President Donald J. Trump has signed an executive order that he said would “expand choices and alternatives” to health insurance plans offered under the Affordable Care Act.
The executive order outlines several strategies designed to increase access to health insurance plans. First, it allows the secretary of labor to increase access to association health plans on a national scale, a move that would allow “American employers to form groups across state lines,” according to Trump. Under such expansion, less stringent interpretation of the Employee Retirement Income Security Act could enable employers across the country who are in the same industry to form groups and offer health insurance to individuals in those groups. This element of the executive order may also enable employers to form association health plans within existing organizations or develop entirely new ones “for the express purpose of offering group insurance,” Trump said.
Employers who take part in an association health plan would not be allowed to exclude any employees from taking part in the plan, nor would they be able to establish premiums based on health conditions.
The executive order also provides two directives for the Department of Labor, the Department of the Treasury and HHS.
The first encourages these departments to increase coverage through low-cost, short-term, limited duration insurance, which is not required to abide by mandates and rules outlined in the ACA. Such plans would benefit “people between jobs, people in counties with only a single insurer offering exchange plans, people with limited coverage networks, and people who missed the open enrollment period but still want insurance,” according to information on the executive order that was released by the White House.
The second directive recommends that these same departments contemplate altering health reimbursement arrangements, which are “employer-funded accounts that reimburse employees for health care expenses, including deductibles and copayments.” The information released by the White House, which notes that money contributed to these plans is not considered taxable income, also states that extending health reimbursement arrangements may provide employees “greater flexibility and control over how to finance their health care needs.”
The American College of Physicians (ACP) issued a response shortly after the executive order was signed, which states that the organization is “extremely concerned” about the recommendations that are being proposed.
“The ACP has said repeatedly that any attempts by Congress to ‘repeal and replace’ the Affordable Care Act must first, do no harm to patients. This executive order utterly fails that test,” the authors wrote. “This executive order violates the clear intent, and likely the statutory requirements, of the Affordable Care Act.”
The ACP also states that it will “consider all avenues to prevent these changes from taking place.”
American College of Physicians. ACP: Executive order may result in significant harm to patients by allowing plans to circumvent health insurance market rules. Available at: https://www.acponline.org/acp-newsroom/acp-executive-order-may-result-in-significant-harm-to-patients-by-allowing-plans-to-circumvent. Accessed Oct. 12, 2017.
WhiteHouse.gov. President Donald J. Trump is taking action to improve access, increase choices, and lower costs for health care. Available at: https://www.whitehouse.gov/the-press-office/2017/10/12/president-donald-j-trump-taking-action-improve-access-increase-choices. Accessed Oct. 12, 2017.