THE PROGNOSIS

Talk to those who know Alex Azar, and you’ll hear about a man who loves to read presidential biographies, spend his free time with his wife and two teenage kids and visit his mom on Maryland’s Eastern Shore.

He’s a lawyer who did a stint in the federal government before joining the drug industry, and has never held political office — a decided contrast to former Department of Health and Human Services Secretary Tom Price, whom President Trump has nominated Azar to replace.

A former Eli Lilly and Co. senior executive before becoming a private consultant in January, Azar is no political fireball, his former co-workers say. They describe him as a tempered, cerebral sort, who initially comes across as quite serious but has a sense of humor underneath. Yet Azar could soon be leading perhaps the most politically charged of all the federal departments, after Trump announced (or rather, tweeted) yesterday that Azar is his pick to head HHS.

“He’s not the kind of guy who is going to be stirring up trouble,” says Tom Scully, who worked with Azar while the two served at HHS in the early 2000s. “He was always willing to admit what he did not know — he’s a very good listener.”

If the Senate confirms Azar, he would take the helm at HHS just as the agency is leaning into dozens of rule changes and waiver requests that could dramatically reshape state Medicaid and Medicare payment programs to lower U.S. health-care spending — and, of course, how the Affordable Care Act is carried out under an administration that is antagonistic to it.

To get a better sense of how Azar may approach his role – and what kind of a person he is -- I chatted with several lawyers and policy folks who worked with Azar at HHS a decade and a half ago under President George W. Bush. Azar first served as general counsel and later as deputy secretary in that department.

Here are some takeaways about what Azar might bring to the job:

1. He knows HHS really, really well.

In his former role as chief counsel and then the department's second-in-command, Azar dealt with issues arising across HHS – a sprawling department encompassing the Centers for Medicare and Medicaid Services, FDA, CDC, NIH and more – so he would come to the job with a lot of internal expertise at his fingertips.

Tom Barker, who was Azar’s deputy in the general counsel’s office, recalled weekly Thursday meetings with Mark McClellan, CMS administrator at the time, where they would discuss goings-on at the agency. Azar did the same with the other department heads as well, Barker said.

Those who know Azar also say he appreciates the career employees, a group that often feels marginalized by the political appointees who can cut them out of important decisions. Azar wouldn’t “roll over the recommendation of the career staff based on a political philosophy,” Barker told me.

“I know the careers in the office of general counsel loved working with Alex,” Barker said.

Over the course of Azar’s six years at HHS, his two biggest projects included helping with the Bush administration’s response to the Sept. 11, 2001, terrorist attacks and rolling out the Medicare Part D prescription drug program. Bob Wood, who served as chief of staff to former HHS secretary Tommy Thompson, said Azar was at the “forefront” of both efforts.

“He has such a personal knowledge and understanding of the whole department, ranging from FDA to CMS to the office of global health,” Wood said. “It will be a huge advantage for him to hit the ground running.”

2. He’s a lawyer — and acts like one.

Azar is a Yale Law School graduate who once clerked for conservative Supreme Court Justice Antonin Scalia. Colleagues say he fits the lawyer stereotype — serious-minded and to the point. Peter Urbanowicz, who also worked in the general counsel’s office, recalls that Azar pushed strict adherence to text, perhaps a reflection of his time working for Scalia.

Urbanowicz recalls Azar asking him early on how well he understood the Administrative Procedures Act, which is the federal statute governing how agencies propose regulations.

“He said, ‘You’re going to become the world’s expert on the APA, because we’re going to adhere to that scrupulously,’ ” Urbanowicz said.

Barker describes Azar as “no-nonsense.” He recounted a humorous episode where lawyers from an outside firm started explaining the doctrine of preemption — a legal concept that says federal law trumps state law — to Azar during a meeting about regulating drugs under the federal Food, Drug and Cosmetics Act.

“They came in and started talking to Alex like he was a high school junior,” Barker said. “Alex just looked at them and cut them off and said, ‘I’m familiar with the doctrine of preemption.’ ”

“I think he was mad because it wasn’t just like his time was being wasted — he felt like he was being talked down to,” Barker added.

3. He’s not one to make trouble.

Azar’s colleagues described him as someone who is conservative in his personal beliefs, yet reserved in expressing them. He’s quick to listen, they say. And he doesn’t come across as bent on pushing a solely political agenda.

“I think Tom Price had a lot of strong opinions,” Scully told me. “My guess is Alex will be much more reserved in his personal opinions.”

Barker described his relationship with Azar as one of friendship, even though Azar was also his boss for a time. The two would often eat lunch together in the now-closed Humphrey Building’s cafeteria (Azar would usually bring a lunch from home, Barker recalls). Azar loved biographies; the two read Ron Chernow’s “Alexander Hamilton” on which the Broadway musical is baded and “This Glorious Struggle: George Washington’s Revolutionary War Letters” about the same time.

He’s the smartest person I’ve ever worked for,” Barker said. “In terms of how he will serve as secretary, Alex is very pragmatic, and I think that is the way he will be as secretary of HHS.”

Azar got some surprisingly kind words from Andy Slavitt, former CMS acting administrator under Obama, who said he has "reason to hope" Azar would make a good HHS secretary:

And some predictable praise from House Speaker Paul Ryan (R-Wis.):

Marjorie Dannenfelser, president of antiabortion group Susan B. Anthony List:

But many Democrats and liberals noted that, until recently, Azar worked for Eli Lilly, saying that Trump's selection of him draws the president's commitment to lowering drug prices into question. Sen. Bernie Sanders (I-Vt.):

--Indeed, Azar presided over Lilly as the pharmaceutical company repeatedly raised the prices of its drugs, doubling the U.S. list price of its top-selling insulin over the five years he served as a company president, my colleague Carolyn Y. Johnson reports. U.S. list price of Lilly's Humalog insulin more than doubled, from $123 per vial in January 2012 to $255 per vial when Azar left the company in early 2017. Lilly, along with other insulin makers, was hit by a class-action lawsuit alleging overpricing of insulin earlier this year.

Azar joined Lilly in 2007 as a senior vice president of global corporate affairs and communications, but by 2012 headed the company's largest affiliate, Lilly USA, in 2012, Carolyn reports. His responsibilities included direction of the sales and marketing operations of the entire U.S. commercial business.

“Alex had a successful career at Lilly, and we wish him the best in his future work,” Lilly spokesman Greg Kueterman said in an email.

Supporters argue that Azar's understanding of the complicated dynamics behind pharmaceuticals pricing gives him an advantage in figuring out how to make drugs more affordable But critics argue Azar's background makes him particularly ill-suited to focus on more affordable medicines. 

From International Business Times's David Sirota:

CBS News's Mark Knoller:

Author Steve Silberman:

NBC News's Mike Memoli:

House Minority Leader Nancy Pelosi (D-Calif.):

Statement from top Senate Democrat Chuck Schumer, via ABC's Evan McMurry:

AHH, OOF and OUCH

--Billionaire Bill Gates is giving $50 million out of his own pocket to help treat Alzheimer's disease, an illness he says has struck members of his own family.

“It’s a terrible disease that devastates both those who have it and their loved ones,” Gates wrote yesterday on his blog, announcing his donation to the Dementia Discovery Fund, a private-public partnership researching treatment for Alzheimer's.

“This is something I know a lot about, because men in my family have suffered from Alzheimer’s. I know how awful it is to watch people you love struggle as the disease robs them of their mental capacity, and there is nothing you can do about it. It feels a lot like you’re experiencing a gradual death of the person that you knew."

The Alzheimer’s Association reports that the disease is currently the sixth leading cause of death in the United States.

Gates told CNN that a cure was “probably setting a high bar,” saying that “any type of treatment would be a huge advance from where we are today.”

OOF: Yesterday, the jury considering bribery charges against Sen. Bob Menendez told the judge on the first day of deliberations that they couldn't agree on a verdict -- and the judge told them to go home, eat a good meal, rest and try against tomorrow, our colleague Devlin Barrett reports. The New Jersey Democrat is accused of corrupt bargaining with Florida eye doctor Salomon Melgen, who allegedly gave Menendez gifts such as a luxury hotel stay, private flights and hundreds of thousands of campaign donations in return for the senator negotiating on his behalf on various government matters.

“As of 2 p.m., on behalf of all the jurors, we cannot reach a unanimous decision on any of the charges,” the jury wrote in a note to Judge William Walls. “Is there any additional guidance? And what do we do now?”

Walls chose to send the jury home an hour early and asked it to continue deliberations this morning. Last week, a female juror excused for a long-planned vacation predicted the trial would end in a hung jury and said she felt Menendez was not guilty. “What I saw, the government didn’t give me enough. So I think the defense showed me enough to say he’s not guilty on every count,” Juror No. 8, Evelyn Arroyo-Maultsby, said as she left the courthouse.

OUCH: The explosion of dating sites and apps like Tinder, Grindr and OkCupid may be connected to a rise in sexually transmitted disease nationwide, but the companies don’t want to be involved in STD prevention or acknowledge their roles in public health, Vox’s Julia Belluz writes.

In 2015, a report from health officials in Rhode Island first attributed an increase in STDs to high-risk behaviors such as the use of online dating sites “to arrange casual and often anonymous sexual encounters,” Julia writes. And since, STD statistics have gotten even worse. There were more than 2 million cases of chlamydia, gonorrhea, and syphilis reported nationwide last year, per a September CDC report, the highest cumulative number ever recorded.

So what’s with the silence? The dating apps are "hesitant to support sexual health,” Jeffrey Klausner, a professor of medicine and STD researcher at UCLA, told Vox. “They realize that their sites could be stigmatized for being associated with STDs. They do as little as possible.”

Michael Weinstein, the president of the AIDS Healthcare Foundation, compared these dating apps "digital bathhouses." He told Vox they've made it easier for the spread of disease transmission “because these are closed pools of people in limited geographies." That's why he's urging the online companies to work on collecting data about STDs, self-testing, partner notification, and condom promotion, Julia writes.

TRUMP TEMPERATURE

--Trump's been pressuring Congress to include repeal of the ACA's individual mandate in the tax overhaul bills, and is reportedly sitting on a potential executive order to weaken it. Yesterday, the president kept pouring the pressure on lawmakers, with a tweet, naturally:

 

--Our colleagues Damian Paletta and Mike DeBonis report that Trump will head to the House on Thursday to make his case after returing today from his Asia swing. But they note the repeated call from the president has been "mostly ignored so far by congressional leaders as they try to hold together a fragile coalition of Republicans who can help push these bills into law."

The Congressional Budget Office has said that repealing the ACA’s individual mandate, which penalizes people for not having health insurance, would save more than $300 billion, which Trump suggests using to cut taxes even further. House Ways and Means Committee Chair Rep. Kevin Brady (R-Tex.) said Trump’s idea “remains under consideration.” “The president has already indicated to me a number of times that he’s really interested in including the individual mandate repeal,” Brady said, per the New York Times.

Trump's tweet comes during a crucial time in the tax cut debate, Mike and Damian report. The House is hoping to pass its bill by the end of this week, while the Senate Finance Committee began voting on its own version yesterday.

PRICE CHECK

--Price is gone, but the investigations aren't over. HHS's inspector general will look into who authorized the former secretary's use of chartered jets on at least 26 trips from May to September, Politico reports.

“The investigation, along with escalating demands from Congress for information on how Price obtained permission to use at least $400,000 of taxpayer money for the private jets, adds an extra dose of uncertainty to a department that’s already roiled by questions of who will replace Price, and internal feuds over who may have leaked information about Price’s travels, according to current and former HHS officials,” Rachana Pradhan and Dan Diamond write.

The report was published just hours before Azar was named as Trump’s pick to replace Price.

Rachana and Dan also note that the probe could bring attention to John Bardis, the HHS assistant secretary of administration, who is tasked with overseeing travel approval in the department along with the general counsel’s office. Bardis still works for HHS.

HEALTH ON THE HILL

-- Sen. Rand Paul (R-Ky.) returned to Washington yesterday, more than a week after he suffered six broken ribs while being attacked in the yard of his Kentucky home. He tweeted this:

 

--Here’s how our colleagues Ed O’Keefe and Paul Kane described Paul’s return to Capitol Hill: “Accompanied by two aides, the senator had no obvious scars or bruises but was clenched in pain as he walked. An aide attempted to deflect reporters as Paul quietly explained that he’s still struggling to breathe as his ribs heal. He even waved off and politely declined a friendly handshake from Sen. Marco Rubio (R-Fla.) — one of his 2016 presidential campaign opponents — not out of spite, but because he said it might be too painful.”

Paul’s chief strategist Doug Stafford told Politico last week that the senator’s injury had left him in considerable pain. “This type of injury is also accompanied by severe pain that can last weeks to months,” Stafford said.

But Paul did nothing to quiet confusion about the details of what happened between him and his neighbor. The senator, citing the ongoing case against his attacker, said he would not discuss what may have been behind the attack. In what was initially described as a “minor” incident, Paul’s 59-year-old neighbor Rene Boucher tackled the senator at his home in Bowling Green, Ky on Nov. 3. Boucher pleaded not guilty on Thursday on a one-count charge of fourth-degree assault.

The president weighed in on Monday evening:

REPRODUCTIVE WARS

— Can a state require a “crisis pregnancy center” — which counsels women against getting an abortion — to also tell patients that subsidized contraception and abortions are available? That is a highly controversial question the Supreme Court will consider next year, as one of three cases it will take up involving First Amendment concerns about free speech, The Post's Robert Barnes reports.

Several of these centers have sued California over a state law requiring them to disclose whether they have medical personnel on staff and to inform women that the state offers financial assistance for birth control and abortions. “The California case promises to be a high-profile conflict that raises important free speech issues about when a state’s intent to regulate the medical profession violates constitutional protections,” Robert writes.

The U.S. Court of Appeals for the 9th Circuit upheld the law, saying the state could regulate professional speech and had a valid interest in safeguarding public health, but the centers argue that they're targeted because their message is unpopular with the state’s leaders.

“The state, rather than using countless alternative ways to communicate its message, including its own powerful voice, instead compels only licensed facilities that help women consider alternatives to abortion to express the government’s message regarding how to obtain abortions paid for by the state,” says the petition filed by the National Institute of Family and Life Advocates.

Abortion rights groups are arguing these crisis pregnancy centers are misleading women by withholding some information from them:

ThinkProgress's Ian Millhiser:

SECOND OPINION

--Your voices: During these six weeks of open enrollment on Healthcare.gov and state-run marketplaces, we're featuring a daily reader letter in this section. Please share what you experienced while signing up for coverage; we'd love to feature your story! Here is today's: 

"My wife and I are both diehard leftists–while I would prefer single-payer, I love that Obamacare has expanded access. In fact, last year, I qualified for an Obamacare subsidy and was actually pretty happy with the coverage I was getting for about $70 per month. Fast forward one year, and things are very different. We moved to Chicago, finished school, and have entered a very different period of our lives. Together, student loans are costing us almost $600 a month. I got a new job that doesn't pay great, but it's livable. The company offers health insurance, but they only subsidize the cost for me. My wife is an archaeology technician, and so her jobs are often short-term (and thus don’t offer health care).

"We hoped Obamacare would keep her insured, especially since she turns 26 this year and isn't eligible to stay on her mom’s plan. After filling out the Healthcare.gov application, we were shocked that the cheapest plan was $250 a month with a $7,000 deductible that barely covered anything, even after the deductible was reached. Moreover, none of the plans offered even covered the specific medication she needs ... Why would we pay almost $400 per month when the plans don't even cover what we need? Since we’re making more money than we did when we were students, Obamacare subsidies are out of reach. Even with 'more' money, we’re still broke. We figure we will try and pay for the medication out-of-pocket, because insurance is apparently a luxury that we can’t afford. It’s been pretty upsetting. I feel like it shouldn't be this expensive."      --William Ratliff, Aurora, Ill.

A few more choice reads from The Post and across the World Wide Web:

The vice president is driving a White House agenda dominated by the conservative, anti-regulatory policies he embraced as Indiana governor.
Politico
Americans who won scientific and economic honors won’t meet Trump, Pence when in Washington this week.
Anne Gearan
MEDICAL MISSIVES
Mexican traffickers are trying to turn the city into a distribution hub for the deadly drug.
Nick Miroff
The medicine, an antipsychotic drug, has a sensor that will show doctors whether and when patients are taking it. Other medicines will follow, experts say.
New York Times
About half of adults in the U.S. will be considered hypertensive under the new guidelines, compared to a third now.
Lenny Bernstein and Ariana Eunjung Cha
Experts expect 1.2 million more jobs for home health and personal care aides by 2026
Danielle Paquette
STATE SCAN
Is Tennessee Farm Bureau the type of insurer that creates chaos in the market, or is it the solution to Obamacare's ills?
STAT News
Taxpayers in many red states have effectively been sending money to other states for Medicaid expansion, which can be used to pay for things like opioid treatment.
New York Times
DAYBOOK

Today

  • NIHCM Foundation holds an event on stabilizing hte individual health insurance market.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on gene editing technology. 
  • The House Oversight Subcommittee on healthcare, benefits, and administrative rules and subcommittee on intergovernmental affairs holds a hearing.
  • RealClearPolitics holds an event on examining the pharmaceutical supply chain.

Coming Up

  • Advocates for Opioid Recovery & Collaborative for Effective Prescription Opioid Policies hold an event on Wednesday.
  • The Cato Institute holds an event on liberating telemedicine with Sen. Brian Schatz (D-Hawaii) on Wednesday.
  • The Senate Health Education, Labor and Pensions Committee holds a hearing with Surgeon General Jerome Adams on Wednesday.
SUGAR RUSH

Have high blood pressure? Here's what you need to know:

Here are President Trump's top five false or misleading claims:

 

An effigy of President Trump was burned in Manila during a protest against his visit to the Philippines for the ASEAN summit:

Watch Stephen Colbert chat with former vice president Joe Biden:

Trevor Noah on the sexual misconduct allegations against Roy Moore: