Trump makes end run on health rules

Frus­trated by fail­ures in Congress, he tries to put own stamp on care

Richmond Times-Dispatch - - NATION & WORLD - In­for­ma­tion from The Wash­ing­ton Post was in­cluded in this re­port.

WASH­ING­TON — Frus­trated over set­backs in Congress, Pres­i­dent Don­ald Trump wielded his rule-mak­ing power Thurs­day to launch an end run that might get him closer to his goal of re­peal­ing and re­plac­ing “Oba­macare.”

Whether Trump’s ex­ec­u­tive or­der will do the trick isn’t clear.

Ex­perts say con­sumers aren’t likely to see ma­jor changes any­time soon, although the White House is promis­ing lower costs and more op­tions.

Some ex­perts warned that hard-won pro­tec­tions for older adults and peo­ple in poor health could be un­der­mined by the skinny lower-premium plans that Trump or­dered fed­eral agen­cies to fa­cil­i­tate.

Others say the pres­i­dent’s plans will have a mod­est im­pact, and might even help some con­sumers who don’t ben­e­fit from fi­nan­cial as­sis­tance un­der the Obama-era Af­ford­able Care Act.

Peo­ple on dif­fer­ent sides of the po­lar­ized de­bate did agree that it will take months for the bu­reau­cracy to turn Trump’s broad-brush goals into ac­tual poli­cies that af­fect mil­lions of peo­ple who buy their own health in­sur­ance poli­cies.

“To­day is only the be­gin­ning,” Trump said at the Oval Of­fice sign­ing cer­e­mony. He promised new mea­sures in coming months, adding, “We’re go­ing to also pres­sure Congress very strongly to fin­ish the re­peal and re­place of Oba­macare once and for all.”

One of the main ideas from the ad­min­is­tra­tion in­volves eas­ing the way for groups of em­ploy­ers to spon­sor cov­er­age that can be marketed across the coun­try. That re­flects Trump’s long-stand­ing be­lief that com­pe­ti­tion across state lines will lead to lower pre­mi­ums.

Those “as­so­ci­a­tion health plans” could be shielded from some state and fed­eral in­sur­ance re­quire­ments. Re­spond­ing to con­cerns, the White House said par­tic­i­pat­ing em­ploy­ers could not ex­clude any work­ers from the plan, or charge more to those in poor health. Selfem­ployed peo­ple might be able to join.

Other el­e­ments of the White House plan in­clude:

Eas­ing cur­rent re­stric­tions on poli­cies that last less than a year — an op­tion for peo­ple mak­ing a life tran­si­tion, from re­cent col­lege grad­u­ates to early re­tirees. Those poli­cies are not sub­ject to cur­rent fed­eral and state rules that re­quire stan­dard ben­e­fits and other con­sumer pro­tec­tions.

Al­low­ing em­ploy­ers to set aside pre­tax dol­lars so work­ers can use the money to buy an in­di­vid­ual health pol­icy.

“This could be much ado about noth­ing, or a very big deal, de­pend­ing on how the reg­u­la­tions get writ­ten,” said Larry Le­vitt of the non­par­ti­san Kaiser Fam­ily Foun­da­tion. “The in­tent of the ex­ec­u­tive or­der is clear, to dereg­u­late the in­sur­ance mar­ket. ... It’s un­clear how far the ad­min­is­tra­tion will ul­ti­mately go.”

Late Thurs­day, the White House con­firmed that it would end crit­i­cal pay­ments to health in­sur­ers that help mil­lions of lower-in­come Amer­i­cans af­ford cov­er­age, although a state­ment did not spec­ify when. Ac­cord­ing to two peo­ple briefed on the de­ci­sion, the cut­off will be as of Novem­ber. The sub­si­dies to­tal about $7 bil­lion this year.

Trump has threat­ened for months to stop the pay­ments, but held off while other ad­min­is­tra­tion of­fi­cials warned him that such a move would cause an im­plo­sion of the ACA mar­ket­places that could be blamed on Repub­li­cans.

End­ing the pay­ments is grounds for any in­surer to back out of its fed­eral con­tract to sell health plans for 2018.

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