How Will Healthcare Fare in Trump’s First 100 Days?

Ever since Franklin Roosevelt succeeded Herbert Hoover in the White House, the nation has focused tremendous attention on a new president’s first 100 days. As Donald J. Trump prepares to take office, national attention will turn again to the first 100 days to see how the new president tries to steer the ship of state while he has the wind at his back.

We have seen presidents as different as George W. Bush and Barack Obama use their first 100 days to make fairly dramatic changes in economic and social policy. Bush pushed through a series of tax cuts and a new plan to add a prescription drug benefit to Medicare. Obama got Congress to okay his $800 billion stimulus package and began the debate that ended with the enactment of the Affordable Care Act (ACA) in 2010.

Now Trump prepares to use his first 100 days to pave the way to reverse Obamacare and press for a set of business-friendly tax cuts. A resolution calling for Obamacare’s repeal was the first action item on the agenda for the House of Representatives. The Senate will likely follow suit. Repealing the ACA is highly popular with the President’s political base but will prove much more difficult than it may seem today.

Here are five reasons why Obamacare repeal won't be the slamdunk that everyone has predicted.

The spin game has already begun. Democrats are winning. Obama lost the messaging battle when the GOP latched onto the false claim that the ACA would create “death panels.” Trump seems to be starting from behind because Democrats – and the media – have, so far, focused on the negative impact of repeal, namely 20 million-plus Americans losing health insurance. As long as the debate remains focused on who will lose coverage, the GOP will struggle. A Trump spokesman said, “We don’t want anyone who currently has insurance to not have insurance.” That’s going to be a promise that will be hard to keep.

There’s no agreement on a replacement. Republicans have been promising to “repeal and replace” Obamacare for eight years but still don’t agree on what a replacement will look like and cost. In fact, they're not even close. That’s why they are now calling for repeal today and replacement…sometime in the future. Agreement won’t get easier with time.

The “losers” are crying foul. Besides the 20 million Americans who have insurance and would potentially lose it, the biggest losers under repeal are health insurance companies and hospitals. Insurers worry they will be left holding the bag as Congress repeals the tax subsidies for individuals to buy coverage but leave in place a prohibition against denying coverage to those with pre-existing conditions. That would force insurers to either hike their prices significantly higher or simply drop out of the individual market. Either way they are the bad guy. Hospitals worry they will be faced with rising bad debts that they won’t be able to recover but a federal law that requires them to stabilize and treat anyone who comes to their ER. Another key sector that has kept quite until now is the Republican Governors who would have to push through and sign legislation to cut millions from their Medicaid rolls. Many of them are up for reelection in 2018 and worry they'll be left holding the bag.

There aren’t many winners. Repealing Obamacare has been a popular war chant for Republicans, but the public and the media never took it seriously while Obama was in office. Repeal will help some Americans, especially those with higher incomes who will get some additional tax relief along with a handful of industries – medical device makers and suntan salons – that were taxed to pay some of the cost of the subsidies for the uninsured. For Trump to win his battle to repeal the ACA he’ll need a lot more support than that.