President Donald Trump’s pick for Health and Human Services secretary is on the verge of taking control of the department with a clear mandate: Take down Obamacare from the inside.
With Republicans stalled on repeal, the GOP is looking to Alex Azar to put a conservative stamp on the health care system through shrewd rulemaking and the use of expansive regulatory powers — and all without the help of a Congress that’s failed to scrap the 2010 health care law.
That makes Azar the point person responsible for leading the revival of a health policy agenda that floundered through the first year of the Trump administration, hampered by high-profile legislative failures and the scandal-shortened tenure of former HHS Secretary Tom Price.
“Alex recognizes immediately the power of the department and the ability to get things done," said Tommy Thompson, a former HHS secretary and one of Azar’s informal advisers. “They wanted somebody that’s going to be a mover.”
The former pharmaceutical executive and veteran of George W. Bush's HHS is likely to face intense questioning from Senate Finance Committee Democrats on Tuesday about his plans for Obamacare.
The 50-year-old has long criticized the health law, publicly supporting the GOP’s repeal effort and at one point saying Obamacare was “circling the drain.”
During a November confirmation hearing before the Senate’s health committee, he maintained that Obamacare is inherently flawed — though he voiced support for measures aimed at stabilizing the Obamacare insurance markets.
Yet Azar has won bipartisan praise for his policy expertise and pragmatism, and is widely expected to breeze through his confirmation vote. On Monday, Democratic Sen. Joe Manchin pledged to vote for the 50-year-old nominee, saying he’s “in the right place at the right time.”
Other Democrats have expressed hope that Azar will focus on finding bipartisan solutions aimed at improving Obamacare and the broader health care system.
“His predecessor seemed to get up every single day and look for ways on which you could cut corners on implementing the law,” said Sen. Ron Wyden, the top Democrat on the Finance panel and one of several Democrats who compared Azar favorably with Price. “If you’re willing to be a secretary who says I’m going to carry out this law, I’m going to find efficient ways to do it, I’m going to work with both sides of the aisle — I think people would find that refreshing.”
But Azar, who once said one of the few good things about Obamacare is the power it provides to the HHS secretary, isn’t likely to chart a course that wins many fans from across the aisle.
Once installed, he is expected to finalize rules expanding the availability of cheaper, less regulated short-term and association health plans — potentially at the expense of the Obamacare markets’ stability.
Separate rules aimed at reining in Obamacare’s expanded Medicaid population by clearing the way for states to impose work requirements are already underway. During November’s hearing, Azar endorsed the administration’s decisions to shorten Obamacare’s sign-up period and cut its marketing budget, saying insurers should “do their own doggone job.”
He’s also backed HHS’ bid to let employers raise objections to covering birth control on moral grounds, arguing that “employers’ rights” need to be balanced against “a woman’s choice of insurance.”
And by flexing the agency’s expansive regulatory muscle, Azar’s allies say he’ll look to reshape the health care landscape to fit the White House’s focus on shedding regulations across the board — and likely far beyond Obamacare.
Azar has expressed enthusiasm about the potential for expanding the Medicare Advantage program, multiple people who have spoken with him during the confirmation process said, seeing it as a path toward weighing changes to Medicare.
He’s also pledged to make reining in high drug costs a top priority. But Azar, who previously ran the U.S. operations of drug giant Eli Lilly, has reliably defended the pharmaceutical industry against criticism over the skyrocketing drug prices, maintaining that the solution should focus more on structural changes to the broader health care industry.
“Each Cabinet secretary brings their own unique spin to how they run the place, what their priorities are,” said Tevi Troy, who served as deputy HHS secretary under the Bush administration and has spoken to Azar throughout the confirmation process. “The regulatory stuff is really something, I think, Alex is really well suited to.”
Azar has yet to lay out more specific policy goals, advisers said, wary of setting an agenda before he’s officially confirmed, or pushing ideas that could clash with the White House’s ever-changing priorities.
Yet congressional Republicans and those close to Azar said HHS under his leadership could fulfill the sweeping deregulation agenda that Price repeatedly promised would take place in tandem with Congress’ repeal efforts — and yet never got off the ground.
With Republicans hesitant to take another divisive shot at Obamacare repeal during an election year, that administrative unraveling is set to form the backbone of the GOP’s next steps on health care.
“You look at the law that set up Obamacare, and there was [over 1,000] shalls: The secretary shall do this, the department shall do this,” Thompson said. “That’s going to give Alex a leg up and a step forward."