By Miriam Raftery
January 22, 2017 (Washington D.C.) – In one of his first actions as President, Donald Trump signed an Executive Order directing federal agencies to reduce financial costs of the Affordable Care Act on insurance companies, healthcare providers and patients, allowing agencies to “waive, defer, grant exemptions or delay implementation of any provision or requirement” of the ACA, also known as Obamacare.
California Insurance Commissioner Dave Jones issued a stating blasting the decision. “Based on my experience as the regulator of the largest insurance market in the United States, this Executive Order is likely to destabilize health insurance markets across the United States. President Trump’s Executive Order is also contrary to his promise to provide health care coverage to all Americans,” Jones says.
Trump has pledged to repeal the Affordable Care Act and replace it with terrific “insurance for everybody,” though Republican leaders in Congress have quickly said they believe the President meant access to healthcare, meaning the option to purchase insurance—not guaranteed healthcare for all as all other industrialized nations in the world currently have.
Jones says Trump’s order will “create uncertainty in health insurance markets as to whether the federal government will enforce critically important provisions of the Affordable Care Act. The Executive Order specifically directs federal agencies not to enforce ACA provisions that make sure that all Americans are getting health insurance so that the costs of treating sick and unhealthy Americans are spread across large enough risk pools,” he notes. “Without enforcement of these ACA provisions, many health insurers will ultimately be forced to withdraw from health insurance markets.” That would “decrease competition, make health insurance unavailable, and drive up health insurance prices,” he predicts.
A major insurance company spokesman agrees. Larry Levitt, senior vice president at the Kaiser Family Foundation, says Trump’s order is likely to result in widespread waivers from the individual mandate for insurance which he predicts “would likely create chaos in the individual insurance market.”
David Anderson, health policy analyst at Duke University, believes such actions would make the market “sicker and an overage more expensive,” for consumers, Politico has reported.
The order doesn’t specifically exactly what would be cut or waived. However, one stated goal is to “provide greater flexibility to States.” The Washington Post suggests this could open the door to changing rules for states that expanded Medicare under the ACA, an action that could affect many low-income Americans.
Reuters reports that Joe Antos at the American Institute Think Tank has suggested that insurance companies might be allowed to offer policies that exclude costly items such as maternity care, coverage that is required under the ACA to protect mothers and their unborn babies.
Under Trump’s order, agencies could also roll back taxes on health insurers, medical device makers and the wealthy that have been used to help finance costs of the ACA. Trump’s administration could allow employers to avoid ACA requirements to cover workers or face penalties.
It is unclear how much of the ACA Trump could dismantle through executive action, without action by Congress, which passed the ACA. But the Republican-controlled Senate already voted to begin repeal of the ACA, without waiting for a replacement. The House, also in Republican control, voted many times during Obama’s administration to repeal the ACA without a replacement plan.
Repeal of the ACA would also affect people who never had an ACA or Obamacare plan, since the ACA also set rules for private insurance companies such as prohibiting insurers from denying coverage to people due to preexisting conditions, and allowing parents to keep kids on their plans until age 25.
President Trump, on the campaign trail, repeatedly vowed to repeal Obamacare but has said he would replace it—not create a massive void of uncertainty in the marketplace.
Congressional Republicans who ran on a platform of repealing the ACA are now learning that it may be more difficult than they anticipated, with recent polls showing over 60% of Americans now support the ACA and don’t want it repealed, though many acknowledge problems with the ACA that they want to see fixed, such as high premiums for some middle-income people and a shortage of doctors accepting Medicare patients due to an increase in people enrolled in Medicare and lower reimbursement rates for physicians.
Editor’s Note: We are basing our excerpts of Trump’s Executive Order from copies posted in articles by members of the White House press corps, since the White House website’s press room to date has nothing posted under presidential actions, executive orders, press briefings, statements or news releases. Other than Trump’s inaugural speech, not a word of anything he has done since the swearing in ceremony Friday has yet appeared at www.WhiteHouse.gov for the public and press across the nation to evaluate – a troubling departure from prior administrations that have promptly posted such materials. Nor is there any press contact listed for media to call or e-mail with questions.