President Trump delivered his third State of the Union address Tuesday night, touching on topics he considers key achievements of his administration and offering a look at priorities to come.
He took credit for criminal justice reform, cited a decline in drug overdose deaths, and sounded the alarm on prescription drug prices. Here, we take a closer look at some key quotes from Trump’s speech.
“Our roaring economy has, for the first time ever, given many former prisoners the ability to get a great job and a fresh start. This second chance at life is made possible because we passed landmark criminal justice reform into law. Everybody said that criminal justice reform couldn’t be done, but I got it done, and the people in this room got it done.”
The First Step Act was not only a major accomplishment for Trump, but it showed that Republicans and Democrats can work together on criminal justice reform. (For some background on just how they did that, including Trump son-in-law Jared Kushner’s role, listen to this podcast on the unlikely coalitions behind the reform.)
Its commonsense measures — rewarding good behavior, supporting people leaving federal prisons so they can successfully reenter society, compassionately releasing the elderly and terminally ill, ending the shackling of pregnant women, and making the Fair Sentencing Act of 2010 retroactive — changed the national conversation on mass incarceration in this country. We need to build on that momentum.
The First Step Act also reauthorized the Second Chance Act, which was passed in 2008 to help state, local, and tribal governments reduce recidivism and improve outcomes. It was inspired by another State of the Union address — George W. Bush’s in 2004. Bush talked about America as “the land of second chance, and when the gates of the prison open, the path ahead should lead to a better life.”
George W. Bush in 2004. (C-SPAN)
The Sentencing Project recently analyzed the First Step Act’s progress, finding mixed outcomes — including Department of Justice attempts to block eligible people from release — and outlining recommended next steps, such as additional funding.
Much more remains to be done to build a justice system that produces better outcomes: stronger public safety, more consistent justice, more equitably distributed opportunity.
As a nation, we also need to push for local and state policies that tackle the drivers of mass incarceration, such as our probation and parole system and our punitive use of fines and fees, and we must improve conditions for those working and living inside prisons, which have for too long been inaccessible and unaccountable to the public.
“I’ve been speaking to Senator Chuck Grassley of Iowa and others in Congress in order to get something on drug pricing done, and done quickly and properly. I’m calling for bipartisan legislation that achieves the goal of dramatically lowering prescription drug prices. Get a bill on my desk, and I will sign it into law immediately.”
Drug prices are too high and American families continue to suffer, yet progress has stalled on drug pricing legislation.
House Speaker Nancy Pelosi’s signature drug pricing bill, H.R. 3, passed the House last year (those were the chants of “H.R. 3” you heard last night from some Democratic lawmakers in the audience) but the bill has yet to find support in the Senate. Meanwhile, a bipartisan Senate proposal, S. 2543, touted by Senate Finance Committee Chair Chuck Grassley and ranking member Ron Wyden, is a viable option if it can secure 60 votes among Democrats and Republicans.
Pharma’s usual tactics to sideline effective policy is masking the bipartisan support for reforms included in both pieces of legislation. For example, the inflation penalty is a provision supported by both parties, including the White House, that would effectively lower patient spending by slowing the growth of list prices and lessening out-of-pocket costs. It would also lower employer spending by holding steady net prices for drugs already on the market and potentially slowing net price growth for certain drugs with limited competition.
Under the inflation penalty provision, drug manufacturers would be penalized when list prices for Medicare Part B and Part D prescription drugs rise faster than inflation. The inflation penalty, as laid out in S. 2543, is estimated to save taxpayers $60 billion over the next decade.
American voters have repeatedly said they want Congressional action on drug pricing. It’s time to get it done.
“The American patient should never be blindsided by medical bills. That is why I signed an executive order requiring price transparency. Many experts believe that transparency, which will go into full effect at the beginning of next year, will be even bigger than health care reform. It will save families massive amounts of money for substantially better care.”
The administration’s proposed federal price transparency rule requiring hospitals to share their rates is an important first step to shed light on the exorbitant and often unjustified costs for hospital services, but the new regulations are unlikely to result in meaningful cost savings. Why? Simply revealing the prices doesn’t change the fact that hospitals — especially those in consolidated markets — have the leverage to demand high prices from insurers, who pass those costs on to employers and patients in the form of premiums and out-of-pocket costs.
While these transparency requirements alone aren’t enough to reduce health care costs for American families, they have the potential to bring much-needed attention to the drivers of those costs — the increasingly high prices set by hospitals and providers. And that’s a good thing.
“With unyielding commitment, we are curbing the opioid epidemic. Drug overdose deaths declined for the first time in nearly 30 years. Among the states hardest hit, Ohio is down 22 percent, Pennsylvania is down 18 percent, Wisconsin is down 10 percent — and we will not quit until we have beaten the opioid epidemic once and for all.”
We’re glad to hear Trump say there’s no quitting until we beat the epidemic, because there is a lot of work ahead at the federal and state levels to get there. The decline in drug overdose deaths Trump cites comes from data released by the Centers for Disease Control and Prevention’s National Center for Health Statistics. Drug overdose deaths did decline between 2017 and 2018 in 14 states (including Ohio, Pennsylvania, and Wisconsin) and the District of Columbia.
It’s worth noting that despite that decline, both Ohio and Pennsylvania are still among the states with the overall highest drug overdose death rates, 35.9 percent and 36.1 percent, respectively. Only West Virginia, Delaware, and Maryland ranked higher. And in five states — California, Delaware, Missouri, New Jersey, and South Carolina — the drug overdose death rate was higher in 2018 than in 2017.
Overall, the number of drug overdose deaths in 2018 was still high: almost 68,000. So what has been done to bring that number down?
In 2019 the Trump administration began implementing key provisions of the SUPPORT Act. It required Medicaid to cover opioid use disorder medications through 2025 and required both Medicaid and Medicare to cover more treatment programs. It also expanded providers who, with a waiver, can prescribe buprenorphine, a lifesaving drug considered the gold standard for treating opioid addiction.
The National Institutes of Health funded $945 million for pain and substance use disorder treatment research through the HEAL Initiative. And states saw an infusion of federal dollars to address opioid addiction in their communities.
So what still needs to be done? We’d like to see federal action removing the requirement that doctors have a waiver to prescribe buprenorphine, something HR 2482 does. We’d also like to see the federal government require providers that receive federal dollars use evidence-based medication and treatment practices; approve state requests to pay for treatment in jail 30 days before a person is released using Medicaid dollars; and lift the U.S. Drug Enforcement Administration’s moratorium on mobile methadone clinics, which is seen as a major barrier to treatment.
While we appreciate the work done to address the opioid crisis at the federal level, it is too soon to declare victory. Our grantee Regina LaBelle, director of the Addiction and Public Policy Initiative at Georgetown Law, said it best: “We’re just at the beginning of a much longer term effort to change the way we treat addiction in this country… it will be many more years before we can say the nation’s policies truly embrace addiction as a public health issue.”
What didn’t make the cut.
Higher education had scant mention in Trump’s speech: He said he was proud of his administration’s funding increase for historically black colleges and universities. While this is a positive move, we were disappointed that he didn’t address the college completion crisis in this country or ways to protect our veterans from predatory colleges.
Trump also didn’t mention one of his executive actions of 2019 that we think is worthy of praise. In July 2019, he issued an executive order aimed at fixing the nation’s flawed organ donation system, which could save 25,000 lives a year and $13 billion in taxpayer funds over five years, Arnold Ventures-supported research shows. Our Co-Chair Laura Arnold recently sat down with U.S. Health Secretary Alex Azar to talk about why the reforms are necessary and how his office is implementing them for her “Deep Dive with Laura Arnold” podcast.
