By Erin Durkin
The next potential Health and Human Services secretary appears likely to emphasize administrative actions to dismantle Obamacare after congressional Republicans failed to repeal the law this year.
Former Eli Lilly and Company executive Alex Azar—who was HHS deputy secretary in the George W. Bush administration— shares former Secretary Tom Price’s criticism of the Affordable Care Act, but he could well take a different approach to the issue than Price—a former House member picked in part for his congressional background.
Tevi Troy, who also served in the Bush administration and succeeded Azar as HHS deputy secretary, said that the administration may find more choices with Azar when it comes to reforming the health care system. “I think Price was a little more defined on where he was on repealing the ACA given that he had his own plan to repeal,” Troy said. “Alex is a critic of the ACA but may show some flexibility.”
Testifying in front of the Senate Health, Education, Labor, and Pensions Committee Wednesday, Azar said that health care needs to be more affordable, available, and tailored to individuals.
“Under the status quo, premiums have been skyrocketing year after year and choices have been dwindling,” he said. “We must address these challenges for those who have insurance coverage and for those who have been pushed out or left out of the insurance market by the Affordable Care Act.”
Unlike Price, who had many years of experience as a lawmaker, Azar has deep experience at HHS, making him intimately familiar with the regulatory process.
“He is ideally suited to know what things the administration can do and what the administration should do” to dismantle Obamacare, said Sally Pipes, president of the Pacific Research Institute.
Troy said Azar can take actions either in the absence of ACA repeal or to eventually implement a repeal-and-replace plan.
“When it comes to the ACA, it might signal that having someone who knows the legislative process isn’t enough, but you should get someone who knows the department, who knows the job, and knows how to make things move through on the administrative side,” he said.
Azar will face the same limitations Price did when it came to single-handedly making changes under the ACA without congressional action. But the administration on its own has been able to shorten the open enrollment period and slash funding for outreach and education.
And Azar sent some signals Wednesday that he may continue along the same lines. Democratic Sen. Robert Casey asked Azar if he would oppose initiatives within the administration to “undermine the Affordable Care Act,” and pointed to cutting advertising as an example.
“I would disagree that there is any effort to sabotage the program,” Azar said. “People want to make the program work. … The advertising cuts actually put the advertising for this program, now many years into it, at the level of Medicare Part D and Medicare Advantage. At some point, these insurance companies have to do their own doggone job and fund their own advertising.”
He also told senators that he was open to making Medicaid a block-grant program, a proposal which had been part of the explosive fight over Obamacare repeal this year. The rate at which funding would grow for the program caused rifts among Senate Republicans and complicated negotiations.
“I think, looking at block-granting and empowering states to be fiscal stewards, there can be an effective approach,” Azar said.
Among the changes the administration seeks to make, Azar would be instrumental in leading and implementing President Trump’s executive order that would expand the use of association health plans that could be exempt from ACA regulations.
Another key change would be to extend the length a person can use short-term, limited-duration plans beyond the three-month restriction imposed by the Obama administration. These types of plans are exempt from many consumer protections in the ACA.
“This order has the potential to price millions of people with pre-existing conditions and serious illnesses out of the individual insurance market and put millions more at risk through the sale of insurance plans that won’t cover all the services patients want to stay healthy or the critical care they need when they get sick,” 18 patient groups said in a statement in October.
Azar asserted that he shared the same health goals as the Democrats. “Our goals are the same in the sense that we want to improve access to affordable insurance that is better,” he told Sen. Tim Kaine. “The president wants this; I want this. I think we may only differ about tactics and approaches.”
But Sen. Elizabeth Warren remained unconvinced. “Tom Price lied through his confirmation hearing, and now you come in here and say the same things he said. No one should be fooled,” she said.