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Promises kept? On health care, Trump's claims of 'monumental steps' don't add up

By Julie Rovner and Phil Galewitz, Kaiser Health News on

Published in News & Features

When it comes to health care, President Donald Trump has promised far more than he has delivered. But that doesn't mean his administration has had no impact on health issues - including the operation of the Affordable Care Act, prescription drug prices and women's access to reproductive health services.

In a last-ditch effort to raise his approval rating on an issue on which he trails Democrat Joe Biden in most polls, Trump on Thursday unveiled his "America First Healthcare Plan," which includes a number of promises with no details and pumps some minor achievements into what the administration calls "monumental steps to improve the efficiency and quality of healthcare in the United States."

As the election nears, here is a brief breakdown of what Trump has done - and has not done - on some key health issues.


Trump has not managed to repeal and replace the Affordable Care Act, despite his claims that the law is dead.

But his administration, and Republicans in Congress, have made changes to weaken the law while not dramatically affecting enrollment in marketplace plans.


Congress failed to rewrite the law in summer 2017, but Republicans who controlled both the House and Senate at the time included in their year-end tax cut bill a provision that reduced the penalty for failing to have health insurance to zero. That change eliminated what was by far the most unpopular provision of the law.

It also sparked a lawsuit by Republican state attorneys general and governors arguing that the tax change undercuts the law and thus should invalidate it. The case is set to be heard by the Supreme Court the week after the Nov. 3 election. The Trump administration is formally supporting the GOP plaintiffs in that suit.

The administration also used executive and regulatory action to chip away at the law's efficacy. Trump ended disputed cost-sharing subsidies to help insurers lower out-of-pocket costs for policyholders with low incomes. And the administration shortened the open enrollment period by half and slashed the budget for promoting the plans and paying people to help others navigate the often-confusing process of signing up.

Administration officials have complained that plans sold on the ACA marketplaces are not affordable, so they set new rules that allowed companies to sell competing "short-term" policies that were less expensive than ACA-sanctioned plans. But those plans are not required to provide comprehensive benefits or cover preexisting conditions.


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