Insurers' fears ease over Trump ObamaCare order

Insurers' fears ease over Trump ObamaCare order
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(This story previously appeared in The Hill Extra.)


Health insurers are trying to calm fears about President Trump's murky executive order on ObamaCare amid worries it could lead to chaos in the insurance system.

The health plans say they anticipated such an order and called it a small step. They caution that major changes would likely have to come through Congress and that without legislative action, any changes would be administrative and incremental.

Trump signed the order — which instructs agencies “to waive, defer, grant exemptions from, or delay the implementation of” any provision of the law that poses a financial burden — on his first day in office on Jan. 20.

The potential actions from order could include declining to enforce the individual mandate and reducing reinsurance payments, according to the Incidental Economist’s Adrianna McIntyre and Nicholas Bagley, a health law professor with the University of Michigan.


Consumers and insurers could also sue if vital components of the law are altered or eliminated.

White House press secretary Sean Spicer on Monday dodged questions about whether the Trump administration would enforce the individual mandate, saying the president would work with Congress to repeal and replace the Affordable Care Act. Republicans have long targeted the mandate as government overreach, especially when insurance options are few and expensive.

“It’s not about forcing anything,” Spicer said in a press briefing. “It’s about doing the right thing.”

Insurance groups say their lobbyists have been working daily with policymakers on specific aspects of a potential replacement. One industry insider said the individual mandate hasn’t been as effective as insurers had hoped, and they’ve been working on alternate solutions with lawmakers.

“There is no question the individual healthcare market has been challenged from the start,” said America’s Health Insurance Plans spokesperson Kristine Grow. “The president said he would take swift action, and he has. We have been meeting with policymakers to offer our recommendations for a better marketplace, and we have found them to be highly engaged and focused on finding real solutions." 

Ceci Connolly, president of the Association of Community Health Plans, said the public guesswork is the biggest liability, since it has the potential to scare consumers who are currently covered under the Affordable Care Act.

“The big challenge with this executive order is that it has the potential to severely disrupt the individual market based entirely on speculation and uncertainty.”

Insurance groups say they are more concerned with actions that Health and Human Services nominee Rep. Tom Price (R-Ga.) and Centers for Medicare and Medicaid Services nominee Seema Verma will take if they’re confirmed, as well as what comes through the legislative pipeline.

House v. Burwell.

The most significant action Trump could take is dropping the Obama administration’s appeal in House v. Burwell, which challenges the government’s authority to appropriate money for ObamaCare enrollees’ out-of-pocket expenses. 

The issue is of serious concern to insurers, who would have to foot the bill on their own if the subsidies are eliminated. Some insurers could possibly exit the exchanges midyear based on their contracts with state governments, Connolly said. 

But insurance groups and conservative policy wonks both think lawmakers are likely to fund the subsidies on their own if Trump drops the appeal. Grow said there is a possibility lawmakers could appropriate money on their own if the subsidies are struck down.

“We would be thrilled,” Connolly said of a congressional solution. “We would be very happy and supportive of that kind of decision. But nothing is certain or a done deal at the moment.”

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