Vice President Mike Pence is exerting growing influence over the American health care system, overseeing the appointments of more than a half-dozen allies and former aides to positions driving the White House’s health agenda.
On Monday President Donald Trump nominated Alex Azar, a former Indianapolis-based drug executive and longtime Pence supporter as HHS secretary. If confirmed, Azar would join an Indiana brain trust that already includes CMS Administrator Seema Verma and Surgeon General Jerome Adams. Two of Verma’s top deputies — Medicaid director Brian Neale and deputy chief of staff Brady Brookes — are former Pence hands as well, as is HHS’ top spokesman, Matt Lloyd.
Yet another Pence ally — Indiana state Sen. Jim Merritt — is in the running to be White House drug czar.
Pence’s sway with the policymakers controlling Obamacare, Medicare and Medicaid comes at a time when Trump and Congress continue to struggle with the of the Affordable Care Act. But Pence and his cadre are driving a national agenda dominated by the kinds of conservative, anti-regulatory policies he embraced as Indiana governor.
“The vice president feels like these are some of the people responsible for the success of his state,” said Indiana Rep. Larry Bucshon. “I do think, behind the scenes, he has a lot of influence with the president.”
Pence has assumed a lead role on health with Trump’s blessing, Republicans who speak with the president and vice president emphasized. He remains one of Trump’s steadiest confidantes in a White House marked by intra-office power struggles, and established himself early on as a main envoy to congressional Republicans on Obamacare repeal.
“He really is the lead liaison between the White House and Congress in terms of legislation,” Sen. John Hoeven said. “Clearly he has a big part in trying to shape the policy.”
It was Pence who brought Freedom Caucus Chairman Mark Meadows and Tuesday Group moderate Tom MacArthur together on a compromise that brought the House’s repeal bill back to life.
And it was Pence, along with Verma, who offered Senate Republicans a steady sounding board during their fraught work on health care.
Associates said Pence’s involvement is a product of his intensive focus on health care as a governor, and the need to fill out Trump’s positions with policy details. And he has been able to offer up a network of political and policy contacts with deep credentials to a novice president who has struggled to fill positions with well-qualified candidates.
“People who don’t have a history with Donald Trump, but did have a history with Mike Pence — the fact that Mike was there was a reason to serve because they trust him, they know him and they want to make him successful,” said Ryan Streeter, who served as then-Gov. Pence’s deputy chief of staff for policy.
The White House directed questions to Pence’s office, which did not respond to requests for comment.
Given a national stage, Pence’s allies are pushing some of the conservative ideas they experimented with in Indiana.
Verma, for instance, is proposing sweeping changes to allow state officials to push Medicaid in a more conservative direction by tying some enrollees’ benefits to work requirements and imposing policies aimed at limiting costs.
That’s an outgrowth of the path Verma — along with Neale and Brookes — charted as a consultant to then-Gov. Pence, where she helped win federal waivers allowing Indiana to add conservative features to its Medicaid program in exchange for expanding coverage. At the time, the Obama administration blocked Indiana’s attempts to impose a work requirement — an idea that’s now become a centerpiece of the Trump administration’s Medicaid initiative.
“For this population, for able-bodied adults, we should celebrate helping people move up, move on, and move out,” she said in a speech last week.
She is also eliminating or rewriting reams of regulations on doctors and hospitals that she heralds as a return to conservative, free-market principles designed to promote competition by loosening federal requirements on the industry.
Pence and another pair of former aides — White House legislative affairs director Marc Short and special assistant Paul Teller — also provided the push behind Trump’s move to satisfy the religious right by gutting Obamacare’s contraception mandate.
The change, which allows employers to object on moral grounds to covering birth control, stirred controversy even among some Trump administration advisers — but proved Pence’s influence within the White House.
“Everybody knows where Mike stands on these issues,” Streeter said of the vice president’s evangelical and anti-abortion track record. “Whereas I would suspect there would be people in Trump’s White House who would rather tone down on those issues.”
Short had served as chief of staff during Pence’s time as a congressman. Teller was executive director of the Republican Study Committee when Pence chaired the conservative caucus.
The expected addition of Azar should further deepen Pence’s ties with the health department. Azar spent nearly a decade at Indianapolis-based drug-maker Lilly USA, where associates said he was well known in the city’s tight-knit political and policy circles.
“His credentials are not based on his geographic location,” one Azar ally said, highlighting his past experience as a general counsel and deputy HHS secretary in the George W. Bush administration. “But I sure wouldn’t dispute the idea that it probably doesn’t hurt that he’s known and respected by the vice president’s team.”
On perhaps one of the biggest health care issues still facing the administration — drug prices — Azar is likely to break from Trump’s calls to crack down on the pharmaceutical industry and import drugs from other countries. Instead, he’s so far favored the more traditionally conservative, pharma-friendly position that emphasizes a broader look at what’s driving up health costs — and sidesteps a shakeup of the status quo.
“The first thing is, the issue shouldn’t be just to focus on drug prices,” Azar said on Fox Business Network in June, dismissing the idea of drug reimportation. “The U.S. distribution system is a crown jewel. Let us not mess that up.”