Ron) Lee WydenGOP senator blocks Schumer resolution aimed at Biden probe as tensions run high Republican Senators raise concerns over Oracle-TikTok deal Hillicon Valley: TikTok, Oracle seek Trump's approval as clock winds down | Hackers arrested for allegedly defacing U.S. websites after death of Iranian general | 400K people register to vote on Snapchat MORE (D-Ore.), issued a relatively measured statement on the nomination Monday after blasting the Trump administration’s health-care record as “objectively abysmal.”

“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. “Health care is too personal to be driven by politics, but that is what the leadership of HHS has offered so far.”

Republicans praised Azar’s experience, and his former colleagues said he comes with conservative health-care bona fides. Still, clashes with advocates and Democrats are likely, as Azar doesn’t appear to support ObamaCare.

“I think, Stuart, you and I generally agree that the status quo is pretty bad and any change to that that’s productive is a good thing,” Azar told Fox Business host Stuart Varney on July 17.

On July 26 — two days before Senate Republicans failed to pass a scaled-down version of an ObamaCare repeal bill — Azar predicted that, “at the end of the day this is a hot potato that lands back in Secretary Price’s lap for him to use as many authorities as he has to grant flexibility and try and dig us out of the ObamaCare mess as much as he can.”

Azar will also be in the hot seat over his nearly 10-year-long tenure at pharmaceutical company Eli Lilly. He most recently served as president of Lilly USA and left the company in January. He also served on the board of the Biotechnology Industry Organization, a lobbying group.

Earlier this year, Eli Lilly was one of three companies included in a lawsuit alleging that they conspired to increase the price of insulin, a lifesaving medication for those with diabetes.

Trump has repeatedly blasted the pharmaceutical industry for “getting away with murder” with steep drug prices, but critics have said he’s done little to make drug companies change their ways. The nomination of an industry insider further fuels this criticism.

Sen. Bernie Sanders Bernie SandersNYT editorial board remembers Ginsburg: She 'will forever have two legacies' Two GOP governors urge Republicans to hold off on Supreme Court nominee Sanders knocks McConnell: He's going against Ginsburg's 'dying wishes' MORE (I-Vt.) has torn into drugmakers from his Senate perch and said he “will vigorously oppose” the nomination.

“At a time when the United States pays, by far, the highest prices in the world for prescription drugs, the last thing we need is to put a pharmaceutical executive in charge of the Department of Health and Human Services,” Sanders said. “The nomination of Alex Azar, the head of Eli Lilly’s U.S. operations, shows that Trump was never serious about his promise to stop the pharmaceutical industry from ‘getting away with murder.’ ”

Some who know Azar say his time working in the pharmaceutical industry is an asset, as he has a deep knowledge of the industry and knows what needs to be done to create a change.

“I don’t know of anyone in the country who understands the problems of drug distribution better than Alex does, and that’s going to be a significant issue,” said former HHS Secretary Mike Leavitt. Azar served as Leavitt’s No. 2 at the department.

“There will be people who will be critical because he worked in the pharmaceutical industry, but the reality is he knows this distribution system and he knows its problems, and his job now is to fix them.”

Nathaniel Weixel contributed.