President Trump vowed to overhaul the health care system, notably saying in one of his first post-election speeches that pharmaceutical companies were "getting away with murder" over their pricing tactics.
Yes, but: Four years later, not a lot has changed. If anything, the health care industry has become more financially and politically powerful.
"Most of the bigger ideas have either been stopped in the courts or just never got implemented," said Cynthia Cox, a vice president at the Kaiser Family Foundation who follows the health care industry.
- The administration killed its own regulation that would have changed behind-the-scenes negotiations between drug companies and pharmacy benefit managers.
- One of the most consequential drug proposals — tying Medicare drug prices to lower prices negotiated abroad — is not remotely close to going into effect.
- Forcing drug companies to disclose prices in TV ads was a small gambit, and the courts ultimately struck down the idea.
The other side: The policies the administration has seen through, so far, have been relatively modest.
- New rules could force hospitals and health insurers to disclose their secret prices. Hospitals have sued, although the courts are not sympathetic to their pleas, and health insurers still have two years before their rule could go into effect.
- A federal appeals court upheld Trump's cuts related to a federal drug discount program for hospitals and hospital-based clinic payments, but the industry is considering taking the cases to the Supreme Court.
- Trump made it easier to sell short-term health plans.
Between the lines: Health care has consistently raked in large sums of profit every year of Trump's presidency. That has been especially true during the pandemic.
- The 2017 tax cuts and this year's tax cuts that were attached to the coronavirus legislation significantly benefited large health care companies that had massive cash reserves overseas or wanted easy tax refunds.
Meanwhile, surprise medical bills are still a thing, consolidation hasn't stopped, lobbying has skyrocketed and federal coronavirus bailouts have favored affluent hospital systems over rural and safety-net hospitals.
- Spending also continues to soar for people who get health insurance through their jobs because hospitals, drug companies and other providers still have no limits on how much they charge for their services and products, and because health insurers and employers always pass along the costs to everyone else.