December 14, 2017

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Trump’s First Order Has Strong Words On Health. Actual Impact May Be Weak.

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The Trump administration has significant power to undermine the workings of the Affordable Care Act. The bigger question is how much of that power it will use.

President Donald Trump’s executive order on Inauguration Day urging federal officials to “take all actions consistent with law to minimize the unwarranted economic and regulatory burdens” of the federal health law did not provide administration officials with any new powers to unravel parts of the law.

“They had all this authority before,” said Len Nichols, a health policy professor at George Mason University in Virginia who supports the health law. Trump, he said, “is signaling ‘I care’” about this issue.

In the short term, efforts will be minimal, said Joe Antos of the conservative American Enterprise Institute, because the White House is still getting its personnel on board. There are no high-level political appointees yet installed at the Department of Health and Human Services, Labor and Treasury, which have primary authority over the law.

“They need their appointees,” said Antos. Until more Trump personnel actually start work, he added, “I don’t think they’re going to be able to do much.” The nominees for secretaries of HHS, Labor and Treasury are encountering various degrees of turbulence in their Senate confirmation process.

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But even when the new personnel do take office, it remains unclear exactly how far the new administration will go. That’s because while they can make the law stop working, it will take Congress to actually put in place something new.

“If they start down that road” of unraveling the law, said Nichols, “then the insurers will pull out as soon as possible. And 2018 will not be pretty.” That’s a reference to the fact that plans offering coverage in the individual market are concerned that changes would make it easier for healthy people to exit the market, leaving only sicker and more expensive people behind and no way to spread costs.

Yet both Trump and Republican leaders in Congress have vowed not to strip away anyone’s insurance and to provide a “stable transition” to a new system. Trump told The Washington Post earlier in the month his goal was “insurance for everybody.”

And Antos said that many of the administration’s options might be more difficult than they first appear.

For example, he pointed to one item that has

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