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WASHINGTON -- President Biden's 2023 State of the Union address on Tuesday night contained at least one healthcare surprise, according to an expert -- a pledge to extend the solvency of the Medicare program.

During a section of the speech dealing with addressing the debt ceiling, Biden said that "instead of making the wealthy pay their fair share, some Republicans want Medicare and Social Security to sunset." He was referring to a to sunset all government regulations -- including those establishing Medicare and Social Security -- every 5 years unless Congress reauthorizes them.

"If anyone tries to cut Medicare, I will stop them," Biden said. "I will not allow [it] to be taken away ... In fact, we're going to extend the Medicare Trust Fund by at least two decades. I will not raise taxes on anyone making under $400,000 a year. And I will pay for the ideas I've talked about tonight by making the wealthy and big corporations begin to pay their fair share" of taxes.

Matt Kazan, MPP, managing director at Avalere, a healthcare consulting firm here, said in a phone interview after the speech concluded that he was surprised by Biden's mention of extending the trust fund. "I'm interested to see what he puts out in his budget to accomplish that," he said. "His following remarks were around tax policy, so I'll be curious [whether] his intention is to extend solvency purely on tax policy or on Medicare policy, or some combination of the two. I presume his budget, once released, will shed some light on that."

Other healthcare issues Biden touched upon in his speech, which ran for a little over an hour, included:

Protecting abortion rights. "Congress must restore the right that was taken away" by the Supreme Court in the Dobbs v. Jackson Women's Health Organization decision "and protect Roe v. Wade -- protect every woman's constitutional right to choose," said the president. "The Vice President and I are doing everything we can to protect access to reproductive healthcare and safeguard patient privacy. But already, more than a dozen states are enforcing extreme abortion bans. Make no mistake; if Congress passes a national ban, I will veto it."

Extending Medicare's cap on insulin costs to other health plans. "We capped the cost of insulin at $35 a month for seniors on Medicare," Biden said. "But there are millions of other Americans who are not on Medicare, including 200,000 young people with type I diabetes who need insulin to save their lives. Let's finish the job this time. Let's cap the cost of insulin for everybody at $35. Folks, Big Pharma is still going to do well, I promise you all. They're going to do very well."

Addressing the opioid crisis, particularly fentanyl overdoses. "Fentanyl is killing more than 70,000 Americans a year," he said. "Let's launch a major surge to stop fentanyl production, sale, and trafficking, with more drug-detection machines to inspect cargo and stop pills and powder at the border. [Let's work] with couriers like FedEx to inspect more packages for drugs [and implement] strong penalties to crack down on fentanyl trafficking."

Reducing suicide among military veterans. The president noted that the incidence of suicide among veterans has decreased from 25 per day to 17 per day over the past few years. "The VA [Department of Veterans Affairs] is doing everything it can, including expanding mental health screenings and a proven program that recruits veterans to help other veterans understand what they're going through and get them the help they need," he said. However, "we've got to do more."

Implementing the cancer "moonshot." Our goal is to cut the cancer death rate by at least 50% over the next 25 years, turn more cancers from death sentences into treatable diseases, and provide more support for patients and families," Biden said of the moonshot project his administration announced a year ago. He referred to President George W. Bush's success with the President's Emergency Plan for AIDS Relief (PEPFAR) program to fight HIV/AIDS worldwide. "It's been a huge success. He fought big, he fought large ... I believe we can do the same thing with cancer. Let's end cancer as we know it and cure some cancers once and for all."

Improving mental healthcare for children. "Let's do more on mental health, especially for our children," said Biden. "When millions of young people are struggling with bullying, violence, and trauma, we owe them greater access to mental health care at their schools."

Mental health and substance abuse treatment is an area that seems ripe for bipartisan consensus, Rodney Whitlock, PhD, vice president of McDermott+Consulting, a consulting firm here, said in an email. "There are no guarantees of legislative outcomes, but the two sides start from more common ground there than other places in healthcare."

Allison Orris, JD, a senior fellow at the Center on Budget and Policy Priorities, a left-leaning think tank here, said she was impressed by the amount of the speech that was devoted to healthcare. "The amount of time the president spent talking about healthcare was heartening and underscores the priority the administration is putting on key healthcare issues," she said in a phone interview. "Particularly at a moment when there is not active legislation moving on healthcare, the attention to it I thought was notable."

Orris also mentioned what wasn't in the speech. "In an environment where Congress may not pass as much legislation as we saw in the past 2 years, this administration will be very focused on what they can do through regulations and administrative actions to continue the progress they've made on healthcare," she said, calling the omission "entirely understandable." "It's something that wasn't in the speech, but we may see more of it in the budget or in their general work over the next couple of years, including strategies to help eligible people get, keep, and use health insurance, and a focus on simplifying healthcare rules."

Biden's healthcare goals sounded relatively modest, Thomas Miller, JD, resident fellow at the American Enterprise Institute, a right-leaning think tank here, said in an email, referring to an additional healthcare item Biden had included. "The president's health policy horizons remain more constrained than his rhetorical ambitions," Miller wrote. "Apart from running short victory laps" over some healthcare successes, "the president mostly asked for further expansion of the as-yet untested Inflation Reduction Act's drug pricing limits to the private sector and a permanent authorization of the Affordable Care Act [premium] subsidies expiring in 2025. Diabetes drug price ceilings may work out differently in implementation practice than in their political promise trappings."

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