Trump tries and fails to repeal ACA in his first 100 days

For decades, the first 100 days of a new presidency have been used to gauge a commander-in-chief's power and effectiveness. It's that rare time when a president should be able to exert considerable influence having just swept into office.

By virtually all accounts, President Donald Trump's first 100 days in office have been mired by missteps, miscalculations and missed opportunities—other than securing Justice Neil Gorsuch's confirmation to the Supreme Court, where he will have numerous opportunities to interpret healthcare law. At the same time, the president has set the wheels in motion to fulfill major campaign promises of easing the regulatory burden and, particularly with healthcare, giving states more flexibility in how they fashion health services.

Trump's pledge to repeal and replace the Affordable Care Act by April 29—day 100—dominated the political landscape and eclipsed virtually all other issues on the healthcare agenda. The president and GOP leadership failed twice to bring their replacement plan, the American Health Care Act, to a vote in the House, the latest setback occurring late last week when it was clear there were not enough votes.

While 100 days may seem like a long time, it isn't, as Kahn noted. For any new president, advancing their agenda relies on having people in place at the department and agency level. In terms of top level officials at HHS, Trump is on par with previous administrations. He has nominated four officials for top positions at HHS, which compares to six for President Barack Obama, five for President George W. Bush, nine for President Bill Clinton and five for President George H.W. Bush, according to Mallory Barg Bulman, vice president of research and evaluation at Partnership for Public Service, which monitors agency appointments.

Trump has two confirmed leaders in place at HHS: Price and Verma. Dr. Scott Gottlieb is expected to be approved by the Senate in the coming days to head the FDA. By their 100th day, Obama and George W. Bush had just one; Clinton and George H.W. Bush had two.

While Barg Bulman didn't have exact data on sub-agency head levels, reports are that progress is slow in filling those leadership roles. "The administration has laid out some very broad goals," she said. "You need people in those positions to implement those policies. It will take time to get leadership in place."

Ultimately, Trump's first 100 days is sure to be measured by the debate of repealing Obamacare. "They put a lot of energy into repeal and replace," said Kahn. "It has sucked up a lot of oxygen."