Trump signs ex­ec­u­tive or­der tar­get­ing Af­ford­able Care Act.

Lodi News-Sentinel - - Front Page - By Noam N. Levey

WASH­ING­TON — Pres­i­dent Don­ald Trump moved Thurs­day to scale back rules on health in­sur­ance across the coun­try in the ad­min­is­tra­tion’s most am­bi­tious ef­fort to date to use its reg­u­la­tory pow­ers to un­der­mine the Af­ford­able Care Act.

The con­tro­ver­sial new ex­ec­u­tive or­der Trump is­sued aims to open the way for a greater num­ber of rel­a­tively cheap health plans that could of­fer skimpier cov­er­age than al­lowed un­der the health care law, of­ten called Oba­macare.

His new or­der will “pro­vide mil­lions of Amer­i­cans with Oba­macare re­lief,” Trump said as he for­mally re­leased the or­der. The changes will “in­crease com­pe­ti­tion, in­crease choice and in­crease ac­cess to lower priced, high qual­ity health care op­tions.”

“Peo­ple will have great, great health care,” Trump added, speak­ing to an au­di­ence made up of Cabi­net of­fi­cials, Vice Pres­i­dent Mike Pence, Ken­tucky Re­pub­li­can Sen. Rand Paul and own­ers of sev­eral small busi­nesses, who the White House said would ben­e­fit by the new plans.

But while loos­en­ing con­sumer pro­tec­tions in the ACA might make in­sur­ance cheaper for those in good health, that would hap­pen at the ex­pense of mil­lions of sicker Amer­i­cans, who will have to pay more, warn pa­tient ad­vo­cates, state reg­u­la­tors and oth­ers across the health care sec­tor.

The pres­i­dent’s moves, which come af­ter con­gres­sional Repub­li­cans re­peat­edly failed to roll back the 2010 health care law this year, also re­newed fears that Trump is de­ter­mined to de­lib­er­ately desta­bi­lize in­sur­ance mar­kets and weaken Obama’s sig­na­ture do­mes­tic pol­icy achieve­ment. The ad­min­is­tra­tion has al­ready taken steps to un­der­mine those mar­kets, in­clud­ing sharply cut­ting fed­eral sup­port for ef­forts to en­roll peo­ple in mar­ket­place cov­er­age next year.

The ACA im­posed new re­quire­ments on in­sur­ers, pro­hibit­ing them from turn­ing away sick con­sumers or plac­ing an­nual and life­time lim­its on med­i­cal cov­er­age, some­thing that was once com­mon­place, and man­dat­ing a ba­sic set of ben­e­fits. Those in­clude cov­er­age of pre­scrip­tion drugs, ma­ter­nity care and men­tal health treat­ment.

Repub­li­cans have long com­plained that th­ese re­quire­ments drive up costs.

Trump’s or­der leaves many im­por­tant parts of the new plans un­set­tled. That’s be­cause the pres­i­dent can­not scrap the ex­ist­ing in­sur­ance pro­tec­tions al­to­gether. They are in the law and can there­fore only be changed by an act of Con­gress.

In­stead, Trump’s ex­ec­u­tive or­der di­rects fed­eral agen­cies to de­velop new rules that would al­low in­sur­ers to by­pass some of th­ese re­quire­ments through al­ter­na­tive kinds of in­sur­ance plans.

How ef­fec­tive the new plans will be at low­er­ing costs for some — and how much of a threat they pose to the mar­ket­places — will de­pend on how ag­gres­sively the agen­cies act in writ­ing those new rules. They face con­straints from ex­ist­ing fed­eral laws, and their new rules could draw chal­lenges in court, just as Repub­li­cans chal­lenged Obama-era rules that they ar­gued over­stepped the pres­i­dent’s author­ity.

Trump’s new pro­pos­als in­clude ex­panded use of short­term plans, which don’t have to meet the in­sur­ance pro­tec­tions in the ACA.

The Obama ad­min­is­tra­tion is­sued rules that pro­hib­ited con­sumers from buy­ing th­ese plans for more than three months.

But the Trump ad­min­is­tra­tion is propos­ing to al­low peo­ple to re­main on th­ese plans longer and re­new them.

Trump’s or­der also in­structs fed­eral agen­cies to make it eas­ier for in­di­vid­ual Amer­i­cans or small busi­nesses to join to­gether to get health in­sur­ance through so-called as­so­ci­a­tion health plans.

It di­rects the Trea­sury Depart­ment to look at ways to ex­pand the use of tax-free ac­counts called Health Re­im­burse­ment Ar­range­ments that al­low em­ploy­ers to pro­vide their work­ers with ad­di­tional money for health care ex­penses.

And the or­der calls on fed­eral agen­cies to look at how con­sol­i­da­tion among hospi­tals, doc­tors and other providers may be driv­ing up costs in some mar­kets around the coun­try.

Back­ers of as­so­ci­a­tion health plans ar­gue they give small em­ploy­ers and in­di­vid­u­als the abil­ity to get cheaper cov­er­age. And ad­min­is­tra­tion of­fi­cials said Thurs­day that new as­so­ci­a­tions would be sub­ject to some of the ACA’s health in­sur­ance re­quire­ments.


U.S. Pres­i­dent Don­ald J. Trump makes re­marks prior to sign­ing an ex­ec­u­tive or­der to pro­mote health care choice and com­pe­ti­tion on Thurs­day in the White House in Wash­ing­ton, D.C.

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