By Julie Rovner February
6, 2019
It was not the centerpiece, but health
was a persistent theme in President Donald Trump’s State of the Union address
at the Capitol on Tuesday night.
Although the administration has focused
more on issues of trade, taxes and immigration, the president laid out a series
of health-related goals, including some that even Democrats indicated could be
areas of bipartisan negotiation or compromise. Trump vowed to take on
prescription drug prices, pursue an end to the HIV epidemic and boost funding
for childhood cancers.
He also took a victory lap for goals
promoted by his administration that had been accomplished. “We eliminated the
very unpopular Obamacare individual mandate penalty,” he said, referring to the
requirement in the Affordable Care Act that most people must have health
insurance or pay a fine. It was eliminated as part of the 2017 GOP tax bill,
despite backlash from critics that it could undercut Obamacare, after many
failed attempts by Republicans to repeal the law.
And Trump noted congressional passage
of a “right to try” bill that was supposed to make it easier for terminally ill
patients to gain access to experimental medications, but so far few patients have
been able to make the law work for them.
The most likely ground for
bipartisanship will be the issue of drug prices, where Democrats are as eager
as the president to do something to rein in prices that are spiraling upward.
“It is unacceptable that Americans pay
vastly more than people in other countries for the exact same drugs, often made
in the exact same place. This is wrong, this is unfair, and together we will
stop it. We will stop it fast,” he said. “I am asking the Congress to pass
legislation that finally takes on the problem of global freeloading and
delivers fairness and price transparency for American patients.”
Democrats are cautiously optimistic on
the drug price front. “I really am hopeful about making strides on prescription
drug legislation this year on a bipartisan basis,” Wendell Primus, top health
aide to House Speaker Nancy Pelosi, said at a conference for health policy
researchers hours before the speech.
But not all of Trump’s claims Tuesday
about his efforts on drug pricing stand up to close scrutiny. He proclaimed
that “in 2018 drug prices experienced their single-largest decline in 46
years.” The drug-price portion of the consumer price index (CPI) declined
slightly last year for the first time since 1972, but prices for many individual
drugs are still rising sharply.
Factors beyond the administration’s
actions appear to have played the biggest role in the overall slowdown. Drug
price increases have slowed largely because patents have expired on expensive,
blockbuster drugs and several years have passed since the introduction of
expensive medicines to treat hepatitis C, according to independent analysts.
But even as consumer drug prices have
moderated, drug spending per hospital admission soared 19 percent from 2015 to
2017, a study sponsored by hospital trade groups found last month. That
includes anesthesia drugs, chemotherapy infusions and other medicines that are
not counted in the CPI.
Some well-placed Republicans praised
the drug price effort. “I expect deep-pocketed interests to oppose anything and
everything to protect the status quo,” said Sen. Chuck Grassley (R-Iowa),
chairman of the powerful Senate Finance Committee. “But the moment is ripe for
action and Americans expect us to work together to get the job done.”
News organizations including Kaiser
Health News have reported on dozens of cases of surprise hospital bills,
unaffordable costs for life-sustaining drugs and other health-expense shocks
for patients. Shereese Hickson, whose experience with a $123,000 bill for
multiple sclerosis drugs was covered by KHN and National Public Radio, was
watching the speech.
“I’m glad he mentioned it,” she said of
Trump’s promise to bring transparency and competition to pharmaceutical prices.
“But I would like to see if it really will come true. If you do that — that’s
going against the drug companies. They’ll be losing money and they’re not going
to let that happen.”
Paul Davis — a retired doctor from
Findlay, Ohio, whose family’s experience with a $17,850 bill for a simple urine
test was detailed in a KHN-NPR “Bill of the Month” feature
last year and who met with Trump about surprise billing last month — said he
was disappointed Trump did not go into further detail about his health care
proposals.
“He didn’t say anything,” he said.
Davis said he would have liked to have
heard more about the administration’s recently announced plan to eliminate drug
rebates negotiated by middlemen in the Medicare drug program, as well as the
recently implemented policy requiring hospitals to list their prices online.
“If he wanted to use the podium to talk
about the wonderful things that he’s done, that’s one of the things he’s gotten
accomplished,” Davis said.
In their official responses to the
speech, Democrats were more combative. “In this great nation, Americans are
skipping blood pressure pills, forced to choose between buying medicine or
paying rent,” said Stacey Abrams, former Georgia House minority leader and a
rising star in the national Democratic Party. “Maternal mortality rates show
that mothers, especially black mothers, risk death to give birth. And in 14
states, including my home state where a majority want it, our leaders refuse to
expand Medicaid, which could save rural hospitals, economies and lives.”
California Attorney General Xavier
Becerra, who gave the Spanish-language Democratic response, reminded viewers
that while the Trump administration is seeking to have the Affordable Care Act
overturned in court, Democrats would provide “medical care for your family that
no politician can take away from you.”
In another outreach to Democrats, Trump
vowed that his budget “will ask Democrats and Republicans to make the needed
commitment to eliminate the HIV epidemic in the United States within 10 years.
Together, we will defeat AIDS in America,” he said.
Groups that have been fighting HIV
praised the promise.
“While we might have policy differences
with the president and his administration, this initiative, if properly
implemented and resourced, can go down in history as one of the most
significant achievements of his presidency,” said Michael Ruppal, executive
director of The AIDS Institute.
Trump also promised that his budget,
which has been delayed by the recent government shutdown, will seek new funding
to expand research into cures and treatments for childhood cancer.
He said he will seek “$500 million over
the next 10 years to fund this critical lifesaving research.” The National
Institutes of Health has long been a bipartisan favorite in Congress, although
Trump in his first budget did seek cuts in NIH funding.
The one area in which bipartisanship
will clearly not prevail is that of abortion. Trump reiterated a promise he
made to anti-abortion groups as a candidate in 2016 and pushed for a federal
bill to ban abortions after 20 weeks of pregnancy.
“Let us reaffirm a fundamental truth:
All children — born and unborn — are made in the holy image of God,” he said.
Senate Republicans voted on such a bill
in 2018; it failed to advance by a large margin.
The bill still lacks the votes in the Senate, and the House now has a majority
that supports abortion rights.
Abortion opponents praised the
president’s comments. “Once again, President Trump has proved he is our
nation’s most pro-life president ever and he is keeping his promise to the
voters who fueled his victory,” said Marjorie Dannenfelser of the Susan B.
Anthony List.
Abortion-rights supporters, meanwhile,
chastised Trump’s comments.
“Shame on the president for using the
State of the Union to vilify people who have abortions and the providers who
care for them,” said Megan Donovan of the Guttmacher Institute. “Make no
mistake: This is part of a larger agenda to eliminate access to abortion
altogether.”
Staff writers Jay Hancock, Emmarie
Huetteman and Ana B. Ibarra contributed to this report.
Julie Rovner: jrovner@kff.org, @jrovner
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