With Republicans in Congress unable to pass a bill to overhaul the Obama health law, President Donald Trump on Thursday took a first step to force change, approving a series of executive actions which he says will allow Americans to buy less expensive health insurance policies in the future, though the exact details of the new plans from the Trump Administration must still be developed, and won't go into effect immediately.
“I just keep hearing repeal, replace, repeal, replace, and that’s what we’re starting," the President said in a White House ceremony, emphasizing that this announcement takes the "first steps to providing millions of Americans with Obamacare relief.
"Today is only the beginning," the President declared, as he vowed to finish the repeal and replacement of Obamacare, "once and for all."
"This order takes first steps to make it easier for businesses to help their workers afford high quality and more flexible health care," the President added, though the details of how all of this would develop still must be worked out by the feds.
White House officials though stressed that any reforms would be months away, and might not change insurance coverage rules until 2019.
The reason for the delay - the changes offered up by the President would have to go through a regular government rule-making process, which takes time.
In a release, the White House said the moves by the President would "take the first steps to expand choices and alternatives to Obamacare plans and increase competition to bring down costs for consumers."
But the details of the executive actions did not indicate immediate change:
+ The order "directs the Secretary of Labor to consider expanding access to Association Health Plans"
+ The order directs three different cabinet departments "to consider expanding coverage through low cost short-term limited duration insurance" policies. Those short-term plans would not be subject to coverage rules under the Obama health law, and would likely not cover people with pre-existing conditions.
+ The Trump order directs three different cabinet departments "to consider changes to Health Reimbursement Arrangements."
"It's a promise to make changes," said Nicholas Bagley, a law professor at the University of Michigan, who added on Twitter, "it doesn't itself change anything."
"It's a chance for Trump to look like he's doing "something." But he's not, or at least not yet," Bagley added.
In documents released by the White House, there were no specifics offered on buying health insurance across state lines - something touted often by the President and GOP lawmakers - other than saying these moves by Mr. Trump would "potentially allow some employers to join together across State lines to offer coverage."
Sales of health insurance across state lines is already legal under the Obama health law, but few states and companies have engaged in that practice; many state insurance commissioners are not fans of that, either.
Reaction from Republicans and the business community was positive to the President's actions.
"This is what real free market replacement looks like," said Sen. Rand Paul (R-KY).
"Millions of Americans will be eligible to band together to demand less-expensive insurance. The 28 million individuals left behind by Obamacare will now be eligible for inexpensive insurance," Paul said.
"In the wake of the Senate’s failure to repeal Obamacare, we are grateful to President Trump for addressing regulations that make it harder and costlier for small business owners to provide healthcare for themselves and their employees," said Juanita Duggan, the head of the National Federation of Independent Business.
As for Democrats and groups that support the Obama health law, while they were waiting to see the details of what will actually change, their view was simple - that this is an effort to sabotage Obamacare.
"This will sabotage health insurance markets and will be catastrophic for millions of Americans, whose coverage will become more expensive," said Sen. Kirsten Gillibrand (D-NY).
"The executive order envisions loosely regulated plans that offer cheaper and skinnier insurance to those who are healthy," said Larry Levitt, a top executive at the Kaiser Family Foundation.
"Insurers will raise premiums and leave markets," said Andy Slavitt, who oversaw the health law during part of the Obama Administration. "New entrants will be the junk insurance companies that had gone away."
Here is the full Executive Order signed by the President, as released by the White House:
PROMOTING HEALTHCARE CHOICE AND COMPETITION ACROSS THE UNITED STATES
By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows:
Section 1. Policy. (a) It shall be the policy of the executive branch, to the extent consistent with law, to facilitate the purchase of insurance across State lines and the development and operation of a healthcare system that provides high-quality care at affordable prices for the American people. The Patient Protection and Affordable Care Act (PPACA), however, has severely limited the choice of healthcare options available to many Americans and has produced large premium increases in many State individual markets for health insurance. The average exchange premium in the 39 States that are using www.healthcare.gov in 2017 is more than double the average overall individual market premium recorded in 2013. The PPACA has also largely failed to provide meaningful choice or competition between insurers, resulting in one-third of America's counties having only one insurer offering coverage on their applicable government-run exchange in 2017.
(b) Among the myriad areas where current regulations limit choice and competition, my Administration will prioritize three areas for improvement in the near term: association health plans (AHPs), short-term, limited-duration insurance (STLDI), and health reimbursement arrangements (HRAs).
(i) Large employers often are able to obtain better terms on health insurance for their employees than small employers because of their larger pools of insurable individuals across which they can spread risk and administrative costs. Expanding access to AHPs can help small businesses overcome this competitive disadvantage by allowing them to group together to self-insure or purchase large group health insurance. Expanding access to AHPs will also allow more small businesses to avoid many of the PPACA's costly requirements. Expanding access to AHPs would provide more affordable health insurance options to many Americans, including hourly wage earners, farmers, and the employees of small businesses and entrepreneurs that fuel economic growth.
(ii) STLDI is exempt from the onerous and expensive insurance mandates and regulations included in title I of the PPACA. This can make it an appealing and affordable alternative to government-run exchanges for many people without coverage available to them through their workplaces. The previous administration took steps to restrict access to this market by reducing the allowable coverage period from less than 12 months to less than 3 months and by preventing any extensions selected by the policyholder beyond 3 months of total coverage.
(iii) HRAs are tax-advantaged, account-based arrangements that employers can establish for employees to give employees more flexibility and choices regarding their healthcare. Expanding the flexibility and use of HRAs would provide many Americans, including employees who work at small businesses, with more options for financing their healthcare.
(c) My Administration will also continue to focus on promoting competition in healthcare markets and limiting excessive consolidation throughout the healthcare system. To the extent consistent with law, government rules and guidelines affecting the United States healthcare system should:
(i) expand the availability of and access to alternatives to expensive, mandate-laden PPACA insurance, including AHPs, STLDI, and HRAs;
(ii) re-inject competition into healthcare markets by lowering barriers to entry, limiting excessive consolidation, and preventing abuses of market power; and
(iii) improve access to and the quality of information that Americans need to make informed healthcare decisions, including data about healthcare prices and outcomes, while minimizing reporting burdens on affected plans, providers, or payers.
Sec. 2. Expanded Access to Association Health Plans. Within 60 days of the date of this order, the Secretary of Labor shall consider proposing regulations or revising guidance, consistent with law, to expand access to health coverage by allowing more employers to form AHPs. To the extent permitted by law and supported by sound policy, the Secretary should consider expanding the conditions that satisfy the commonality‑of-interest requirements under current Department of Labor advisory opinions interpreting the definition of an "employer" under section 3(5) of the Employee Retirement Income Security Act of 1974. The Secretary of Labor should also consider ways to promote AHP formation on the basis of common geography or industry.
Sec. 3. Expanded Availability of Short-Term, Limited‑Duration Insurance. Within 60 days of the date of this order, the Secretaries of the Treasury, Labor, and Health and Human Services shall consider proposing regulations or revising guidance, consistent with law, to expand the availability of STLDI. To the extent permitted by law and supported by sound policy, the Secretaries should consider allowing such insurance to cover longer periods and be renewed by the consumer.
Sec. 4. Expanded Availability and Permitted Use of Health Reimbursement Arrangements. Within 120 days of the date of this order, the Secretaries of the Treasury, Labor, and Health and Human Services shall consider proposing regulations or revising guidance, to the extent permitted by law and supported by sound policy, to increase the usability of HRAs, to expand employers' ability to offer HRAs to their employees, and to allow HRAs to be used in conjunction with nongroup coverage.
Sec. 5. Public Comment. The Secretaries shall consider and evaluate public comments on any regulations proposed under sections 2 through 4 of this order.
Sec. 6. Reports. Within 180 days of the date of this order, and every 2 years thereafter, the Secretary of Health and Human Services, in consultation with the Secretaries of the Treasury and Labor and the Federal Trade Commission, shall provide a report to the President that:
(a) details the extent to which existing State and Federal laws, regulations, guidance, requirements, and policies fail to conform to the policies set forth in section 1 of this order; and
(b) identifies actions that States or the Federal Government could take in furtherance of the policies set forth in section 1 of this order.
Sec. 7. General Provisions. (a) Nothing in this order shall be construed to impair or otherwise affect:
(i) the authority granted by law to an executive department or agency, or the head thereof; or
(ii) the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.
(b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.
(c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.
DONALD J. TRUMP