President Trump on Tuesday night was careful not to provide new details of his economic policy agenda. He reiterated his call for cut tax rates for businesses and individuals, and he mentioned the $1 trillion infrastructure plan that he wants Congress to authorize.
Both of these will be heavy lifts for lawmakers, but Trump is making a calculated decision by keeping specific policy prescriptions out of major speeches. It gives congressional leaders more room to maneuver when they aren’t boxed in by the White House. For example, the White House has given conflicting signals on whether it supports a border-adjustment tax. This has led to confusion on Capitol Hill and threatened to bog down the entire tax reform process.
Trump has promised he will provide Congress with details of his ideas to overhaul the tax code, and businesses are also clamoring for any detail of whether he will gut loopholes as a way to offset reduced rates. But for now, Trump played it safe, sticking to his longtime call for lower tax rates but avoiding other key details. The tricky negotiating, something he has long prided himself on, will have to come at a later date.
Though President Trump has called the dismantling of the Affordable Care Act his top domestic priority, his remarks about health care came deep into his address to Congress. Largely repeating what he has been saying since his election, the president spoke in broad terms about longtime staples of GOP thinking on how to shift the nation’s health-care system.
Trump laid out what he called the principles that should guide Congress in working to “save Americans from this imploding Obamacare disaster.” He reiterated his position that people with preexisting medical problems should have access to insurance. He did not, however, mention an idea popular among Republicans to rely on state-level “risk pools” for those people, instead of the ACA’s rule that insurers may not turn them away or charge them more.
The president also endorsed federal tax credits instead of the current subsidies available to more than four-fifths of consumers buying health plans on ACA marketplaces. And he repeated his support for an expansion of health savings accounts. He spoke of giving states “the resources and flexibility they need with Medicaid” but did not say whether he preferred turning the program into a system of block grants to states or a cap for each person in the program — a debate underway on Capitol Hill.
He embraced a favorite cause of his new health and human services secretary, Tom Price, calling for unspecified changes to medical malpractice laws. In addition, he urged “work to bring down the artificially high price of drugs,” without specifying an approach he has mentioned recently: giving the government greater power to negotiate with pharmaceutical companies the prices of drugs in public insurance programs.
Midway through his address to Congress, President Trump paused to highlight the inspiring story of Megan Crowley, 20, whose life is a testament — in part — to American entrepreneurship.
When Megan was diagnosed with an extremely rare disease as a baby, her father, John Crowley, founded a small biotechnology start-up to try to cure Megan and her brother — an effort that ultimately grew into an 80-person company and helped create the drug that keeps Megan healthy today.
Megan’s affliction, Pompe disease, is exceedingly rare. The course of the disease varies by patient, but it causes children’s muscles to weaken and, eventually, their lungs may fail. Today, thanks to the work of her father — and the American biotechnology industry — Megan is a sophomore at University of Notre Dame.
Trump said that cutting regulations at the Food and Drug Administration, which regulates drugmakers, would be a path to more stories like Megan’s.
“If we slash the restraints, not just at the FDA but across our government, then we will be blessed with far more miracles like Megan,” Trump said. “In fact, our children will grow up in a nation of miracles.”
Crowley’s story is gripping enough that it led to a book and inspired a 2010 movie, Extraordinary Measures, where he was played by Brendan Fraser. And in many way it seems to hit all the right notes for Trump’s vision of American business and medicine: John Crowley wasn’t an industry insider. When he founded his first biotech company, he was motivated by the desire to cure his kids, not pharmaceutical greed. He was a tough, driven American dad who created American jobs.
But pull back the curtain a little further, and it becomes clear that this success story is quintessentially American in a different way than Trump might care to admit. The actual drug, that saved Megan’s life is manufactured in Belgium and was developed by a biotech company founded by a Dutch immigrant — a company that is today owned by a French firm. The drug was invented through a scientific experiment that couldn’t have happened without international collaboration. And a president who has said he wants to bring down drug prices just held up as a shining example of innovation a drug that costs an average of $298,000 a year, per patient.
It’s also unclear whether the Crowley’s inspiring story and the development of the drug Myozyme (also called Lumizyme) is really an example of how “our slow and burdensome approval process at the Food and Drug Administration keeps too many advances, like the one that saved Megan’s life, from reaching those in need,” as Trump described.
Other companies have pointed to Myozyme as an example of the agency’s flexibility in getting drugs approved quickly, based on small amounts of data.
Briefing materials prepared by the drug company Sarepta Therapeutics to support the approval of their drug last year cited Myozyme as an “approval precedent” that they hoped to follow.
Last April, at a hearing in support of Sarepta’s drug, one of the researchers involved in Myozyme’s approval testified to the advisory committee that its passage through the regulatory process as a helpful parallel to consider.
Against the recommendation of its advisory committee, which wanted to see more evidence, regulators approved that drug.
Correction: A previous version of this post incorrectly stated which actor played John Crowley in the movie, Extraordinary Measures. He was played by Brendan Fraser.
President Trump decried the “slow and burdensome” approval process for new drugs at the Food and Drug Administration.
But approvals have sharply accelerated over the last several years. For 2016, the median time was about 10 months for regular approvals and eight months for priority ones, according to the agency. That compared to almost 27 months and 20 months, respectively, in 1993.