10 questions senators must ask Trump's newest HHS pick, Alex Azar

10 questions senators must ask Trump's newest HHS pick, Alex Azar
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Confirmation hearings for Alex Azar, President Trump’s second nominee to head the U.S. Department of Health and Human Services (HHS), provide senators with an opportunity to press the administration on its plans for health care reform and on controversial subjects ranging from opioids to birth control.

Drawing on my experience as a former Senate staffer and a senior counselor at HHS, I’ve prepared a list of questions, suitable for use by both Democrats and Republicans, that the secretary-designate absolutely must answer before being confirmed. Senators from both parties need to send a clear message to the Trump administration: the cabinet confirmation honeymoon is over.

Health Care Reform

1) For the current Affordable Care Act open enrollment period, President Trump is cutting outreach funding by 90 percent and navigator funding by approximately 40 percent. How will you persuade the president to restore funding for outreach leading up to and through the next open enrollment period?

2) Cutting cost-sharing reduction payments increases costs for consumers and the federal government — with no offsetting benefits. What will you do to reinstate CSRs and stabilize health insurance markets?

3) HHS is currently cutting back on the Obama administration’s efforts to bend the cost curve downward through delivery system reform. Do you support outcome-oriented programs that encourage teamwork and reward results with bundled payments? If you don’t support such programs, what realistic proposals can you offer for slowing the growth of health care costs?

4) Your predecessor was AWOL throughout negotiations over so-called “repeal and replace.” What is the role of the HHS secretary in establishing a way forward on health care reform?


5) With great fanfare, the president declared a public health emergency stemming from widespread opioid abuse and addiction. But the very next day, HHS quietly announced a proposed rule that would allow states to modify ObamaCare’s “essential health benefits” (EHB) requirement out of existence. Are you aware that EHB includes substance abuse treatment? And that substance abuse treatment was almost never covered by insurers before the EHB requirement was enacted?

6) EHB is the most effective tool that the government has yet devised to combat opioid addiction. Coupled with the Medicaid expansion, it has enabled millions of Americans to obtain treatment. Will you commit to pushing back against the president’s plan to strip treatment from millions of Americans with opioid addiction?

Mental Health

7) Mental health is very much in the news, and yet the Trump administration seems to be hell-bent on reducing government support for treatment. Medicaid is by far the largest funder of mental health and substance abuse funding, accounting for 25 percent of the nation’s total annual spending on these services. Yet, the administration’s budget for FY 2018 called for more than $600 billion in Medicaid cuts, which could eliminate benefits for 7.5 million people. How will you seek to reverse this destructive course and renew HHS’s commitment to mental health treatment?

Birth Control

8) The teen birth rate declined by more than half from 2007 to 2017 as birth control became more accessible. However, the Trump administration recently relaxed Obamacare’s birth control mandate on the grounds that providing free birth control makes women promiscuous. Are you aware of any credible evidence to support this claim? Do any medical professionals support this claim? Will you continue to use this false charge as the basis for denying women free birth control?

9) Under Trump, HHS has announced a new focus on protecting Americans from the moment of conception. The HHS strategic plan makes no mention of birth control at all. What will you do to ensure that HHS makes science the foundation of its decisions about women’s health, including access to birth control?

Tropical Diseases

10) In recent years, the threat of tropical diseases like Ebola and Zika has grown dramatically. How will you ensure that HHS is doing all it can to stop future outbreaks? What program will you put in place for responding to outbreaks that spread to the U.S. despite your precautions?

As the confirmation hearing unfolds, the spotlight will shine equally on committee members of both parties. The Azar hearings offer senators the opportunity to confront the Trump administration over erratic and counterproductive policy choices. Senators need to assert their constitutional prerogatives by asking tough questions of this nominee.

Drew Littman is policy director with Brownstein Hyatt Farber Schreck. From 2009‒2011, Littman served as Sen. Al Franken’s (D-Minn.) chief of staff.