5 things healthcare should know about Trump’s State of the Union

Healthcare policy was not the main focus of President Donald Trump’s first State of the Union address, though the Jan. 30 speech did include mentions of lowering prescription drug prices, fighting opioid addiction and an endorsement of “right-to-try” legislation being considered by Congress.

Here are five important policies from the speech—as well as reactions from Trump’s opponents—that healthcare professionals should know about:

1. Trump touted individual mandate repeal, but didn’t call for full ACA repeal

Unlike his address to a joint session of Congress in Feb. 2017, Trump didn’t ask Congress to repeal and replace the Affordable Care Act (ACA). Several attempts at doing so last year failed to pass both houses, but Republicans did repeal the ACA’s individual mandate penalizing people who went uninsured, which Trump mentioned in his speech.

“We repealed the core of disastrous Obamacare. The individual mandate is now gone,” he said.

The mandate will still be in effect for 2018 and much of the ACA remains, including the Medicaid expansion and premium support subsidies. Some Republicans, such as Sen. Ted Cruz, R-Texas, have said they want to take another run at repealing the law, but passage in the Senate looks more unlikely after the Republican majority was reduced to 51-49 with the election of Sen. Doug Jones, D-Alabama.

2. Urged passage of “right to try” bill

Trump said Congress should pass legislation allowing terminally ill patients the “right to try” experimental treatments which have yet to be approved by the Food and Drug Administration (FDA).

“People who are terminally ill should not have to go from country to country to seek a cure,” he said. “I want to give them a chance right here at home.”

The idea has garnered support among both Democrats and Republicans at the state level and was passed unanimously by the Senate last year. Critics have said these bills are “inherently deceptive,” offering false hope to patients and circumventing FDA oversight.

3. Promised action on prescription drug prices

Trump called reducing prescription drug prices “one of my greatest priorities.”

“In many other countries, these drugs cost far less than what we pay in the United States,” he said. “That is why I have directed my administration to make fixing the injustice of high drug prices one of our top priorities. Prices will come down.”

A day earlier, he had said lowering drug prices would be a top priority for new HHS Secretary Alex Azar. Azar, however, is a former pharmaceutical executive who oversaw big price hikes for insulin products when he ran the U.S. operations of Eli Lilly. He’s also come out against importing prescription drugs from countries where they’re less expensive.

Trump had repeatedly promised to tackle drug prices during his campaign. In his first year in office, it appeared the pharmaceutical industry successfully shifted the focus to out-of-pocket costs and pharmacy benefit managers, avoiding big shifts in policy that could affect revenues.

“I think of the pharmaceutical pricing issue as somewhat of a titanic struggle between pharma and the plans. If you think of it that way, in the Trump administration, pharma won Round 1,” Len Nichols, a health policy professor at George Mason University, told Vox.

4. Getting “much tougher on drug dealers and pushers” to stem opioid epidemic

In his first year in office, Trump declared opioid addiction a public health emergency, though no new regulations have followed. In his speech, he advocated for both stricter enforcement and expanded treatment.

“We must get much tougher on drug dealers and pushers if we are going to succeed in stopping this scourge,” he said. “My administration is committed to fighting the drug epidemic and helping get treatment for those in need. The struggle will be long and difficult—but, as Americans always do, we will prevail.”

One of the guests to the address was Ryan Holets, a 27-year-old police officer from Albuquerque, New Mexico, who adopted the child of heroin-addicted homeless woman.

5. Democratic response: “We choose a health system that offers mercy”

Rep. Joe Kennedy III, D-Massachusetts, a grandson of former U.S. Attorney General Robert Kennedy and great-nephew of President John F. Kennedy, delivered the official Democratic response to Trump’s speech. He several times criticized the administration’s track record on health policy, such as letting the Children’s Health Insurance Program’s funding lapse for several months and promoting ACA repeal bills which would’ve benefited states that didn’t expand Medicaid.

“They are turning American life into a zero-sum game where order for one to win, another must lose,” he said. “Where we can guarantee America’s safety if we slash our safety net. We can extend healthcare to Mississippi if we gut it in Massachusetts.”