THE PROGNOSIS

President Trump sought to place the health care of Americans on center stage during his State of the Union address last night.

But as on other issues, his record is decidedly mixed.

The president applauded the rollback of a key portion of the Affordable Care Act, which he has called a disaster. He called for protections for people with preexisting conditions, though his administration has worked against keeping them by trying to eliminate Obamacare. He pledged to bring down the price of prescription drugs and called for childhood cancer funding, earning some applause from Democrats. But Trump also called for halting the spread of HIV transmission before 2030 -- even though his previous budgets have proposed slashing money from government initiatives in that area.

Democrats will deride his boasts about protecting preexisting conditions and repealing the ACA's penalty for lacking coverage. But Trump's remarks about high drug prices are in a middle category: It’s an issue where there’s room for bipartisan agreement but also partisan disputes over how far the government should go in regulating the pharmaceutical industry.

It’s been one year since Trump promised prescription drugs would become less expensive. Last night, he tried to take a victory lap even though the policies his administration has proposed on the issue could take months or years to make a difference.

“Already, as a result of my administration's efforts, in 2018 drug prices experienced their single largest decline in 46 years,” Trump said. “But we must do more,” the president added. “It is 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, unfair, and together we can stop it.”

Over the past year, Trump has sought repeatedly to take credit for bringing down pharmaceutical prices in the United States where they’re higher than anywhere else. He’s tweeted frequently about the issue – sometimes even trying to predict industry moves in advance – and last month hauled Health and Human Services Secretary Alex Azar and other top officials to the White House to express frustration more progress wasn’t being made.

There’s truth to the drug price reductions Trump boasted about last night, although it's too early to claim his proposals have made the difference. The consumer price index for prescription drugs fell by 0.6 percent in 2018, according to the Bureau of Labor Statistics. As my colleague Glenn Kessler recently noted, that decline would be the first drop in 46 years in the December-to-December timeframe (although there have been other 12-month periods with index declines).

Trump’s administration has certainly tried to look aggressive on the issue. The Food and Drug Administration says it has set a record for generic drug approvals. HHS has proposed requiring drugmakers to display prices in television ads, lowering some Medicare drug payments by pegging them to an international index and nixing secretive rebates exchanged between drug companies and pharmacy middlemen.

These ideas – which haven’t been finalized – could help move the needle. But they’ll take time to put in place and the administration would need Congress to pass a bill in order to fully implement the international pricing index it has proposed for Medicare. Trump appeared to recognize that reality, asking Congress to pass such legislation.

Seema Verma, administrator of the Centers for Medicare and Medicaid Services:

Sen. Kamala Harris (D-Ca.), who is running for her party's presidential nomination:

Here are the other health-care takeaways from Trump’s address:

1. He asked Congress for funding to support the administration’s new effort to end new HIV transmissions in a decade.

“Trump went beyond the promises of any of his predecessors since AIDS appeared as a deadly scourge nearly four decades ago,” my colleague Amy Goldstein reports. “He announced a strategy to stop the spread of HIV by 2030 by concentrating as-yet unspecified resources on 48 counties and other ‘hot spots’ where half the nation’s new infections occur.

“Scientific breakthroughs have brought a once-distant dream within reach,” Trump said. “Together, we will defeat AIDS in America and beyond.”

The new initiative will focus on 48 counties and seven states where new HIV infections are concentrated, Amy reports. “Teams of HIV health workers — CDC employees or working through CDC grants — will fan out into such communities, trying to encourage residents at risk of HIV to get tested and to start preventive medicine or, if they test positive, to go on drug regimens to lessen their chances of getting sick or spreading the virus,” she writes.

Officials said the goal is to reduce new HIV infections by 75 percent within five years and 90 percent over the next decade.

HHS Secretary Alex Azar:

Catherine Rampell, an opinion columnist at The Post:

Rep. Anthony Brown (D-Md.):

2. Trump also asked Congress for more money to combat childhood cancer.

Trump told the story of 10-year-old Grace Eline, who was diagnosed with brain cancer last year and was a guest of First Lady Melania Trump. He said the budget request he’ll present to Congress will request additional funding for childhood cancer research.

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

3. Trump said lawmakers should pass legislation prohibiting abortion midway through pregnancy.

He denounced two controversial measures in New York and Virginia making it easier to obtain a late-term abortion. 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.

“There could be no greater contrast to the beautiful image of a mother holding her infant child than the chilling displays our nation saw in recent days,” Trump said. “Lawmakers in New York cheered with delight upon the passage of legislation that would allow a baby to be ripped from the mother's womb moments before birth.”

Trump slammed Virginia Gov. Ralph Northam (D), whose description of how the law might apply to a live birth prompted accusations from Republicans that he was implying infanticide.

“These are living, feeling, beautiful babies who will never get the chance to share their love and dreams with the world,” the president said. “And then, we had the case of the Governor of Virginia where he basically stated he would execute a baby after birth.”

The president asked lawmakers to pass a measure prohibiting abortions past 20 weeks of pregnancy based on the idea that a fetus can feel pain beyond that point of development. The House has passed such legislation in the past, but it’s always been blocked by Democrats in the Senate.

“Let us work together to build a culture that cherishes innocent life,” Trump said. “And let us reaffirm a fundamental truth:  all children -- born and unborn -- are made in the holy image of God.”

Trump added that he’ll again propose paid family leave in his budget, an idea he spent considerable time on in last year’s State of the Union address. “I am also proud to be the first president to include in my budget a plan for nationwide paid family leave -- so that every new parent has the chance to bond with their newborn child,” he said.

New York Times reporter Emily Cochrane:

Anti-abortion rights group Susan B. Anthony List President Marjorie Dannenfelser:

Anti-abortion rights group March for Life:

Planned Parenthood President Leana Wen, a guest of Speaker Nancy Pelosi (D-Calif.):

4. Trump patted Congress on the back for ditching Obamacare’s individual mandate penalty and for passing the "Right to Try" act and an opioids package.

“We eliminated the very unpopular Obamacare individual mandate penalty -- and to give critically ill patients access to life-saving cures, we passed Right to Try,” he said.

"Right to Try" is a new law the president signed last year, which allows terminally ill patients access to drugs not fully approved by the Food and Drug Administration if they've exhausted all other treatment options. It's the only bill Trump mentioned in last year's State of the Union.

Politico's Sarah Karlin-Smith:

House Energy and Commerce ranking member Greg Walden (D-Ore.):

5. Trump gave a rah-rah for preexisting condition protections.

“The next major priority for me, and for all of us, should be to lower the cost of healthcare and prescription drugs -- and to protect patients with pre-existing conditions,” Trump said.

But here’s what Trump didn’t mention: His administration is refusing to defend in court a challenge against the ACA which could dismantle its protections for patients with preexisting medical conditions.

Jonathan Cohn, senior national correspondent for HuffPost:

Rep. Ben Ray Lujan (D-N.M.):

Rep. Seth Moulton (D-Mass.):

AHH, OOF and OUCH

AHH: House Speaker Nancy Pelosi (D-Calif.) said she was disappointed the president did not discuss “the gun violence epidemic” in his speech, even as he listed threats against the country.

“The overwhelming reaction that I’m receiving is that the president talked about security in so many different ways, and he totally ignored the gun violence epidemic in our country,” she told reporters after the address, Roll Call’s Katherine Tully-McManus reports.

Pelosi’s guests to the address included Mattie Scott, a California chapter president at the Brady Campaign  and Fred Guttenberg, whose daughter Jaime was killed in last year’s Parkland, Fla. shooting. “They were just so saddened by the fact that he made no pass at it, no acknowledgment of it, while representing that he was talking about keeping American people safe,” Pelosi said.

The president did make a reference to the October shooting at the Tree of Life synagogue in Pittsburgh, though the mention was mostly in the context of anti-Semitism and to honor a first responder.

OOF: A top policy aid to Pelosi reportedly met with top health-industry executives to express that Democratic Party leadership had reservations about the kind of universal health care plan some new members of the party are pushing.

The Pelosi aide, Wendell Primus, met with Blue Cross Blue Shield executives and outlined five concerns party leadership had with “Medicare-for-all,” the Intercept’s Ryan Grim reports, citing sources familiar with the meeting. Their objections centered around cost, stakeholder opposition and implementation issues. Primus assured the executives in the early December meeting that they would help the insurance industry bat down efforts for a single-payer health care plan, and insisted the party was more focused on tackling high drug prices, Ryan reports.

Pelosi appears to remain skeptical as congressional Democrats have introduced a range of Medicare-for-all plans, without unifying support behind any one proposal or a deep understanding of what all the proposals would encompass, as Health 202 wrote last month. 

For his part, Primus told Ryan he did not discuss a specific deal with insurers during the December meeting. And Pelosi spokesperson Henry Connelly described the presentation as a “a broad look at the health care environment and some of House Democrats’ legislative priorities over the next two years in a period of GOP control of the Senate and White House.” “We’re not going to barter lower prescription drug costs for inaction in the rest of the health care industry,” Connelly said.

OUCH: Just as a bill in Utah to limit voter-approved Medicaid expansion is moving quickly through the state legislature, lawmakers in Idaho are also working on a measure pushing back on expansion of the program.

Three months after 61 percent of the state’s voters approved Medicaid expansion, a group of 15 conservative state lawmakers in Idaho are working on a bill to add work requirements and monthly premiums for individuals eligible for the expanded program, Kaiser Health News’s Phil Galewitz reports.

Republicans in Idaho said the legislation is an effort to control spending. “We need to put some sideboards on the expansion,” Idaho House majority caucus leader John Vander Woude said, adding voters didn’t understand the cost associated with expansion when they voted for it at the ballot. He said the referendum voters approved “had no financing to show what it would cost… the best way to implement this is do it in a cost-effective way to get the results we are looking for.”

Phil writes Jamila Michener, an assistant professor of government at Cornell University warned the actions coming out of Idaho and Utah “could chill other potential Medicaid expansion ballot referendums planned for 2020 in Florida and other states.”

HEALTH ON THE HILL

— Republican leaders on the House Energy and Commerce Committee are asking their Democratic counterparts to hold a hearing on Medicare-for-all, anxious to highlight how expensive such a plan could be. Ranking member Greg Walden (R-Ore.) and health subcommittee leader Rep. Michael Burgess (R-Tex.) wrote that Democrats should explain how they'd pay for dramatically expanding government-sponsored health coverage and whether that would upend the current system of private insurance.

“The American people should hear how House Democrats expect to address the massive costs associated with Medicare-for-All,” the pair wrote to Chairman Frank Pallone (D-N.J.). “We have a responsibility to review any legislative proposal that is supported by so many members of the House majority, especially one that threatens to impact directly the lives of millions of Americans by upending how they receive their coverage.”

— Two of the seven drug company summoned by Senate Finance Chairman Chuck Grassley (R-Iowa) and ranking member Ron Wyden (D-Ore.) to testify before Congress have agreed to send representatives to appear before the panel, the committee said yesterday.

Merck’s chief executive Ken Frazier said he’ll be one of the pharmaceutical leaders who will testify at a hearing set for Feb. 26, Reuters reports. A spokesman for the committee did not say which other company had agreed to testify. AbbVie Inc, AstraZeneca Plc , Bristol-Myers Squibb Co, Johnson & Johnson, Pfizer Inc and Sanofi SA are the other companies invited.

— A bipartisan group of senators working on legislation to address surprise medical bills has asked health-care providers and insurers for information about how states laws on billing practices, whether hospitals should play a role in tackling surprise medical bills and how much insurers pay for out-of-network care.

“We want to protect patients from costly surprise bills while preventing undue disruption in the health care system,” Sens. Bill Cassidy (R-La.), Michael Bennet (D-Colo.), Todd Young (R-Ind.), Tom Carper (D-Del.), Lisa Murkowski (R-Alaska), and Maggie Hassan (D-N.H.) wrote to stakeholders.

— Sen. Patty Murray (D-Wash.), the top Democrat on the Senate Health, Education, Labor and Pensions Committee, led a group of senators in calling on three insulin manufacturers, Eli Lilly, Novo Nordisk and Sanofi, to explain the increasing cost of the medication.

“The increase in the price of insulin has been responsible for driving average price increases for all injectable brand-name drugs,” they write in a letter to companies. “It is clear these steep price increases are resulting in patients lacking access to the life-saving medications they need."

STATE SCAN

— State lawmakers in Hawaii have proposed a bipartisan bill that would ban cigarette use for everyone except people 100 years and older.  The bill looks to slowly phase out cigarettes in the state almost entirely, except for centenarians, by 2024, our Post colleague Lindsey Bever reports.

“I know it may be a hard road,” Republican state Rep. Cynthia Thielen told Lindsey, “but you have to take that first, strong step — and that’s what we’re doing.”

Hawaii was the first state to ban smoking for people younger than 21. “The bill aims to raise the legal minimum age to purchase or possess cigarettes to 30 by next year; 40 by 2021; 50 by 2022; 60 by 2023 and 100 by 2024,” Lindsey reports. “The timetable would allow the state to plan for a loss in cigarette-tax revenue, according to reports. The bill does not apply to cigars, chewing tobacco or e-cigarettes.”

“Basically, we essentially have a group who are heavily addicted — in my view, enslaved by a ridiculously bad industry — which has enslaved them by designing a cigarette that is highly addictive, knowing that it highly lethal. And it is,” Democratic state Rep. Richard Creagan, the bill’s co-sponsor, told the Hawaii Tribune-Herald.

AGENCY ALERT

— First in Health 202: The nonpartisan public interest group Restore Public Trust is launching an ad campaign today characterizing HHS secretary Alex Azar as a pharmaceutical insider, highlighting how Eli Lilly raised drug prices during Azar's tenure there. The 30-second ad launched online today and will begin airing in D.C. on Fox News, CNN, and MSNBC on Thursday. The ad is the first campaign of a longer-term effort by the group on drug pricing.

The ad:

—And here are a few more good reads: 

TRUMP TEMPERATURE
Fact Checker
Here's a round-up of nearly 30 dubious claims made by the president during his speech
Glenn Kessler, Salvador Rizzo and Meg Kelly
The Fix
Meghan McCain’s comments came in response to a report detailing a private lunch with television news anchors, where Trump derided the late senator's book sales.
Michael Brice-Saddler
Trump is expected to tout his progress on drug pricing during Tuesday's State of the Union.
Politico
The proposal seeks to lower out-of-pocket spending in Medicare by taking aim at the secret deals that drug makers strike with industry go-betweens.
New York Times
MEDICAL MISSIVES
Health
William Brown's carotid artery was severed in the explosion, which led to a stroke, a Texas medical examiner found.
Alex Horton
INDUSTRY RX
The city’s health department said it was ordering restaurants to stop selling food products containing the increasingly trendy cannabidiol.
New York Times
DAYBOOK

Today

  • 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.

Coming Up

  • The House Energy and Commerce Health Subcommittee holds a hearing on the Trump administration’s family separation policy on Thursday.
SUGAR RUSH

Fact-checking President Trump's State of the Union:

Members of Congress stood and applauded when Trump highlighted women's electoral gains during his address: