Meet the 24 most powerful people advising Trump on healthcare as the president vies for a second term
Summary List Placement
President Donald Trump released a seven-point agenda on healthcare for his second term, and a four-point list of goals for ending the coronavirus pandemic by 2021. During his presidency he has leaned on several players to craft the details of healthcare policy, whether it be in Congress, within his administration, or outside of it. Democrats think they have the edge on healthcare, and are running against Trump's record on handling the coronavirus pandemic — and his attacks on the Affordable Care Act — heading into Election Day. For more stories like this, sign up here for our healthcare newsletter, Dispensed.
President Donald Trump's healthcare agenda for a second term is laid out in just seven bullet points. It's a contrast to the detailed policy proposals put out by his Democratic rival, Joe Biden. If elected to the White House for another four years, among Trump's promises are to end surprise medical bills, cut prescription drug prices, and lower premiums for health insurance. Left out of the list is a promise he made in 2016 to repeal and replace the Affordable Care Act, commonly known as "Obamacare." Trump hasn't been able to keep that promise, though the ACA looks different than it once did. Trump signed a bill into law that zeroed out a fine for going without insurance, and his administration allowed people to sign up for cheaper plans outside of the ACA's rules. Still, the threat to the healthcare law isn't gone. The Trump administration is siding with GOP states in a lawsuit that threatens to unravel the healthcare law — a lawsuit that will head before the Supreme Court only one week after Election Day. Democrats, including Biden, frequently raise the president's attacks on the ACA when trying to make their own case to voters. But perhaps the biggest threat to the president's reelection is the coronavirus pandemic. More than 189,000 Americans have died from COVID-19, the disease caused by the coronavirus, and 6.3 million people have been infected. The latest Kaiser Family Foundation Tracking Poll finds that 61% of voters disapprove of Trump's handling of the pandemic and 35% approve. In his public remarks, the president has shifted the blame for the outbreak to China, where the virus started. He has pressured agencies to quickly create and authorize treatments and a vaccine. In his agenda document, he says he wants to bring the US back to normal by 2021. Read more: These are the most powerful people advising Joe Biden on healthcare and the coronavirus as he takes on Trump As Trump strives toward that goal, there are people in and outside his administration who are shaping his thinking and actions. It's been widely reported that the president is influenced by whoever he talks to last, but there are also close allies he has allowed to take the lead on certain healthcare policies, including his vice president, Mike Pence. Influential Trump administration officials, such as Health and Human Services Secretary Alex Azar, frequently urge the public to pay attention to the president's initiatives outside of the ACA: those to combat the spread of HIV, to reduce opioid overdose, and to help people on dialysis. During his presidency, Trump has leaned on Republicans in Congress to craft policies on ACA replacements and on prescription drugs, and many members of his administration have close ties to conservative think tanks like the Heritage Foundation and the Galen Institute. Insider has assembled a list of people who've helped to shape the president's policies during his time in office and who are likely to continue having influence if he wins a second term. We did a look back at the policies he has passed during the last few years and also spoke with people close to the White House and the Trump campaign. The list is in alphabetical order. Read more: The Trump administration is taking ideas from rural communities to transform healthcare. We got an early look at the project.As the nation's top doctor, Dr. Jerome Adams raised awareness about the opioid crisis.
Before the coronavirus pandemic, Surgeon General Jerome Adams was primarily focused on reducing the stigma of addiction. As the nation's top doctor, he urged the public to view addiction as a disease and has openly shared that his brother has a drug addiction. He advised more Americans to stock the opioid overdose-reversal drug, naloxone. When Trump came to office, the drug-overdose crisis — driven by opioid use — was considered the largest public health threat facing the US. It had a death toll of more than 63,600 people in 2016. Now, Adams is one of the members of the coronavirus task force. He has come under fire for initially saying people shouldn't wear masks, and then reversing course when more evidence showed masks were helpful in reducing coronavirus transmission. In a recent interview with Business Insider, Adams said that structural racism and social determinants of health, including poverty, were to blame for why communities of color had been hard hit by the coronavirus. In the coming months he plans to raise awareness about hypertension and maternal mortality, both issues that disproportionately affect the Black community. Read more: The coronavirus is devastating communities of color. The Trump administration's top doctor blames 'structural racism' and shares his plans to take action. Alex Azar, Health and Human Services secretary, has shaped the president's drug pricing executive orders.
Alex Azar oversees the Department of Health and Human Services, the agency that includes the government's medical research, healthcare, and public health institutions. Azar led initiatives from the administration in areas including drug pricing, expanding health insurance options for workers at small businesses, and eliminating HIV transmission within a decade. He's also overseeing an initiative to improve care for people on dialysis, which received widespread praise when it was announced. Azar championed the executive order Trump signed in July to eliminate drug rebates negotiated by insurance middlemen known as pharmacy benefit managers. He also pushed for drug companies to post their prices in TV ads, but that's facing legal challenges. Azar's feud over health policy with Seema Verma, who oversees the Centers for Medicare and Medicaid, was part of a lengthy series of reporting by Politico. Despite the infighting, both have stayed on with the administration. Azar is a member of the Coronavirus Task Force and was initially leading it. In February, Trump handed over the authority to Vice President Mike Pence, saying Azar had many other responsibilities at HHS. Azar is a lawyer who previously worked at HHS under former President George W. Bush. From 2007 to 2017, Azar was a senior executive at pharmaceutical giant Eli Lilly. Dr. Deborah Birx oversees the coronavirus response.
Dr. Deborah Birx is coordinating the federal government's response to the coronavirus pandemic and frequently appears on news shows to talk about the virus. Birx was well-known and well-regarded in scientific circles for working on HIV/AIDS efforts, including overseeing the President's Emergency Plan For AIDS Relief that was created by George W. Bush. As leader of the coronavirus response, she pushed back against the president's effort to quickly re-open schools and warned in August that the US had entered a "more widespread" phase of coronavirus transmission. But she has also faced criticism and her advice has at times been at odds with that of the president. House Speaker Nancy Pelosi said in August that she didn't have confidence in Birx to lead the response, accusing Trump of spreading disinformation about the virus. The New York Times reported in July that Birx helped the administration downplay the long-term threat of the pandemic, thinking it would follow the same trajectory of certain European countries where the spread subsided after shut-down orders. Doug Badger is a trusted healthcare policy source on Capitol Hill.
Doug Badger is a well-respected voice in conservative healthcare policy circles who has written pieces that defend Trump's healthcare agenda and bash Democratic proposals. He's a trusted source for conservative healthcare policy among Republicans on Capitol Hill. Having sway with members of Congress is key to influencing Trump, who frequently leans on lawmakers to craft the details of his healthcare policy proposals. Badger works closely at the Galen Institute with Brian Blase, who used to coordinate healthcare policy for Trump's White House. He's also a visiting fellow at the Heritage Foundation. Previously, Badger worked on healthcare policy in the White House under former President George W. Bush, particularly on health savings accounts and on Medicare's drug program. Brian Blase was a key architect of Trump's healthcare policy agenda and has continued to champion the president's actions.
Brain Blase coordinated Trump's healthcare policy agenda and has continued to be influential since leaving the White House. While he was in the administration, Blase oversaw the implementation of three executive orders and scrutinized healthcare industry consolidation. Blase told Business Insider that he was frustrated when outside critics said the administration didn't have a healthcare plan, as he worked on a 120-page report on healthcare reform while at the White House. It made numerous recommendations for the administration and Congress. "It's not legislative text, but it's a pretty thorough reform agenda," he said. He pushed for a provision that makes it easier for employers to use health reimbursement arrangements so workers can buy their own health insurance. The provision appeals to conservatives because it allows workers to have more choice about which insurer they want and gets closer to the goal of disentangling health insurance from employment. Blase also oversaw the details of plans the Trump administration put in place that let people buy insurance outside of Obamacare's rules, including giving people the option to buy short-term heath insurance and association health plans. Since leaving the White House, he has continued to make recommendations about how the Trump administration can trumpet its health agenda and how the president could go further to change the ACA. Blase is now a senior fellow at the Galen Institute, where he focuses on healthcare policy, and is president of Blase Policy Strategies LLC. Sen. Bill Cassidy of Louisiana works with the White House on price transparency and surprise medical bills.
Sen. Bill Cassidy of Louisiana created the main plan in Congress to replace the Affordable Care Act along with Sen. Lindsey Graham of South Carolina. Trump backed the plan at the start of his term, and while it didn't gain enough support in Congress, Cassidy has remained in close talks with the White House on issues of price transparency and prescription drugs. "When I need to know about health insurance, and pre-existing conditions, and individual mandates I call Bill or I call Barrasso," Trump said in February, referring to GOP Sen. John Barrasso of Wyoming. Cassidy, who is up for re-election this year, led a bipartisan working group to craft legislation on surprise medical bills and frequently attended White House events on the subject. During this year's State of the Union address, Trump also endorsed a plan Cassidy created for paid family leave. The plan would let new parents draw early from the child tax credit. Cassidy, a gastroenterologist, has said he sees paid leave as a way to improve health outcomes. Sen. Tom Cotton of Arkansas pushed the White House to zero out the ACA's individual mandate, leading to the looming Supreme Court lawsuit.
Trump has said he considers the fine on the uninsured, known as the individual mandate, as "the absolute worst part of Obamacare." The tax bill he signed into law zeroed out the fine, and afterward Trump declared he had "essentially" repealed the healthcare law. The idea to end the individual mandate in the tax bill came from Sen. Tom Cotton of Arkansas. It was initially supposed to be a major part of the Republican ACA repeal bill, but that effort failed and GOP senators turned to tax reform instead. During the debate over the tax bill, the Congressional Budget Office incorrectly predicted that zeroing out the fine would lead to 4 million more people becoming uninsured by 2019. Though Democrats blasted Republicans as "sabotaging" the law by undoing the tax, they have not tried to re-institute the fine, which was politically unpopular. The loss of the fine is what has led to the lawsuit before the Supreme Court that threatens to throw out the entire healthcare law. GOP states who brought the lawsuit argue that the fine had been central to Obamacare and that the rest of its provisions would not work and should not stand without it. The Trump administration sided with Republican states in the lawsuit. Greg D'Angelo is associate director for health programs at the Office of Management and Budget.
Greg D'Angelo is associate director for health programs at the Office of Management and Budget. In that role, he oversees the financial allocations for all health agencies. D'Angelo was instrumental in finding a way to zero out the fine on the uninsured as part of the GOP tax bill Trump signed into law, according to OMB. The agency is the last to review regulations that come out of various health agencies, whether on telehealth expansion or on modernizing electronic health records, before they become official. D'Angelo said during a panel last year that the administration's plan to require hospitals and insurers to disclose their negotiated prices "may not be a silver bullet" but was a necessary first step to increasing competition in healthcare. D'Angelo previously was a GOP adviser in the Senate on Medicare and Medicaid. This slide has been updated to include more information about Greg D'Angelo's role. Marjorie Dannenfelser, president of Susan B. Anthony List, successfully championed rules to limit abortion access.
Marjorie Dannenfelser has called Trump the "most pro-life president in history." As head of Susan B. Anthony List, an organization that seeks to elect anti-abortion politicians, Dannenfelser has had sweeping influence on the administration's policies. And her husband, Marty, also works in the White House as a senior policy adviser. Despite calling himself "very pro-choice" before entering politics, Trump has delivered for the anti-abortion movement. Earlier this year, he became the first sitting president to speak in person at the annual March for Life rally in DC. He has appointed judges favored by the anti-abortion movement — among them two Supreme Court Justices, Neil Gorsuch and Brett Kavanaugh. On policy, his administration created exemptions from an Obama-era rule that said all health insurance companies had to provide a range of birth control without charging patients directly. He required health insurers to specify whether they cover abortions and to bill for the coverage through a separate set of premiums. He also set up a commission, made up primarily of abortion opponents, who want to limit the use of fetal tissue in government-funded medical research. Scientists are using cells derived from decades-old elective abortions to develop a coronavirus vaccine. Dr. Anthony Fauci is the leading voice educating the public about the coronavirus.
Clashes between Dr. Anthony Fauci and Trump are regularly in the news cycle — and on the president's Twitter feed. Still, the president has listened to the longtime infectious disease expert on how to handle the coronavirus pandemic. For instance, Fauci and Birx persuaded him not to re-open the economy by Easter, as he'd originally planned. In July, the White House said it didn't agree with an op-ed by Peter Navarro, trade adviser, criticizing Fauci, and Trump and Pence defended him. "I have a very good relationship with Anthony, we're on the same team," Trump said. Fauci is director of the National Institute of Allergy and Infectious Diseases, which is overseeing the development of a vaccine. From the early days of the pandemic he has frequently talked to reporters about the administration's response and what scientists are learning about the virus. He is part of the coronavirus task force, where he has advised on stay-at-home orders, mask wearing, and social distancing. A Quinnipiac University poll in July found 65% of voters said they trusted the information Fauci provided about the virus. Marie Fishpaw helped write a backup plan for Obamacare.
Marie Fishpaw is part of the Health Policy Consensus Group, which is made up of more than 100 conservative leaders. The group published the Health Care Choices Proposal as an alternative to the ACA, which would give states more control over insurance funding and regulations. The document is intended to be an alternative for Republicans in Congress to consider should the ACA be struck down by the Supreme Court or should they have full control of government again. Trump frequently lets Congress take the lead on major healthcare policy proposals. Fishpaw is director of domestic policy studies at the Heritage Foundation, a conservative research and educational institution, where she leads the development of healthcare and welfare policy at Heritage. Fishpaw has previously worked in the White House and on Capitol Hill. She served as the deputy assistant to Vice President Dick Cheney and as a senior staff member in the House's Energy and Commerce Committee. Dr. Brett Giroir leads public health initiatives.
Dr. Brett Giroir oversees public health programs for the administration, including an initiative on eliminating HIV transmission. According to Science Magazine, it was he and Azar that brought the HIV proposal to the White House. Giroir works closely with Azar as assistant secretary for health at HHS and is leading coronavirus testing efforts. Earlier this year, Giroir said the administration would be launching an effort to improve outcomes for people who have sickle cell disease, a blood disorder. He also works on initiatives to reduce drug overdoses in the US. Dr. Scott Gottlieb is a trusted adviser in Trump's inner circle.
Dr. Scott Gottlieb was commissioner of the Food and Drug Administration and continues to be influential to Trump's thinking. He began advising Trump during his campaign and worked on his transition team. When Gottlieb was at FDA, he cracked down on e-cigarettes and had the opioid Opana ER withdrawn from the market because people were injecting it for illicit use. A record number of cheaper, generic drugs were authorized under his leadership. Despite no longer being part of the administration, Gottlieb frequently appears on network shows and writes commentary pieces about the coronavirus pandemic response. He's informally advising the White House on its response. Gottlieb has defended the FDA from Trump's allegations that its workers are politically motivated. Despite sometimes clashing with the administration's message, he's still highly regarded by Trump and by those in the White House. Politico has referred to Gottlieb as the "shadow coronavirus czar." Sen. Lindsey Graham of South Carolina is one of Trump's closest allies in Congress and speaks with him frequently.
Sen. Lindsey Graham of South Carolina paired up with Sen. Bill Cassidy of Louisiana to come up with a replacement plan for the ACA. Trump backed the plan at the start of his term but it didn't gain enough support in Congress. Over Trump's presidency, Graham has become one of his closest allies and personal friends. Graham, who is up for reelection this year, has told voters that if Republicans win Congress they'll take another swing at repealing the ACA. At the same time, he hasn't been shy about expressing differences with Trump, including on the coronavirus response. Joe Grogan pushed for pricing reforms on drugs and hospitals.
Joe Grogan influenced Trump's executive orders on drug prices and on increasing price transparency for healthcare. Grogan, who announced in April that he'd be resigning as director of Trump's domestic policy council, pushed for Trump to start the process of letting states import drugs from countries where they're cheaper. He also pushed for an international price index model that would tie American drug prices to those paid in Europe and other developed countries. The text of that executive order hasn't been released and the US is unlikely to implement it before the election. Grogan also pushed for a plan that would obligate hospitals to disclose their negotiated prices and pushed for modernizing electronic health records. He said in 2019 that he thought tobacco should be regulated outside of the FDA, and Trump called for such a move in his State of the Union Address. Before coming to the White House, Grogan was a lobbyist for the pharmaceutical giant Gilead Sciences, which had been under fire for the prices of its hepatitis C cure, Sovaldi, and its HIV-prevention drug, Truvada. Theo Merkel coordinates Trump's healthcare policy agenda.
Theo Merkel coordinates Trump's healthcare policy agenda in the White House. The role involves carrying out the nitty-gritty of policymaking on executive orders and rulemaking, as well as advising the president and reviewing his speeches. Merkel replaced Blase in the role in 2019, and some of his work has focused on pushing healthcare providers to disclose what they charge for medical services. Merkel previously worked on healthcare policy for GOP Sen. Pat Toomey of Pennsylvania, who worked on addressing improper Medicaid payments. In an interview with the Washington Examiner, Merkel said in that role he frequently spoke with Centers for Medicare and Medicaid Services Administrator Seema Verma about Medicaid. Sen. Rand Paul of Kentucky got Trump to pay attention to association health plans.
Sen. Rand Paul was a sharp critic of Trump when he ran for the presidency, and wouldn't support the Graham-Cassidy Obamacare replacement plan. But by late 2017 Axios was referring to the Kentucky senator as the "Trump whisperer." Paul encouraged the Trump administration to tap into association health plans as a way to give people an escape hatch out of ACA plans. The plans allow small businesses and individual workers to band together to provide medical coverage that will be less expensive than ACA insurance. The plans are allowed to include people from different states, realizing a conservative goal of providing health insurance across state lines. Vice President Mike Pence has been behind a range of hires and policy picks for Trump.
Many of Trump's healthcare priorities have been shaped by his vice president, Mike Pence. His influence can be seen through Trump's hires and policy priorities. For instance, Pence was key in bringing on Verma to lead the Centers for Medicare and Medicaid Services. She had become a close ally to Pence through her outside consulting company, where she came up with a more conservative plan to expand Medicaid in Indiana when Pence was governor. Other leaders in the administration have close ties to Pence. Adams was Indiana's health commissioner and Azar was an executive for Eli Lilly, which is based in Indianapolis. During his time in the House, until 2013, Pence supported repealing the Affordable Care Act and spearheaded efforts to try to cut federal funding from Planned Parenthood. He also was a champion of the "Right to Try" bill Trump signed into law that allows terminally ill people to request experimental drugs. As president, Trump has authorized rules that make it harder for organizations that provide abortions to accept federal family planning funds. The rules bans providers who accept the funding from directly referring for abortions and mandates that abortions happen in a separate building from other family planning services. They're being contested in court, but Planned Parenthood has stopped participating in the federal program, forgoing as much as $60 million. Trump even tapped Pence to lead his administration's coronavirus task force. Read more: 2020 isn't over yet. But these 11 Republicans are already making waves positioning themselves for 2024. Dr. Robert Redfield pushed the White House to work to end HIV transmission in a decade.
Dr. Robert Redfield paired up with Fauci to bring an initiative to Azar and Giroir to end HIV transmission in a decade. Azar and Giroir took the idea to Trump, who announced during his 2019 State of the Union Address that it would take off. Redfield is a longtime HIV researcher, and the proposal from the administration was received warmly even from Democrats. He runs the Centers for Disease Control and Prevention, which is also playing a crucial role in working to curb the coronavirus pandemic. If Trump wins a second term, the HIV initiative will continue. The Trump administration's plan was to reduce HIV transmission by 75% in five years and by 90% in 10 years. The plan rests primarily on targeting hot spots with high areas of transmission by getting people onto medication that controls the virus. It also expands prevention drugs to people at high risk of infection. Brooke Rollins oversees Trump's domestic agenda.
Trump tapped Brooke Rollins in May to oversee his domestic policy initiatives. The role isn't well known but is highly influential with the president, and involves overseeing Trump's efforts to reopen the country during the coronavirus pandemic. While Rollins isn't a healthcare policy expert, the role extends to healthcare policies on Trump's agenda. Rollins was appointed to the slot to replace Grogan, who was highly involved in shaping the president's drug pricing and transparency initiatives. These proposals will continue on into a second term. Before coming ot the White House, Rollins led the Texas Public Policy Foundation, a free-market think tank. Avik Roy's drug pricing recommendations influenced Azar's plan.
Avik Roy is a leading conservative expert on healthcare reform who also works closely with Blase. His work on prescription drug spending influenced Azar's price-reform initiatives, and a source close to the White House said officials were closely watching his recommendations for addressing the coronavirus pandemic. Roy runs the nonprofit Foundation for Research on Equal Opportunity in Austin, Texas, where he has called for free-market principles to govern universal healthcare. Roy was adviser to past Republican presidential campaigns for Marco Rubio, Rick Perry, and Mitt Romney. Grace-Marie Turner founded an influential conservative healthcare policy group.
Grace-Marie Turner founded and leads the Health Policy Consensus Group, an organization that brings together conservative ideas on healthcare policy. The consensus group comes up with ideas that they share with key decision makers in the White House, and also helps them think through their own policy ideas. Its members were involved in shaping health reimbursement arrangements, association health plans, and short-term plans when Blase worked at the White House. Turner, who is president of the conservative Galen Institute, said she works to not only provide policy advice but to connect officials with similar thinkers. The consensus group, which includes Fishpaw from the Heritage Foundation, published the Health Care Choices Proposal as an alternative to the ACA. Turner told Business Insider that the group planned to release another iteration of its proposal in March but then went back to the drawing board when the pandemic hit. "There was such a huge change to our economy and the health sector," she said. "We had to put the ideas in context of what we learned from the pandemic." The group is expected to unveil the paper after Labor Day, Turner said, and it will include recommendations to make permanent a few changes the administration made during the pandemic such as boosting the use of telemedicine and letting doctors practice across more states. Turner said the paper also will stress that people should be allowed to keep the health insurance they want regardless of what jobs they have. The document will emphasize giving states more power and patients more choice, she said. Seema Verma, administrator at the Centers for Medicare and Medicaid Services, was instrumental in allowing virtual visits during the pandemic.
As head of the Centers for Medicare and Medicaid Services, Seema Verma oversees an agency with a $1 trillion budget that funds healthcare for 130 million Americans. Verma arrived at CMS with big plans to change Medicaid, saying it should focus on the most vulnerable people. One of the main provisions she led was to allow states to require certain people on the program to work or train for work as a condition of staying enrolled. The idea faced legal challenges in states that tried to implement it. During the coronavirus pandemic, Verma led changes to telehealth. Congress gave her agency the go-ahead to act quickly to alter government regulations so that more doctors and patients could meet over phone and video visits. Now there's a huge push to make some of these changes permanent. "One thing I really have appreciated about the president is his empowerment of me," Verma said in a recent interview with Business Insider. "I've known him from the campaign and he's always said, 'Seema, go out there and do good things.'" Read more: Trump's Medicare chief has a big decision to make over whether doctors should be paid for phone calls and video visits. Here are the 3 biggest concerns she's weighing over the future of healthcare. Before joining the federal government Verma was president and CEO of SVC, Inc., a healthcare consulting firm. Russ Vought has led the Trump administration's deregulatory push.
Russ Vought is director of the Office of Management and Budget, where he goes before Congress to elaborate on Trump's budget proposal and has the final say on regulations from various health agencies. He has been one of the key people advising the president during talks about coronavirus stimulus packages with Congress, and has expressed concerns about increasing the deficit, according to the Washington Post. At OMB, Vought has pushed agencies to reduce government regulations. He helped to temporarily kill a proposal crafted by Azar that would have upended the way pharmacy benefit managers negotiate rebates for prescription drugs, saying it would have resulted in higher premiums for seniors. Trump somewhat revived the rule this summer by directing officials to take a hard look at its price tag. Previously Vought worked as the vice president of Heritage Action and worked for the Republican Study Committee.