Earlier today, President Trump signed a new Executive Order aimed at weakening the most draconian elements of Obamacare and aiming to make it easier for Americans to purchase the affordable healthcare coverage they need.
Some conservatives worry that using an executive order for such an action is hypocritical, considering that it uses a method that the right spurned during the Obama era, but the order's effect could massively ease the healthcare burdens of middle-class Americans.
The order loosens “some Obamacare requirements so that people can buy less comprehensive, but also less expensive, healthcare coverage, in the wake of the Senate’s failure this year to move any legislation to change the law.”
The executive order directs the departments of Health and Human Services, Labor, and Treasury to take steps to make it easier for people to band together and buy coverage through what is known as “association health plans.” It also would allow people to buy low-cost, short-term health insurance plans, which the Obama administration limited to three months, and would expand the use of health savings accounts. The process will take several months and will not go into effect in time for open enrollment, which runs from Nov. 1 to Dec. 15.
Senator Rand Paul (R-KY) praised the President’s efforts and lauded the new order.
“President Trump is doing what I believe is the biggest free-market reform of healthcare in a generation,” Senator Paul said, before adding that the order would allow millions of people to buy insurance across state lines. “I want to commend the president for having the boldness and foresight and leadership to get this done.”
We’ve been hearing about the disaster of Obamacare for so long — in my case, many years, most of it outside in civilian life. And for a long period of time since I’ve started running and since I became President of the United States, I just keep hearing “repeal and replace, repeal and replace.” Well, we’re starting that process, and we’re starting it in a very positive manner.
And I can say, when you get Rand Paul on your side, it has to be positive, that I can tell you. (Laughter.) Boy. (Applause.) I was just saying as he’s getting up and saying all these wonderful things about what we’re going to be announcing, I said, boy, that’s pretty unusual. I’m very impressed. (Laughter.)
But seven years ago, congressional Democrats broke the American healthcare system by forcing the Obamacare nightmare onto the American people. And it has been a nightmare. You look at what’s happening with the premiums and the increases of 100 percent and 120 percent, and even in one case, Alaska, over 200 percent. And now, every congressional Democrat has blocked the effort to save Americans from Obamacare, along with a very small, frankly, handful of Republicans — three. And we’re going to take care of that also because I believe we have the votes to do block grants at a little bit later time, and we’ll be able to do that.
Premiums have gone skyrocketing. But today, one-third of all the counties in America have only a single insurer selling coverage on an exchange, and next year it looks like nearly half of all counties in our country — think of that — all of the counties, one half will have only one insurer. And many will have none. Many will have absolutely created roadblocks for people to have any form of the insurance we’re talking about.
Which is why, in a few moments, I will sign an executive order taking the first steps to providing millions of Americans with Obamacare relief.
It directs the Department of Health and Human Services, the Treasury, and the Department of Labor to take action to increase competition, increase choice, and increase access to lower-priced, high-quality healthcare options. And they will have so many options. This will cost the United States government virtually nothing, and people will have great, great healthcare. And when I say people, I mean by the millions and millions.
We aim to allow more small businesses to form associations to buy affordable and competitive health insurance. This would open up additional options for employers to purchase the health plans their workers want.
I’m also directing Secretary Acosta to consider ways to expand these associations and these healthcare plans all across state lines. This will create tremendous competition and transformative — in so many ways — change aimed at creating more and lower prices for millions of Americans.
But the competition will be staggering. Insurance companies will be fighting to get every single person signed up, and you will be hopefully negotiating, negotiating, negotiating, and you’ll get such low prices for such great care. Should have been done a long time ago, and it could have been done a long time ago.
This will allow thousands of small business employers to have the same purchasing power as large employers to get more affordable and generous insurance options for their workers.
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.
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