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When Donald Trump was elected president in 2016, along with Republican majorities in both the House and the Senate, the future of US health policy was immediately thrown into doubt. Trump had campaigned against the Affordable Care Act (ACA), promising to replace it with “something terrific” (Sanger-Katz 2017). Trump had also pledged that “I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid” (Brewster 2017). It was impossible to predict on election night what health reform proposals Trump would actually support once he was faced with the unfamiliar reality of having to govern. Would he embrace the welfare state retrenchment proposals of conservatives like House Speaker Paul Ryan (R-WI)? Or would he seek to carve out a bipartisan middle ground? During his first year in office, it became clear that Trump would govern from the right on domestic policy and that he would almost certainly sign any health reform bill that landed on his desk. The question then became whether the GOP’s seven-year drive to repeal the ACA—the boldest effort to dismantle a major social program in modern US history—would finally succeed. It very nearly did. The House passed a sweeping ACA repeal bill (which also contained a massive cut to Medicaid), but similar legislation fell two votes short in the Senate when Republicans John McCain, Lisa Murkowski, and Susan Collins joined all Democrats to vote against the measure. Still, the battle over health care reform continued. The individual mandate at the heart of the bill was eliminated as part of tax reform, and the Trump administration used its executive authority to undermine the law’s implementation.

Introduction: Health Reform after the 2016 Election