Eric Hargan is about to get a demotion, and he is just fine with that.
The acting secretary of Health and Human Services is more than thrilled to go back to the position he originally held when President Trump tapped him to lead the agency after the former secretary, Tom Price, resigned over scrutiny of his travel revealed a taste for the excess.
“I was confirmed for my job as deputy secretary, and four days later, I was appointed to be the acting secretary,” he said of the agency whose duties include overseeing drug development, public health efforts, Obamacare, and food safety.
Once Alex Azar, the president’s new choice to run HHS, is confirmed, Hargan said he will happily go back to his original job.
Hargan spoke to the Washington Examiner as Azar faced his first Senate hearing Wednesday to succeed Price. Hargan has held the position since early October, but this is certainly not his first rodeo at HHS. From 2003 to 2007, he served here under former President George W. Bush.
Hargan is a man grounded in his Mound City family roots, a small southern Illinois town just across the Ohio River from Kentucky where his parents not only advocated a lifetime in public service, they led by example.
“I grew up on a farm, my father held different local elected offices from county commissioner to school board, and my mother worked in a variety of healthcare roles throughout her life; first at St. Mary’s hospital, which is no longer there, and then at the Cairo Community Health Clinic. All total, a career serving her community's healthcare that spanned 58 years,” he said.
It is a background that shaped his journey from a town of 700 to the center of power and wealth in America. And whether he is serving as acting secretary or deputy secretary, Hargan sees his role at HHS as one that digs deep to cut bureaucracy, roll back antiquated regulations, and mold the agency to become more accountable in its mission to serve public health.
He speaks about the need to address the opioid crisis, a widespread problem that has not only impacted his own small town, but also the cities and suburbs in between — on both coasts. “I have heard so many stories of parents whose children who live a pattern of overdoses, sometimes day after day. One of the things in the agency we want to do is to clarify that both doctors and hospitals can share that information with parents and family members when their loved ones are incapacitated or in immediate danger from an opioid overdose. It is an empowerment designed to assist the families and the neighborhoods and communities who are on the front lines of the epidemic,” he said.
Two days later, Hargan would appear before reporters at the White House to discuss Trump's decision to donate his third quarter salary to HHS in order to combat the opioid crisis. Hargan said the donation would be used for the planning and design of a large-scale public awareness campaign about the opioid addiction.
“His decision to donate his salary is a tribute to his compassion, to his patriotism and his sense of duty to the American people,” Hargan told the reporters.
Besides the opioid crisis, Hargan also discussed his mission to dismantle antiquated practices, move beyond Obamacare, and reshape HHS’s role in disaster relief.
WASHINGTON EXAMINER: In your role as acting secretary, do you plan on staying on once they have a secretary sworn in?
HARGAN: Oh yeah, absolutely. Actually, I signed up to be deputy secretary, and now I've got four days as deputy secretary before becoming acting secretary, which is a pretty quick runway. It's the short runway to becoming acting secretary, so I wasn't planning on this. I'm planning on going back to what I actually signed up for in the administration.
WASHINGTON EXAMINER: As deputy secretary, what is your role? Are you the person in charge of making the trains run and serve as the bridge with the White House?
HARGAN: So, you really are the chief operating officer, so everything from the budget process to the regulatory system here at the department, and sort of all of the operations in the department are traditionally under the deputy secretary. So, that's the normal role for what I've taken on. It is what I did as acting deputy secretary under President Bush at HHS, but now I'm the confirmed deputy secretary.
WASHINGTON EXAMINER: People look at HHS, and the first thing they think is healthcare. In this politicized world, the second thing they think is Obamacare. What is the actual role, for HHS, for the healthcare law?
HARGAN: Well, at HHS, like the rest of the executive branch, you have to faithfully execute the laws that are given to us by Congress. That's the ultimate role. So, the laws that we have to execute in our relationship to the [Affordable Care Act] or any other law is that we're supposed to faithfully execute it. Now, given how Congress drafts laws, there are parameters in there. So, we take direction from the president on down to try to figure out exactly how those laws are supposed to work at the level to make sure that we do the best that we can for the American people with regard to making sure that they get good healthcare and options on how they arrange their own healthcare themselves.
WASHINGTON EXAMINER: What role does HHS have in hurricane relief and disaster relief?
HARGAN: Within hurricane relief and disaster relief more generally, HHS has the function of dealing with healthcare. So, we really interact on all kinds of levels to make sure that the people have access to healthcare during hurricanes. And then during a period of response afterwards, which is kind of the more intense phase, where you're really dealing with people on the ground when they're themselves in disaster. Then recovery, which is a more long-term look. You're looking at dealing with people and their lives, in other words, trying to rescue them, make sure that they have access to doctors, medicines, facilities that they need to have in quick order, whether it's in temporary healthcare facilities or trying to make sure that the ones that are there become operational, and providing people with volunteers and all the stockpiles of pharmaceuticals and other material we have set up already.
We kind of pre-position; when we know disaster's coming, see a hurricane coming a long way away, you pre-position people, our responders, to wait out the storm. A certain number of them, plus a stockpile of material that we set aside. But you also can't put everything you have ahead of time, but you want to have some people on the ground who are able to work on hour one after a storm passes. Then, you're able to access all of the other things that the government is able to provide. So, all the stockpiled materials, all of the federal workers, and all of the amazing network of volunteers that raise their hand before we help train them, before and even after a disaster passes, who want to help out. So, we have people that are willing to really put their lives on hold for months at a time. Volunteers who leave hospital systems and private hospital systems, nonprofit, for profit, and raise their hand and say, "I want to help out with this disaster." And they do. I've met them, in Puerto Rico, and USVI [the U.S. Virgin Islands], people that are there, and they're not being paid by the federal government. They're there out of the good of their hearts to help people, to help their fellow Americans through the disaster response.
And in our system, we have people who rode out Irma, who rode out these disasters ahead of time, and it's a set of really magnificent people afterwards. I have to say when you see three massive hurricanes in a row — Harvey, Irma, and Maria — the fact that the system was able to handle three disasters in a row, really widespread disasters in a row, is a huge test to what the department has become. I was here under President Bush during the Katrina response. And a lot of good work was done then, but I don't know what would have happened if we had had three Katrinas in a row.
It was an amazing feat through planning and resilience, both on the part of the people responding and then the people who had been dealing with both the hurricanes and the consequences to them, as well. That's been great to see, from what I've seen on the ground, going to Puerto Rico and USVI. That itself was also astonishing, when you see what devastation has been brought down there. A lot of which, I think people on the mainland really don't understand how terrible the devastation has been. You can look at the pictures, but seeing it firsthand really brought it home.
WASHINGTON EXAMINER: Why do you think that Puerto Rico became such a political football?
HARGAN: Why did Puerto Rico become a political football?
WASHINGTON EXAMINER: Was there any difference in your response — do you feel that you, HHS, responded effectively?
HARGAN: I mean, when you look at how the response has been in substance, yes. I would say that that has been great. I mean, when I was in Puerto Rico, I heard nothing but praise from the people I met there on the ground from the health commissioner to the individuals. There was a great deal of high praise for the response that our people had put in place, so I was happy about that. I think what makes that situation unusual is that there's gonna be far more time of recovery in Puerto Rico than you would see otherwise. That may have some influence on the fact that there's more political things going on in this. I said that we're focused on what we always do, which is providing health, particularly healthcare and human services. I've seen that up close, and heard all the local people praising our people and the way that they responded, so that's all I can say about the political side of things.
WASHINGTON EXAMINER: Let's talk a little bit about regulation reform. What are some of the things you see as accomplishments this year for the agency? And has HHS done anything of impact on the average American’s pocketbook?
HARGAN: Well, a lot of the regulatory reform that the department has been doing so far has been part of a government-wide effort that has been taking place all the way across the board. If you look at the amount of net cost that we've imposed, [it] has been, I think, zero through six months. In terms of what we have been doing, there have been several different efforts here. The staff here at HHS knows in many cases that the regulations that they have been implementing are, in some cases, decades old, and they're out of date. We're giving them the opportunity to take a look again, a fresh look, at how they're affecting people at all points in the regulatory system. We're looking at how patients interact with us, how doctors interact with us, hospitals, product suppliers, because sometimes, when you're imposing regulations on people, you're affecting them, but you don't always know you're putting a patch in there. You don't realize that before you know it, somebody's dealing with 10 or 12 different regulations at the same time; they just have no idea how to comply. They've been imposed over periods of years or decades, and it's kind of encrusted the system.
You can't see it necessarily from the inside, so that's why we put out these RFIs [requests for information or ideas], and we put out a lot of them because we really want to let in new ideas. I mean, I look at it sometimes; it's like opening the doors of the greenhouse for a second. It's stuffy, and it's a hothouse, you let the doors open, and there's a little bit of fresh air that gets in and we need that inside the government. Sometimes, we're living with systems that are decades old. What I tell people, I say, "Would you want to be watching a 50 year old TV?" Right? Do you want one in your home? No.
We sometimes live with regulations, and the community healthcare sector lives with regulations that are that old. They're 50 years old, or older, and we don't allow that necessarily in other parts of our lives. We don't tend to drive cars with 50-year-old engines; we don't want to use a 50-year-old washing machine or watch a 50-year-old television set. But we're living with 50-year-old government processes.
An example from earlier this year, we got rid of the Y2K regulations this spring; these are regulations that had been sitting out there long after the requirements had been met. The fact that they were still out there is astonishing. They were technically a legal requirement. Anyone can take them seriously. This is an example of where people in various industries waste their time, whether in the government or outside of it, complying with something that directs resources to paperwork that is taking resources away from providing care and providing time to the patients. Allowing the people inside the government to work on what should be [a] higher focus, and not on complying with laws, statutes, regulations that are really outdated and processes that need to be reformed.
So, to give you an example, we have an agency here that has required, up until recently, people to submit electronically and by paper. They submit these giant files, hundreds of pages, thousands of pages, by paper and by electronically. What happens when the application comes in, they look at the electronic copy. But they take the paper copy, they don't do anything with it, they accept it, they file it, and sometime in the future, they destroy it. It is never seen; it's never used; if they want to look at that particular information, they look at it electronically. If they want to see it again, they don't go run around and try to find where they put that paper copy. They print it out again, right? Or they print out the pages that they want to see. So, why are we requiring the healthcare provider community to send in paper copies?
Now, that's a little thing, but it adds up. It's sort of root and branch, some of our agencies are taking. Every single regulation they have ever done, they are looking at it over and over again, and hopefully, sometimes it's gonna be cleaning things out. There are regulations that are no longer used, right? Does that have an effect? Maybe not, but at least it's some sort of process where we get rid of setting standards for things that don't even exist anymore.
All of this allows us to redirect resources from this useless amount of compliance, the time we spend and they spend on dealing with this and redirect it to providing resources and care to where it should be directed. When you look at it, we say we're giving billions of dollars to a hospital; they may be able to hire more nurses or doctors or buy more drugs, be able to provide more charity care. They are gonna be able to liberate those resources and put them where they're supposed to go. It's a benefit on jobs as well.
WASHINGTON EXAMINER: What is HHS’s role in the opioid crisis? And where is it in your priorities?
HARGAN: Well, you know, first of all, when the president gave the call right when he came into office, that opioids were gonna be a real priority, and we can see that this is real as well. Both on the side that we address on the licit side, meaning people getting prescriptions that maybe they shouldn't have, or shouldn't have gotten as many of them. And then, the illicit side, which is being able to treat people that have access [to] and use illegal drugs as well. We are really working on this as a public health emergency, and we've really redoubled our efforts to tackle it. We had our office of civil rights put on a clarification that means that families understand that they can actually hear from the doctors about what is going on with their family member. The doctors know they can communicate to families that their loved ones are suffering from overdoses and are incapacitated. Previously, people thought that our HIPAA law meant that they couldn't share that information. They thought that we'd prosecute them for it. So, the law said, "Nope. That's not a requirement of the law." That is then a misunderstanding that is longstanding, and on the part of doctors and hospitals, they thought, "We actually can't even tell the families about this problem." So, people would have their kids, their loved ones, die of overdoses, and never have known that this was a problem that [was] happening over and over again. The doctors knew, the hospitals knew; the families didn't know. That was not the legal requirement. We clarified that.
We're also working with the president's commission that Gov. [Chris] Christie put together. We're working on getting the response to that department-wide. The National Institutes of Health is working on developing public-private partnerships dealing with developing non-addictive painkillers on that front. FDA has renewed its focus on making sure that it works through approvals of new drug treatments that they can work on with industries. That's their particular area. SAMHSA [Substance Abuse and Mental Health Services Administration] is obviously in the spotlight for dealing with substance abuse and mental health. We have a clinician there who was previously [with] SAMHSA who is a real star in this area, and who is a fountain of knowledge. I think getting somebody in there who has such a wealth of knowledge and a lot of credibility, that's a good first step.
When the president tells us to focus, we focus, and we have a trillion-dollar plus department. Even us just shifting our focus a little bit — a lot can get done, if we're serious. I saw that under President Bush, when he took office. The president's emergency plan for AIDS relief, his particular passion in that for HIV/AIDS ended up, by all accounts, saving millions of lives in sub-Saharan Africa.
President Trump is focusing on the opioid crisis, again, like the AIDS crisis in Africa; the opioids crisis in the U.S. is a real crisis. It has rolled on from where I grew up to everywhere now. It crosses all demographics, all races, and all socioeconomic backgrounds. It is the crisis of our time and one we are laser-focused on.