Trump did it first:
“HHS further acknowledged concerns expressed “by the vast majority of commenters” that the “low income” definition of 350% of the federal poverty level would have “created significant administrative challenges for health centers” and that those challenges would have resulted in a diversion of resources from patient care in the midst of the COVID-19 pandemic.“
Because Trump was incompetent, he didn’t know how to get this done.
Trump tried to wish insulin to be less expensive the way he declassified top secret documents, he would just think about it and in his mind it was done.