Trump moves to unravel parts of Obamacare
Washington — Frustrated over setbacks in Congress, President Donald Trump wielded his rule-making power Thursday to launch an end run that might get him closer to his goal of repealing and replacing “Obamacare.”
Whether Trump’s executive order will be the play that breaks through isn’t clear.
Experts say consumers aren’t likely to see major changes any time soon, although the White House is promising lower costs and more options.
Some experts warned that hard-won protections for older adults and people in poor health could be undermined by the skinny lower-premium plans that Trump ordered federal agencies to facilitate.
Others say the president’s plans will have a modest impact, and might even help some consumers who don’t now benefit from financial assistance under the Obama-era law.
People on different sides of the polarized health care debate did agree that it will take months for the government bureaucracy to turn Trump’s broad-brush goals into actual policies that affect millions of people who buy their own health insurance policies.
“Today is only the beginning,” Trump said at the Oval Office signing ceremony. He promised new measures in coming months, adding, “we’re going to also pressure Congress very strongly to finish the repeal and replace of ‘Obamacare’ once and for all.”
In Michigan, Maryanne Udow-Phillips, executive director of the Center for Healthcare Research and Innovation at the University of Michigan, said Trump’s orders didn’t include any detail, so it’s impossible to know what the orders will mean for consumers.
But health policy experts are concerned that the orders will result in fewer consumer protections, she said.
“What’s been discussed in the past is to reduce the regulatory structures that health plans have to follow when they sell plans in multiple states,” Udow-Phillips noted. “If it were the case that association health plans were able to form and were not subject to state regulation that would be a considerable concern.
“The National Association of Insurance Commissioners, which is bipartisan, has come out in opposition to association health plans, because they’re concerned that it’s a way to circumvent state regulation – and they’re very concerned about the solvency of these plans,” she added.
“We have seen health plans, when there’s been minimal regulation, that have lost their financial ability to insure people,” Udow-Phillips said.
Jen Anderson, spokeswoman for the Michigan Primary Care Association, said there also are concerns that Trump’s orders could destabilize the individual marketplace by allowing younger, healthier people to migrate to low-cost association plans that provide few health care benefits.
“It’s opening up a lot of loopholes,” Anderson said. “If there are more loopholes for more people to buy outside the marketplace, it makes it harder for people who need the marketplace to actually buy an affordable plan.”
Dominick Pallone, executive director of the Michigan Association of Health Plans, said his group plans to closely monitor how federal regulatory agencies implement Trump’s orders.
“Unfortunately, this executive order does not appear to offer any assistance in stabilizing the Individual Market,” Pallone added. “MAHP continues to urge the president and Congress to continue to provide cost sharing reduction subsidies for those who qualify and take additional actions to help states to stabilize the Individual Market.”
The Michigan Health and Hospital Association also expressed concern about the potential ramifications of Trump’s order. “Our primary concern is the health and well-being of Michigan residents, and we’ll continue working with all stakeholders to make sure men, women and children have access to the care and benefits they need,” said Laura Wotruba, the association’s director of public affairs.
In Washington, Democrats denounced Trump’s order as more “sabotage” while Republicans called it “bold action” to help consumers. A major small business group praised the president, while doctors, insurers and state regulators said they have concerns and are waiting to see details.
“We want to make sure that all the consumer protections are there and included,” said Michael Munger, president of the American Academy of Family Physicians.
One of the main ideas from the administration involves easing the way for groups of employers to sponsor coverage that can be marketed across the land. That reflects Trump’s longstanding belief that competition across state lines will lead to lower premiums.
Those “association health plans” could be shielded from some state and federal insurance requirements. Responding to concerns, the White House said participating employers could not exclude any workers from the plan, or charge more to those in poor health. Self-employed people might be able to join.
Other elements of the White House plan include:
Easing current restrictions on short-term policies that last less than a year -- an option for people making a life transition, from recent college graduates to early retirees. Those policies are not subject to current federal and state rules that require standard benefits and other consumer protections.
Allowing employers to set aside pre-tax dollars so workers can use the money to buy an individual health policy.
“This could be much ado about nothing, or a very big deal, depending on how the regulations get written,” said Larry Levitt of the nonpartisan Kaiser Family Foundation. “The intent of the executive order is clear, to deregulate the insurance market ... it’s unclear how far the administration will ultimately go.”
Levitt said association health plans and short-term health insurance policies could be de- signed to lure healthier people away from the state insurance markets created by the Obama health law. They’d offer lower premiums to those willing to accept fewer benefits. That would drive up costs for consumers in the already-shaky “Obamacare” markets, making them less attractive for insurers and raising subsidy expenses for the government.
But economist Douglas HoltzEakin, president of the centerright American Action Forum, said it looks like the impact will be on market niches, not the broad landscape of health insurance.
“This just isn’t a revolution to insurance markets,” he said. “It’s a policy change. What we’ve got isn’t working, so we might as well try something else.”
On Capitol Hill, House Democratic Leader Nancy Pelosi called Trump’s move “cynical.”
“The American people overwhelmingly rejected Trumpcare, but President Trump is still spitefully trying to sabotage their health care, drive up their costs and gut their coverage,” Pelosi said in a statement.
But Sen. Rand Paul, R-Ky., called Trump’s action “one of the most significant free market health care reforms in a genera- tion” that would “reduce government interference and provide more affordable health care options to everyday Americans.”
Paul attended the White House ceremony and was honored by Trump with a pen used to sign the executive order. Paul was among the handful of GOP senators whose opposition scuttled the most recent effort to repeal Obama’s law. Congressional Republicans have moved on from health care, and are now focusing on tax cuts.
About 17 million people buying individual health insurance policies are the main focus of Trump’s order. Nearly 9 million of those consumers receive tax credits under the Obama law and are protected from higher premiums.
But those who get no subsidies are exposed to the full brunt of cost increases that could reach well into the double digits in many states next year. Many in this latter group are solid middleclass, including self-employed business people and early retirees.
Cutting their premiums has been a longstanding political promise for Republicans, but experts see no immediate impact.