Photo illustration: Sarah Grillo/Axios. Photo: Brendan Smialowski/AFP via Getty Images
President Trump has made sweeping changes to federal health agencies while quietly maintaining the status quo on some health policies. But you probably won't hear much about any of that in his address to Congress tonight.
Why it matters: These high-profile speeches aren't made for nuance, and Trump has been vague on his plans for Medicaid, drug pricing and vaccines, among other issues. Other than a possible passing remark, here's what you probably won't hear tonight:
Details on Medicaid
Trump has repeatedly said he does not want to "touch" Medicaid, except for looking at "fraud."
- But Capitol Hill conversations about reconciliation invariably turn to overhauling the program, and there's still uncertainty about what exactly Trump really means.
- For example, congressional Republicans appear united around work requirements for Medicaid, even though that is touching the program.
- It is possible the administration will apply an expansive definition of "fraud" so as not to appear to violate his pledge.
- Bottom line: Don't expect Trump to dive into policy or spell out exactly what he's OK with.
Views on drug price negotiation
The Trump administration signaled it would defend Democrats' drug price negotiations in a lawsuit brought by Novartis that seeks to scrap that portion of the Inflation Reduction Act.
- "The government has a substantial interest in curbing the rising costs of public spending on prescription drugs, and the establishment of the negotiation program furthers that interest," the Trump DOJ wrote.
- The deadline for drugmakers to decide whether to agree to the next round of drug negotiations was Friday. But even if the administration agrees with the concept, Trump isn't likely to mention one of former President Biden's signature accomplishments.
- If he does mention drugmakers at all, it's more likely to be about bringing production to the U.S. or imposing tariffs on pharmaceuticals.
A call for vaccinations
The measles outbreak in Texas has focused more attention on HHS Secretary Robert F. Kennedy Jr., a longtime vaccine critic.
- Kennedy did make a nod toward the measles vaccine in a Fox News op-ed Sunday but stopped short of a full-throated call for people to get vaccinated.
- Don't expect Trump to go there.
- If he does bring up Kennedy's work at all, he is more likely to give a general nod to the Make America Healthy Again effort around issues like chronic disease or healthy foods.
Flashback: Health care was a big focus of Trump's first joint address to Congress in 2017, in which he outlined his goals to get rid of the "failing" and "imploding" Affordable Care Act and replace it with his own health care system.
- That effort failed, and eight years later, it's telling how little appetite Republicans have for big health initiatives, while the ACA remains intact.
The bottom line: It's essential to look at rules, court filings and statements from Trump health nominees to interpret where health policy may be going.
- A batch of important Medicare provider payment rules this spring should provide more tea leaves to read and decipher.
