Trump pledges great care as op­po­nents cry sab­o­tage

Pres­i­dent or­ders se­ries of health in­sur­ance tweaks that could cause mar­ket tremors

Chicago Sun-Times - - NATION - Gre­gory Korte @ gre­go­ryko­rte USA TO­DAY Con­tribut­ing: Jayne O’Don­nell in McLean, Va.; Darcy Costello in Louisville; and Heidi Przybyla in Wash­ing­ton.

Pres­i­dent Trump signed an ex­ec­u­tive or­der Thurs­day that he said will lower health in­sur­ance pre­mi­ums by al­low­ing more con­sumers to buy health in­sur­ance through as­so­ci­a­tion health plans across state lines.

The or­der could help reach the mil­lions of unin­sured peo­ple who don’t have ac­cess to em­ployer plans but find Oba­macare beyond reach be­cause of its sky­rock­et­ing pre­mi­ums and scat­tered avail­abil­ity. It would al­low more small busi­nesses to pool their re­sources into as­so­ci­a­tions that would use their pur­chas­ing power to buy group plans for their em­ploy­ees.

The move could put peo­ple into less­reg­u­lated plans with­out the same min­i­mum cov­er­age re­quire­ments or con­sumer pro­tec­tions.

Trump’s or­der pro­poses other pol­icy changes that he said will fill the gaps left by Oba­macare’s ex­change plans, which have no com­pe­ti­tion in one- third of U. S. coun­ties. He wants reg­u­la­tors to ex­pand the use of health re­im­burse­ment ar­range­ments, or HRAs, and to al­low short- term health plans to be of­fered for up to a year for peo­ple who are in between jobs, missed the en­roll­ment dead­line or have few other in­sur­ance op­tions.

“This is some­thing that mil­lions and mil­lions of Amer­i­cans will be sign­ing up for. They’ll be very happy, and they’ll get great health care,” Trump said as he signed the or­der in a White House cer­e­mony at­tended by mem­bers of Con­gress, ad­min­is­tra­tion of­fi­cials and small- busi­ness own­ers.

None of the changes takes ef­fect im­me­di­ately, re­quir­ing reg­u­la­tions from the La­bor, Health and Trea­sury De­part­ments.

Those reg­u­la­tions will need to take into ac­count pub­lic com­ments on the pro­pos­als.

Brian Blase, a Trump ad­viser on health care pol­icy, said that process would “pro­vide the op­por­tu­nity for broad par­tic­i­pa­tion by the Amer­i­can peo­ple.”

The ex­ec­u­tive ac­tion fol­lows a string of leg­isla­tive de­feats in Trump’s cru­sade to have Con­gress re­peal the Af­ford­able Care Act, which set up a se­ries of state health in­sur­ance ex­changes known as Oba­macare.

Trump is turn­ing to a va­ri­ety of smaller ad­just­ments that he said would in­crease com­pe­ti­tion, choice and ac­cess to high- qual­ity health in­sur­ance:

Ex­pand the avail­abil­ity of as­so­ci­a­tion health plans, or AHPs, to al­low more em­ploy­ers to par­tic­i­pate.

Fed­eral rules limit as­so­ci­a­tion health plans to em­ploy­ees of small busi­nesses with a “com­mon­al­ity of in­ter­est.” Trump will ask fed­eral agen­cies to re­write the rules to make plans avail­able across state lines. Be­cause those plans won’t have the same min­i­mum cov­er­age re­quire­ments as Oba­macare, the pre­mi­ums may be cheaper.

Lengthen the term of short- term lim­ited du­ra­tion in­sur­ance, or STLDIs, up to one year. Cur­rently, in­sur­ance com­pa­nies can of­fer th­ese Oba­macare re­place­ment plans for only three months at a time.

Mod­ify the reg­u­la­tions on HRAs to al­low em­ploy­ers to cover more out- of­pocket health care ex­penses out­side Oba­macare plans. “The re­quire­ments to adopt an HRA to­day are com­pli­cated and in­volved,” said David Kaut­ter, an as­sis­tant Trea­sury sec­re­tary. Sim­pli­fy­ing those reg­u­la­tions would turn HRAs into a “use­ful tool in ex­pand­ing the range of health care op­tions avail­able.”

ACA sup­port­ers worry young, healthy con­sumers who help sub­si­dize older, sicker pa­tients will pull out of state ex­changes, re­sult­ing in even higher pre­mi­ums for the Oba­macare plans.

“You’ll have one part of the mar­ket that’s of­fer­ing garbage in­sur­ance at cu­trate prices and an­other part of the mar­ket that’s very vul­ner­a­ble to a death spi­ral,” said Eliot Fish­man, se­nior di­rec­tor of health pol­icy at Fam­i­lies USA, which sup­ports the ACA.

House Mi­nor­ity Leader Nancy Pelosi, D- Calif., said she hadn’t seen the finer points of the ex­ec­u­tive or­der, “but I do know it’s a sab­o­tage of the Af­ford­able Care Act.”

Like many of Trump’s more am­bi­tious ex­ec­u­tive or­ders, the health in­sur­ance di­rec­tive is fuzzy on the de­tails and in­structs his ad­min­is­tra­tion to change the reg­u­la­tions “to the ex­tent per­mit­ted by law and sup­ported by sound pol­icy.”

The or­der gives agen­cies dead­lines of 60 to 120 days to “con­sider propos­ing reg­u­la­tions or re­vis­ing guid­ance” on health plans. That means the new pol­icy could run into le­gal road­blocks, although reg­u­la­tors are gen­er­ally re­luc­tant to defy a pol­icy di­rec­tive from the pres­i­dent.

The ex­ec­u­tive ac­tion fol­lows a string of leg­isla­tive de­feats in Trump’s cru­sade to have Con­gress re­peal the Af­ford­able Care Act.

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