Trump nominating Azar as next HHS secretary

President Trump on Monday tapped Alex Azar for secretary of Health and Human Services (HHS), a role vacated by Tom PriceThomas (Tom) Edmunds PriceOvernight Health Care: Funding bill could provide help for children's health program | Questions for CVS-Aetna deal | Collins doubles funding ask for ObamaCare bill Warren questions Conway's role in curbing opioid epidemic Trump promised ‘best people’ would run government — they upended it MORE in late September amid revelations that Price took repeated trips on government and private jets that cost taxpayers more than $1 million.

"Happy to announce, I am nominating Alex Azar to be the next HHS Secretary," Trump tweeted. "He will be a star for better healthcare and lower drug prices!"

Azar has a deep knowledge of the regulatory process, those who worked with him said, but Democrats are likely to raise red flags on how he'll handle ObamaCare and drug prices.

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The role is high-profile, tasked with overseeing various facets of health care, from Medicare and Medicaid to drug approvals and disease control — and most controversially, the implementation of the health-care law Republicans want to tear down.

The GOP controls 52 seats, and Azar only needs 51 votes to win Senate confirmation.

Azar left the pharmaceutical company Eli Lilly in January after working there for nearly a decade, most recently serving as the president of Lilly USA. He now runs a consulting firm, according to his LinkedIn profile. Working in HHS during President George W. Bush's administration, he served as the department’s general counsel from 2001 to 2005 and then assumed the role of deputy secretary for the next two years.

He would bring “competence, leadership, a smart, conservative agenda, and also an understanding of how the regulatory process works, which I think is important given that the Trump administration is trying to accomplish a lot of its health policy goals via the administrative process,” said Tevi Troy, who served as Bush’s deputy head of the White House Domestic Policy Council when Azar was at HHS.

Nominating someone familiar with the regulatory process could be important for Trump, who is examining ways to unwind ObamaCare that wouldn’t need approval from Congress after Republicans’ months-long effort to repeal and replace the health law failed.

Azar served as HHS’s No. 2 under Secretary Mike Leavitt, who said he asked Azar to oversee the department’s regulatory process.

“He understands the process and he knows the levers and how you make it work and where the potential roadblocks are,” Leavitt said. “I think he would be of particular value given the fact that ... so far a repeal bill has not occurred and they’re going to need to make their imprint on existing laws through replacing the ideology underpinning it.”

GOP leadership worked on a repeal bill for months, but it was dogged with concerns from centrists that it could hurt their constituents’ coverage under the ObamaCare Medicaid expansion and from conservatives who argued it didn’t do enough to lower premiums.

Azar was asked for his position on that bill by a Fox Business host over the summer.

“I think, Stuart, you and I generally agree that the status quo is pretty bad and any change to that that’s productive is a good thing,” Azar said on July 17, adding he’d like to see more changes.

Stuart Varney, the host, responded: “You cut right through to it. I keep saying that something — no matter what it is — something is better than nothing. Where do you stand on that?”

“It’s very dangerous to let the perfect be the enemy of the good, especially when you have to get 50 people in the U.S. Senate to agree to it,” Azar replied.

Two days before Senate Republicans failed to pass a scaled-down version of an ObamaCare repeal bill, Azar predicted on Fox Business, “At the end of the day this is a hot potato that lands back in Secretary Price's lap for him to use as many authorities as he has to grant flexibility and try and dig us out of the ObamaCare mess as much as he can.”

It’s likely lawmakers will question his role at the Eli Lilly, as they have pressed pharmaceutical companies for more transparency behind their prices, especially after some high-profile price hikes last year.

Drug prices are one issue where Trump is more in line with Democrats and has many times said the industry is “getting away with murder.”

Still, the administration hasn’t taken a hard line, and legislation backed by Democrats is not likely to move anywhere in the GOP-controlled Congress. It’s hard to see Republicans voting against Azar's nomination simply because he worked at a drug company.

Democrats, though, are another story.

Two ranking members on panels overseeing health care — Sen. Ron WydenRonald (Ron) Lee WydenDemocratic senator predicts Franken will resign Thursday Avalanche of Democratic senators say Franken should resign Lobbying world MORE (D-Ore.), with the Finance Committee, and Sen. Patty MurrayPatricia (Patty) Lynn MurrayDemocrats turn on Al Franken VA slashes program that helps homeless veterans obtain housing: report The Hill's 12:30 Report MORE (D-Wash.), with the Health Committee — sent a letter in October to Trump outlining their priorities for the next HHS secretary. Some of the 51 priorities are key components of Trump’s agenda, setting up a potential confirmation showdown.

Wyden said in a press release Monday that he will "closely scrutinize Mr. Azar’s record and ask for his commitment to faithfully implement the Affordable Care Act and take decisive, meaningful action to curtail the runaway train of prescription drug costs."

The Senate Health Committee tends to hold hearings on HHS nominees, but Senate Finance Committee is the panel that sends the nomination to the full Senate. 

Murray noted Monday morning that she hopes Azar supports her bipartisan bill with Health Committee Chairman, Sen. Lamar AlexanderAndrew (Lamar) Lamar AlexanderOvernight Finance: Trump says shutdown 'could happen' | Ryan, conservatives inch closer to spending deal | Senate approves motion to go to tax conference | Ryan promises 'entitlement reform' in 2018 Senate approves motion to go to tax conference House conservatives, Ryan inch closer toward spending deal MORE (R-Tenn.). She outlined several criteria she'll use to consider Azar's nomination: 

“I will seek to understand whether he is willing to stand up to President Trump and his Administration to ensure the needs of all patients and families are put first, whether science or ideology will drive his decision-making, and whether he plans to continue the Administration’s ongoing and unprecedented attack on women’s constitutionally protected health care rights," Murray said in a statement. 

Price’s nomination was a hard-fought battle.

Democrats on the Finance Committee boycotted a vote to send Price’s nomination to the Senate floor. The panel’s chairman, Sen. Orrin HatchOrrin Grant HatchMcConnell names Senate GOP tax conferees Ryan pledges 'entitlement reform' in 2018 Utah governor calls Bannon a 'bigot' after attacks on Romney MORE (R-Utah), had to temporarily suspend committee rules to pass the nomination.

Notably, as HHS general counsel, Azar worked to help then-Secretary Tommy Thompson officially declare the first public health service emergency after the Sept. 11 terrorist attacks.

“He was able to research the law very quickly and said 'We have the authority to do so' and gave me the authority,” Thompson said. “And we went away and declared a health emergency. It was badly needed and it was right on, and nobody’s ever questioned [the agency's legal ability to do it]."

This story has been updated.