WASHINGTON — Turning to an industry he's rebuked, President Donald Trump on Monday picked a former top pharmaceutical and government executive to be his health and human services secretary, overseeing a $1 trillion department responsible for major health insurance programs, medical research, food and drug safety, and public health.
The nomination of Alex Azar is unusual because HHS secretaries have tended to come from the ranks of elected officials such as governors, leaders in academia and medicine, or top executive branch managers — not industries regulated by the department.
“He will be a star for better healthcare and lower drug prices!” Trump tweeted in announcing the nomination Monday morning. Trump has a track record of making industry-friendly nominations, such as tapping former ExxonMobil CEO Rex Tillerson as secretary of state and wealthy investor Wilbur Ross as secretary of commerce.
But Trump also has been a scathing critic of the pharmaceutical industry, both as a candidate and as president.
Azar, 50, a lawyer by training, has spent most of the last 10 years with pharmaceutical giant Eli Lilly, rising to president of its key U.S. affiliate before leaving in January to start his own consulting firm. He's seen as an expert on government health care regulation.
As secretary, Azar would be returning to HHS after serving in senior department posts in the George W. Bush administration. Now he would have to scrupulously avoid conflicts with Lilly's far-reaching interests, from drug approval to Medicare reimbursement. The drugmaker has drawn criticism from patient advocacy groups for price increases to one of its biggest products: insulin.
Azar's nominations to HHS in the Bush era sailed through the Senate. This time, he'll face Democrats wary of the administration's unyielding quest to repeal the Affordable Care Act.
“The Trump administration's track record on health care to date is objectively abysmal,” said Sen. Ron Wyden of Oregon, senior Democrat on the Finance Committee, which would send Azar's nomination to the full Senate. “I will closely scrutinize Mr. Azar's record.”
Sen. Patty Patty Murray, D-Wash., flagged a potential conflict of interest. “I am ... interested in how, given Mr. Azar's professional background, he believes he can fairly execute any significant effort to lower drug prices for patients,” she said in a statement. Murray is the senior Democrat on the Health, Education, Labor and Pensions Committee, which will also hold hearings.
Americans consistently rank the high cost of prescription drugs as one of their top health care priorities, putting it ahead of divisive issues like repealing “Obamacare” in public opinion polls.
Trump has been a sharp critic of the industry. “The drug companies, frankly, are getting away with murder,” he said at a Cabinet meeting this fall. Prices are “out of control” and “have gone through the roof,” Trump said.
In the spring, a Trump tweet sent drug stocks tumbling after the president said he was working on a new system that would foster competition and lead to much lower prices. In meetings with industry executives, however, Trump has focused on speeding up drug approvals, a cost-reducing tactic they would back.
Professionally, Azar has another set of skills that may be valuable to the president. In his previous service at HHS, the Yale law graduate developed an insider's familiarity with the complex world of federal health care regulation, serving first as the department's chief lawyer and later as deputy secretary.
Frustrated by fruitless efforts to overturn the Obama-era health law in Congress, Trump might see the regulatory route as his best chance to make a mark on health care.
Congressional Democrats are likely to pounce on Azar's drug ties, reminding Trump of his promise to “drain the swamp” of Washington influence peddling.
If confirmed, Azar would join the club of Trump administration officials from big business. Ross was chairman of a private equity firm he founded and later sold. Last year Forbes estimated his net worth at about $2.9 billion, but Forbes’ latest estimate is about $700 million, based on financial disclosure filings. Treasury Secretary Steven Mnuchin was a former Goldman Sachs executive and hedge fund manager. Tillerson came from the oil industry, starting as an engineer and rising to CEO of ExxonMobil.
Admirers say Azar's drug industry experience should be considered an asset, not a liability.
“To the extent that the Trump administration has talked about lowering drug prices, here's a guy who understands how it works,” said Tevi Troy, who served with Azar in the Bush administration and now leads the American Health Policy Institute, a think tank focused on employer health insurance.
“Would (Azar) have been better off if he had been meditating in an ashram after serving as deputy secretary?” asked Troy.
Azar spent his formative years in Maryland. He got his bachelor's degree in government and economics from another Ivy League institution, Dartmouth. He once clerked for the late Supreme Court Justice Antonin Scalia, a revered figure for conservatives. During the Bill Clinton years, he served a stint with independent counsel Kenneth Starr.
If confirmed, Azar would be Trump's second HHS secretary, replacing former Georgia congressman Tom Price, who stepped down after just seven months, when his use of private charter planes for government travel created a public controversy that displeased the president.