President Trump announced on Twitter he plans to nominate Alex Azar to be the next secretary of the Department of Health and Human Services.
Azar will be “a star for better healthcare and lower drug prices,” Trump wrote in his tweet announcing the coming nomination.
Azar will replace former Georgia congressman Tom Price, who resigned from his post at HHS after a scandal involving the use of taxpayer dollars to travel via private charter jets.
In choosing Azar to lead the sprawling $1 trillion agency, the administration is going with someone with a more traditional administrative and executive background, in contrast with Price. A physician and six-term member of Congress, Price resigned in September after he frustrated Trump with his performance in the health care law repeal debate and after Politico revealed Price spent around $1 million traveling in private jets for department business.
Azar served as both general counsel and as deputy secretary for the agency under the George W. Bush administration from 2005 to 2007. Both of those positions required Senate approval, and he was confirmed by voice vote in both instances. Subsequently, he moved into the private sector as the president of Lilly USA, the biggest affiliate of pharmaceutical giant Eli Lilly and Co., until earlier this year.
A graduate of Yale Law School, Azar clerked for the late Justice Antonin Scalia before going to work for the private firm Wiley, Rein & Fielding. He was a protégé of Kenneth Starr and worked on Starr’s team when he was independent counsel investigating President Bill Clinton’s Whitewater real estate scandal. Later, he was active in George W. Bush’s 2000 campaign for president and was brought on as general counsel by Tommy Thompson, Bush’s HHS secretary. He entered health care “largely by accident,” according to his Yale biography.
Scott Whitaker, the chief executive of the medical device industry’s main lobbying group, AdvaMed, was Thompson’s chief of staff and worked closely with Azar from 2001 to 2005. He said Azar would help stabilize the department after Price’s resignation in September.
“It would be a natural place to go, to a former deputy secretary of the department, who’s got the seasoned sort of credentials to stabilize and lead an agency like that right now,” Whitaker said. “He’s a smart, thoughtful leader in health care and I think a calming force as well.”
As deputy HHS secretary, Whitaker said Azar played a key role in implementing the President’s Emergency Plan for AIDS Relief, which provided treatment overseas, and the Medicare prescription drug benefit. While Democrats were initially skeptical of the Medicare benefit expansion in part because they favored a more generous program, those two Bush administration priorities have been embraced by lawmakers in both parties.
Leaders of the HHS divisions — the Centers for Medicare and Medicaid Services, the National Institutes of Health, the Centers for Disease Control and Prevention and the Food and Drug Administration, among others — reported to Azar, Whitaker said.
Azar is a vocal critic of the 2010 health care law. In a Fox Business interview in May, he said, “There’s actually fairly few levers that the government can do at this point to stabilize this fundamentally broken system.” He added, “I don’t think there’s much appetite for doing that either by the Trump administration or up in Congress.”
In March he told CNBC, “Obamacare made the HHS Secretary and the national government the insurance commissioner for the United States, and they want to get rid of that.”
Azar left Lilly in January “to pursue other opportunities,” the company said in a statement at the time. Shortly before the leadership shuffle, the company had reduced the size of its U.S. presence in anticipation of a loss of revenue due to generic competition for key products. In December 2016, the company announced that a drug for Alzheimer’s had failed in the late stages of clinical trials and that they would halt further development of the product. Lilly’s neuroscience division was in Azar’s broad portfolio.
Azar went on to found Seraphim Strategies in February, which advises clients on pharmaceuticals and health care.
Former Indiana GOP Gov. Mitch Daniels, who also held senior roles with Lilly and the Bush administration, got to know Azar once he joined the drug company in Indianapolis. That “common background” brought them together, Daniels said, adding that it was evident Azar is “very bright” and Washington-savvy.
“This would probably be useful I would guess to this administration, many of whom don’t have as much of that background,” he said. “So he would I think excel at the broader aspects of policy and possibly trying to implement and negotiate for change, assuming anyone is willing to negotiate about anything.”
While most Republicans would likely be comforted by Azar’s past experience, Democrats looking to oppose him could easily point out that nomination continues the Trump administration’s industry-friendly approach to selecting cabinet members.
Sen. Ron Wyden of Oregon, the top Democrat on the Finance Committee, which would confirm Azar’s nomination, said he was hoping for a secretary that would hold Trump accountable on a key issue. “I want to see them ensure that the president meets the public pledge he made throughout the campaign to lower pharmaceutical prices,” Wyden said.
In February, Azar told attendees of a Biotechnology Innovation Organization meeting that Trump, despite repeated threats to the pharmaceutical industry, wasn’t likely to do anything groundbreaking on drug prices.
“The president made this very clear: Respect innovation,” Azar said, according to the trade publication Genetic Engineering & Biotechnology News. “Respect the need to invest in innovation. Respect the work that people in this room do. I simply do not see efforts to undermine that.”
Robert Weissman, president of the consumer watchdog Public Citizen, said Azar would be an “industry shill” if confirmed.
“It is highly unlikely that a pharmaceutical company executive who has made passionate arguments against price restraints is going to advance real reform. Much more likely is that he serves as the instrument by which Big Pharma aims to defend its monopolies and unaffordable prices,” Weissman said in a statement following early reports of Azar’s selection.