Throughout his campaign, Donald Trump was a vocal critic of the Affordable Care Act. Within hours of his swearing in, President Trump issued his first executive order aimed at dismantling Obamacare. In a meeting in the Oval office before he left for the Inaugural Ball, the President signed an order that aggressively begins the process of repealing the ACA. While the order itself cannot repeal the law, the document goes a long way toward eliminating key portions of Obama’s signature legislation.
Taking A Closer Look at the Executive Order—What’s In It?
In the one page order there are several important statements to note—powerful words that will effectively begin the dismantling of Obamacare even before Congress begins its debate in the coming weeks.
First of all, President Trump orders the immediate repeal of the Affordable Care Act and directs all agencies to “take all actions consistent with the law to minimize the unwarranted economic and regulatory burdens of the act and prepare to afford the States more flexibility and control”
In addition, the Order directs the heads of Federal agencies to “waive, defer, grant exemptions from or delay any provision…that would impose a fiscal burden on any Stat or a cost….on individuals, families insurers or makers of medical devices products or medications.”
Finally, President Trump orders all head of agencies to “encourage the development of a free and open market in interstate commerce for the offering of healthcare services and healthcare insurance”
What Will Be the Impact?
The most immediate result of Trump’s first executive order on healthcare is that he has now signaled both lawmakers and all Americans that he intends to make good on his promise to immediately begin work to repeal the ACA.
Using the words “to the maximum extent allowed by law” throughout the document also sends a message to all Federal agencies that they must move quickly and decisively to begin to dismantle certain provisions of the law. It is likely that a system will be developed to allow free competition of insurers for the individual market across state lines. IN addition, the move will likely result in less regulation and more flexibility for BOTH States and insurance companies—Something that had been requested and denied numerous times during the Obama administration.
While the order does not directly eliminate the individual mandate, it does substantially weaken the law by instructing government agencies to delay, or defer any tax penalties related to failure to purchase insurance. It is likely that no penalties will be levied going forward while Congress works to repeal the ACA.
While many insurers have pulled out of the ACA market due to high cost, high risk and low returns, President Trump’s orders may result in significant changes in the insurance market by providing more stability and predictability. By making the individual market more attractive to insurers through relaxing regulation and allowing for more inter state competition and business opportunities, it is likely that the Executive Order will result in more choices for consumers—whereas many Obamacare marketplaces currently have only one choice.
What Are the Next Steps?
The Executive Order sets the stage for the repeal of Obamacare. It is now incumbent on Congress and the likely head of HHS, Tom Price to move forward quickly. While repeal is vitally important, we MUST provide a simultaneous replacement. Uncertainty will undermine any efforts to revamp healthcare in the US and ensure coverage, access and affordability for all. A replacement plan must be produced and discussed openly in the coming weeks. I believe that Republicans in both the House and Senate have the scaffolding of a new healthcare law in place—now they must craft it into law. It is vital, however, that Republicans learn from the errors of their colleagues on the other side of the aisle—any legislation must be bipartisan—having one Party craft the law without ANY input from the other would be disastrous (just as the ACA turned out to be). A replacement healthcare law should address the shortcomings of the ACA and should keep the few things (such as protection for those with pre existing conditions) that actually worked. We must continue to provide subsidies to those who cannot afford insurance in order to stabilize the market. We must, however, demand individual accountability from patients, doctors, insurers and government stakeholders. Patients MUST be engaged in their own care and take steps such as smoking cessation, diet and exercise, etc in order to improve their OWN health (in partnership with their doctors). Insurers must be allowed to compete across state lines and must be allowed to operate in ways that provide maximal access for patients but must be held accountable to control costs. Doctors must provide efficient, high quality care—and be allowed to do so without government interference.
There are many challenges ahead of Congress and President Trump in the coming weeks—none bigger than healthcare. The Executive Order issued on Inauguration Day has signaled that this administration will be one of action. Now it is time for Congress to do their part and provide a real, working replacement for the ACA that can be immediately implemented. We must remember that any new healthcare law must put #PatientsFirst and allow Medicine to return to its roots—Doctors and patients working together to improve health outcomes and ensure a long and happy life.