At his State of the Unionaddress, President Trump vowed to take on prescription drug prices,pursue an end to the HIV epidemic and boost funding for childhoodcancers. (Photo: Doug Mills/Pool via Bloomberg)

It was not the centerpiece, but health was a persistent theme inPresident Donald Trump's State of the Union address at the Capitolon Tuesday night.

Although the administration has focused more on issues of trade,taxes and immigration, the president laid out a series ofhealth-related goals, including some that even Democrats indicatedcould be areas of bipartisan negotiation or compromise. Trumpvowed to take on prescription drug prices, pursue an end to theHIV epidemic and boost funding for childhood cancers.

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He also took a victory lap for goals promoted by hisadministration that had been accomplished. “We eliminated the veryunpopular Obamacare individual mandate penalty,” he said, referringto the requirement in the Affordable Care Act that most people musthave health insurance or pay a fine. It was eliminated as part ofthe 2017 GOP tax bill, despite backlash from critics that it couldundercut Obamacare, after many failed attempts by Republicans torepeal the law.

And Trump noted congressional passage of a “right to try” billthat was supposed to make it easier for terminally ill patients togain access to experimental medications, but so far few patients have been able to make the law work forthem.

The most likely ground for bipartisanship will be the issue ofdrug prices, where Democrats are as eager as the president to dosomething to rein in prices that are spiraling upward.

“It is unacceptable that Americans pay vastly more than peoplein other countries for the exact same drugs, often made in theexact same place. This is wrong, this is unfair, and together wewill stop it. We will stop it fast,” he said. “I am asking theCongress to pass legislation that finally takes on the problem ofglobal freeloading and delivers fairness and price transparency forAmerican patients.”

Democrats are cautiously optimistic on the drug price front. “Ireally am hopeful about making strides on prescription druglegislation this year on a bipartisan basis,” Wendell Primus, tophealth aide to House Speaker Nancy Pelosi, said at a conference forhealth policy researchers hours before the speech.

But not all of Trump's claims Tuesday about his efforts on drugpricing stand up to close scrutiny. He proclaimed that “in 2018drug prices experienced their single-largest decline in 46 years.”The drug-price portion of the consumer price index (CPI) declinedslightly last year for the first time since 1972, but prices formany individual drugs are still rising sharply.

Factors beyond the administration's actions appear to haveplayed the biggest role in the overall slowdown. Drug priceincreases have slowed largely because patents have expired onexpensive, blockbuster drugs and several years have passed sincethe introduction of expensive medicines to treat hepatitis C,according to independent analysts.

But even as consumer drug prices have moderated, drug spendingper hospital admission soared 19 percent from 2015 to 2017, a studysponsored by hospital trade groups found last month. That includesanesthesia drugs, chemotherapy infusions and other medicines thatare not counted in the CPI.

Some well-placed Republicans praised the drug price effort. “Iexpect deep-pocketed interests to oppose anything and everything toprotect the status quo,” said Sen. Chuck Grassley (R-Iowa),chairman of the powerful Senate Finance Committee. “But the momentis ripe for action and Americans expect us to work together to getthe job done.”

After Shereese Hickson's doctor prescribed her a new multiplesclerosis drug last year, the total bill came to just over$123,000. Her portion was about $3,620.

News organizations including Kaiser Health News have reported ondozens of cases of surprise hospital bills, unaffordable costs forlife-sustaining drugs and other health-expense shocks for patients.Shereese Hickson, whose experience with a $123,000 bill formultiple sclerosis drugs was covered by KHN and National Public Radio, was watching thespeech.

“I'm glad he mentioned it,” she said of Trump's promise to bringtransparency and competition to pharmaceutical prices. “But I wouldlike to see if it really will come true. If you do that — that'sgoing against the drug companies. They'll be losing money andthey're not going to let that happen.”

Paul Davis — a retired doctor from Findlay, Ohio, whose family'sexperience with a $17,850 bill for a simple urine test was detailed in a KHN-NPR “Bill of the Month” feature last year andwho met with Trump about surprise billing last month — said he wasdisappointed Trump did not go into further detail about his healthcare proposals.

“He didn't say anything,” he said.

Davis said he would have liked to have heard more about theadministration's recently announced plan to eliminate drug rebatesnegotiated by middlemen in the Medicare drug program, as well asthe recently implemented policy requiring hospitals to list theirprices online.

“If he wanted to use the podium to talk about the wonderfulthings that he's done, that's one of the things he's gottenaccomplished,” Davis said.

Elizabeth Moreno was billed $17,850 for a urine test. AfterMoreno's insurer declined to pay any of the bill because the labwas out-of-network, her father, Dr. Paul Davis, paid the lab $5,000to settle the bill.

In their official responses to the speech, Democrats were morecombative. “In this great nation, Americans are skipping bloodpressure pills, forced to choose between buying medicine or payingrent,” said Stacey Abrams, former Georgia House minority leader anda rising star in the national Democratic Party. “Maternal mortalityrates show that mothers, especially black mothers, risk death togive birth. And in 14 states, including my home state where amajority want it, our leaders refuse to expand Medicaid, whichcould save rural hospitals, economies and lives.”

California Attorney General Xavier Becerra, who gave theSpanish-language Democratic response, reminded viewers that whilethe Trump administration is seeking to have the Affordable Care Actoverturned in court, Democrats would provide “medical care for yourfamily 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 commitmentto 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 andhis administration, this initiative, if properly implemented andresourced, can go down in history as one of the most significantachievements of his presidency,” said Michael Ruppal, executivedirector of The AIDS Institute.

Trump also promised that his budget, which has been delayed bythe recent government shutdown, will seek new funding to expandresearch into cures and treatments for childhood cancer.

He said he will seek “$500 million over the next 10 years tofund this critical lifesaving research.” The National Institutes ofHealth has long been a bipartisan favorite in Congress, althoughTrump in his first budget did seek cuts in NIH funding.

The one area in which bipartisanship will clearly not prevail isthat of abortion. Trump reiterated a promise he made toanti-abortion groups as a candidate in 2016 and pushed for afederal bill to ban abortions after 20 weeks of pregnancy.

“Let us reaffirm a fundamental truth: All children — born andunborn — 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 stilllacks the votes in the Senate, and the House now has a majoritythat supports abortion rights.

Abortion opponents praised the president's comments. “Onceagain, President Trump has proved he is our nation's most pro-lifepresident ever and he is keeping his promise to the voters whofueled his victory,” said Marjorie Dannenfelser of the Susan B.Anthony List.

Abortion-rights supporters, meanwhile, chastised Trump'scomments.

“Shame on the president for using the State of the Union tovilify people who have abortions and the providers who care forthem,” said Megan Donovan of the Guttmacher Institute. “Make nomistake: This is part of a larger agenda to eliminate access toabortion altogether.”

Staff writers Jay Hancock, Emmarie Huetteman and Ana B.Ibarra contributed to this report.

Kaiser Health News isa nonprofit news service covering health issues. It is aneditorially independent program of the Kaiser Family Foundation,which is not affiliated with Kaiser Permanente.

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