Meet the New Boss, Same as the Old

By Matthew Hines

On Monday, President Donald Trump announced Alex Azar, a former deputy HHS secretary and pharmaceutical executive, to be the next Secretary of Health and Human Services.

The president posted on Twitter, “He will be a star for lower health care and better health prices!”

In choosing Azar, the president chose an insider to health care policy. He is the son of Dr. Alex Azar, a retired physician who teaches at Johns Hopkins Hospital, and worked in health care and drug policy for Eli Lilly & Co., rising to be the president of the American division. Between 2005 and 2007, he served as deputy to then-Secretary of Health and Human Services Mike Leavitt during President George W. Bush’s second term.

Azar has conservative bona fides. His opposition to the Affordable Care Act is a matter of record. Also, his past experience as the understudy for Secretary Leavitt also makes him an expert in navigating the complex world of healthcare regulatory policy.

Tevi Troy, who was Azar’s successor as deputy HHS secretary, told The National Discourse that in addition to Azar’s public sector experience, Azar’s experience in the private health care sector is also an asset. “It’s a good thing that he’s worked in the pharmaceutical industry,” he said.

This past June, in an interview with Bloomberg TV, Azar remarked, “One of the nice things in it is it does give tremendous amount of authority to the secretary of HHS.” If past statements are a guide to future action, then Mr. Azar’s statement could open the door to executive action which could lead to undermining the landmark health law, thus bypassing Congress.

By choosing a secretary with the capacity to use all the powers of his office to interpret enforcement of a law, Trump seems to be employing the very strategy he had criticized his successor: bypassing Congress when it suits him and when the president does not get the desired outcome. However, President Obama had to do it out of necessity, as he faced a Congress that barely acknowledged his legitimacy to office.

Trump, however, has no such problem. Azar ensures, one might think, a more consistent policy that will conform to the president’s wishes. This sets up a possible eventual clash between a Congress which must legislate on the landmark law and a secretary who could undermine their every move. In this sense, nothing has changed. The songwriter Van Halen once declared, “Meet the new boss, same as the old boss.”

Movement conservatives might love him to use his expansive view of the office to advance other pet GOP ideas. He favors converting Medicaid into a block grant. While on the surface it is a good idea, the nature of a block grant is there are few standards on how the money is to be spent and on whom.

Congress, ostensibly, could block grant Medicaid money and not designate general standards such as what we now use. Under the current system, there is enough of a push and pull that it allows states some freedom of how to use the funds, while also requiring minimum standards of usage.

A graduate of Yale Law School, Azar clerked for Supreme Court justice Antonin Scalia, and developed his skills as a staff attorney in the team investigating the Whitewater accusations leveled against President Bill Clinton and his wife Hillary. Before becoming the Number Two at HHS, he served as general counsel to the department.