William Pierce
William Pierce

To many, Washington has never looked so dysfunctional. For nearly a decade, the healthcare agenda has reflected this political reality. However, new leaders with well-honed communication and management skills have helped return the agenda to near normalcy.

For those entrenched in the world of healthcare, it’s hard to remember a time of regular order since the passage of the Affordable Care Act. From its passage, legal challenges, implementation difficulties, constant attacks by Republicans to last summer’s “repeal and replace” effort by the Trump Administration and the Republican-led Congress, the landmark health care bill has been symbolic of the industry’s turbulence and that of the greater political landscape. However, since the late Senator McCain’s deciding vote on repeal and replace last summer, things have been relatively quiet.

Are we returning to a more “regular order?”

Jennifer Sunshine
Jennifer Sunshine

Recent developments at HHS provide a partial explanation why the healthcare agenda has calmed somewhat despite the continued disorder in other areas of government. In becoming HHS Secretary, Alex Azar brought with him six years of experience at the Department as the former General Counsel and Deputy Secretary and over a decade of management experience leading Eli Lilly’s US business. Upon confirmation Azar quickly asserted his leadership, put a clear agenda in place and set about managing the department. It was all made easier by the fact there were strong leaders in key positions including Dr. Scott Gottlieb at the FDA, HHS Deputy Secretary Eric Hargan and Dr. Francis Collins at NIH.

That’s not to say there haven’t been political fire drills. The separation of immigrant families at the border dominated headlines for months and placed an immense responsibility on Azar and HHS to communicate the administration’s response to the agency and public. All the while he was working to advance the mission of the department and his agenda. Similarly, FDA officials have seen great public pressure to address rising prescription drug costs and the opioid crisis. Despite these challenges, Azar and Gottlieb have seemingly managed to control the narrative of these events, while also carrying out the critical missions of their organization.

But for Republicans, there is a challenge on the horizon – the November elections. If Democrats gain control of the House, it is universally expected they will use their new-found chairmanships to initiate and conduct investigations of policy decisions, programs and regulations -- including ACA implementation and drug pricing issues. Additionally, a Democratic house majority could pass legislation that supports their agenda by shoring up the ACA and maybe even drug reimportation and/or government negotiation of drug prices in Medicare. Of course, as long as Republicans continue to control the Senate, most legislation will go no further than the House, though it is the investigations that could provide strong political resonance.

Given this scenario, the question is can this return to “regular order” last? Time – and events -- will tell.


William Pierce has over 30 years in health care policy and media experience including working for two members of Congress and being the spokesman for HHS from 2001-2005. He has worked at APCO Worldwide since 2005.

Jennifer Sunshine has 17 years’ experience in health care policy and regulatory affairs including working for two leading healthcare trade associations and advising clients at CMS, FDA, and VA on various Congressionally mandated health initiatives.