Trump or­ders strike at pil­lars of ACA

Star Tribune - - FRONT PAGE - Staff writer Glenn Howatt con­trib­uted to this re­port.

The fifth year’s open-en­roll­ment sea­son for con­sumers to buy cov­er­age through ACA ex­changes will open in less than three weeks, and in­sur­ers have said that stop­ping the cost­shar­ing pay­ments would be the sin­gle great­est step the Trump ad­min­is­tra­tion could take to


• Let groups of em­ploy­ers spon­sor cov­er­age that can be sold across state lines, and shield those plans from some state and fed­eral re­quire­ments.

• Al­low short-term plans to last a year in­stead of 3 months.

• Halt bil­lions of dol­lars in pay­ments to in­sur­ers that have helped cover costs for low­in­come Amer­i­cans.

harm the mar­ket­places — and the law.

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

Word of the pres­i­dent’s de­ci­sion, which was first re­ported by Politico, came just hours af­ter he signed the ex­ec­u­tive or­der in­tended to cir­cum­vent the ACA by mak­ing it eas­ier for in­di­vid­u­als and small busi­nesses to buy al­ter­na­tive types of health in­sur­ance with lower prices, fewer ben­e­fits and weaker govern­ment pro­tec­tions. The White House and al­lies por­trayed the pres­i­dent’s move as wield­ing ad­min­is­tra­tive pow­ers to ac­com­plish what con­gres­sional Repub­li­cans have failed to achieve: fos­ter­ing more cov­er­age choices while tear­ing down the law’s in­sur­ance mar­ket­places.

Crit­ics, who in­clude state in­sur­ance com­mis­sion­ers, most of the health-in­sur­ance in­dus­try and main­stream pol­icy spe­cial­ists, pre­dict that a pro­lif­er­a­tion of th­ese other kinds of cov­er­age will have dam­ag­ing rip­ple ef­fects, driv­ing up costs for con­sumers with se­ri­ous med­i­cal con­di­tions and prompt­ing more in­sur­ers to flee the law’s mar­ket­places. Part of Trump’s ac­tion, they say, will spark court chal­lenges over its le­gal­ity.

The most far-reach­ing el­e­ment of the or­der in­structs a trio of Cabi­net de­part­ments to re­write fed­eral rules for “as­so­ci­a­tion health plans” — a form of in­sur­ance in which small busi­nesses of a sim­i­lar type band to­gether through an as­so­ci­a­tion to ne­go­ti­ate health ben­e­fits. Th­ese plans have had to meet cov­er­age re­quire­ments and con­sumer pro­tec­tions un­der the 2010 health care law, but the ad­min­is­tra­tion is likely to ex­empt them from those rules and let such plans be sold from state to state with­out in­sur­ance li­censes in each one.

In ad­di­tion, the or­der is de­signed to ex­pand the avail­abil­ity of short-term in­sur­ance poli­cies, which of­fer lim­ited ben­e­fits as a bridge for peo­ple between jobs or young adults no longer el­i­gi­ble for their par­ents’ health plans. The Obama ad­min­is­tra­tion ruled that short-term in­sur­ance may not last for more than three months; Trump wants to ex­tend that to nearly a year.

Health pol­icy ex­perts pointed out that the or­der’s lan­guage is fairly broad, so the en­su­ing fine print in agen­cies’ rules will de­ter­mine whether the im­pact will be as sweep­ing or quick as Trump boasted — his di­rec­tive will pro­vide “mil­lions of peo­ple with Oba­macare re­lief,” he said.

In Min­nesota, small­busi­ness lead­ers re­sponded fa­vor­ably.

“The de­sire and the need to have more op­tions and cheaper op­tions has re­ally been height­ened now,’’ said Mike Hickey, Min­nesota di­rec­tor for the Na­tional Fed­er­a­tion of In­de­pen­dent Busi­ness. Hickey said the fed­er­a­tion has pressed for the abil­ity to sell health in­sur­ance plans to mem­bers’ em­ploy­ees across state lines, and Trump’s or­der could be a first step.

Min­nesota’s ma­jor health in­sur­ers were less san­guine.

Allison O’Toole, chief ex­ec­u­tive of MN­sure, the state’s health in­sur­ance ex­change, said Trump’s or­der won’t have much im­me­di­ate ef­fect, and that con­sumers’ choices in the up­com­ing open-en­roll­ment pe­riod will be much like they’ve been in the past. But in the long run, she said she fears the ef­fect will be wor­ri­some.

“There are very real con­cerns that this or­der could siphon off healthy peo­ple from the in­di­vid­ual mar­ket, fur­ther desta­bi­liz­ing it and driv­ing up pre­mi­ums.”

DOUG MILLS • New York Times

Pres­i­dent Don­ald Trump signed the ex­ec­u­tive or­der at a White House event sur­rounded by small-busi­ness own­ers.

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