White House officials drew up a short list of potential replacements for Health and Human Services Secretary Alex Azar and Medicare chief Seema Verma at the height of their contentious feud in case either was forced out late last year, three people with knowledge of the exercise told POLITICO.
The officials developed the list days after the increasingly personal clash between Azar and Verma spilled into public view following a Nov. 26 POLITICO report that first detailed their rift. Two people with knowledge stressed that the names were not shared with President Donald Trump and that Azar and Verma are expected to remain in their roles through at least the rest of Trump’s first term.
Azar and Verma have worked to quell their feud since Vice President Mike Pence and White House acting Chief of Staff Mick Mulvaney last month urged them to get along. Although Trump berated Azar over bad health care polling last week, White House and HHS officials said his job remains secure.
Still, the previously unreported effort to identify possible replacements shows the extent to which White House officials were planning for the possibility that Trump’s top two health officials would abruptly leave the administration heading into an election year.
White House officials sought candidates qualified to serve as an acting leader through the rest of Trump's first term and potentially survive a Senate confirmation process. They also considered whether candidates aligned with Trump's political views, said one person familiar with the matter.
The White House did not respond to specific questions for this story, but spokesperson Judd Deere told POLITICO that "there’s no daylight between the White House, HHS, and CMS as we work to implement the President’s policies and improve the American health care system for everyone."
HHS and CMS declined to comment.
The list of candidates to replace Azar included Trump’s first FDA commissioner, Scott Gottlieb, who has bipartisan support in Congress and close relationships with multiple administration officials. Gottlieb previously was considered for the role after Trump’s first health secretary, Tom Price, was ousted in fall 2017. Gottlieb declined to comment.
Gottlieb’s abrupt departure from FDA last spring and subsequent criticism of the administration’s vaping strategy rankled some White House officials, however. They also believed if he were tapped as HHS head, he would need to undergo Senate confirmation in order to serve an extended term as acting secretary under federal vacancies regulations.
Another candidate was Adam Boehler, who led the influential Medicare innovation center, where he reported to Verma, and he also personally advised Azar on overhauling how health care services are paid for. Boehler is also viewed by White House officials as a contender to lead HHS or CMS if Trump is reelected.
He has since left CMS and was confirmed by the Senate in September to lead the new U.S. International Development Finance Corporation, which oversees investments in developing nations' economies.
While Boehler is said to have strong working relationships with Azar and Verma, he has a key ally in the White House: senior adviser Jared Kushner, a longtime friend and Trump’s son-in-law. However, officials were wary that Boehler lacks the conservative credentials of Trump’s first two health secretaries. Azar was a senior HHS official during the George W. Bush administration and stalwart Republican fundraiser, and Price was a former GOP congressman with deeply conservative views.
When asked about his interest in running HHS, Boehler told POLITICO he is focused on his current portfolio and expressed support for Azar and Verma.
Joe Grogan, the White House domestic policy council chief, was also floated as a potential replacement for Azar, based on his conservative bona fides and deep involvement with the Trump administration's health agenda, according to two people familiar with the matter.
But Grogan does not already hold a Senate-confirmed job, meaning he also could not serve as acting HHS secretary for an extended period. The White House did not respond to a question about whether Grogan was interested in the job of HHS secretary.
Eric Hargan, the Senate-confirmed deputy HHS secretary, also was considered as a stopgap to replace Azar if needed. He already served as interim secretary for four months following Price’s ouster in September 2017. Hargan has reportedly told colleagues that he has no interest in succeeding Azar, although he does not want Verma to take the role, said one individual with knowledge of his plans. HHS did not respond to a question about Hargan's views.
At least one name, Paul Mango, emerged as a potential replacement for Verma atop the Centers for Medicare and Medicaid Services, which oversees the major health entitlements and Obamacare. Mango, who currently serves as HHS deputy chief of staff, is well-liked by top HHS officials, who helped him land an earlier job as Verma’s chief of staff at CMS — despite Verma's reservations that he was unsuited for the role and was being groomed to replace her.