Trump moves to un­ravel parts of Oba­macare

The Detroit News - - Front Page - BY RI­CARDO ALONSO-ZALDIVAR As­so­ci­ated Press

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.

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