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The Wall Street Journal reported over the weekend on the latest Affordable Care Act sabotage plan from the Trump administration, executive orders that would undermine the law's protections for people with pre-existing conditions. Never mind that Trump and myriad Republicans were elected on the promise that they would keep those protections in place.
The WSJ reports that he will issue an executive order that will make it easier for people to create "association health plan" and exempt those plans from some of the rules that apply to other health insurance plans such as the requirement to cover essential health benefits like maternity care or mental health. Secondly, the report says, Trump will order agencies to unwind a rule that limited the duration short-term medical insurance, low-cost plan offering limited protection for a short time frame. Trump intends to extend the duration of those plans for one year. Finally, he will order agencies to expand health reimbursement accounts which are funded by employers, allowing workers to pay out-of-pocket costs and premiums. Obama administration regulations restrict employers from using these accounts to send employees onto the individual market to buy their own insurance.
What all this would likely do is draw younger, healthier people out of the individual market—out of Obamacare—and destabilize the markets which in turn would make coverage more expensive and more difficult for some small businesses and individuals to obtain. Particularly people with high medical expenses. In combination, these new regulations would start the death spiral for Obamacare's markets. But the AHP expansion is what has healthcare experts worried most.
"There will be healthy folks who can benefit from lower premiums, but people with serious medical conditions would be shut out from this market and left with dwindling options," Sabrina Corlette, a research professor at Georgetown University's Center for Health Insurance Reforms, told HuffPost.
Mila Kofman, who has studied AHPs closely as both a scholar and a government regulator, agreed. "If you cherry-pick the healthiest small businesses or individuals, you essentially could destroy the regulated markets that are left, because they end up covering just sicker people," Kofman, who is now executive director of the Washington, D.C., health benefits exchange, said. "This is a really big deal."
It's a really big deal being done in a much sneakier way than Congress passing any of its repeal bills, and so it might fly under the public radar. But the damage would be profound. How far Trump can legally go with this is in question—health insurance law is covered by both the ACA and the 1974 Employee Retirement Income Security Act (ERISA). But he definitely has power to loosen the regulations that provide affordable, comprehensive coverage to everyone.