On Monday, President Donald Trump nominated Alex Azar for Secretary of the Department of Health and Human Services (HHS). The role was vacated in late September after then-HHS Secretary Tom Price resigned amid revelations that he took trips on government and private jets costing taxpayers more than $1 million.
Azar, 50, has a long history of traversing the revolving door between government and big business, in his case, between HHS and the big pharmaceutical companies. Under George W. Bush, Azar served as HHS general counsel from 2001 to 2005, supervising the Office of the Chief Counsel of the Food and Drug Administration (FDA). From 2005 to 2007, he was the deputy secretary of HHS, supervising “all operations of the HHS, including the regulation of food and drugs.”
In 2007, Azar left HHS to become the senior vice president of corporate affairs and communications for Eli Lilly, the giant pharmaceutical company. The firm described Azar’s role as “lead[ing] Lilly public affairs and lobbying efforts.” It continued: “He was eventually promoted to president of Lilly USA. Azar left Lilly in January and now consults with pharmaceutical and health insurance companies.”
Between 1999 and 2005, while Azar was HHS general counsel, an investigation carried out by the FDA’s Office of Criminal Investigations and the FDA’s Office of the Chief Counsel, among others, found that Eli Lilly engaged in systematic and illegal off-label sales of Zyprexa, a psychiatric drug.
The government found that Eli Lilly “created marketing materials promoting Zyprexa for off-label uses, trained its sales force to disregard the law, and directed its sales personnel to promote Zyprexa for off-label uses.” Investigators found that the company “expended significant resources” to promote unapproved uses of the drug “in nursing homes and assisted-living facilities.”
According to company documents, Lilly pressured doctors to prescribe the drug to elderly patients. Bloomberg News pointed out earlier this week that the company actually ghostwrote scholarly articles about its drugs and then asked doctors to sign their names to them, despite the fact that Lilly’s promotion of Zyprexa for dementia went against the findings of seven reputable medical studies.
In 2009, with Azar still leading lobbying efforts for Lilly, the century-old company settled criminal allegations related to Zyprexa. The company pleaded guilty to a misdemeanor criminal charge and agreed to pay a fine of $1.415 billion, a drop in the bucket considering Lilly sold more than $30 billion worth of Zyprexa during the period under investigation.
Eli Lilly spent $3.4 million lobbying Congress in the first quarter of this year. This is the corporate background of the man praised in the tweet by the president announcing his nomination as “a star for better health care and lower drug prices.”
If confirmed as HHS secretary, Azar would oversee Medicare, the government health insurance program for the elderly; Medicaid, the health insurance program for the poor, jointly administered by the federal government and states; the FDA and many other programs vital to the health and wellbeing of virtually every American.
Azar would also be tasked with implementing provisions of the Affordable Care Act (Obamacare), legislation that he has vocally opposed, describing it in an interview with Fox Business in May as “fundamentally broken” and “circling the drain.”
Asked in July about an Obamacare repeal bill then under discussion, he told Fox Business, “At the end of the day this is a hot potato that lands back in Secretary Price’s lap for him to use as many authorities as he has to grant flexibility and try and gets us out of the Obamacare mess as much as he can.”
Azar opposes the expansion of Medicaid under the ACA and said in an interview posted on zetemaproject.org that he believed the expansion had been unsuccessful and that he would have “much preferred that if we were expanding care to those unable to afford health care, we would have chosen vehicles that would actually harness the private sector.”
He would undoubtedly work actively with Centers for Medicare and Medicaid Services (CMS) head Seema Verma, who has announced that CMS will actively partner with states to impose work requirements and other restrictions on Medicaid recipients.
Verma recently told a meeting of the National Association of Medicaid Directors that Medicaid serving “working age, able-bodied adults does not make sense.” Trump and congressional Republicans want to fund Medicaid through block grants to the states, which would mark the beginning of the end of Medicaid as a guaranteed program based on need.
Senate Minority Leader Charles Schumer of New York said Azar’s confirmation process “will be a referendum on the Trump administration’s repeated efforts to sabotage our health care system and raise premiums on millions of Americans.” He added, however, that he was willing to give the long-time drug industry lobbyist and Medicaid opponent “a chance.”