How healthcare changed during Trump’s first year in office

Seeking to fulfill a campaign promise to repeal and replace the Affordable Care Act (ACA), President Donald Trump spent much of his first year in office putting pressure on Congress to fast-track sweeping legislation that would substantially change prevailing healthcare policy. Through a number of iterations, the efforts ultimately resulted in a policy that peels away some ACA provisions, such as the penalties associated with the individual mandate.

Additionally, Trump’s first year included a focus on addressing the opioid crisis. He created the President’s Commission on Combating Drug Addiction and the Opioid Crisis and tasked the group with collecting input from many healthcare stakeholders and formulating recommendations for a federal strategy.

 

 

President Donald Trump: Year 1

 

January

• Donald J. Trump is sworn in as the 45^th president of the United States.
• Trump vows to repeal and replace the Affordable Care Act (ACA), causing concern among behavioral health providers.

February

• Tom Price, an orthopedic surgeon, is confirmed as secretary of the Department of Health and Human Services (HHS).
• Jeff Sessions is confirmed as attorney general. He is known for his tough stance on marijuana and support of law enforcement solutions to combat the addiction crisis.

March

• The House prepares the American Health Care Act (AHCA), which makes substantial changes to ACA rules. The Congressional Budget Office projects the plan will cause 24 million to lose health coverage.
• House Speaker Paul Ryan pulls the AHCA bill off the floor on the day the vote is scheduled.
• Seema Verma is confirmed as the administrator of the Centers for Medicare and Medicaid Services. She is a consultant known for previously helping Vice President Mike Pence design Indiana’s waivered Medicaid model that requires some populations to pay into the program.
• Trump names Richard Baum as acting director of the Office of National Drug Control Policy (ONDCP).
• On March 29, Trump signs an executive order establishing the President’s Commission on Combating Drug Addiction and the Opioid Crisis.

April

• Surgeon General Vivek Murthy, who had produced a comprehensive federal report on addiction in America under the Obama administration, is asked to step down, but according to a statement from HHS, Murthy refuses and instead is dismissed.
• Trumps taps Rep. Tom Marino (R-Pa.) as the new permanent director of ONDCP—the drug czar.
• HHS awards states $495 million in grants to combat the opioid crisis. The funding comes from the 21^st Century Cures Act and Comprehensive Addiction and Recovery Act of 2016.

May

• After several changes, the House passes the American Health Care Act; the Senate responds with its intent to craft a new piece of legislation.
• Trump is quoted as saying, “Obamacare is dead.”
• Physician Scott Gottlieb is confirmed to lead the Food and Drug Administration; pharmaceutical manufacturers are pleased with his promise to make approvals easier, while critics question his previous positions on the payroll of pharma companies.
• A White House budget proposal includes a 95% cut to ONDCP funding; HHS cites redundancy of efforts.

June

• Trump labels the House healthcare bill that passed in May as “mean,” even though he initially applauded the proposal. He urges the Senate to craft something more generous.
• In reconciling with the House bill, moderate Senate Republicans aim to authorize $45 billion in funding over 10 years specifically to combat addiction. Senate Democrats in states hard-hit by opioid overdose argue the funding is not enough and that repeal of ACA will grievously undermine efforts to combat addiction.

July

• The Senate puts its final health reform bill on the table, aiming to drive a vote before the July 4^th recess. Negotiations within the Republican party continue through the month, and Trump says little about the bill, which ultimately withers for lack of votes.
• On July 28, a new attempt with a “skinny repeal” of ACA, which contained no replacement provisions, failed with a 51 senators voting against it, including a dramatic “no” vote from Sen. John McCain (R-Ariz.).
• An initial report from the President's Commission on Combating Drug Addiction and the Opioid Crisis recommends that Trump declare a national state of emergency.

August

• A week after the commission report is released, Trump speaks briefly about the opioid crisis but stops short of declaring it an emergency. In a press conference later the same day, Price says the country already has the resources it needs to combat the crisis.
• On August 10, Trump is quoted as saying, “The opioid crisis is an emergency, and I am saying, officially, right now, it is an emergency. It's a national emergency.”

September

• New Jersey Gov. Chris Christie, who leads the president’s opioid commission, says at a press conference that the president had reiterated his desire to finalize the state of emergency declaration. Christie separately introduces a public-private partnership among pharmaceutical manufacturers to create non-addictive pain drugs and more addiction medication choices.
• Senate Republicans craft the Graham-Cassidy healthcare bill. Opponents have new concerns that this legislation would be more aggressive in dismantling ACA provisions than past bills—including a formula that disproportionately cuts Medicaid funding for states that enacted expansion under ACA. Trump says the bill has “a very good chance” of passing, but ultimately it does not earn enough votes.
• HHS Secretary Tom Price resigns after questions involving his travel expenditures.

October

• Trump’s nominee to head ONDCP, Rep. Tom Marino (R-Pa.), withdraws from consideration because of accusations he was influenced by drug distributors to limit DEA’s effectiveness in addressing the opioid crisis.
• Trump declares the opioid epidemic a public health emergency, rather than a national emergency as many had expected. No new funding is allocated. His announcement of a new federal policy to expedite the waiver process for states requesting a workaround for the IMD exclusion, however, is seen to have more significant implications for providers.

November

• The President's Commission on Combating Drug Addiction and the Opioid Crisis releases its final recommendations and disbands. The report contains 56 strategies, including expanding drug courts and mandating that opioid prescribers check prescription drug monitoring databases. It receives mixed reviews.
• Trump nominates Alex Azar, a former pharmaceutical company leader, to lead HHS. Azar served at HHS under George W. Bush and is expected to chip away at ACA.
• A Senate tax bill is introduced that also has a mechanism to withdraw the ACA individual coverage mandate.

December

• Congress passes tax reform legislation that includes provisions removing financial penalties for not having health insurance, essentially rendering the ACA individual mandate unenforceable.  The Congressional Budget Office had estimated that about 4 million fewer people would have health coverage in the first year, growing to 13 million by 2027.

January 2018

• A Senate committee advances the Azar appointment at HHS.
• Republicans and Democrats continue to seek negotiation on reauthorizing the Children’s Health Insurance Program.
• The public health emergency declared in response to the opioid crisis is set to expire the third week of January.