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December 10, 2019

A 'deep rift' between Azar, Verma is affecting Trump health policy, sources claim

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    In an exclusive published late last month, Politico reports that a "deep" rift has emerged HHS Secretary Alex Azar and CMS administrator Seema Verma in recent months between that sources say has delayed some of the Trump administration's health care initiatives, including an Affordable Care Act (ACA) replacement plan.

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    Sources report contention between Azar, Verma

    Based on interviews with more than a dozen current and former officials at HHS, CMS, and the White House—each of whom requested anonymity, according to PoliticoPolitico in the exclusive described growing tensions between Azar and Verma.

    The officials told Politico that Azar and his top aides have tried to block Verma from decision making in an effort to reduce her influence at the department, Politico reports. For example, officials said Azar's and Verma's aides have clashed over which official should "tak[e] high-profile speaking engagements, how to announce agency priorities, and who gets to decide personnel matters such as promotions and the hiring of top aides," according to Politico.

    For instance, six officials told Politico that Azar tried to prevent Verma from traveling with President Trump to Florida on Air Force One in October to announce Trump's recent executive order regarding Medicare, even though CMS had largely developed the order. Verma ultimately did travel with Trump to the event, and HHS has disputed the report that it had tried to block her from doing so, Politico reports.

    According to Politico, unnamed senior officials in the administration also said the rift between Azar and Verma has delayed some of the administration's top health care initiatives.

    For instance, officials told Politico that Verma had spent about six months creating a plan called for by Trump to replace the ACA, but Azar earlier this year rejected the proposal before Verma could present it to Trump. According to the officials, Azar thought the plan was too costly and would bolster the ACA. Azar's decision "sen[t] the administration back to the drawing board," Politico reports.

    Three officials also told Politico that Verma during a meeting at the White House with Trump, Azar, and senior administration officials criticized a drug pricing proposal that Azar had been championing for three months. The officials said Verma's critiques aligned her with other White House officials who have challenged Azar on several policies, and the White House ultimately "shelved" the proposal, Politico reports.

    Axios' "Vitals" reports that "tensions" between Azar and Verma "got so bad at the end of the summer that HHS brought in a third-party lawyer to investigate" claims of sex discrimination that Verma had made against Azar. However, Heather Flick, a lawyer who had previously worked at HHS under Trump, found the claims were unsubstantiated. Flick told Axios, "I found no evidence supporting allegations of sex discrimination at HHS."

    Ultimately the infighting has "sidetracked one of the biggest arms of the federal government," Axios reports. One official told Politico, "The amount of time spent dealing with things like this, and having to have these fights and have these issues, are time that could've been spent thinking of better drug pricing proposals or other ways to advance parts of the agenda."

    HHS denies reports of clashes between Azar, Verma

    For its part, HHS has denied reports of clashes between Azar and Verma.

    HHS spokesperson Caitlin Oakley last month called the reports "absurd." She said, "As the head of [HHS], which includes CMS as an agency, … Azar is working positively and productively with all operating and staff divisions to advance [Trump's] agenda and deliver real results for the American people."

    A CMS spokesperson "did not directly respond to questions about [Azar's and Verma's] working relationship," Politico reports. The spokesperson told Politico, "Under [Trump's] bold leadership to put patients first, CMS has a record number of initiatives aimed at transforming the health care system to deliver access to low cost, high quality care, and improved health outcomes for all Americans." The spokesperson continued, "Advancing [Trump's] health care agenda is [Verma's] number one priority and focus."

    Clashes spur action from Trump, Pence

    However, three individuals with knowledge of the matter have said Trump, himself, is aware of and has tried to quash "the long-running feud," Politico reports.

    According to Politico, two individuals said Trump met with Verma privately in mid-November to discuss the issues. Trump around that time told Azar to try to fix his working relationship with Verma, sources told Politico.

    Verma also recently met with Vice President Mike Pence, who is "one of [Verma's] strongest backers in the White House," regarding the issues, Politico reports. Two administration officials told Axios that, at Pence's request, Azar last week had a meeting with Verma to try to resolve the matter, and Verma during the meeting raised concerns about Azar's leadership style. A source familiar with the meeting told Axios that Azar and Verma agreed to try to better their working relationship, and Azar said he would address Verma's concerns going forward.

    According to Politico, "Neither Azar nor Verma's job is believed to be at immediate risk." A senior official told Axios that Trump has told Azar he "is fond of both [Azar and Verma] and he expects them to work together on what could easily be a signature issue in 2020 for him."

    Verma seeks federal reimbursement for stolen property

    Meanwhile, documents obtained by Politico show that Verma in 2018 filed a request asking HHS to reimburse her $47,000 for uninsured property that was stolen earlier that year during a work-related trip. According to Politico, the property included clothing, jewelry and other possessions.

    HHS ultimately reimbursed Verma $2,852.40 for the stolen property, according to a CMS spokesperson.

    An HHS spokesperson said the department has long had a policy of reimbursing staff for certain goods lost during a work-related trip, as long as the goods "are not inherently for other uses." The spokesperson explained, "When paying for such goods, the department pays a discounted rate based on age for the items that were lost." The spokesperson continued, "It's perfectly appropriate that [Verma] filed a personal property loss claim for goods stolen while on work travel and this is not an unusual practice for federal employees" (Pradhan et al., Politico, 11/26; Swan/Owens, Axios, 12/6; Owens, "Vitals," Axios, 12/9; Swan/Owens, Axios, 12/5; Diamond et al., Politico, 12/5; Diamond, Politico, 12/7).

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