HHS Secretary Alex Azar touted the Trump administration's healthcare agenda, but glossed over some high-profile initiatives from the past year that stalled or fell flat in his annual State of the Department speech Thursday.
Among the steps the two-year secretary highlighted are HHS' final rule requiring hospitals publish their chargemasters in an easily understandable way and a proposed rule requiring insurers disclose negotiated rates between them and a provider, so patients ostensibly can know what they're going to pay prior to receiving a medical service.
Along with promoting interoperability, "fixing these problems will be a fundamental shift toward putting the patient at the center of our healthcare system," Azar said.
Little mentioned in the nearly 8,600-word speech were several major efforts pitched by the Trump administration that didn't bear fruit or sparked bad publicity last year, such as proposed regulation to lower drug prices, Medicaid work requirements and cutting away at the Affordable Care Act.
And the drug pricing and price transparency policies the HHS head touted face significant roadblocks.
The powerful hospital lobby, led by the American Hospital Association, has challenged the transparency final rule in a district court, arguing the push exceeds the government's authority and violates the First Amendment. The second price transparency rule, which received swift backlash from payers and employers, is still in the public comment period, but insiders expect a prompt lawsuit if it is finalized by the administration.
Azar noted retail drug prices dropped in 2018 for the first time in more than four decades, chalking that up to record FDA approvals of generics, biosimilars and novel drugs.
However, though the U.S. government's tracker has found prices have been flat or in decline, recent market analyses have found big pharmaceutical companies are still hiking prices, albeit more modestly than past years. A major HHS plan to lower U.S. drug costs by tying the list price of drugs in Medicare Part B to prices in foreign countries is still under review by the Office of Management and Budget.
Azar failed to mention that stalled initiative, called the International Pricing Index model, which received lukewarm bipartisan support at best and censure over government price controls at worst. However, Azar did vow to implement a late 2019 proposal sometime this year to lower prescription drug costs by allowing states, pharmacies and drug wholesalers to import cheaper drugs from Canada.
Azar also stayed silent on perhaps the biggest wildcard for healthcare going into 2020: potential unraveling of the ACA.
Though HHS was not responsible for the Republican-led states' effort to repeal the ACA, which expanded health insurance to roughly 20 million Americans, Trump's Department of Justice backed the effort last year. The lawsuit, likely to end up before the Supreme Court, could gut the law, and HHS has been criticized for not having a comprehensive plan in place to serve as a stopgap in case of repeal.
CMS Administrator Seema Verma has gone on record insisting the administration does have a plan, but the agency has yet to supply any details, leading liberal critics and patient advocates to believe no such plan exists.
Azar only mentioned Medicaid twice in the speech, discussing how HHS approved a demonstration allowing the program to cover inpatient treatment for patients with serious mental illnesses. The omission is glaring in light of the administration's ongoing efforts to roll back Medicaid, primarily through Section 1115 demonstration waivers out of CMS.
That agency fulfilled a conservative dream late last month to allow states to cap Medicaid funding for able-bodied adults who received coverage under the ACA's expansion, despite Trump's 2016 campaign pledges to protect Medicaid, a cornerstone of the health safety net since the 1960s.
House Democrats passed a resolution also Thursday to condemn the guidance, with House Energy and Commerce Chairman Frank Pallone Jr., D-N.J, slamming it as illegal and an "unprecedented attack on Medicaid" that would cut benefits for poor citizens.
Azar did note in his speech the $1.3 trillion-department is focused on "promoting work and family in our human services programs," which could be an oblique reference to work requirements, another highly criticized Medicaid policy from HHS. However, work requirements, which tie beneficiary Medicaid eligibility to hours worked or volunteered, have largely been tied up in the courts.
The HHS secretary did air some less controversial policies in his address at the Hubert H. Humphrey building in Washington, including expanding flexibility in privately run Medicare Advantage plans to allow them to cover more supplemental benefits like at-home meal delivery or transportation, and CMS efforts to dial back administrative burden on providers.
In the coming year, Azar said HHS plans to continue fighting HIV and other diseases, tackling mental illness, working with Congress to reform drug pricing, advancing transparency and consumerism, reducing disparities in rural medical care and moving toward value in healthcare payment.
"In the year to come, and the five years I hope I have ahead, we have our work cut out for us," Azar said.