President Trump, frustrated by the Senate’s failure to repeal Obamacare, took his first unilateral steps to tweak the struggling heath care system Thursday by signing an executive order that clears the way for giving consumers more insurance alternatives.
The order broadly directs several Cabinet agencies to develop guidelines to increase health care competition and choice, with a goal of lowering prices and improving health care services. It could also hasten the dismantling of Obamacare by encouraging younger and healthier Americans to pull out of its insurance exchanges.
“This will cost the United States government virtually nothing, and people will have great, great health care,” said Mr. Trump, surrounded by employers and administration officials. “This will create tremendous competition. It could have been done a long time ago.”
Sen. Rand Paul, the Kentucky Republican who attended the event, called it “the biggest free market reform of health care in a generation.”
“This reform, if it works and goes as planned, will allow millions of people to get insurance across state lines at an inexpensive price,” Mr. Paul said.
The move allowed Mr. Trump, who promised to repeal Obamacare on the first day of his presidency, to show he is taking some action after a year of frustration and failure in Congress to rescind the law. Senior administration officials said the order doesn’t make changes to Obamacare immediately and that they hope the administration can implement many of the proposals within six months.
Republicans and business groups hailed the move, saying it will provide more options for consumers and result in lower costs for workers and employers.
“In the wake of the Senate’s failure to repeal Obamacare, we are grateful to President Trump for addressing regulations that make it harder and costlier for small-business owners to provide health care for themselves and their employees,” said Juanita Duggan, president and CEO of the National Federation of Independent Business.
Democratic lawmakers and their allies said the president’s action was a cynical effort to hasten the demise of Obamacare.
Senate Minority Leader Charles E. Schumer of New York tweeted that Mr. Trump “is using a wrecking ball to single-handedly rip apart & sabotage our healthcare system.”
Debra Ness, president of the National Partnership for Women & Families, said Mr. Trump’s “irresponsible” executive order “will loosen or eliminate critical consumer protections for certain health insurance plans, driving up the costs of premiums and making it harder for people, especially those with pre-existing conditions, to afford coverage.”
“This is yet another dangerous, shameless move by the Trump administration to sabotage the Affordable Care Act and destabilize the health insurance marketplace — but sabotaging the ACA means sabotaging the coverage that millions of women and families rely on,” she said. “The president is once again trying to advance his political agenda at the expense of our health.”
Sarah Lueck, an analyst with the liberal Center for Budget and Policy Priorities, said the president’s action “could destabilize the health insurance markets where millions of individuals and small businesses get their coverage and undermine protections for people with pre-existing health conditions.” She said it is designed to encourage more people to buy health care coverage that is exempt from Obamacare’s standards, such as the requirement that plans cover a package of “essential health benefits.”
She called it “a threat to comprehensive coverage, to people with pre-existing medical conditions, and to the ACA’s risk pools that provide insurance options to both the healthy and the sick.”
A statement from the American Cancer Society said the order “jeopardizes the ability of millions of cancer patients, survivors and those at risk for the disease from being able to access or afford meaningful health insurance.”
The president’s order is aimed in part at encouraging the expansion of association health care plans, which are pooled plans with multiple employers to provide workers and companies with lower costs.
The president’s action also will direct the Treasury Department to expand short-term insurance options, which offer limited benefits for people between jobs or young adults who are no longer eligible for their parents’ health care plans. Under the order, people could buy such coverage for up to one year instead of the current three months.
Despite his actions, Mr. Trump said Congress still must complete the job of repealing Obamacare and replacing it with a system of block grants to states.
“With these actions, we are moving toward lower costs and more options in the health care market and taking crucial steps toward saving the American people from the nightmare of Obamacare,” the president said. “We will also pressure Congress very strongly to finish the repeal and replacement of Obamacare once and for all.”
House Speaker Paul D. Ryan, Wisconsin Republican, defended Mr. Trump’s use of executive action after Republicans criticized Mr. Obama for his expansive use of those powers.
“We think the Obama administration went too far on the regulatory front. This is meant to address that,” Mr. Ryan said.
He said this sort of move was always part of plans of Republicans, who envisioned a three-prong approach: repealing the 2010 law, using executive powers to reshape the markets and then passing legislation to pursue conservative solutions.
White House Chief of Staff John F. Kelly said the president viewed this action as the best option available until Congress makes another effort to repeal Obamacare in the spring.
“This was a way to take care of as many Americans as he could legally,” Mr. Kelly said.
While Mr. Trump still wants Congress to repeal Obamacare, he believes “before that can be done, his administration must act to provide relief,” said Andrew Bremberg, White House director of domestic policy.
Mr. Bremberg said this year that nearly half of the counties in the U.S. will have only one health care plan available under Obamacare. About one-third of workers at small businesses now receive health insurance through their employers, compared with about half of such workers in 2010, he said.
The order directs the Labor Department to consider a broader interpretation of the Employee Retirement Income Security Act (ERISA) that the White House said “could potentially allow employers in the same line of business anywhere in the country to join together to offer health care coverage to their employees.”
The White House said the main groups to benefit from expanding short-term insurance coverage are people between jobs and people in counties with only a single insurer offering exchange plans.
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