Health Care Costs Loom Over Midterms as Trump Prepares His Drug Pricing Speech

President Donald Trump may not be up for re-election quite yet, but for many voters, the midterm elections are shaping up to be a referendum on the first two years of his made-for-TV presidency.

A new poll shows that voters in major political parties are more concerned about a midterm candidate’s stance on Trump more than any other policy question, followed closely by a candidate’s “character and experience.” Trump is expected to deliver a long-awaited speech today laying out plans to lower pharmaceutical prices — another top priority for voters in both parties.

Trump looms largest in battleground areas where Democrats are running competitive races in districts that traditionally lean Republican. In these areas, 31 percent of Democrats and 37 percent of Republicans say a candidate’s support for or opposition to Trump would have the most impact on how they vote for Congress. Another 31 percent of Democrats in battleground areas say health care is their top issue.

The Kaiser Family Foundation, a health care policy tank, released the poll on Thursday. Pollsters found that health care costs are one of the top policy issues motivating voters of all stripes this year, along with gun policy and job growth. Another recent Kaiser poll found that a majority of voters say lowering the cost of pharmaceutical drugs should be the top priority on Capitol Hill, and most believe the pharmaceutical industry has far too much power in Washington.

The results come as Trump prepares to deliver a speech on drug prices that has been postponed at least twice, leaving observers to wonder whether Trump and his health czar Alex Azar, a former Bush administration health official and pharmaceutical executive, were rethinking their approach to bringing down costs.

Meanwhile, the pharmaceutical industry has been on a multimillion-dollar lobbying blitz, as Truthout reported last week. Drug giant Novartis revealed this week that it had entered into a $1.2 million agreement with Trump’s lawyer Michael Cohen for advice on how Trump may approach health policy. The company said Cohen was unable to provide any useful consulting services and now regrets making a deal with the president’s personal lawyer, who is currently being investigated by special counsel Robert Mueller.

During his campaign, Trump railed against drug manufacturers for setting high prices and promised again to bring costs down during his State of the Union address in January. Critics say that, despite the tough talk, the White House has yet to propose concrete reforms that could bring down drug prices for a large number of consumers.

A majority of Democrats (30 percent) say health care is their top issue for congressional candidates compared to 15 percent of Republicans and 19 percent of independent voters, but concerns about affordability cross party lines, according to the most recent Kaiser poll. When it comes to the cost of prescription drugs, 66 percent of Republicans, 78 percent of Democrats and 72 percent of independents said they would be more likely to vote for candidates that vow to bring prices down.

The United States generally has higher prices for drugs and health care services than other industrialized nations because our economic peers tend to have national health care systems and pricing controls to keep costs down. Trump is expected to zero-in on disparity during his speech and demand that other countries pay their fair share back to manufacturers, many of which are based in the US and develop medicines used by the rest of the world.

Trump already angered European allies this week by withdrawing from the Iran nuclear deal, so they may not respond favorably to any suggestion that they pay more for pharmaceuticals.

Critics point out that raising prices in other countries won’t necessarily inspire drug makers to lower them here. In a recent letter to Trump criticizing efforts to protect patent monopolies for drug manufacturers in international negotiations, congressional Democrats said there is “no evidence” that pharmaceutical companies will lower prices at home if they make more money abroad, but there is ample evidence that drug makers maximize profits wherever and whenever they can.

“There is absolutely no reason to believe that trade policies designed to raise prescription drug prices overseas will result in equivalent or any decreases in prices in the United States,” wrote the group of Democrats, led by Rep. Jan Schakowsky (D-Illinois) and Rep. Rosa DeLauro (D-Connecticut).

Not to be outdone on an issue close to consumers’ hearts, Schakowsky and other Democrats in Congress rolled out a report this week showing that drug prices have continued to climb under the Trump administration, despite the president’s populist rhetoric on the issue. Democrats are pushing Trump to embrace aggressive reforms, including new rules curbing patent abuse, and allowing the government to negotiate drug prices directly through the Medicare program.

“The president has said for over a year and a half that drug companies are ‘getting away with murder,’ but all he’s done about it is give them a ‘get out of jail free’ card,” Sen. Ron Wyden (D-Oregon) said in a statement on Thursday. “Trump promised health care for everybody at a lower cost, now families are stuck with high premiums and junk plans.”

The Trump administration and members of both parties in Congress are also taking a hard look at the system of secret rebates that shapes drug prices within the pharmacy supply chain. Drug manufacturers have attempted to deflect the blame for high costs on insurance companies and their pharmacy benefit managers, which demand secret rebate payments for drugs made available to consumers through their health plans.

Policy makers suspect savings from rebate deals are not being passed on to consumers at the pharmacy, and advocates are demanding greater transparency. Food and Drug Administration Director Scott Gottlieb has even floated the idea of revoking a “safe harbor” clause in federal law that allows corporations in the drug supply chain to strike the rebating deals in secret without violating anti-kickback laws.