President Donald Trump has had two years of a miserable health care record that helped drive his party’s significant midterm losses. He has undermined protections for people with pre-existing conditions, tried to cut health care coverage from 20 million Americans by repealing the Affordable Care Act, and, when that failed, he sabotaged the ACA at virtually every turn. Seven million fewer people have health insurance than when Trump’s term began.
Looking toward the next election, Trump hoped to use his State of the Union speech for a health care reset. To anyone paying the slightest attention, he failed.
Most incredibly, he called it a “priority” to “protect patients with pre-existing conditions.” That's a tough sell since his administration is supporting a lawsuit in Texas that would, as Trump hopefully put it last week, “terminate” the ACA. This would mean not just an end to pre-existing condition protections and 20 million low- and moderate-income Americans dropped from coverage, it would also eliminate the subsidy for Medicare prescription drugs that has made them affordable for millions of seniors in the coverage gap known as the “donut hole.”
Like much of Trump’s rhetoric, the real purpose of his State of the Union remarks on the ACA and prescription drugs was to try to persuade us to forget the reality of his administration’s policies.
For instance, Trump called high drug prices "unacceptable" and stressed the need to reduce them. And the high cost of prescription drugs is a real concern for American families. One in four report not being able to afford their prescription drugs. Four in 10 who have been diagnosed with cancer say they spend through their life savings on treatments within two years.
Beyond that, it is a mark of some progress that both parties are now speaking the same language about unaffordable drug costs. During the Obama administration, policies to reduce drug costs were met with constant resistance from the Republicans in Congress.
Yet Trump is adding costs to consumers left and right. For instance, he has introduced plans that allow insurance companies to decide what to cover and whom to exclude. A recent study by the Kaiser Family Foundation found that these plans (called short-term plans because they can be offered for 364 days and then renewed) are not much insurance at all: Only 29 percent cover outpatient prescription drugs, only 57 percent cover mental health, only 38 percent cover substance abuse treatment, and none covers maternity care.
Drug prices are up, not 'substantially' down
If you think it’s hard to brag about making drugs more affordable while raising drug costs for seniors and introducing insurance where only three in 10 plans even cover drugs, you haven’t met our president. He’s the same one introducing Swiss cheese plans that allow people with pre-existing conditions to be excluded while calling these protections a priority.
The polite word for it is nerve.
This isn’t the first time Trump has talked about reducing drug costs. A year ago, Trump said that fixing the "injustice" of high prescription drug prices would be a priority and that costs would “come down substantially."
It’s worth looking at what has changed since he made that commitment. A report from Pharmacy Benefit Consultants finds that drug prices soared over the first 14 months of Trump’s presidency, with the list prices of 20 prescription drugs increasing more than 200 percent.
Last year, there were about 1,800 prescription drug price increases, according to data compiled by 46brooklyn Research. This year already, Pfizer and Novartis have raised prices on dozens of drugs.
This isn’t to say that Trump’s Health and Human Services Secretary Alex Azar and his team haven’t been working on some proposals to reduce drug costs. They have, and some are quite worthy efforts. The most ambitious one takes off from an Obama proposal to reduce the cost of drugs provided in a doctor’s office. Republicans and some Democrats in Congress roundly criticized it at the time and are quieter now. Politics as usual or a small sign of progress?
Trump has backed away from negotiated prices
The problem is that none of these proposals comes close to addressing the crisis millions of Americans face in paying for their medications. The most direct way for Trump to reduce drug costs is to do what Obama proposed and then-candidate Trump promised — to use the buying power of Medicare and Medicaid to directly negotiate drug prices with the pharmaceutical companies to lower their prices.
Yet soon after he became president, Trump changed his tune on direct negotiations. After meeting with pharmaceutical executives, adopting the industry’s rhetoric, he called it “price fixing.” Instead Trump has pushed two years of increased costs and reduced coverage, crowned by hollow rhetoric.
Today, there is nothing stopping drug companies from continuing to raise prices and no place Americans can go for relief when they do. Americans overwhelmingly want the government to use its buying power to reverse increases and control the cost of drugs. And they want an administration that will make that a priority.
High drug costs and protections for people with pre-existing conditions will be powerful issues for Democrats in the 2020 election. That's because whomever they nominate for president will be running against Trump’s record, not his rhetoric.