Trump’s first 100 days marred by failed ACA repeal effort
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 He also signed an order in late January that required agencies to identify two rules to be repealed for every new proposed rule.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.”