The recent State of the Union Address by President Trump featured all the expected pageantry and political theatre — with members of Congress standing to applaud, often based on party affiliations.
While a lot will be written about the speech, and the corresponding Democratic Party response, I wanted to take a moment to review the portions of the address that focused on health care.
There were a variety of health-related matters that were called out during the course of the speech, including specific calls for action on the following:
- Protecting patients with pre-existing conditions
- Lowering the cost of health care and prescription drugs
- Prescription drug price leveling with other countries
- Passing legislation to ensure price transparency among hospitals, insurance companies, and prescription drug providers, all of which is designed to force competition
- Target and eliminate HIV
- Targeted fight against childhood cancers
- Nationwide paid family leave
Many of these items are topics that have been part of the national discussion on health over the last several years and have been a focal point of prior administration health care communications. Let’s take a deeper dive into what you need to know about a few of these proposals.
Protection for pre-existing conditions has bipartisan support
While protections for patients with pre-existing conditions currently exist, via the Affordable Care Act, President Trump’s calling out of this popular facet of the ACA confirms that regardless of the ACA’s fate there will be bipartisan agreement that this protection must remain.
Lowering prescription drug costs
Prescription drug costs are a frequent talking point for President Trump, and a cornerstone of his ‘American Patients First — The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs’, released in May of 2018. In the blueprint, Health and Human Services Secretary Alex Azar calls attention to four main challenges for reforming the current system: High list prices; seniors and government programs overpaying for drugs due to lack of negotiation tools; high out-of-pocket costs for consumers; and disproportionate share of the research and development costs carried by the United States, compared to other developed nations. So, how will the government start saving the consumer real dollars?
Passing savings to the consumer
The talking points in the State of the Union follow the release of a proposal, at the end of January 2019, by the Department of Health and Human Services. In the proposal, the HHS department would exclude safe harbor protections under the Anti-Kickback Statue rebates on prescription drugs by manufactures to pharmacy benefit managers, Part D plans and Medicaid managed care organizations.
Existing safe harbors are often criticized as favoring / incentivizing drugs with higher list prices, and this proposal is intended to address this issue by providing a new safe harbor to protect direct discounts that patients will see directly at the pharmacy counter.
The shadow of healthcare prices — there needs to be more transparency
In this speech, the President also called out price transparency within the health care space specifically mentioning health insurance, hospitals, and prescription drugs as needing to disclose ‘real’ prices to force competition. The recently released Health and Human Services proposal, mentioned above, is also intended to provide price transparency by requiring pharmacy benefit managers to disclose details of fee arrangements with the drug manufacturers and insurance plans.
Put national paid family leave on your radar
Another program potentially impacting employers called out during the address was a national paid family leave program. The State of the Union Address is traditionally light on specifics regarding proposals and plans, but with many state programs already being rolled out, having a nationwide solution could simplify the management of these leaves for some employers.
Opportunities for bipartisan partnership are possible
Additional opportunities for common ground come from the targeted disease programs that were called out as components of the President’s budget — eliminating HIV and the fight against childhood cancers. Both programs, while lacking specifics, are programs designed to gather popular and bipartisan support.
Want to learn more about what to look out for this year in compliance issues? Check out our recent webinar below.