Trump signs executive order that could effectively gut Affordable Care Actfs individual mandate
By Ashley Parker and Amy Goldstein
January 20 at 11:04 PM - The Washington Post
President Trump signed an executive order late Friday giving federal agencies
broad powers to unwind regulations created under the Affordable Care Act, which
might include enforcement of the penalty for people who fail to carry the health
insurance that the law requires of most Americans.
The executive order, signed in the Oval Office as one of the new presidentfs
first actions, directs agencies to grant relief to all constituencies affected
by the sprawling 2010 health-care law: consumers, insurers, hospitals, doctors,
pharmaceutical companies, states and others. It does not describe specific
federal rules to be softened or lifted, but it appears to give room for agencies
to eliminate an array of ACA taxes and requirements.
However, some of these are embedded in the law, so it is unclear what
latitude the executive branch will have.
Though the new administrationfs specific intentions are not yet clear, the
orderfs breadth and early timing carry symbolic value for a president who made
repealing the ACA — his predecessorfs signature domestic achievement — a leading
campaign promise.
Additionally, the orderfs language about easing economic and regulatory
burdens aligns with long-standing Republican orthodoxy that the government
exerts too heavy a hand on the U.S. health-care system.
gPotentially the biggest effect of this order could be widespread waivers
from the individual mandate, which would likely create chaos in the individual
insurance market,h said Larry Levitt, senior vice president at the Kaiser Family
Foundation. In addition, he said, the order suggests that insurers may have new
flexibility on the benefits they must provide.
gThis doesnft grant any new powers to federal agencies, but it sends a clear
signal that they should use whatever authority they have to scale back
regulations and penalties. The Trump administration is looking to unwind the
ACA, not necessarily waiting for Congress,h Levitt said.
The order, several paragraphs long, does not identify which of the many
federal rules that exist under the ACA the new administration intends to rewrite
or eliminate. In general, federal rules cannot be undone with a pen stroke but
require a new rulemaking process to replace or delete them.
But in giving agencies permission to gwaive, defer, grant exemptions
from or delayh ACA rules, the order appears to create room for the Department of
Health and Human Services to narrow or gut a set of medical benefits that the
ACA compels insurers to include in health plans that they sell to individuals
and small businesses.
The order does not mention Medicaid, but it says one
of its goals is to gprovide greater flexibility to States,h raising the question
of whether the Trump HHS might try to loosen rules for states that have expanded
the program for lower-income Americans, as the law allows.
The order directs all federal agencies gto minimize the unwarranted economic
and regulatory burdensh of the ACA — the first step of Trumpfs central campaign
promise to repeal and replace former president Barack Obamafs health-care
plan.
Trumpfs action drew swift protests from ACA proponents who
have coalesced to try to preserve the law. gWhile President Trump may have
promised a smooth transitionh from the current law to a replacement, said Leslie
Dach, director of the fledging Protect Our Care Coalition, gthe executive order
does the opposite, threatening disruption for health providers and
patients.h
Also late Friday, Reince Priebus, Trumpfs chief of staff, issued an executive
memorandum ordering a freeze on regulations for all government agencies.
The memo could freeze several new Energy Department efficiency standards,
such as those affecting portable air conditioners, commercial boilers and
uninterruptable power supplies, which were issued Dec. 28 but not yet
published in the Federal Register. The regulations were part of the Obama
administrationfs broader effort to cut greenhouse-gas emissions linked to
climate change.
The move echoes a missive that then-White House Chief of Staff Rahm Emanuel
sent the heads of every federal agency on Jan. 20, 2009, asking them to freeze
any rules that had not yet been published in the Federal Register, and to
consider a 60-day extension of the effective date of rules that had not yet gone
into effect.
Also Friday, Trump signed the official paperwork installing Defense
Secretary James Mattis and Homeland Security Secretary John F. Kelly, two of his
Cabinet picks the Senate voted to confirm earlier in the day.
Trumpfs health-care order came at the end of what had otherwise been a
largely ceremonial day. The White House did not immediately return requests for
comment.
During his campaign and afterward, Trump pledged that fundamental changes to
the health-care system would be a first priority. In a speech outside
Philadelphia six days before the November election, Trump vowed to abolish the
ACA before he was sworn in. gHave to do it,h he said. gI will ask Congress to
convene a special session so we can repeal and replace.h
Last week, both chambers of Congress approved a budget resolution that was
the first legislative step toward repealing the 2010 law, which was the
centerpiece of the Obama administrationfs health policies. But health care was
not among a half-dozen issue areas listed on the new WhiteHouse.gov website
that debuted shortly after noon on Friday.
Earlier Friday, in the Capitol, the new president took several more
perfunctory executive actions shortly after he was sworn in at noon, the most
notable being to overturn a recent mortgage-fee reduction — geared at
helping first-time and low-income home buyers — that Obama announced last week
and that called for the Federal Housing Administration to cut its annual
borrowing fee by a quarter of a percentage point.
Trump also signed a waiver for Mattis to lead the
Defense Department, despite his having been retired from military service for
only three years. Without the waiver, federal law would have prohibited Mattis
from serving as defense secretary until he had been retired from the military
for at least seven years.
And just moments after Trump took the oath of office, he began implementing
his general vision, transforming the official White House website with a new set
of policy pledges that offered the broad contours of the Trump administrationfs
top priorities. They included fierce support for law enforcement and gun ownersf
rights to defend themselves. There were also some notable absences, such as the
omission of a policy page on climate change.
The issues page of Trumpfs White House offered no new plans or policies but
rather a rehash of many of his most prominent campaign promises — a signal to
the nation that Trump, more pragmatic than ideological, plans to implement at
least the key guideposts of his campaign vision.
The policies laid out on the website included plans to both withdraw from and
renegotiate major trade deals, grow the nationfs military and increase
cybersecurity capabilities, build a wall at the nationfs southern border and
deport undocumented immigrants who have committed violent crimes.
gOur job is not to make life more comfortable for the rioter, the looter, or
the violent disrupter,h read the law-and-order section, which calls for gmore
law enforcementh and gmore effective policing.h gOur job is to make life more
comfortable for parents who want their kids to be able to walk the streets
safely. Or the senior citizen waiting for a bus. Or the young child walking home
from school.h
The climate change Web page that existed under Obama was not replaced on the
Trump site, with scant mention of climate change under the new presidentfs
energy plan. Also gone or not immediately replaced were Web pages the previous
administration had devoted to the rights of lesbian, gay, bisexual and
transgender individuals; people with disabilities; and civil rights more
generally.
Trumpfs entire campaign was largely a repudiation of Obama, and a new
Republican administration is unlikely to have the same set of issues and
priorities as an outgoing Democratic one. But the missing issue pages were
particularly alarming to Democrats and activists, especially after a vitriolic
campaign in which Trump drew criticism for seeming to mock a disabled reporter
and being insensitive to the needs and rights of minority communities.
On energy, Trump vowed to eliminate gharmful and unnecessary policiesh such
as the Climate Action Plan and the Waters of the United States rule. The first
represents a variety of efforts Obama had pursued to reduce U.S.
greenhouse-gas emissions while the second is a rule issued by the
Environmental Protection Agency to protect not only the largest waterways but
also smaller tributaries that others believe should fall under the jurisdiction
of states rather than the federal government.
The initial Trump website also did not devote a
separate section to immigration, another central tenet of his candidacy, though
it mentioned immigration under the law enforcement section. Despite rumors
within the immigration advocacy community that one of Trumpfs initial executive
actions could be to revoke Obamafs protections for gdreamersh — undocumented
immigrants brought to the country as young children — his website so far focused
only on big-picture enforcement and security goals.
gHe is dedicated to enforcing our border laws, ending sanctuary cities, and
stemming the tide of lawlessness associated with illegal immigration,h read part
of the immigration section.
The new administrationfs language echoed Trumpfs tough
rhetoric on the campaign trail, including his promises to strengthen
the law enforcement community, crack down on what he views as a broad range of
trade violations and potentially forge alliances with countries long considered
dangerous rivals, such as Russia.
gFinally, in pursuing a foreign policy based on American interests, we will
embrace diplomacy,h read part of Trumpfs policy vision. gThe world must know
that we do not go abroad in search of enemies, that we are always happy when old
enemies become friends, and when old friends become allies.h
Melania Trump, the first lady, also received a biographical
overhaul. Her web page featured a black and white glamour shot of her, and
touted her jewelry line and modeling career, describing the many high fashion
photographers with whom she has worked and the glossy magazines for which she
has posed (Vogue and the Sports Illustrated swimsuit edition, among others).
The first ladyfs biography also correctly stated that she
began college at the University of Ljubljana in Slovenia, her home country, but
never graduated — a fact that was misstated during the campaign.
Only at the very end of her page did Melania offer a glimpse
of the sort of first lady she might be: gMrs. Trump cares deeply about issues
impacting women and children,h read the biography, gand she has focused her
platform as First Lady on the problem of cyber bullying among our youth.h
Juliet Eilperin, Chris Mooney and Steven Mufson contributed to this
report.