Skeptical Democratic senators are getting a chance to question President Donald Trump's pick for health secretary about what he'll do about rising drug prices and the future of "Obamacare."
Alex Azar's first confirmation hearing — before the Senate Health Education, Labor and Pensions Committee — was scheduled for Wednesday. The former drug company and government executive has the support of committee Republicans. He's signaling that he wants to shift away from partisanship, and some prominent Democrats seem to be willing to give him a chance.
"While there may be disagreements on policy, I do think he's willing to hear people out," says former Senate Majority Leader Tom Daschle, a Democrat who met with Azar recently and has known him for years.
"He's the best choice we have, given the current political situation," says Kavita Patel, a health care expert with the Brookings Institution, who worked in former President Barack Obama's administration and, before that, for the late Sen. Edward M. Kennedy.
All sides agree that Azar, 50, is headed for Senate confirmation, which would be his third after appointments to senior positions at the Department of Health and Human Services in the George W. Bush administration.
Nevertheless, he faces tough questioning, given the Senate's hyper-partisan atmosphere, which has sunk or battered other nominees.
Sen. Patty Murray of Washington, the health panel's ranking Democrat, has tweeted her intent to ask Azar if he would be a toady for Trump's "extreme, politically driven & harmful agenda." Sen. Elizabeth Warren, D-Mass., says she has "concerns" about whether Azar can deliver "better health care and lower drug prices."
In prepared remarks released Tuesday night, Azar said "drug prices are too high," placing the issue as his top priority. He shied away from detailed proposals, however, saying instead that he has the knowledge and experience to get drug companies, pharmacies, insurers and government programs to work toward solutions.
The Senate Finance Committee will hold another hearing on Azar soon and formally decide whether to send the nomination to the full Senate.
If confirmed, Azar would be Trump's second HHS secretary, replacing Tom Price, who resigned under pressure after using private charter flights at taxpayer expense.
Azar's career path could prove a challenge given Trump's vow to "drain the swamp" of Washington.
He'll face questions about whether his lucrative, decade-long stint as an executive with Indianapolis-based Eli Lilly and Co. will conflict with his work to lower drug prices. On Azar's watch, patient advocacy groups criticized Lilly for price increases to one of its biggest products: insulin.
In speeches while at the company, Azar questioned whether the government's regulatory machinery has kept up with the pace of scientific change, and he warned that price controls could stifle innovation — standard industry arguments.
"Will he carry pharma's water? I don't think so, based on my interactions with him," says former Senate Majority Leader Bill Frist, a Republican from Tennessee. Like Daschle, he is active in the Bipartisan Policy Center, a Washington think tank.
Before resigning from Eli Lilly earlier this year, Azar built a financial portfolio now worth $9.5 million to $20.6 million, according to disclosure records filed with the Office of Government Ethics. He also was paid nearly $2 million in his final year at the company, received a $1.6 million severance and sold off more than $3.4 million in Lilly stock. He also declared $100,000 to $1 million in capital gains from the sales, along with millions more in stock and bond holdings.
Azar is an Ivy League-educated lawyer with conservative credentials. Early on he built connections in Republican circles — he clerked for Supreme Court Justice Antonin Scalia, worked under Kenneth Starr during the Whitewater probe of President Bill Clinton's land deals and raised campaign cash for GOP presidential candidates Mitt Romney and Jeb Bush.
His previous posts at HHS allowed him to build relationships with Democrats, too. Daschle said he worked most closely with Azar in 2001, when Daschle was a South Dakota senator and anthrax was found in his office. Azar was then the HHS general counsel. Four years later, he was confirmed as deputy secretary of the agency.
Dan Mendelson, president of the consulting firm Avalere Health and a Clinton administration veteran, said Azar's credibility comes from an understanding of federal programs and HHS divisions like Medicare, Medicaid and the Food and Drug Administration.
"He has policy wonk credentials," says Mendelson, a Democrat who has known Azar for about 20 years and considers him a friend. "I can't think of a better person to tackle the opioids crisis, for example, because he understands all the different levers."