Trump order paves way for agencies to weaken health law

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By David Morgan and Susan Cornwell

<span class="articleLocation”>President Donald Trump is ordering federal
agencies to undermine Obamacare through regulatory action, a
move that could weaken enforcement of the requirement for
Americans to buy health coverage and give insurers leeway to
drop some benefits.

Trump’s first executive order, signed hours after taking
office on Friday, directs the federal government to scale back
regulations, taxes and penalties under President Barack Obama’s
healthcare law, the Affordable Care Act (ACA).

Republican lawmakers, who are working on new legislation to
repeal and replace Obamacare, praised the order as showing
Trump’s commitment to gutting the program and lowering steep
healthcare costs they blame on the law.

Trump did not specify which parts of the program would be
affected by his order, and any changes are unlikely to affect the government-funded or subsidized insurance plans covering
more than 20 million people in 2017.

Trump’s nominee to head the U.S. Department of Health and
Human Services, Georgia Representative Tom Price, has said there
was no plan for “pulling the rug out” on millions of Americans’
healthcare as a replacement is designed.

But the scope of Trump’s order drives home the uncertainties
of that process, healthcare experts said.

“The order could affect virtually anything in the law,
provided it is couched as a delay in implementing the law,” said
Stuart Butler, a senior fellow at the Brookings Institution.

Trump’s administration could decide to delay or not enforce
the individual mandate, a requirement that Americans buy health
coverage if they do not already have benefits from their
employer or the government, as well as a similar requirement for
employers of a certain size to insure their workers, experts
said.

Others say those changes, if not handled carefully, could
force insurance premiums higher and make healthcare less
affordable for Americans – outcomes that Trump and Republicans
say they are trying to avoid.

“The administration has to run a really fine line here,”
said Dan Mendelson, chief executive of the Washington-based
consulting firm Avalere Health. “They’re not going on record as
saying what they’re going to do at this point.”

The administration could also alter, or fail to enforce,
requirements that insurers cover a basic set of health benefits
in all of their plans, from maternity and newborn care to mental
health services.

“This could be a signal to the insurance industry that
they could offer new products that, for example, didn’t include
maternity benefits, in order to attract more sales from people
who would prefer a slimmer package,” said Joe Antos of the
American Enterprise Institute think tank.

‘FLEXIBILITY’ URGED

Republican Lamar Alexander, chairman of the Senate Health
Committee, said last week that Price, once confirmed, could
relax requirements for U.S. states to get exemptions from the
law, as well as make it easier for states to get waivers on the
Medicaid health plan for low-income households.

“Allow states more flexibility to determine the essential
health benefits … that’s probably the single most important
step that could be taken to create a market where more insurers
are likely to sell policies,” Alexander said.

His committee is one of several in the House and Senate
working on repealing and replacing Obamacare.

Three of the largest health insurers – Aetna Inc,
UnitedHealth Group Inc and Humana Inc – have
essentially pulled out of the market offering health insurance
to individuals under Obamacare, citing financial losses for
covering a population that was sicker than they had expected.

The remaining players include Anthem Inc, as well as
insurers that specialize in administering lower-cost Medicaid
plans, such as Molina Healthcare Inc.

Ana Gupte, a senior healthcare analyst at the investment
bank Leerink Partners, said Trump’s executive order could
reassure people in the market that Obamacare will be dismantled
one way or another.

That could be positive for insurers who would no longer face
the law’s health insurance tax, she said. But it could
negatively impact acute-care hospitals that have seen more
customers and insurers that sell policies to state Medicaid
programs, which could shrink in size.

“It’s clear that Congress is looking to repeal the law and
that it’s poised to happen with a replacement. This is one more
avenue to make sure their agenda is executed,” Gupte said.



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