Reactions to Trump’s plans to dismantle ACA through executive order (Updated)

The signed order has elicited a range of reactions from satisfaction from small business associations and Donald Trump’s base to concern from critics who accused him of sabotaging ACA. Late Thursday the White House acknowledged it would end subsidies to insurance companies.

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With a stroke of his pen, President Donald Trump sidestepped the messy legislative process of fixing ongoing problems with the Affordable Care Act and the failed attempts by the GOP-led Congress to repeal and replace it with an executive order. Although its goal is to provide alternatives to the insurance marketplace set up by the ACA and offer cheaper health insurance options through association health plans to help small businesses, it calls for the departments of Health and Human Services, Labor and Treasury to convert those ideas into policy.

Update Last night came news that Trump will sign another executive order Friday to get rid of the subsidies to insurers selling Obamacare, a move confirmed by Press Secretary Sarah Huckabee Sanders. The subsidies were set up to help low-income Americans pay for insurance.

Update 2 On Friday morning the Trump administration told the U.S. Court of Appeals for the D.C. Circuit that it would cease payments to insurers to help lower-income Americans buy insurance on the Obamacare marketplace, according to The Washington Post.

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The orders come just weeks before Open Enrollment is set to begin on November 1. A senior administration official told The Washington Post that the provisions of the executive order mean the lower cost plans won’t be available before next year.

The executive order for health plans has elicited a range of reactions from satisfaction from his base to raising the hackles of Senate Minority Leader Chuck Schumer and House Minority Leader Nancy Pelosi who accused Trump of sabotaging ACA.

After news of ending the subsidies came to light, Pelosi and Schumer issued a joint statement, according to The New York Times

“It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America,” they said. “Make no mistake about it, Trump will try to blame the Affordable Care Act, but this will fall on his back and he will pay the price for it.”

Although the Republican National Committee came out in favor of the signed order, some Republicans were not thrilled about the plan to cut subsidies, such as Ileana Ros-Lehtinen, a Representative from Florida.

Scott Flanders, CEO of private online insurance exchange eHealth said in a press release he was pleased with the order Trump signed.

“Today’s actions by the Trump administration will help consumers who can’t afford Obamacare plans by giving them lower cost, longer-term options. Lifting restrictions on short-term insurance plans, for instance, is a long-overdue step that will help consumers who are caught in Obamacare’s affordability gap.”

Juanita Duggan, the CEO of the National Federation of Independent Businesses, said on its website the group was “grateful to President Trump for addressing regulations that make it harder and costlier for small business owners to provide healthcare for themselves and their employees.”

Dr. Bob Kocher, a partner with venture capital firm Venrock who had a hand in developing ACA and invests in healthcare startups, said in an email he was concerned with what association plans would and wouldn’t cover.

“I think association health plans may sound attractive at first since they may be designed to have lower premiums, [but] they will prove to be very unpopular and a bad idea. The fallacy of this idea is that when you segregate sick people and healthy people, the sick people cannot afford care and the healthy people cannot afford to get sick — and they all will at some point.  In these plans, conditions like cancer or childbirth may not be covered and even if they are, the $10,000 + deductibles make them impossible to afford.  For sick people, premiums spike because there is no risk pool of healthy people to share costs which is the entire point of insurance.”

Tom Nickels, American Hospital Association Executive Vice President, expressed concern that the executive order’s provisions could destabilize the individual and small group markets, leaving millions of Americans who need comprehensive coverage to manage chronic and other pre-existing conditions without affordable options. 

Although Trump’s order will play well to his base, it remains to be seen how the order will play out on a state level.

The Atlantic cited University of Michigan law professor Nicholas Bagley, who noted that even with the executive order, states have the power to regulate short-term plans and even make them comply with the ACA. But individual-market customers might not know exactly how this executive order would affect them before then.

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