President Trump didn’t waste any time getting started on structuring the post-Obamacare world. He signed an executive order Friday night instructing federal agencies to minimize the economic and regulatory burden of the Affordable Care Act on states, individuals, insurance companies, and healthcare providers.
Perceptions of the order vary wildly, and it’s hard to know exactly what to make of it. The order is viewed by observers on our side of the ledger as largely symbolic, but important in reinforcing the message to Trump’s supporters and dazed Democrats that he is serious about repealing Obamacare. The order sets the tone, but is short on specifics.
It starts out by declaring it is the policy of the administration to seek prompt repeal of Obamacare in Congress. Then it instructs agencies to exercise all available authority and discretion to waive, defer, delay, or grant exemptions to any requirement of the Act.
Some on the Left claim this language guts Obamacare completely, especially with respect to the individual and employer mandates, and all the new taxes. But that’s a stretch. It clearly does not repeal Obamacare all by itself. Moreover, the order explicitly tells agencies they should act only “to the maximum extent permitted by law” and they must follow the regular rulemaking process where new regulations are needed. With notice and comment periods, new regulations could take months or years. It has been suggested that these restrictions don’t mean much and agencies could just go wild under the order, delaying the employer mandate, for example. After all, Obama opened the door by doing so much through executive fiat with a pen and a phone. Anything is possible, and I don’t have any inside information to confirm or contradict the theory that the order is really meant to be carte blanche. We’ll have to wait and see.
But there are three areas where the order could make a real difference. It could result in the administration no longer defending the House lawsuit against Obama’s illegal cost sharing subsidies, currently being paid with unappropriated money. Second, it might become easier for people to claim a hardship exemption to the individual mandate when they fill out their tax forms. Kellyanne Conway suggested on a Sunday show that Trump might get rid of, or stop enforcing the individual mandate, MIGHT, so nothing’s definite yet. Third, the order probably means states will find it easier to get waivers to charge small premiums and impose work requirements on their Medicaid recipients. The Obama administration had routinely denied state requests for such work requirement waivers.
To me, the most important part of the order is the provision encouraging the development of a free and open market for health insurance with the goal of achieving the maximum number of options for consumers. Some say this guts Obamacare’s coverage mandates, like preexisting conditions. I doubt that, and find the provision significant for another reason. I’m reading the tea leaves a bit, but this is the first concrete assurance I have seen that Trump’s ambiguous comments on ’60 Minutes’ about ‘taking care of everybody’ and again just last week about providing ‘insurance for all’ do NOT mean he wants a government-run single-payer healthcare system. And that’s a good thing.
Fox News (full text of the order)