Health and Human Services Secretary Alex Azar hit some bumps on the second day of his Capitol Hill budget road show, confronted with questions over his predecessor's travel scandal and what the administration was doing to study gun violence.
Azar also was grilled during two Feb. 15 hearings over what his agency was doing to prevent Idaho from allowing insurers to sell health plans that may fail to meet the requirements mandated by the Affordable Care Act, or ACA.
In addition, he was asked to explain why the administration wants to cut funding by $1 billion at the Centers for Disease Control and Prevention, or CDC — a reduction that has alarmed the public health community.
A day earlier, Azar was on Capitol Hill defending President Donald Trump's fiscal 2019 budget proposal at the House Ways and Means Committee, where he touted the administration's plans for reducing drug costs and addressing the opioid crisis.
The health chief acknowledged he was promoting a document he had no hand in crafting, given he only stepped into the HHS secretary's role on Jan. 29.
Azar replaced Tom Price, who resigned on Sept. 29, 2017, amid a scandal involving his flights on chartered and government jets, which may have cost taxpayers as much as $1 million.
Price had vowed to pay back about $52,000 of those costs.
When pressed at the House hearing by Rep. Ray Lujan, D-N.M., on whether Price had reimbursed taxpayers and if the matter had been investigated by HHS, Azar said he did not know.
Rep. Frank Pallone, D-N.J., ranking member on the Energy and Commerce Committee, noted he sent a letter that morning to Azar calling for a "top-down review" of HHS in light of not only Price's travel scandal, but also the financial conflicts of interest that led to the Jan. 31 resignation of the now former CDC director, Brenda Fitzgerald.
Pallone also raised concerns that Centers for Medicare and Medicaid Services Administrator Seema Verma may be in violation of her ethics agreement and a promise to recuse herself from involvement in the review process of state waivers that involved her former clients.
In addition, the New Jersey lawmaker said he was troubled by reports that the agency had awarded a contract outside of the competitive bidding process to a company owned by Housing and Urban Development Secretary Ben Carson's daughter-in-law.
CDC budget cuts
During the Senate Finance hearing, Georgia Republican Johnny Isakson said he was "deeply concerned" about Trump's proposal to cut $1 billion from the CDC's budget, particularly at a critical time when the agency is involved in responding to the flu and its research laboratories, where some of the deadliest pathogens are kept, are in desperate need of upgrading.
"The CDC is our safety blanket," Isakson said, calling Trump's request "almost unconscionable."
The major reduction in the CDC's budget would come from the administration's plan to transfer the agency's National Institute of Occupational Safety and Health to the National Institutes of Health and the Strategic National Stockpile — a cache of drugs and other medical supply intended to respond to large-scale emergencies in the U.S. — to the HHS Office of the Assistant Secretary of Preparedness and Response, Azar explained.
He did not, however, acknowledge the administration's plan to cut 43% the CDC's Public Health Preparedness and Response Program — the office that responds to emergencies and crises.
Gun violence research
Azar surprised House panel members when he suggested he would permit the CDC to pursue research into the causes of gun violence — a topic the agency has shunned for the most part for the past 20 years for fear of violating the 1996 Dickey Amendment.
In a notice posted on its website, the CDC said it has interpreted the provision to mean the agency's funds may not be spent on research "intended to restrict or control the purchase or use of firearms."
But Azar said he thought the provision "does not in any way impede our ability to conduct our research mission."
"Our Centers for Disease Control and Prevention [are] in the science business and the evidence-generating business and so I will have our agency certainly be working in this field, as they do across the whole broad spectrum of disease control and prevention."
Preventing Idaho from going rogue
A number of House and Senate Democratic members questioned Azar about what he was doing to stop Idaho from letting insurers sell health plans that violate the ACA.
Sen. Ron Wyden, D-Ore., the Senate Finance Committee's ranking member, said those "junk" plans would leave Idahoans without the ACA's protection, like preventing insurers from discriminating on the basis a pre-existing condition.
Sen. Mike Crapo, R-Idaho, however, insisted his state was not breaking the law.
"I don't see a violation at all," Crapo said. "Idaho is still providing Obamacare-compliant plans for anyone who wants to purchase them, but they are allowing others to have options."
Azar said he viewed the Idaho situation as a "cry for help."
"It's saying that where we are right now with our individual market because of the structure we have is not serving enough of our citizens," the HHS secretary said.
Azar made no commitments during the Feb. 15 hearings to uphold the ACA like he did a day earlier at the House Ways and Means Committee.
He did, however, agree that if Idaho submitted a waiver request to HHS, the application would undergo "great deliberation, caution and care" in its assessment.
Wyden, however, said he believed Idaho would simply attempt to move forward without seeking HHS' permission.