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February 6, 2019

The health care pledges from Trump's State of the Union

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    President Trump during his State of the Union address Tuesday night challenged the United States to end HIV/AIDs transmissions by 2030 and called on Congress to pass legislation to lower prescription drug prices, fund research for new childhood cancer treatments, and more.

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    Trump announces goal to end US HIV/AIDS epidemic by 2030

    Trump during his address unveiled a new goal to eliminate new transmissions of HIV/AIDS in the United States within the next 10 years. Trump said recent scientific advancements have brought "a once-distant dream" of eliminating HIV/AIDS "within reach."

    Trump said he plans to ask Congress for funding for the initiative in his upcoming budget proposal. HHS Secretary Alex Azar later explained that Trump's goal is to reduce the number of new HIV infections in the United States by 75% over five years, and "end the HIV epidemic in America" by 2030.

    Trump's plan will focus on increasing HIV prevention efforts in communities with the highest rates of HIV, as well as increasing access to treatment for U.S. residents currently living with HIV, The Hill reports. Specifically, Trump administration officials said the plan will center on 48 U.S. counties where about 50% of new HIV infections emerge, according to the New York Times.

    Under the plan, the Trump administration will bring community health workers to the counties to help with the prevention, diagnosis, and treatment of HIV infections. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said the administration's campaign will focus on providing U.S. residents in the 48 counties with increased access to antiretroviral drugs to treat HIV, and pre-exposure prophylaxis to prevent the spread of HIV infections.

    Trump calls on lawmakers to lower US drug prices, increase price transparency

    Trump during his address said, "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, unfair, and together we will stop it. We will stop it fast." He added, "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."

    For example, Trump called on federal lawmakers to pass legislation that would better align U.S. and international drug prices, Forbes reports. Trump did not provide details on how lawmakers should implement such a change, but his administration in October 2018 released a proposal that would align Medicare payments for certain Part B drugs with prices paid in certain other countries, according to The Hill. Trump's proposed "international pricing index model" has faced some pushback from lawmakers and pharmaceutical industry members who see it as a form of price fixing that could stifle innovation, CNN reports. 

    Trump also called on federal lawmakers to pass legislation that would require hospitals, insurers, and manufacturers to "disclose real prices" for their services and products to the federal government "to foster competition and bring costs down." According to Modern Healthcare, Trump did not provide specific details on how his administration would like those price disclosures implemented. CMS in January implemented a rule that requires hospitals to post a list of their standard charges online, but the rule lacked clear guidance on what the lists should contain, and industry observers have said the posted information is hard to decipher.

    While Trump made clear there was more work to be done, he noted that 2018 saw the "single largest decline" in U.S. drug prices in the past 46 years thanks to policies his administration put in place. However, CNN reports that the figure cited is "misleading" because it refers to the annual change in the consumer price index for prescription drugs, which fell 0.6% from December 2017 to December 2018. CNN reports that CPI can vary greatly each month, and some experts have said it is no longer the best way to measure changes in the prescription drug market.

    Trump calls for $500M to fight childhood cancer

    Trump also called on Congress to allocate $500 million over 10 years to fund research on childhood cancer, saying such an initiative is one "all Americans can get behind."

    Trump referenced 10-year-old cancer survivor Grace Eline, who attended the address as one of his guests. "You are a great inspiration to everyone in this room," he said to Eline.

    However, Trump noted that there has been few new therapies targeting childhood cancers in recent years, and said the funding could help drive new innovations. He said he intends to include the $500 million in funding in his annual budget request to Congress, which the White House typically releases in February, the Washington Examiner reports.

    Trump says Congress should ban late-term abortions

    Trump during his address also called on federal lawmakers to pass legislation banning late-term abortions, which are currently permissible under the Supreme Court's Roe v. Wade decision, Reuters reports.

    Late-term abortions often are defined as those occurring after 20 weeks of pregnancy. According to the Guttmacher Institute, 17 states have banned abortions after 20 weeks of pregnancy based on the belief that fetuses can feel pain at that point. However, scientific consensus does not support that claim. For instance, a comprehensive study published in 2005 in JAMA found that the fibers needed to feel pain begin to develop between 23 and 30 weeks' gestation. Studies on premature infants similarly indicate they are not able to feel pain until 29 or 30 weeks' gestation. A statement written in 2015 on behalf of the American Congress of Obstetricians and Gynecologists reads that "no research since its publication has contradicted its findings."

    Trump in his speech noted that New York Gov. Andrew Cuomo (D) last month signed a bill into law that allows abortions after 24 weeks of pregnancy if a woman's health or life is at risk. Trump said, "To defend the dignity of every person, I am asking the Congress to pass legislation to prohibit the late-term abortion of children who can feel pain in the mother's womb."


    Many observers praised Trump for the health care initiatives he outlined in his address.

    Rep. Raja Krishnamoorthi (D-Ill.) called Trump's comments on health care pricing a high point of his address. Krishnamoorthi said, "I thought that was a good moment in the speech, I thought that to the extent that he follows through we maybe have an opportunity to make a deal." However, Krishnamoorthi noted that Trump did not provide "specifics." Krishnamoorthi said, "I wish he would have talked about negotiation under Medicare Part D, I wish he would have talked about reducing obstacles to generics, I wish he would have talked about transparency to pricing."

    Senate Finance Committee Chair Chuck Grassley (R-Iowa) said, "Trump's call for greater transparency in health care should be a no-brainer. I expect deep-pocketed interests to oppose anything and everything to protect the status quo. But the moment is ripe for action and Americans expect us to work together to get the job done."

    However, some observers raised concerns over Trump's call for federal lawmakers to align U.S. and international drug prices, and several groups pointed to research indicating U.S. drug prices have continued to rise in 2018.

    Patrick Hedger, director of policy at the FreedomWorks Foundation, said, "America remains the leading engine for pharmaceutical investment and innovation and this cannot be sacrificed as part of health care reform. [Trump] and Congress should focus their efforts on continuing to reduce regulations on pharmaceutical companies and encourage competition in a free American marketplace."

    While observers welcomed Trump's commitment to ending the HIV/AIDS epidemic, many also noted that Trump's goal to eliminate HIV/AIDs in the United States does not align with some of his administration's actions. For instance, they said Trump has reduced funding for domestic and global HIV/AIDS programs.

    For example, Gregg Gonsalves, professor of epidemiology at the Yale School of Public Health and a former HIV/AIDS activist, said Trump's goal is achievable, but he raised concerns about steps the administration has taken, such as allowing states to implement Medicaid work requirements, that could reduce U.S. residents' access to health care and inhibit HIV/AIDS patients' ability to get the treatment they need to prevent transmitting the disease.

    Regarding Trump's call for Congress to ban late-term abortions, Cuomo in a New York Times opinion piece defended his decision to enact a law that allows certain women to receive abortions after 24 weeks of pregnancy. He wrote that the law "guarantees a woman's right to abortion in the first 24 weeks of a pregnancy or when the fetus is not viable, and permits it afterward only when a woman's life or health is threatened or at risk." He added, "Contrary to what its detractors claim, the [law] does not allow abortions minutes before birth, nor does it allow third-trimester abortions 'for any reason."'

    Kristin Brandi, an obstetrician-gynecologist and a board member of Physicians for Reproductive Health, said the administration is "using … theoretical extreme examples to try to scare people" about abortions.

    The American Cancer Society Action Network praised Trump's call for additional funding for research into childhood cancers. Lisa Lacasse, the group's president, noted, "Cancer remains the leading disease-related cause of death among U.S. children." She said, "Federally-funded cancer research is the engine that drives ongoing progress in the fight against pediatric cancers," and she called "on Congress and the administration to … ensure childhood cancer research remains a national priority" (Weixel, The Hill, 2/5; Luthi, Modern Healthcare, 2/5; Japsen, Forbes, 2/5; Gooch, Becker's Hospital CFO Report, 2/5; Hellmann, The Hill, 2/5; Pear, New York Times, 2/5; Belluz, Vox, 2/5; Siddon, CQ News, 2/5 [subscription required]; Brice/Chiacu, Reuters, 2/5; Higgins, CNBC, 2/6; Reilly, Time, 2/6; Cuomo, New York Times, 2/6; Leonard, Washington Examiner, 2/5; Tubman, Yahoo News, 2/5; Roza, Inside Health Policy, 2/6 [subscription required]); Lybrand et al., CNN, 2/6).

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