WASHINGTON — Two of President Trump’s top health officials were stewing in a drab room at the Centers for Disease Control and Prevention in Atlanta early last month as Mr. Trump and his health secretary, Alex M. Azar II, were concluding a laboratory tour, one that they had been left off.
One of the officials, Dr. Jerome M. Adams, the surgeon general, was then invited to join the president and the secretary to shake hands. The other, Seema Verma, who heads the Centers for Medicare and Medicaid Services, was not. Instead, a staff member told the powerful Medicare chief to head to the receiving line with the rank-and-file. Furious, she left for the airport to catch a commercial flight home to Washington.
The episode from March 6, described by senior administration officials who believed Mr. Azar was behind the snub, illustrated to them why Mr. Azar’s future as secretary of health and human services is a constant question, even as his sprawling department battles the worst public health crisis in a century. Where Mr. Azar goes, personal conflicts seem to follow, senior administration officials say. Officials at the Department of Health and Human Services disputed that notion.
The department’s newly installed spokesman, Michael R. Caputo, dismissed such talk as beside the point.
“I can tell you that the American people want information they can use to fight the coronavirus, not palace intrigue,” he said.
But even before the coronavirus pandemic, senior White House officials had grown deeply frustrated with Mr. Azar and his management of the department.
Now, Mr. Azar finds himself increasingly sidelined by the president and his advisers, who blame the secretary for early failures on testing and for what they describe as inconsistent stewardship of the coronavirus task force in its first month.
But Vice President Mike Pence took over for Mr. Azar as the leader of the task force at the end of February, and in the weeks since the episode at C.D.C. headquarters, Mr. Azar has been excluded from key coronavirus meetings, administration officials say, including one led by Mr. Grogan and another involving only the nation’s top medical officials.
“These are all arguably people who theoretically report to him, work for him, but like everything else, that has been upended in this administration, where it isn’t very clear if cabinet secretaries are choosing or even co-choosing their top political appointees,” said Kathleen Sebelius, a health and human services secretary under President Barack Obama. “I don’t have any idea how you operate in that environment when you’re excluded from meetings with your agency.”
Aides to Mr. Azar say he remains fully in charge of his department and is an integral part of the administration’s response to the virus. White House officials continue to dismiss questions about his status.
“Even with the president’s tweet on Sunday flatly denying rumors that Secretary Azar is on his way out or that he is doing anything other than an excellent job, the media is still focused on outrageous claims of palace intrigue that are only meant to distract the American people from the Trump administration’s bold leadership in response to this pandemic,” Judd Deere, a White House spokesman, said.
But the monthslong coronavirus crisis has exacerbated deep and longstanding divisions between Mr. Azar, a former pharmaceutical executive, and political officials in other parts of the administration, including some of those closest to Mr. Trump in the White House.
In the last several weeks, the president himself grew angry with Mr. Azar after stories in The Washington Post and The New York Times depicted the White House as being slow to respond to the coronavirus outbreak, according to several officials familiar with his thinking. They said Mr. Trump was enraged that he was being criticized in accounts that portrayed Mr. Azar as having been aggressive in responding to the threat early.
Mr. Azar’s allies say he was among the only people who tried to alert the West Wing to a looming public health crisis in January and early February. They note that some officials accused Mr. Azar of being “an alarmist” for his repeated warnings about the coronavirus at a time when Mr. Trump was publicly playing down the threat.
But others have said Mr. Azar was not clear enough with Mr. Trump about the magnitude of the threat. Several aides to the president said that Mr. Azar was so focused on keeping his job and preserving his standing in the White House that he gave conflicting information — dire one day, optimistic the next — that ended up confusing Mr. Trump and his senior advisers.
The incident at the C.D.C. headquarters has also reverberated with White House and health officials, some of whom saw it as an example of Mr. Azar’s pettiness. Ms. Verma had made a special effort to get to Atlanta, after traveling the day before with Mr. Pence, catching up to the president after his tour had been canceled, then abruptly put back on his schedule.
But she was left off the president’s tour, which unfolded on national television. Mr. Azar stood with Mr. Trump, who wore a red “Keep America Great” hat produced by his re-election campaign, and Dr. Robert R. Redfield, the director of the C.D.C., for almost an hour as the president extolled his administration’s work, while Ms. Verma and Dr. Adams were nowhere to be seen. To then be told to join a receiving line with other guests waiting to shake Mr. Azar’s hand infuriated Ms. Verma.
One senior administration official, who asked not to be identified in order to discuss the events, insisted that Mr. Azar had no knowledge of the staging of the C.D.C. event, and that it was dictated by White House advance officials.
Mr. Azar remains a member of the primary coronavirus task force and continues to be an active participant in the group’s meetings, though for weeks he has not appeared regularly alongside the president or vice president during the daily news conferences held afterward. In recent weeks, Mr. Azar has also made fewer national media appearances, which are coordinated through Mr. Pence’s office.
He has also been missing from the “operational check-ins” held before the task force’s meetings where officials organize and prepare. The gatherings in the Roosevelt Room are led by Mr. Grogan and include the heads of the key health agencies within Health and Human Services, including the C.D.C., the National Institute of Allergy and Infectious Diseases and the Food and Drug Administration.
Mr. Grogan has told associates that he purposefully excluded Mr. Azar, according to one senior administration official.
Mr. Azar is not a part of the regular meetings of a group of the administration’s senior health officials with medical degrees, including Dr. Anthony S. Fauci, the federal government’s top infectious disease expert, and Dr. Deborah L. Birx, the White House’s coronavirus response coordinator.
“If you don’t have the health secretary as the lead, it’s very unclear who is the lead,” Ms. Sebelius said.
The recent tensions have prompted White House officials, including Mark Meadows, the new chief of staff, to discuss possible replacements for Mr. Azar once the coronavirus crisis stabilizes, according to senior administration officials. Among the names discussed have been Ms. Verma, Dr. Birx and Dr. John C. Fleming, a former House Republican and H.H.S. official who is now an aide to Mr. Meadows.
But some of Mr. Trump’s aides cautioned that advisers had gotten ahead of themselves by putting out word that Mr. Azar could be replaced in the coming weeks. Senior administration officials say the president will most likely wait until the summer to make a change, once the immediate crisis has diminished, if he makes one at all before the election.
Mr. Azar has told several administration officials that he wants to leave his post on his own terms.
But if Mr. Azar is removed, it will not just be the result of concerns about the administration’s response to the coronavirus. Mr. Grogan fought regularly with Mr. Azar over efforts to lower prescription drug prices, an issue Mr. Trump sees as central to his health agenda.
Mr. Trump also blamed Mr. Azar for aggressively pushing for a partial ban on flavored e-cigarettes, a decision the president made in January and then quickly regretted, advisers said. He berated Mr. Azar about it in a call on Jan. 16 in front of his political advisers.
Mr. Azar’s well-documented battles with Ms. Verma now extend to which of them is seen as controlling the distribution of congressionally approved money to health care providers. While Mr. Azar attended the funeral for his father earlier this month, officials in Mr. Pence’s office signed off on Ms. Verma making the announcement, a White House official confirmed. The official said that Mr. Pence was acting out of a desire to get the money out the door, not to slight Mr. Azar.