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January 31, 2018

Trump names 3 health policy priorities in the State of the Union—with 1 surprising omission

Daily Briefing

    President Trump in his first State of the Union address Tuesday briefly praised Republicans' elimination of the Affordable Care Act's individual mandate penalty, but made no direct calls to continue ACA repeal-and-replace efforts.

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    Instead, Trump, in his one hour and 20 minute speech, called for major bipartisan deals on infrastructure and immigration, and touched on several public health issues that his administration will focus on in 2018.

    Trump touts health policy wins

    Individual mandate penalty

    While repealing and replacing the ACA was a key legislative priority for Republicans in 2017, Trump mentioned the law just once in his State of the Union address.

    "We eliminated an especially cruel tax that fell mostly on Americans making less than $50,000 a year, forcing them to pay tremendous penalties simply because they could not afford government-ordered health plans," Trump said, adding, "We repealed the core of disastrous Obamacare."

    Trump was referring to a provision in the GOP's tax reform law that effective Jan. 1, 2019, eliminates the penalty most U.S. residents who do not have health insurance must pay under the ACA's individual mandate.

    Though Trump in his speech said, "The individual mandate is now gone," industry experts note that the individual mandate is still in effect this year, and that some individuals could face a penalty of $695 or 2.5% of household income, whichever is higher, if they are uninsured.

    Some industry experts also questioned whether the individual mandate is truly the "core" of the ACA. While the ACA's individual mandate was once touted as a key provision to nudge all U.S. residents to purchase health insurance, policy experts in recent years have said the mandate's penalty was too low to have a strong effect. Further, industry experts note that most U.S. residents insured under the law have gained coverage through the ACA's Medicaid expansion, which remains in effect, Forbes reports.

    For instance, Larry Levitt, EVP for health reform at the Kaiser Family Foundation, said, "If anything, the core of the ACA is the expansion of Medicaid, subsidies to help consumers afford insurance, and protections for people with pre-existing conditions," adding, "The individual mandate helps the insurance market work and is the most unpopular part of the ACA, but it's not the heart of the law."

    Veterans' health care

    Trump during his speech also touted the administration's efforts to improve care for veterans. He said, "Last year, the Congress passed, and I signed, the landmark VA Accountability Act," adding, "Since its passage, my administration has already removed more than 1,500 VA employees who failed to give our veterans the care they deserve—and we are hiring talented people who love our vets as much as we do. I will not stop until our veterans are properly taken care of, which has been my promise to them from the very beginning of this great journey."

    Trump identifies public health priorities for 2018

    Rx drug prices

    Trump said one of his administration's "greatest priorities" in 2018 will be to lower drug costs and increase access to breakthrough and affordable generic drugs.

    Along those lines, Trump noted that FDA already has "approved more new and generic drugs and medical devices than ever before in our country's history." According to Reuters, FDA approved 46 novel medicines in 2017, marking a 21-year high.

    However, he noted that U.S. residents continue to pay more for drugs than those in other countries. "That is why I have directed my administration to make fixing the injustice of high drug prices one of our top priorities," Trump said, adding, "Prices will come down."


    Trump also urged Congress to pass a bill, known as right-to-try legislation, expanding terminal patients' access to experimental drugs that have not been approved by FDA.

    Trump said his administration believes "that patients with terminal conditions should have access to experimental treatments that could potentially save their lives," adding, "People who are terminally ill should not have to go from country to country to seek a cure—I want to give them a chance right here at home. It is time for the Congress to give these wonderful Americans the 'right to try.'"

    According to STAT News, 30 states have right-to-try laws on the books, and FDA already has a pathway for granting expedited access to treatment to patients with terminal illness. FDA Commissioner Scott Gottlieb, and several patient advocacy groups, have said that any right-to-try legislation should be written in a way that maintains FDA's authority over the drug approval process.

    Opioid misuse epidemic

    Trump also reiterated his administration's commitment "to fighting the drug epidemic and helping get treatment for those in need."

    However, industry experts have said the Trump administration could do more to combat the epidemic, noting that no additional funding has been allocated and key administration positions with authority related to the epidemic remain unfilled.

    Trump during his speech spotlighted Ryan and Rebecca Holets who adopted a child whose mother was addicted to heroin. "Ryan and Rebecca: You embody the goodness of our nation," Trump said.

    He added, "The struggle will be long and it will be difficult—but as Americans always do, in the end, we will prevail." As part of those efforts, Trump said the United States needs to take "tougher" action against "drug dealers and pushers."

    Democratic response

    In the Democratic response, Rep. Joe Kennedy (D-Mass.) accused the Trump administration of "turning American life into a zero-sum game, where for one to win, another must lose, where we can guarantee America's safety if we slash our safety net, where we can guarantee health care in Mississippi if we gut it in Massachusetts ... where we can take care of sick kids if we sacrifice DREAMers."

    Kennedy said, "The greatest, strongest, richest nation in the world should not have to leave anyone behind ... We choose a living wage, paid leave, and affordable child care ... a good education you can afford, and a health care system that offers you mercy whether you suffer from cancer, depression, or addiction" (Frieden, MedPage Today, 1/30; Vox, 1/30; Japsen, Forbes, 1/30; Hirschler, Reuters, 1/2; O'Donnell, USA Today, 1/30; Swetlitz, STAT News, 1/30; Nicholas et al., Wall Street Journal, 1/31).

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