Trump or­der weak­ens Oba­macare

The Columbus Dispatch - - Front Page - By Jes­sica Wehrman

WASH­ING­TON — With a Re­pub­li­can-con­trolled Con­gress un­able to re­peal Oba­macare, Pres­i­dent Don­ald Trump is mov­ing for­ward on other op­tions that he hopes will un­ravel the Af­ford­able Care Act.

“If the Sen­ate can’t pro­vide Amer­i­cans with re­lief, then I’ll take mat­ters into my own hands,” he said in a fundrais­ing mis­sive to sup­port­ers shortly af­ter sign­ing an ex­ec­u­tive or­der Thurs­day in the White House.

Trump threw a bomb into the mar­ket­places by say­ing he’ll end crit­i­cal pay­ments

to the health in­sur­ers that help mil­lions of lower-in­come Amer­i­cans af­ford cov­er­age.

The White House con­firmed late Thurs­day that it would halt fed­eral pay­ments for cost­shar­ing re­duc­tions, 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, which help el­i­gi­ble con­sumers af­ford their de­ductibles and other out-of-pocket ex­penses, 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.

Trump also di­rected his ad­min­is­tra­tion to con­sider ex­pand­ing ac­cess to low-cost, short-term in­sur­ance not sub­ject to Oba­macare re­quire­ments such as the man­date to cover es­sen­tial health ben­e­fits — in­clud­ing hos­pi­tal­iza­tion, pre­scrip­tion drugs, ma­ter­nity care and sub­stance-abuse treat­ment — or reg­u­la­tions that re­quire in­sur­ance com­pa­nies to cover peo­ple re­gard­less of their med­i­cal his­tory.

Trump’s ad­min­is­tra­tion ar­gues that loos­en­ing such re­stric­tions would cre­ate far cheaper op­tions for those seek­ing in­sur­ance.

His ex­ec­u­tive or­der also re­laxes reg­u­la­tions on as­so­ci­a­tion health plans, which al­low small-em­ployer groups and in­di­vid­u­als to band to­gether to buy health in­sur­ance. The ex­pan­sion of such plans could al­low U.S. em­ploy­ers to form in­sur­ance groups across state

lines, which Repub­li­cans say would lower costs.

Fi­nally, the or­der di­rects Trump’s Cabi­net to con­sider ex­pand­ing ac­cess to Health Re­im­burse­ment Ar­range­ments — tax-free, em­ployer-funded ac­counts re­im­burs­ing em­ploy­ees for health-care ex­penses.

“With th­ese ac­tions, we are mov­ing to­ward lower costs and more op­tions in the health-care mar­ket and tak­ing cru­cial steps to­wards sav­ing the Amer­i­can peo­ple from the night­mare of Oba­macare,” Trump said in a cer­e­mony where he was flanked by law­mak­ers, Vice Pres­i­dent Mike Pence and other sup­port­ers.

Trump said his ac­tions will cost the fed­eral govern­ment “vir­tu­ally noth­ing, and peo­ple will have great, great health care.”

Larry Le­vitt, a se­nior vice pres­i­dent for the Kaiser Fam­ily Foun­da­tion, tweeted: “Pres­i­dent Trump’s ex­ec­u­tive or­der as­pires to do a lot. If it ful­fills its as­pi­ra­tions, it would un­der­mine (Oba­macare) sig­nif­i­cantly. A big if.”

Le­vitt also wrote, “Likely losers with the ex­ec­u­tive or­der: Peo­ple with pre-ex­ist­ing con­di­tions. Win­ners: Healthy peo­ple (and their small em­ploy­ers), lawyers.”

Peo­ple on dif­fer­ent sides of the po­lar­ized de­bate did agree that it will take months for the fed­eral bu­reau­cracy to turn Trump’s broad-brush goals into ac­tual poli­cies.

To sup­port­ers, Trump’s or­der opens new in­sur­ance al­ter­na­tives at po­ten­tially lower prices, help­ing to fol­low through on a cam­paign prom­ise to undo Oba­macare that Repub­li­cans have made since the law was passed in 2010.

To de­trac­tors, the move was re­peat­edly de­scribed with one word: Sab­o­tage.

“In­stead of em­ploy­ing

back­door tac­tics meant to un­der­mine im­por­tant health­care pro­tec­tions, Pres­i­dent Trump should come to the ta­ble with mem­bers of both par­ties to pur­sue mean­ing­ful health-care re­form that ben­e­fits Ohioans,” said Sen. Sher­rod Brown, D–Ohio.

Brown ar­gued that the ex­panded as­so­ci­a­tion plans would limit ac­cess to such ben­e­fits as ma­ter­nity ser­vices and emer­gency care and desta­bi­lize the Oba­macare mar­ket by flood­ing the in­sur­ance mar­ket with skimpier plans.

Brown and oth­ers — in­clud­ing Ohio Gov. John Ka­sich — had ar­gued for a bi­par­ti­san so­lu­tion to shoring up the Oba­macare mar­kets. Sen. Patty Mur­ray, D-Wash., and Sen. La­mar Alexan­der, R-Tenn., en­gaged in bi­par­ti­san talks that were thwarted by GOP Sen­ate lead­ers.

U.S. Rep. Tim Ryan, D-Niles, was es­pe­cially crit­i­cal of Trump’s ac­tions.

“Since he first an­nounced his cam­paign for the pres­i­dency, I’ve heard Pres­i­dent Trump falsely claim dozens of times that the Af­ford­able Care Act was col­laps­ing. To­day, I am in dis­be­lief that the pres­i­dent would so bla­tantly sab­o­tage Amer­ica’s health­care sys­tem in or­der to make that false­hood a re­al­ity. His ex­ec­u­tive or­der will cre­ate a loop­hole that would al­low in­sur­ers to sell wa­tered-down in­sur­ance plans that do not cover es­sen­tial health ben­e­fits like preg­nancy cov­er­age, men­tal-health care, and cancer screen­ings. It dis­man­tles cov­er­age pro­tec­tions for peo­ple with pre-ex­ist­ing con­di­tions and fur­ther dis­ad­van­tages the sick and mid­dle class.”

While Democrats de­cried Trump’s ac­tion, Repub­li­cans

such as Rep. Jim Jor­dan, R-Ur­bana, said Trump was “do­ing what vot­ers sent him here to do.”

“To­day’s ex­ec­u­tive or­der on health care will start to give ev­ery­day Amer­i­cans the re­lief they need from soar­ing pre­mi­ums,” Jor­dan said, while call­ing on Con­gress to fully re­peal Oba­macare.

“Oba­macare added a tan­gled mess of bu­reau­cracy, man­dates and reg­u­la­tions to our health-care sys­tem,” said Rep. Pat Tiberi, R-Genoa Town­ship, adding that those on the Oba­macare ex­changes have been pay­ing more for lower qual­ity care.

“The pres­i­dent is tak­ing a nec­es­sary step by in­struct­ing his ad­min­is­tra­tion to do what they can un­der cur­rent law to re­store the free mar­ket, lower costs and im­prove ac­cess to qual­ity care.”

On Thurs­day, Ohio’s Demo­cratic House del­e­ga­tion — Reps. Joyce Beatty of Jef­fer­son Town­ship, Marcia Fudge of Cleve­land, Marcy Kap­tur of Toledo and Ryan — sent a let­ter to Cen­ter for Medi­care and Med­i­caid Ser­vices Ad­min­is­tra­tor Seema Verma com­plain­ing about cuts in ser­vices and outreach pro­grams de­signed to en­roll ci­ti­zens in Oba­macare.

“In­di­vid­u­als will now be with­out the help they need to en­roll in health-care plans even though ev­ery Amer­i­can is re­quired to have health in­sur­ance un­der cur­rent law and face tax con­se­quences if they fail to ob­tain cov­er­age,” the group wrote.

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