Trump signs health care in­sur­ance or­der

The Reporter (Lansdale, PA) - - FRONT PAGE - By Ri­cardo Alonso-Zaldivar

WASH­ING­TON » Frus­trated by health care fail­ures in Con­gress, Pres­i­dent Don­ald Trump di­rected his ad­min­is­tra­tion Thurs­day to re­write some fed­eral in­sur­ance rules as a be­gin­ning of re­newed ef­forts to un­der­mine “Oba­macare,” the pro­gram he’s promised to kill.

“With th­ese ac­tions, we are mov­ing to­ward lower costs and more op­tions in the health care mar­ket,” Trump said be­fore sign­ing his di­rec­tive in the Oval Of­fice. Trump said he will con­tinue to pres­sure Con­gress to re­peal and re­place for­mer Pres­i­dent Barack Obama’s Af­ford­able Care Act.

Some ex­perts said the White House plan could un­der­mine cov­er­age on the ACA’s in­sur­ance mar­ket­places, par­tic­u­larly for peo­ple with health

problems. That would hap­pen if healthy peo­ple flock to lower-cost plans with lim­ited ben­e­fits.

Other ex­perts said Trump’s pro­pos­als ap­pear to be mod­est and would have lim­ited im­pact.

The steps the pres­i­dent out­lined Thurs­day will take months for the fed­eral bu­reau­cracy to fi­nal­ize in reg­u­la­tions. Ex­perts said con­sumers should not ex­pect changes for next year.

One of the main ideas from the ad­min­is­tra­tion in­volves eas­ing the way for groups and as­so­ci­a­tions of em­ploy­ers to spon­sor cov­er­age that can be mar­keted across the land. That re­flects Trump’s long­stand­ing be­lief that in­ter­state com­pe­ti­tion will lead to lower pre­mi­ums for con­sumers who buy their own health in­sur­ance poli­cies, as well as for small busi­nesses.

Those “as­so­ci­a­tion health plans” could be shielded from some state and fed­eral in­sur­ance re­quire­ments. But 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.

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 ex­ec­u­tive or­der is the start of a long process as the gears of the fed­eral bu­reau­cracy churn, not the fi­nal word,” said Larry Le­vitt of the non­par­ti­san Kaiser Fam­ily Foun­da­tion.

It’s also un­likely to re­verse the trend of in­sur­ers ex­it­ing state mar­kets. About half of U.S. coun­ties will have only one “Oba­macare” in­surer next year, although it ap­pears that no coun­ties will be left with­out a car­rier as was ini­tially feared. White House of­fi­cials said over time, the new poli­cies will give con­sumers more op­tions.

Democrats are brac­ing for an­other ef­fort by Trump to dis­man­tle “Oba­macare,” this time with the rule­mak­ing pow­ers of the ex­ec­u­tive branch. Staffers at the de­part­ments of Health and Hu­man Ser­vices, La­bor and Trea­sury have been work­ing on the op­tions since shortly af­ter the pres­i­dent took of­fice.

On Capi­tol Hill, House Demo­cratic Leader Nancy Pelosi said Trump “knows very lit­tle” about health care pol­icy or leg­is­la­tion. She said she was un­fa­mil­iar with the de­tails of the ex­ec­u­tive or­der, “but I do know it’s a sab­o­tage of the Af­ford­able Care Act.”

But Sen. John Bar­rasso, R-Wyo, said Trump is tak­ing “bold ac­tion” to give pa­tients “the free­dom and flex­i­bil­ity to choose the health care plan that works best for them.”

As Trump him­self once said, health care is com­pli­cated and get­ting his way won’t be as easy as sign­ing a pres­i­den­tial or­der.

State at­tor­neys gen­eral and state in­sur­ance reg­u­la­tors may try to block the ad­min­is­tra­tion in court, if fed­eral reg­u­la­tions are seen as a chal­lenge to state over­sight author­ity.

Ex­perts say the ex­ec­u­tive or­der won’t pre­mi­ums for 2018, which are ex­pected to be sharply higher in many states for peo­ple buy­ing their own poli­cies.

Spon­sors would have to be found to of­fer and mar­ket the new style as­so­ci­a­tion plans, and in­sur­ers would have to step up to de­sign and ad­min­is­ter them.

“This just isn’t a rev­o­lu­tion to in­sur­ance mar­kets,” said econ­o­mist Dou­glas Holtz-Eakin, pres­i­dent of the cen­ter-right Amer­i­can Ac­tion Fo­rum. “It’s a pol­icy change. What we’ve got isn’t work­ing, so we might as well try some­thing else.”

Sen. Rand Paul, R-Ky., was at the White House cer­e­mony, and Trump hon­ored him by hand­ing him a pen used to sign the 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.


Pres­i­dent Don­ald Trump shows an ex­ec­u­tive or­der on health care that he signed in the Roo­sevelt Room of the White House on Thurs­day.

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