Not many people knew what to expect when Donald Trump moved into the White House. Not only was this the business executive’s first experience with politics, but he had also flipped back and forth on many issues throughout the course of his campaign. His stances on certain issues seemed to be constantly changing, and many of his positions were unclear even to seasoned political analysts, public health experts, and congressional representatives alike. Most people could only watch and wait to see how Trump would approach governing, especially when it came to complex and highly-partisan issues like health care.
Here are a few steps the President took during his first 100 days in office and what you should know about the current state of health care in America.
January 20: Executive Order to Repeal the Affordable Care Act
Hours after his inauguration, Donald Trump signed an executive order to seek the repeal of the Affordable Care Act. While the order itself did not repeal the ACA, it did prioritize the issue and make Congress work toward alternatives if the act were to be replaced.
According to Alicia Adamczyk, who has closely followed health care policy in America, the executive order allows insurance companies to delay or hold off on implementing any parts of the ACA that “would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, health care providers, health insurers, patients, recipients of health care services, [etc.]” (Section 2).
In non-legal terms, this means that insurance companies wouldn’t have to implement any new ACA policies as long as they could prove that the policies would cost either the company itself or its customers. Essentially, insurance companies were put on a policy freeze and didn’t have to take any action set forth by Congress. Adamczyk reported that this created a fair amount of turmoil in the insurance market, as many companies were unsure how long this would last and how soon an ACA repeal would follow.
This executive order was actually viewed more as a symbolic gesture than an actual step toward dismantling the ACA, according to the New York Times — especially because it was created within hours of taking office. By signing this document, Trump showed Congress that he planned to prioritize health care reform and hoped to make dramatic changes within the first few months.
February 16: IRS Stops Enforcing Mandate for Health Insurance
While the first executive order was more symbolic, the steps that followed seemed to have a greater impact on American citizens. On February 16, The Insurance Journal reported that the Internal Revenue Service stopped requiring tax filers to indicate whether they had health insurance or had paid a penalty under the ACA.
The ACA required all Americans to carry some form of health insurance, provided either by their employer or through the ACA marketplace. By reducing the number of uninsured Americans, the plan’s goal was for more people to be able to receive treatment who might have had to pay out of pocket or avoid hospital visits before. Citizens reported their health care status through the IRS for government tracking and enforcement.
The goal of making health insurance mandatory was to encourage more young and healthy people to sign up for it, reports Forbes These two key demographics help support the insurance costs of elderly patients and people who need treatment. However, when insurance is optional, some young people decline to pay for it, according to US News, because they aren’t as likely to get sick or injured. This puts the entire burden on sick patients, almost negating the benefits of insurance.
After the Executive Order, the IRS said it would approve tax filings that did not mark whether or not the user has health insurance instead of rejecting them as it had in previous years. While the health insurance option is still on the form, it is no longer mandatory.
March 23: GOP Push to Repeal Obamacare Fails
In late March, Republican House leaders started pushing for an ACA repeal vote. However, before the “American Health Care Act,” or what many called “TrumpCare,” could even be brought to the floor, plans were scrapped because House leaders didn’t have the votes for it to pass.
The days following the attempted vote were some of the most uncertain during the President’s first 100 days in office. Within a few hours of the defeat, the President tweeted, “Obamacare, unfortunately, will explode. It’s going to have a very bad year.” However, he was also quoted as saying that since the GOP couldn’t pass the health care vote this time around, he was moving on to other issues, according to the New York Times. This left both political parties unsure whether a new health care bill would ever reach the House or Senate floor.
April 27: The 100-Day Mark
In the days leading up to the 100-Day mark, many politicians and media commentators like Politico speculated that Trump would try to push another health care vote before the end of April. Trump had promised health care reform within his first 100 days in office and reportedly wanted a major win for his party and presidency with an ACA repeal.
However, Speaker Paul Ryan decided against holding a vote because the bill still needed more votes to pass. Roughly 15 House Republicans stood against the vote and 20 were undecided, preventing the bill from reaching majority approval. House Republicans could only afford to lose 22 votes for the bill to move on to the Senate.
May 4: The House Passes a Health Care Bill
A week after President Trump reached his 100-day mark, Speaker Paul Ryan presented an updated health care vote to the house floor. The measure passed with 217 GOP votes and will move on to the Senate for a vote before going to the president’s desk. Twenty Republican members voted against the bill along with all of the Democratic representatives.
Several changes will be made to the bill while it is in the Senate. Business Insider reports that the bill is unpopular with American voters, with only 38 percent in favor of it. In order for it to pass, the bill will have to gain in popularity enough to win over GOP and Democratic senators.
The first 100-days of the Donald Trump Presidency proved to be a roller coaster for the health care field. The next year and even the next four years are expected to bring major changes to health care reform across America. If you’re interested in working in the forefront of these changes and helping patients navigate the medical world, consider pursuing an online master of public health degree at the Keck School of Medicine of USC. Your expertise can help people learn about their options in this rapidly changing landscape.