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Trump offers 'principles' in replacing ACA, wants to change FDA procedures

In his first address to a joint session of Congress, President Donald J. Trump laid the broad strokes for replacing the Affordable Care Act while still ensuring access to health care coverage for everyone.

Trump's comments were quickly criticized by AAFP and ACP.

Saying that “Obamacare is failing” in certain parts of the country, Trump proposed five specific components the new plan should have, saying these ideas will allow for lower costs, expanded choice, and increased access:

• ability to purchase health insurance across state lines;
• legal reforms that protect doctors and limit unnecessary procedures that cause health insurance and prescription drug costs to rise;
• flexibility and resources in the form of block grants for state governments to determine their needs with Medicaid;
• expanded health savings accounts and tax credits to assist citizens in purchasing the coverage the individual wants; and
• measures to ensure both a stable transition for those presently in the health care exchanges and that those with pre-existing conditions have access to coverage.

“Mandating every American to buy government-approved health insurance was never the right solution for our country,” Trump said. “The way to make health insurance available to everyone is to lower the cost of health insurance, and that is what we are going to do.”

Trump cited states like Arizona, where health care premiums have gone up 116% in the last year alone, and Kentucky, where one-third of the counties only have one health insurer, as some of the reasons for implementing a new health care plan.

Despite responses to his address by those in attendance that fell along party lines, Trump encouraged bipartisan cooperation to achieve these and the other initiatives he mentioned in his speech.

“Action is not a choice, it is a necessity. So I am calling on all Democrats and Republicans in Congress to work with us to save Americans from this imploding Obamacare disaster,” he said. “Our citizens deserve this and so much more, so why not join forces and finally get the job done and get it done right.”

He also urged “slashing the restraints” to speed up what he called the “slow and burdensome approval process” at the FDA, but did not offer specifics on how that should occur. Trump argued that the FDA approval process delayed “medical advances … from reaching those in need.”

Healio has reported previously on the FDA’s response to criticism that the approval process for certain treatments is sluggish, specifically citing nearly two dozen cases where products with promising phase 2 trials failed in phase 3 development. The FDA also grants nearly all requests for compassionate use exemptions for terminally ill patients.

In a statement issued after the speech, AAFP President John Meigs, Jr., MD, said he was “disheartened” by the president’s comments, saying not everyone will be covered under Trump’s proposals as was suggested.

“Family physicians have long supported policies that ensure access to health care coverage for all Americans. They have cared for patients who have no insurance and continue to see the devastating effects of delayed or denied health services. Since 2010, family physicians have seen a significant increase in coverage in their states. They know what the consequences will be if Congress eliminates or dismantles current coverage provisions and patient protections,” Meigs said in a statement. “We will continue to advocate for meaningful, affordable health care for all. Furthermore, we will press the Trump administration to hold true to its promises to not cause millions of people to lose their health care coverage.”

In response to Trump's speech, ACP President Nitin Damle, MD, MS, MACP, said in a statement that while the president mentioned some plans regarding health care that have the support of the ACP, he is still concerned that many Americans will go without coverage if ACA is indeed repealed and replaced.

“President Trump expressed support for continuing to ensure that patients with preexisting conditions have access to coverage and that states be given resources to maintain Medicaid coverage, goals ACP supports.  However, the President’s call to ‘repeal and replace’ the ACA could result in tens of millions of patients, many of whom are seen by internists like myself, losing essential coverage, benefits and consumer protections, if any of the so-called ‘replacement’ policies addresseed in our letter are adopted,” Damle said.

ACP also sent letters to leaders of both the House and Senate today that referenced its concerns about the impact proposed changes to ACA would have on cost, quality and access. ACP had previously sent lawmakers a letter that stated that any changes to current law, including to the ACA, Medicaid and the Children’s Health Insurance Program should “first, do no harm” to patients and actually result in better coverage and access to care for essential medical services. - by Janel Miller

Disclosure: Meigs is president of the AAFP; Damle is president of ACP.

Reference: https://www.c-span.org/video/?424147-1/president-trump-addresses-joint-session-congress&start=2118