New health chief...

Trump's new health chief takes over battered agency

By ADAM CANCRYN

The Senate confirmed Alex Azar as secretary of Health and Human Services, installing him atop a department seeking a fresh start after a turbulent first year under the Trump administration.

Azar cruised to confirmation Wednesday in a 55-43 vote, with six Senate Democrats — largely from red states — and Independent Angus King joining nearly all Republicans to back his candidacy.

A former pharmaceutical executive and twice-confirmed veteran of George W. Bush’s HHS, the 50-year-old nominee earned bipartisan respect in recent weeks for his familiarity with the sprawling agency and a stated desire to reset relations with lawmakers on both sides of the aisle.

“I think he’s incredibly competent,” said Democratic Sen. Heidi Heitkamp. “I don’t share a lot of his philosophy, but I think he understands — as someone who has been at the administration — the importance of the rule of law and compliance.”

Democrats Tom Carper, Chris Coons, Joe Donnelly, Doug Jones and Joe Manchin also voted in favor of President Donald Trump’s HHS pick. Rand Paul, who has disagreed with Azar over the merits of drug reimportation, was the only Republican present to oppose the nomination.

Azar’s appointment gives HHS its first permanent leader since September, when Tom Price resigned in the wake of the GOP’s failed Obamacare repeal bid and reports in POLITICO about his use of charter jets.

As the nation’s top health official, Azar has pledged to prioritize reining in drug prices. He’s also been a consistent critic of the Affordable Care Act, vowing to focus on making health care more affordable for those left out of the Obamacare markets.

With Congress reluctant to embrace another politically fractious health agenda in an election year, Azar is poised to become the face of administration efforts largely focused on unraveling Obamacare and remaking the health system through rulemaking and regulatory action.

“We have a system where Washington is too often in the driver seat and defining what is healthcare,” Azar wrote in response to questions from Democrats on the Senate’s health committee. “And that is taking away choices and the ability of individuals and families to find the care they need.”

That’s prompted criticism from Democrats who warn that Azar — the former president of Eli Lilly’s U.S. operations — is too friendly with the pharmaceutical industry to tackle surging drug prices, and who will be just as eager as Price to pick apart Obamacare and roll back its coverage gains.

"Mr. Azar is latest in a string of ideologically driven health care appointees from President Trump," said Sen. Patty Murray (D-Wash.). "I am alarmed that he might not stand up to the pharmaceutical industry. And I am alarmed that he might not stand up to President Trump’s agenda driven by sabotage and ideology."

Still, Azar has tried to contrast the Trump administration’s turbulent first year with his own vision for the department — a strategy aimed at tamping down the partisan fury, even as he’s set to ramp up HHS’ conservative ambitions.

In conversations with lawmakers and advisers, Azar has stressed the immediate need to reset the relationship with Capitol Hill, with HHS staffers and with the press — and to quickly rebrand HHS as an efficient, hyper-competent operation free of the drama that plagued Price’s brief tenure.

“Look at Scott Gottlieb,” said one person close to Azar, pointing to the FDA commissioner who’s won bipartisan praise while quietly and effectively carrying out the Trump administration’s priorities. “That’s the model.”

In practice, that means moving quickly to strengthen the lines of communication with congressional Republicans and at the White House and establish HHS as a key cog in translating the party’s priorities into concrete policy.

Azar is expected to launch a listening tour on the Hill to solicit policy ideas — a bid to erase the bad taste left by a Price tenure that proved more frustrating than productive, and to emphasize that his role is to implement Congress’ plans rather than push his own.

“He has priorities, but I think he’s got a more open mind on what the policies are to pursue those priorities,” said Tevi Troy, CEO of the American Health Policy Institute and a former colleague who has spoken with Azar throughout his confirmation process. “He wants to focus on Congress feeling like they’re being heard.”

The charm offensive is likely to target Democrats, too — a sharp contrast from Price, who quickly alienated Democratic lawmakers amid efforts to repeal Obamacare.

Azar already has several Bush-era allies scattered throughout the Trump administration, including Domestic Policy Council Director Andrew Bremberg and Lance Leggitt, who recently joined the council as deputy director after a stint as HHS chief of staff. He also knows Vice President Mike Pence from his time at Eli Lilly in Indiana.

Azar is also set to lean on old colleagues within HHS to turn around a department that’s struggled with vacancies and a divide between career staffers and political appointees that's hampered its productivity.

Eric Hargan, a close friend of Azar who’s expected to remain on as deputy secretary, made the rounds of various HHS offices during his time as acting secretary to rally employees, staffers said. Azar’s first days in office will prioritize spending extensive time with staff as well, people familiar with the plans said.

The goal is to send the message that career staff will be far more involved in policymaking than during the Price era, during which non-political employees often groused about being left out of the loop.

“You can’t go in there and think of the career people like anything other than your colleagues,” said Stewart Simonson, who served as deputy general counsel under Azar at the Bush administration’s HHS. “It’s not an us and them thing. If you think that, it’s over.”

Azar has also signaled plans to remake HHS as more press-friendly, at the urging of advisers alarmed by the secrecy that’s surrounded the agency’s work thus far and the perception that negative press made it harder to get things done.

Those priorities — along with a push to fill several still-vacant leadership posts — aren't going to ease the skepticism of Democrats wary of the Trump administration's health care plans, who are vowing to keep the pressure on Azar.

"Despite the cheerful overtures that he has made to senators on both sides of the aisle, he has not offered even a single concrete example of how he would actually change the system," said Sen. Ron Wyden (D-Ore.).

But with the Trump administration looking to bypass Congress and put its health agenda in the hands of HHS, Azar's focus is less on finding political consensus than on getting the department back in shape, and firing up the policymaking machine.

"He will look to put his imprint on things quickly," said Bob Wood, a lobbyist at BGR Group who worked with Azar during the Bush years. "He has a vision, he's ready for this job, he's more prepared than anyone that I can think of."