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Meet Alex Azar, Trump’s secretary of Health and Human Services pick. President Trump on Monday announced he was picking Alex Azar to replace Tom Price as the head of the Department of Health and Human Services. Azar brings a blend of government and corporate experience. He served four four years as general counsel (2001-2005) and two years as deputy secretary (2005-2007) of HHS during the Bush administration and, until recently, served as president of drugmaker Eli Lilly’s U.S. operations. So he’ll bring a lot more management and HHS-specific experience than his predecessor. Yet Azar’s views on healthcare policy were not as clearly spelled out as Price, who prior to joining the administration spent years in Congress as a critic of Obamacare who had authored a plan to replace the law. However, in speeches and interviews, particularly during the healthcare debate, Azar came across as a critic of Obamacare and a supporter of efforts to repeal the law.

Azar called Obamacare ‘fundamentally broken,’ blasted CBO healthcare estimates as ‘notoriously bad,’ and said he wished GOP Senate bill hadn’t kept so many of Obamacare’s taxes. The nominee was a frequent guest on Fox Business during the healthcare debate, and his appearances provide us with a window into his thinking. In one appearance in May, Azar said, “There's actually fairly few levers that the government can do at this point to try and stabilize this fundamentally broken system. One thing that you could do would basically provide reinsurance money to insurance companies to tempt them to stay in. But I don't think there's going to be a lot of appetite for doing that either in the Trump administration or up on Congress." At the time, he said the House-passed GOP healthcare bill still amounted to “a large wealth transfer to individuals to help people be able to afford insurance. This Medicaid reform in the House bill may be the largest single entitlement reform in history. But let's remember, all it does is slow the rate of predicted growth of Medicaid. Only in Washington is a cut slowing growth." In July, as the healthcare bill was facing a vote in the Senate, Azar critiqued the Congressional Budget Office, complaining that the group’s economists were “miles off” in their Obamacare projections. "CBO is notoriously bad at predicting the dynamics of the insurance market,” he said. “They have never gotten it right. They do a fine job as normal economists. But when United Healthcare, Aetna, Anthem. When they can't even predict their risk pool, their enrollment levels for the coming year in Obamacare, how the devil do we think that a bunch of health economists in Washington, in the government are going to a better job than them 10 years out?” He pushed back against Sen. Rand Paul’s description of the GOP Senate bill’s payments to the states as a “bailout” to insurers, but he did say that Paul was "a good clarion voice on the Right to help keep the debate honest." He wouldn’t directly answer whether he would vote for the Senate bill, saying it was probably better than the status quo, but that he would want to make a number of changes and mentioned he was particularly “disappointed” that the bill kept so many of Obamacare’s taxes.

Azar worked for Ken Starr’s Whitewater investigation and clerked for Antonin Scalia. In addition to his time at HHS, Azar spent the earlier part of his career deeply entrenched in the conservative legal establishment. After graduating from Yale Law School in 1991, Azar clerked for conservative U.S. appellate judge Michael Luttig and then for the late Supreme Court Justice Antonin Scalia. Following that, he worked under independent counsel Ken Starr on the Whitewater investigation. He became involved in the Bush-Cheney 2000 campaign, which eventually led to his first job at HHS in 2001.    

Welcome to Philip Klein’s Daily on Healthcare, compiled by Washington Examiner Managing Editor Philip Klein (@philipaklein), Senior Healthcare Writer Kimberly Leonard (@LeonardKL) and Healthcare Reporter Robert King (@rking_19).  Email for tips, suggestions, calendar items and anything else. If a friend sent this to you and you’d like to sign up, click here. If signing up doesn’t work, shoot us an email and we’ll add you to our list.

Trump calls for individual mandate repeal in tax reform, again. Trump on Monday urged congressional Republicans to kill Obamacare's "unfair and highly unpopular" individual mandate in tax reform legislation that the House could vote on as early as this week. "I am proud of the [Republican] House and Senate for working so hard on cutting taxes (and reform)," Trump tweeted Monday morning, a day before he returns from his 12-day trip to Asia. "Now, how about ending the unfair and highly unpopular individual mandate in [Obamacare] and reducing taxes even further?" he continued. "Cut the top rate to 35 percent [with] all of the rest going to middle income cuts?" The president's tweet comes days after the Senate Finance Committee released its own tax reform proposal, which sets the top individual tax rate at 38.5 percent and does not include a repeal of the individual mandate.

Ron Johnson urges end of 'failed' Obamacare program. A little-known Obamacare program intended to create competition on the exchanges is falling short, leading a Republican senator to ask a federal agency why it is still devoting funding and manpower to it. The Affordable Care Act created the Multi-State Plan Program to drive competition on the law’s exchanges, but only one state — Arkansas — is participating in the program next year. Sen. Ron Johnson, R-Wis., said he is concerned about wasting the manpower of 42 federal employees on the program, which gets $10 million a year. “It has utterly failed, so let's just put a stake in it, save the money and put the human resources to better use,” Johnson told the Washington Examiner. He wrote in a Nov. 6 letter to OPM that the agency asked for more funding for the program, which appears to be a "drain on OPM's finite resources."

Supreme Court to hear challenge to California law requiring clinics to explain abortion options. The Supreme Court on Monday decided to hear a case challenging a California law that requires pregnancy clinics to provide patients with information about abortion options. Religious nonprofit groups with anti-abortion views sued California to prevent the law from taking effect, but the 9th Circuit Court of Appeals rejected the organizations' October 2016 motion to block the law. The National Institute of Family and Life Advocates, one of the organizations that sued, petitioned the U.S. Supreme Court to hear its challenge. NIFLA argued that the law "forces licensed pro-life medical centers to post notices informing women how to contact the state at a particular phone number for information on how to obtain state-funded abortions, directly contradicting the centers' pro-life message." In its decision to hear the case, the Supreme Court said it would look to resolve the question of whether the California law's requirements violate the First Amendment’s protection of free speech.

Army to expand mental health waivers for new recruits. The Army will allow people with a history of some mental health problems to seek waivers to join the service. The Army enacted a new policy in August that expanded waivers to potential recruits with a history of drug and alcohol abuse, “self-mutilation,” depression, and bipolar disorder, according to USA Today. Lt. Col. Randy Taylor, a spokesman for the Army, told USA Today the Army decided to expand the waivers because of increased access to medical information for potential recruits. A ban on waivers was issued by the Army in 2009 after suicides among troops spiked. The Army faces a goal of recruiting 80,000 new soldiers by September. Last year, the Army had a goal of 69,000 new recruits, which it met by accepting people who didn’t perform well on aptitude tests and by offering hundreds of millions of dollars in bonuses. The Army also increased the number of waivers it granted for marijuana use, according to USA Today.

Azar’s links to Scalia, conservative judge please anti-abortion group. Azar got some initial praise Monday morning from the anti-abortion group Students for Life of America. The group was happy that Azar clerked for conservative icon and Supreme Court Justice Antonin Scalia and for former appellate court Judge J. Michael Luttig, who is now general counsel for Boeing. “We hope that day one, Alex Azar begins to restore life-affirming care to our healthcare system, rather than abusing people’s consciences and wallets in service of Planned Parenthood and its allies,” said President Kristan Hawkins.

John Kasich befuddled over GOP objections to Alexander-Murray. Opposition from some Republicans to the bipartisan Obamacare stabilization plan from Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., has flummoxed Ohio’s Republican Gov. John Kasich. The plan to make insurer payments for two years in exchange for state flexibility from the law’s regulations has stalled in the Senate because of opposition from Trump and House Speaker Paul Ryan. Kasich lauded the plan’s objectives. “It reduces the deficit slightly and it takes no one off healthcare and it stabilizes the market and they say that’s not a good plan,” he said on ABC’s “This Week Sunday.” “What is it they want?” Host Martha Raddatz asked Kasich if the Tuesday gubernatorial election in Virginia and Maine state ballot that approved Medicaid was a message to Washington about rushing toward attempting Obamacare repeal again. “I hope Republicans will hear it,” he said. Republicans have labeled the insurer payments a “bailout” even though they reimburse insurers for lowering co-pays and deductibles for low-income Obamacare customers, which is required under the law.

Five states seek to halt Trump's rollback of birth control mandate. Five states are going to court to try to preserve an Obamacare mandate that forces employers and insurance plans to offer free birth control. California, Delaware, Maryland, New York and Virginia late Thursday filed a request for a preliminary injunction to stop federal regulations that weaken Obamacare’s birth control mandate. California had sued to stop the rollback after it was announced by the Trump administration in early October. “These backwards rules will deny millions of women across the U.S. access to healthcare, unconstitutionally permitting discrimination against women,” California Attorney General Xavier Becerra said Thursday about the new court filing.

West Virginia sets deadline for ending children's insurance program. West Virginia will end its Children Health Insurance Program by Feb. 28 if Congress doesn’t approve funding for the nationwide program. The state board that runs CHIP voted Thursday to end the program on that date since Congress has not reached an agreement on funding. Other states are also expected to run out of funding in early 2018, and some estimates show states could run out of funds as early as next month. The board said in a statement that if Congress approves funding, it will meet to rescind the closure plan and the program to fund insurance for low-income kids will continue. Some lawmakers have suggested that CHIP funding could be put in an end-of-year spending deal to fund the government. Government funding expires Dec. 8.

Mike Pence: Veterans Affairs 'more efficient, effective and accountable' under Trump. Vice President Mike Pence lauded the administration's handling of the Department of Veterans Affairs, saying that under Trump, the agency has grown more accountable and has expanded healthcare access. Speaking Saturday at Arlington National Cemetery in Arlington, Va., to mark Veterans Day, Pence said that Trump is keeping his promises to veterans. Pence said Trump has cleaned up inefficiencies caused by mismanagement and personnel issues at the department. "This president has taken decisive action to end a pattern of neglect and treatment at the VA," he said. "We’ve already fired or suspended over 1,500 V.A. employees for negligent behavior."

Democrats question Trump administration about 'Jane Doe' abortion case. Democratic senators admonished the Trump administration Friday for blocking a teenage girl who was in the country illegally from having an abortion and asked for a briefing on the policies around such decisions from for Office of Refugee Resettlement, the agency that oversaw the teen's care.

In a letter, the senators accused the agency of "failing at this mission by denying access to legal healthcare, undermining privacy, denying access to attorneys, and potentially identifying sponsors in violation of the law." They asked for documentation about the agency's policies on medical care, including abortion and contraception, and information about disclosing pregnancy or abortions to a minor's parent. They also asked for documents about how the agency selects counselors for minors who are seeking abortions.


NBC News E-cigarettes: The dangers and health risks of vaping

The Hill Record Obamacare sign-up drive enters third week

STAT News This insurer does not play by Obamacare’s rules, and the GOP sees it as the future

Washington Post The Trump appointee you’ve never heard of who’s reshaping healthcare

New York Times Trump administration guiding health shoppers to agents paid by insurers

Politico Price investigation continues to roil HHS

NPR Brain scientists look beyond opioids to conquer pain

Axios More people are choosing the cheapest and most expensive ACA plans


MONDAY | Nov. 13

Nov. 11-14. Sydney. Society for Neuroscience international conference on Frontotemporal Dementia. Details.

Nov. 13-15. Crystal Gateway Marriott. National Alliance of Healthcare Purchaser Coalition. Details.

3 p.m. 2075 Rayburn. Congressional briefing on “Tackling the Opioid Epidemic and its Hidden Casualties: Local Health Departments on the Frontlines.” Details.

TUESDAY | Nov. 14

8 a.m. Charlie Palmer Steak. 10 Constitution Ave. RealClearPolitics event on “Examining the Pharmaceutical Supply Chain: From Production to Patient.” Details.

10 a.m. 430 Dirksen. Health, Education, Labor and Pensions Committee hearing on “Gene Editing Technology: Innovation and Impact. Details.

5 p.m. Ajax. 1011 4th St. NW. Politico event on “Emerging Healthcare Leaders.” Details.


8:30 a.m. Ritz-Carlton. 1150 22nd St NW. Friends of Cancer Research annual meeting. Details.

10 a.m. 430 Dirksen. Senate Health, Education, Labor and Pensions Committee hearing on “Encouraging Healthy Communities: Perspective from the Surgeon General.” Details.

2 p.m. 1225 I St. NW.. Bipartisan Policy Center announces “My Healthy Weight” initiative. Details.

3:30 p.m. House Capitol Room 8. Capitol Hill briefing on maternal mortality held by ACOG, the Preeclampsia Foundation, the Society for Maternal-Fetal Medicine, and the March of Dimes in cooperation with Reps. Jaime Herrera Beutler and Lucille Roybal-Allard, co-chairmen of the Congressional Caucus on Maternity Care.

THURSDAY | Nov. 16

Nov. 16-17. National Academies of Sciences, Engineering and Medicine colloquium on the Science of Science Communication. Details.

8 a.m. Boston. Opioid Insights for Action Day at the OptumLabs. Details.

8 a.m. 1777 F St. NW. The Hill event on “Preparing for a Treatment: Managing and Delivering an Alzheimer’s Breakthrough.” Details.

MONDAY | Nov. 20

9 a.m. 1789 Massachusetts Ave. NW. American Enterprise Institute event on “The future of delivery system reform.” Details.