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August 28, 2020

Weekly line: Trump's 8 health care priorities for a second term

Daily Briefing

    President Trump's campaign on Sunday released a list of second-term priorities that included eight key health care goals.

    Sept. 8 webinar: 2020 State of the Union

    The list was short on details, but Trump and other speakers at this week's Republican National Convention have touted his previous work in health care—and critics, observers, and fact checkers have weighed in as well.

    Here's what you need to know.

    Goal 1: Eradicating Covid-19

    The first health care goal is "eradicat[ing] Covid-19," which includes four steps:

    • Developing a coronavirus vaccine by the end of 2020;
    • Making critical medications and supplies for U.S. health care workers;
    • Refilling America's emergency stockpiles and preparing for future pandemics; and
    • "Return[ing] to normal in 2021."

    Throughout this week's GOP convention, several different speakers have praised Trump's response to America's coronavirus epidemic and framed him as a strong leader who would guide the nation through the crisis.

    For instance, Trump's son, Donald Trump Jr., said, "As the virus began to spread, the president acted quickly and ensured ventilators got to hospitals that needed them most. … There is more work to do, but there is light at the end of the tunnel."

    Similarly, Vice President Pence said Trump ensured that "[n]o one who required a ventilator was ever denied a ventilator in the United States." Pence also said that Trump "took unprecedented action and suspend[ed] all travel from China" before the United States saw its "first case of the coronavirus spread within the" country.

    And First Lady Melania Trump said the president "will not rest until he has done all he can to take care of everyone impacted by this terrible pandemic."

    Further, G.E. Ghali, an oral surgeon and chancellor of the Louisiana State University Health Sciences Center who survived Covid-19, praised Trump's efforts to expedite experimental treatments and tests for the coronavirus, adding, "Trump truly moved mountains to save lives."

    Trump also touted his work on accelerating experimental treatments for Covid-19, and he promised that the United States "will produce a vaccine by the end of the year, or maybe even sooner."

    However, as Politico’s Joanne Kenen writes, Trump and his administration's response to the coronavirus epidemic have faced sharp criticism from many public health experts, who've argued that America hasn't done nearly enough to curb coronavirus transmission and prevent future spikes.

    Kenen writes that the speakers notably didn't mention "that the United States [has] more than five million cases and more than 175,000 dead, with schools and businesses still closed and millions unemployed."

    Further, the New York Times' Katherine Wu writes that Pence's remarks regarding ventilators were incorrect. "Hospitals across the nation experienced ventilator shortages when inundated with coronavirus cases in the spring, prompting local leaders to plead with the federal government for assistance," Wu writes, adding, "Some hospitals resorted to pairing two patients on one ventilator—a desperate and risky measure to alleviate shortages."

    In addition, the Times' Edward Wong writes that Pence's claims regarding Trump's China travel ban were misleading. "Trump did not suspend all travel from China" initially, as the country at first allowed for "notable exceptions to the ban," including certain "American citizens and permanent residents," as well as "close family members of American citizens." Further, Wong argues that "[t]he ban was porous," as a Times "analysis of data determined that nearly 40,000 travelers arrived in the United States on direct flights from China in the two months after … Trump imposed his ban."

    Fact-checkers also criticized comments regarding accelerated Covid-19 treatments. For example, Axios' Sam Baker notes that Trump touted FDA's recent emergency use authorization (EUA) for convalescent plasma as a move that will "save thousands of lives."

    But, Baker writes, "The evidence is much thinner than that [and] clinical studies into its effectiveness are still ongoing." Earlier this week, FDA Commissioner Stephen Hahn publicly apologized for overstating the potential life-saving benefits of the experimental therapy.

    In addition, some public health experts said Trump's pledge that the United States will approve a coronavirus vaccine by the end of this year could be misguided. As STAT News' Lev Facher explains, "While it is possible that [FDA] could issue [an EUA] for a vaccine by the end of the year, it is far from a sure bet," because "no drug company has completed clinical trials for a [coronavirus] vaccine."

    The Times pointed out that Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, "has repeatedly said it will likely be the end of 2020 or the start of 2021 before it is clear whether clinical trials were successful," and "[s]ome researchers working on vaccine candidates have said getting data this year will be a real feat."

    Goals 2 and 3: Lowering prescription drug prices and health insurance costs

    Trump's daughter Tiffany Trump during remarks at this week's Republican National Convention said that her father has worked to expand access to quality and affordable health care, including by "sign[ing] Right to Try into law, the favored nations clause, and other actions to lower drug prices and keep Americans from getting ripped off."

    Kaiser Health News and PolitiFact called some of those claims "somewhat misleading." According to KHN/PolitiFact, the White House last month announced that Trump signed an executive order, "which he has referenced as the 'favored nations clause,'" that calls for establishing an international pricing index that would set Medicare's price for certain costly medications to the lowest price in other economically advanced countries. But the White House hasn't yet released the executive order's text, nor has any action occurred to implement it.

    Further, KHN/PolitiFact reported that, "[w]hile Trump has long talked about lowering drug prices as one of his top health care goals, he has made little progress in doing so, outside of issuing several executive orders that have yet to be enacted." And at the start of this year, drugmakers announced that they were increasing their list prices for at least 450 drugs sold in the United States.

    When it comes to lowering health insurance costs, Trump and his administration have taken action to increase Americans' access to short-term and association health plans, which can cost less than other health insurance options. Critics have argued, however, that they may not offer as robust coverage as other plans, such as those sold through the Affordable Care Act's (ACA) exchanges.

    Goal 4: Ensuring health coverage for preexisting medical conditions

    Notably, the list of Trump's second-term health care objectives did not mention repealing the ACA—a goal that Trump has long sought—even though his administration currently is backing a lawsuit in front of the Supreme Court that seeks to strike down the law.

    Some observers hypothesized that not including the ACA on the list was intentional, as the law enacted popular protections that prevent Americans with pre-existing medical conditions from paying more for or being denied health coverage.

    Keeping these protections in place has become a sticking point in efforts to repeal the ACA, with Republicans—including Trump—pledging that they'd reimplement such protections if the ACA ultimately is eliminated.

    But the mere mention of needing to protect health coverage for pre-existing conditions is telling. As Axios' Alayna Treene writes, "[A] promise to 'Cover All Pre-Existing Conditions' … wouldn't be necessary if [Trump] wasn't supporting a lawsuit to overturn the [ACA]."

    Goal 5: Protecting Medicare

    Trump's list also includes protecting Medicare, without further details.

    Democratic lawmakers have argued that Trump's recent calls to eliminate the federal payroll tax could jeopardize Medicare, as a portion of that tax funds Medicare. However, as Inside Health Policy's Chelsea Cirruzzo notes, a Department of the Treasury memo on Trump's proposed payroll tax holiday indicates that Trump could keep the Medicare portion of the payroll tax intact.

    Trump's 3 other health care goals

    The remaining health care goals on Trump's list, which didn't get quite as much attention this week, are:

    • Eliminating surprise medical bills;
    • Positioning patients and providers in charge of the health care system; and
    • Improving veterans' health care.

    According to Trump's campaign, Trump "[o]ver the coming weeks … will be sharing additional details about his plans through policy-focused speeches on the campaign trail." And you can be sure the president's observers, critics, and fact checkers will continue to weigh in along the way.

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