Watch The Daily Signal’s interview with Health and Human Services Secretary Alex Azar above, or read a lightly edited transcript of the conversation below.
Genevieve Wood: Secretary Azar, thank you very much for sitting down with The Daily Signal.
Secretary Alex Azar: Glad to be here, thanks.
Wood: Appreciate it. You head the Health and Human Services Department, and the issue of Obamacare and health care has been a huge issue for the country for many years now. But it’s kind of seemed like it’s fallen off the radar screen, in terms of news coverage.
Where are we right now in getting rid of Obamacare and really putting in a free-market system?
Azar: Well obviously, we in the administration remain completely committed towards repealing and replacing Obamacare. … We’ve proposed something along the lines of what’s called Graham-Cassidy, which is a statutory change that would basically take that program and block grant it, and give it to states and let them run systems independently.
We keep looking at ways that we can help the forgotten men and women who were shut out by Obamacare, and the increases that happened in the individual market, where insurance became unaffordable and unavailable for so many—tens of millions of Americans.
We’re creating short-term plans that are cheaper for them, more affordable for them. We’re creating association health plans that let corporations and small businesses band together to create more affordable options. We’ve freed them from the burden, the multibillion-dollar burden of the individual tax that charged them for buying insurance they didn’t want to buy.
We’re taking those steps, but we keep looking at all of our administrative powers to think, how can we make a more private-sector insurance system? How can we make these programs more fiscally sustainable? How can we empower states to innovate? How can we make insurance more affordable, and how can we bring more consumer-directed care into our system?
Wood: You made the comments in your remarks … at Heritage that you want to bring free-market principles to our health care system. Ultimately you’re going to need Congress to act, but there is a lot that you can do, individually, through the agencies. What are your priorities right now?
Azar: I’ve got four key priorities. On the Obamacare in the individual insurance market, what I want to do is look at the authorities that I’ve got, both on the individual market as well as in Medicaid—how can I put those programs more into the private sector? How do we reinforce private-market vehicles? How can we put those on a more fiscally sustainable path?
People do not realize that the Medicaid expansion and the tax subsidies that go to individuals to buy individual insurance are uncapped. Those liabilities, those individual entitlements have no cap on them. They can go up and up and up, indefinitely, OK? It chases the premium, and so can we make those more fiscally sustainable? Can we empower states? Can we make insurance more affordable, and can we bring consumer centrism into the system?
Wood: You made the comment that when you see something not working, one of the first things you ask is, how is government involved?
Azar: Yep.
Wood: Is it causing the problem? Could there be something that it could do to help? How do you see that applying with health care?
I mean, this is not a problem that cropped up yesterday. Even [before] Obamacare, our health care system has needed reform for years. You also made the comment that it’s interesting that it’s conservatives who actually want to reform this, whereas progressives really don’t want to make progress, they want to stick with the same old, same old.
Azar: Yep. They’re more tied to the vested interest.
I’ll give you one example, which is, in all of our economy, what are we doing with social media and this next generation, economically. We’re having more integration, more cooperation in how we deliver services and provide them.
Health care. Health care remains disaggregated. The doctor, the hospital, the anesthesiologists, the diagnostic, the rehab, the pharmacy—all is separate. So you say, that’s an odd thing, isn’t it? That that’s all done separately, rather than—
Wood: It’s not the way anything else works.
Azar: Nothing else is done in that way. It’s integrated and collaborative. OK, we have a law in place, the Anti-Kickback Statute, that makes it a crime for those players to work together, unless they’re exempted by my department, to allow them to share financial proceeds and work together. Big surprise: We have frozen in place, a 1960s delivery-style that is disaggregated and uncoordinated, when all the world says in health care we need integrated, collaborative, coordinated delivery of care.
That’s what we’re looking at: How can we reform our system while clearly protecting against kickbacks, protecting the public fist against fraud and abuse, but how can we open the system up to innovation and deliver care the way we know it needs to be delivered?
Wood: What does the timeline look like for those watching who say, OK, we want to see some big changes here. We know Congress is headed into an election season, so probably not a lot’s going to happen between now and then, though we always remain hopeful. What does the timeline look like for big changes happening?
Azar: Yep. We’re going to be making big change just progressively as we go through my tenure. What do I do? First, we lay out a clear strategy. We’re very transparent about the direction that we’re going, because you can’t run a large organization and bring the public and the constituencies along without a clear direction. So first, lay out the strategy, then you begin to execute against that strategy.
We do so. We have rule-making that we have to go through, that takes a bit of time. But we’re driving ahead, we’re charging forward—even on drug pricing. One of the key initiatives, in May we laid out a very clear blueprint of the direction that we’re going, and we’re now just plowing through, executing one initiative after the other, in sequence, and you’re just going to see a constant cadence of activity. You’ll see that in individual markets, you’re seeing that on the opioid crisis, you are going to see that on value-based transformation of health care.
Wood: Finally, I know the audience always wants to know, in your talks with the president, how committed is he? What is his view of what you’re doing at HHS?
Azar: I have actually been surprised, because I did work in the prior administration. I have been surprised by the constant and detailed level of interaction that I have with the president.
I’m either in person or on the phone with him most days, and he is very focused on the issues at HHS. Those issues—drug pricing, the individual insurance market, value-based care, the opioid crisis. He is really focused, he knows the direction he wants to go in, he knows the outcomes that he wants me to deliver, and he’s constantly pushing and pressing. Why not yet, why not yet? I want it done yesterday.
Wood: I know that’s something many people will want to hear.
Azar: Courage would be something one would describe the president with. Patience in getting results would not be one.
Wood: Well, that’s a rarity in Washington, but a good rarity.
Azar: Yes.
Wood: Mr. Secretary, thank you very much for sitting down and talking with us.
Azar: Thank you, great to see you.
