- U.S. President Donald Trump issued an executive order related to the Affordable Care Act just hours after his inauguration on Friday.
- Under the executive order, HHS and other federal agencies with responsibilities under the ACA "shall exercise all authority and discretion available to them to waive, defer, grant exemptions from or delay implementation of any provision or requirement that would impose a fiscal burden on any state or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers" and more.
- While the order does not immediately change former President Obama's signature healthcare law, it sets the stage for how the Trump administration could slowly unwind enforcement of certain ACA provisions, such as the individual mandate.
Earlier this month, Trump said he would have "healthcare taken care of in this country" as soon as HHS Secretary nominee Rep. Tom Price (R-GA) is confirmed, but his Senate Finance Committee confirmation hearing is scheduled for later this week (January 24). Despite the recent flood of reports outlining the highly detrimental impact a repeal-and-replace would have on the consumer market as well as the hospital and insurance industries, the administration has embarked on a race to reform the complex healthcare system.
"This will set the gears of the bureaucracy moving in a very different direction," Larry Levitt, senior vice president at the Kaiser Family Foundation, told CNN. "Many of the changes envisioned in this order will take time to implement, but it signals a clear direction."
The executive order also instructs agencies to increase states' flexibility and encourage the "development of a free and open market in interstate commerce" for health insurance and healthcare services. However, Health Policy and Strategy Associates President Robert Laszewski says the President dropped a "bomb" into an "already shaky" ACA marketplace, as quoted by The Washington Post, since a large number of health insurers have already substantially rolled back their participation.
What worries Nicholas Bagley, an assistant professor of law at the University of Michigan Law School, is Trump's "marching orders" to delay the implementation of the individual mandate. As the ACA is currently written, the individual mandate is needed to help create healthy risk pools to keep the markets stable. "The insurance markets in many states could go into a tailspin," Bagley wrote in an The Incidental Economist article. By delaying an individual mandate, "Rates for 2018 will skyrocket and some insurers could fold," Bagley predicts. "In addition, delaying the mandate would preempt any debate in Congress about whether to keep the mandate in place during a transition period to a yet-to-be-disclosed replacement."