If there were ever an occasion for President Trump to create some buzz for his health care agenda in 2018, it was on Monday morning, in a case of man-meets-moment. Trump introduced new Health and Human Services Secretary Alex Azar before the Cabinet official’s swearing-in ceremony, one day before the State of the Union address.
But the bees remained grounded. Missing from the president’s remarks—and Azar’s, for that matter—was the word “Obamacare.” Trump instead highlighted prescription drug prices—a pet issue he raised at many points during the 2016 campaign—and the opioid crisis, only winking toward Azar’s oversight of regulations pursuant to the health care law.
“He will help lead our efforts to confront the national emergency of addiction and death due to opioids. And I think we’re going to be very tough on the drug companies in that regard and very tough on doctors in that regard, because what’s going on is pretty incredible,” said Trump of Alex Azar , who replaced Tom Price. “And finally, put an end to this plague on the lives on families and communities. People go in for a minor operation into a hospital, they come out, they’re addicted to opioids. They’re addicted to drugs after a short period of time.
“We have to get the prices of prescription drugs way down and unravel the tangled web of special interests that are driving prices up for medicine and for really hurting patients,” he continued. “And we’re going to get that done. That’s going to be so important.”
So important that he later turned toward Azar, a former top official at Eli Lilly and Company, and said of the issue, “Whenever I speak to Alex, I speak to him about that, I think, prior to anything else.”
Congressional Republicans included in their tax reform law a de facto repeal of Obamacare’s individual mandate, lowering the penalty to zero dollars. It was a major fulfillment of previous campaign pledges, at least symbolically: Party leaders messaged repeatedly that the mandate was the least popular provision of the law, and of Obamacare’s core pillars, it certainly is the best-known among the public. But nixing it does not constitute the full “repeal and replace” House speaker Paul Ryan spoke of early last year: The regulations mostly responsible for manipulating the cost of insurance in the individual market remain in place, as does Medicaid expansion.
Azar has regulatory power, and thus some ability to change the government’s implementation of the law; Trump issued an executive order in October, for example, directing HHS and other agencies to draft regulations pertaining to the availability of certain insurance and health plans. But as Ryan said previously, it’s only one of three sets of actions Republicans originally had envisioned; the others were replacing Obamacare wholly and then passing some additional health policies, like prescription drug reform. The latter would need bipartisan buy-in because of the Senate’s 60-vote threshold.
GOP lawmakers have disagreed publicly in recent weeks about how—or even if—they will approach Obamacare in 2018. Ryan named health care reform one of three issues of focus this year, in an interview with WEEKLY STANDARD editor in chief Steve Hayes last month. “I don’t think the health care issue is done. At the end of the day, we’ve got to go after the root cause—health care inflation and entitlements,” Ryan said. That contrasted with Senate Majority Leader Mitch McConnell, who said “we’ll probably move on to other issues”—to which Sen. Lindsey Graham responded, “[Y]ou are sadly mistaken.”
Internecine disagreement: Where have we seen that one before?
