- The Washington Times - Tuesday, February 5, 2019

President Trump signaled a new direction on health care Tuesday, replacing the partisan demands for an end to Obamacare that dotted past speeches with new plans to tackle major health crises such as HIV/AIDS, and proposals to work on controlling health care costs without major changes to the insurance system.

Mr. Trump said he wants to end HIV transmission in the U.S. by 2030 by directing resources to places with high transmission rates and at-risk populations. He said efforts to reel in the prescription painkiller and heroin crisis will continue, along with his campaign to slash prescription drug costs.

“It is unacceptable that Americans pay vastly more than people in other countries for the exact same drugs, often made in the exact same place. This is wrong, unfair and together we can stop it,” he said in remarks prepared for his State of the Union Address.

It’s a shift from Mr. Trump’s first address to Congress in 2017, when he focused on his plea to replace Obamacare with a plan to increase choices, lower costs and provide better care, warning his predecessor’s law was on the verge of collapse.

That effort faltered, forcing Mr. Trump to limit his 2018 boasts to a more limited victory over Obamacare’s “individual mandate” tax. The GOP had zeroed out the penalty in their sweeping tax overhaul, leaving the rest of President Obama’s law, which still insures millions, largely in place.

Tuesday’s pivot to more bipartisan goals mirrored Mr. Trump’s overarching theme of the night — that it’s time to come together.

It also reflected the limits of what he can do on health care reform, after Democrats retook the House majority by highlighting the GOP’s foibles in trying to craft a partisan replacement. Those Democrats are now looking beyond the 2010 law at ways to expand taxpayer-funded coverage, leaving Republicans to look for wins elsewhere.

“Many Republicans do see health care costs — including drug costs and surprise medical bills — as popular issues where they can be on the right side, and maybe even achieve bipartisan legislation,” said Timothy Jost, a law professor at Washington and Lee University who tracks the debate. “I also think, however, that they are hoping that the Democrats will get out in front of public opinion on universal coverage, and that health care may again become a winning issue for [Republicans] in 2020.”

Senate Health Committee Chairman Lamar Alexander says it’s best to focus on the costs of care for everyone, rather than tearing each other apart over the sliver of Americans who have struggled to buy insurance on their own.

“We absolutely should shift our focus from a perpetual argument over 6 percent of the insurance market to how do we reduce health care costs,” Mr. Alexander told The Washington Times.

He’s forging bipartisan plans to tackle high prescription-drug costs, make prices more transparent and end “surprise billing,” in which patients get eye-popping bills because they landed in the wrong hospital or an ER doctor is out of their insurance network.

Also, his panel Tuesday held a hearing on the role of direct primary care centers where families can pay a flat fee for many preventive services, so they stave off costly conditions down the road.

“Right there, you can see a pretty good list of subjects that both Democrats and Republicans have been talking about, and which will be of a lot more benefit to the American patient and consumer than an eight-year, Hatfield-and-McCoy argument over the health insurance market,” he said.

The chairman said Mr. Trump’s health secretary, Alex M. Azar II, has been an ally in his efforts and that Mr. Trump’s use of the bully pulpit will be invaluable.

“If the president talks about reducing health care costs, that will be a tremendous help,” he said.

Democrats say they’re ready to tackle things like surprising billing and the high cost of prescription drugs. Several of them linked arms with Republicans this week in pressing drugmakers and insurers for information on both fronts, saying their input will help them draft legislation.

Yet senior Democrats say Mr. Trump cannot be trusted to leave Obamacare alone entirely, citing his support for a state-driven lawsuit that could upend the law.

Democrats also say Mr. Trump’s actions to pare back Obamacare have already taken a toll.

“After two years of relentless sabotage by the Trump administration and congressional Republicans, premiums are higher than they should be, copays are higher than they should be, and for the first time in eight years, fewer Americans have health insurance than the year before,” said Senate Minority Leader Charles E. Schumer. “The state of the Trump healthcare system: failing the middle class.”

Andy Slavitt, the chief of public insurance programs under Mr. Obama, said Mr. Trump would reverse his support for the Obamacare lawsuit if he were serious about pivoting toward bipartisan solutions, though he sees some progress on other fronts.

“I do think it is a mark of progress that both parties are now speaking the same language about unaffordable drug costs — mirroring the American public,” he said. “During the Obama administration, we could not get bipartisan support for very similar proposals.”

• Tom Howell Jr. can be reached at thowell@washingtontimes.com.

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