Nobody knows what to make of the Trump executive order, not even Senate Republicans — About 72 hours ago, President Donald Trump issued his first executive order: one that directed agencies to do everything “to the maximum extent permitted by law” to waive and delay Obamacare fees and regulation.
Key players in the Affordable Care Act debate are still struggling to make heads or tails of what it actually means. This is what Sen. Susan Collins (R-ME) told some reporters on Capitol Hill today:
I think that the executive order is very confusing and that we really don’t know yet what the impact will be. Until there is a secretary in place who can interpret the regulations or do the rulemaking to rescind regulations, it’s very difficult to say what the impact of the executive order is going to be. As someone who, regardless of who is president, has always felt that Congress should set the rules and write the laws, we need legislation. There are some improvements that can be made through the executive order process and through the regulatory process, but that by no means takes away the need for comprehensive legislation.
I had two experts look at the order Friday night, and they made the case that it was a political scream but a practical whisper — something that sets the tone for health policy in the Trump era but doesn’t make any substantive changes quite yet.
Former Republican Senate staffer Rodney Whitlock described it to the New York Times as “something incredibly cryptic that nobody understands.”
Thinking about it more over the past two days, I’m inclined to say that the executive order matters more than I initially thought — precisely because no one quite understands what it means. If you’re an insurance plan, for example, the executive order says that we have no clue about the regulatory landscape around the health care law in the coming months and year. If that’s the case, why bother sticking around and selling coverage? Why not get out now?
The executive order itself makes no tangible changes. But its introduction of more uncertainty may very well do that.
Let’s say Trump doesn’t enforce the individual mandate. Can some states make their own? Trump adviser Kellyanne Conway said in an interview this weekend that Trump “may” not enforce the Affordable Care Act’s mandate that nearly all Americans purchase health insurance coverage. You can read a bit more about that here.
One question I had was whether states that like Obamacare could step in — could California or New York, for example, create a tax penalty that mimics what’s in the health care law right now. Turns out health law expert Nicholas Bagley looked at this question a few months ago, and the answer seems to be yes, although the strategy might have some limitations:
The gambit might not work. Insurers might still head for the hills because they doubt that the Republicans will pass a viable replacement. But the California exchange is healthy and, if a mandate replacement is in place by mid-2017, the economic picture for insurers in 2018 and 2019 won’t look all that different than it does today. There’s a chance that California could save 1.6 million people from losing coverage.
The strategy won’t fly in most states. In Michigan, for example, a Republican-dominated legislature isn’t about to adopt an individual mandate. But its prospects might be brighter in blue states like New York, Connecticut, Washington, and Oregon.
Kliff’s Notes: today’s top 3 health policy reads
“Executive actions Trump could take to change the ACA”: A fantastic list from Adrianna McIntyre and Nick Bagley of the Incidental Economist
“Obamacare chief’s new mission: Save Obamacare”: “Rather than return to his lucrative career as a health entrepreneur in Minnesota, Andy Slavitt expects to spend his time with hospital CEOs, governors, drug companies and ‘everybody with a vested interest’ in repairing rather than discarding the health law, he said in an exclusive exit interview with POLITICO on Sunday.”
“Court strikes down Aetna-Humana merger”: “Why Aetna and Humana lost: The biggest reason is Medicare Advantage. Aetna and Humana are major players in the private alternative to traditional Medicare. Their merger would have created the largest Medicare Advantage company and would have heavily consolidated the market, giving those beneficiaries fewer options.”