Intended for healthcare professionals

Feature US policy

A year in health and healthcare under President Trump

BMJ 2018; 360 doi: (Published 16 January 2018) Cite this as: BMJ 2018;360:k192
  1. Liz Seegert, freelance journalist
  1. New York City, USA
  1. liz{at}

On 20 January 2017 Donald Trump was inaugurated as US president. Liz Seegert looks at whether he has kept his campaign promises about health and healthcare, and with what effect

Healthcare insurance

As a presidential candidate, Donald Trump repeatedly vowed to repeal the Affordable Care Act (ACA) and replace it with “something really terrific” on the first day of his presidency.1 That didn’t happen, but his administration and Congress, which is controlled by Republicans, have chipped away at regulations and funding to undermine the health law. Left intact, the ACA would have covered an estimated 93% of the non-elderly US population by 2022.2

The administration made several attempts to overturn the ACA and substitute its own plan. Despite controlling both houses, however, Republicans could not muster the required votes. The administration made multiple executive orders and rule changes, which destabilised key aspects of the act. They stopped cost sharing reduction payments to insurers this autumn, prompting outcries from physician groups, hospitals, patient groups, and others.3 Despite promises to “drain the swamp,” Tom Price, the first secretary of the Department of Health and Human Services, resigned under a cloud over his use of a private jet for government business.4 Former pharmaceutical executive Alex Azar will likely become his replacement.5 Trump’s choice to lead the Centers for Disease Control and Prevention, Brenda Fitzgerald, has a record of partnering with industry.6 Many key positions that will have a bearing on health are still unfilled, including director of the White House Office of Science and Technology Policy, who would act as science adviser to the president. …

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