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Alex Azar II, the nominee to be the next secretary of the U.S. Department of Health and Human Services (HHS), today told Democratic senators that he will agree with them about many issues but will probably disagree with them about the Affordable Care Act.

Azar talked about the ACA often today at a hearing on his nomination organized by the Senate Health, Education, Labor and Pensions Committee.


Sen. Elizabeth Warren, D-Mass, asked Azar what he thinks about “repealing and replacing” the health law.

“I guarantee that you and I will fundamentally differ on the contours of a system to do that,” Azar told her.

But Azar also praised the Medicare payment reform efforts organized by Sylvia Mathews Burwell, former President Barack Obama’s second HHS secretary, and he said he would do his best to run any Affordable Care act programs that survive as well as he could.

“My job is to faithfully implement the programs as passed by Congress, whatever they are,” Azar told Sen. Bob Casey, D-Pa., earlier in the hearing.


(Related: Trump Picks Former Lilly Drug Executive as HHS Secretary)

Casey said he believes that officials in President Donald Trump’s HHS are trying to sabotage the ACA public health insurance exchange system and the HealthCare.gov open enrollment period, by cutting HealthCare.gov advertising spending and funding for HealthCare.gov navigators, or nonprofit exchange plan enrollment helpers.

Azar rejected the idea that Trump administration officials are trying to sabotage the ACA system.

HHS officials are running the open enrollment period as well as they can, but making reasonable program adjustments, such as cutting advertising spending to about the same level as advertising spending for the Medicare Advantage and Medicare Part D prescription drug programs, Azar said.


Azar also talked about how he would run ACA programs in a response to Sen. Patty Murray, D-Wash., the highest-ranking Democrat on the committee.

“Any program HHS has, I want to run it as efficiently and effectively as possible,” Azar said.

Alex Azar II

Trump nominated Azar to succeed Tom Price, who ran into trouble after facing accusations that his travel spending was too high.

Azar was born in Pennsylvania. He has a bachelor’s degree from Dartmouth and a law degree from Yale.

He began his career as a law clerk for U.S. Supreme Court Associate Justice Antonin Scalia.


From 1994 through 1996, he was a junior lawyer in the federal office that investigated former President Bill Clinton’s real estate investments. 

After a stint as a lawyer at a big law firm, he moved over to HHS. He started out in 2001, under former President George W. Bush, as the HHS general counsel. In 2005, he won Senate confirmation to become the HHS deputy secretary.

From 2007 through 2012, Azar worked for the U.S. unit of Eli Lilly and Company, a pharmaceutical manufacturer. He was the head of the U.S. unit from 2012 through 2016.


The Senate HELP was just his first. He will also have to get through a hearing at the Senate Finance Committee before his nomination can get to the Senate floor for a full vote.

The Hearing

The Senate HELP Committee posted documents related to the hearing, and a video recording of the committee’s hearing, here.

Here’s a look at five more interesting things Azar said at the hearing, drawn from the hearing video.

Sen. Patty Muray, D-Wash. (Photo: Senate HELP)


Sen. Patty Muray, D-Wash. (Photo: Senate HELP)

1. He likes the Obama administration’s efforts to move the Medicare program toward more use of value-based reimbursement. 

For Medicare policymakers, “value-based programs” can mean efforts to pay more for high-value care, such as important and useful vaccinations, and less for care that may do little to affect outcomes, such as X-rays that may not have much effect on treatment decisions.

“Value-based programs” may also refer to efforts to pay a doctor or hospital for full treatment of a health problem, or for care for a whole patient for a whole year, rather than on a fee-for-service basis.


Azar said he sees Medicare provider payment pilot programs as important legacies of Burwell’s tenure at HHS.

“I would like to keep doing that,” Azar said.

Azar said improving Medicare is important to improving the entire U.S. health care and health finance system, because Medicare is so much bigger than any other public or private U.S. health care program.

“So much of the health care system really free rides off of whatever Medicare is doing,” Azar said.

2. Azar likes the U.S. Centers for Disease Control and Prevention (CDC).


The CDC is part of HHS.

While Azar was at HHS, he helped manage the HHS response to worries about anthrax attacks and influenza outbreaks. 

Sen. Johnny Isakson, R-Ga., pointed out that the CDC has its headquarters in Atlanta, in his state. Isakson asked Azar to commit to speaking up for the CDC. He said funding the CDC is critical to protecting the country against diseases that no one has heard of.

(Related: Some Projected Net Health Insurance Costs Go Poof)

“The CDC and its leadership and its career staff are the envy of the world,” Azar said.


Azar said he shares Isakson’s view that supporting the CDC is critical.

Isakson also Azar to prepare a report on eliminating drug maker efforts to game the drug pricing system.

“I’m not interested in blame,” Isakson said. “I’m interested in solutions.”

Azar did not go into much detail about what he would about high drug costs, but he said many of the stories about why drug prices are so high “make your jaw drop.”

“That shouldn’t be happening,” Azar told Sen. Sussan Collins, R-Maine, in a response to one news report about drug pricing problems.


3. Azar likes health savings accounts (HSAs). 

Azar noted that HSA users must combine their accounts with high-deductible health coverage.

An HSA user can use the cash to pay for “preventive services” before meeting the deductible, but just what counts as a “preventive service” is unclear, Azar said.

Classifying some drugs as “preventive services” might be a way to help HSA holders get more value from their coverage, Azar said.

4. Azar would like to do something to make electronic medical records systems work together better.


Congress has been enacting laws that were supposed to make electronic medical records systems work together since at least 1996.

Sen. Lamar Alexander, R-Tenn., the chairman of the committee, complained several times during the hearing that the systems still conflict. He said patients often have to photocopy their records and take the paper copies to new providers, rather than letting electronic systems transfer the records.

Azar said he wanted to work on that issue but not give a detailed description of how he might proceed.

Alexander told Azar that the Senate HELP Committee has already had six hearings on the topic, and that he expects the committee to hold a less formal, more bipartisan roundtable meeting on the topic sometime in the next two years. He said he wants Azar to come to the roundtable meeting and help fix the mess.


Alexander said that Congress has probably done all that it can to solve the problem, and that HHS now must use its administrative powers to finish the job.

5. Azar was careful about how he answered questions about birth control. 

The Affordable Care Act itself does not mention birth control.

The ACA does state that the HHS secretary must consult with experts to develop a package of high-value preventive services that all non-grandfathered major medical plans must cover without imposing deductibles or other “cost-sharing” charges on the patients.


Obama’s first HHS secretary, Kathleen Sebelius, signed off on advisors’ recommendation that the preventive services package should include birth control products and services.

Some religious employers, and other employers, have tried to avoid having their health plans pay for all forms of birth control, or certain forms of birth control, because of religious concerns or other moral concerns. 

Sen. Al Franken, D-Minn., tried to get Azar to commit to protecting the current employer birth control mandate.

Azar said he believes the idea that offering people easy access to birth control reduces health care costs and abortion rates probably makes sense.


“I will follow the law,” Azar said.

But Azar said he would also try to find balance between the need to enforce the law and the need to respect objections to the law.

Only about 200 employers have asked for exemptions from the birth control mandate, Azar said.

When the Obama administration was implementing the preventive services package requirements, it created a much bigger birth control coverage gap, by exempting established, “grandfathered” employer-sponsored health plans with tens of millions of enrollees, Azar said.


—Read Trump Health Pick Has Blamed Health Plans, PBMs for Drug Costs on ThinkAdvisor.

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