Trump pledges great care as opponents cry sabotage
President orders series of health insurance tweaks that could cause market tremors
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.