Understanding Trump’s Obamacare order

WASHINGTON—President Donald Trump’s Friday executive order curbing Obamacare delighted his supporters but will likely have no immediate impact on healthcare in the United States.

“It was a more a political statement than it was anything else,” said Joe Antos, a healthcare scholar at the American Enterprise Institute. “It was really a statement of objectives as opposed to specific orders for action.”

Early this month, Vice President Mike Pence told reporters on Capitol Hill that Trump would begin taking action on the Affordable Care Act (ACA) before Inauguration Day was over. The president made good on that promise with his first executive order, which aimed to “minimize the economic burden” of the ACA.

The order does not expunge any parts of Obamacare, nor does it drastically change how the law is implemented across the country until Trump’s political appointees get confirmed. But it does reaffirm the Trump administration’s intentions to repeal the ACA—a nod to the millions of Americans who voted for him.

Before that occurs, the order directs all related federal agencies to “exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the act that would impose a fiscal burden on any state.”

The order essentially instructs agencies to interpret regulations as loosely as allowed under the law to minimize the burden on individuals, insurers, healthcare providers, and others.

These different interpretations could mean more Americans would be exempt from the ACA’s individual mandate and avoid penalties. But that’s unlikely until Trump’s political appointees move into their new offices.

After Trump signed the order Friday, media outlets and healthcare pundits scrambled to interpret its meaning without much success.

But Antos told me the reason for that is the order doesn’t tangibly do anything.

“It was the only thing any incoming president can actually do,” he said. “An incoming president can’t make Congress move any faster than they are going to move anyway.”

Since Trump won the White House, Congress has been going back and forth on what to do about healthcare. Virtually no Republican thinks Obamacare is working the way it should, but there are many different ideas about what to replace it with and when to take action. Even when lawmakers agree on a strategy, it could take several years to implement.

Congress is currently in the process of repealing the ACA through reconciliation. But a Republican replacement plan will need eight votes from Senate Democrats to break a filibuster. If that happens and Trump signs it into law, the White House and all 50 states will have to develop the new rules for the emerging marketplace. Providers will then have to agree on pricing, and states will need to OK insurance plans for sale.

Robert Laszewski, president of Health Policy and Strategy Associates, explained this process on his blog and said there’s no way all that happens until 2019 at the earliest.

Michael Cannon, the Cato Institute’s director of health policy studies, disagreed. He told me while the order doesn’t take any specific actions, it could embolden agencies to roll back the ACA as much as they can under the law, which sets the right tone for the new administration.

“The main takeaway here is if President Trump wants Congress to act, wants Congress to repeal Obamacare, he needs to be doing more stuff like this,” Cannon said.

Today, Sens. Susan Collins, R-Maine, and Bill Cassidy, R-La., introduced their idea to replace the ACA. At the core of their plan: If any state likes Obamacare, they can keep it. The senators hope this will create a smoother transition between healthcare systems.

But Collins did not express much confidence in Trump’s executive order.

“I think that the executive order is very confusing. We really don’t know yet what the impact will be,” she said.