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After repeated failures in Congress, Trump is thwarting Obamacare with the stroke of a pen.
President Trump signed an executive order Thursday that would allow healthy people to buy cheaper health insurance if they are unsatisfied with plans offered on the Affordable Care Act (ACA) marketplace. Why? Because the plans under the executive order offer much limited coverage.
Following the Republicans’ failure to pass their latest Obamacare repeal measure last month, Trump is using his executive authority to accomplish what Republicans couldn’t. Under the GOP bill, ACA enrollees would be offered lackluster plans, with cheap premiums — plans that would be unusable for people with a pre-existing condition or people who later develop a medical condition because plans fail to cover what they need. Many senators expressed concern about the impact of the legislation on vulnerable populations.
The executive order will not take immediate effect, as key details are being left for federal agencies to work out through rule-making. The order should be open to the public for comment when the rule is posted. A White House official said Thursday that the order is just the “beginning” of the administration’s actions pertaining to the ACA.
The move could break Trump and the GOP’s promise to protect sicker people’s access to affordable insurance. (Talking Points Memo has a good timeline of all the moments the GOP promised to cover people with pre-existing conditions.) Trump vowed to safeguard these consumers as a candidate, and later as the president. Now, with a stroke of a pen, he has gone back on his word, again.
This is how, as the order is threefold: it would allow small businesses (like a group of freelancers), and possibly individuals, to band together and buy insurance like a large employer would; these are called association health plans. These plans could be exempt from some Obama-era rules like the requirement that insurers cover essential health benefits, such as maternity care or mental health.
The order says “associated health plans cannot develop premiums based on health conditions.” Health policy expert Timothy Jost told ThinkProgress “they [insurers] could not discriminate against employees individually but may be able to against small groups of employees and would certainty be able to eliminate essential health benefits and take other steps to make coverage very unattractive to individuals with health care problems.”
The order also calls for expanded access to short-term health plans, which are bare-bones plans that are exempt from the health law’s regulations. Short-term health plans use “medical underwriting” that allow insurers to use health information to evaluate applicants; this practice commonly excludes people with pre-existing conditions from coverage. Under current health law, people can only have these plans for three months, but Trump’s executive order would extend their lifespan to a year, per the request of some Senate Republicans.
