In this June 8, 2006 file photo, then Deputy Health and Human Services Secretary Alex Azar meets reporters at the HHS Department in Washington. Azar was a top HHS official during the George W. Bush administration. (AP file photo)

WASHINGTON – President Donald Trump has tapped Alex Azar, a former pharmaceutical executive and a top health official during the George W. Bush administration, to lead the Health and Human Services Department.

The decision to enlist the 50-year-old Azar – who served as president of Lilly USA, the biggest affiliate of Eli Lilly and Co., before stepping down in January to work as a health-care consultant – represents a pragmatic pick. An establishment figure with a reputation as a conservative thinker and methodical lawyer, Azar would be expected to use his experience as HHS general counsel and deputy secretary to pursue Trump’s goals through executive action.

In nominating him Monday morning, Trump tweeted, Azar “will be a star for better healthcare and lower drug prices!” He has a close rapport with the department’s top political appointees as well as Vice President Mike Pence.

Azar has been highly critical of the Affordable Care Act, telling Fox Business in May that the law was “certainly circling the drain” and saying in a speech two months ago that many of its problems “were entirely predictable as a matter of economic and individual behavior.”

In a June interview on Bloomberg Television, Azar made it clear he thought the administration could shift the ACA in a more conservative direction even if congressional Republicans failed to repeal much of it. “I’m not one to say many good things about Obamacare, but one of the nice things in it is it does give tremendous amount of authority to the secretary of HHS,” he said.

He also supports converting Medicaid from an entitlement program covering everyone who is eligible into block grants, a long-standing GOP goal that has sparked opposition from Democrats as well as some centrist Republicans. He has opposed expanding the program under the ACA to people with slightly higher incomes.

The nominee boasts sterling conservative credentials, clerking for the late Supreme Court Justice Antonin Scalia before working under special counsel Kenneth Starr to investigate Bill Clinton’s failed Whitewater real estate investments. Still, administration officials think he could work more deftly with competing health-care interests and politicians than his predecessor, Tom Price.

Price did little to foster better relations between the administration and Capitol Hill despite his dozen years as a Georgia congressman. He stepped down in September after revelations that he had racked up more than $1 million in expenses this year by making official trips on noncommercial aircraft.

Tevi Troy, who succeeded Azar as HHS deputy secretary under Bush, recalled in an interview that the two of them were part of a small group who gathered on the campus of Cornell University for a Federalist Society meeting in the fall of 1988. It was a freezing weekend in Ithaca, New York, and the fact that Azar drove up from Yale Law School was a testament to his conservative ideals, Troy quipped. “There were probably only about 30 people there,” he said.

Azar’s ties to Pence date to his days at Lilly, an Indiana-based pharmaceutical firm, when Pence was the state’s governor.

While Azar initially backed Jeb Bush for president in 2016 and served on his Indiana steering committee, he later donated $2,700 to a “Trump Victory” committee. Since 2008, records show, he has donated more than $96,000 to GOP candidates.

In an undated Yale Law School alumni profile, Azar said that he “wrestled with the question” as to whether he should take his first job at HHS but that it set him on the career path he has followed ever since.

“I realized I had found my life’s calling: to help people around the world live longer, healthier, and happier lives,” he said.

As HHS general counsel, Azar worked on the administration’s response to the 9/11 terrorist attacks and the ensuing anthrax attacks, stem-cell policy and the advent of the Medicare prescription drug benefits. He then served two years as deputy secretary, during which he pushed for greater disclosure of prices associated with medical services to help foster competition and contain costs. He also backed converting medical records to electronic form.

“It is absurd to me that one of the largest sectors of the economy is run in a way where consumers don’t have a way to find out about price or quality,” Azar said at an event in Providence, Rhode Island, in 2007. “We will not continue to be the dominant power in the world if we continue to spend so much more on health care than other economies.”

In recent weeks, Azar has been regarded as the only likely choice to be nominated to become the next secretary of HHS, the government’s largest civilian agency, encompassing the National Institutes of Health, the Centers for Disease Control and Prevention, the Food and Drug Administration and the Centers for Medicare and Medicaid Services, among other branches.

Anticipating his selection, Senate Democrats have begun preparing for his confirmation hearings and intend to focus on his ties to the pharmaceutical industry, his position on high drug prices and the way he would continue implementing the ACA.

Azar’s selection comes even as Trump has repeatedly attacked U.S. drug companies for profiting too much, suggesting the federal government should negotiate with them to get lower prices.

“The drug companies, frankly, are getting away with murder, and we want to bring our prices down to what other countries are paying, or at least close and let the other countries pay more,” the president told reporters in October. “Because they’re setting such low prices that we’re actually subsidizing other countries, and that’s just not going to happen anymore.”

Azar has opposed such price controls, but he has found other ways to address concerns about drug countries’ hard-charging tactics.

Recruited for a lobbying and communications position at Eli Lilly at a time when it was facing multiple lawsuits and some negative publicity, Azar championed a soft-sell approach in which company officials found the kinds of pharmaceuticals doctors wanted, even if they came from another firm.

“It’s a bet we’re making,” he told the Indianapolis Star in 2014.

The Washington Post’s Alice Crites contributed to this report.

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