PRESIDENT Donald Trump is ordering federal agencies to undermine Obamacare through regulatory action, a move that could weaken enforcement of the requirement for Americans to buy health coverage and give insurers leeway to drop some benefits.
Trump’s first executive order, signed hours after taking office on Friday, directs the federal government to scale back regulations, taxes and penalties under President Barack Obama’s healthcare law, the Affordable Care Act (ACA).
Republican lawmakers, who are working on new legislation to repeal and replace Obamacare, praised the order as showing Trump’s commitment to gutting the program and lowering steep healthcare costs they blame on the law.
Trump did not specify which parts of the program would be affected by his order, and any changes are unlikely to affect the government-funded or subsidized insurance plans covering more than 20 million people in 2017.
Trump’s nominee to head the U.S. Department of Health and Human Services, Georgia Representative Tom Price, has said there was no plan for “pulling the rug out” on millions of Americans’ healthcare as a replacement is designed.
But the scope of Trump’s order drives home the uncertainties of that process, healthcare experts said.
“The order could affect virtually anything in the law, provided it is couched as a delay in implementing the law,” said Stuart Butler, a senior fellow at the Brookings Institution.
Trump’s administration could decide to delay or not enforce the individual mandate, a requirement that Americans buy health coverage if they do not already have benefits from their employer or the government, as well as a similar requirement for employers of a certain size to insure their workers, experts said.
Others say those changes, if not handled carefully, could force insurance premiums higher and make healthcare less affordable for Americans – outcomes that Trump and Republicans say they are trying to avoid.
“The administration has to run a really fine line here,” said Dan Mendelson, chief executive of the Washington-based consulting firm Avalere Health. “They’re not going on record as saying what they’re going to do at this point.”
The administration could also alter, or fail to enforce, requirements that insurers cover a basic set of health benefits in all of their plans, from maternity and newborn care to mental health services.
“This could be a signal to the insurance industry that they could offer new products that, for example, didn’t include maternity benefits, in order to attract more sales from people who would prefer a slimmer package,” said Joe Antos of the American Enterprise Institute think tank.