Call it a bipartisan gesture or clever politics. But President Trump is expected to embrace in tonight’s State of the Union address an issue near and dear to House Speaker Nancy Pelosi (D-Calif.): halting the spread of HIV.
The president plans to propose a goal of halting new transmissions of the AIDS virus by 2030 by providing more funding for treatment and prevention, a plan advocates say has been worked on for months by the Department of Health and Human Services and the Centers for Disease Control and Prevention.
While the president is expected to lay out broad goals during his speech to Congress, more details could come Wednesday morning from Brett Giroir, the assistant secretary for health at HHS who has been closely involved in the effort. Giroir is scheduled to deliver a keynote address to the American Public Health Association. HHS is expected to roll out the plans within days, my colleagues Lenny Bernstein, Lena Sun and Amy Goldstein report.
At this juncture, it’s certainly difficult to imagine Pelosi and Trump joining hands on anything of significance, after unprecedented partisan rancor that left the government partially shuttered for weeks and delayed the address itself.
The two exchanged barbs during the shutdown, with the speaker seeking to display her control over the House by uninviting the president to give his annual address and Trump denying her the use of military aircraft for a trip to Afghanistan. Pelosi’s response to an HIV plan could also be tempered by the array of actions the Trump administration has taken to peel away the Affordable Care Act, including refusing to defend it in court.
And responding to HIV is just one of several health-related topics the president could bring up tonight — including the high cost of prescription drugs, surprise medical bills and paid family leave. But it’s one that could still win him some applause from Pelosi and her Democratic Caucus.
Combating the spread of the virus was a top priority for Pelosi when she joined Congress in 1987, representing a district that was being ravaged by the disease. As a House freshman, she focused her first-ever floor speech on the topic, saying Congress must “take leadership of course on the crisis of AIDS.” She has testified on AIDS funding before congressional committees and worked with the George W. Bush administration to ramp up global funding to comnbat the disease.
The patient community is already responding favorably to reports of Trump's plan. Greg Millett, director of public policy for the American Foundation for AIDS Research, told Lenny, Lena and Amy that the initial plan may focus on wiping out HIV transmission in 46 U.S. counties responsible for about half of all new HIV cases in the United States, based on information he has seen.
“I think it’s definitely possible to end HIV transmission in specific places in the United States,” Millett said. “And the reason I say that is that we’re already on a trajectory to do that.”
“It sounds like a bold initiative,” Carl Schmid, deputy executive director of the AIDS Institute and co-chair of the Presidential Advisory Council on HIV/AIDS, told me. “If you’re going to end HIV by 2030, this is how it’s going to be done — through increased treatment and increased prevention.”
Here are some other health-care policies Trump could touch on tonight:
1. Surprise medical bills.
Many Americans report difficulties in understanding upfront how much their care will cost. It’s common for patients to undergo a surgery or outpatient procedure they think is fully covered under their insurance plan, only to later receive a hefty bill because one or more of their providers were out of network.
This issue has caught the attention of members of Congress from both parties. The American College of Emergency Physicians recently released a six-point plan to counteract the problem, and Sens. Bill Cassidy (R-La.) and Maggie Hassan (D-N.H.) have introduced legislation to stop unexpected charges.
“[People] go in, they have a procedure, and then all of a sudden they can't afford it; they had no idea it was so bad,” Trump said at a patient roundtable in January. “We're going to stop all of it, and it's very important to me.”
2. The high cost of U.S. drugs.
On Thursday, HHS proposed banning drug rebates paid to pharmacy middlemen that Trump has often blamed for high drug prices. It’s the latest in a series of agency actions taken by the administration over the past year to tamp down drug costs. There’s a good chance of hearing more tonight from Trump, who has been eager to tout successes in this area.
“It’s like Nixon going to China, in my world, for the president to take on drug pricing out there,” Bill Hoagland, senior vice president at the Bipartisan Policy Center, told reporters yesterday.
Antiabortion advocates have pressed Trump to highlight recent state bills in New York and Virginia that would have lifted some limits on late-term abortions.
The Virginia measure, which has been tabled, would have allowed a single doctor to sign off on a third-trimester abortion instead of the three currently required and would have removed language requiring the danger to the mother be “substantial and irremediable.” The new law in New York allows women to now get late-term abortions if their health — not only their life — is threatened.
Abortion foes, who say Trump has been a strong ally for them, want the president to highlight not just abortion-rights legislation but also renewed efforts by Democrats to remove the federal Hyde restrictions on when taxpayer dollars may be used for abortions.
“I think it is a good opportunity to highlight true extremism on the issue,” said Tom McClusky, a lobbyist for March for Life. “What is in the Democratic platform and in these bills is the very definition of extremism.”
4. Paid family leave.
Trump called for paid family leave in his State of the Union address last year. Since then, his daughter Ivanka has worked with Sen. Marco Rubio (R-Fla.) on a bill allowing new parents to secure paid leave by drawing from their Social Security benefits. Rep. Ann Wagner (R-Mo.) has worked on similar legislation in the House.
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AHH: The Utah state Senate has passed a bill limiting the Medicaid expansion voters approved three months ago. Voters had approved Proposition 3 to expand Medicaid to low-income Utahns earning up to 138 percent of the federal poverty rate. But in a 22-to-7 vote, state senators passed a Republican-backed bill “sending to the House a replacement Medicaid expansion plan that initially costs considerably more money to cover fewer people than the voter-approved Proposition 3,” the Salt Lake Tribune’s Benjamin Wood reports.
This bill instead expands coverage to residents earning up to 100 percent of the poverty rate but repeals the Medicaid expansion if the state doesn't obtain a waiver from the federal government. State lawmakers are hotly debating whether permission will be granted by the Centers for Medicare and Medicaid Services, which hasn't yet approved a partial Medicaid expansion. The plan will also cost more to implement, at least initially.
“Senate leaders last week acknowledged that their plan would initially be more expensive to implement than Proposition 3,” Benjamin writes. “But those costs would ultimately drop, they argued, once the federal government signs off on the state’s changes and agrees to pay 90 percent of Utah’s Medicaid costs.”
The bill goes next to the Utah House, where leaders have expressed support for replacing Prop 3.
Jonathan Schleifer, executive director of The Fairness Project, which helped fund expansion efforts in multiple states called the bill "a slap in the face to Utahns who voted for full Medicaid expansion in their state...Utahns voted for more healthcare and more tax dollars brought home."
OUCH: There are 13 million people living in poverty in the United States who get no help from food stamps or other nutrition programs, child-care assistance, subsidized housing, or cash benefits, our Post colleague Tracy Jan reports, citing a new Urban Institute analysis.
That’s a quarter of people living in poverty, with incomes less than $25,100 a year for a family of four, who are disconnected from the reach of social safety net programs, she writes. And among families of four making less than $13,000 a year, almost a third receive no such benefits.
“Black Americans are most likely to receive assistance, with 85 percent of those in poverty receiving at least one form of aid,” Tracy writes. “Hispanics and Asians are least likely, with 66 and 67 percent, respectively. Among whites, 70 percent receive at least one benefit.” She adds research suggests there are many reasons some groups may receive more help than others, and studies have shown “lower-income white families have more resources to fall back on than lower-income nonwhite families.”
OOF: Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and the committee's top Democrat Ron Wyden (D-Ore.), have called on the executives of seven major pharmaceutical companies to testify before the panel at a hearing later this month.
The committee announced its second drug pricing hearing of the new Congress will be held on Feb. 26.
At its first hearing last week, the pair expressed disappointment that many drug company executives had declined their invitations to testify. “The drugmakers are going to have to show up,” Wyden said last week.
“The companies that declined said they would discuss their ideas in private, but not in public,” Grassley said during the hearing. “That is not what I mean when I talk about transparency.”
The senators said Monday they invited AbbVie, AstraZeneca, Bristol-Myers Squibb, Johnson & Johnson, Merck & Co., Pfizer and Sanofi to testify.
“Pharmaceutical companies receive billions of dollars a year from federal programs like Medicare and Medicaid,” Grassley and Wyden said in a statement. “This is an opportunity for companies that produce life-saving treatments to explain how they price these treatments and whether the status quo is acceptable. Patients and taxpayers deserve to hear from leaders in the industry about what’s behind this unsustainable trend and what can be done to lower costs.”
— The White House released a list of 13 guests invited by President Trump and first lady Melania Trump to attend the State of the Union. Among the list is Matthew Charles, the first prisoner released as a result of the First Step Act, the bipartisan criminal-justice-reform bill the president signed into law in December. Charles was released after spending 35 years in prison for selling crack cocaine, the White House said.
The White House also invited Ashley Evans, a woman who has struggled with opioid and substance abuse and later this month will celebrate more than a year in recovery.
— Rep. Alexandria Ocasio-Cortez (D-N.Y.) has invited the activist who confronted then-Sen. Jeff Flake (R-Ariz.) about his support for the nomination of Brett M. Kavanaugh to the Supreme Court. Ana Maria Archila and another woman blocked the doors of an elevator on Capitol Hill to grill Flake about his support for Kavanaugh amid several allegations of sexual misconduct.
“The women described themselves as survivors of sexual assault and tearfully urged Flake to reconsider his position,” our colleague Elise Viebeck writes. “The encounter was carried live on CNN and became an iconic moment in the national controversy over Kavanaugh’s nomination.”
— Today the Senate Health, Education, Labor and Pensions Committee is scheduled to hold a hearing on how primary care affects health costs and outcomes. Chairman Lamar Alexander (R-Tenn.) will stress the importance of promoting overall patient wellness, keeping patients out of the emergency room and allowing patients to compare costs, in remarks shared in advance with The Health 202.
“I believe we can empower primary care doctors, nurse practitioners, and physicians assistants to go even a step further. Even if information on the cost and quality of health care is easily accessible, patients still have trouble comparing different health care options,” Alexander is expected to say. “For example, earlier this year, hospitals began to post their prices online, as required by the Centers for Medicare and Medicaid Services, but to the average consumer, this information has proved to be incomprehensible.” Live stream and witnesses here.
— Sen. Bernie Sanders (I-Vt.) is calling on drugmaker Catalyst Pharmaceuticals to explain why it set a price of $375,000 a year for medication that’s been available to patients free for years.
Sanders wrote a letter regarding the drug, Firdapse, used to treat rare autoimmune disorder Lambert-Eaton myasthenic syndrome (LEMS). The Vermont senator called on the company to explain the financial and nonfinancial factors in the decision to set the annual list price at $375,000, the average and median amount patients will pay for the drug out-of-pocket, and an estimate of how many patients will suffer or die as a result of the list price.
"Until now, patients have been able to access an unapproved version of this drug for free through a Food and Drug Administration compassionate use program," Sanders writes to Catalyst chief executive Patrick J. McEnany.
“Catalyst’s decision to set the annual price at $375,000 is not only a blatant fleeing of American taxpayers, but it is also an immoral exploitation of patients who need this medication,” he added. “I am profoundly concerned that Catalyst’s actions will cause patients to suffer or die.”
— In remarks at a health-care conference, HHS Secretary Alex Azar suggested hospitals can do more to help patients understand the list price information they are now required to make available online.
As of the beginning of the year, a new policy requires all hospitals to post their list prices online in a move by the Trump administration to increase price transparency. But industry experts warn the posted list prices won’t necessarily help patients understand their out-of-pocket costs.
Azar seemed to dismiss those concerns, Modern Healthcare’s Robert King reports. "To the extent that hospital list prices aren't useful information to the patients they serve, well, hospitals are the ones in the best position to do something about that," Azar said.
— There was a rush of women seeking long-acting reversible birth control following the 2016 presidential election, a new study has found.
“The study, which only looked at women enrolled in commercial health insurance, found a 21.6 percent increase in the insertion rates of long-acting reversible contraceptive methods among women ages 18-45 in the 30 days after President Trump was elected,” the New York Times’s Christina Caron reports. “When the researchers examined the 30 days before and after the election, and compared it to the same time period in 2015, they found that an additional 2.1 IUDs or implants inserted per 100,000 women per day were associated with the election.”
The study's authors suggest the increase could be related to concerns about whether the Affordable Care Act, which requires insurers to cover 18 types of contraception, would be repealed during the Trump administration. Christina points out, however, the motivation of the women who acquired the implants was not part of the survey.
But here’s how lead study author and Harvard Medical School assistant professor of medicine Lydia Pace put it: “Was there something else that happened that could account for that rise? Not that I know of.”
— And here are a few more good reads:
- The Senate Health, Education, Labor and Pensions Committee holds a hearing on primary care costs and outcomes.
- The House Energy and Commerce Health Subcommittee holds a hearing on the GOP-led lawsuit to overturn the ACA and the impact on people with pre-existing conditions on Wednesday.
- The House Energy and Commerce Health Subcommittee holds a hearing on the Trump administration’s family separation policy on Thursday.
From The Post's Fact Checker: What Trump did and didn't get done from his 2018 State of the Union proposals:
Virginia Lt. Gov. Justin Fairfax (D) denied a sexual assault allegation from 2004 raised in an online report: