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Analysis

Campaign to End HIV and 5 Other Healthcare Takeaways from Trump's State of the Union

By Jack O'Brien  
   February 06, 2019

President Donald Trump's speech focused on new public health initiatives and lowering the cost of healthcare.

In a State of the Union address primarily centered around foreign policy and the ongoing partisan battle over funding the southern border wall, President Donald Trump still managed to deliver several healthcare policy announcements.

During his joint address to Congress on Tuesday night, Trump's most consequential healthcare proposal was a public health campaign to end HIV transmissions in America by 2030. The president also announced a 10-year, $500 million initiative to curb childhood cancer headed by the National Institutes of Health (NIH). 

Harkening back to last year's address, Trump emphasized the goal shared among Republicans and Democrats to reduce the price of healthcare and prescription drugs.

Trump also briefly mentioned signing two pieces of bipartisan healthcare legislation, the VA Accountability First Act of 2017 and the major opioids package approved last fall.

Below are healthcare highlights from Trump's speech as well as commentary and reaction from across the political aisle to his proposals:

1. Campaign to end HIV transmissions by 2030

As reported earlier this week by Politico, Trump publicly announced plans to end transmissions of HIV in America by 2030.

The benchmarks include a 75% reduction in new HIV infections by 2025 and at least a 90% reduction in transmissions by 2030.

Trump added that with this concerted effort, the federal government is poised to "defeat AIDS." 

 

2. Push for drug pricing plan and end to "global freeloading"

One of Trump's most prominent healthcare goals remains lowering prescription drug prices for consumers, which has earned rare bipartisan support on Capitol Hill.

Trump said the administration's efforts to this end in 2018, led by HHS Secretary Alex Azar, resulted in the lowest prescription drug prices in 46 years.

An important development was Trump indicating his support for the drug importation effort led by Sen. Chuck Grassley, R-Iowa, a policy Senate Republicans have historically been opposed to. 

CMS Administrator Seema Verma praised Trump's comments on Twitter during the speech, saying he had an "unwavering stance on lowering the costs of healthcare & prescription drugs."

 

3. $500 million for childhood cancer effort

Trump announced a decade long initiative to improve childhood cancer data, which will be led by the National Cancer Institute (NCI), a division of the NIH. 

Dr. Ned Sharpless, the director of the NCI, embraced the $500 million task on Twitter, saying "Let’s change the course of childhood cancer!" 

However, it should be noted that the funding set aside for this effort over the course of a decade is much smaller than the annual budget for NIH, which totalled $39 billion in fiscal year 2019.

This included $425 million appropriated for Alzheimer's and related dementias research.

 

4. Mention of surprise medical bills absent

Despite speculation that Trump would discuss his recent interest in solving the surprise medical bills phenomenon, he did not mention the issue during his speech.

Last week at a White House roundtable on the subject, Trump instructed health officials to examine strategies to fix the problem of frequent, expensive medical bills plaguing consumers across the country.

As reported earlier this week by New Hampshire Public Radio, Sen. Maggie Hassan, D-N.H., brought a Seabrook resident as her guest of honor to highlight the issue of "balance billing."

Related: Trump Targets Surprise Medical Bills in Chat with Patients, Experts

 

5. Shift to protecting pre-existing conditions

Several times, Trump pressed the need to protect patients with pre-existing conditions though he did not address the ongoing appeal to the Fifth Circuit court ruling that the ACA is unconstitutional.

As he did during last year's speech, Trump heralded the repeal of the individual mandate penalty as a result of the tax reform bill passed in 2017, which earned a round of applause from Republican lawmakers.

This has become a central issue to healthcare policy in Washington, as Democrats primarily ran on a platform of protecting those with pre-existing conditions during the midterm elections and criticizing Republicans who voted repeatedly to repeal the ACA.

Related: 4 States Seek to Join Coalition Defending ACA on Appeal

 

6. Another shutdown still dominates atmosphere in Capitol Hill

Aside from the healthcare points noted above, the address was focused around the February 15 funding deadline for the current continuing resolution to keep the government open. 

Following the longest federal government shutdown in U.S. history, another funding gap looms as negotiations over funding the southern border wall remain outstanding.

If a compromise isn't reached or a national emergency is not announced by Trump, this could once again impact some federal health programs.

 

Reaction to the speech

The official Democratic response, delivered by former Georgia gubernatorial candidate Stacey Abrams, touched on healthcare by calling on the Trump administration to protect patients with pre-existing conditions and urged states to embrace Medicaid expansion if they had not already.

Senate Health, Education, Labor and Pensions chairman Sen. Lamar Alexander, R-Tenn., praised Trump's speech as optimistic, specifically referring to his stance on reducing healthcare costs, in a press release Tuesday night. 

"As much as half of everything we spend on health care in the United States is unnecessary," Alexander said in a statement. "It's a tax on our families, on our businesses and on our governments, and we can go to work in a bipartisan way to reduce prescription drug costs, to end surprise medical billings, and to have more transparency about the prices of all the treatments and the medical services that we buy. I look forward to working with him in the Senate health committee I chair to accomplish these goals."

John Kelliher, Managing Director of Berkeley Research Group and former chief counsel to the House Committee on Ways and Means, told HealthLeaders in an email that the healthcare aspects of Trump's speech were "less than expected."

"[The Trump] administration does have two relatively bold proposals out right now - international reference pricing for Part B drugs as a potential demonstration program and ending the use of rebates between drug makers and PBMs in Medicare Part D," Kelliher wrote. "Both proposals are controversial and have a very long distance to go before they become actual policy. Both proposals are so complex that they are very unlikely to even be doable prior to the next presidential election and thus may never happen."

Azar after hours

Secretary Azar spoke to Fox Business following the speech and heralded Trump's second State of the Union address as an "inspiring agenda" that all members of Congress should be able to rally around.

Azar highlighted three key elements for bipartisan consensus to improve healthcare: tackling high prescription drug prices, increasing price transparency in the healthcare industry, and embracing Trump's "bold vision" for ending the HIV epidemic in America, addressing child cancer, and protecting pre-existing conditions.

He also echoed Trump's call for an end to "foreign free-riding" regarding prescription drugs and added that the president's commitment to supporting last week's anti-kickbacks announcement would not delight "those who support the status-quo."

Jack O'Brien is the finance editor at HealthLeaders, a Simplify Compliance brand.

Photo credit: OCTOBER 15, 2016, EDISON, NJ - Donald Trump speaks at Edison New Jersey Hindu Indian-American rally for "Humanity United Against Terror" - Image / Editorial credit: Joseph Sohm / Shutterstock.com


KEY TAKEAWAYS

Trump confirmed press reports that the administration is launching a public health campaign to end HIV transmissions by 2030.

He also announced a 10-year, $500 million initiative to curb childhood cancer.

The official Democratic response, delivered by former Georgia gubernatorial candidate Stacey Abrams, highlighted the importance of protecting those with pre-existing conditions.


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