Saint Louis University Journal of Health Law & Policy

Document Type

Symposium Article


Some provisions of the Patient Protection and Affordable Care Act of 2010 (ACA) as well as regulatory policies under the Obama administration reflected the overwhelming evidence that to reduce health care costs, and to improve quality of care and population health, the social determinants of health (SDOH) must be addressed. These policies included funding for partnerships between public health agencies, community organizations, and health care institutions, promotion of value-based payment models that incentivize integrated health and social care delivery, and support for Medicaid program innovations that directly address social needs as part of health care. The Trump administration, through a series of legislative and regulatory changes, has undermined many of these efforts, reversing the momentum toward a more preventive and integrated health care system. This article traces how the Trump administration’s policy approach to investments in value-based and integrated care models, state Medicaid waivers, and funding of the safety net backtrack from Obama administration evidence-based reforms that acknowledged the large role that SDOH play in health inequity, worsening population health outcomes in the U.S., and out of control health care costs.