Trump’s first 100 days marred by failed ACA re­peal ef­fort

Modern Healthcare - - NEWS - By Matthew We­in­stock

For decades, the first 100 days of a new pres­i­dency have been used to gauge a com­man­der-in-chief's power and ef­fec­tive­ness. It's that rare time when a pres­i­dent should be able to ex­ert con­sid­er­able in­flu­ence hav­ing just swept into of­fice.

By vir­tu­ally all ac­counts, Pres­i­dent Don­ald Trump’s first 100 days in of­fice have been mired by mis­steps, mis­cal­cu­la­tions and missed op­por­tu­ni­ties—other than se­cur­ing Jus­tice Neil Gor­such’s con­fir­ma­tion to the Supreme Court, where he will have nu­mer­ous op­por­tu­ni­ties to in­ter­pret health­care law. At the same time, the pres­i­dent has set the wheels in mo­tion to ful­fill ma­jor cam­paign prom­ises of eas­ing the reg­u­la­tory bur­den and, par­tic­u­larly with health­care, giv­ing states more flex­i­bil­ity in how they fash­ion health services.

Trump’s pledge to re­peal and re­place the Af­ford­able Care Act by April 29—day 100—dom­i­nated the po­lit­i­cal land­scape and eclipsed vir­tu­ally all other is­sues on the health­care agenda. The pres­i­dent and GOP lead­er­ship failed twice to bring their re­place­ment plan, the Amer­i­can Health Care Act, to a vote in the House, the lat­est set­back oc­cur­ring late last week when it was clear there were not enough votes.

De­spite set­backs on the leg­isla­tive front, Trump did fol­low through on cam­paign prom­ises to push a dereg­u­la­tion agenda, largely through ex­ec­u­tive ac­tion. One of his first ac­tions as pres­i­dent was to sign an or­der that froze all pend­ing Obama-era reg­u­la­tions un­til they could be re­viewed by his ad­min­is­tra­tion. He also signed an or­der in late Jan­uary that re­quired agen­cies to iden­tify two rules to be re­pealed for ev­ery new pro­posed rule. Most re­cently, the pro­posed in­pa­tient PPS rule in­cludes a re­quest for in­for­ma­tion on how the CMS can con­tinue to ease reg­u­la­tory bur­den.

Sim­i­larly, the ad­min­is­tra­tion used the first 100 days to ad­vo­cate giv­ing states more power in shap­ing their health­care mar­kets. On March 13, HHS Sec­re­tary Tom Price sent a let­ter to the gov­er­nors en­cour­ag­ing them to ap­ply for sec­tion 1332 waivers un­der the ACA. “State in­no­va­tion waivers that im­ple­ment high-risk pool/state-op­er­ated rein­sur­ance pro­grams may be an op­por­tu­nity for states to lower pre­mi­ums for con­sumers, im­prove mar­ket sta­bil­ity and in­crease con­sumer choice,” he wrote.

Trump's other top health­care leader, CMS Ad­min­is­tra­tor Seema Verma, is an­other cog in the wheel to pro­vide states with more flex­i­bil­ity in their health­care regimes, ac­cord­ing to Chip Kahn, CEO of the Fed­er­a­tion of Amer­i­can Hos­pi­tals.

“My take­away from meet­ing with her is that she wants to un­leash in­no­va­tion through the states and give states more flex­i­bil­ity,” Kahn said.

While 100 days may seem like a long time, it isn't, as Kahn noted. For any new pres­i­dent, ad­vanc­ing their agenda re­lies on hav­ing peo­ple in place at the depart­ment and agency level. In terms of top-level of­fi­cials at HHS, Trump is on par with pre­vi­ous ad­min­is­tra­tions. He has nom­i­nated four of­fi­cials for top po­si­tions at HHS, which com­pares to six for Pres­i­dent Barack Obama, five for Pres­i­dent Ge­orge W. Bush, nine for Pres­i­dent Bill Clin­ton and five for Pres­i­dent Ge­orge H.W. Bush, ac­cord­ing to Mal­lory Barg Bul­man, vice pres­i­dent of re­search and eval­u­a­tion at Part­ner­ship for Pub­lic Ser­vice, which mon­i­tors agency ap­point­ments. Trump has two con­firmed lead­ers in place at HHS: Price and Verma. Dr. Scott Got­tlieb is ex­pected to be ap­proved by the Se­nate in the com­ing days to head the FDA. By their 100th day, Obama and Ge­orge W. Bush had just one; Clin­ton and Ge­orge H.W. Bush had two.

While Barg Bul­man didn’t have ex­act data on sub-agency head lev­els, re­ports are that progress is slow in fill­ing those lead­er­ship roles. “The ad­min­is­tra­tion has laid out some very broad goals,” she said. “You need peo­ple in those po­si­tions to im­ple­ment those poli­cies. It will take time to get lead­er­ship in place.”

Ul­ti­mately, Trump’s first 100 days are sure to be mea­sured by the de­bate of re­peal­ing Oba­macare. “They put a lot of en­ergy into re­peal and re­place,” Kahn said. “It has sucked up a lot of oxy­gen.”

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