Thwarted by the Republican Congress’s inability to take health insurance away from millions of people, Donald Trump is continuing his efforts to dismantle the Affordable Care Act from the inside. He’s expected to sign executive orders on Thursday intended to siphon off healthy Obamacare enrollees into skimpy cheaper plans. The order will loosen rules for what these plans have to cover and who they have to cover, like people with pre-existing conditions. The cumulative effect of the new rules he’s ordering will be to damage Obamacare’s regulated markets, leaving just the sickest, most expensive patients there. A press release issued by the White House in advance of his signing the orders is short on details, heavy on rhetoric attacking Obamacare, but generally follows what previous leaks and news reports have suggested he will do.
He’s got a three-bladed hatchet that he’s taking to the law, one that will make it easier for people to create “association health plans” and exempt those plans from some of the rules that apply to other plans. He’ll also extend the lifespan of already existing short-term medical insurance, low-cost plans that offer limited protection. Now they’re limited at three months but he’s likely to extend that to 12 months and make them renewable. Finally he’s expected to allow people to use accounts known as Health Reimbursement Accounts to pay for premiums. This would allow companies to use pre-tax dollars to help workers pay for premiums, not just other out-of-pocket costs.
The most consequential and damaging element of this is the AHP expansion, allowing small businesses, trade associations, and as-of-yet undefined others to group together to purchase health insurance that would be exempt from some of the existing Obamacare rules. Plans would be exempt from covering all of the essential health benefits now required, like prescription drug coverage, or maternity or mental health care. The plans would be much cheaper, pulling small business and other groups out of the Obamacare markets, leaving the sick people—and the ones who need more comprehensive coverage—in those markets, where premiums would get more and more expensive.