The key challenges Trump will face in implementing his healthcare policies

As President-elect Trump celebrates his hard fought victory over Secretary Clinton, a number of questions remain as to how he will be able to push legislation through Congress. Even with the Republicans retaining their Senate and House majorities, for Trump to move legislation forward, he will need to build bipartisan support, something that has proven difficult in recent years.

trump-election-night
U.S. President-elect Donald Trump pauses while speaking during an election night party at the Hilton Midtown hotel in New York, U.S., on Wednesday, Nov. 9, 2016. Trump was elected the 45th president of the United States in a repudiation of the political establishment that jolted financial markets and likely will reorder the nation's priorities and fundamentally alter America's relationship with the world. Photographer: Andrew Harrer/Bloomberg

Full repeal of the Affordable Care Act
While Trump has regularly discussed a full repeal and replacement of the Affordable Care Act, he faces some challenges in making that occur. Since the Republicans do not have 60 seats in the Senate, the Democrats would be able to filibuster any ACA repeal and replace plan. It would be possible for the Senate to use a process known as reconciliation, which requires only 50 votes, to repeal the law. However, repeal without any replacement plan could mean more than 20 million individuals lose their health insurance coverage. Republicans in Congress, many of whom are facing re-election in 2018, would most likely be unwilling to repeal the ACA without some type of replacement plan as well. The Republicans could use a strategy of leveraging reconciliation to repeal the entire ACA (including Medicaid expansion and subsidies on exchanges) but delay the repeals going into effect for 12 or 18 months. During this period they would attempt to work with Democrats to come to a consensus on a replacement.

Also see: "The president-elect’s stand on 10 key benefit issues."

Cadillac tax repeal
With the 40% Cadillac tax scheduled to go into effect in 2020, and Democrats discussing whether this tax should be repealed, President-elect Trump may see an opportunity to weaken the ACA. Democrats in Congress will have to weigh the benefits of repeal against adding to the Affordable Care Act’s costs. The Cadillac tax is projected to raise $79 billion through 2026. Repealing it would remove those projected revenues, adding to the Affordable Care Act’s overall costs.

Will President-elect Trump be able to create a bipartisan coalition to move his agenda forward? It will be key to watch his first 100 days. If he is able to get a “quick win” or two, it will show there is willingness in Congress to work with him. On the other hand, if he cannot find common ground quickly, he may find Democrats in Congress make moving his agenda forward difficult.

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