5 Healthcare Takeaways From the State of the Union

President Donald Trump on Tuesday delivered his first State of the Union address, and although he did not spend much of the 80-minute speech on healthcare, it did have its moments. Here are 5 takeaways on healthcare from the State of the Union address:

1. Reducing drug prices is one of Trump’s “greatest priorities.” The speech, coupled with Trump’s language during the swearing-in of new HHS Secretary Alex Azar, mark a return to the rhetoric of the 2016 campaign, when Trump and Democratic candidate Hillary Clinton shared the belief that Medicare needed the power to negotiate with pharmaceutical companies. Critics say Trump has done little since taking office to follow through, but Wall Street took him seriously. Pharmaceutical stocks tumbled Wednesday, with the bigger players taking the harshest hit.

2. “Right-to-try” legislation gets a push. The president’s call for Congress to pass a law, now pending in the Senate, that would give patients direct access to investigational medications was the only specific policy measure he mentioned in the speech. But in an interview with The American Journal of Managed Care^®, National Coalition of Health Care President and CEO John Rother said that a law would not address the problem of annual unjustified price hikes for expensive drugs for chronic conditions, such as insulin for diabetes and anti-inflammatory biologics for rheumatoid arthritis.

3. His mention of the opioid crisis drew criticism. The Huffington Post wrote that Trump's address spent 49 seconds on a crisis that has claimed 64,000 lives in year, and instead of offering new solutions, tied the issue to immigration reform. By Wednesday, Democrats were asking what’s taking so long. Led by Senators Elizabeth Warren, D-Massachusetts, and Patty Murray, D-Washington, they sent a letter to the General Accounting Office asking for an investigation into what the administration has done since declaring the opioid crisis a public health emergency on October 26, 2017.

4. Trump touted the end of the individual mandate. In highlighting the tax bill at the top of his speech, the president noted that the plan “repealed the core of the disastrous Obamacare. The individual mandate is now gone.” This is the provision of the Affordable Care Act (ACA) that required Americans to buy coverage or pay a penalty for not having it. Based on the Massachusetts plan adopted under former GOP Governor Mitt Romney, it is designed to balance the insurance pool with young and healthy people, instead of leaving just older, sicker people buying individual coverage.

5. What Trump didn’t say makes news. Trump did not call for a full repeal of the rest of the ACA, after Republicans spent much of the year trying. Word out of the GOP retreat Thursday is that they’ve stopped trying. Republicans failed to repeal the ACA last year through the budget reconciliation process, and now they have just 51 votes, thanks to a Democratic victory in Alabama. Plus, it seems that repealing protections for pre-existing conditions or Medicaid expansion has few takers in an election year. The question is whether the ACA has been damaged enough already through the loss of the individual mandate and failure to fund cost-sharing reductions to make a repeal moot.