Health Reform in the Trump Era: Will Politics Unmake Policy?

Abstract

Abstract Donald J. Trump’s unexpected victory in the 2016 presidential election cast a long shadow over the American welfare state. With continued Republican control of the House and Senate, Trump’s occupancy of the Oval Office removed a critical constraint on Republican efforts to dismantle key Democratic social policy achievements—both old and new. Despite the absence of these important institutional veto-points, the policies that were first identified and targeted by Republicans during the Trump era have proved to be more robust than many observers and policymakers initially believed. By applying the theoretical insights and methodological tools of American Political Development, this article explores how long-running policy processes have altered the political landscape in often underappreciated ways to narrow the prospects for large-scale policy reform. More specifically, this article examines the political dynamics of Medicare and the Affordable Care Act in the early days of the Trump administration. The pressures exerted on both programs by an unpredictable president and unified Republican control of Congress provides a unique opportunity to differentiate between and assess the prospects for policy sustainability and policy stability.