What Does Trump’s Executive Order on Obamacare Mean?

Today, President Trump signed an executive order directing HHS, the Treasury, and Labor Dept to consider several changes to health insurance regulations. This EO does not change any laws or rules currently in place, just directs the above departments to consider drastic rule changes. No changes were made to the Open Enrollment period scheduled for Nov 1st through Dec 15th, nor were any changes made to the plans currently available on the marketplace. ACA compliant employer-based coverage is unchanged for the moment as well. 

The short of it: You may eventually have access to cheaper plans, but they won’t have the same coverage levels, including protections for pre-existing conditions.

Winners: The young, healthy, and people who can’t afford marketplace plans, who can opt for cheaper coverage.

Losers: Sick people, employers and their employees, who will likely see premiums rise significantly OR their benefits cut.

Long term: Healthy, young, and financially-strapped people could leave the marketplace, leading to higher premiums for everyone, especially in the employer market. Facing higher costs, employers are likely to switch to plans that don't cover essential health benefits, including mental health coverage and maternity care. 

Dylan Matthews at Vox answers some other questions: 

1) When does this actually go into effect?

Trump has technically asked federal agencies to consider issuing new regulations that achieve the executive order's goals. That's all.

Federal rulemaking takes some time, months upon months. Senior administration officials told reporters today that they didn't expect any changes to be made before the end of the year.

2) Which Obamacare regulations are actually being targeted?

This answer comes in two buckets.

For association health plans: If they can be considered large-group plans, they no longer have to comply with Obamacare's requirement that they cover certain essential health benefits. Large employers are exempt from that rule, which is limited to individual and small-group plans.

For short-term insurance: These plans are completely free from the ACA's regulations. Carriers can deny people coverage based on their medical history, charge people higher premiums based on their health status, and limit their benefits significantly more than the health care law allows. 

3) Can individuals buy into association health plans? 

This is maybe the biggest question. Experts generally agree that if individuals are allowed to join the association plans, the impact on the Obamacare marketplaces will be much more severe.

The executive order itself seems to limit the plans to businesses. But administration officials, in their call with reporters, indicated that they will look at whether they can allow self-employed people to buy into these associations.

"That is both a legal and policy question," one official said, adding it was "potentially possible" to allow those people to join associations.

4) Will this coverage be considered compliant with the individual mandate?

This is another issue with huge consequences. The one deterrent for people absconding to these skimpy plans, particularly the short-term insurance, is that they could still be subject to the individual mandate because the plan doesn't qualify as minimal coverage.

But if that changes, people would have even more incentive to abandon Obamacare and buy these skimpier plans, which would further damage the law's markets.

In the call with reporters, administration officials were coy. They simply noted that the executive order didn't address what is considered minimal coverage. They did point out that large-group coverage, which is what many association plans may soon be considered, is generally found to satisfy the mandate.

Any further changes to that threshold, particularly if the Trump administration makes short-term coverage compliant, would be a game changer.

5) What can states do?

We won't know until we see the regulations how much the traditional state authority to regulate association health plans and short-term insurance will be preempted. But experts are watching closely.

If states still have significant oversight, they could — if they so chose — potentially do a lot to limit people migrating to these skimpier plans.

But the Trump administration may try to write the new rules to handcuff states as much as possible.

6) Can these changes be challenged in court?

We simply won't know for sure until the administration proposes some actual regulations.

"It’s just a set of marching orders," Nicholas Bagley, a law professor at the University of Michigan, said of the executive order.

"We can speculate about what the agencies might do, and whether what they might do might be unlawful," he added. "But it’s hard to handicap the odds of a challenge to something that hasn’t yet happened."