President Trump proposes plans to end AIDS, fight childhood cancer.

Actually, I thought that President Trump did a good job even being conciliatory in his State of the Union speech even covering various aspects of healthcare. Joyce Frieden the News Editor of MedPage stated that Healthcare played a major part in Tuesday’s State of the Union address, with President Trump covering a wide variety of health-related topics.

Only a few minutes into the speech, the president foreshadowed some of his healthcare themes. “Many of us have campaigned the same core promises to defend American jobs and … to reduce the price of healthcare and prescription drugs,” Trump said. “It’s a new opportunity in American politics if only we have the courage together to seize it.”

A few minutes later, he touted some of his administration’s actions so far. “We eliminated the very unpopular Obamacare individual mandate penalty,” Trump said. “And to give critically ill patients access to lifesaving cures, we passed — very importantly — the right to try.”

Drug Prices a Major Player

The subject of drug prices occupied a fair amount of time. “The next major priority for me, and for all of us, is to lower the cost of healthcare and prescription drugs and to protect patients with preexisting conditions,” he said. “Already, as a result of my administration’s efforts in 2018, drug prices experienced their single largest decline in 46 years. But we must do more. It’s 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; this is unfair, and together we will stop it, and we’ll stop it fast,” he said. “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, finally.”

He then turned to several other health topics. “We should also require drug companies, insurance companies, and hospitals to disclose real prices, to foster competition, and bring costs way down,” Trump said. He quickly moved on to the AIDS epidemic. “In recent years we’ve made remarkable progress in the fight against HIV and AIDS. Scientific breakthroughs have brought a once distant dream within reach. My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years.”

“We have made incredible strides, incredible,” he added to applause from members of Congress on both sides of the aisle. “Together we will defeat AIDS in America and beyond.”

Childhood Cancer Initiative

Although the remarks on HIV had been expected, the president also announced another health initiative that wasn’t as well-known: a fight against childhood cancer. “Tonight I’m also asking you to join me in another fight all Americans can get behind — the fight against childhood cancer,” he said, pointing out a guest of First Lady Melania Trump: Grace Eline, a 10-year-old girl with brain cancer.

“Every birthday, since she was 4, Grace asked her friends to donate to St. Jude’s Children’s Hospital,” Trump said. “She did not know that one day she might be a patient herself [but] that’s what happened. Last year Grace was diagnosed with brain cancer. Immediately she began radiation treatment, and at the same time she rallied her community and raised more than $40,000 for the fight against cancer.”

“Many childhood cancers have not seen new therapies in decades,” he said. “My budget will ask Congress for $500 million over the next 10 years to fund this critical life-saving research.”

These health initiatives met with mixed reactions. “President Trump is taking a bold step to design an innovative program and strategy, and commit new resources, to end HIV in the United States … Under the President’s proposal, the number of new infections can eventually be reduced to zero,” Carl Schmid, deputy executive director of The AIDS Institute, said in a statement. Michael Ruppal, the institute’s executive director, added, “While we might have policy differences with the president and his administration, this initiative if properly implemented and resourced, can go down in history as one of the most significant achievements of his presidency.”

But the Democratic National Committee (DNC) wasn’t quite so enthusiastic; it sent an email calling the goal of ending HIV by 2030 “notable” but added, “The Trump administration has consistently undermined advancements in HIV/AIDS research, attacked people living with HIV/AIDS, and sabotaged access to quality healthcare at every opportunity.” Among other things, the administration redirected money from the Ryan White HIV/AIDS Program to help fund the separation of immigrant families, and proposed cutting global HIV/AIDS funding by over $1 billion, which could cause 300,000 deaths per year, the DNC said.

Abortion in the Spotlight

As for the childhood cancer initiative, “$500 million over 10 years to solve childhood cancer is … not a lot,” one Bloomberg reporter tweeted. However, Gail Wilensky, Ph.D., a senior fellow at Project HOPE, in Bethesda, Maryland, pointed out that this amount ” is in addition to the National Institutes of Health budget [for cancer] … A lot of money is going to cancer anyway [already] and the National Cancer Institute been one of the more protected parts of government, so it’s not like they have a big deficit to make up.”

Overall, “it was a surprisingly good speech,” said Wilensky, who was the administrator of the Centers for Medicare & Medicaid Services under President George H.W. Bush. “It covered a lot of areas, and there were a number of issues that were very hard not to applaud … I thought he did a pretty admirable job of forcing applause and a sense of togetherness by the country, talking about compromise and the common good.”

The president also touched on a more controversial area of healthcare: abortion. He referred to a recent abortion bill that passed in New York State and another that failed in Virginia — both of which dealt with abortion late in pregnancy — adding, “I’m asking Congress to pass legislation to prohibit late-term abortion of children who can feel pain in a mother’s womb. Let us work together to build a culture that cherishes innocent life.”

That appeal to the anti-abortion movement “is a position that Republicans have taken in the past, which is the importance of life right after birth and life right before birth,” said Wilensky. Abortion later in pregnancy “is an area that tends to engender a more unified response than most others, even for people who are ambivalent or more supportive of abortion rights. Very late-term abortion makes people uncomfortable … It’s easy to understand why people get uneasy.”

“Already, the biggest move the Trump administration has made to control health care costs and access has been on the regulatory front,” said Bob Laszewski, founder of Health Policy and Strategy Associates, an Alexandria, Virginia, consulting firm, citing the announcement of proposed regulations to end drug rebates under Medicare and Medicaid kickback rules and rules for short-term health plans. “I take it from Trump’s remarks that they will continue with this regulatory approach instead of waiting for any bipartisanship in the Congress,” he said.

“The only area there now seems to be a hint of bipartisanship is over the issue of drug prices being too high,” Laszewski added. “It was clear from Trump’s remarks, and the Democrats’ positive response on this one issue, that this could become an area for cooperation.”

No Large-Scale Reforms Offered

Rosemarie Day, a healthcare consultant in Somerville, Massachusetts, said in an email that the president “certainly did not propose any large-scale reforms to the healthcare system during the speech, and he was short on specifics for most of it. According to a recent Kaiser Family Foundation poll, health care is the number one issue among voters so this may appear to some as a missed opportunity. It’s increasingly looking like Republicans are leaving the big health care reform ideas to the Democratic presidential candidates.”

The ideas he did propose “were mostly noncontroversial and somewhat vague,” Day continued. “The more interesting proposal was lowering the cost of healthcare and drugs, which is a high priority for consumers. The way he discussed going about it was by requiring drug companies, insurance companies, and hospitals to disclose real prices. This raises many questions, such as what does a ‘real’ price mean? … This will be an interesting area to watch, since ‘real prices’ are currently closely held secrets, and a legal requirement to disclose them would constitute a significant change from the status quo.”

In the Democratic response to the speech, Stacey Abrams, a Democrat who ran unsuccessfully last year for governor of Georgia, lashed out against enemies of Obamacare. “Rather than suing to dismantle the Affordable Care Act as Republican attorneys general have, our leaders must protect the progress we’ve made and commit to expanding healthcare and lowering costs for everyone,” said Abrams, the first black woman to deliver the rebuttal to a State of the Union address.

She also spoke of her personal struggle with healthcare costs for her family. “My father has battled prostate cancer for years. To help cover the costs, I found myself sinking deeper into debt because, while you can defer some payments, you can’t defer cancer treatment. In this great nation, Americans are skipping blood pressure pills, forced to choose between buying medicine and paying rent.”

She also pushed back against state governors and legislators who continue their resistance to Medicaid expansion. “In 14 states, including my home state, where a majority want it, our leaders refused to expand Medicaid which could save rural hospitals, save economies and save lives.”

With Dems now in charge, repeal-and-replace no longer on the table!

Former Rep. John Dingell Left An Enduring Health Care Legacy

If anyone is interested in healthcare and its history here in the U.S. one must include the legacy of former Rep. John Dingell, the Michigan Democrat who holds the record as the longest-serving member of the U.S. House, died Thursday night in Michigan. Julie Rovner reviewed his history last week after his death. He was 92.

And while his name was not familiar to many, his impact on the nation, and on health care, in particular, was immense.

For more than 16 years Dingell led the powerful House Energy and Commerce Committee, which is responsible for overseeing the Medicare and Medicaid programs, the U.S. Public Health Service, the Food and Drug Administration and the National Institutes of Health.

Dingell served in the House for nearly 60 years. As a young legislator, he presided over the House during the vote to approve Medicare in 1965.

As a tribute to his father, who served before him and who introduced the first congressional legislation to establish national health insurance during the New Deal, Dingell introduced his own national health insurance bill at the start of every Congress.

And when the House passed what would become the Affordable Care Act in 2009, leaders named the legislation after him. Dingell sat by the side of President Barack Obama when he signed the bill into law in 2010.

Dingell was “a beloved pillar of the Congress and one of the greatest legislators in American history,” said a statement from House Speaker Nancy Pelosi. “Yet, among the vast array of historic legislative achievements, few hold greater meaning than his tireless commitment to the health of the American people.”

He was not always nice. Dingell had a quick temper and a ferocious demeanor when he was displeased, which was often. Witnesses who testified before him could feel his wrath, as could Republican opponents and even other committee Democrats. And he was fiercely protective of his committee’s territory.

In 1993, during the effort by President Bill Clinton to pass major health reform, as the heads of the three main committees that oversee health issues argued over which would lead the effort, Dingell famously proclaimed of his panel, “We have health.”

Dingell and his health subcommittee chairman, California Democrat Henry Waxman, fought endlessly over energy and environmental issues. Waxman, who represented an area that included western Los Angeles, was one of the House’s most active environmentalists. Dingell represented the powerful auto industry in southeastern Michigan and opposed many efforts to require safety equipment and fuel and emission standards.

In 2008, Waxman ousted Dingell from the chairmanship of the full committee.

But the two were of the same mind on most health issues, and together during the 1980s and early 1990s they expanded the Medicaid program, reshaped Medicare and modernized the FDA, NIH and the Centers for Disease Control and Prevention.

“It was always a relief for me to know that when he and I met with the Senate in the conference, we were talking from the same page, believed in the same things, and we were going to fight together,” Waxman said in 2009.

Dingell was succeeded in his seat by his wife, Rep. Debbie Dingell, herself a former auto industry lobbyist.

House Panel Mulls ACA Fixes, Responses to Trump Policies

Now to the article of the week, Ryan Basen, a writer for MedPage noted that focusing on preventive care, expanding subsidies, and regulating association health plans (AHPs) were among the solutions proposed Tuesday to aid Americans with pre-existing health conditions, as the U.S. House Ways and Means Committee held its first hearing under the new Congress.

While the hearing was entitled “Protecting Americans with Pre-Existing Conditions,” much discussion centered around the policies within the Affordable Care Act, Republican efforts to repeal it, and recent reforms that tweaked American healthcare. Many lawmakers used their allotted time to blast other party members for either being too supportive of the ACA or attempting to “sabotage” it. Some lawmakers, however, promised to work together with members of the opposing party to help patients with pre-existing conditions — which some noted includes themselves and family members.

“Protections for people with pre-existing conditions has become the defining feature of the Affordable Care Act,” said witness Karen Pollitz, a senior fellow with the Kaiser Family Foundation; she noted that these protections also enjoy widespread public support.

The ACA forced insurance plans to accept and retain members with pre-existing conditions, many of whom could not afford plans before the legislation was enacted. But Trump administration policies and other reforms worry some experts and lawmakers that the millions of American with pre-existing conditions — ranging from moderate mental health diagnoses to cancer — are gradually being priced out of the healthcare system again, they said.

Protecting patients with pre-existing conditions are linked to controlling costs throughout American healthcare, many said. Recent legislation led to “artificial” cost increases for ACA marketplace plans and pushed some insurers to leave the market altogether, Pollitz said. These policies also have driven up premium prices.

“What we have here is an infrastructure problem,” Rep. John Larson (D-Conn.) said. “The disagreements are over how to pay for it.”

“All we are really debating here is who gets to pay,” Rep. David Schweikert (R-Ariz.) said. “It’s time for radical rethinking: Are you [Democrats] willing to work with us to break down the barriers to having cost disruption?”

Several who spoke Tuesday offered potential solutions. Witness Keysha Brooks-Coley, of the American Cancer Society Cancer Action Network, suggested lawmakers strengthen the ACA by addressing its so-called “family glitch” and eliminating the “subsidy cliff”; both policies currently withhold subsidies from many Americans who need them to pay for healthcare, she said.

Rep. Brad Wenstrup, DPM (R-Ohio), called for turning lawmakers’ focus from squabbling about politics to studying preventative care. “There’s no part of me as a doctor that doesn’t want Americans to have access to quality healthcare,” the podiatrist said. “But I don’t necessarily agree with the direction (the ACA) went.”

“Let’s talk about incentivizing health: What do we have not only for the patient but for the physician?” he added. “Think about who gets rewarded in today’s system. Do we recognize the doctor who prevented the patient from needing open-heart surgery? That’s where we need to go if you want to talk about the cost curve.”

One solution is actually quite simple, according to witness Rob Roberston, secretary-treasurer for the Nebraska Farm Bureau: regulate AHPs and encourage individuals to band together in groups to reduce premium costs, as many farmers and ranchers have in Nebraska. “This is not a political issue,” he said. “This is an issue of hardship, and we need to fix these individual markets and protect pre-existing conditions at the same time.”

Alas, judging by many lawmakers’ tone during a hearing that stretched over four hours, this does appear to be a political issue. “It’s really this long debate over Obamacare,” Rep. Devin Nunes (R-Calif.) said. “We really need to work for a solution because Obamacare wasn’t a solution.”

Rep. Lloyd Doggett (D-Texas) then got into it. “What has led us here has been eight years of Republican persistence in trying to destroy the Affordable Care Act,” he said. “It’s great to hear they [Republicans] want to work with us and I hope they do.” The ACA is not perfect, Doggett acknowledged, but he quipped that perhaps “the most pre-existing condition” present Tuesday was “the political amnesia of those who have forgotten what it was like before the Affordable Care Act.”

Raising his voice, Rep. Earl Blumenauer (D-Ore.) echoed the point: “If we would have been working together for the last six years to refine the Affordable Care Act, costs would be lower, coverage would be better.”

Many witnesses spoke against the Administration’s policy to loosen regulations on cheaper short-term plans that do not have to abide by ACA strictures. “The expansion of these plans does not help the consumer,” Brooks-Coley said. “It puts them at increased risk. … They are only less expensive upfront because they don’t cover [serious conditions].” In addition, Pollitz noted, many of these plans drop patients once they become ill and “have been shown to increase costs of ACA-compliant plans.”

The witnesses were asked to gauge what would happen if protections for patients with pre-existing conditions were to be removed. Younger women would pay more than men the same age, Pollitz said, and all pre-existing patients “would find it much more difficult to find coverage.”

“True harm would come,” Andrew Stolfi, Oregon Division of Financial Regulation’s insurance commissioner, told the committee. He cited Oregon’s pre-ACA experience: “You were lucky if you were even given the choice to take an insurer’s limited terms.”

Ways and Means chairman Richard Neal (D-Mass.) ended the hearing with optimism: “Today I heard a lot of members on the other side of the aisle say they support [requiring coverage for] pre-existing conditions, and I welcome that and hope we can work together.”

So, now what do the physicians think is needed to improve our health care system? Next week let’s discuss.