Much of the enforcement of ACA regulations are at the will of the executive branch, and Trump is doing everything he can to use those regulations to collapse the individual plan markets and force repeal of the law. Of course, doing so will wreck the country's insurance markets, plunge insurers into chaos, and jack up premiums on pretty much everyone.
But that's the point. Trump's biggest sabotage efforts so far will come next week with a new executive order that will almost certainly devastate health care coverage for millions.
President Donald Trump will sign an executive order next week to start lifting some insurance rules set by his predecessor’s Affordable Care Act in the aftermath of the failed Republican bid to repeal the law, a senior administration official said Saturday.
The order is aimed at expanding insurance options for Americans who buy coverage on their own or work for a small employer, and would include broad instructions for agencies to explore ways to loosen regulations and potentially lower premiums, as well as looking at three specific areas of health insurance. It has been anticipated by industry officials and political observers in the days since the GOP repeal effort crashed.
Republicans have long contended that the insurance rules set by the 2010 health law, popularly dubbed Obamacare, have driven up premiums in the individual and small group markets, for healthier Americans especially. Democrats and supporters of the law typically counter that the rules have protected consumers from unwittingly buying shoddy products and helped subsidize the costs of sicker Americans.
Mr. Trump will order three agencies, the departments of Health and Human Services, Labor and Treasury, to take steps to make it easier for people to band together and buy insurance through “association health plans,” the official said.
Such plans would in some ways be like large employer’s health plans, subject to some restrictions set by the Affordable Care Act, including a ban on lifetime limits. But they would be free of other regulations, including the requirement that insurance plans cover a set package of benefits. These plans are popular with conservatives; some insurers fear that associations would peel off healthier and younger individuals and leave traditional insurance plans to cover sicker and older customers.
The president also will order the agencies to start winding back an Obama-era rule curbing coverage known as “short-term medical insurance,” a low-cost but limited-protection option, and allow people to once again buy those plans for up to a year, the official said.
The Obama administration banned the sale of those plans that offered coverage for more than 90 days, arguing they were inadequate for people’s needs. Some industry officials have pressed the administration to restore them, saying that when marketed honestly they can fit the needs of particular consumers currently priced out of buying the more generous coverage available as a result of the 2010 health-care overhaul.
In addition, the executive order would order agencies to expand health reimbursement accounts, employer-funded arrangements that employees can use to pay out-of-pocket medical costs and premiums. Obama-era guidance from 2013 had prevented pretax employer dollars in the arrangements from being used to buy health insurance on the individual market.
The three moves would represent the most substantive step the White House has taken to date in paring back Affordable Care Act rules using administrative powers. They don’t go as far as many critics of the law would like but are likely to be followed by other steps, administration officials said.
The three steps combined would be a nightmare: they would recreate high-risk pools with little coverage and no guaranteed benefits other than catastrophic coverage and allow employers to move employee plans to that model,meaning millions of people would be dodging both the individual mandate and the penalty fee for not having insurance.
It would cause insurance rates for everyone else to skyrocket as a result, collapsing the markets for both individual plans and for employer-based plans too, meaning instead of real insurance, employers could offer health savings accounts for junk plans with no real coverage, and have to pay up front for the privilege (and lose the money at the end of the year if they didn't use it for health care).
In other words, it's a direct recipe for blowing up Obamacare and everyone knows it.
Democrats have characterized the effort as potentially sabotaging the consumer protections they set in the ACA, and they have won support from some insurance industry officials. The National Association of Insurance Commissioners has said it has concerns.
Some industry officials say that siphoning off healthier individuals from the existing insurance markets with the promise of skimpier benefits but lower premiums could further undermine those markets, increasing premiums ever more for the sicker, costlier enrollees that remain.
“Its aim is clearly to do with the pen what Congress wouldn’t—eliminate pre-existing condition protections, essential benefit protections and lifetime caps and turn the ACA into a sparsely available high-risk pool,” said Andy Slavitt, who was the Obama administration’s top official at the Centers for Medicare and Medicaid Services.
Only garbage coverage plans would be available through the ACA, and everyone would suffer.
But again, that's the point.