First 100 Days: Top Healthcare Changes Under the Trump Administration

Saturday marks the 100th day of Donald Trump’s presidency, and ends the time period during which a president’s power and influence are supposed to be greatest. As a result, the first 100 days are used to measure the successes and accomplishments of a new president.

 

During Trump’s first 100 days, some significant changes took place that will impact healthcare in the United States.

 

Healthcare Appointments

Some of President Trump’s biggest wins came from his appointments. Despite opposition from Democrats, Trump put in place Tom Price, MD, as HHS Secretary, and Seema Verma, as CMS administrator.

 

Price was previously a congressman, and during his tenure as representative for Georgia’s 6th congressional district, he was vocal about his opposition to mandatory payment reform pilots. In particular, he did not like the Comprehensive Care for Joint Replacement. In addition, Price had opposed the Medicare Access and CHIP Reauthorization Act, one of the few examples of legislation that had passed with broad bipartisan support in recent years.

 

Verma had previously been a consultant and one of the most important entries on her resume was the work she did with Vice President Mike Pence when he was still governor of Indiana to create the state’s Medicaid expansion program. Under Verma, CMS has already indicated an increased willingness to grant waivers to give states more flexibility in creating Medicaid programs.

 

While Scott Gottlieb, MD, has not yet been confirmed as the next FDA commissioner, he has gotten through the Senate Committee on Health, Education, Labor & Pensions, and now he awaits a full Senate vote.

 

The AHCA and Changes to the ACA

Keeping his campaign promise, on his first day in the Oval Office, President Trump signed an executive order for federal agencies to ease the burden of the Affordable Care Act (ACA). The order directed federal agencies to stop issuing regulations to expand the law.

Early on, the House GOP leadership revealed an initial healthcare bill proposal–the American Health Care Act (AHCA)–which would repeal large parts of the ACA.

“Obamacare is rapidly collapsing,” House Speaker Paul Ryan (R-Wisconsin) said in a statement. “Skyrocketing premiums, soaring deductibles, and dwindling choices are not what the people were promised seven years ago. It’s time to turn a page and rescue our healthcare system from this disastrous law. The American Health Care Act is a plan to drive down costs, encourage competition, and give every American access to quality, affordable health insurance." 

Although a vote on the AHCA could not be eked out within the first 100 days, a lot of work has been done to set the stage for health reform. The proposed bill was ultimately pulled from the House floor without a vote, but the AHCA has been given new life with a string of amendments to make moderates and conservatives more willing to vote for it.

 

State Waivers

With a new administration in control, CMS is now more willing to work with states and provide waivers. More states will be looking to add work requirements to the Medicaid program, and Florida is already moving forward with legislation that would require able-bodied Medicaid beneficiaries to show they are working, taking part in job training, or looking for work.

 

Wisconsin is pushing the waiver even further. The state may become the first to implement mandatory drug screening, testing, and treatment for anyone seeking Medicaid.

 

Gorsuch to the Supreme Court

After days of contentious hearings and a vote that was so close the Senate had to get rid of the filibuster for Supreme Court nominees, Neil Gorsuch became the newest member of the Supreme Court, replacing the late Antonin Scalia.

 

Gorsuch has the potential to have an impact on healthcare through the cases that make it to the Supreme Court. The way Gorsuch ruled in previous cases on the 10th US Circuit Court of Appeals indicates that he believes strongly in religious freedom and sanctity of life.

 

Previous writing indicate he is against assisted suicide and he ruled in Burwell v Hobby Lobby that companies should not be required to provide insurance coverage for contraceptives, which is a requirement under the Affordable Care Act.

 

Bundled Payment Delay

A new cardiac bundled payment program from CMS and an expansion to its joint replacement program were supposed to take effect in 2017, but the agency will likely delay the start date for both to January 1, 2018.

 

The first hint of the delay came during a presentation by Kate Goodrich, MD, MPH, director of the Center of Standards and Quality and chief medical officer at CMS, at the 66th Scientific Session of the American College of Cardiology. During her talk, she mentioned “some retrofitting” of the cardiac payment bundle, but little else about a potential delay.

 

It is likely no coincidence that his move happened under Price’s rule at HHS, since he is against many mandatory programs and would likely want to move to more voluntary ones.