Politics Analysis | This executive order is Trump’s most significant step yet to undermine Obamacare

20:41  12 october  2017
20:41  12 october  2017 Source:   MSN

Trump to cut off key ObamaCare payments: report

  Trump to cut off key ObamaCare payments: report President Trump plans to cut off key payments to insurers selling ObamaCare coverage, Politico reported Thursday, citing two sources familiar with the matter.Such an action would represent Trump's most aggressive move yet to dismantle ObamaCare, after GOP efforts to repeal and replace the health-care law failed this year.Trump has repeatedly threatened to cut off the disbursements to insurers, known as Cost Sharing Reduction (CSR) payments. They are worth an estimated $7 billion this year, Politico noted.

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Sen. Lamar Alexander (R-Tenn.) and Sen. Patty Murray (D-Wash. © AP Photo/Alex Brandon Sen. Lamar Alexander (R-Tenn.) and Sen. Patty Murray (D-Wash.

Since his election, President Trump's efforts regarding Obamacare have been almost all geared at undermining it. Now that Congress has failed to repeal the law, he's acting as much as he can on his own. And depending on how it's implemented, the executive order Trump signed Thursday could be his most significant step yet to sabotage the law.

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It will expand the availability of plans that are loosely regulated and don't have to provide essential health benefits, which could pull people off the Obamacare exchanges. Here's a look at the options available to Trump to fix, save, undermine or gut Obamacare, and where this new executive order fits on that scale.

GOP Rep. breaks with Trump: Cutting health care subsidies does 'opposite' of what he promised

  GOP Rep. breaks with Trump: Cutting health care subsidies does 'opposite' of what he promised A Republican lawmaker slammed President Trump's action on health care Friday.Rep. Ileana Ros-Lehtinen (R-Fla.) said that cutting key payments to ObamaCare insurers will mean more of her constituents will be uninsured.

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Option 1: Prop up Obamacare. Trump could support a bipartisan effort in Congress to provide regular subsidies to insurers to cover the cost of lower-income people who pay less under Obamacare.

Has he done this? No. Trump seems entirely uninterested in this. In fact, one of the reasons Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) are trying to make these subsidies more regular is because they are concerned that Trump could suddenly stop issuing them. That could be calamitous for thousands of people who rely on them. Experts also warn that the unpredictability is bad for all health insurance markets because insurers don't know how much the government will be helping them out.

Trump has suggested that he might work with Democrats to pass some kind of ambiguous health-care overhaul. But no one in Washington is taking that seriously, especially given his 180 on an immigration deal with Democrats.

What You Need to Know About Trump’s Executive Order on Health Care

  What You Need to Know About Trump’s Executive Order on Health Care President Trump on Thursday took his biggest step yet toward accomplishing what Congress could not: dismantling the Affordable Care Act. Saying he was starting the process of Obamacare repeal, Trump signed an executive order that he and his allies say will provide more options and lower costs in the health care market. Saying he was starting the process of Obamacare repeal, Trump signed an executive order that he and his allies say will provide more options and lower costs in the health care market. “We are going to also pressure Congress very strongly to finish the repeal and the replace of Obamacare once and for all,” the president added.

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Option 2: Undermine Obamacare. If Obamacare is going to be the law of the land, Trump can try to cut holes in it so big that the law is unrecognizable. The approach seems to be to force Obamacare to fail, forcing Congress to fully repeal it.

Has he done this? Oh yes.

  • Trump has slashed by 90 percent the federal government's budget to advertise and help enroll people on the exchanges.
  • The Post's Juliet Eilperin reports that he's told the federal government to refuse to help Iowa prop up its struggling marketplace, which is a federal-state partnership.
  • Add this executive order to the list: The Post's Amy Goldstein reports that the order will allow small businesses to form an association to negotiate health benefits, called association health plans. Under Trump's rule, these disputed plans could soon be sold across state lines with no regulation on what health benefits they have to cover.
  • Many state insurance commissioners, both Republican and Democrat, oppose expanding associations because doing so could allow a plan formed in Ohio that, say, doesn't include protections for preexisting conditions to be sold in Indiana, and there's nothing that Indiana officials could do about it.

    Trump: I'm 'very proud of my executive order' on health care

      Trump: I'm 'very proud of my executive order' on health care President Trump tweeted Saturday he's proud of his executive order on health care. He also claimed that health insurance stocks fell after his decision to end health subsidies."Very proud of my Executive Order which will allow greatly expanded access and far lower costs for HealthCare," Trump tweeted.

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    Goldstein reports that the National Association of Insurance Commissioners warned Congress in February that something like this “would result in less protections for the most vulnerable populations and the collapse of individual markets.”

    In fact, aside from a few ideologically rigid conservatives, association health plans aren't really a mainstream discussion, said Paul Ginsburg, a health policy expert and director of the USC Brookings-Schaeffer Initiative.

    “To aggressively pursue association health plans is very much an attempt to undermine the markets in the Affordable Care Act,” Ginsburg said.

    Trump will also direct the government to expand the availability of short-term health-insurance plans, from three months to a year. That “could do serious damages to the marketplaces and the individual market,” said Gary Claxton, an analyst with the Kaiser Family Foundation.

    Experts Say Trump Order Could Upend Health Care System

      Experts Say Trump Order Could Upend Health Care System With Republican efforts to repeal Obamacare stalled, President Donald Trump issued a new executive order on Thursday that could undermine the law."Seven years ago, congressional Democrats broke the American healthcare system by forcing the Obamacare nightmare onto the American people. And it has been a nightmare," Trump said at the White House, adding that the order represented the first step "to providing millions of Americans with Obamacare relief.

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    These plans are designed to be short-term — say, if you're between jobs and can't get on the exchanges. They don't have to cover essential health benefits, they are not renewable, and they are cheaper. But Trump's order would make them closer to an alternative for full health insurance, which could make them an attractive plan for healthy people, which could increase the volume of sicker people on the exchanges.

    “If you leave the sicker people on the exchanges, then premiums will rise more, and it gets you back to the possibility of a death spiral,” said Alice Rivlin, a health policy expert with the Brookings Institution.

    Option 3: Fully gut Obamacare. Trump can't do this, because it's a law Congress passed. But he could put nonstop pressure on Congress to repeal the entire law.

    Has he done this? Yes and no. Trump has made clear how frustrated he is that Republicans were unable to repeal Obamacare. But he has largely pivoted to overhauling the tax code.

    There's one more thing health policy experts say Trump could do on his own to rip up Obamacare: end the payments to insurers that cover lower-income people's premiums (the very same payments Congress is trying to shore up). Most health-policy experts agree that if these subsidies are taken away without a change in how much lower-income people pay for their health insurance, insurance markets would implode, forcing insurance companies to leave Obamacare exchanges, causing Obamacare itself to implode.

    As of Thursday, Trump has done everything to sabotage Obamacare but that.

Trump kills key Obamacare subsidies: What it means .
President Trump will no longer fund Obamacare's cost-sharing subsidies. Here's what that means.The administration announced late Thursday night that it would immediately stop supporting the cost-sharing subsidies that reimburse insurers for reducing the deductibles and co-pays of lower-income Obamacare enrollees. Trump has been paying the subsidies on a month-to-month basis, unnerving many insurers.

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