The Health 202: New HHS head faces pressure from Republicans, too

THE PROGNOSIS

A scathing letter from a member of his own party awaited Alex Azar as he became Health and Human Services secretary this week, one of many piled-up tasks he faces at an agency that has lacked a leader for the past four months.

Since October, HHS has fallen sadly short of its duties to comply with document and information requests from Congress, House Oversight Chairman Trey Gowdy (R-S.C.) wrote to Azar. HHS has shown a pattern of “nonresponsiveness and wanton disregard” for the committee’s responsibility to oversee the executive branch, according to Gowdy’s letter, dated Jan. 29.

“Despite the committee’s effort to accommodate HHS’ legitimate interests, the department has missed mutually-agreed deadlines, produced meager and incomplete sets of information (much of which is available publicly) and taken a posture of nonchalance with respect to the committee’s requests,” wrote Gowdy, who announced this week he won’t seek reelection.

House Oversight Chairman Trey Gowdy (R-S.C.) says he will not seek reelection. (AP Photo/Carolyn Kaster)

In fact, HHS has gotten so bad at responding to requests from Gowdy’s committee that it seems like its legislative affairs department “has fallen into a state of permanent disrepair,” Gowdy wrote, listing six specific examples of information his committee requested from the department to which he didn’t receive a full response. 

The charges are just one indication of the massive job that awaits Azar at HHS, a sprawling agency at the center of some of the most pressing and controversial issues of the day. It’ll be his job to guide the agency through all sorts of new waters, from Medicaid waivers giving states new latitude, to revisions to Medicare payment changes, to Obamacare rule changes – just to name a few.

The good news for Azar is that his reception inside his new department has been decidedly positive, both within HHS and from outside observers. The warm welcome is a sharp contrast from to the feelings surrounding the new secretary’s predecessor, former congressman Tom Price (R-Ga.), who resigned in disgrace last fall over his use of private jets.

“I like Tom, but politicians sometimes are not the ideal people to be running big departments,” Tom Miller, a health-care fellow at the conservative American Enterprise Institute, told me, adding that Azar is a “smart lawyer” who doesn’t do things that “blow up” in his face.

Unlike Price, Azar already has several years at HHS under his belt, where he worked before moving to major drug manufacturer Eli Lilly. He also has a law degree and is described by former colleagues as someone who is less political and more pragmatic in his approach.

On Tuesday, Azar held an agencywide staff meeting that was webcast. There’s talk that he is trying to connect with top health-care lawmakers on Capitol Hill; staff for Sen. Patty Murray (Wash.), who serves as the ranking Democrat on the Health, Education, Labor and Pensions Committee, confirmed Azar has been in touch to set up a meeting with the senator.

Reporters also have some hope that media relations with HHS might improve in the Azar era. Although most reporters will tell you the Obama administration was hardly perfect when it came to communicating with the press, things got even worse under Price and after his departure.

HHS regularly invites only media it perceives as friendly to phone calls with agency officials; two recent examples were when the agency announced a new religious freedom division and when it issued guidance laying out how states could impose new work requirements on Medicaid recipients.

Azar has only been secretary for five days, so it’s still not clear how he’ll reshape HHS. But even some Democrats – six of whom voted to confirm him in the Senate – believe he will have a positive impact.

“I think he’s incredibly competent,” Sen. Heidi Heitkamp (D-N.D.) recently told Politico. “I don’t share a lot of his philosophy, but I think he understands — as someone who has been at the administration — the importance of the rule of law and compliance.”

AHH, OOF and OUCH

Acting CDC Director Anne Schuchat. (AP Photo/Molly Riley)

AHH: Many CDC employees are overjoyed their acting director is back in charge, after the resignation Wednesday of Brenda Fitzgerald stemming from conflicts over her financial interests (including revelations that Fitzgerald bought shares in a tobacco company after she took the helm), The Post’s Lena H. Sun reports. When they got the notice the principal deputy director, Anne Schuchat, who has nearly three decades of CDC experience, would be taking over (again) as acting director, employees were happy to hear the news.

“Yes! There is palpable relief that she’s back in charge,” said one analyst. “You’d have joyous celebration if they made her permanent director.”

Early Thursday, Schuchat sent a “Dear Colleagues” email to staff thanking them for their work. “It is an honor to provide leadership for our nation’s premier public health agency, and all of you, in this role. Please know that I take this responsibility very seriously and care tremendously about our continued excellence and strength,” she wrote.

By Thursday afternoon, 40 comments had been posted anonymously on the CDC internal announcement board applauding her return and suggesting that her HHS bosses should just make her the permanent director. (The only other announcement with more comments asked employees whether they work while sick.)

“HHS needs to make the obvious and easy decision to appoint Dr. Schuchat as CDC’s director permanently,” one person wrote.

“Dr. Schuchat — thank goodness you’re back. You’re amazing, thank you. I echo — Dr. Schuchat for director,” added another poster.

Funding Congress appropriated back in 2014, prompted by the Ebola epidemic, is running out. (Photo by Michel du Cille/The Washington Post)

OOF: The CDC is dramatically cutting back its epidemic prevention activities in 39 out of 49 countries because money is running out, government officials said yesterday. Four years ago, in response to the 2014 Ebola epidemic in West Africa, Congress approved a one-time, five-year emergency package to train frontline workers and strengthen laboratory and emergency-response systems. But in September 2019, CDC will run out of the $600 million it was awarded, and the Trump administration has not budgeted additional resources, Lena reports.

“Two weeks ago, the CDC began notifying staffers and officials abroad about its plan to downsize these activities, because officials assume there will be no new resources,” a senior government official told Lena. The official said notice is being given to CDC country directors “as the very first phase of a transition,” adding that there is a need for “forward planning”  to accommodate longer advance notice for staffers and for leases and property agreements.”

A patient has her blood drawn for a liquid biopsy at a hospital in Philadelphia. (AP Photo/Jacqueline Larma)

OUCH: Lifesaving therapies for breast cancer patients, like chemotherapy and radiation, can cause heart failure and other serious cardiac problems, sometimes years after treatment, the American Heart Association said in a stark warning issued yesterday. The organization said patients and doctors shouldn’t avoid the treatments but instead take steps to prevent or minimize the cardiac risks, The Post’s Laurie McGinley reports. It stressed that breast cancer survivors can improve their chances of a long, healthy life by exercising regularly and sticking to a healthy diet.

“The cautionary message, published online Thursday in the journal Circulation, came in the organization’s first comprehensive scientific statement on the complex interactions between breast cancer and cardiovascular disease,” Laurie writes. “In many ways, the AHA statement is trying to change the mind-set of women diagnosed with breast cancer who consider it the biggest threat to their health. It noted that breast cancer survivors who are 65 and older and were treated for their cancer are more likely to die of cardiovascular problems than breast cancer.”

INDUSTRY RX

President Trump displays the $1.5 trillion tax overhaul package he signed in December. (AP Photo/Evan Vucci, File)

–Cigna announced this week it’s raising minimum wages for its employee to $16 an hour and improving retirement benefits for about 30,000 workers because of the tax overhaul passed by Republicans late last year, which lowered the corporate tax rate from 35 percent to 21 percent. The major health insurer said it will spend $15 million on higher wages, mostly for frontline employees, and invest $30 million in an additional 1 percent match to its 401(k) program.

“It is because of our employees that Cigna continues to deliver on our mission to improve the health, well-being and sense of security of those we serve,” Cigna CEO David Cordani said in a statement. “Reinvesting a portion of savings from tax reform in our employees is a reinvestment in our mission.”

HEALTH ON THE HILL

Sen. John Thune (R-S.D.). (AP Photo/J. Scott Applewhite)

–The dream of repealing the ACA is over for Republicans, even the most conservative lawmakers are admitting. There was no mention of repealing or replacing the health-care bill at the GOP retreat in West Virginia this week, Politico’s Burgess Everett reports. “Senate Republicans would struggle to pass a bill slashing at Obamacare under the best circumstances this year,” he writes. “They lost a Senate seat in Alabama in December and are down another vote as Sen. John McCain undergoes cancer treatment. GOP leaders would rather put the debacle of last year’s failed attempt behind them.”

“I don’t think leadership wants to,” Sen. Bill Cassidy (R-La.) told Burgess. Cassidy had worked with Sen. Lindsey Graham (R-S.C.) on last fall’s Graham/Cassidy bill which, like a health-care before it, failed to gain enough support. “In the sense of Graham-Cassidy, a partisan exercise? Doesn’t look like it.”

Sen. John Thune (R-S.D.) called it a “heavy lift.” “I think everybody knows…We sort of tested the limits of what we can do in the Senate last year. And we’re one vote down from where we were then,” he told Burgess.

While the decision to forgo another whack at overhauling the law means the GOP will fail to fulfill a promise the party has made to voters for eight years, it also means they are now facing reality. “And it underscores how Republicans overpromised in their ability to reform the nation’s health care and never fully recognized how divided the party is over key Obamacare planks like protecting pre-existing conditions and preserving the law’s Medicaid expansion,” Burgess writes.

In a statement, Sen. Patty Murray (D-Wash.) called it “good news that at least some Republicans are facing reality and accepting that families don’t want any part of Trumpcare.”

(Istockphoto/Getty Images)

–Yesterday, a patients’ rights group announced a six-figure advertising buy through Feb. 7 to promote a bill aiming to lower drug prices. The group, Patients for Affordable Drugs NOW — a new political action arm of the group Patients for Affordable Drugs — said it’s targeting Senate and House members in Arizona, Florida, Kentucky, Pennsylvania, Wisconsin, West Virginia and D.C. to vote for the bipartisan CREATES Act, which targets drug-company tactics delaying the entry of less-expensive generic versions of brand-name drugs from the marketplace.

“We hear from patients every day who are being forced to choose between buying groceries and taking lifesaving drugs,” the group’s founder David Mitchell said in a statement. “Americans are hurt, angry, and demand action from Washington.” The group, which calls itself P4ADNOW, says it will spend more than seven figures in this year’s midterm elections to support candidates “committed to bringing down the high cost of prescription drugs and providing relief to patients.” 

–Have a relaxing Super Bowl weekend, and we’ll see you back here Monday. A few final reads:

MEDICAL MISSIVES

MALPRACTICE

DAYBOOK

Coming Up

• The Senate Health, Education, Labor and Pensions committee holds a hearing on the opioid crisis on Feb. 8.

SUGAR RUSH

President Trump calls 2017 “one of the greatest years:”

Watch Trump get a pair of Aflac socks and praise his wife’s 2005 commercial for the insurance company: 

Supreme Court Justice Ruth Bader Ginsburg said she is not planning to retire: “As long as I can do the job full steam, I will be here:”