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Trump Executive Order: Minimizing the Economic Burden of the Affordable Care Act Pending Repeal

My quick take [edited to be slightly less quick]:

Section 1 is warming up the idea that administrative actions will be taken without waiting for any new legislation to reduce the application of ACA penalties and take the teeth out of regulations. This could include freely offering “hardship” exemptions from the individual mandate, though that would frighten insurers and would tend to reduce the number participating on the Exchanges.

Section 2 further sets the stage for the non-enforcement or the creatively flexible enforcement of the individual mandate, employer mandate, and any other requirement/tax/penalty in the ACA.

Section 3 appears to be about making it easier for states to get 1332 and 1115 waivers. Or, probably more accurately, the standards for granting waivers will change dramatically. States will be given more ability to attach strings to Medicaid, and some QHP requirements will also likely change to fit the Republican philosophy that having more “skin in the game” is in the public interest. How a waiver would fare if it reduced cost sharing and instead sought to save money by setting lower provider and pharma fees is another matter entirely.

Section 4 sets the stage for selling insurance across state lines, weakening the power of state insurance regulators. If a major player like Anthem or United decides to embrace this idea, it could set off a race to the bottom on benefits. (If that happens, which state will be the health insurance version of South Dakota or Delaware?) This would be both a public health and public relations nightmare, so I don’t think that cross-state insurance regulation and sales will ultimately spread widely.

Section 5 acknowledges that when changing regulations is needed to do what the administration wants to do, they will need to follow proper procedure (which means it will take more time).

More to come.

Jonathan Halvorson edits the New Economy section for THCB and is a senior consultant with Sachs Policy Group. FD: As a consultant Jonathan works with startups, providers and health plans, advising clients on policy issues, strategic direction and related topics.

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John IrvineSteve2 Recent comment authors
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Six states already allow/encourage selling across state lines. Barriers to entry are real. No takers so far. Also, will be interesting to see how the feds taking away regulation from the states will go over.