Trump Discusses VA, Drug Prices, ACA at News Conference


January 11, 2017

When he wasn't talking about hacking, Russia, or the news media, President-elect Donald Trump today made his agenda for healthcare a little clearer during his first news conference since the presidential election.

Trump reiterated his previously stated position that he wants the Affordable Care Act (ACA) repealed and replaced simultaneously, or nearly so, "on the same day or the same week." He said repeal-and-replace legislation would be filed soon after "our secretary is approved," presumably referring to Rep. Tom Price, MD (R-Ga), Trump's choice to head the Department of Health and Human Services.

"We're going to that is far less expensive and far better," he told reporters.

In another cabinet matter, Trump announced that he will nominate David Shulkin, MD, to serve as secretary of Veterans Affairs. Dr Shulkin now heads the VA's Veterans Health Administration (VHA), overseeing more than 1700 hospitals, clinics, and other facilities that serve some 9 million veterans. The president-elect said that Dr Shulkin, a rare holdover from the Obama administration on his team, will lead the effort to provide veterans with timelier healthcare.

"They have a minor, early-stage form of cancer and they can't see a doctor," Trump said. "By the time they get to the doctor, they're terminal."

To improve access to care, the VHA last month announced it would allow advanced practice registered nurses (APRNs) — except for certified registered nurse anesthetists — to treat patients without physician supervision. That decision, executed by Dr Shulkin, has drawn criticism from major medical societies, which contend that patients are better served by APRNs who work as members of physician-led teams.

Trump suggested that Dr Shulkin would have powerful allies in his mission to "straighten out the whole situation for our veterans." The Cleveland Clinic, the Mayo Clinic, and other leading hospitals "would align themselves with us on the Veterans Administration," he said. "And we're going to set up a group."

Trump did not elaborate on the nature of the alignment, or the new group. A spokesperson for the Cleveland Clinic told Medscape Medical News that she did not know exactly what Trump was referring to. The spokesperson noted that Trump had met with Cleveland Clinic CEO Toby Cosgrove, MD, and his counterparts at the Mayo Clinic and other health institutions last month to discuss healthcare issues, including the VHA.

"It sounds like he wants to keep this group going," the spokesperson said. She noted that Dr Cosgrove at one time was in the running for the VA post before he withdrew his name.

"We're Going to Save Billions of Dollars"

The pharmaceutical industry received a Trump scolding at one point during the news conference. The president-elect said that like other industries, Big Pharma was shipping its jobs overseas. "We've got to get our drug industry back," he said. "They supply our drugs, but they don't make them here, to a large extent."

He also repeated his campaign vow to have government programs such as Medicare bid on prices with drug companies "because they're getting away with murder.

"Pharma has a lot of...lobbyists and a lot of power, and there's very little bidding on drugs," he said. "We're going to start bidding, and we're going to save billions of dollars over a period of time."

Trump's comments on healthcare represented the more placid moments of the news conference. He angrily denied unsubstantiated allegations about his personal life and connections to Russia that appear in a 35-page dossier, supposedly based on dirt collected by the Russians to blackmail the president-elect. "It's all fake news," he said. "It's phony stuff."

He voiced suspicion that US intelligence agencies, which had briefed him about the dossier as well as Russian attempts to tilt the presidential election in his favor, might have leaked the document to the press.

Follow Robert Lowes on Twitter @LowesRobert


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