Trump Pick For HHS Secretary Grew Up On Maryland's Eastern Shore

SALISBURY, MD — President Donald Trump chose former top pharmaceutical and government executive Alex Azar II — a native of Maryland's Eastern Shore whose father is a longtime ophthalmologist in Salisbury — to replace Tom Price as secretary of the U.S. Department of Health and Human Services. Price resigned in September amid controversy over his use of private jets.

Azar, 50, who Trump picked on Monday, would oversee a $1 trillion department that's responsible for major health insurance programs, medical research, food and drug safety, and public health. A lawyer by training, Azar has spent most of the last decade with pharmaceutical giant Eli Lilly, rising to president of its key U.S. affiliate before leaving in January to start his own consulting firm. He's seen as an expert on government health care regulation.

HHS secretaries tend to be elected officials, leaders in academia and medicine or top executive branch managers. They rarely hail from industries regulated by the department.

"He will be a star for better healthcare and lower drug prices!" Trump tweeted in announcing the nomination Monday morning. Trump has a track record of making industry-friendly nominations, such as tapping former ExxonMobil CEO Rex Tillerson as secretary of state and billionaire businessman Wilbur Ross as secretary of commerce.

But Trump also has been a scathing critic of the pharmaceutical industry, both as a candidate and as president.

As secretary, Azar would be returning to HHS after serving in senior department posts in the George W. Bush administration. Now he'd have to scrupulously avoid conflicts with Lilly's far-reaching interests, from drug approval to Medicare reimbursement. The drugmaker has drawn criticism from patient advocacy groups for price increases to one of its biggest products: insulin.

Azar earned his bachelor's degree in government and economics from Dartmouth, then graduated from Yale Law School, and clerked for the late Justice Antonin Scalia, then an appeals court judge. He also worked for special prosecutor Ken Starr in the early years of the Whitewater investigation into President Bill Clinton. In an interview last year with theDaily Times, Azar said he tries to visit his family in the area several times a year. He's still a member of his church in Bishopville.

“Salisbury is very much in my bones,” Azar told the newspaper. “I still feel very connected.”

Azar's nominations to HHS in the Bush era sailed through the Senate. This time, he'll face Democrats wary of the administration's unyielding quest to repeal the Affordable Care Act. Americans consistently rank the high cost of prescription drugs as one of their top health care priorities, putting it ahead of divisive issues like repealing "Obamacare" in public opinion polls.

Trump has been a sharp critic of the industry. "The drug companies, frankly, are getting away with murder," he said at a Cabinet meeting this fall. Prices are "out of control" and "have gone through the roof," Trump said.

In the spring, a Trump tweet sent drug stocks tumbling after the president said he was working on a new system that would foster competition and lead to much lower prices. In meetings with industry executives, however, Trump has focused on speeding up drug approvals, a cost-reducing tactic they would back.

Professionally, Azar has another set of skills that may be valuable to the president. In his previous service at HHS, he developed an insider's familiarity with the complex world of federal health care regulation, serving first as the department's chief lawyer and later as deputy secretary.

Frustrated by fruitless efforts to overturn the Obama-era health law in Congress, Trump might see the regulatory route as his best chance to make a mark on health care.

Congressional Democrats are likely to pounce on Azar's drug ties, reminding Trump of his promise to "drain the swamp" of Washington influence peddling. Supporters say Azar's drug industry experience should be considered an asset, not a liability.

"To the extent that the Trump administration has talked about lowering drug prices, here's a guy who understands how it works," said Tevi Troy, who served with Azar in the Bush administration and now leads the American Health Policy Institute, a think tank focused on employer health insurance.

The Associated Press contributed to this report.

Photo credit: Evan Vucci/Associated Press