Federal policy on healthcare, 2017-2020

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Trump Administration (first term)

President Donald Trump
Vice President Mike Pence
Cabinet • White House staff • Transition team • Trump's second term

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Policy positions
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* * *

Polling indexes: Opinion polling during the Trump administration
115th Congress, 2017-2018
Healthcare policy

* * *

For more on healthcare policy, view the following articles:
•Healthcare overview
•Graham-Cassidy Obamacare replacement plan
•Republican effort to repeal the ACA, July 2017
•Better Care Reconciliation Act of 2017 (Senate bill)
•115th Congress on the Better Care Reconciliation Act of 2017
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•House's initial attempt to pass the AHCA, March
•House roll call vote on the AHCA
•Republicans who were likely to vote against the AHCA, March
•Timeline of ACA repeal and replace efforts
•Federal policy on healthcare, 2017-2020

* * *

Ballotpedia's scope changes periodically, and this article type is no longer actively created or maintained.

* * *

President Donald Trump's main healthcare policy initiative was working to fulfill his campaign promise to repeal and replace the Patient Protection and Affordable Care Act (ACA), commonly known as Obamacare. He expressed his support for the House and Senate bills that proposed modifying parts of the ACA. The House passed its bill—the American Health Care Act of 2017—but members of the Senate were unable to agree on a final replacement plan, leaving most of the provisions of the ACA in place. Congress removed the law's individual mandate, which took effect in January 2019.[1]

In October 2017, Trump issued an executive order directing members of his Cabinet to create rules that would allow small businesses to collectively buy health insurance through association health plans, expand short-term health coverage, and expand the use of Health Reimbursement Arrangements (HRAs). The order did not make direct changes to existing health insurance rules; instead, it directed agencies to consider new rules that would be subject to a notice and comment period.

The Trump administration also announced that it would end cost-sharing reimbursements. The administration announced that it would not make the payments scheduled for October 18, 2017, stating that the payments were not formally appropriated by Congress and were, therefore, illegal. Under the ACA, insurers who offered plans on the exchanges were required to provide the reductions, even without reimbursements from the federal government. Trump said that he was committed to passing a bill to repeal and replace the ACA. Before signing the executive order on October 12, 2017, Trump said, “Today is only the beginning. In the coming months, we plan to take new measures to provide our people with even more relief and more freedom. … And we're going to also pressure Congress very strongly to finish the repeal and the replace of Obamacare once and for all. We will have great healthcare in our country.”[2]

This page outlines major events and policy positions of the Trump administration on healthcare. Click on the timeline below to learn more about each headline.

* June 16, 2020: June 16, 2020: DC Court of Appeals strikes down CMS rule requiring disclosure of wholesale drug prices
* July 17, 2019: House votes to repeal tax on high-cost health plans
* July 8, 2019: July 8, 2019: U.S. District Court judge strikes down CMS drug price disclosure rule
* May 10, 2019: May 10, 2019: CMS publishes federal rule requiring pharmaceutical companies to list drug prices in television ads
* February 25, 2019: Senate rejects Born-Alive Abortion Survivors Protection Act
* December 14, 2018: Judge rules individual mandate unconstitutional and ACA invalid
* November 29, 2018: CMS releases State Relief and Empowerment Waivers
* October 24, 2018: Trump signs bipartisan opioid legislation
* October 22, 2018: Trump administration releases guidance easing restrictions on ACA waivers
* October 10, 2018: Senate rejects resolution to undo expanded access to short-term healthcare plans
* July 29 and 30, 2018: Federal government approves reinsurance programs in Wisconsin and Maine
* June 22, 2018: Bipartisan bill to slow opioid crisis passes the House
* May 30, 2018: Trump signs Right to Try bill
* May 11, 2018: Trump administration unveils drug pricing plan
* April 20, 2018: Trump Administration unveils abstinence-focused teen pregnancy program
* April 9, 2018: CMS issues final rule on ACA marketplaces
* March 19, 2018: President Trump unveils plan to address opioid crisis
* February 20, 2018: Trump administration announces proposed rule on short-term health insurance
* January 29, 2018: Sessions announces formation of Joint Criminal Opioid Darknet Enforcement team
* January 22, 2018: Congress approves CHIP funding
* January 19, 2018: Trump administration extends opioid public health emergency
* January 11, 2018: Trump administration releases guidance allowing states to impose work requirements for Medicaid
* January 10, 2018: President Trump signs Interdict Act
* January 4, 2018: Department of Labor proposes Association Health Plan rule
* December 22, 2017: Congress repeals individual mandate as part of tax law
* October 27, 2017: Administration proposes allowing states to redefine essential health benefits
* October 13, 2017: Trump formally ends cost-sharing reimbursements
* October 12, 2017: Trump signs executive order seeking to ease ACA rules
* October 6, 2017: Trump administration rolls back ACA contraception mandate
* August 31, 2017: HHS cuts budget for ACA enrollment outreach
* August 2017: Administration announces cuts to teen pregnancy program
* May 21, 2017: Trump administration releases draft rule on contraception coverage exemptions
* May 17, 2017: CMS issues guidance on health exchange enrollment
* April 13, 2017: CMS issues final rule on individual market regulations
* January 20, 2017: Trump issues executive order on the Affordable Care Act
* Trump's healthcare priorities before taking office
* Trump administration officials on healthcare, 2017
* 115th Congress on healthcare
* Healthcare policy overviews

What is the ACA or Obamacare? The Patient Protection and Affordable Care Act, commonly known as the Affordable Care Act (ACA) or Obamacare, was signed into law by President Barack Obama (D) on March 23, 2010. The aim of the law was to provide health insurance coverage to more Americans, primarily through individual health insurance marketplaces and an expansion of the Medicaid program. Click here to read more about the healthcare law.[3][4]

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## Contents

* 1 June 16, 2020: DC Court of Appeals strikes down CMS rule requiring disclosure of wholesale drug prices
* 2 July 17, 2019: House votes to repeal tax on high-cost health plans
* 3 July 8, 2019: U.S. District Court judge strikes down CMS rule requiring disclosure of wholesale drug prices
* 4 May 10, 2019: CMS publishes federal rule requiring pharmaceutical companies to list drug prices in television ads
* 5 February 25, 2019: Senate rejects Born-Alive Abortion Survivors Protection Act
* 6 December 14, 2018: Judge rules individual mandate unconstitutional and ACA invalid
* 6.1 February 26, 2018: Twenty Republican state attorneys general sue government over ACA
* 6.1.1 June 7, 2018: DOJ supports GOP AGs' lawsuit; argues parts of ACA are unconstitutional
* 7 November 29, 2018: CMS releases State Relief and Empowerment Waivers
* 8 October 24, 2018: Trump signs bipartisan opioid legislation
* 9 October 22, 2018: Trump administration releases guidance easing restrictions on ACA waivers
* 10 October 10, 2018: Senate rejects resolution to undo expanded access to short-term healthcare plans
* 11 July 29 and 30, 2018: Federal government approves reinsurance programs in Wisconsin and Maine
* 12 June 22, 2018: Bipartisan legislation to slow opioid crisis passes the House
* 13 May 30, 2018: Trump signs Right to Try bill
* 13.1 March 21, 2018: House passes Right to Try bill
* 14 May 11, 2018: Trump administration unveils drug pricing plan
* 14.1 Azar’s op-ed on the drug pricing plan
* 15 April 20, 2018: Trump Administration unveils abstinence-focused teen pregnancy program
* 16 April 9, 2018: CMS issues final rule on ACA marketplaces
* 17 March 19, 2018: President Trump unveils plan to address opioid crisis
* 18 February 20, 2018: Trump administration announces proposed rule on short-term health insurance
* 19 January 29, 2018: Sessions announces formation of Joint Criminal Opioid Darknet Enforcement team
* 20 January 22, 2018: Congress approves CHIP funding
* 21 January 19, 2018: Trump administration extends opioid public health emergency
* 22 January 11, 2018: Trump administration releases guidance allowing states to impose work requirements for Medicaid
* 22.1 February 14, 2018: House Democrats ask HHS to reject requests from states to impose work requirements for Medicaid
* 23 January 10, 2018: President Trump signs Interdict Act
* 24 January 4, 2018: Department of Labor proposes Association Health Plan rule
* 25 December 22, 2017: Congress repeals individual mandate as part of tax law
* 26 October 27, 2017: Administration proposes allowing states to redefine essential health benefits
* 27 October 13, 2017: Trump formally ends cost-sharing reimbursements
* 27.1 October 12, 2017: Sanders confirms that Trump will end cost-sharing reduction payments
* 28 October 12, 2017: Trump signs executive order seeking to ease ACA rules
* 29 October 6, 2017: Trump administration rolls back ACA contraception mandate
* 30 August 31, 2017: HHS cuts budget for ACA enrollment outreach
* 31 August 2017: Administration announces cuts to teen pregnancy program
* 32 May 31, 2017: Trump administration releases draft rule on contraception coverage exemptions
* 33 May 17, 2017: CMS issues guidance on health exchange enrollment
* 34 April 13, 2017: CMS issues final rule on individual market regulations
* 35 January 20, 2017: Trump issues executive order on the Affordable Care Act
* 36 Trump's healthcare priorities before taking office
* 37 Trump administration officials on healthcare, 2017
* 38 Donald Trump
* 38.1 President Donald Trump
* 38.1.1 Trump on the BCRA
* 38.1.2 Trump on the AHCA
* 38.1.3 Trump on the ACA
* 38.1.4 Trump on healthcare
* 39 Mike Pence
* 39.1 Vice President Mike Pence
* 39.1.1 Pence on the BCRA
* 39.1.2 Pence on the AHCA
* 39.1.3 Pence on the ACA
* 39.1.4 Pence on healthcare
* 40 Alex Azar
* 40.1 Secretary of Health and Human Services Alex Azar
* 40.1.1 Azar on the ACA
* 40.1.2 Azar on the Medicare
* 41 Tom Price
* 41.1 Former Secretary of Health and Human Services Tom Price
* 41.1.1 Price on the BCRA
* 41.1.2 Price on the AHCA
* 41.1.3 Price on the ACA
* 41.1.4 Price on healthcare
* 41.2 115th Congress on healthcare
* 41.2.1 House bill: American Health Care Act of 2017
* 41.2.2 Senate bill: Better Care Reconciliation Act of 2017
* 41.3 Healthcare policy overviews
* 41.4 See also
* 41.5 External links
* 41.6 Footnotes

## June 16, 2020: DC Court of Appeals strikes down CMS rule requiring disclosure of wholesale drug prices[edit]

On June 16, 2020, the United States Court of Appeals for the District of Columbia Circuit struck down the final rule issued by the Centers for Medicare & Medicaid Services (CMS) in May 2019, which would have required pharmaceutical companies to include the list price, also known as the wholesale acquisition cost, of Medicare-and Medicaid-covered prescription drugs in television advertisements.[5] The appellate court ruling upheld an earlier ruling by Judge Amit Priyavadan Mehta of the United States District Court for the District of Columbia, which prevented the rule from going into effect in July 2019.[6]

Judge Patricia Ann Millett authored the court's majority opinion. She wrote, "[HHS] acted unreasonably in construing its regulatory authority to include the imposition of a sweeping disclosure requirement that is largely untethered to the actual administration of the Medicare or Medicaid programs." Millett concluded, The Department’s construction of the statute would seem to give it unbridled power to promulgate any regulation with respect to drug manufacturers that would have the arguable effect of driving down drug prices—or even healthcare costs generally—based on nothing more than their potential salutary financial benefits for the Medicare or Medicaid program. This suggests a staggering delegation of power, far removed from ordinary administration."[5]

## July 17, 2019: House votes to repeal tax on high-cost health plans[edit]

On July 17, 2019, the U.S. House voted 419-6 in favor of repealing an excise tax, also called the Cadillac tax, on high-cost employer-sponsored health plans. The 40 percent tax, established by the Affordable Care Act, would apply to health benefits exceeding certain thresholds. At the time the House passed the bill to repeal it, the tax was set to go into effect in 2022, and thresholds above which the tax would apply were projected as $11,200 for individual coverage and $30,100 for family coverage.[7]

The bill was passed with the support of 230 Democratic and 189 Republican representatives. Reps. Jim Cooper (D-Tenn.), Justin Amash (I-Mich.), Andrew Harris (R-Md.), Ron Kind (D-Wis.), Scott Peters (D-Calif.), and Chip Roy (R-Texas) voted against the bill.[8]

Rep. Joe Courtney (D-Conn.), who introduced the bill, said, "Out-of-pocket costs are unaffordable for growing numbers of families, even those who have insurance. If the 40% excise tax goes into effect, we know this affordability crisis will dramatically worsen. Actuarial experts have repeatedly warned that this tax will disproportionately and unfairly impact older workers, women, and working families in expensive geographic areas."[9]

In opposition to the bill, president of the Committee for a Responsible Federal Budget Maya MacGuineas said the following: "The Cadillac tax is one of the most important tools we have to control health care cost growth in the private sector. Repealing it will drive up health care costs while adding more than $1.2 trillion to the debt over the next two decades."[7]

## July 8, 2019: U.S. District Court judge strikes down CMS rule requiring disclosure of wholesale drug prices[edit]

On July 8, 2019, Judge Amit Priyavadan Mehta of the United States District Court for the District of Columbia issued a ruling that blocked the new Centers for Medicare & Medicaid Services (CMS) rule requiring pharmaceutical companies to include the list price for some Medicare- and Medicaid-covered prescription drugs in television advertisements. The rule had been set to take effect the next day, on July 9. Three pharmaceutical companies and one trade marketing association had together filed suit with the court to block the rule from going into effect. According to Mehta's summary of the case, the plaintiffs' challenge was twofold: "First, they argue that the Rule exceeds HHS’s authority, because Congress neither expressly nor impliedly granted HHS the power under the Social Security Act to regulate drug marketing. Second, they maintain that the [Rule] is compelled speech that violates the First Amendment."[6]

Mehta's decision to grant the plaintiffs' request for a stay and block the ruling drew primarily on the first argument, which was that HHS overstepped its regulatory authority in issuing the final rule.[10] Mehta wrote, "It is the agency’s incursion into a brand-new regulatory environment, and the rationale for it, that make the Rule so consequential. To accept the agency’s justification here would swing the doors wide open to any regulation, rule, or policy that might reasonably result in cost savings to the Medicare and Medicaid programs, unless expressly prohibited by Congress...So, this case is not just about whether HHS can force drug companies to disclose their list prices in the name of lowering costs. Rather, the [Rule] represents a significant shift in HHS’s ability to regulate the health care marketplace. Congress surely did not envision such an expansion of regulatory authority when it granted HHS the power to issue regulations necessary to carry out the 'efficient administration' of the Medicare and Medicaid programs."[6]

In response, HHS filed a notice of appeal with the United States Court of Appeals for the District of Columbia Circuit in August 2019.[11]

## May 10, 2019: CMS publishes federal rule requiring pharmaceutical companies to list drug prices in television ads[edit]

On May 10, 2019, the Centers for Medicare & Medicaid Services (CMS), an agency within the Department of Health & Human Services (HHS), published a rule that required pharmaceutical companies to include the list price, also known as the wholesale acquisition cost, of certain prescription drugs in television advertisements. The requirement applied to medicine covered by Medicare or Medicaid and did not apply to drugs with a cost of $35 or less.[12]

According to the summary of the final rule published in the Federal Register, the rule was intended to make Medicare and Medicaid administration more efficient by giving beneficiaries of the programs more information about the costs of drugs. CMS argued that the new rule would use public scrutiny to pressure manufacturers into lowering drug prices and would equip patients to make more informed healthcare decisions. Under the rule, television advertisements for prescription drugs were required to state the cost for a 30-day supply. The rule was to go into effect on July 9, 2019.[12]

## February 25, 2019: Senate rejects Born-Alive Abortion Survivors Protection Act[edit]

On February 25, 2019, the Senate rejected the Born-Alive Abortion Survivors Protection Act by a vote of 53-44. It needed 60 votes to advance. The bill proposed making it a felony if a healthcare practitioner failed to care for a child who survived an abortion or attempted abortion.[13]

All Republicans and Democratic Sens. Bob Casey (Pa.), Doug Jones (Ala.), and Joe Manchin (W.Va.) voted for the bill. No Republicans voted against the bill. All 44 votes against the bill were cast by members of the Democratic caucus.[14]

Before the vote, Senate Minority Leader Chuck Schumer (D-N.Y.) spoke in opposition to the bill, saying, “The bill the Senate will vote on shortly is carefully crafted to target, intimidate, and shut down reproductive healthcare providers. Doctors across this country--Democratic doctors, Republican doctors--are lining up against the bill because it would impose requirements on what type of care doctors must provide in certain circumstances, even if that care is ineffective, contradictory to medical evidence, and against the family's wishes. … It has always been illegal to harm a newborn infant. This vote has nothing--nothing--to do with that. Read the language. We are talking about situations when expectant parents tragically learn their pregnancy is no longer viable, and there is a fatal diagnosis. What happens in those circumstances should be decided between a woman, her family, her minister, priest, rabbi, imam, and her doctor.”[15]

Senator Ben Sasse (R-Neb.), the sponsor of the bill, responded to Schumer’s comments, calling them false. Sasse said, “I want to ask each and every one of our colleagues whether we are OK with infanticide. ... Infanticide is what the abortion survivors--Born-Alive Abortion Survivors Protection Act is actually about. Are we a country that protects babies who are alive, born outside the womb after having survived a botched abortion? That is what this is about. Are we a country that says it is OK to actively allow that baby to die, which is the current position of Federal law? That is the question before us, plain and simple. … The bill's terms are simple: A child born alive during a botched abortion would be given the same level of care that would be provided to any other baby born at that same gestational age. That is it.”[16]

After the vote, Senate Majority Leader Mitch McConnell (R-Ky.) said, “Evidently the far left is no longer convinced that all babies are created equal.”[17]

Sen. Sherrod Brown (D-Ohio) criticized McConnell for bringing the bill to the floor for a vote. He said, "This is pure Mitch McConnell. It's all aimed at keeping his base in line, while the president grows increasingly unpopular. We're not doing infrastructure, we're not doing health care. We're not doing anything that matters to help our country. It's just votes on abortion and other kinds of divisive votes he's going to bring."[17]

## December 14, 2018: Judge rules individual mandate unconstitutional and ACA invalid[edit]

On December 14, 2018, U.S. District Court for the Northern District of Texas Judge Reed O'Connor ruled that the Affordable Care Act's (ACA) individual mandate was unconstitutional, and, because it was a critical feature of the law, the ACA was invalid.[18]

O’Connor wrote that the Supreme Court upheld the individual mandate because of Congress' power to tax. As part of the Tax Cuts and Jobs Act, which was signed into law on December 22, 2017, Congress removed the fine for not obtaining health insurance. O’Connor ruled that because the individual mandate was not a tax, it was unconstitutional. He further decided that because the mandate was a critical feature of the law, "the remaining provisions of the ACA are inseverable and therefore invalid."[18]

The ruling had no immediate impact on ACA insurance plans. White House press secretary Sarah Huckabee Sanders said in a statement, "We expect this ruling will be appealed to the Supreme Court. Pending the appeal process, the law remains in place.” Seema Verma, the head of the Centers for Medicare and Medicaid Services, added, "There is no impact to current coverage or coverage in a 2019 plan."[19]

President Donald Trump commented on the ruling in a tweet, writing, “Wow, but not surprisingly, ObamaCare was just ruled UNCONSTITUTIONAL by a highly respected judge in Texas. Great news for America!”[19]

Sen. Brian Schatz (D-Hawaii) criticized the ruling, writing in a tweet, “Republicans want to gut healthcare. It’s not a talking point, it’s not an exaggeration. For ideological reasons, and because many can’t stand that it’s named Obamacare, they are causing millions to feel anxiety and possibly suffer. Shame on them.”[19]

California Attorney General Xavier Becerra said he would appeal the ruling.[19]

On December 30, 2018, O'Connor issued an order stating that the ACA would remain in place during the process to appeal his December 14 decision. Becerra and other state attorneys general had begun the appeal process, The Hill reported.[20]

Reed said in his order that "many everyday Americans would otherwise face great uncertainty during the pendency of appeal."[20]

### February 26, 2018: Twenty Republican state attorneys general sue government over ACA[edit]

On February 26, 2018, 20 states, led by Texas Attorney General Ken Paxton and Wisconsin Attorney General Brad Schimel, filed a lawsuit against the federal government for continuing to enforce the Patient Protection and Affordable Care Act (ACA), commonly known as Obamacare. The lawsuit, which was filed in federal district court in the Northern District of Texas, claimed that the ACA was unconstitutional because the individual mandate was removed, invalidating the entire law. The lawsuit stated, “Once the heart of the ACA—the individual mandate—is declared unconstitutional, the remainder of the ACA must also fall."[21][22]

The individual mandate required every individual to obtain health insurance and established fines for those who did not. As part of the tax law, Congress ended the penalty starting in 2019. Although the individual mandate remained, the government could not enforce the mandate without a penalty.[22]

Paxton said, “The U.S. Supreme Court already admitted that an individual mandate without a tax penalty is unconstitutional. With no remaining legitimate basis for the law, it is time that Americans are finally free from the stranglehold of Obamacare, once and for all."[21]

In addition to Texas and Wisconsin, Alabama, Arkansas, Arizona, Florida, Georgia, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Nebraska, North Dakota, South Carolina, South Dakota, Tennessee, Utah, Wisconsin, and West Virginia joined the lawsuit.[22]

#### June 7, 2018: DOJ supports GOP AGs' lawsuit; argues parts of ACA are unconstitutional[edit]

On June 7, 2018, the U.S. Department of Justice (DOJ) argued in court that the Affordable Care Act’s (ACA) provisions that prevent insurers from denying people with pre-existing conditions coverage or charging them more and the individual mandate that requires individuals to have insurance or face a tax penalty are unconstitutional. The DOJ said that these provisions were invalid because the individual mandate penalty was repealed as part of the tax law, making it unconstitutional. In a letter to members of Congress, Attorney General Jeff Sessions wrote, “The department in the past has declined to defend a statute in cases in which the president has concluded that the statute is unconstitutional and made manifest that it should not be defended, as is the case here.”[23][24]

According to ‘’The Hill’’, “The move is a break from the normal practice of the DOJ to defend federal laws when they are challenged in court.” However, previous administrations have also chosen to not defend laws it disagreed with. In 2011, the DOJ under President Barack Obama did not defend the Defense of Marriage Act (DOMA), which defined marriage as being between a man and a woman.[23]

Democratic Reps. Bobby Scott (D-Va.), Frank Pallone Jr. (D-N.J.), and Richard Neal (Mass.) criticized the DOJ’s decision, saying in a statement, “The Justice Department’s refusal to defend the Affordable Care Act (ObamaCare) in federal court is a stunning attack on the rule of law, the stability of our health care system, and Americans’ access to affordable health care. The administration’s attempt to eliminate protections for the 130 million Americans with pre-existing conditions is just the latest — and potentially the most damaging — example of the coordinated effort by congressional Republicans and the Trump administration to sabotage the Affordable Care Act, driving up uninsured rates and out-of-pocket costs for Americans.”[25]

## November 29, 2018: CMS releases State Relief and Empowerment Waivers[edit]

On November 29, 2018, the Centers for Medicare and Medicaid Services (CMS) released State Relief and Empowerment Waivers that it said would allow states more flexibility in how they provide health insurance options. The waivers allow states to use Affordable Care Act (ACA) insurance subsidies to help citizens pay for plans that do not meet the law’s coverage requirements. The waivers did not make changes to the requirements for health insurance issuers to provide protections for people with pre-existing conditions.[26]

The four waiver concepts appear below, according to a fact sheet released by CMS.[26]

* Account-Based Subsidies: “Under this waiver concept, a state can direct public subsidies into a defined-contribution, consumer-directed account that an individual uses to pay for health insurance premiums or other health care expenses.”

* State-Specific Premium Assistance: “States can use the State-Specific Premium Assistance waiver concept to create a new, state-administered subsidy program. A state may design a subsidy structure that meets the unique needs of its population in order to provide more affordable health care options to a wider range of individuals, attract more young and healthy consumers into their market, or to address structural issues that create perverse incentives, such as the subsidy cliff.”

* Adjusted Plan Options: “Under this waiver concept, states would be able to provide financial assistance for different types of health insurance plans, including non-Qualified Health Plans, potentially increasing consumer choice and making coverage more affordable for individuals.”

* Risk Stabilization Strategies: “To address risk associated with individuals with high health care costs, this waiver concept gives states more flexibility to implement reinsurance programs or high-risk pools.”

Health and Human Services Secretary Alex Azar issued the following statement supprting the waiver concepts: “The Trump Administration is committed to empowering states to think creatively about how to secure quality, affordable healthcare choices for their citizens. Part of that commitment is providing guidance on how states can use the waiver authorities within the ACA to open up more state-based, consumer-directed, fiscally sustainable healthcare options. The specific examples laid out today show how state governments can work with HHS to create more choices and greater flexibility in their health insurance markets, helping to bring down costs and expand access to care.”[27]

## October 24, 2018: Trump signs bipartisan opioid legislation[edit]

On October 24, 2018, President Donald Trump signed the HR 6—the SUPPORT for Patients and Communities Act. The law was the culmination of a bipartisan effort to combat the opioid crisis. It passed the Senate by a vote of 99-1 and the House by a vote of 396-14.[28]

During a signing ceremony, Trump said, "Together we are going to end the scourge of drug addiction in America. We are either going to end it or we are going to make an extremely big dent in this terrible, terrible problem."[29][28]

The bill allocated $500 million a year toward the opioid crisis under the 21st Century Cures Act; made it easier to use Medicaid funding for opioid treatment; created grant programs to fight opioid abuse; and required the U.S. Postal Service monitor mail for opioid trafficking, among other things.[29]

According to a White House fact sheet, the law included the following provisions:[30]

“  |

* IMD CARE Act: Provides States with a Medicaid State plan option to provide residential treatment in facilities (Institutions for Mental Diseases) more than 16 beds, in certain circumstances.

* STOP Act: Requires the United States Postal Service to share advanced electronic data with CBP on 100 percent of packages entering the country.

* This will help identify suspicious shipments and stop deadly fentanyl from entering from China and Mexico.

* CRIB Act: Supports the most vulnerable victims of the opioid crisis by allowing State Medicaid programs to cover healthcare services to infants suffering from neonatal abstinence syndrome in pediatric recovery centers.

* Currently, pediatric recovery centers cannot bill Medicaid for services to babies in withdrawal, thereby limiting how many families they are able to serve.

* CARA 2.0 Act: Increases the funding authorization levels for certain programs enacted in 2016 under the CARA Act.

* Youth Prevention and Recovery: Leverages existing job training resources to create a pilot program to address workforce shortages exacerbated by the opioid crisis.

* This will help employers fill job openings and get those in recovery back on their feet.

* ONDCP Reauthorization: Reauthorizes ONDCP and allows its media campaigns to focus on anti-drug messages for all age groups, not just youth as the law currently states.

* This also reauthorizes the Drug-Free Communities Support Program and the High Intensity Drug Trafficking Areas Program.

* Improving Recovery and Reunifying Families Act: Authorizes $15 million for a “recovery coach” program for parents with children in foster care due to parental substance use.

* The goal of the program is to reduce the length of time children spend in foster care due to a parent who is struggling with a substance use disorder.

* CAREER Act: Improves resources and wrap-around support services for those recovering from a substance use disorder who are transitioning from treatment programs to the workforce.

* This includes $25 million authorized for workforce participation grants.[31]

| ”

|
|

## October 22, 2018: Trump administration releases guidance easing restrictions on ACA waivers[edit]

On October 22, 2018, the Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of the Treasury issued a guidance that gave states the ability to offer healthcare plans with less comprehensive coverage than what was required by the Affordable Care Act (ACA). The guidance allowed states to apply for State Relief and Empowerment Waivers to offer alternative healthcare plans, including short-term or association health plans, as long as the state also offered ACA-compliant plans. The guidance took effect immediately, but only health plans issued in 2020 and later would be impacted.[32]

According to a press release from CMS, “Federal law, under Section 1332 of the ACA, authorizes states to waive certain provisions of the law so long as the new state waiver plan meets specific criteria, or 'guardrails,' that help guarantee people retain access to coverage that is at least as comprehensive and affordable as without the waiver, covers as many individuals, and is deficit neutral to the federal government.” The Trump administration said that guidance issued by the Obama administration was too restrictive and did not give states flexibility to offer different healthcare plans.[32]

The guidance outlined five principles for states to follow as they created new healthcare plans and applied for waivers. CMS said that the waivers should aim to "provide increased access to affordable private market coverage; encourage sustainable spending growth; foster state innovation; support and empower those in need; and promote consumer-driven healthcare.”[32]

Speaking about the guidance, CMS Administrator Seema Verma said, “This is a new day – this is a new approach to empower states to provide relief. States know much better than the federal government how their markets work. With today’s announcement, we are making sure that they have the ability to adopt innovative strategies to reduce costs for Americans, while providing higher quality options.”[32]

According to The Hill, some in the healthcare field said that the new guidance would cause instability in the ACA marketplace. “Experts have found that allowing healthy people to buy into an insurance market separate from sick people could destabilize the system. Only people who need ObamaCare’s protections would be left in one market, and would likely face sky-high premiums.”[33]

The guidance was created in response to President Donald Trump’s October 12, 2017, executive order seeking to ease ACA rules. Other actions taken under the order were allowing consumers to purchase short-term healthcare plans, providing exemptions to the ACA’s individual mandate, and changing ACA marketplaces.

## October 10, 2018: Senate rejects resolution to undo expanded access to short-term healthcare plans[edit]

On October 10, 2018, the Senate rejected a resolution that proposed overturning a Trump administration rule that expanded access to short-term healthcare plans by a vote of 50-50. The rule allowed individuals to purchase health insurance plans that were not required to cover people with pre-existing conditions or other health services. Republican Sen. Susan Collins (R-Maine) voted with the 49 senators in the Democratic caucus in support of the resolution. Fifty Republicans voted against the resolution.[34][35]

Speaking about healthcare before the vote, Senate Democratic Leader Chuck Schumer (D-N.Y.) said, “In a few short weeks the American people will head to the polls where they can vote for another two years of Republican attempts to gut our health-care system, or they can vote for Democratic candidates who will safeguard the protections now in place and work to make health care more affordable.”[36]

Sen. Lamar Alexander (R-Tenn.), the chairman of the Senate Health Committee, said that the short-term plans provided people with less expensive healthcare options. He said the message is “you can pay less with less coverage and at least you will have some insurance. But our Democratic friends will say, 'Oh no, we don't want to do anything that will lower the cost of insurance'"[36]

## July 29 and 30, 2018: Federal government approves reinsurance programs in Wisconsin and Maine[edit]

On July 29, 2018, the U.S. Departments of Health and Human Services and the Treasury approved Wisconsin's application for a State Innovation Waiver under section 1332 of the Patient Protection and Affordable Care Act (ACA), authorizing the state to implement a reinsurance program. The program, named the Wisconsin Health Care Stability Plan, was designed to pay 50 percent of insurers' claims between $50,000 and $250,000. The program was slated to provide $200 million in reinsurance funding in 2018, with an estimated $34 million coming from the state and the remainder coming from the federal government. According to a statement issued by Governor Scott Walker's (R) office, the program was expected to reduce insurance premiums by 3.5 percent in 2019 compared to 2018 rates.[37]

On July 30, 2018, the federal government approved a similar proposal for Maine. The Maine Guaranteed Access Reinsurance Association was designed to pay 90 percent coinsurance for claims ranging from $47,000 to $77,000 and 100 percent coinsurance for claims exceeding that up to $1 million.[38]

A transitional reinsurance program, which expired in 2016, was established under the ACA. It required most health insurers to pay a fee to the federal government based on their enrollment figures for a plan year. The fee went toward payments to insurers providing plans on the individual market that covered high-cost individuals. The purpose of the program was to prevent premiums from rising too high to cover the cost of these individuals.

## June 22, 2018: Bipartisan legislation to slow opioid crisis passes the House[edit]

On June 22, 2018, the House passed a bipartisan package of 58 bills aimed at fighting the opioid crisis. The legislation included provisions such as requiring healthcare providers to write prescriptions for Medicare recipients electronically to monitor the levels and frequency of prescriptions; lifting many prescription limits on an opioid addiction treatment drug; extending Medicare coverage to include addiction treatment; directing the National Institutes of Health to develop nonaddictive painkillers; and requiring medical records to list a patient's addiction history.

Rep. Greg Walden (R-Ore.), chairman of the House Energy and Commerce Committee, said of the bill’s bipartisanship, "At a time when it seems we couldn’t be more divided, it’s clear that striking back against addiction is something that transcends politics and brings us together as a community, as a country and a Congress."[39]

Rep. Frank Pallone Jr. (D-N.J.) questioned the legislation's impact, saying, "This bill makes incremental changes to support those affected by the opioid crisis, but it's far from perfect. I do question if this bill will have a meaningful impact on the opioid crisis."[40]

## May 30, 2018: Trump signs Right to Try bill[edit]

On May 30, 2018, President Donald Trump signed S 204—the Trickett Wendler, Frank Mongiello, Jordan McLinn, and Matthew Bellina Right to Try Act of 2017. The law allows terminally ill patients to use unapproved, investigational drugs after all approved treatment options have been tried.[41]

During a signing ceremony, Trump said, "With the Right to Try law I’m signing today, patients with life-threatening illnesses will finally have access to experimental treatments that could improve or even cure their conditions. These are experimental treatments and products that have shown great promise, and we weren’t able to use them before. Now we can use them. And oftentimes they’re going to be very successful. It’s an incredible thing. The Right to Try also offers new hope for those who either don’t qualify for clinical trials or who have exhausted all available treatment options. There were no options, but now you have hope. You really have hope."[42]

It passed the House on May 22, 2018, by a vote of 250-169. Two hundred and twenty-eight Republicans and 22 Democrats voted for the bill. One hundred and sixty-nine Democrats and no Republicans voted against the bill. The Senate passed the bill by unanimous consent on August 3, 2017.[43]

More than 100 advocacy groups, including the American Cancer Society Cancer Action Network and Friends of Cancer Research, opposed the bill because they said it could give patients false hope that their disease could be cured by an experimental drug. They also said that the Food and Drug Administration’s (FDA) compassionate-use program allows terminally ill patients access to experimental treatments.[44]

Rep. Frank Pallone Jr. (D-N.J.), the House Energy and Commerce Committee’s ranking member, opposed the bill. He said during debate about the bill, “FDA oversight of access to experimental treatments exists for a reason — it protects patients from potential snake oil salesmen or from experimental treatments that might do more harm than good. By removing FDA oversight, you are counting on physicians and manufacturers to serve as the gatekeeper and protector of patients. I simply don’t buy that that’s going to work.”[44]

Supporters of the bill said that terminally ill patients should have access to any treatment that could potentially save their lives. They also said that the FDA’s program to approve experimental treatments on a case-by-case basis was not efficient enough for patients with life-threatening illnesses.[44]

Rep. Michael Burgess (R-Texas), the House Energy and Commerce health subcommittee chairman, said, “It’s about patients. It’s about having more time with their loved ones.”[44]

### March 21, 2018: House passes Right to Try bill[edit]

On March 21, 2018, the House passed a bill that would allow terminally ill patients access to experimental drugs not approved by the Food and Drug Administration (FDA) to treat their illness. The House passed HR 5247—the Trickett Wendler, Frank Mongiello, Jordan McLinn, and Matthew Bellina Right to Try Act of 2018—by a vote of 276-149. The House chose to vote on its own version of the Right to Try bill instead of taking up the version that the Senate passed on August 3, 2017.[45]

The major difference between the House and Senate versions centered on who could qualify for experimental drugs. The Senate bill proposed allowing access by a patient “diagnosed with a life-threatening disease or condition.” The House bill proposed allowing access by a patient “diagnosed with a stage of a disease or condition in which there is reasonable likelihood that death will occur within a matter of months.” Patients would also qualify if their illness could result in “significant irreversible morbidity that is likely to lead to severely premature death.”[41][46][47]

The House bill was not taken up by the Senate. Instead, the House voted to pass the Senate’s version of the bill on May 22, 2018.

## May 11, 2018: Trump administration unveils drug pricing plan[edit]

WhiteHouse.gov, "President Trump Delivers Remarks on Lowering Drug Prices," May 11, 2018

On May 11, 2018, President Donald Trump released his administration’s plan to lower drug prices. While introducing the plan, Trump said, “Under this administration, we are putting American patients first. I’ve instructed Secretary Azar to begin moving forward on reforms that will bring soaring drug prices back down to earth. Our plan takes steps to derail the gravy train for special interests by ending Obamacare’s twisted incentives that actually encourage higher drug prices.”[48]

The plan included the following, according to a White House fact sheet:[49]

“  |

* Take steps to end the gaming of regulatory and patent processes by drug makers to unfairly protect monopolies.
* Advance biosimilars and generics to boost price competition.
* Evaluate the inclusion of prices in drug makers’ ads to enhance price competition.
* Streamline and accelerate the approval process for over-the-counter drugs.
* Speed access to and lower the cost of new drugs by clarifying policies for sharing information between insurers and drug makers.
* Avoid excessive pricing by relying more on value-based pricing by expanding outcome-based payments in Medicare and Medicaid.
* Work to give Part D plan sponsors more negotiation power with drug makers.
* Examine which Medicare Part B drugs could be negotiated for a lower price by Part D plans, and improving the design of the Part B Competitive Acquisition Program.
* Update Medicare’s drug-pricing dashboard to increase transparency.
* Prohibit Part D contracts that include “gag rules” that prevent pharmacists from informing patients when they could pay less out-of-pocket by not using insurance.
* Require that Part D plan members be provided with an annual statement of plan payments, out-of-pocket spending, and drug price increases.
* Work across the Administration to address intellectual property theft and foreign freeloading.[31]

| ”

|
|

Sen. Ron Wyden (D-Ore.), the top Democrat on the Senate Finance Committee, criticized the plan, saying, “They’re breathing a sigh of relief in pharmaceutical board rooms across the country. It’s still open season for drug companies to set astronomical prices that families can’t afford.”[51]

### Azar’s op-ed on the drug pricing plan[edit]

In an op-ed, discussing the Trump administration's plan to lower drug prices, Secretary of Health and Human Services Alex Azar identified the following four major problems in drug markets:[52]

* Drug manufacturers increasing the list prices of drugs;
* Government programs and private payers not having the tools to negotiate drug prices;
* Patients paying high out-of-pocket costs for the drugs; and
* "Foreign countries and their government-run health-care systems bully our drug manufacturers into unrealistically low prices, allowing other countries to freeload off of American innovation."

To address these problems, Azar said that HHS would do the following:[52]

* Increase competition in drug markets;
* Give Medicare Part D plans the tools that private-sector health plans often use to negotiate discounts;
* Develop new incentives for drug manufacturers to lower list prices; and
* Develop options to lower patients’ out-of-pocket spending.

## April 20, 2018: Trump Administration unveils abstinence-focused teen pregnancy program[edit]

On April 20, 2018, the U.S. Department of Health and Human Services announced a change in its teen pregnancy prevention program that shifted the focus of the program towards an abstinence-based curriculum. The new program reversed the Obama-era focus on what The Hill called a “comprehensive sex ed approach.”[53]

## April 9, 2018: CMS issues final rule on ACA marketplaces[edit]

On April 9, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a final rule—the HHS Notice of Benefit and Payment Parameters for 2019—that created exemptions to the Patient Protection and Affordable Care Act’s (ACA) individual mandate and instituted changes to the ACA’s marketplaces. The rule allowed states to redefine the essential health benefits insurers are required to cover under the ACA. Under the law, the essential health benefits are broad categories of benefits that insurers on the healthcare exchanges must offer; states determine which specific services in those categories are covered by selecting a benchmark plan offered in the employer-sponsored insurance market. The rule allowed states to set the specific benefits standards by choosing services from different plans, rather than selecting a single plan in whole. States were also given the authority to set the standards according to another state's benchmark plan.[54]

Other changes in the rule included an adjustment to the methodology for calculating risk adjustment payments, which try to balance risk among insurers on the exchanges, raising the percentage increase in premiums that requires government review from 10 percent to 15 percent, and removing standardized plan options.[54]

Speaking about the rule, CMS Administrator Seema Verma said, “Too many Americans are facing skyrocketing premiums that they can’t afford and every year consumers are faced with the threat of fewer choices. This rule gives states new tools to stabilize their health insurance markets and empower citizens to find coverage that fits their families’ needs and budgets.”[54]

The rule included the following changes, according to a CMS press release:[54]

* Essential Health Benefits: States were given more flexibility in creating EHB-benchmark plans. “Instead of being limited to 10 options, states will now be able to choose from the 50 EHB-benchmark plans used for the 2017 plan year in other states or select specific EHB categories, such as drug coverage or hospitalization, from among the categories used for the 2017 plan year in other states.”

* Qualified Health Plan (QHP) Certification Standards: States were given more “oversight authority regarding state review of network adequacy.” The meaningful difference requirement for QHPs was eliminated.

* Exemptions: “Exchanges will be able to make a determination of lack of affordable coverage based on projected income using the lowest cost Exchange metal level plan offered through the Exchange when there is no bronze level plan available in the service area.”

* Risk Adjustment: The HHS-operated risk adjustment program was “recalibrated for the 2019 benefit year to incorporate new data that reflects the actual experience of individual and small group market enrollees, which should more closely reflect the risk within markets. In States where HHS operates the risk adjustment program, CMS will also provide states with the flexibility to request a reduction to the otherwise applicable risk adjustment transfers in the individual, small group or merged market by up to 50 percent beginning with the 2020 benefit year.”

* Advanced Premium Tax Credit (APTC) Program Integrity: Exchanges were required to “implement stronger checks to verify applicants actually earn the income they claim to qualify for APTCs.” The Exchanges were also required “to discontinue APTCs for enrollees who fail to file taxes and reconcile past APTCs, even if the Exchange does not first send notice directly to the tax filer.”

* Special Enrollment Periods (SEPs): The rule aligned “the enrollment options for all dependents who are newly enrolling in Exchange coverage through an SEP and are being added to an application with current enrollees, regardless of the SEP the dependent qualifies under. For consumers newly gaining or becoming a dependent and enrolling through the birth, adoption, foster care placement, or court order SEPs, CMS amended and standardized the alternate coverage start date options available under all of these SEPs.”

* Medical Loss Ratio (MLR): The rule allowed “states to request reasonable adjustments to the MLR standard for the individual market if the state shows a lower MLR standard could help stabilize its individual insurance market.”

* Small Business Health Options Program (SHOP): The rule allowed “SHOPs to eliminate the online enrollment process and allows employers to enroll directly with an Exchange-registered agent, broker, or issuer and, the FF-SHOPs and SBE-FP for SHOPs will exercise the flexibilities outlined in the notice for plan years beginning on or after January 1, 2018.”

* Rate Review: The exempted “student health insurance coverage from Federal rate review requirements, and raises the default threshold for review of reasonableness from 10 percent to 15 percent.”

## March 19, 2018: President Trump unveils plan to address opioid crisis[edit]

On March 19, 2018, President Donald Trump announced his administration’s plan to address the opioid crisis. The plan aimed to reduce opioid over-prescription, stop the flow of illegal drugs into the U.S., and increase access to addiction treatment. In his speech in New Hampshire announcing the plan, he also stated a desire for increased penalties for high-volume drug traffickers, including the death penalty. During the speech, President Trump said of the increased penalties, “We have to get tough. This isn’t about nice anymore.”[55][56]

## February 20, 2018: Trump administration announces proposed rule on short-term health insurance[edit]

On February 20, 2018, the Departments of Health and Human Services (HHS), Labor, and the Treasury issued a proposed rule “to expand the availability of short-term, limited-duration health insurance by allowing consumers to buy plans providing coverage for any period of less than 12 months, rather than the current maximum period of less than three months,” according to a press release from HHS.[57]

Under the Patient Protection and Affordable Care Act (ACA), commonly known as Obamacare, short-term health insurance plans can only be accessed for three months. The proposed rule would expand the time period to 12 months. According to The Hill, individuals with pre-existing conditions could be charged more and the short-term plans do not have to cover the essential benefits required by the ACA.[58]

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma said, “Americans who find themselves between jobs or simply can’t afford coverage because prices are too high will be helped by President Trump’s Healthcare for All Executive Order. In a market that is experiencing double-digit rate increases, allowing short-term, limited-duration insurance to cover longer periods gives Americans options and could be the difference between someone getting coverage or going without coverage at all.”[57]

Sen. Ron Wyden (D-Ore.) criticized the proposed rule, saying, “Bottom line, this is a green light to discriminate against Americans with pre-existing conditions that’s going to make quality health insurance more expensive and less accessible.”[58]

This proposed rule was a response President Donald Trump’s October 12, 2017, executive order.

## January 29, 2018: Sessions announces formation of Joint Criminal Opioid Darknet Enforcement team[edit]

On January 29, 2018, Attorney General Jeff Sessions announced the formation of the Joint Criminal Opioid Darknet Enforcement (J-CODE) team to fight online drug trafficking.

In a press release announcing the team's formation, Sessions said, “Criminals think that they are safe on the darknet, but they are in for a rude awakening. We have already infiltrated their networks, and we are determined to bring them to justice. In the midst of the deadliest drug crisis in American history, the FBI and the Department of Justice are stepping up our investment in fighting opioid-related crimes. The J-CODE team will help us continue to shut down the online marketplaces that drug traffickers use and ultimately that will help us reduce addiction and overdoses across the nation.”[59]

## January 22, 2018: Congress approves CHIP funding[edit]

On January 22, 2018, Congress approved funding for the Children's Health Insurance Program (CHIP) in a six-year reauthorization. The previous funding for CHIP expired in September 2017, and disagreements between Democrats and Republicans in Congress over how to best fund the program caused a four-month lapse in federal funding. At the time of the reauthorization, the program covered 9 million low-income children.[60]

## January 19, 2018: Trump administration extends opioid public health emergency[edit]

On January 19, 2018, the U.S. Department of Health and Human Services announced that it extended the 90-day emergency declaration for the opioid crisis that President Donald Trump initiated in October 2017 for another 90 days. In a statement, the White House said, "By declaring the opioid crisis a nationwide public health emergency, the President has used the bully pulpit to bring national attention of this critical issue to not only everyday Americans, but also Members of Congress, state and local officials, and his entire executive branch, who have the necessary tools and authorities within their agencies to address this crisis."[61]

## January 11, 2018: Trump administration releases guidance allowing states to impose work requirements for Medicaid[edit]

On January 11, 2018, the Trump administration released guidance allowing states to impose work requirements for adults to receive Medicaid, as long as they are not disabled, pregnant, or elderly. States will have the ability to define work as a job or community engagement activity, including community service, caregiving, education, job or skills training, job searching, and substance use disorder treatment. For the first time in the history of the program, states can apply for waivers to allow them to require that citizens are employed or are engaging in some type of community engagement to receive Medicaid benefits.[62]

Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin were seeking waivers. Seema Verma, the administrator of the Centers for Medicare and Medicaid Services (CMS), said, “Our policy guidance was in response to states that asked us for the flexibility they need to improve their programs and to help people in achieving greater well-being and self-sufficiency.”[63][64]

MaryBeth Musumeci, associate director of the Kaiser Family Foundation’s Program on Medicaid and the Uninsured, said that the change could result in people losing their healthcare coverage. She said, “There is a real risk of eligible people losing coverage due to their inability to navigate this process or miscommunication or other breakdowns in the administrative process.” When asked about the possibility of people losing coverage, Verma said it would be beneficial if the program allowed people to move off of Medicaid and receive employer-provided healthcare coverage. She said, “People moving off of Medicaid is a good outcome because we hope that that means they don’t need the program anymore.”[64]

Sen. Ron Wyden (D-Ore.), the top Democrat on the Senate Finance Committee, criticized the change, saying in a statement that the majority of Medicaid enrollees either already have a job or “are unable to work due to age or impairment. This action by the Trump administration goes after people who are just trying to get by while taking care of their kids or elderly parents, struggling with a chronic condition, or going to school.”[64]

House Freedom Caucus Chairman Mark Meadows (R-N.C.) praised the move, saying, “We’ve talked to the White House on a number of occasions about work requirements for some of our support programs and strongly encourage it.”[63]

### February 14, 2018: House Democrats ask HHS to reject requests from states to impose work requirements for Medicaid[edit]

On February 14, 2018, 172 House Democrats asked Health and Human Services (HHS) Secretary Alex Azar to reject requests from states to impose work requirements to receive Medicaid benefits. In a letter, they wrote, "Such actions to tie health coverage to work are motivated purely on the basis of ideology and mistaken assumptions about what Medicaid is and who it covers. ... The reality is that [the Centers for Medicare & Medicaid Services'] recent actions ignore a fundamental truth: most of those who can work, are working, but may fall through the cracks and lose their coverage due to harsh and inflexible implementation of this ideologically-driven policy."[65]

The letter came after the Trump administration approved Indiana and Kentucky's requests to impose work requirements for adults to receive Medicaid, with exceptions.[65]

## January 10, 2018: President Trump signs Interdict Act[edit]

On January 10, 2018, President Donald Trump signed the Interdict Act, a bipartisan bill intended to stem the tide of synthetic opioids, like fentanyl, from coming into the U.S. illegally. The Interdict Act gives more resources and funding to U.S. Customs and Border Protection to detect and analyze illegal synthetic opioids at border entry points.[66]

## January 4, 2018: Department of Labor proposes Association Health Plan rule[edit]

In accordance with an October 12, 2017, executive order issued by President Donald Trump, the Department of Labor released a proposed rule regarding Association Health Plans (AHPs) on January 4, 2018. The rule proposed expanding the criteria based on which employers and sole proprietors could join together to offer one group health plan to employees. The rule proposed exempting small employers who form such associations from certain requirements that apply to the individual and small-group insurance markets, but not the large-group market, under the Affordable Care Act (ACA). Employers would be exempt from providing plans that cover the 10 essential health benefits as defined by the ACA and would not be required to follow the requirement that enrollees in plans offered by an insurer within these markets be grouped into a single risk pool. The rule would preserve the ACA's prohibitions against charging people higher premiums or denying coverage based on health status. The Department of Labor stated that the rule was open to a 60-day public comment period.[67]

Sen. Rand Paul (R-Ky.) said in support of the rule that it would "allow more Americans to join in groups to purchase lower-cost health insurance across state lines.” Chris Hansen, president of the American Cancer Society Cancer Action Network, criticized the proposed rule, stating, “Those with serious health conditions like cancer would be left paying ever-increasing premiums for comprehensive coverage.”[68]

## December 22, 2017: Congress repeals individual mandate as part of tax law[edit]

See also: Federal policy on taxes, 2017-2018

On December 22, 2017, President Donald Trump signed HR 1—the Tax Cuts and Jobs Act—into law. The law, among other things, eliminated the ACA's individual mandate beginning in 2019.[69]

The ACA required every individual to obtain health insurance and established fines for those who did not. The fines were designed to be based on the number of months a person went without health insurance in a given year and to increase each year from 2014 to 2016. The fine schedule was written as follows:[70][71]

* 2014: maximum of $95 or 1 percent of income, whichever is greater
* 2015: maximum of $325 or 2 percent of income, whichever is greater
* 2016 and thereafter: maximum of $695 or 2.5 percent of income, whichever is greater

The Internal Revenue Service (IRS) was given responsibility for collecting the fine, assessed annually as a tax penalty during the income tax filing period. The law established a hardship exemption from the fine for individuals who meet certain qualifications--such as being homeless, being a victim of domestic violence, or filing for bankruptcy.[72]

## October 27, 2017: Administration proposes allowing states to redefine essential health benefits[edit]

On October 27, 2017, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would allow states to redefine the essential health benefits insurers are required to cover under the Affordable Care Act. Under the law, the essential health benefits are broad categories of benefits that insurers on the healthcare exchanges must offer; states determine which specific services in those categories are covered by selecting a benchmark plan offered in the employer-sponsored insurance market. The rule, if finalized, would allow states to set the specific benefits standards by choosing services from different plans, rather than selecting a single plan in whole. States could also set the standards according to another state's benchmark plan.[73]

The rule would also allow states to relax the ACA's requirement that insurers spend at least 80 percent of revenue on medical services. States could set this percentage lower if they show CMS that it would stabilize their insurance market.[73]

Other changes in the rule included an adjustment to the methodology for calculating risk adjustment payments, which try to balance risk among insurers on the exchanges, raising the percentage increase in premiums that requires government review from 10 percent to 15 percent, and removing standardized plan options.[73]

## October 13, 2017: Trump formally ends cost-sharing reimbursements[edit]

On October 13, 2017, the Trump administration submitted a filing to the U.S. Court of Appeals for the D.C. Circuit stating that the U.S. Department of Health and Human Services would cease the cost sharing reimbursements immediately. The administration stated that it would not make the next payments scheduled for October 18, 2017. It said that the payments were not formally appropriated by Congress and are therefore illegal. Under the Affordable Care Act, insurers who offer plans on the exchanges are required to provide the reductions, even without the reimbursements from the federal government. Up until this point, the Trump administration had been deciding whether to make the payments on a month-by-month basis. For more on the future of the cost-sharing reductions, click here.[74][75]

What are cost-sharing reductions?
The Affordable Care Act (ACA) required insurers participating in the health insurance exchanges to offer low-income consumers reductions in their cost-sharing burden. Cost-sharing refers to the division of payments for healthcare services between insurers and the individuals they cover. Premiums, copayments, and deductibles are all forms of cost sharing. Under the ACA, individuals earning between 100 percent and 250 percent of the federal poverty level are eligible for a reduction in their share of these costs, paying as little as 6 percent of a plan's costs, compared to 30 percent under a standard silver-level plan.[76]

The law intended to reimburse insurers for these reductions in cost sharing. The reimbursements were estimated to total $7.35 billion in 2017. However, the reimbursements are at the center of a lawsuit initiated by the House of Representatives in 2014 that alleges that the executive branch has been making the payments without an express appropriation from Congress, in violation of the Constitution.[77]

### October 12, 2017: Sanders confirms that Trump will end cost-sharing reduction payments[edit]

See also: Federal policy on cost-sharing reduction payments, 2017

In an email to reporters, White House press secretary Sarah Huckabee Sanders said that Trump would end cost-sharing reduction payments to insurance companies selling Obamacare plans. Sanders said, “Based on guidance from the Department of Justice, the Department of Health and Human Services has concluded that there is no appropriation for cost-sharing reduction payments to insurance companies under Obamacare. In light of this analysis, the Government cannot lawfully make the cost-sharing reduction payments. ... The bailout of insurance companies through these unlawful payments is yet another example of how the previous administration abused taxpayer dollars and skirted the law to prop up a broken system.”[78]

House Minority Leader Nancy Pelosi (D-Calif.) and Senate Minority Leader Chuck Schumer (D-N.Y.) released the following statement regarding the Trump administration's decision to end the payments:

“  | Sadly, instead of working to lower health costs for Americans, it seems President Trump will singlehandedly hike Americans’ health premiums. It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America. Make no mistake about it, Trump will try to blame the Affordable Care Act, but this will fall on his back and he will pay the price for it. President Trump has apparently decided to punish the American people for his inability to improve our health care system. Trumpcare collapsed because Americans overwhelmingly recognized the cruelty and higher costs it meant for them and their loved ones. Now, millions of hard-working American families will suffer just because President Trump wants them to. If these reports are true, the President is walking away from the good faith, bipartisan Alexander-Murray negotiations and risking the health care of millions of Americans.[31] | ”

|
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House Speaker Paul Ryan (R-Wis.) released the following statement regarding the Trump administration's decision that the cost-sharing reduction payments were not properly appropriated by Congress:

“  | Under our Constitution, the power of the purse belongs to Congress, not the executive branch. It was in defense of this foundational principle that the House, under the leadership of former speaker John Boehner, voted in 2014 to challenge the constitutionality of spending by the Obama administration that was never approved by Congress. The House was validated last year when a federal court ruled that the Obama administration had indeed been making unauthorized and therefore illegal payments through Obamacare. Today’s decision by the Trump administration to end the appeal of that ruling preserves a monumental affirmation of Congress’s authority and the separation of powers. Obamacare has proven itself to be a fatally flawed law, and the House will continue to work with Trump administration to provide the American people a better system.[31] | ”

|
|

## October 12, 2017: Trump signs executive order seeking to ease ACA rules[edit]

On October 12, 2017, President Donald Trump signed an executive order seeking to modify some elements of healthcare insurance. The order directed the secretary of labor to consider expanding access to Association Health Plans (AHPs) and potentially allow the sale of AHPs across state lines. It could expand the ability of small businesses and groups to pool together to buy health insurance plans that would be exempt from some of the ACA’s requirements. The order also directed “the Departments of the Treasury, Labor, and Health and Human Services to consider expanding coverage through low cost short-term limited duration insurance (STLDI).” The order directed officials to consider allowing short-term plans to cover a longer period of time and to be renewable. The Obama administration limited the use of short-term plans to three months and made them non-renewable. These plans do not have to follow ACA rules, such as the mandate to cover essential health benefits. It also directed the Departments of the Treasury, Labor, and Health and Human Services to consider changes to Health Reimbursement Arrangements (HRAs) that could allow employers to use pre-tax dollars to help pay workers' insurance premiums. It directed officials to consider allowing employers to use HRAs to help pay premiums for individual health plans. The order does not make direct changes to existing health insurance rules; instead, it directs agencies to consider new rules that will be subject to a notice and comment period.[81][82]

Before signing the order, Trump said, “Today is only the beginning. In the coming months, we plan to take new measures to provide our people with even more relief and more freedom. And, by the way, on another subject, that will include massive tax cuts. … And we're going to also pressure Congress very strongly to finish the repeal and the replace of Obamacare once and for all. We will have great healthcare in our country.”[2]

Some of Trump's comments on the order appear below.

* Trump on association health plans: "We aim to allow more small businesses to form associations to buy affordable and competitive health insurance. This would open up additional options for employers to purchase the health plans their workers want. I'm also directing Secretary Acosta to consider ways to expand these associations and these healthcare plans all across state lines. This will create tremendous competition and transformative -- in so many ways -- change aimed at creating more and lower prices for millions of Americans. But the competition will be staggering. Insurance companies will be fighting to get every single person signed up, and you will be hopefully negotiating, negotiating, negotiating, and you'll get such low prices for such great care. Should have been done a long time ago, and it could have been done a long time ago. This will allow thousands of small business employers to have the same purchasing power as large employers to get more affordable and generous insurance options for their workers."[2]

* Trump on short-term insurance: "My administration will explore how we can expand something called short-term limited duration insurance. These health insurance policies are not subject to any very expansive and expensive Obamacare coverage mandates and rules. The cost of the Obamacare has been so outrageous it is absolutely destroying everything in its wake. They were so attractive that, just last year, the previous administration crippled the market in an effort to keep people from fleeing the failing Obamacare plans. In fact, they prevented these plans from lasting more than three months. They will take action to fix that and to make these affordable, flexible plans much more widely available. So we're going to have a very widely available plan that's going to cost much less."[2]

* Trump on health reimbursement arrangements: "Finally, today's executive order instructs Secretaries Acosta, Mnuchin, and Hargan to explore how they can allow more businesses to use tax-free health reimbursement arrangements or HRAs to compensate their employees for their healthcare expenses. Currently, only about one-third of small business employees receive coverage at work, forcing millions of workers to enroll in the exchanges or remain uninsured and to pay the individual mandate penalty. Not good. Not good. That is one of the most unpopular things I've ever seen in government, I can tell you. This order takes first steps to make it easier for businesses to help their workers afford high-quality and more flexible healthcare through reimbursement accounts. With these actions, we are moving toward lower costs and more options in the healthcare market and taking crucial steps towards saving the American people from the nightmare of Obamacare."[2]

Senate Minority Leader Chuck Schumer (D-N.Y.) criticized the order, writing in a series of tweets, “Having failed to repeal the #ACA in Congress, @POTUS is using a wrecking ball to singlehandedly rip apart & sabotage our healthcare system. This executive order is just the latest in a series of steps he has taken to sabotage health care at the expense of millions of Americans. .@POTUS' exec order couldn't be further from his ‘great health care’ promise. It will up costs for seniors & ppl w/ preexisting conditions. And it will add further chaos to the markets. If the system deteriorates, make no mistake about it, the blame will fall squarely on @POTUS.”[83]

Sen. Rand Paul (R-Ky.) praised the order, saying, “Today's a big day. President Trump is doing what I believe is the biggest free market reform of health care in a generation. This reform, if it works and goes as planned, will allow millions of people to get insurance across state lines at an inexpensive price. 28 million people were left behind by Obamacare. [They] do not have insurance today. This specifically targets and will help people who don't have insurance, or people for whom insurance is too expensive. I'm very glad to be part of this, and I really want to commend the president for having the boldness and the leadership and the foresight to get this done.”[84]

## October 6, 2017: Trump administration rolls back ACA contraception mandate[edit]

On October 6, 2017, the Trump administration published rules stating that any employer or insurer could stop following the contraception mandate that was part of the Patient Protection and Affordable Care Act (ACA), also known as Obamacare, if they had moral or religious objections to providing birth control to employees. The rule took effect immediately.[85][86][87]

Previously, only religious organizations and closely-held for-profit companies were eligible for an exemption from the ACA's contraception mandate. Under the exemption, organizations could notify the government of their religious objections to contraception, which would then make an arrangement with the insurance company to provide contraceptive coverage to the employees. Under the new exemptions, "employers will not have to file anything with the government to stop offering the birth-control coverage; instead, they simply have to notify their employees of the decision," according to The Hill.[85]

Speaking about the rules, a Department of Health and Human Services official said, "We should have space for organizations to live out their religious ideas and not face discrimination because of their religious ideas. That was the case beforehand, and that ends today."[85]

The rules were criticized by both the American Civil Liberties Union (ACLU) and the National Women’s Law Center (NWLC). Fatima Goss Graves, president and CEO of the NWLC, said, "Today’s outrageous rules by the Trump Administration show callous disregard for women’s rights, health, and autonomy. By taking away women’s access to no-cost birth control coverage, the rules give employers a license to discriminate against women. This will leave countless women without the critical birth control coverage they need to protect their health and economic security. We will take immediate legal steps to block these unfair and discriminatory rules.”[85]

The rules were praised by Susan B. Anthony List President Marjorie Dannenfelser, who said in a statement, “Today President Trump delivered a huge victory for conscience rights and religious liberty in America. No longer will Catholic nuns who care for the elderly poor be forced by the government to provide abortion-inducing drugs in their health care plans."[88]

## August 31, 2017: HHS cuts budget for ACA enrollment outreach[edit]

On August 31, 2017, the U.S. Department of Health and Human Services (HHS) announced it would cut funding for ACA advertising and enrollment outreach from $100 million to $10 million. HHS spokeswoman Caitlin Oakley stated, "A health-care system that has caused premiums to double and left nearly half of our counties with only one coverage option is not working. The Trump administration is determined to serve the American people instead of trying to sell them a bad deal." The department also said, "There are diminishing returns from this spending [on enrollment outreach]". Advertising for the fall 2017 open enrollment period will take place primarily through digital means, such as text and email.[89][90]

The department also announced that exchange navigators--outside employees and organizations who assist individuals with enrolling in ACA health plans--would see their funding tied to their performance going forward. For example, navigators that signed up 70 percent of their target enrollment numbers would receive 70 percent of the funding set aside for navigators.[89]

## August 2017: Administration announces cuts to teen pregnancy program[edit]

Are teen pregnancy prevention programs facing a crackdown?

October 13, 2017: Sun-Sentinel reporter Dan Sweeney cited two articles about cutbacks in federal funding for teen pregnancy prevention programs, writing, "Given both these stories, it now seems we're in the middle of a nationwide crackdown on programs to prevent teen pregnancy."
Is there a nationwide crackdown on programs to prevent teen pregnancy?

Read Ballotpedia's fact check »

In August 2017, the U.S. Department of Health and Human Services (HHS) notified 81 organizations that participate in the Teen Pregnancy Prevention (TPP) program that the five-year grants they were awarded would end in 2018 instead of 2020. According to HHS, the "Teen Pregnancy Prevention (TPP) Program is a national, evidence-based program that funds diverse organizations working to prevent teen pregnancy across the United States. OAH invests in both the implementation of evidence-based programs and the development and evaluation of new and innovative approaches to prevent teen pregnancy. The OAH TPP Program reaches adolescents age 10-19, with a focus on populations with the greatest need in order to reduce disparities in teen pregnancy and birth rates." TPP was created in 2010.[91][92]

Baltimore City Health Commissioner Dr. Leana Wen told The Hill that “There was no communication about the reason. The notice of the award just stated that instead of a five-year grant, it is now a three-year grant."[91]

Mark Vafiades, a spokesman for HHS’s office of the assistant secretary for health, commented on the decision to shorten the length of the grants, saying, “Given the very weak evidence of positive impact of these programs, the Trump administration, in its FY 2018 budget proposal did not recommend continued funding for the TPP program. Current TPP grantees were given a project end date of June 30, 2018.”[91]

The First 100 Days

* * *

In the first 100 days of the Trump administration, the following executive and legislative actions were taken to change healthcare policy:

* The American Health Care Act was introduced to repeal or modify some of the ACA's provisions. The bill passed the House on May 4, 2017.
* CMS issued new regulations for plans sold on the health insurance exchanges, loosening some insurance rules, shortening the open enrollment period, and requiring proof of events that trigger special enrollment periods.

## May 31, 2017: Trump administration releases draft rule on contraception coverage exemptions[edit]

On May 31, 2017, Vox released a copy it obtained of a draft rule from the U.S. Departments of Labor, Treasury, and Health and Human Services. The rule would expand the religious exemption from the Affordable Care Act's requirement on employers to offer birth control coverage. The draft rule would allow any employer, insurance company, college, or university with religious or moral objections to opt out of offering health plans that cover contraception.[93][94]

The Affordable Care Act required most employers to offer health plans that cover contraception. Pursuant to a 2014 United States Supreme Court ruling, religious nonprofits and closely held for-profit companies were granted an exemption from the mandate. The draft rule, if put in place, would have the effect of expanding the number of companies who could apply for a religious exemption. The rule must be reviewed by the Office of Management and Budget before being placed in the Federal Register for a 60-day comment period before being finalized.[95]

## May 17, 2017: CMS issues guidance on health exchange enrollment[edit]

The Centers for Medicare and Medicaid Services (CMS) issued guidance to allow insurers and insurance brokers to enroll individuals in ACA-compliant health plans without using the federal platform Healthcare.gov. This means that in addition to enrolling consumers in coverage, insurers and brokers could also determine eligibility for tax credits and reduced cost sharing. Previously, consumers would need to enroll through Healthcare.gov themselves, have a broker walk them through the site, or choose a plan through a broker’s website before being redirected to Healthcare.gov for tax credit determinations.[96]

The guidance memo stated that this action was intended to reduce what it deemed the regulatory burden on insurers and brokers who facilitate ACA health plan enrollment, and to stabilize the ACA risk pool by expanding enrollment. Larry Levitt, Senior Vice President for Special Initiatives at the Kaiser Family Foundation, said that the move could make the personal financial information of consumers more vulnerable as they provide it to various third parties.[97]

## April 13, 2017: CMS issues final rule on individual market regulations[edit]

On April 13, 2017, the Centers for Medicare and Medicaid Services (CMS) finalized a rule changing some of the regulations for plans sold on the ACA's health insurance exchanges. According to CMS, the rule was intended to help stabilize the individual and small group markets and affirm the traditional role of State regulators."[98]

Under the new rule, the open enrollment period to sign up for a plan was shortened from three months to six weeks, and individuals who sign up in a special enrollment period must provide documentation proving the triggering life event, such as divorce or job loss. For individuals who have unpaid premiums, insurers may apply any future premium payment to this past debt before providing new coverage. Insurers were also allowed to vary plan actuarial values, which coincide with metal levels (bronze, silver, etc.) on the exchanges, by a wider amount and still have them fall within the respective metal levels. In addition, insurers are no longer required to meet federal standards for ensuring their networks contain an adequate number of providers; only state standards now apply.[99]

## January 20, 2017: Trump issues executive order on the Affordable Care Act[edit]

On January 20, 2017, President Donald Trump issued an executive order related to the Affordable Care Act titled Executive Order Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal. The order stated that it was the intention of the administration to repeal the Affordable Care Act. In the meantime, the order gave broad authority to the head of the Department of Health and Human Services, as well as the heads of other executive offices and governmental departments, "to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications." No specific action was directed as a result of the order.[100]

## Trump's healthcare priorities before taking office[edit]

In his contract with American voters—the ”100-day action plan to Make America Great Again”—Trump said that he would work with Congress to repeal and replace the Patient Protection and Affordable Care Act (ACA), also known as Obamacare, during his first 100 days in office. Trump’s stated goal for reforming healthcare was “to create a patient-centered healthcare system that promotes choice, quality and affordability with health insurance and healthcare, and take any needed action to alleviate the burdens imposed on American families and businesses by the law.”[101]

According to his presidential transition website, Trump proposed replacing the ACA with a plan that would:[101]

* provide Health Savings Accounts (HSAs);
* allow the states to regulate health insurance;
* allow people to purchase insurance across state lines; and
* re-establish high-risk pools.

## Trump administration officials on healthcare, 2017[edit]

See also: Trump administration officials on healthcare, 2017 and Affordable Care Act under the Trump administration, 2017

# Donald Trump[edit]

### President Donald Trump[edit]

#### Trump on the BCRA[edit]

* On July 10, 2017, Trump tweeted, "I cannot imagine that Congress would dare to leave Washington without a beautiful new HealthCare bill fully approved and ready to go!"[102]
* On June 22, 2017, Trump tweeted, "I am very supportive of the Senate #HealthcareBill. Look forward to making it really special! Remember, ObamaCare is dead."[103]

#### Trump on the AHCA[edit]

* On June 25, 2017, Trump confirmed in an interview on "Fox and Friends" that he called the House's healthcare bill mean. Referring to former President Obama's comment that tweaks to the AHCA "cannot change the fundamental meanness at the core of this legislation," Trump stated, "He actually used my term, mean. That was my term. Because I want to see, and I speak from the heart, that’s what I want to see. I want to see a bill with heart."[104]
* On May 4, 2017, during a ceremony in the Rose Garden, Trump praised leaders in the House for crafting the AHCA and for getting the votes to pass the bill. Trump said, "I went through two years of campaigning, and I’m telling you, no matter where I went, people were suffering so badly with the ravages of Obamacare. And I will say this, that as far as I’m concerned, your premiums, they’re going to start to come down. We’re going to get this passed through the Senate. I feel so confident. Your deductibles, when it comes to deductibles, they were so ridiculous that nobody got to use their current plan -- this nonexistent plan that I heard so many wonderful things about over the last three or four days. After that, I mean, it’s -- I don’t think you’re going to hear so much. Right now, the insurance companies are fleeing. It’s been a catastrophe. And this is a great plan. I actually think it will get even better. And this is, make no mistake, this is a repeal and replace of Obamacare. Make no mistake about it. Make no mistake. And I think, most importantly, yes, premiums will be coming down. Yes, deductibles will be coming down. But very importantly, it’s a great plan. And ultimately, that’s what it’s all about. We knew that wasn’t going to work. I predicted it a long time ago. I said, it’s failing. And now, it’s obvious that it’s failing. It’s dead. It’s essentially dead. If we don’t pay lots of ransom money over to the insurance companies it would die immediately. So what we have is something very, very incredibly well-crafted. Tell you what, there is a lot of talent standing behind me. An unbelievable amount of talent, that I can tell you. I mean it."[105]

* On March 24, 2017, after a failed attempt to pass the AHCA, Trump said, "I've been saying for the last year and a half that the best thing we can do politically speaking is let Obamacare explode. It is exploding right now. Many states have big problems -- almost all states have big problems. I was in Tennessee the other day, and they’ve lost half of their state in terms of an insurer; they have no insurer. And that's happened to many other places. I was in Kentucky the other day, and similar things are happening. So Obamacare is exploding. With no Democrat support, we couldn't quite get there. We were just a very small number of votes short in terms of getting our bill passed. A lot of people don't realize how good our bill was because they were viewing phase one. But when you add phase two -- which was mostly the signings of Secretary Price, who's behind me -- and you add phase three, which I think we would have gotten -- it became a great bill. Premiums would have gone down and it would have been very stable, it would have been very strong. But that's okay. But we're very, very close. And again, I think what will happen is Obamacare, unfortunately, will explode. It's going to have a very bad year. Last year you had over a 100 percent increases in various places. In Arizona, I understand it's going up very rapidly again, like it did last year; last year it was 116 percent. Many places, 50, 60, 70 percent, I guess it averaged -- whatever the average was -- very, very high. And this year should be much worse for Obamacare. So what would be really good, with no Democrat support, is if the Democrats, when it explodes -- which it will soon -- if they got together with us and got a real healthcare bill. I would be totally up to do it. And I think that's going to happen. I think the losers are Nancy Pelosi and Chuck Schumer, because now they own Obamacare. They own it -- 100 percent own it. And this is not a Republican healthcare, this is not anything but a Democrat healthcare. And they have Obamacare for a little while longer, until it ceases to exist, which it will at some point in the near future. And just remember this is not our bill, this is their bill. Now, when they all become civilized and get together, and try and work out a great healthcare bill for the people of this country, we're open to it. We're totally open to it."[106]

* On March 13, 2017, during a listening session on healthcare, Trump discussed the plan to replace the ACA. He said, "Many Americans lost their plans and doctors altogether, and one-third of the counties -- think of it, one-third only have one insurer left. The insurance companies are fleeing. They’re gone; so many gone. The House bill to repeal and replace Obamacare will provide you and your fellow citizens with more choices -- far more choices at lower cost. Americans should pick the plan they want. Now they’ll be able to pick the plan they want, they’ll be able to pick the doctor they want. They’ll be able to do a lot of things that the other plan was supposed to give and it never gave. You don’t pick your doctor, you don’t pick your plan -- you remember that one. We’re not going to have one-size-fits-all. Instead, we’re going to be working to unleash the power of the private marketplace to let insurers come in and compete for your business. And you’ll see rates go down, down, down, and you’ll see plans go up, up, up. You’ll have a lot of choices. You’ll have plans that nobody is even thinking of today. They will have plans that today nobody has even thought about, because the market is going to enforce that, with millions and millions of people wanting healthcare. More competition and less regulation will finally bring down the cost of care, and I think it will bring it down very significantly. Unfortunately, it takes a while to get there, because you have to let that marketplace kick in, and it’s going to take a little while to get there. Once it does, it’s going to be a thing of beauty. I wish it didn’t take a year or two years, but that’s what’s going to happen, and that’s the way it works. But we’re willing to go through that process."[107]

* On March 10, 2017, Trump said, "We must act now to save Americans from the imploding Obamacare disaster. Premiums have skyrocketed by double-digits and triple-digits in some cases. As an example, Arizona -- which I talk about all the time -- 116 percent increase and it’s going up a lot higher. ’17 would be a disaster for Obamacare. That’s the year it was meant to explode, because Obama won’t be here. That was when it was supposed to be -- it will get even worse. As bad as it is now, it’ll get even worse. Choices are disappearing as one insurer drops out after another. Today, one-third of all counties now have only one insurer on the Obamacare exchanges, and the exchanges themselves are a disaster. The House repeal-and-replace plan ends the Obamacare tax hikes, cutting taxes by hundreds of billions of dollars. It eliminates the Obamacare mandate that forces Americans to buy government-approved plans. ... It provides states with flexibility over how Medicaid dollars are spent, giving power from Washington and back to local government, which we all want to see. We’re going to do a much better job. And the plan empowers individual Americans to buy the health insurance that is right for them, not the plan forced on them by government."[108]

* On March 9, 2017, Trump tweeted: "Despite what you hear in the press, healthcare is coming along great. We are talking to many groups and it will end in a beautiful picture!"[109]

* In a series of tweets on March 7, 2017, Trump discussed the American Health Care Act of 2017. He wrote, "Our wonderful new Healthcare Bill is now out for review and negotiation. ObamaCare is a complete and total disaster - is imploding fast! ... Don't worry, getting rid of state lines, which will promote competition, will be in phase 2 & 3 of healthcare rollout. @foxandfriends. ... I am working on a new system where there will be competition in the Drug Industry. Pricing for the American people will come way down!"[110][111][112]

#### Trump on the ACA[edit]

* On July 31, 2017, Trump tweeted, "If ObamaCare is hurting people, & it is, why shouldn't it hurt the insurance companies & why should Congress not be paying what public pays?"[113]

* On July 29, 2017, Trump tweeted, "If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!"[114]

* On July 24, 2017, the day before the Senate was expected to hold a procedural vote to begin debating healthcare, Trump said in a speech, "Every Republican running for office promised immediate release from this disastrous law...so far Senate Republicans have not done their job in ending the Obamacare nightmare.”[115]

* On June 30, 2017, Trump said that the Senate should vote to repeal the ACA if they were unable to pass the Better Care Reconciliation Act of 2017 (BCRA). He tweeted, "If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!"[116]

* On June 24, 2017, Trump tweeted, "Democrats slam GOP healthcare proposal as Obamacare premiums & deductibles increase by over 100%. Remember keep your doctor, keep your plan?"[117]

* On March 24, 2017, after a failed attempt to pass the AHCA, Trump was asked if it was "fair to Americans to let Obamacare explode?" Trump replied, "Well, it's going to happen. There's not much you can do about it. It's going to -- bad things are going to happen to Obamacare. There's not much you can do to help it. I've been saying that for a year and a half. I said, look, eventually it's not sustainable. The insurance companies are leaving -- you know that. They're leaving one by one, as quick as you can leave. And you have states, in some cases, who will not be covered. So there's no way out of that. But the one thing that was happening, as we got closer and closer, everybody was talking about how wonderful it was, and now we'll go back to real life and people will see how bad it is. And it's getting much worse. You know, I said the other day, when President Obama left -- '17, he knew he wasn’t going to be here; '17 is going to be a very, very bad year for Obamacare. Very, very bad. You're going to have explosive premium increases. And the deductibles are so high people don’t even get to use it. So they'll go with that for a little while. And I honestly believe -- I know some of the Democrats, and they're good people -- I honestly believe the Democrats will come to us and say, look, let's get together and get a great healthcare bill or plan that's really great for the people of our country. And I think that's going to happen."[106]

* While speaking at the Conservative Political Action Conference on February 24, 2017, Trump said, "We also inherited a failed health care law that threatens our medical system with absolute and total catastrophe. Now, I’ve been watching -- and nobody says it -- but Obamacare doesn’t work, folks. I mean, I could say -- I could talk -- it doesn’t work. And now people are starting to develop a little warm heart, but the people that you’re watching, they’re not you. They’re largely -- many of them are the side that lost. You know, they lost the election. It’s like, how many elections do we have to have? They lost the election. But I always say, Obamacare doesn’t work. And these same people two years, and a year ago, were complaining about Obamacare. And the bottom line: We’re changing it. We’re going to make it much better. We’re going to make it less expensive. We’re going to make it much better. Obamacare covers very few people. And remember, deduct from the number all of the people that had great health care that they loved, that was taken away from them; was taken away from them. Millions of people were very happy with their health care. They had their doctor, they had their plan. Remember the lie -- 28 times. 'You can keep your doctor, you can keep your plan' -- over and over and over again you heard it. So we’re going to repeal and replace Obamacare. And I tell Paul Ryan and all of the folks that we’re working with very hard -- Dr. Tom Price, very talented guy -- but I tell them from a purely political standpoint, the single-best thing we can do is nothing. Let it implode completely -- it’s already imploding. You see the carriers are all leaving. I mean, it’s a disaster. But two years don’t do anything. The Democrats will come to us and beg for help. They’ll beg, and it’s their problem. But it’s not the right thing to do for the American people. It’s not the right thing to do."[118]

* On February 18, 2017, Trump said, "We are going to be submitting in a couple of weeks a great healthcare plan that's going to take the place of the disaster known as ObamaCare. It will be repealed and replaced. Just so you understand, our plan will be much better healthcare at a much lower cost. OK? Nothing to complain about."[119]

#### Trump on healthcare[edit]

* In his first address to Congress on February 28, 2017, President Donald Trump discussed his vision for America's healthcare system:

“  | Here are the principles that should guide the Congress as we move to create a better health-care system for all Americans:

First, we should ensure that Americans with preexisting conditions have access to coverage, and that we have a stable transition for Americans currently enrolled in the health-care exchanges.

Secondly, we should help Americans purchase their own coverage, through the use of tax credits and expanded health savings accounts — but it must be the plan they want, not the plan forced on them by the government.

Thirdly, we should give our great state governors the resources and flexibility they need with Medicaid to make sure no one is left out.

Fourthly, we should implement legal reforms that protect patients and doctors from unnecessary costs that drive up the price of insurance — and work to bring down the artificially high price of drugs and bring them down immediately.

Finally, the time has come to give Americans the freedom to purchase health insurance across state lines — creating a truly competitive national marketplace that will bring cost way down and provide far better care.[31]

| ”

|
|

—President Donald Trump[120]

* During a press conference on January 11, 2017, Trump criticized pharmaceutical companies. He said, "The other thing we have to do is create new bidding procedures for the drug industry, because they’re getting away with murder. PhRMA, PhRMA has a lot of lobbyists and a lot of power and there’s very little bidding on drugs."[121]

During the 2016 presidential election, Trump advocated healthcare reform based on free market principles. He said that he would repeal Obamacare, reduce barriers to the interstate sale of health insurance, institute a full tax deduction for insurance premium payments for individuals, make Health Saving Accounts inheritable, require price transparency, block-grant Medicaid to the states, and allow for more overseas drug providers through lowered regulatory barriers. Click here to read more of Trump's public comments on healthcare before and during the 2016 presidential election.

# Mike Pence[edit]

### Vice President Mike Pence[edit]

#### Pence on the BCRA[edit]

* During a speech in Cleveland, Ohio, on June 28, 2017, Pence discussed the BCRA. He said, "The bill repeals Obamacare’s mandates and taxes on the American people and American business. It restores freedom and saves jobs. The legislation being considered in the Senate expands health savings accounts, offers tax credits to help you buy the coverage that you need at a price you can afford. And the bill ensures that every American with preexisting conditions has access to the coverage and the care that they need -- no exceptions. And the Senate’s bill reforms -- like the House bill, the Senate’s bill reforms and strengthens Medicaid for the people who need it most. This legislation will give states like Ohio the freedom and flexibility that your governor and your legislature need to be able to style Medicaid here in Ohio to meet the needs of the most vulnerable in the way that works best in Ohio -- because this President believes in state-based solutions, not one-size-fits-all-Washington answers to the challenges we face. And I’m also pleased that the Senate bill addresses something that hits close to home right here in the Midwest and here in Ohio, and that is the scourge of opioid abuse and addiction."[122]

#### Pence on the AHCA[edit]

* On June 3, 2017, Pence urged members of Congress to pass the American Health Care Act of 2017 (AHCA) during a political rally in Iowa. He said, "First and foremost, this summer, this Congress must come together and heed the president's leadership, and we must repeal and replace Obamacare. ... Once we repeal and replace Obamacare, we're going to roll our sleeves up, and working with these great leaders in Congress, we're going to pass one of the largest tax cuts in American history."[123]
* On May 4, 2017, after the House passed the AHCA, Pence said, "It was March, 2010, seven years ago, Democrats passed a government takeover of healthcare. And at that time, Republicans in Congress promised the American people that law would not stand. Today, thanks to the perseverance, the determination, and the leadership of President Donald Trump, and all the support of those gathered here, we’ve taken a historic first step to repeal and replace Obamacare and finally give the American people the kind of healthcare they deserve."[105]

* On March 19, 2017, while speaking to the Club for Growth, Pence discussed the AHCA. He said, "Make no mistake about it: Our plan is pro-growth and pro-freedom. It ends Obamacare’s individual and employer mandates by eliminating their penalties by the time the whole plan is unfurled. It repeals the taxes I just mentioned right out of the gate. It expands health savings accounts. It enacts the biggest reform in Medicaid since the creation of that program in 1965. These are the kind of solutions that conservatives like us have been talking about for years. And they’re now within our reach. And let me be blunt: We need your help to get this plan passed. The House is set to vote next week on the beginning of this process. It’s called the American Health Care Act, and it is a crucial step towards fulfilling our promise to repeal and replace Obamacare with something that actually works."[124]

* On March 12, 2017, Pence discussed the plan to replace the ACA, while speaking in Louisville, Kentucky. He said, "The truth is ordering every American to buy health insurance, whether they wanted it or not, was never the right solution for health care in this country. So we're going to start -- we’re going to repeal the mandates and taxes and penalties of Obamacare. We’re going to end Obamacare’s individual and employer mandates. We’re actually going to get rid of more than $500 billion in Obamacare’s tax increases. And we’re going to give Americans more choices. We’ll expand health savings accounts. We’ll give Americans a tax credit that will help people buy plans that they need at a price that they can afford. We’ll make sure that Americans with pre-existing conditions still have access to the coverage and the care that they need. And to all the parents here, we’ll make sure you can keep your kids on your plan until they’re 26 years of age. And most significantly in my view, we’ll give states like Kentucky the freedom and flexibility with Medicaid to meet the needs of your most vulnerable in the way that works here in Kentucky."[125]

#### Pence on the ACA[edit]

* On July 10, 2017, Pence said that the Senate should vote to repeal the ACA if they were unable to pass the Better Care Reconciliation Act of 2017 (BCRA). He said, “If they can’t pass this carefully crafted repeal and replace bill — do those two things simultaneously — we ought to just repeal only.”[126]

* On June 5, 2017, during a listening session on healthcare with women entrepreneurs, Pence said, "The truth is the American people are struggling under the weight of the failed policies of Obamacare, and it must go. Secretary Price and his team at Health and Human Services released a study just two weeks ago showing that in real numbers premiums have more than doubled under Obamacare since 2013, up 105 percent. Now, I was in the Congress when Obamacare was passed into law, and I remember all the promises -- if you like your doctor, you can keep them. Remember? If you like your insurance, you could keep it. But the central promise was the cost of health insurance would go down, and here we are that since 2013 alone premiums across this country have increased by 105 percent. America can't afford Obamacare any longer. President Trump and our administration are working every day with members of Congress, and we're not going to rest until we repeal and replace Obamacare with the kind of healthcare reform the American people deserve, healthcare reform built on consumer choice, on free-market principles, on state-based innovation, and a respect for the doctor-patient relationship."[127]

* On April 1, 2017, during a speech at Dynalab Inc, in Reynoldsburg, Ohio, Pence said, "The President and I know what all of you know -- that every day Obamacare survives is another day that the American people struggle. We all know the truth about this failed law. Higher prices, lost plans, fewer choices -- Obamacare is a burden on the people of Ohio and it’s a burden on Ohio’s job creators. That’s why the President has worked so hard to keep his promise to the American people to repeal and replace Obamacare with something that actually works. ... Obamacare is going to continue to explode, putting a great weight on millions of Americans. But the President and I have faith. We have faith that Congress is going to step and do the right thing. Even as we speak, I’m told the members of Congress are forging ahead -- working to craft legislation that will usher in the end of Obamacare. So be assured of this, folks here in the Buckeye State, when Congress finally decides to repeal and replace Obamacare, President Trump and I will be ready to work with them hand in glove. You can take it to the bank: President Trump is never going to stop fighting to keep the promises he made to the American people -- and we will make America great again. We will repeal and replace Obamacare and give the American people the world-class health-care they deserve."[128]

* On March 25, 2017, while speaking in Charleston, West Virginia, Pence said, "And I heard again from these West Virginia small business owners about the need to repeal and replace Obamacare. They told me how Obamacare stands in the way and stifles growth. It’s a burden not just to job creators, it’s also a burden to the American people. Folks, I wasn’t surprised to hear it because every promise of Obamacare has been broken. You all remember what they were. Seven years ago, after Obamacare was signed into law, they told us if you like your doctor, you can keep them -- not true. They said if you like your health plan, you can keep it -- not true. We were all told that the cost of health insurance would go down. Well, that one wasn’t true either. And West Virginia knows this better than most. It's heartbreaking to say that last year alone, Obamacare premiums here in West Virginia spiked by a stunning 32 percent. Over 40 percent of the state doesn’t have any choice of an insurance provider on the Obamacare exchange. West Virginians, and President Trump, we all know the truth about this failed law – that every day Obamacare survives is another day that America suffers. That’s why the President worked tirelessly over the last several weeks to get Congress to repeal and replace Obamacare. You saw his resolve to work with whoever he needed to work with, to call whoever he needed to call to get our plan across the finish line this week on Capitol Hill. I got to tell you, I was inspired by President Trump’s determination and commitment to keep his promise to the American people. And the President and I are grateful for Speaker Paul Ryan and all the House Republicans who stood with us in this effort to begin the end of Obamacare. But as we all learned yesterday, Congress just wasn’t ready. You saw it -- with 100 percent of House Democrats -- every single one -- and a handful of Republicans actually standing in the way of President Trump’s plans to repeal and replace Obamacare. We're back to the drawing board. You know, Nancy Pelosi, the leader of the Democrats in Congress, actually said yesterday was a victory for the American people. But West Virginia knows better. Yesterday wasn’t a victory for the American people. It was a victory for the status quo in Washington, D.C. And it was a victory for the disaster of Obamacare. But I promise you that victory won't last very long. The American people want Obamacare gone. And as the President said today, don't worry, America. He just tweeted this morning. Obamacare is going to continue to explode. And when Republicans and Democrats finally decide to come together and to repeal and replace Obamacare, we’ll be ready to get the job done."[129]

#### Pence on healthcare[edit]

* The Trump campaign released a statement on November 14, 2016, detailing what Pence discussed at the Republican Governors Association Annual Conference. At the event, Pence "reiterated...Trump’s strong commitment to repeal and replace Obamacare and block grant Medicaid funding to state governments to encourage innovation that better delivers healthcare to eligible residents."[130]

As a member of the U.S. House of Representatives, Pence voted against the Affordable Care Act in 2010. Two years later, Pence voted for the repeal of the ACA. He also recommended that the ACA be replaced "with a plan that includes consumer-driven health care." Click here to read more of Pence's public comments on healthcare before and during the 2016 presidential election.

# Alex Azar[edit]

### Secretary of Health and Human Services Alex Azar[edit]

#### Azar on the ACA[edit]

* During an interview with WTHR in Indianapolis, Indiana, on February 20, 2018, Azar was asked about the Trump administration's plan to offer short-term health insurance. Azar said, "The Affordable Care Act is simply not delivering for people in this country. Back home in Indiana, individual market premiums increased 74 percent, almost doubling through the end of the Obama administration. No county in Indiana has more than two insurers. About half of our counties have just one. So, it's not working for folks, especially the 28 million Americans who are still uninsured even though they were promised they would get access to affordable health care insurance. The president, through an executive order, said he wants us to help people get affordable individualized insurance and so today, we're taking a step in the right direction. ... These are plans that could last up to 12 months. They're lower cost because they're not subject to all the regulations at the national level of Obamacare. They can be as low as one-third the cost of Obamacare individual insurance plans that are unsubsidized. We think this can be an important option for people who've been crowded out of that marketplace. Just an option for them to get lower cost insurance coverage. Probably works best for people who have a transition in employment, so they're between jobs and between coverage in their employers. People for whom the Obamacare insurance is just too expensive. And people who live in rural areas where the Obamacare that's available to them may not cover doctors or hospitals that are close enough to where they live."[131]

#### Azar on the Medicare[edit]

* During a speech on September 27, 2018, Azar discussed Medicare for all, saying, "When you drill down into the details, it’s clear that Medicare for all is a misnomer. What’s really being proposed is a single government system for every American that won’t resemble Medicare at all. ... The main thrust of Medicare for all is giving you a new government plan and taking away your other choices."[132]

# Tom Price[edit]

### Former Secretary of Health and Human Services Tom Price[edit]

#### Price on the BCRA[edit]

* On June 25, 2017, Price praised the BCRA in an op-ed in the Deseret News. He wrote, "The health care reform proposal recently introduced in the Senate is a key step in turning this vision into a reality. Built on patient-centered reforms, the Senate plan would provide immediate relief to Utahns from the burdens of Obamacare by repealing the law’s most onerous taxes, rolling back its most costly regulations and revitalizing our hollowed out insurance markets. Just as important, it would begin to put in place a patient-centered health care system in which all Americans can access the kind of affordable, high-quality care they need. ... Unlike Obamacare’s Washington knows best approach, this Administration trusts individuals and families to make their own decisions. To ensure every American has access to affordable care, we support providing targeted tax credits to those who need financial assistance and expands the opportunity for folks to save some of their hard-earned money tax-free to spend on future health needs. Recognizing that the people closest to a problem are best equipped to fix it, states deserve maximum flexibility to create a health care system that meets the unique needs of their citizens, especially those most in need of a strong and sustainable Medicaid program. ... The patient-centered proposals in Congress right now represent a once-in-a-lifetime opportunity to undo the damage caused by an ill-conceived experiment in government-run health care. We’ve waited long enough. Now is the time to act."[133]

#### Price on the AHCA[edit]

* On May 24, 2017, Price released the following statement after the Congressional Budget Office (CBO) released a report analyzing the AHCA: “The CBO was wrong when they analyzed Obamacare’s effect on cost and coverage, and they are wrong again. In reality, Americans are paying more for fewer healthcare choices because of Obamacare, and that’s why the Trump Administration is committed to reforming healthcare. In a new analysis released just last night, HHS reported that premiums in the individual market have more than doubled since many of Obamacare’s regulations and mandates were implemented.”[134]

* On May 4, 2017, after the House passed the AHCA, Price released the following statement: "The status quo is failing the American people. Premiums are skyrocketing; choices are narrowing or vanishing; and patients do not have access to the care they need. Today, the House of Representatives has begun to deliver on President Trump’s promise to repeal a broken law and replace it with solutions that put patients in charge. This is a victory for the American people. The American Health Care Act is focused on patients. It is the first step toward a patient-centered healthcare system that will provide Americans access to quality, affordable healthcare coverage, empowering individuals and families to choose the coverage that best meets their needs, not what Washington forces them to buy, and equipping states to address the diverse needs of their most vulnerable populations. As Congress continues its work, the team at HHS will continue to support the reform effort by reviewing and initiating administrative actions to put patients, families and doctors in charge of medical decisions, bring down costs, and increase choices.”[135]

* During an interview on March 12, 2017, NBC's Chuck Todd asked Price if he could "say for certain that once this bill [the AHCA] is passed nobody, nobody will be worse off financially when it comes to paying for health care?" Price replied, "I firmly believe that nobody will be worse off financially in the process that we're going through, understanding that they'll have choices that they can select the kinda coverage that they want for themselves and for their family, not the government forces them to buy. So there's cost that needs to come down, and we believe we're going to be able to do that through this system. There's coverage that's going to go up. Remember Chuck, there are 20 million folks right now in this nation who said to the federal government, 'Phooey. I'll pay a penalty or I'll take a waiver. I'm not even going to get coverage in the system that we currently have.' That may be a system that works for government or insurance, but it doesn't work for people."[136]

#### Price on the ACA[edit]

* During an interview on March 12, 2017, NBC's Chuck Todd asked Price if the AHCA "which leaves much of the Obamacare architecture in place, is an acknowledgement that the health care system can’t be run by the free market alone." Price replied, "No, not at all. And obviously this is a transition that we're going through, but the important thing is to appreciate that the market as it is right now is failing. Obamacare, the ACA, has failed. You’ve got premiums going up, you've got deductibles where people have an insurance card but they don't have any coverage, got a third of the counties in this nation that only have one insurer offering coverage, five states with only one insurer offering coverage. That's not a choice nor is it responsible to the individuals who are going to be selecting the coverage. So what we need to do is to fix this, to move in a direction that puts patients and families and doctors in charge of their health care, and not Washington, D.C."[136]

* During his confirmation hearing, Sen. Lamar Alexander (R-Tenn.) asked Price how the plan to simultaneous repeal and replace the ACA might work. Price said, “Nobody's interested in pulling the rug out from under anybody. We believe that it is absolutely imperative that individuals who have health coverage should be able to keep health coverage and move, hopefully, to greater choices and opportunities … I think there's been a lot of talk about individuals losing health coverage That is not our goal or our desire, nor is it our plan.”[137]

* In 2015, Price said, “It [the ACA] needs to be fully repealed, because the first step out of the gate for Obamacare is a step in the wrong direction and that is for government control over every aspect of health care, so it's hard to fix the system that they have put in place without ending that premise that government ought to be running and controlling health care.”[138]

* In 2009, Price first introduced HR 2300—the Empowering Patients First Act—as the legislative replacement for the ACA. The bill proposed tax credits based on age, which individuals and families could use to purchase insurance policies, as well as a one-time tax credit for health savings accounts. The issue of tax credits has been a flashpoint among conservatives in debates over healthcare, with some favoring tax deductions over credits. Price said that he supports the idea of tax credits “because we felt it was cleaner.” Other features of Price’s bill included allowing insurers to sell policies across state lines and groups of businesses to purchase “association health plans.” Grants would be provided to states to help cover healthcare costs for individuals with pre-existing conditions. Under the Empowering Patients First Act, individuals on government programs like Medicare and Medicaid would be able to opt out and use their tax credit to purchase private coverage. Much of the bill was featured in House Speaker Paul Ryan’s “A Better Way” agenda.[139]

#### Price on healthcare[edit]

* On March 10, 2017, Price released the following statement on Medicaid: “Our states know best how to care for their citizens – particularly their most vulnerable populations who receive healthcare coverage under Medicaid. Pursuant to the vision put forward by President Trump, the Department of Health and Human Services will be committed to doing everything within our authority to provide our nation’s governors and state legislatures with greater flexibility on how they utilize Medicaid resources in caring for those in need. This will include a review of existing waiver procedures to provide states the impetus and freedom to innovate and test new ideas to improve access to care and health outcomes. These efforts will complement the work Congress is already doing through the American Health Care Act and will do in subsequent legislation to deliver patient-centered healthcare reform.”[140]

* During his confirmation hearing, Price was asked about ensuring access to free contraception. He said, “I think contraception is absolutely imperative for many, many women and the system that we ought to have in place is one that allows women to be able to purchase the kind of contraception they desire.”[141]

* During his confirmation hearing, Price outlined his philosophy on federal healthcare policy in his opening statement. He said, “If confirmed, my obligation will be to carry to the Department of Health and Human Services both an appreciation for bipartisan, team-driven policymaking and what has been a lifetime commitment to work to improve the health and well-being of the American people. That commitment extends to what I call the six principles of health care – six principles that, if you think about it, all of us hold dear: affordability, accessibility, quality, choices, innovation, and responsiveness. We all want a health care system that’s affordable, that’s accessible to all, of the highest quality, with the greatest number of choices, driven by world-leading innovations, and responsive to the needs of the individual patient.”[137]

* During his confirmation hearing, Sen. Elizabeth Warren (D-Mass.) asked if Price would commit to not using his administrative authority as HHS secretary to cut funding for Medicare or Medicaid. Price responded, “What the question presumes is money is the metric. In my belief, from a scientific standpoint, if patients aren’t receiving care, even though we’re providing the resources, then it doesn’t work for patients. I believe that the metric ought to be the care that the patients are receiving.”[137]

* During his confirmation hearing, Sen. Tim Scott (R-S.C.) asked Price about the future of telemedicine. Price responded, “[T]elemedicine is one of the those exciting innovations … and is absolutely vital. I think we need to accentuate the ability to use telemedicine. Oftentimes, telemedicine is not paid for, it's not compensated. People eat, the clinicians eat those costs. They assume those costs that help the patient, yes, but make it so it's much more difficult for them to be able to provide the quality care necessary.”[137]

* In June 2016, at an American Enterprise Institute event, Price said, “They believe the government ought to be in control of health care. We believe that patients and doctors should be in control of health care.”[142]

## 115th Congress on healthcare[edit]

* 115th Congress on healthcare

* American Health Care Act of 2017

* Better Care Reconciliation Act

* Republican effort to repeal the ACA

See also: 115th Congress on healthcare

### House bill: American Health Care Act of 2017[edit]

On March 6, 2017, House Republicans introduced the American Health Care Act of 2017 (AHCA), a reconciliation bill that proposed modifying the budgetary and fiscal provisions of the Patient Protection and Affordable Care Act (ACA), also known as Obamacare. The bill did not propose repealing the ACA in its entirety, a move that was criticized by some conservatives who called for a full repeal of President Barack Obama's signature healthcare law.[143]

The bill proposed repealing the penalties on individuals for not maintaining health coverage and on employers for not offering coverage. The ACA's subsidies for purchasing insurance would have ended, as would have enhanced federal funding for states that expanded Medicaid. The bill also proposed a system of tax credits, based on age rather than income, and a penalty in the form of increased premiums for individuals who did not maintain continuous coverage.[143]

On May 4, 2017, the House passed the AHCA by a vote of 217-213.

### Senate bill: Better Care Reconciliation Act of 2017[edit]

On June 22, 2017, the U.S. Senate released the Better Care Reconciliation Act of 2017 (BCRA), its version of the House bill, the American Health Care Act (AHCA). The bill was a reconciliation bill that proposed modifying the budgetary and fiscal provisions of the Patient Protection and Affordable Care Act (ACA), also known as Obamacare.

The Senate bill encountered the same issues the AHCA encountered in the House: namely, disagreements between the moderate and conservative wings of the party. All Senate Democrats expressed opposition to the BCRA. Senate Minority Leader Chuck Schumer (D-N.Y.) said the bill had a "rotten core" and listed some actions Senate Republicans would have to take in order for Democrats to work with them: "Abandon tax breaks for the wealthy, abandon cuts to medicaid [sic], abandon repeal, and we can sit down and talk about improving health care."[144]

On July 17, 2017, after weeks of negotiating the bill, Senate Majority Leader Mitch McConnell (R-Ky.) said that his party was unable to agree on a replacement bill for the ACA. During the last week of July, the Senate voted on three major proposals to repeal and replace the ACA. A procedural vote on the BCRA was rejected by a vote of 43-57. A proposal to repeal the ACA and delay the effective date for two years to provide time for a replacement bill failed by a vote of 45-55. The final major amendment—the "skinny bill"—was rejected by a 49-51 vote. It contained the provisions to repeal the requirements for individuals to enroll in health insurance and for employers to offer it, among other provisions.[145][146][147][148][149]

After the skinny bill failed, McConnell said, “it is time to move on,” and he called the final defeat disappointing.[150]

For more on the BCRA and the Republican effort to repeal the ACA, click here.

## Healthcare policy overviews[edit]

Healthcare policy overview

Affordable Care Act overview

Lawsuits against the ACA

Cost-sharing reduction payments

Republican and conservative proposals to repeal the ACA

## See also[edit]

* Trump administration officials on healthcare, 2017
* Affordable Care Act under the Trump administration, 2017
* The individual and employer mandates under the Trump administration, 2017-2020
* 115th Congress on healthcare
* 115th Congress on the American Health Care Act of 2017
* American Health Care Act of 2017
* 115th Congress on the Better Care Reconciliation Act of 2017
* Better Care Reconciliation Act of 2017
* Restoring Americans' Healthcare Freedom Reconciliation Act of 2015
* Obamacare overview
* Multistate lawsuits against the federal government, 2017-2020

## External links[edit]

* Search Google News for this topic

## Footnotes[edit]

1. ↑ Breitbart, "Donald Trump: ‘I’m 100 Percent Behind’ Obamacare Replacement Plan," accessed March 22, 2017
2. ↑ 2.0 2.1 2.2 2.3 2.4 WhiteHouse.gov, "Remarks by President Trump at Signing of Executive Order Promoting Healthcare Choice and Competition," October 12, 2017
3. ↑ Kaiser Family Foundation, "Summary of the Affordable Care Act," April 25, 2013
4. ↑ Encyclopaedia Britannica, "Patient Protection and Affordable Care Act (PPACA)," June 26, 2015
5. ↑ 5.0 5.1 United States Court of Appeals for the District of Columbia Circuit, "No. 19-5222," June 16, 2020
6. ↑ 6.0 6.1 6.2 United States District Court for the District of Columbia, "Case No. 19-cv-01738 (APM) Memorandum Opinion," July 8, 2019
7. ↑ 7.0 7.1 The New York Times, "House Votes to Repeal Obamacare Tax Once Seen as Key to Health Law," July 17, 2019
8. ↑ United States House of Representatives, "Final Vote Results for Roll Call 493," July 17, 2019
9. ↑ Insider NJ, "Norcross-Led Repeal of the ‘Cadillac Tax’ Passes House of Representatives, Poised to Lower Healthcare Costs for Americans," July 17, 2019
10. ↑ Health Payer Intelligence, "Federal Judge Strikes Down New Drug Price Transparency Rule," July 10, 2019
11. ↑ DTC Perspectives, "HHS Files Appeal in Drug Disclosure Fight," August 28, 2019
12. ↑ 12.0 12.1 Federal Register, "Medicare and Medicaid Programs; Regulation To Require Drug Pricing Transparency," May 10, 2019
13. ↑ Congress.gov, "S.311 - Born-Alive Abortion Survivors Protection Act," accessed February 27, 2019
14. ↑ Senate.gov, "On Cloture on the Motion to Proceed (Motion to Invoke Cloture Re: The Motion to Proceed to S. 311)," accessed February 25, 2019
15. ↑ Congress.gov, "S. 311; Congressional Record Vol. 165, No. 34, p. 14," February 25, 2019
16. ↑ Congress.gov, "BORN-ALIVE ABORTION SURVIVORS PROTECTION ACT--MOTION TO PROCEED-- Resumed; Congressional Record Vol. 165, No. 34, p. 16 (Senate - February 25, 2019)," February 25, 2019
17. ↑ 17.0 17.1 Politico, "Senate defeats anti-abortion bill, as GOP tries to jam Dems," February 25, 2019
18. ↑ 18.0 18.1 Scribd, "Texas et al. v. United States of America et al.," December 14, 2018
19. ↑ 19.0 19.1 19.2 19.3 Politico, "Judge rules Obamacare unconstitutional, endangering coverage for 20 million," December 14, 2018
20. ↑ 20.0 20.1 The Hill, "Judge who struck down ObamaCare says it will remain in place during appeal process," December 30, 2018
21. ↑ 21.0 21.1 Reuters, "Twenty states sue federal government, seeking end to Obamacare," February 26, 2018
22. ↑ 22.0 22.1 22.2 The Wall Street Journal, "GOP Lawsuit Takes Aim at Affordable Care Act Again," February 27, 2018
23. ↑ 23.0 23.1 The Hill, "Justice Dept. argues key parts of ObamaCare are unconstitutional," June 7, 2018
24. ↑ The Wall Street Journal, "Justice Department Won’t Defend Affordable Care Act in Lawsuit Brought by States," June 7, 2018
25. ↑ The Hill, "Dems blast DOJ for 'stunning attack on the rule of law' in ObamaCare case," June 8, 2018
26. ↑ 26.0 26.1 CMS.gov, "FACT SHEET: State Empowerment and Relief Waiver Concepts," November 29, 2018
27. ↑ HHS.gov, "HHS Secretary Azar Praises Release of State Relief and Empowerment Waiver Concepts," November 29, 2018
28. ↑ 28.0 28.1 Congress.gov, "H.R.6 - SUPPORT for Patients and Communities Act," accessed October 30, 2018
29. ↑ 29.0 29.1 The Hill, "Trump signs sweeping bill aimed at tackling opioid crisis," October 24, 2018
30. ↑ WhiteHouse.gov, "President Donald J. Trump’s Initiative to Stop Opioid Abuse and Reduce Drug Supply and Demand," October 24, 2018
31. ↑ 31.0 31.1 31.2 31.3 31.4 Note: This text is quoted verbatim from the original source. Any inconsistencies are attributable to the original source.
32. ↑ 32.0 32.1 32.2 32.3 CMS.gov, "Trump Administration announces State Relief and Empowerment Waivers to give states the flexibility to lower premiums and increase choices for their health insurance markets," October 22, 2018
33. ↑ The Hill, "Trump administration loosens restrictions on ObamaCare waivers," October 22, 2018
34. ↑ Senate.gov, "On the Joint Resolution (S.J. Res. 63 )," October 10, 2018
35. ↑ Congress.gov, "S.J.Res.63 - A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Secretary of the Treasury, Secretary of Labor, and Secretary of Health and Human Services relating to 'Short-Term, Limited Duration Insurance'." accessed October 17, 2018
36. ↑ 36.0 36.1 The Hill, "Senate defeats measure to overturn Trump expansion of non-ObamaCare plans," October 10, 2018
37. ↑ Centers for Medicare and Medicaid Services, "Wisconsin: State Innovation Waiver under section 1332 of the PPACA," July 29, 2018
38. ↑ Centers for Medicare and Medicaid Services, "Maine: State Innovation Waiver under section 1332 of the PPACA," July 30, 2018
39. ↑ The Hill, "House passes bipartisan bill to fight opioid crisis," June 22, 2018
40. ↑ NBC News, "House passes massive package to address opioids crisis," June 22, 2018
41. ↑ 41.0 41.1 Congress.gov, "S.204 - Trickett Wendler, Frank Mongiello, Jordan McLinn, and Matthew Bellina Right to Try Act of 2017," accessed May 22, 2018
42. ↑ WhiteHouse.gov, "Remarks by President Trump at S.204, 'Right to Try' Bill Signing," May 30, 2018
43. ↑ Clerk.House.gov, "Final Vote Results for Roll Call 214", May 22, 2018
44. ↑ 44.0 44.1 44.2 44.3 The Hill, "House approves 'right to try,' sends bill to Trump's desk," May 22, 2018
45. ↑ Clerk.House.gov, "Final Vote Results for Roll Call 121," March 21, 2018
46. ↑ Congress.gov, "H.R.5247 - Trickett Wendler, Frank Mongiello, Jordan McLinn, and Matthew Bellina Right to Try Act of 2018," accessed May 24, 2018
47. ↑ The Wall Street Journal, "House Passes Bill Giving the Terminally Ill Easier Access to Unproven Drugs," March 21, 2018
48. ↑ WhiteHouse.gov, "Remarks by President Trump on Lowering Drug Prices," May 11, 2018
49. ↑ WhiteHouse.gov, "President Donald J. Trump’s Blueprint To Lower Drug Prices," May 11, 2018
50. ↑ WhiteHouse.gov, "President Donald J. Trump’s Blueprint To Lower Drug Prices," May 11, 2018
51. ↑ The Hill, "Trump unveils plan to lower drug prices," May 11, 2018
52. ↑ 52.0 52.1 WhiteHouse.gov, "Help Is on the Way for Americans Facing High Drug Prices," May 11, 2018
53. ↑ The Hill, "Trump admin announces abstinence-focused overhaul of teen pregnancy program," April 20, 2018
54. ↑ 54.0 54.1 54.2 54.3 CMS.gov, "CMS issues final 2019 Payment Notice Rule to increase access to affordable health plans for Americans suffering from high Obamacare premiums," April 9, 2018
55. ↑ The Hill, "Trump vows tougher borders to fight opioid epidemic," March 19, 2018
56. ↑ White House.gov, "Remarks by President Trump on Combatting the Opioid Crisis," March 19, 2018
57. ↑ 57.0 57.1 HHS.gov, "Trump Administration works to give relief to Americans facing high premiums, fewer choices," February 20, 2018
58. ↑ 58.0 58.1 The Hill, "Trump eases rules on insurance sold outside of ObamaCare," February 20, 2018
59. ↑ Justice.gov, "Attorney General Sessions Announces New Tool to Fight Online Drug Trafficking," January 29, 2018
60. ↑ The Hill, "Congress funds children's health program after four-month delay," January 22, 2018
61. ↑ The Hill, "HHS extends Trump's emergency declaration for opioids," January 19, 2018
62. ↑ Medicaid.gov, "RE: Opportunities to Promote Work and Community Engagement Among Medicaid Beneficiaries," January 11, 2018
63. ↑ 63.0 63.1 The Wall Street Journal, "Trump Administration Sends Mixed Messages on Welfare Work Rules," January 11, 2018
64. ↑ 64.0 64.1 64.2 The Hill, "Trump officials move to allow Medicaid work requirements," January 11, 2018
65. ↑ 65.0 65.1 The Hill, "172 Dems ask Trump official to reject Medicaid work requirements," February 14, 2018
66. ↑ The Hill, "Trump signs bipartisan bill to combat synthetic opioids," January 10, 2018
67. ↑ U.S. Department of Labor, "29 CFR Part 2510, RIN 1210-AB85, Definition of 'Employer' under Section 3(5) of ERISA -- Association Health Plans," January 4, 2018
68. ↑ The New York Times, "Trump Proposes New Health Plan Options for Small Businesses," January 4, 2018
69. ↑ The Wall Street Journal, "Trump Signs Sweeping Tax Overhaul Into Law," December 22, 2017
70. ↑ Cite error: Invalid `<ref>` tag; no text was provided for refs named `landmark`
71. ↑ HealthCare.gov, "If you don't have health insurance: How much you'll pay," accessed August 21, 2017
72. ↑ HealthCare.gov, "Hardship exemptions, forms & how to apply," accessed August 21, 2017
73. ↑ 73.0 73.1 73.2 Fierce Healthcare, "CMS plans to let states tinker with essential health benefits," October 30, 2017
74. ↑ Politico, "White House to continue Obamacare payments, removing shutdown threat," April 26, 2017
75. ↑ The Washington Post, "White House’s decision to stop ACA cost-sharing subsidies triggers strong opposition," October 13, 2017
76. ↑ Kaiser Family Foundation, "Impact of Cost Sharing Reductions on Deductibles and Out-Of-Pocket Limits," March 22, 2017
77. ↑ Bloomberg, "Delay on Obamacare Subsidy Decision Leaves Insurers in Limbo," May 22, 2017
78. ↑ Politico, "Trump will scrap critical Obamacare subsidies," October 12, 2017
79. ↑ DemocraticLeader.gov, "Pelosi, Schumer Joint Statement on News Reports President Trump Will Cut Off Vital ACA Payments, Spike Premiums," October 13, 2017
80. ↑ Speaker.gov, "Statement on Trump Administration's Decision Regarding Obamacare Payments," October 12, 2017
81. ↑ WhiteHouse.gov, "President Donald J. Trump is Taking Action to Improve Access, Increase Choices, and Lower Costs for Healthcare," October 12, 2017
82. ↑ The Hill, "Trump eases ObamaCare rules with executive order," October 12, 2017
83. ↑ Twitter, "Chuck Schumer," October 12, 2017
84. ↑ Real Clear Politics, "Rand Paul: Today Marks 'Biggest Free Market Reform Of Health Care In A Generation,'" October 12, 2017
85. ↑ 85.0 85.1 85.2 85.3 The Hill, "Trump officials roll back birth-control mandate," October 6, 2017
86. ↑ FederalRegister.gov, "Religious Exemptions and Accommodations for Coverage of Certain Preventive Services Under the Affordable Care Act," October 6, 2017
87. ↑ FederalRegister.gov, "Moral Exemptions and Accommodations for Coverage of Certain Preventive Services Under the Affordable Care Act," October 6, 2017
88. ↑ Politico, "Trump rolls back Obamacare birth control mandate," October 6, 2017
89. ↑ 89.0 89.1 The Hill, "Trump to slash ObamaCare outreach funding," August 31, 2017
90. ↑ Fox News, "Trump administration slashes budget for ObamaCare ads," August 31, 2017
91. ↑ 91.0 91.1 91.2 The Hill, "Abrupt Trump cuts to teen pregnancy program surprise groups," August 11, 2017
92. ↑ HHS.gov, "About the Teen Pregnancy Prevention (TPP) Program," accessed August 11, 2017
93. ↑ Vox, "Leaked regulation: Trump plans to roll back Obamacare birth control mandate," May 31, 2017
94. ↑ DocumentCloud, "Preventive Services Final Rule," accessed June 1, 2017
95. ↑ Modern Healthcare, "HHS rule proposes any employer could skip offering birth control coverage," May 31, 2017
96. ↑ Centers for Medicare and Medicaid Services, "Health Insurance Exchange Guidance," May 17, 2017
97. ↑ Modern Healthcare, "Trump administration lets consumers skip HealthCare.gov," May 17, 2017
98. ↑ Centers for Medicare and Medicaid Services, "Patient Protection and Affordable Care Act; Market Stabilization," April 13, 2017
99. ↑ Modern Healthcare, "White House finalizes ACA rule to strengthen individual market," April 13, 2017
100. ↑ The White House, Executive Order Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal," January 20, 2017
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102. ↑ Twitter, "Donald J. Trump," July 10, 2017
103. ↑ Twitter, "Donald J. Trump," June 22, 2017
104. ↑ Talking Points Memo, "Trump Confirms He Called House Repeal Bill ‘Mean,’ Claims Obama Copied Him," June 25, 2017
105. ↑ 105.0 105.1 WhiteHouse.gov, "Remarks by President Trump on Healthcare Vote in the House of Representatives," May 4, 2017
106. ↑ 106.0 106.1 WhiteHouse.gov, "Remarks by President Trump on the Health Care Bill," March 24, 2017
107. ↑ WhiteHouse.gov, "Remarks by President Trump in a Listening Session on Healthcare," March 13, 2017
108. ↑ WhiteHouse.gov, "Remarks by President Trump in a Healthcare Discussion with Key House Committee Chairmen," March 10, 2017
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114. ↑ Twitter, "Donald J. Trump," July 29, 2017
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148. ↑ Senate.gov, "On the Amendment (McConnell Amdt. No. 667 )," July 28, 2017
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150. ↑ The Hill, "McConnell: 'Time to move on' after healthcare defeat," July 28, 2017

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Donald Trump presidential transition, 2024-2025 • Donald Trump's Cabinet, 2025 • Confirmation process for Donald Trump's Cabinet nominees, 2025 • Donald Trump presidential administration, 2025