Aug 20, 2019 - Health

Trump's shrinking health care legacy

President Trump, alongside HHS Secretary Alex Azar and Republican members of Congress

Photo: Alex Wong/Getty Images

President Trump came into office in 2017 with big ambitions on health care. But he’ll end this term with a lot less to show.

The big picture: If Trump ends up being a one-term president — and that’s not a prediction, just 1 of the 2 possibilities in 2020 — his health care legacy would be pretty modest.

Where it stands:

  • The administration scrapped its own plan to overhaul drug rebates. Its proposal to tie some drug prices to the prices European countries pay may not be finished by January 2021, leaving it in the hands of whoever wins in 2020.
  • A Democratic successor could stop approving Medicaid work requirements — one of Trump’s most impactful health policies — and perhaps even pressure states to ditch the requirements Trump approved. And that’s assuming the courts don’t put a definitive stop to work requirements first.

On the Affordable Care Act front, both Barack Obama and Trump changed the rules dictating how long consumers can keep short-term insurance plans; another Democrat could probably change them again. Actions like promoting ACA enrollment would be easy to resume.

Yes, but: Price transparency could become an exception — a real and lasting legacy, even from a one-term administration.

  • Those requirements would have to survive lawsuits from their respective industries, but they’re the kind of thing a Democratic administration might not want to reverse.
  • On the other end of the “Yes, but” spectrum is the lawsuit aiming to get the entire ACA struck down. As long as the odds may be, if the Trump administration gets its way, that would certainly count as a health care legacy.

What we’re watching: All of this also helps explain why the White House is so eager to strike a legislative deal on drug prices. Legislation is generally more durable than executive actions, and on health care, the administration needs something that can last.

Go deeper