On Jan. 20, 2017, Donald J. Trump, a New York Republican, was sworn in by Supreme Court Chief Justice John G. Roberts Jr, as the 45th president of the United States. Mike Pence, former Republican governor of Indiana, was sworn in as vice president. President Trump used his inauguration address to further his campaign messages that both political parties have lost their way and that America must come first.

“Today, we are not merely transferring power from one administration to another, or from one party to another, but we are transferring power from Washington, D.C., and giving it back to you, the people,” he said. “For too long, a small group in our nation’s capital has reaped the rewards of government while the people have borne the cost… Politicians prospered, but the jobs left and the factories closed.”

For the first time since 2006, Republicans now control both the White House and Congress. However, uncertainty remains about how GOP policy priorities will proceed under President Trump, as he has, at times, contradicted other Republicans. According to The White House website, top priorities of the new administration include the following issues: America First Energy Plan, America First Foreign Policy, Bringing Back Jobs and Growth, Making Our Military Strong Again, Standing Up For Our Law Enforcement Community, and Trade Deals Working for All Americans.

Although the Affordable Care Act (ACA) was not specifically mentioned, President Trump has pledged that healthcare reform would be among his first priorities. In an executive order, he directed members of his administration to take steps that will facilitate the repeal and replacement of the ACA. Specifically, the order states that pending a repeal of the ACA, “it is imperative for the executive branch to ensure that the law is being efficiently implemented, take all actions consistent with law to minimize the unwarranted economic and regulatory burdens of the Act, and prepare to afford the States more flexibility and control to create a more free and open healthcare market.”

In the legislative branch, Republican members passed a budget resolution that gives Congress a start on some legislative tools to repeal and replace the ACA.

“By taking this first step toward repealing Obamacare, we are closer to giving Americans relief from the problems this law has caused,” said House Speaker Paul Ryan (R-Wisc.).
“Too many families have seen costs soar, quality drop, and choices reduced to one—which just isn’t a choice at all,” he continued. “This resolution gives us the tools we need for a step-by-step approach to fix these problems and put Americans back in control of their health care.”

Still, President Trump has stated that he would not put forth his plan for repeal and replace until after the confirmation of Rep. Tom Price, MD (R-Ga.) as head of the Department of Health and Human Services. Rep. Price was confirmed by the full Senate on Feb. 10, just prior to this issue of AAOS Now going to press. 

Some legislators, including Sen. Ron Johnson (R-Wisc.), believe that Republicans should work with Democrats to “fix” the ACA. However, Democrats are unlikely to lend much support if Republican leadership continues with a repeal and replace plan. Speaking against the budget resolution on the House floor, Democratic Leader Nancy Pelosi (D-Calif.) said that Democrats will not allow Republicans to “make America sick again.”

GOP members have backed away from a “repeal and delay” plan after legislators, including Sen. Susan Collins (R-Maine), Sen. Bob Corker (R-Tenn.), Sen. Rand Paul (R-Ky.), and Sen. Tom Cotton (R-Ark.), suggested that a detailed framework for the ACA’s replacement be developed first. Instead, Republicans have begun considering a handful of bills in various committees—including the House’s Energy and Commerce Committee—that could make up part of the plan to replace the ACA. Republicans have yet to reach a consensus about how to replace healthcare coverage for the nearly 20 million people who gained insurance under the ACA.

“First, our committees are set to begin holding legislative hearings on bills to deliver relief for Americans struggling under Obamacare,” stated Rep. Ryan at a press conference in January. “This is the next step in a step-by-step approach to repealing and replacing Obama-care with an affordable, patient-centered system. We know that this law is collapsing. We hear it every day from our constituents. We hear it from the families who tell us the deductibles are so high, it doesn’t feel like they have insurance. We hear it from the people who have been denied choices. This law is collapsing, and we need to step in and restore real choices and real competition so that we can actually lower costs for patients and families.”

“Leading up to the 2016 elections, we promised voters that we would get health care back on track,” stated Health Subcommittee Chairman Michael Burgess, MD, (R-Texas) at a recent Energy and Commerce hearing.

“We laid out a step-by-step plan to prioritize access to quality affordable health care, not just insurance,” he continued. “The new administration has taken steps to reduce regulatory burden, and this hearing marks another step in our journey to stabilize and rebuild our healthcare system.”        

Elizabeth Fassbender is the communications manager in the AAOS office of government relations.