Ok, well just hours after Trump confirmed that he called Chuck Schumer in an attempt to revive efforts to build consensus around healthcare reform, WSJ is out reporting that the President will sign an executive order next week that will roll back some ACA rules.
This isn’t unexpected. It was generally seen as the next move after the GOP’s last effort to “repeal and replace” crashed and burned. “It’s being finished now,” Trump said last month following the Graham-Cassidy debacle. “It’s going to cover a lot of territory and a lot of people. Millions of people,” Trump added, slapping a couple of his trademark superlatives on another nebulous promise.
Basically, this order is going to do three things. First, Trump is going to order the Departments of Health and Human Services, Labor and Treasury, to free people up to go the “association health plans,” route. These won’t have to cover a set package of benefits and the criticism is that invariably, they’ll “peel off healthier and younger individuals and leave traditional insurance plans to cover sicker and older customers.”
Second, Trump will apparently lift the ban on “short-term medical insurance,” and finally, third, WSJ says the President “will order agencies to expand health reimbursement accounts, employer-funded arrangements that employees can use to pay out-of-pocket medical costs and premiums.”
What does all of that mean? Well, who knows, really – certainly not Trump. As usual, he’s just doing what someone else has told him will play well with Conservatives.
One thing that seems clear is that the association health plan bit, by virtue of what it means for the prospect of selling insurance across state lines, could imperil any future effort to build broad-based support for a more comprehensive fix.
Additionally, this seems fraught with legal peril. Consider these excerpts from a Politico piece published late last month after Trump hinted that an executive order was coming:
Trump didn’t elaborate on how he would allow insurance to be sold across state lines. But most insurance experts find it hard to imagine how an executive order could supplant existing state regulations, and believe such a move would likely spark a legal challenge.
“Health insurers already have the ability to sell insurance in multiple states as long as they comply with state consumer protection and licensing laws, which many already do,” said Mike Consedine, CEO of the National Association of Insurance Commissioners, in a statement to POLITICO. “The NAIC has long been opposed to any attempt to reduce or preempt state authority or weaken consumer protections.”
Several states – including Wyoming, Maine and Georgia – have already tried allowing across-state sales, and it’s been a colossal bust. The chief reason: There’s been zero interest from insurers. That’s in part because creating competitive provider networks in states where they don’t have any current customers is incredibly difficult.
In addition, insurers in states with tough regulations are fearful of having to compete against out-of-state plans that don’t have to adhere to the same rules.
“My insurers here absolutely cringe when you talk about across-state sales,” said Washington Insurance Commissioner Mike Kreidler, a Democrat.
Kreidler said he didn’t know how an executive order could ever be binding on a state. “I just can’t imagine it having that kind of impact. State law is going to supersede an executive order.”
But hey, that’s fine, right? Because as Trump has already demonstrated on any number of occasions, he’s not averse to using tax payer money to tilt at windmills after creating legal problems that didn’t exist.
Perhaps Andy Slavitt, who was the Obama administration’s top official at the Centers for Medicare and Medicaid Services, summed this effort up best when he told the Journal the following:
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.
Maybe the genius can use one of his EO’s to repeal the McCarran-Ferguson Antitrust Act of 1945 which gives insurers an exemption from Federal Anti-Trust laws so insurers can be sued for their unlawful price gouging and monopolistic activities. Nah, perhaps not.