Throughout Donald Trump’s presidential campaign, he has outlined numerous issues and priorities for his administration. This document provides a high-level overview and timeline of the potential key agenda items for his first 100 days in office. It remains unclear which legislative efforts will gain traction with Congressional lawmakers, although we know the major items that have had previous bipartisan interest. In no particular order, we outline the top three contenders below, anticipating that the legislative agenda will be shaped by transition leaders within the President-elect’s organization in the coming days and weeks.
Major Agenda Items
Affordable Care Act
Republicans are in agreement to repeal the law, and they have a framework from the 2015 reconciliation bill that was vetoed by President Obama. However, Republicans will face a political challenge now of potentially upending the health insurance market again, creating new transition plans, and dealing with the 20 million Americans who could lose health care coverage. While Republicans could use reconciliation again to advance legislation through the Senate, the rules of reconciliation will pose a challenge to including a full replacement package on a reconciliation vehicle. Additionally, Speaker Paul Ryan has indicated an interest in using reconciliation to advance his tax and entitlement reform agenda.
Infrastructure and Jobs
Both Trump and Clinton proposed making investments in infrastructure to bolster jobs and the economy. While Clinton also sought to include green energy and energy efficiency initiatives in her plan, Trump may include Republican energy priorities on oil, coal, and natural gas, as well as building the controversial Keystone XL pipeline. With a significant price tag for this investment, Trump may look to corporate tax reform as an option rather than deficit spending.
Throughout the campaign, Trump has promised to address border security by building a wall along the Mexican border. While his rhetoric has said that Mexico will pay for it, he will face challenges in Congress on how to pay for his border security proposals. Ever the deal maker, Trump met with Mexican President Enrique Peña Nieto earlier this year, and he could negotiate an alternati e agreement on border security with Mexico to remove the necessity of the wall.
Additionally, Trump has laid out a mix of other policy areas he seeks to affect, with various degrees of policy specificity. This includes defense, veterans, trade, foreign policy, as well as child care, an issue championed by his daughter Ivanka. We would anticipate continued policy statements and engagement by the White House on these issues throughout Trump’s term.
MACRA Expiring Provisions and Health Extenders
(Costs listed, where available, are for two years)
Expiring September 30, 2017 :
- Children’s Health Insurance Program (CHIP) ($7B)
- Community Health Centers, National Health Service Corps, and Teaching Health Centers ($8B)
- IPPS Adjustment for Low-Volume Hospitals ($1.1B)
- Medicare-Dependent Hospitals ($400M)
- Medicare Quality Measures ($100M)
- Outreach and Assistance for Low-Income ($100M)
- Special Diabetes Programs ($600M)
- Abstinence Education ($100M)
- Personal Responsibility Education Program ($100M)
- Family-to-Family Health Information Centers (<$50M)
- Health Workforce Demo for Low-Income ($200M)
- Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) ($700M)
- Delay in Medicaid Beneficiary Liability Settlements
Expiring December 31, 2017:
- Work Geographic Practice Cost Indices Floor ($1.1B)
- Medicare Therapy Caps Exception Process ($1.9B)
- Rural Ambulance Add-Ons ($400M)
- Reasonable Cost Reimbursement Contracts Transition
- Home Health Rural Add-On ($200M)
Expiring December 31, 2018:
- Medicare Advantage Special Needs Plans ($600M)