President Trump is flanked by HHS Secretary Alex Azar and CMS Administrator Seema Verma at an event in July. Photo: Alex Wong/Getty Images

The working relationship between the Trump administration's top health officials, HHS Secretary Alex Azar and CMS Administrator Seema Verma, has grown so dysfunctional that both President Trump and Vice President Pence have intervened to try to salvage the situation, according to three senior administration officials.

Why it matters: It's an extraordinary intervention at the highest levels of government. And it highlights, as Politico extensively reported, the White House's urgent desire for the heads of Health and Human Services and the Centers for Medicare and Medicaid Services to repair their working relationship.

Behind the scenes: Azar had a clearing of the air meeting with Verma on Wednesday, at Pence's request, according to two administration officials. This wasn't the first time the White House had to intervene to fix this broken relationship at the top of HHS.

  • On Nov. 15, at the White House event on price transparency, Trump challenged Azar about his troubled working relationship with Verma, per two senior administration officials.
  • The president had made clear, according to a third administration official, that he "is fond of both of them and he expects them to work together on what could easily be a signature issue in 2020 for him."
  • “He just wants them to figure it out between themselves and get the work done,” per a fourth source familiar with the president’s view of the situation.

The tensions between the two officials have already disrupted the rollout of health care initiatives that Trump's team considers important for his reelection.

  • This includes the delay of the administration's Affordable Care Act replacement proposal, which Verma spent six months developing only to have Azar kill it before it reached the president, Politico reported.
  • This Laura Ingraham tweet, in which the Fox host attacked Verma the day the Politico story came out, caught the attention of senior administration officials. Administration officials regard Ingraham — who has lavished praise on Azar — as a staunch ally of the HHS secretary.

At their meeting on Wednesday, Verma raised her concerns directly with Azar about his leadership style. The two officials agreed to try to work better together and that her concerns would be addressed and mitigated going forward, a source familiar with the meeting added.

  • “These concerns are predominantly about media rollouts and in some cases staffing issues that are not reflective of a leadership or management style,” another source familiar with the meeting pushed back. “They are individual instances that are petty and not reflective of a larger leadership or management style.”

HHS, CMS and the White House did not provide a comment.

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