Azar has the tools needed to be an excellent HHS secretary
© Camille Fine

As former senior career attorneys at the U. S. Department of Health and Human Services (HHS), we thought it important to provide our perspective on Alex Azar, whom the president has nominated to be the next secretary of HHS.  We all worked directly with Azar on a daily basis for all or a portion of the time he served as the General Counsel (GC) from 2001-2005 and as Deputy Secretary (DS) from 2005-2007, and are all former career appointees to the Senior Executive Service. We are respectful of the Senate process to consider his nomination, and speak to our experience with his legal acumen, managerial capabilities, and leadership skills.

Our collective assessment, informed by our decades as civil servants under General Counsels appointed by administrations of both parties, is that Azar was an excellent General Counsel who served in this role with distinction, exercising uniformly good judgment and exhibiting unqualified respect for the ethical standards incumbent upon all federal employees. Most significantly, Azar had a high degree of respect for, and understanding of, legal precedents and the rule of law. Further, Azar has one of the strongest legal minds of any attorney with whom we have worked. He could be briefed quickly on complex legal or policy matters and grasped the dispositive issue with clarity and speed, enabling him to assist both materially and expeditiously in problem solving and resolution.

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Beyond his skills in the law, Azar was an excellent leader who, through the example of his own hard work and his clearly demonstrated respect for the work of the career attorney staff, fostered a collegial team environment. Azar managed well a law office of hundreds of attorneys who were dedicated to HHS’ program objectives, including clinical research, ensuring safe and effective drugs, biologics, and medical devices, providing health care coverage, supporting improvements in patient care through health information technology and providing essential human services. We were not surprised when he was later selected to be the deputy secretary, where he was responsible for guiding the entire Department on a day-to day basis.

As GC, Azar regularly was involved in matters regarding Medicare reimbursement. Every time, he asked the basic question -- what did the law allow? For example, when a Medicare payment adjustment appeared to be required, Azar consulted the statute and regulations and examined every relevant word. He wanted to know if the adjustment was the only legally permissible outcome; if it wasn’t, he wanted to determine the other possible outcomes so that the CMS administrator and HHS secretary could decide whether to adopt the payment change.

Azar also understood that a strong ethics program was critical to ensuring that HHS deliberations were conducted impartially. As GC, he secured the funds and staff to increase the size of the OGC Ethics Division, creating the largest government ethics office outside of the Office of Government Ethics itself.

On another occasion, the Bush administration decided that the new Privacy rules established by HIPAA should be revisited and possibly modified. There were some who were skeptical of engaging the career team who had previously drafted the regulations. But Azar, as GC, again demonstrated leadership, professionalism, and value for his team by consulting with and ensuring career lawyers were included in the discussions about the best course of action.

In an unusual action, but one that showed Azar’s leadership and legal ability, he chose to personally defend HHS before the 4th Circuit. Normally, the Department of Justice defends HHS in court, but Azar thought it was important that he do it and quickly became expert on the topic, successfully arguing HHS’ position before the Court.

Azar also demonstrated an ability to navigate organizational change. When HHS took on the role of promoting health IT, he acted quickly to ensure coordinated legal advice across HHS by creating a new role of Senior Counsel for Health IT. When he became deputy secretary, he took on the management responsibility of ensuring the proper establishment and integration of the new Office of the National Coordinator for Health IT within HHS. 

Finally, Azar demonstrated a common touch reflective of his upbringing in a small Maryland town. He related to his staff and fostered an environment that balanced hard work with other aspects of life. Azar knew that leadership took not only a keen intellect, strong organizational skills and serious analytical abilities but also a sense that in pursuing a common goal we were interconnected on a personal level.

We hope these examples of our experiences can provide helpful perspective as the U.S. Senate considers the president's nomination of Alex Azar to be the next secretary of HHS. 

Edgar Swindell was the HHS Designated Agency Ethics Official (DAEO) and the Associate General Counsel in charge of the OGC Ethics Division from 1997 to 2015; Sheree Kanner, was the Chief Counsel to the Centers for Medicare & Medicaid Services from 1997-2003 and served in several other positions in HHS OGC before that; Jodi Daniel served at HHS from 2000-2015 as Attorney Advisor-HIPAA, Senior Counsel for Health Information Technology, and Director, Office of Policy, Office of the National Coordinator for Health IT (ONC).