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Trump Moves Toward Traditional Republican Health Care Plans


President Trump's address to Congress last night was a chance to double down on one very big campaign promise.


PRESIDENT DONALD TRUMP: Tonight, I am also calling on this Congress to repeal and replace Obamacare.


MARTIN: We have, of course, been hearing that from Republicans for years. Now they're driving the train. And it's up to them to make it happen. So what's the plan? NPR health policy correspondent Alison Kodjak is here to suss that out. Good morning, Alison.

ALISON KODJAK, BYLINE: Good morning, Rachel.

MARTIN: So it didn't sound like the president gave any new details about health care last night. But he did appear to embrace this Republican mantra that people should have access to purchase health care. You - he used that word, access.

KODJAK: Yeah, he did.

MARTIN: Remind us why that's important.

KODJAK: Well, it's really a step back from some of the promises he had made earlier during the campaign and early in his presidency, that - where he said he wants everyone to have health care. Access to health care suggests that people have the potential to buy health insurance if they want to.

MARTIN: But it's not required.

KODJAK: It's not required. And it allows Republicans and the president a little bit of cover if, when their repeal and replace goes through, we find that a lot of people don't have insurance who did under the Affordable Care Act, which is what - at least with the plan that's out there now, that's what a lot of people are expecting.

MARTIN: Did he say anything about what he wants in a replacement?

KODJAK: Well, he made - he gave a list of, what he said, principles that he wants to see. What was interesting about the list is that it's essentially exactly the same as the list of principles that Speaker Paul Ryan released last week. There was...

MARTIN: This was the much hailed House plan that everyone's been talking about.

KODJAK: House plan, yeah, that's being sort of looked at by the Congressional Budget Office. And I'm sure it delighted Speaker Ryan because he basically went along with all those principles, you know...

MARTIN: Preexisting conditions...

KODJAK: ...Preexisting conditions, health savings accounts, tax credits, Medicaid, sending it to the states as block grants. So it was almost as if he was reading off of Speaker Ryan's script rather than giving out his own ideas.

MARTIN: He also mentioned the Food and Drug Administration and that it could use some reform. He wasn't very specific about that. Any idea what that means?

KODJAK: Well, let's listen to what he said.


TRUMP: Megan's story is about the unbounded power of a father's love for a daughter. But our slow and burdensome approval process at the Food and Drug Administration keeps too many advances, like the one that saved Megan's life, from reaching those in need.

MARTIN: Who's Megan?

KODJAK: So this is a young woman he pointed to and told her story. She was suffering from a rare disease, and her father apparently started a company to help discover a new drug that helped save her life. What he is saying is essentially that the FDA is actually an impediment to new discoveries. That's - that's sort of a free-market mantra, that the FDA is in the way.

But it's pretty controversial because there are a lot of people - I mean, the FDA is there to make sure that the drugs that are approved and go on the market in the U.S. are safe. And there's been a lot of swings back and forth over the years to reduce the regulation, to speed up the process. But when that happens, in the past, sometimes we've had drugs get on the market, like Vioxx, which was a pain pill that essentially caused heart attacks. And a lot of people died.

MARTIN: And real quick, just overall, he used a lot of big rhetoric but not so many details.

KODJAK: Not so many details. He did, earlier this week, say that he found that health care was a much more complex topic than anyone thought. And I think that's coming through in this speech.

MARTIN: Yeah. NPR's Alison Kodjak. Thanks so much, Alison.

KODJAK: Thanks, Rachel. Transcript provided by NPR, Copyright NPR.

Alison Fitzgerald Kodjak is a health policy correspondent on NPR's Science Desk.