(Bloomberg) – President Donald Trump signed an executive order Friday commanding federal agencies to try to waive or delay requirements of Obamacare that impose economic or regulatory burdens on states, families, the health-care industry and others.
The order declares that Trump’s administration will seek the “prompt repeal” of the law and that the government should prepare to “afford the states more flexibility and control to create a more free and open healthcare market.”
The immediate impact of the order wasn’t clear. One possibility is that under Trump, the Department of Health and Human Services could more broadly interpret a set of so-called “hardship” exemptions under the law, allowing more people to be exempted from the requirement that they carry insurance or pay a fine.
“I think a universal hardship exemption would be illegal and would probably be challenged by a lawsuit,” said Timothy Jost, a professor with expertise in health law at Washington and Lee University School of Law and a contributor to Bloomberg View. Representative Tom Price, Trump’s nominee for HHS secretary, “would have to discuss with his lawyers what he could and and could not do.”
‘Up to Congress’
Jost doesn’t expect agencies to take action until Price is confirmed as HHS secretary, possibly as early as next month.
“This is going to be a project that takes a while,” he said. “It will still be up to Congress to change the law.”
Also see: “ Unwinding ACA: Impacts & Implications .”
Topher Spiro, the vice president for health policy at the Democratic Party-aligned Center for American Progress, called the order “meaningless campaign messaging” in a statement.
But Representative Greg Walden, the chairman the House Energy and Commerce Committee, applauded Trump’s order. Walden’s panel has a key role in crafting a repeal of the Affordable Care Act and its replacement.
“It is heartening to see President Trump take immediate action to begin undoing the damage caused by Obamacare,” Walden said, describing the law as “crumbling.”
About 20 million people have gained coverage under the health-care law, according to the Health and Human Services Department.
“In the coming weeks, we will repeal Obamacare and begin rebuilding our broken health-care system and cleaning up the mess left behind by the previous administration,” Walden said.
Spicer also said Trump’s chief of staff, Reince Priebus, would issue a memo to government agencies ordering a freeze on new regulations. Trump has pledged to repeal two existing regulations for each new one his government issues.
Trump ran for president on a vow to repeal the ACA, and Congress has passed a budget resolution allowing for a partial repeal to advance. Republicans haven’t yet agreed on a policy to replace or amend the law, and there are internal divisions in the party about how extensive any changes should be.
Trump said in his order that government agencies should “ensure that the law is efficiently implemented” pending its repeal. Enrollment for insurance plans sold under the ACA for 2017 closes at the end of this month.
“While lacking specifics, this is more than symbolic,” Dean Rosen, a health-care lobbyist with Mehlman Castagnetti Rosen & Thomas who had served as health adviser to former Senate Majority Leader Bill Frist, said in an e-mail. “It reaffirms the commitment of the Trump administration to fulfilling the president’s campaign promise of repealing and replacing Obamacare and directs federal agencies, in the meantime, to aggressively and proactively use the breadth of their legal authority to increase free-market competition and provide states with maximum flexibility.”
Governor John Kasich of Ohio, a Republican whose constituents have experienced large gains in insurance coverage thanks to the law, has cautioned that Republicans may face “serious consequences” if changes result in people losing that coverage.
The Congressional Budget Office said in a Jan. 17 report that as many as 32 million Americans would lose their insurance coverage over 10 years if the health law is repealed without an alternative policy in place.
‘Insurance for Everybody’
Trump told the Washington Post that a replacement plan will provide “insurance for everybody,” and said in a Jan. 11 news conference that he wanted repeal and a replacement policy to be passed “essentially simultaneously.”
California Insurance Commissioner Dave Jones issued a statement on Saturday about Trump’s executive order, saying it’s “likely to destabilize health insurance markets across the United States.”
“President Donald Trump’s executive order is directly contrary to his pledge to replace the Affordable Care Act with terrific ‘insurance for everybody’ while repealing the ACA,” Jones said in the statement. If the law’s provisions are not enforced, “many health insurers ultimately will be forced to withdraw from health insurance markets,” which will “decrease competition, make health insurance unavailable, and drive up health insurance prices.”
Across State Lines
Trump’s order also requires government agencies, “to the maximum extent permitted by law,” to provide “greater flexibility” to states under the health law. Agencies should aim to “encourage the development of a free and open market in interstate commerce for the offering of health care and health insurance,” he said.
Some Republicans and Trump have proposed that insurers be allowed to sell plans across state lines. Health plans are primarily regulated by states, and insurers say it would be difficult for out-of-state plans to compete with in-state offerings.
Changes to the structure of health plans under the ACA, such as what benefits insurers are required to offer or how much they can charge, could be made through administrative actions at the Department of Health and Human Services or by rewriting regulations.
Trump also signed commissions for Defense Secretary James Mattis and Homeland Security Secretary John Kelly, who were confirmed by the Senate late Friday. They were both then sworn in by Vice President Mike Pence.
President Barack Obama’s chief of staff, Rahm Emanuel, also ordered a moratorium on all new or pending federal regulations on the day the Democrat took office in 2009.\
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