Three things to know about Trump’s HHS lead pick Azar


Experts share more about Alex Azar’s background and predict what his top agenda items are likely to be.

On November 13, the White House announced that President Trump nominated Alex Azar, MD, who has had multiple roles in HHS previously, as his choice to serve as Secretary of HHS. Azar would replace Trump’s original pick, Tom Price, who resigned on September 29.

Here are three things managed healthcare organizations should know about the pick:

1. In addition to working for HHS, Azar served as president of a major pharmaceutical company.

Azar served as an HHS general counsel from 2001 to 2005 and as an HHS deputy secretary from 2005 to 2007. At HHS, he was responsible for reviewing, analyzing, and managing the department’s legal and policy issues. “Having worked at HHS, Azar has a deep understanding of how the agency works,” says Christopher J. Metzler, PhD, president/CEO, Metzler Enterprises, a medical organization that provides primary care and related medical services. “Among his responsibilities were working with Medicare Part D on pandemic preparedness and on Hurricane Katrina recovery efforts. He was also solely responsible for HHS’ administrative rulemaking process.”

His legal career also includes serving as a law clerk for the late Supreme Court Justice Antonin Scalia and as independent counsel for Kenneth Star at the beginning of the Clinton Whitewater investigation, adds Bob Morgan, a healthcare attorney at the law firm Much Shelist. 

In the private sector, Azar held various positions at pharmaceutical giant Eli Lilly and Co. from 2007 to 2017, and served as its president for the last five years of his tenure there. “As a healthcare industry leader, his understanding of the industry will enhance HHS’ role in shaping the healthcare delivery system,” says Mike Strazzella, practice group leader, federal government relations, Buchanan, Ingersoll & Rooney, PC, a law firm.

2. His top agenda items might be making recommendations on to how to address the ACA and transitioning Medicaid into block grant payments.

“I think addressing the continued implementation of the ACA and reducing the federal costs commitment will be at the top of his to-do list, because he has supported repeal efforts,” Strazzella says. In addition, he will be under pressure to examine drug pricing, shared savings, and innovative delivery system models.

On another front, “Azar has spoken glowingly about transitioning Medicaid into block grant payments and transitioning healthcare oversight to states, consistent with his predecessor at HHS and with current healthcare priorities of the White House,” Morgan says. “It will be interesting to see whether he takes HHS waiver requests in a different direction, as states are increasingly polarized between expanding government-subsidized health insurance (such as Maine) versus instituting means-testing and various cost-sharing provisions on Medicaid participants (such as Arkansas).”

For instance, “He could allow innovative waivers for both red and blue states that adopt conservative or progressive approaches to insurance coverage,” Morgan continues. “He might also surprise the industry by being harder on the pharmaceutical industry in order to prove his independence from his past employer.”

Another area to watch is whether Azar will allow Medicare to negotiate drug prices for Medicare recipients to lower costs or if he will be aligned with the drug industry and fail to lower drug prices in any significant way. “Allowing Medicare to negotiate volume discounts is a relatively easy and obvious way to lower costs,” says Jeffrey R. Hoffman, principal, ECG Management Consultants, which offers healthcare strategies and solutions.

3. Azar will face many challenges, beginning as early as the confirmation process. Whether Azar’s position at Eli Lilly represents a conflict of interest in the HHS secretary role is something the Senate will determine through the confirmation process. “I would expect senators to grill Azar on his ability to deal with high drug prices aggressively and independently,” says Drew Littman, policy director, Brownstein Hyatt Farber Schreck, a lobbying and law firm.

Strazzella says as secretary, Azar would be challenged with finding a new affordable model to ensure consumers have access to healthcare services. Azar will also be challenged to determine payment models that lower healthcare costs, best practices to implement health information exchanges, and drive forward innovative technologies to deliver healthcare.

Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.

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