What's Being Said About Alex Azar's Confirmation as HHS Secretary

Former pharma exec could represent a departure from the priorities of his predecessor and the president's campaign, say observers.

The Senate confirmed former Eli Lilly executive Alex Azar as the next Health and Human Services secretary Wednesday with a 55-43 vote, despite opposition from most Democrats.

Azar, who served HHS under President George W. Bush, has enjoyed broad-based support among Republicans who cite his experience in the pharmaceuticals industry as an asset. Democrats largely describe Azar’s work history as a liability that could exacerbate the problems caused by rising drug prices.

Even so, seven members broke from the Democratic caucus Wednesday to vote in favor of the confirmation, giving Azar the majority he needed to succeed former HHS Secretary Tom Price, who resigned last September, amid controversy, after less than eight months on the job.

Cross-aisle votes

The six Democrats and one Independent who voted with the GOP offered a variety of reasons for their support:

Sen. Chris Coons, D-Del., said he’s known and been impressed by Azar for several decades.

“I personally met with Mr. Azar last month and pressed him on a number of key issues that he will impact as Secretary, including the Affordable Care Act, drug pricing, and continued progress on health care system delivery reform,” Coons said in a statement. “There is plenty that we disagree on, but I was encouraged by his answers during our conversation and I believe he is committed to representing the interests of Delawareans and Americans everywhere.  I disagree with most of the Trump Administration’s health policies, but HHS needs a competent leader.  Mr. Azar is prepared to be that.”

Sen. Tom Carper, D-Del., said he continues to have concerns about Azar’s views on the Affordable Care Act and Medicaid but that he is encouraged by Azar’s goal of transforming the healthcare delivery system into one that rewards quality over quantity.

“We should reward doctors, hospitals and pharmaceutical companies for making people well, not for the number of procedures done, hospitalizations required or drugs prescribed,” Carper said in a statement.

Sen. Heidi Heitkamp, D-N.D., praised Azar as intelligent and competent, noting he will be a “solid” leader for HHS.

“We had a good conversation about health priorities for North Dakota like rural health and Native American health,” Heitkamp said in a statement. “He and I don’t agree on everything philosophically, but I believe he’s someone I could work well with and who I’ll be able to have open communication with to help improve health care for North Dakotans.”

Sens. Joe Donnelly, D-Ind.; Doug Jones, D-Ala.; Joe Manchin, D-W.Va.; and Angus King, I-Me.—who voted in favor of Azar’s confirmation—did not release statements on their websites about the vote.

Sen. Rand Paul of Kentucky was the only Republican to vote against Azar’s confirmation. Sens. John McCain of Arizona and Bob Corker of Tennessee were absent.

Outside observers

Bloomberg’s Sahil Kapur noted that Azar’s priorities could differ markedly from those President Donald Trump touted as a candidate.

“The president campaigned on allowing drug re-importation to lower costs; he largely ignored that after taking office, and his new HHS Sec. Alex Azar is a former pharma executive who's been cool to the idea,” Kapur wrote.

And Axios noted that the new direction could differ markedly from the one Price began implementing less than a year ago.

“He's not a fan of the Affordable Care Act, so don't expect HHS to enforce it more enthusiastically now that Price is gone,” Axios wrote. “Don't look for an aggressive crackdown on rising drug prices, either.”

That being said, Azar could be more willing to pursue mandatory pilot programs and other initiatives Price opposed, Axios noted.

With lawmakers unlikely to dive headlong into another hot-button healthcare agenda during an election year, wrote Politico’s Adam Cancryn, Azar is set to “become the face of administration efforts largely focused on unraveling Obamacare and remaking the health system through rulemaking and regulatory action.”