President Donald Trump on Monday nominated former pharmaceutical executive Alex Azar to be his next Health and Human Services secretary, moving to stabilize the agency at the center of his administration’s biggest domestic policy failure.
Azar, a veteran of George W. Bush’s administration, would succeed Tom Price, who resigned after POLITICO reported he spent roughly $1 million on private and government air travel in just seven months on the job.
"He will be a star for better healthcare and lower drug prices!" Trump tweeted from the Philippines this morning.
If confirmed, the 50-year-old Azar would be thrust onto the front lines of a White House agenda that includes repealing Obamacare, reining in drug prices and rolling back regulations — goals that have remained largely unfulfilled since Trump took office.
The Trump administration is wagering Azar has the policy and political chops to get those priorities back on track, and managerial expertise required to repair relationships within HHS and on Capitol Hill left frayed by congressional Republicans’ dysfunctional repeal effort and the subsequent scrutiny of Price’s travel habits.
Azar spent nearly a decade at Indianapolis-based Eli Lilly, where he rose to become president of the pharmaceutical giant’s U.S. operations before leaving earlier this year. Prior to that, he served as HHS general counsel and then deputy secretary across six years years with the Bush administration.
It was there where Azar built a reputation as a pragmatic and highly competent — if demanding — leader steeped in both the processes of policymaking and the federal bureaucracy.
A low-key operator who’s since remained mostly out of the political spotlight, he is viewed as a near-diametrical opposite of his firebrand predecessor, people close to Azar and the White House’s search process said. That’s an appealing distinction for an administration still smarting over Price’s scandal-plagued downfall, and eager for a steady hand to guide its growing set of health care initiatives.
"It’s a great pick for where the agency is right now," said Lanhee Chen, who worked with Azar on Mitt Romney’s 2012 presidential campaign. "I don’t think anybody can question his credentials from an experience perspective."
Even the AIDS Institute, often critical of the Trump administration on health issues, praised the selection.
"As both a former HHS Deputy Secretary and General Counsel, together with his private sector experience, Alex Azar has the knowledge, expertise, and leadership to oversee our Nation’s health response," said Carl Schmid, the group’s deputy executive director.
The nomination comes at a critical point for the administration. The White House is barreling toward the end of its first year with no major legislative accomplishments — the consequence of a botched Obamacare repeal effort riddled with missteps and infighting.
Price, an ex-congressman who was picked based in part on his anti-Obamacare zeal and connection to congressional conservatives, failed to deliver crucial votes and ended up largely absent from a process the White House had expected him to lead.
Trump insists Congress will take another shot at dismantling the law early next year. But with midterm elections looming and Republicans on Capitol Hill wary about another pitched battle over health care, achieving that goal will require far stronger leadership and a clearer policy vision from the administration.
The White House in the interim has taken a series of administrative steps to undermine Obamacare that pose an ongoing threat to the stability of the health care markets, including a vague but sweeping mandate to rewrite federal insurance regulations and the elimination of a key stream of federal subsidies for insurers that sent shivers through the Obamcare markets.
If confirmed, Azar would have to translate Trump’s hasty orders into workable long-term policy or risk watching the markets fall into chaos early on in his term.
Republicans initially worried that challenge would complicate the search for a qualified HHS secretary.
But Azar quickly emerged as the front-runner, bolstered by his ties to a number of administration officials including Vice President Mike Pence, Domestic Policy Council Director Andrew Bremberg and HHS acting Secretary Eric Hargan. He served with the latter two during the Bush administration, before ingraining himself in Indiana’s tight health policy community over his tenure at Lilly.
"I know [Pence] thinks highly of Alex — a lot of us in Indiana do," said Bob Grand, a longtime Pence donor who speaks frequently with the vice president.
Just as importantly, Azar’s allies have pitched him as a no-drama manager who won’t let his personal ideology get in the way of the administration’s priorities. A staunch conservative who clerked for Antonin Scalia before joining Ken Starr’s Whitewater investigation team in the 1990s, he’s nevertheless regarded as a team player who’s maintained relationships with Republicans across the political spectrum.
Azar was an adviser on Mitt Romney’s 2012 presidential campaign, and during the 2016 cycle did a stint on Jeb Bush’s Indiana steering committee. When Bush dropped out, he joined Ted Cruz’s state steering committee. And after Cruz dropped out and Trump emerged as the GOP nominee, Azar donated $2,700 to Trump’s campaign fund just ahead of the election.
"He’s a traditionally intellectual conservative, [House Speaker] Paul Ryan type," said one person who knows Azar from his time in Indiana. "He is by no means a Steve Bannon type of ideologue."
That marks a sharp contrast with Price, a doctor whose hard-right policy views and sympathy for his fellow physicians guided his decision-making — and who quickly alienated career staffers within the health department.
Still, Azar’s status as the ultimate "safe pick" — as several Republicans put it — in a field that included ex-Sen. Rick Santorum and former Louisiana Gov. Bobby Jindal is likely to prompt concern from the far right and intense scrutiny from the left.
Azar is a largely unfamiliar name to the grassroots tea party groups who have carved out a prominent place in today’s GOP, multiple conservative strategists said, and who will be skeptical of his establishment background.
And while Democrats privately consider Azar’s selection far from the worst-case scenario, they’re sure to seize on his time at Lilly as evidence he’ll be overly deferential to the powerful pharma lobby.
"All these drug corporations are jacking up prices because Washington isn’t doing its job to oversee them, and so I have great concerns," Sen. Tammy Baldwin, who has championed bipartisan legislation on drug pricing, said of Azar’s candidacy. "I’ll look at it when it officially comes to us, but I’m very disquieted."
Trump has threatened to crack down on pharmaceutical companies over rising drug prices, but hasn’t followed through with any concrete action. And his administration is already stocked with pharmaceutical industry players.
Joe Grogan, OMB’s director of health programs, spent the last five years as head of federal affairs for Gilead Science. The White House’s lead on health policy for its Domestic Policy Council, Katy Talento, is a former aide for Sen. Thom Tillis, a big booster of the drug industry. In August, Trump appointed Tomas Philipson, co-founder of pharmaceutical advisory firm Precision Health Economics, to his Council on Economic Advisers.
Azar has echoed much of the pharma playbook on pricing in recent months, deflecting blame for high costs to other parts of the industry and to other countries. He’s opposed government negotiations of drug pricing and drug importation, and suggested during a Fox News appearance that the administration should pressure Europe over its "radical price controls."
During the tail end of Azar’s time at Lilly, the company was hit with a class-action lawsuit alleging collusion to drive up the cost of insulin. Lilly has since come under investigation by state attorneys general over its insulin pricing.
Allies of Azar waved off concerns that he’d end up being a shill for the industry, arguing his time with the drug maker represents just one segment of a lengthy resume.
"I would hope people would evaluate him based on the entirety of his career," Chen said. "It’s politics, so you can imagine how people might use his background against him. But I hope that they don’t."
Senate Democrats won’t be inclined to give Azar a pass. In late October, the ranking members on the Finance and HELP Committees — the panels that will oversee Azar’s confirmation process — sent the Trump administration a list of 51 principles they said they’ll use to evaluate the next HHS nominee.
And against the backdrop of a GOP agenda that’s still committed to repealing Obamacare, Azar’s nomination will serve as a high-profile opportunity to launch fresh attacks on a White House that critics argue has shed its populist promises in favor of big-business influence.
"They’ve also said they’re going to drain the swamp and crack down on Wall Street," Sen. Patrick Leahy said. "You’ve got the rhetoric. Let’s see what the reality is."