‘Modest’ steps follow Trump’s big promises
Senate debates immigration
WASHINGTON, Feb 11, (AP): US President Donald Trump makes big promises to reduce prescription drug costs, but his administration is gravitating to relatively modest steps such as letting Medicare patients share in manufacturer rebates.
Those ideas would represent tangible change and they have a realistic chance of being enacted. But it’s not like calling for Medicare to negotiate drug prices.
Skeptics say the overall approach is underwhelming, and Trump risks being seen as an ally of the powerful pharmaceutical industry, not its disrupter.
The White House Council of Economic Advisers has released a 30page strategy for reducing drug costs, and it calls current policies “neither wise nor just.” The plan, outlined before Trump releases his new budget proposal Monday, focuses mainly on Medicare and Medicaid changes, along with ideas for speeding drug approvals and fostering competition.
“Despite promises to drastically lower prices the mix of proposed changes does not appear likely to do so, even though there are some constructive proposals,” said John Rother, CEO of the National Coalition on HealthCare, an advocacy group whose members include consumer organizations, medical societies, hospitals and insurers.
Polls show the high cost of drugs is a top concern of Americans, regardless of political leanings. In his State of the Union speech, Trump seemed to foreshadow major change, saying “fixing the injustice of high drug prices” is a top priority this year.
“And prices will come down substantially,” Trump added. “Watch.”
As a candidate, Trump advocated Medicare negotiations and he called for allowing consumers to import lower-priced medicines from abroad. But the White House strategy paper veers away from such dramatic steps. His new health secretary, Alex Azar, was a top executive at pharmaceutical giant Eli Lilly.
Medicare negotiations and drug importation are unacceptable to the drug industry, which has spent tens of millions of dollars since Trump’s inauguration to influence the Washington conversation around drug prices, including a high-profile TV advertising campaign portraying its scientists as medical trailblazers.
The White House strategy largely sidesteps the question of whether drugmakers set their prices too high to start with. Rather, it recommends changes to policies that the administration believes unwittingly lead to higher prices, and suggests ways to speed drugs to market and increase competition.
It takes aim at foreign governments that dictate what drug companies can charge their own citizens. Trump often has noted that the same medications Americans struggle to pay for can be bought for much less abroad. The White House report examined 35 economically advanced countries, and found that US consumers and taxpayers pay for more than 70 percent of drug company profits that fund innovation.
“Other nations are free-riding, or taking unfair advantage,” according to the review.
Trump
Trump is the question mark:
The Senate will open up a rare, open-ended debate on immigration and the fate of the “Dreamer” immigrants on Monday. But the most influential voice in the conversation may be on the other side of Pennsylvania Avenue.
If the aim is to pass a legislative solution soon, President Donald Trump remains a crucial and, at times, complicating player. His day-to-day turnabouts on the issues have confounded both Democrats and Republicans and led some to urge the White House to minimize his role in the debate for fear he’ll say something that undermines the effort.
Yet his ultimate support will be vital if Congress is to overcome election-year pressures against compromise. No deal crafted in the Senate is likely to see the light of day in the more conservative House, without the president’s blessing and promise to sell compromise to his hard-line base. Trump, thus far, has balked on that front.
“The Tuesday Trump versus the Thursday Trump, after the base gets to him,” is how Sen Jeff Flake, R-Arizona, a proponent of compromise, describes the president and the impact conservative voters and his hard-right advisers have on him. “I don’t know how far he’ll go, but I do think he’d like to fix it.”
Senate Majority Leader Mitch McConnell, RKentucky, scheduled an initial procedural vote for Monday evening to commence debate. It is expected to succeed easily, and then the Senate will spend days or weeks — no one knows how long — sorting through proposals.
Democrats and some Republicans say they want to help the “Dreamers,” young immigrants who have lived in the US illegally since they were children and have only temporarily been protected from deportation by an Obama-era program. Trump has said he wants to aid them and has even proposed a path to citizenship for 1.8 million, but in exchange wants $25 billion for his proposed US-Mexico border wall plus significant curbs to legal immigration.
McConnell agreed to the open-ended debate, a Senate rarity in recent years, after Democrats forced a government shutdown last month and would supply enough votes to reopen agencies with a promise of a debate and votes on immigration. They’d initially demanded a deal toward helping Dreamers, not a simple promise of votes.
What’s certain is that to prevail, any plan will need 60 votes, meaning substantial support from both parties is mandatory. Republicans control the chamber 51-49 but GOP Sen John McCain of Arizona has been home for weeks battling brain cancer. It’s unclear who will offer what. Some version of Trump’s plan and a bipartisan proposal to give Dreamers a chance at citizenship — with no border security money or legal immigration restrictions — seem likely to surface. Both are considered certain to fail.