ALSO SEE: Trump Signs Sweeping
Order That Could Gut Obamacare

Trump Signs Sweeping Order That Could Gut Obamacare

By Jennifer Haberkorn and Nolan D. McCaskill, Politico

21 January 17

It could be used to stop the enforcement of the individual mandate.

few hours after taking the oath of office, President Donald Trump signed a sweeping executive order that encourages federal agencies to dismantle large parts of Obamacare, possibly including the hugely unpopular mandate requiring most Americans to purchase insurance.

While only Congress can repeal the law, the nine-paragraph order effectively tells the federal government to take as much leeway as possible to "ease the burdens" on individuals, states and the health industry.

The order changes nothing immediately and doesn't spell out exactly what Trump would like his government to do. But it sends a strong symbolic message to his supporters, while offering some clues to his direction. Federal agencies could use the order to stop enforcing the individual mandate, which has been the most contentious piece of the law -- a move that could throw the individual insurance market into an almost immediate spiral.

Such steps would make the market "sicker and on average more expensive," said David Anderson, a Duke University health policy analyst who's studied the law's insurance regulations. "It may lead to carriers reconsidering their participation for the 2018 plan year."

But some analysts doubted the administration would take such dramatic actions -- at least not right away -- since both Trump and congressional Republicans have pledged to keep the Obamacare market afloat to avoid "pulling the rug out from anyone" until they have a replacement. Trump has yet to detail how he would fulfill his promise to replace the health care law.

The order could also be used to unwind the law’s taxes on the wealthy, as well as industry taxes on health insurers and medical device drug makers that helped finance Obamacare’s major coverage expansion.

In addition, it directs agencies to provide relief to the states, which could be a nod toward expanding an Obamacare waiver program that would give state officials more freedom to implement the health law as they chose.

“It's mostly symbolic, but is designed at the least to give states greater flexibility in their requests for waivers that introduce market-oriented reforms,” such as work requirements in Medicaid, said Lanhee Chen, former policy director for Mitt Romney’s 2012 presidential campaign.

Trump signed the order early this evening, seated at his new desk inside the Oval Office and joined by Vice President Mike Pence and White House chief of staff Reince Priebus.

Supporters expressed jubilation that he was moving so quickly to fulfull his campaign promises, while defenders of Obamacare reacted with shock and anger.

"While President Trump may have promised a smooth transition, the executive order does the opposite, threatening disruption for health providers and patients," said Leslie Dach, campaign director of Protect Our Care, a coalition of organizations fighting efforts to repeal Obamacare. "The president's executive order, combined with the strategy of the Congressional Republican leadership to rush ahead with repeal with no viable replacement plan, will result in taking insurance away from tens of millions of Americans, raising premiums for millions more, and threatening one sixth of the US economy."

The order says Cabinet heads "shall exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay" any provision in the Affordable Care Act that would impose a "cost, fee, tax, penalty or regulatory burden."

HHS could use the order to decide not to enforce the requirement that employers provide coverage to their workers or face a penalty. The policy has never been enforced, so there would be no change in existing policy.

The mandate on individuals, however, was in place. But some experts believe the fines have been too weak to be effective. And some are skeptical the administration would gut parts of the law that might cause the individual insurance market to collapse.

"Both the administration and Congress recognize that that might have a destabilizing impact on the market and Congress may address this issue in the forthcoming reconciliation bill," said Chris Condeluci, a former Republican health policy staffer.

Congress has already taken steps to start repealing the health care law from the legislative branch. It began the process known as reconciliation, a budget procedural rule that allows the Senate to skirt the 60-vote filibuster threshold.

Trump has said he wants a simultaneous — or near simultaneous — repeal and replacement of the law, although Republicans are struggling to coalesce around a plan to accomplish such a feat. Earlier plans for a delayed repeal were halted after Republican rank-and-file balked at repeal without having a new plan.

Republican lawmakers have made clear in recent weeks that they would look to Trump to take as much regulatory action as possible against Obamacare while they work through the messy process.

The order may even relieve pressure on Congress to act immediately.

"They’re a bit befuddled and they can say Trump is taking care of this," said Tim Jost, a health care law and policy expert. "It is a change of direction but doesn’t really change anything in terms what’s actually happening."

Trump reiterated in the order that his administration seeks the "prompt repeal" of the health care law. "Pending such repeal, it is imperative for the executive branch to ensure that the law is being efficiently implemented, take all actions consistent with law to minimize the unwarranted economic and regulatory burdens of the Act, and prepare to afford the States more flexibility and control to create a more free and open healthcare market," the order says.