Lawmakers, insurers and the health-care industry rushed over the weekend to decipher the full meaning and consequences of President Donald Trump’s executive order urging agency heads to do whatever they can to unwind some provisions of the Affordable Care Act.
The order, issued late Friday, encouraged officials to use “all authority and discretion available to them” to waive or delay ACA provisions they deem onerous on individuals, states or insurers. It isn’t yet clear how many provisions officials may choose to apply that to or when, leaving the political and health care worlds in a state of some confusion.
At a minimum, the move signals Mr. Trump’s willingness to take aggressive public aim at the law often dubbed Obamacare, as Republicans in Congress wrestle with their own efforts to dismantle the law and come up with a new health-insurance system in its place.
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Conservatives who railed against Barack Obama’s vast powers to build up the Affordable Care Act declared vindication Saturday with President Donald Trump’s executive order to tear it apart.
“For me, it’s a mix of irony and schadenfreude,” says Josh Blackman, a law professor who’s written two books that criticized the Obama administration’s implementation of the law. “I’ve warned for years that, with a new president in the White House, the exact same powers could be used for different purposes. That’s what we’re seeing now, to a T.”
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President-elect Trump continues to baffle his most ardent critics. A recent example is his declaration to Washington Post reporters on Saturday night that “We’re going to have insurance for everybody.” As Forbes opinion editor Avik Roy has pointed out, for at least 17 years, Donald Trump has been an advocate of universal coverage.
As is his prerogative (and evidently his wont), President-elect Trump offered no real explanation of what he meant by this. He assured us “they’ll be beautifully covered” but likewise reassured Republicans in Congress “I don’t want single payer.” So let’s take a moment to ponder how his words can be parsed. This is especially important given that his nominee to head the Department of Health and Human Services, Dr. Tom Price, “stopped short of saying all Americans should be covered” during his confirmation hearing yesterday.
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The attempted imposition of the notorious Obama-era “HHS mandate” on religious organizations, especially Catholic institutions, reflected an attitude that has been pervasive during Obama’s presidency, which is one of barely concealed hostility toward persons or organizations holding on to traditional religious beliefs. It should be the first order of business of the incoming Trump administration to rid the federal government of this attitude and the associated policies that flow from it.
The place to begin that process is with the HHS mandate itself. The mandate is a rule, finalized initially in 2013, that requires nearly all employers in the United States to provide all manner of free contraception in their health-plan offerings. The Obama administration went out of its way to impose this requirement even on many Catholic institutions, such as universities and hospitals, knowing full well that the requirement violated fundamental teachings of the church. It then provided only the narrowest of exemptions to the general requirement and fought every legal challenge trying to provide greater latitude to religious organizations or employers with religious sensibilities.
The individual mandate is Obamacare’s least popular feature. It was the subject of the 2012 lawsuit asserting Obamacare was unconstitutional: Never before had the federal government forced any resident to buy a good or service from a private business. The people lost that argument. Nevertheless, Republicans have pledged to eliminate the individual mandate. This commitment remains good politics. However, it is also good economics.
According to last November’s Kaiser Family Foundation Tracking Poll, only 35 percent of respondents have a favorable view of the individual mandate. The proportion drops to just 21 percent among Republicans, and just 16 percent among Trump supporters.
As the 115th Congress convenes and President-elect Trump prepares to take office tomorrow, our nation faces incredible challenges and opportunities. On health care in particular, the stakes couldn’t be higher, nor the path forward more clear. As leaders working on state-based policy solutions across the country, we have seen the impact of Obamacare on our communities up close. That’s why we’ve produced a report, being released today, on the need to unwind the law’s disastrous expansion of Medicaid.
Given the focus on the disastrous launch of the law’s insurance exchanges in 2013, many people don’t know that most of Obamacare’s coverage gains have come not through those exchanges, but through its new expansion of Medicaid to able-bodied, working-age adults.
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Shortly after the end of his inaugural parade, President Donald Trump issued his first executive order: instructions for the federal government to dismantle the Affordable Care Act “to the maximum extent permitted by law.”
The executive order is a powerful political statement about the health care law, one that directs agencies to “waive, defer, grant exemptions from, or delay” any taxes or penalties they possibly can. The order doesn’t give Trump any new powers, but does suggest that he wants to move quickly on dismantling major parts of the health overhaul.
“This order doesn’t in and of itself do anything tangible,” says Larry Levitt, vice president at the Kaiser Family Foundation. “But it directs federal agencies to start taking steps to use their administrative authority to unwind the ACA in all sorts of ways. This is a signal that the Trump administration is not waiting for Congress to start making big changes.”
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Here are the priorities an Obamacare replace plan should have:
1. It should get 60 votes in the Senate.
2. It should repeal and replace in one go.
3. Cover at least as many people as Obamacare.
4. Don’t leave poor people out in the cold.
5. Fight provider cartels.
6. Enable technology-driven innovation.
7. Nudge people away from employer-provided insurance.
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During the 2016 campaign, Donald Trump promised to begin repealing and replacing the Affordable Care Act on Day One of his presidency. Within hours of his inauguration, he put a small down payment on that promise, issuing an executive order instructing federal agencies to “take all actions consistent with law to minimize” the law’s economic burdens.
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Republicans have made a great deal of progress toward broad agreement on a general policy approach over the past half-decade. The GOP has been preparing for the opportunity to enact conservative health care reform for years, and it now faces both a party electorate and a health care system that will not allow for endless indecision. It is too soon to know what the final product will look like, and whether a series of reconciliation bills or some uneasy combination of partisan and bipartisan measures will emerge. But it does seem likely that a year of intense action on health care is beginning.
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