Trump signs or­der to thwart health pro­gram

San Francisco Chronicle - - NATION - By Robert Pear and Reed Abelson Robert Pear and Reed Abelson are New York Times writ­ers.

WASH­ING­TON — Pres­i­dent Trump signed an ex­ec­u­tive or­der Thurs­day that clears the way for po­ten­tially sweep­ing changes in health in­sur­ance, in­clud­ing sales of cheaper poli­cies with fewer ben­e­fits and fewer pro­tec­tions for con­sumers than those man­dated un­der the Af­ford­able Care Act.

But most of the changes will not come un­til fed­eral agen­cies adopt reg­u­la­tions, af­ter an op­por­tu­nity for pub­lic com­ments — a process that could take months.

The or­der re­sulted from Trump’s frus­tra­tion with his in­abil­ity to per­suade a Re­pub­li­can-con­trolled Con­gress to re­peal the Af­ford­able Care Act, a pil­lar of Pres­i­dent Barack Obama’s le­gacy. Sup­port­ers of the cur­rent health law called the or­der “sab­o­tage,” a way to de­stroy the ACA with­out win­ning a ma­jor­ity in Con­gress.

Trump di­rected three Cabi­net agen­cies to de­velop rules that would ex­pand ac­cess to less ex­pen­sive, less com­pre­hen­sive in­sur­ance, in­clud­ing poli­cies that could be sold by trade as­so­ci­a­tions to their mem­bers and short-term med­i­cal cov­er­age that could be of­fered by com­mer­cial in­sur­ers to in­di­vid­u­als and fam­i­lies.

Short-term poli­cies could be par­tic­u­larly use­ful to peo­ple in coun­ties where only a sin­gle in­surer is of­fer­ing plans in the ACA mar­ket­place, the White House said. But short-term poli­cies can limit ben­e­fits and charge higher pre­mi­ums to peo­ple who have ex­pen­sive med­i­cal con­di­tions, a type of dis­crim­i­na­tion banned in poli­cies reg­u­lated un­der the ACA.

Many of the new in­sur­ance prod­ucts could be ex­empt from re­quire­ments of the ACA that Repub­li­cans say have con­trib­uted to sharp in­creases in pre­mi­ums but that sup­port­ers say have cre­ated a base­line of care that has pro­tected con­sumers from “junk in­sur­ance.”

Ad­min­is­tra­tion of­fi­cials said they had not yet de­cided which fed­eral and state rules would ap­ply to the new prod­ucts.

Trump’s or­der could even­tu­ally make it eas­ier for small busi­nesses to band to­gether and buy in­sur­ance through new en­ti­ties known as as­so­ci­a­tion health plans, which could be cre­ated by busi­ness and pro­fes­sional groups. A White House of­fi­cial said th­ese health plans “could po­ten­tially al­low Amer­i­can em­ploy­ers to form groups across state lines” — a goal cham­pi­oned by Trump and many other Repub­li­cans.

The ac­tion Thurs­day fol­lowed the pat­tern of pre­vi­ous pol­icy shifts that orig­i­nated with sim­i­lar di­rec­tives from the pres­i­dent. Within hours of his in­au­gu­ra­tion in Jan­uary, Trump or­dered fed­eral agen­cies to find ways to waive or de­fer any pro­vi­sions of the ACA that might bur­den con­sumers, in­sur­ers or health care providers. In May, he di­rected of­fi­cials to help peo­ple with re­li­gious ob­jec­tions to the fed­eral man­date for in­sur­ance cov­er­age of con­tra­cep­tion.

Both of those or­ders were fol­lowed up with spe­cific, sub­stan­tive reg­u­la­tions.

Doug Mills / New York Times

Pres­i­dent Trump signs an ex­ec­u­tive or­der that clears the way for po­ten­tially sweep­ing changes in health in­sur­ance.

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