HHS Secretary Alex Azar, the president’s point man on Obamacare and drug prices, has reluctantly taken on a new role — public explainer and punching bag for the migrant crisis created by Donald Trump’s zero tolerance border policy.
Azar — an even-keeled technocrat whom the White House enlisted as the fixer after Homeland Security Kirstjen Nielsen’s highly criticized press conference last month — has since been attacked by dozens of lawmakers, interrupted by protesters and pilloried on cable TV. Meanwhile, he’s working through a thicket of court orders and red tape to try to reunite thousands of migrant children in his custody with their parents, including 102 under the age of 5. It’s sapped Azar’s time and pulled his agency away from other priorities, such as lowering drug costs and helping solve the opioid epidemic.
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“He didn’t want the job — but no one did,” said an HHS official, who asked to speak on background because he did not want to discuss internal agency politics. “And he’s doing his best, but he stepped into the middle of a shit storm. It’s a tough situation.”
While making some progress on a tight court-ordered deadline, HHS has already fallen short of the first test. After Azar pledged to reunite all the migrant children under age 5 with their parents, HHS said as many as 64 won’t be moved by a Tuesday deadline.
It’s an uncomfortable position for a Cabinet member who’s largely avoided negative headlines and been praised by Trump as “one of the great professionals.” His allies stress that Azar, a proven problem-solver in the George W. Bush administration and later at drug giant Eli Lilly, inherited a spiraling crisis. The policy of family separation began in the White House and DHS — and it’s not clear the HHS secretary even agreed with it, his supporters say.
Azar took ownership in good-soldier fashion, knowing the sprawl of his bureaucracy — HHS takes custody of refugees — would deposit the crisis in his lap.
“HHS is not responsible for the policy. HHS is responsible for the result of the policy,” said a longtime colleague and adviser, who declined to speak on the record about the sensitive topic. “And unfairly, the administration and the press is looking in and expecting them to solve it.”
Azar has pulled long hours personally reviewing case files of migrant children — the agency shared a photo last week of him in the HHS emergency center, paging through documents after midnight — and has given a half-dozen public briefings or interviews defending the efforts to put families back together.
“Secretary Azar is highly engaged and has ensured HHS is executing its mission to care for minors in our custody and get them placed with a family member or sponsor as soon as possible,” an HHS spokesperson told POLITICO. “He has rolled up his sleeves and has worked to bring together the resources and personnel needed to make that happen.”
Azar is “deeply committed to working with the White House night and day both on individual cases and the crisis at large,” added Lindsay Walters, White House deputy press secretary.
But lawmakers in both parties have been frustrated by Azar’s often-vague answers about such basic questions as whether all children above age 5 will be reunited. They also say HHS failed to anticipate logistical challenges and should have moved quicker to reunite separated families.
“I have not felt that HHS has done a very good job in [a] very tough situation,” Sen.(R-Ohio) told Azar in a hearing two weeks ago.
“Azar shucked and jived more than a welterweight,” Rep.(D-N.J.), after the HHS secretary held a 30-minute call on Friday with members of Congress, then ducked off ahead of questions. “[L]istening to the gibberish from Azar’s mouth, the Trump administration doesn’t have an atom of compassion or competence.”
House appropriators on Wednesday unanimously backed a Democratic proposal that threatens to strip $100,000 per day from Azar’s office budget if he fails to sufficiently explain to Congress — by August — how HHS is reunifying the separated children. Senate Democrats on Wednesday also raised questions about whether Azar misled them when he testified last month that “there is no reason why any parent would not know where their child is located.”
Even White House officials were said to be upset with Azar after he appeared to dodge some responsibility for the crisis last month, telling a Washington Post roundtable, “immigration policy isn’t really what we at HHS do.”
Azar quickly recalibrated. “We get it. Nobody wants their kids separated from their parents,” he said in a Fox News interview that evening.
The secretary’s supporters say that Azar recognized the need to step forward as the face of the crisis. “It was not a request from the White House necessarily,” said a former HHS official who’s advised Azar. “It’s evolved — and driven out of his sensibility for public service. To dive in and take this on.”
Azar’s efforts to personally manage crisis
As Azar’s public role in handling the migrant issue has grown, the low-key official has become a target on cable TV, online and in person. A protester interrupted the Washington Post event, calling Azar part of “the deportation force.” Lawmakers berated him at congressional hearings, vowing to hold the secretary accountable. His Twitter account has becomefor congressional Democrats and liberals to take swings at — no matter what Azar posts.
The frustration about the crisis has also mounted inside HHS, sometimes in unexpected corners. On Tuesday, a member of the secretary’s research advisory panelshe opposed the agency’s policies and called on Azar to end “this horrific chapter,” which was quickly seconded by other attendees at the meeting convened at HHS. Staff in other departments say they’re worried about the crisis’ spillover effects, citing that the cost of the administration’s child separation policy might cut into HIV/AIDS funding and other public health work.
HHS officials say the secretary has treated the situation like a full-blown crisis, activating his agency’s emergency response team and calling for volunteers from across the department. He’s also been hands-on and highly visible, leading press briefings in lieu of hisScott Lloyd, including a 45-minute conference call with reporters on Thursday where Azar handled every question but one.
Meanwhile, he’s kept other commitments, like addressing a conference about drug costs on Monday or hosting a school safety commission meeting on Wednesday. Azar also attended Monday’s White House announcement of the Supreme Court nomination of Judge Brett Kavanaugh — a close friend with whom he shared a similar career path for a decade.
While agency staff told POLITICO that the migrant crisis has siphoned time and resources away — and HHSCongress last week that lawmakers’ frequent visits have strained efforts to reunite families — Azar has tried to instill confidence and self-reliance, say members of his team.
“He works hard and is here early and late,” said an HHS official who works closely with Azar, calling him a “player-coach” who sets high expectations but also finds ways to reassure his staff as they pull long hours. “He’s personally called [refugee office] grantees to thank them for the excellent work they’re doing each and every day in caring for the minors in their shelters and facilities,” the official added.
Azar’s unflappable nature during the crisis also has won him praise on Capitol Hill. “I’ve never seen a better witness than you,” Senate Finance Chairman— a 41-year veteran of the Senate — told Azar after a contentious hearing last month that was intended to focus on drug prices but was largely sidetracked by the migrant crisis.
Azar this week talked down Senate Homeland Security Chairman, who on Monday told CNN that “it boggles my mind” that families hadn’t been reunited. But on Tuesday — after a long conversation with the HHS secretary — Johnson struck a conciliatory tone. “I was voicing my frustration because we were trying to get daily updates [and couldn’t] … I want to work with him as a partner to get this information out.”
But Azar’s allies say that the scope of the crisis, and the public outrage, is outpacing the secretary’s ability to respond. “He’s the agency’s best spokesman, but he can’t [personally] call every frustrated lawmaker,” said one official who works with him.
Inside HHS leadership, there’s frustration that the media has spread reports that the health department “lost” migrant children — which immigration advocates have said is— or suggested the agency isn’t prioritizing its response. MSNBC’s Rachel Maddow Azar for taking a recent weekend trip to his Dartmouth College 30th reunion in New Hampshire, suggesting that his focus should be reuniting families. “Once a crisis like this broke … maybe you would cancel,” Maddow said.
HHS also has been blamed for conditions beyond its control, with images of Homeland Security facilities — where children have been temporarily held in spartan conditions — spreading across media and being wrongly portrayed as health department-run facilities.
“I was just on television earlier today, and behind me on the screen was B-roll footage not of children in any facility managed by HHS,” Azar told reporters last Thursday. “That’s just simply incorrect,” he added, exhorting the media to “dig and check” before parroting attacks on the agency.
A career as problem-solver
Azar boasts credentials that endeared him to the conservative establishment — and beyond. He clerked for Supreme Court Justice Antonin Scalia, worked on the Whitewater investigation of the Clinton family and served as a lawyer in Bush v. Gore — which ended with Republicans winning the White House and Azar being steered toward the health department, where he served as its top lawyer and deputy secretary.
At HHS, Azar became known as a low-key problem-solver, such as when he spotted a loophole in the patent process with generic drugs and worked to close it. The resultingwas repeatedly touted by then-President George W. Bush as an example of helping consumers save money.
“He took it upon himself and his staff to re-regulate that regulation,” said an official who worked closely with Azar at the time. “He ended up saving about $30 billion over 10 years.”
Azar also has a decade of business experience, including five years as president of Eli Lilly’s U.S. operations — a track record that stands out among Trump’s Cabinet and has impressed the president, who called him “the most respected man” in the drug industry.
Azar’s leadership of HHS is “like playing a violin by a great, talented person,” Trump said on stage in June. “He can handle a lot, this guy,” the president said at another White House event.
There’s no sign that the president has lost faith in his health secretary — and Azar is working hard to keep it that way, said a former HHS official who remains close to him. “He wants to be Trump’s Mr. Fix-it.” Azar, mirroring Trump’s boastful rhetorical style, claimed during a CNN interview Tuesday night that his agency’s care for migrant children “is one of the great acts of American generosity and charity.”
“We really believe we have got a lot to be proud of,” Azar said, citing the agency’s decision to use background checks, which havesome adults with criminal histories. “We save kids’ lives by keeping them from being with some really evil people.”
Staff who work with Azar say he’s encouraged the agency to stay bold amid the crisis — perhaps no surprise from an official who endorsed a self-help business book subtitled “Achieving Your Wildly Important Goals.”
“I watched a team … who walked and talked like winners,” then-Lilly USA president Azar wrote in the introduction to the 2012. “I wanted that mindset throughout my entire organization.”
Unlike his predecessor Tom Price, who commuted back to Georgia on the weekends when was HHS secretary, Azar has relocated to Washington and recently agreed to sell his house in Indianapolis.
“He’s settling back” in the D.C. area, said a longtime friend. “He’s not planning on going anywhere.”
Adam Cancryn contributed to this report.