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ACA Mandate Repeal, Drug Prices, Opioids in State of the Union

Alicia Ault
January 30, 2018

In his first State of the Union address tonight, President Donald J. Trump said he would work to reduce prescription drug prices, urged Congress to pass a "right-to-try" law, and applauded the elimination of the Affordable Care Act requirement that individuals purchase insurance. He also highlighted the need to take action on the opioid crisis.

The recently enacted tax reform package did away with the penalty that individuals faced if they did not buy health insurance.

"We eliminated an especially cruel tax that fell mostly on Americans making less than $50,000 a year, forcing them to pay tremendous penalties, simply because they couldn't afford a government ordered health plan," said the president. "We repealed the core of the disastrous Obamacare. The individual mandate is now gone, thank heaven," he said.

Trump also touted what he called an improved drug approval process at the US Food and Drug Administration (FDA). He claimed that in 2017, the FDA had "approved more new and generic drugs and medical devices than ever before in our country's history."

The president said, however, that drug prices are too high and said that one of his "greatest priorities" would be to find a way to bring them down, calling them "very, very unfair." Trump added, "That is why I have directed my administration to make fixing the injustice of high drug prices one of my top priorities for the year. And prices will come down substantially. Watch."

Building on that, he said that patients with terminal illnesses should have the right to try experimental therapies. "People who are terminally ill should not have to go from country to country to seek a cure," said Trump. "It's time for Congress to give these wonderful, incredible Americans the right to try," he said, eliciting a large burst of applause.

Some 38 states have passed right-to-try laws. In August 2017, the Senate passed a right-to-try bill, but the House has not taken up legislation.

Some physician organizations have expressed concern about such laws. The American Society of Clinical Oncology (ASCO) said in April 2017 that it is concerned that the laws currently in place "do not adequately protect patients, do little to facilitate patient access to such therapies, and potentially interfere with recent reforms that are already streamlining patients' access to investigational agents."

Weighing in on Opioid Epidemic

About an hour into the speech, the president weighed in on the opioid epidemic. Noting that 174 Americans die from an overdose each day, he said, "We must get much tougher on drug dealers and pushers if we are going to succeed in stopping this scourge."

He said that his administration "is committed to fighting the drug epidemic in helping get treatment for those in need," adding, "The struggle will be long and it will be difficult. But as Americans always do, in the end we will succeed, we will prevail." It was similar to a statement made after the President's Commission on Combating Drug Addiction and the Opioid Crisis issued its report in November 2017.

He also took time to recognize one of his guests at the speech, Ryan Holets, a 27-year-old Albuquerque, New Mexico, police officer who, with his wife, adopted the baby of a woman who was addicted to heroin.

Many members of Congress were wearing purple ribbons in support of those who have struggled with opioids, and some brought guests who had been affected by the epidemic.

Trump also said that his administration would be paying more attention to healthcare for veterans, claiming to have removed more than 1,500 employees "who failed to give our vets the care they deserved."

He also noted that his administration had "taken historic actions to protect religious liberty," referring in part to the recent announcement that the Department of Health and Human Services will establish a new conscience and religious freedom division.

The president also addressed the future of protection for so-called Dreamers — children who came to the US with their parents who have been allowed to stay on to work and study. He proposed what he called a "four pillar" plan that would include a path to citizenship for what he said were 1.8 million individuals, more border security, an end to the visa lottery system, and elimination of "chain migration."

Rep. Joe Kennedy (D-MA) gave the Democratic response from a technical high school in Fall River, Massachusetts. He said that the Trump administration was turning American life into "a zero sum game," in which "for one to win, another must lose."

In that game, "We can guarantee America's safety if we slash our safety net. Where we can extend health care in Mississippi if we gut it in Massachusetts. Where we can take care of sick kids if we sacrifice Dreamers," he said.

Democrats, on the other hand, "choose a healthcare system that offers you mercy, whether you suffer from cancer, or depression, or addiction," Kennedy said.

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Reviewed on 1/31/2018

SOURCE: Medscape, January 30, 2018.

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