Senate confirms Azar as HHS secretary

The Senate on Wednesday approved Alex Azar to head HHS, where he's expected to reshape the ACA exchanges, which face uncertain futures after executive and legislative efforts to dismantle them.

The chamber confirmed Azar Wednesday afternoon 55-43, in a mostly party-line vote.

Azar fills a vacancy left by former HHS Secretary Dr. Tom Price, who resigned in September over his use of private jets on the government's dime.

Many Democrats voted against the nominee citing his record as a drug company executive who oversaw sharp price spikes during his tenure at pharmaceutical giant Eli Lilly & Co.

Azar takes over at HHS after a tumultuous year on the healthcare policy front. Although congressional Republicans ultimately failed to repeal the Affordable Care Act after three attempts, they eliminated the individual mandate penalty and delayed key ACA taxes meant to offset the costs of the program.

President Donald Trump's executive order to expand association health plans leaves the door open for substantial changes to the law's coverage mandates. As HHS secretary, Azar has vast authority to dictate terms of 1332 waivers states can use to reshape their exchanges.

Azar vowed over the course of his Senate confirmation hearings to address escalating drug prices, but he limited specific recommendations to a pharmaceutical benefit manager model to negotiate drug prices for Medicare Part B's physician-administered sales and expanded generic competition.

Senators have begun to release Azar's written testimony for the record as well to shed further light on his policy bent and how his work will align with the Trump administration's work over the past year and shift away from past policy.

One example is his neutral stance on a recent recommendation from HHS' Office of Inspector General to add medical-device identifiers to billing claims after the office found the government had spent $1.5 billion in Medicare funds to treat people who had failed cardiac implants.

Murray noted in her questions that providers have said the addition wouldn't add undue burden, but Azar didn't commit to following the OIG recommendation before talking to all stakeholders involved "to understand the potential benefits and talks."

Advocates of the billing system change are already worried his noncommitment signals that it won't happen since the forms get a redesign only once every 10 years.

As a former general counsel at HHS, Azar brings administrative chops to the job that his embattled predecessor Price lacked. He helped launch the Medicare Advantage program as HHS general counsel under President George W. Bush.

Former colleagues praise Azar's efficiency and leadership—traits that make Democrats who oppose his policies wary of the direction he is likely to take the department.

"This nomination is about more than just the administration's failure on prescription drug prices," Oregon Sen. Ron Wyden, the ranking Democrat on the Finance Committee, said on the Senate floor Tuesday. "It's a referendum on an entire healthcare agenda."

Wyden went on to say that he has "no confidence Mr. Azar will change course at HHS" from the Trump administration's current actions.