Trump signs order that could gut ACA

WASHINGTON President Donald Trump signed an executive order late Friday giving federal agencies broad powers to unwind regulations created under the Affordable Care Act, including enforcement of the penalty for people who fail to carry the health insurance that the law requires of most Americans.

The executive order, signed in the Oval Office as one of the new president’s first actions, directs agencies to grant relief to every one of the constituencies affected by the sprawling 2010 health care law: insurers, hospitals, doctors, pharmaceutical companies and states. While the order does not describe specific federal rules to be softened or lifted, it appears to give room for agencies to eliminate an array of taxes and requirements that exist under the law.

Though the new administration’s specific intentions are not not yet clear, the order’s breadth and early timing carry symbolic value for a president who made repealing the ACA — his predecessor’s signature domestic achievement — a leading campaign promise.

Additionally, the order’s language about easing economic and regulatory burdens aligns with long-standing Republican orthodoxy that the government exerts too heavy a hand on the U.S. health care system.

The order, several paragraphs long, does not identify which of the many federal rules that exist under the ACA the new administration intends to rewrite or eliminate. In general, federal rules cannot be undone with a pen stroke but require a new rule-making process to replace or delete them.

But in giving agencies permission to “waive, defer, grant exemptions from or delay” ACA rules, the order appears to create room for the Department of Health and Human Services to narrow or gut a set of medical benefits that the ACA compels insurers to include in health plans that they sell to individuals and small businesses.

The order’s reference to relief from financial burdens could mean that the administration might try to ease taxes that the ACA imposes on various parts of the health care industry — though it is unclear whether that would be possible, since the taxes are contained in the law itself.

The order does not mention Medicaid, but it says one of its goals is to “provide greater flexibility to States,” raising the question of whether the Trump HHS might try to loosen rules for states that have expanded the program for lower-income Americans, as the law allowed.

The order directs all federal agencies “to minimize the unwarranted economic and regulatory burdens” of the Affordable Care Act — the first step of Trump’s central campaign promise to repeal and replace former president Barack Obama’s health care plan.

Also late Friday, Reince Priebus, Trump’s chief of staff, issued an executive memorandum ordering a freeze on regulations for all government agencies.

The memo could freeze several new Energy Department efficiency standards affecting portable air conditioners, swimming pool umps, commercial boilers and uninterruptable power supplies, which were issued Dec. 28 but not yet published in the Federal Register. The regulations were part of the Obama administration’s broader effort to cut greenhouse gas emissions linked to climate change.

The move echoes a missive that then-White House Chief of Staff Rahm Emanuel sent the heads of every federal agency on Jan. 20, 2009, asking them to freeze any rules that had not yet been published in the Federal Register, and to consider a 60-day extension of the effective date of rules that had not yet gone into effect.

Also Friday, Trump signed the official paperwork installing Defense Secretary James Mattis and Homeland Security Secretary John Kelly, two of his Cabinet picks whom the Senate had voted to confirm earlier in the day.

Juliet Eilperin and Steven Mufson contributed to this report.