Azar, Open to Medicaid Caps, Confirmed as HHS Secretary

After a combative confirmation process, the United States Senate has confirmed Alex Azar as the second Department of Health and Human Services secretary in the Trump administration.

Azar, a former pharmaceutical executive with Eli Lilly & Co., received a 55-43 vote of support from the U.S. Senate, with six Democrats defecting from the pack to join the Republican-led majority. Two senators, Republicans Bob Corker and John McCain, did not vote.

The newly confirmed HHS secretary faced intense questioning from some Democratic senators during his confirmation process, with Sen. Elizabeth Warren of Massachusetts accusing him of passing through the “revolving door” of public officials departing private industry.


Azar, 50, expressed interest in converting Medicaid to a block-grant system during two Senate hearings. Under such a structure, states would receive a single amount of Medicaid funding to use as they saw fit each year, as opposed to the current open-ended structure.

“I have actually said before that looking at block granting and empowering states to be fiscal stewards can be an effective approach,” Azar said during a November hearing.

Speaking to the Senate Finance Committee earlier this month, Azar said “the devil’s in the details” of a potential block-grant structure, with a wide variety of variables that need to be ironed out through legislation.


Block granting was a controversial component of Republicans’ attempts to repeal the Affordable Care Act this past summer, and a public outcry over  potential Medicaid cuts helped to derail the plan.

“If you put Medicaid into a block grant, that means that the state is only going to get so much money, and regardless if the population swells, if the needs are greater, that money is it,” Sen. Bill Nelson, a Florida Democrat, said Wednesday in opposing Azar’s nomination.

Sen. Christopher Murphy of Connecticut, meanwhile, said his vote against Azar wasn’t a “slam dunk” because of the then-nominee’s support for alternative payment models in his testimony — contrasting his viewpoints with the fee-for-service advocacy of former HHS secretary Tom Price.

“I want to applaud Mr. Azar for his seriousness about working with Democrats and Republicans to try to shift our payment system over to something that makes more sense,” Murphy said. “And his openness about how important the Obama-era reforms were and his decision, if he gets this job, to reverse some of the sabotage to those alternative payment models that Secretary Price began.”

The Democratic senators also went after Azar for his history as a pharmaceutical company executive, and his criticism of the Affordable Care Act. Industry groups such as LeadingAge and the American Health Care Association, meanwhile, have supported Azar’s nomination.

“We congratulate Secretary Azar and look forward to working together with him and his colleagues at HHS,” AHCA president and CEO Mark Parkinson said in a statement issued late Wednesday. “Secretary Azar’s health care expertise will help the long-term care profession continue to deliver quality care to the millions [of] seniors and individuals with disabilities we serve.”

Azar replaces Price, who was forced to step down last fall amid an inquiry into publicly funded travel on private aircraft.

Written by Alex Spanko

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