White House to order health care alternatives

WASHINGTON — The White House is finalizing an executive order that would expand health plans offered by associations to allow individuals to pool together and buy insurance outside their states, a unilateral move that follows failed efforts by Congress to overhaul the health care system.

President Donald Trump has long asserted that selling insurance across state lines would trigger competition that brings down premiums for people buying their own policies. Experts say that’s not guaranteed, partly because health insurance reflects local medical costs, which vary widely around the country.

White House actions may come too late to have much impact on premiums for 2018.

Trump was expected to sign the executive order next week, likely on Thursday, a senior administration official said Sunday.

Under the president’s executive action, membership groups could sponsor insurance plans that cost less because — for example — they wouldn’t have to offer the full menu of benefits required under the Affordable Care Act, also called “Obamacare.” It’s unclear how the White House plans to overcome opposition from state insurance regulators, who see that as an end-run to avoid standards.

“There are likely to be legal challenges that could slow this effort down,” said Larry Levitt of the Kaiser Family Foundation.

Association plans “kind of went away with the ACA, and now the idea seems to be to recreate them,” said Jeff Smedsrud, a health insurance marketing entrepreneur. “It’s not clear what they would really look like.”

Smedsrud said a different option also under consideration by the White House, to loosen restrictions on “short term” insurance plans, could be a safety valve for some consumers.

Those plans generally have limited benefits and remain in force for less than a year. During the Obama administration, the availability of short-term coverage was restricted. One of Smedsrud’s companies sells short-term plans.

Others warned that over time the White House order could undermine state insurance markets created under Obama’s law, by siphoning off healthy people to plans with lower premiums.

The order was being drafted as Trump expressed willingness to work with Democrats on health care after Republicans were unable to approve legislation that would have repealed “Obamacare.”