Senate Confirms Trump Nominee Alex Azar as Health Secretary

WASHINGTON — The Senate confirmed Alex M. Azar II on Wednesday to be secretary of health and human services, clearing the way for President Donald Trump’s second health secretary to begin controlling more than a trillion dollars a year in spending on medical insurance coverage for about one-third of all Americans.

The vote was 55-43.

Azar, an ophthalmologist’s son and former drug company executive who served in the administration of George W. Bush, faces two huge challenges.

He is supposed to find a way to rein in prices charged by drug companies, which Trump said last year were “getting away with murder” — a view shared by many consumers.

In addition, Azar must decide how to administer the Affordable Care Act, a task for which he will be personally and legally responsible, at a time when Trump and many Republicans in Congress want to undermine and eventually kill the law.

On many issues, Azar will face a choice: whether to try to stabilize insurance markets and repair the health law or to “let Obamacare fail,” as Trump threatened to do last summer. His choices could have significant consequences for consumers and for Republicans on the ballot this fall.

At hearings before two Senate committees to review his qualifications, Azar presented himself as a problem-solving pragmatist rather than an ideologue. At no time did he deviate much from the policies set by Trump.

“The Affordable Care Act has failed millions of Americans who have lost the plans they liked and the doctors they liked,” Azar declared.

Azar, 50, graduated from Yale Law School and was a law clerk for Justice Antonin Scalia of the Supreme Court.

Democrats dismissed the idea that Azar might be a moderating influence in the administration.

Sen. Patty Murray of Washington, the senior Democrat on the Senate health committee, said Wednesday: “I’m alarmed that Mr. Azar believes a woman’s employer should be able to decide, based on ideology, whether or not her birth control should be covered. I’m alarmed by his extreme and out-of-touch views on Roe v. Wade,” the 1973 Supreme Court decision that established a constitutional right to abortion.

Sen. Tim Kaine, D-Va., explained why he had decided to oppose Azar: “The Trump administration’s determination to destroy the Affordable Care Act through executive action has destabilized our health care system and threatened coverage for millions. I fear Alex Azar could make things even worse.”

But Republicans were broadly supportive. Sen. Orrin Hatch, R-Utah, chairman of the Finance Committee, who has been in the Senate for 41 years, told Azar, “You’re one of the best public servants that I’ve seen in the whole time that I’ve been here.”

Azar said repeatedly in recent weeks that “drug prices are too high,” but he placed most of the responsibility on “a system” that encourages price increases. “Everyone shares blame,” he told the Senate health committee in November.

Sen. Debbie Stabenow, D-Mich., was frustrated. “Mr. Azar says he agrees that prices are too high, but he does not seem ready or willing to do much about it,” she said.

From 2012 to early 2017, Azar was the president of Lilly USA, a unit of Eli Lilly and Co., the global drugmaker based in Indiana. Sen. Ron Wyden of Oregon, the senior Democrat on the Finance Committee, said Azar told the panel that “he had never — not even one time — signed off on a decrease in the price of a medicine.”

“On Mr. Azar’s watch,” Wyden said, “the price of Forteo, a Lilly drug used to treat osteoporosis, more than doubled,” as did the prices for Humalog, used to treat diabetes, and Strattera, for attention deficit hyperactivity disorder.

Six Democratic senators and one independent joined 48 Republicans in voting for Azar. Opposing him were 41 Democrats, one Republican and one independent.

The Democrats who voted for Azar were Sens. Thomas R. Carper and Chris Coons, both of Delaware; Joe Donnelly of Indiana; Heidi Heitkamp of North Dakota; Doug Jones of Alabama; and Joe Manchin III of West Virginia. Sen. Rand Paul of Kentucky was the only Republican to vote no. The independent senators split, with Angus King of Maine supporting Azar and Bernie Sanders of Vermont opposing him.

Hatch said Azar’s experience as a drug company executive, far from creating a conflict of interest, was an asset. And he said he hoped Azar would undo many of the policies put in place because of “poor decisions made throughout the eight years of the Obama administration.”

Azar will replace Tom Price, who resigned as health secretary in September, in the face of multiple federal inquiries into his use of private and government planes for travel.

Republicans tried unsuccessfully last year to roll back the expansion of Medicaid authorized by the Affordable Care Act. But the Trump administration is determined to make major changes in the program.

Azar told Congress that states should be allowed to impose work requirements on able-bodied Medicaid beneficiaries. “One of the best ways to improve the long-term health of low-income Americans is to empower them with skills and employment, for those who are able to work,” Azar said.