Trump orders strike at pillars of ACA
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.”
President Donald Trump signed the executive order at a White House event surrounded by small-business owners.