Updated at 1:48 p.m. ET
President Trump is nominating a former pharmaceutical executive to lead the Department of Health and Human Services, the agency that, among other things, regulates prescription drugs.
The nomination comes at a time when rising drug prices have become a hot political issue.
On Twitter on Monday, Trump announced the nomination of Alex Azar, who until January had served as president of the U.S. arm of Eli Lilly & Co., based in Indianapolis. He said Azar, whose own Twitter feed is private, would be "a star for better healthcare and lower drug prices."
Azar, who served as deputy HHS secretary under President George W. Bush, is known as a detail-oriented bureaucrat who understands how to work the regulatory system to get things done.
"He's precise, highly motivated, he has high standards for performance for himself and for other people," said Mike Leavitt, who was HHS secretary when Azar was deputy. "He had full responsibility as deputy secretary for the regulatory processes at HHS."
Leavitt says Azar is likely to use that knowledge to alter the Affordable Care Act, or Obamacare, to make it more friendly to Republican ideals. Azar, he says, can work to "change the ideology under which the existing law is implemented."
"That's the place where they have essential unilateral authority, if they follow the administrative rules act," Leavitt told Shots. "Alex understands that process better than almost anybody and that undoubtedly had some bearing on the president's decision to appoint him."
Azar also favors moving authority to the states over Medicaid, the program that provides health care to the poor, elderly and disabled. That means turning over the program to the states to make them "better stewards of the money," he said in an interview at a February conference on YouTube. "It turns these sovereign states and governors from supplicants to the HHS secretary into people running their own health insurance system for the poor."
He said at the time that HHS could use its regulatory powers to allow states to customize the rules around Medicaid. Seema Verma, who runs the Centers for Medicare & Medicaid Services and would work for Azar if he's confirmed, has said she, too, favors giving states waivers to create their own Medicaid systems.
Where Azar stands on drug prices is less clear. President Trump said after his election and before his inauguration that he wants the government to work to lower drug prices and that he wants the Medicare program to use its buying power to negotiate better prices.
Since then, the president hasn't said much specifically on the subject. But he did mention it when he announced his intention to nominate Azar on Twitter.
Azar spent five years at Lilly, which makes several blockbuster medications, including Cialis, which treats erectile dysfunction; the antidepressant Cymbalta; and several forms of insulin. Insulin prices have drawn particular fire because they keep spiraling higher, even though insulin has been around almost a century.
The prices of Lilly's insulin drugs Humalog and Humulin, for instance, have both risen about 225 percent since 2011, according to data from the investment research firm Bernstein.
"Drug corporations have undue influence over health policy in America, and they use it to make money on the backs of patients and taxpayers," said Ben Wakana, executive director of Patients For Affordable Drugs, an advocacy group.
Still, Wakana says Azar has a good track record. "Mr. Azar is well-qualified and has the chance to stand up for patients because he knows exactly how our drug pricing system is broken. If he wants to take meaningful action to lower drug prices, we want to help him."
While Azar was at Lilly, he also sat on the board of directors of the Biotechnology Innovation Organization, a trade group for biotech companies. Previously, Azar served as general counsel and later as deputy secretary of Health and Human Services during the George W. Bush administration.
If he's confirmed, Azar would replace Dr. Tom Price, who resigned from HHS in September after a Politico investigation found that he had taken private charter aircraft on work-related trips at times when cheaper commercial flights were available.
Azar, a lawyer, would take over one of the largest federal agencies with an annual budget of more than $1 trillion. The department runs the Medicare and Medicaid programs, is responsible for implementation of the Affordable Care Act and oversees the National Institutes of Health and the Food and Drug Administration.
ROBERT SIEGEL, HOST:
President Trump has announced his choice to become the new secretary of Health and Human Services. Alex Azar is a former drug company executive who also served as deputy HHS secretary in the George W. Bush administration. If he is confirmed, he'll be charged with administering the Affordable Care Act, a law that President Trump has tried repeatedly to repeal and which the nominee himself has publicly opposed.
Joining us now is NPR health policy correspondent Alison Kodjak to tell us more about Trump's choice. Hello, Alison.
ALISON KODJAK, BYLINE: Hi, Robert.
SIEGEL: The president today announced his choice on Twitter. Alex Azar would succeed Tom Price as HHS secretary. Price, of course, resigned in September in the midst of a controversy over his choosing to travel on private chartered airplanes at the expense of taxpayers. What can you tell us about Alex Azar?
KODJAK: Well, unlike Secretary Price, he is not a doctor. He is a lawyer. And most recently he was president of Eli Lilly, the pharmaceutical giant, their U.S. operations. He left that job in January. He served as No. 2 at HHS under - in the George W. Bush administration. And today I talked with former HHS secretary Mike Leavitt, who was Azar's boss at that time.
He says Azar - he described him as sort of a meticulous bureaucrat. He knows how the government works and particularly how the regulatory system works, which may not sound very interesting, but Leavitt says that's probably exactly why the president chose him. Since the repeal of the Affordable Care Act has failed, the administration's likely going to try to change how the law works from the inside, changing the regulations that govern how the law is implemented.
SIEGEL: Wouldn't that take a great deal of time? Regulations take months or even years to revise. Do you have any sense of what he'll actually try to do?
KODJAK: There's not a whole lot out there in terms of specifics. Obviously, we're undergoing open enrollment right now, so that's already ongoing. But last spring, Azar was on Fox News, and in that interview, he sort of declared the Affordable Care Act pretty close to dead. Here's how he put it.
(SOUNDBITE OF ARCHIVED RECORDING)
ALEX AZAR: Well, it's certainly circling the drain.
KODJAK: And then he went on to say that there isn't much the government can do to save it.
(SOUNDBITE OF ARCHIVED RECORDING)
AZAR: There's actually fairly few levers that the government can do at this point to try to stabilize this fundamentally broken system.
KODJAK: Now, since then, the Affordable Care Act markets have opened. People are enrolling. But when he said - made these statements, Congress was still working on Obamacare repeal bills. I suspect that since then he's come up with some ideas. And one that he's mentioned a few times is creating a reinsurance program that's very popular with Republicans. They protect insurance companies from unexpected losses, and they also theoretically can help lower premiums.
SIEGEL: Of course, the Department of Health and Human Services is huge. It's more than just the ACA. It oversees a trillion dollars of government spending - Medicare, Medicaid, the Food and Drug Administration. Where else could Alex Azar leave his mark?
KODJAK: Well, he has spoken publicly about Medicaid, the program for the poor and disabled and the elderly. President Obama expanded it, and Republicans for the last year have been trying to rein it in because they worry about this huge and growing entitlement program. Azar at a conference earlier this year in an interview said he'd like to see Medicaid turned into a block grant program. And that was in most of the Republican bills. The concern is that if the money is capped as a block grant, it won't allow for the increases in health care costs that are going to be part of this growing need for Medicaid. So the fear is that services may have to be cut.
SIEGEL: And just for a moment, a word about pharmaceuticals. He's a drug company - a former drug company executive.
KODJAK: Well, President Trump has been promising to lower drug prices, and in his tweet today announcing Azar he said that again. So what Leavitt says is that Azar knows how the drug system works. And he might be able to do that.
SIEGEL: NPR's Alison Kodjak on Alex Azar, President Trump's nominee for Health and Human Services secretary to succeed Tom Price. Alison, thanks.
KODJAK: Thanks, Robert.
(SOUNDBITE OF TYCHO'S "HORIZON") Transcript provided by NPR, Copyright NPR.