Trump’s Executive Order: “By siphoning off healthy individuals, these junk plans could cannibalize the insurance exchanges.”

“President Donald Trump signed an executive order Thursday morning intended to allow small businesses and potentially individuals to buy a long-disputed type of health insurance that skirts state regulations and Affordable Care Act protections.
The White House and allies portray the president’s move to expand access to “association health plans” as wielding administrative powers to accomplish what congressional Republicans have failed to achieve: tearing down the law’s insurance marketplaces and letting some Americans buy skimpier coverage at lower prices. The order is Trump’s biggest step to carry out a broad but ill-defined directive he issued his first night in office for agencies to lessen ACA regulations from the Obama administration…
According to White House and agency officials, , the most far-reaching element of the multi-prong order instructs a trio of Cabinet departments to rewrite federal rules for association health plans – a type of insurance in which small businesses of a similar type band together through an association to negotiate health benefits.
The order will expand the availability of short-term insurance policies, which offer limited benefits meant as a bridge for people between jobs or young adults no longer eligible for their parents’ health plans. The Obama administration ruled that short-term insurance may not last for more than three months; Trump will extend that to nearly a year.” (A)

“In an effort to allow employers to form groups and obtain coverage across state lines, the order directs the administration to consider expanding Association Health Plans (AHPs), which allow small businesses in a similar sector or trade to band together to negotiate health benefits with other states.
This is a controversial measure and some experts predict there could be legal challenges, but supporters say it would increase competition by allowing employers to find the states offering the cheapest plans. It could also give more leverage to small businesses to negotiate policies. Additionally, the order calls for a broader interpretation of the Employee Retirement Income Security Act (ERISA), a law that regulates group plans provided by employers.
While ObamaCare mandated that short-term insurance policies should not last for more than three months, Trump is looking to expand those plans. The order says these short-term limited duration insurance (STLDI) offerings typically cost one-third of the price of the cheapest ObamaCare plans, while featuring broad provider networks and coverage. These plans are also not subject to most ObamaCare requirements…
The administration’s order also directs the government to look into ways to expand the use of Health Reimbursement Arrangements, or tax-free accounts that allow employers to reimburse employees for medical expenses. This measure is intended to give Americans greater control over their finance and health care.” (B)

“Although Mr. Trump has been telegraphing his intentions for more than a week, Democrats and some state regulators are now greeting the move with increasing alarm, calling it another attempt to undermine President Barack Obama’s signature health care law. They warn that by relaxing standards for so-called association health plans, Mr. Trump would create low-cost insurance options for the healthy, driving up costs for the sick and destabilizing insurance marketplaces created under the Affordable Care Act.
“It would have a very negative impact on the markets,” said Mike Kreidler, the insurance commissioner in Washington State. “Our state is a poster child of what can go wrong. Association health plans often shun the bad risks and stay with the good risks.”
They also worry that the Trump administration intends to loosen restrictions on short-term health insurance plans that do not satisfy requirements of the Affordable Care Act.
“By siphoning off healthy individuals, these junk plans could cannibalize the insurance exchanges,” said Topher Spiro, a vice president of the Center for American Progress, a liberal research and advocacy group. “For older, sicker people left behind in plans regulated under the Affordable Care Act, premiums could increase.”” (C)

“Critics, however, worry that the order may free these association health plans from several key Obamacare regulations and from state oversight, allowing them to sell plans with lower premiums but skimpier benefits. That could draw younger and healthier customers away from Obamacare and send premiums skyrocketing for sicker people left in the exchanges.” (D)

“If Donald Trump signs an executive order as early as this week allowing insurance companies to be able to sell health plans across state lines, it’s unlikely to have any takers willing to prop up medical provider network in new regions.
The trend in insurance is to narrow – not expand – networks of doctors and hospitals.
“Insurance companies have not been very interested because we are moving to these network based plans,” Sabrina Corlette, professor with the Center on Health Insurance Reforms at Georgetown University said last week during a Commonwealth Fund briefing. “Since the 1990s, health insurance has evolved and has been a network driven product.”
It’s unclear exactly what will be in Trump’s executive order, which he mentioned within days after the failure of the latest Republican attempt to replace and replace the Affordable Care Act.
Health insurance companies in some states can already sell health coverage across state lines, but it hasn’t worked in large part because plans haven’t wanted to spend the money contracting with more doctors and hospitals in areas they have no enrollees. Six states have enacted laws allowing health plan sales across state lines and “no state was known to actually offer or sell such policies,” National Conference of State Legislatures said in a new report last week.
“In the states that have tried to do this, there has been zero interest from carriers,” Georgetown’s Corlette, who is also the consumer representative to the National Association of Insurance Commissioners.” (E)

We’re Tracking the Ways Trump Is Scaling Back Obamacare. Here Are 11.,
By HAEYOUN PARK ,, https://www.nytimes.com/interactive/2017/10/12/us/trump-undermine-obamacare.html

TRUMP HEALTH CARE EXECUTIVE ORDER WILL DO WHAT GOP FAILED TO DO: LEAVE SICK AMERICANS WITHOUT HEALTH CARE, BY CHRISTIANNA SILVA
http://www.newsweek.com/trump-health-care-executive-order-will-do-what-gop-failed-do-leave-sick-683614

President Donald Trump’s executive order could take health care insurance away from millions of sick Americans, which was also a criticism of his earlier effort to repeal and replace the Affordable Care Act in Congress. The new plan would roll back some of Obamacare’s protections and coverage, but it could lower premiums for healthy Americans.

“Republicans in Congress should take President Donald Trump’s hint about working with Democrats on health care as motivation to follow through with their own promises, Mick Mulvaney, director of the White House Office of Management and Budget, said on Sunday’s “Meet The Press.”
Mulvaney’s comment comes on the heels of a Saturday morning tweet from Trump, stating: “I called Chuck Schumer yesterday to see if the Dems want to do a great HealthCare Bill. ObamaCare is badly broken, big premiums. Who knows!”
When asked what Republican lawmakers should take from that tease, Mulvaney responded, “Keep your promises.”
“The president wants to get something done,” he said. “He sees and understands what Obamacare is doing to folks back home, and he really doesn’t like it very much. So he’s looking for folks who will work with him to help change that. We had hoped it would be the Republicans in the Senate. They failed twice to do that. And can you blame the president then to sort of step back and say, ‘Okay, if my own party can’t deliver what I need, can I work with the other side?’ That’s not an unreasonable position.”” (F)

“Republican Sen. Ron Johnson said Sunday he believed Congress could reach an agreement on health care that includes continuing the funding of a key set of Obamacare subsidies to keep down insurance premiums.
The conservative Wisconsin senator said in an interview on CNN’s “State of the Union” that he understands some of his Republican colleagues are against funding the cost-sharing reduction — or CSR — payments. But he said the government should keep making the payments to prevent the cost of insurance skyrocketing.
President Trump has not committed to paying insurers the cost-sharing subsidies, which reduce deductibles and co-pays for low-income Obamacare enrollees. This has prompted many insurers to raise their premiums for 2018 to make up for the anticipated loss of the subsidies. The 2018 rates have already been finalized.
Johnson added that any such move to support continuing those payments would come with strings attached. “We should get something in return for that,” he said. For example, he said, Congress should make it so anyone has the option to purchase a “catastrophic plan” — insurance with relatively low premiums but high deductibles that provides fewer benefits. Johnson also said they should make health savings accounts more usable.” (G)

“Local and state groups that help with ObamaCare enrollment say they will likely have to reduce their services following funding cuts from the Trump administration.
Funding for the “navigator” groups, which provide outreach, education and enrollment assistance, was cut in half this year for being “ineffective,” Trump officials have said.
Now most of the navigator programs say they will have to limit their services this year, according to a new survey from the Kaiser Family Foundation (KFF).
Among programs that got reduced funding this year, 45 percent of statewide programs and two-thirds of regional programs said it is “somewhat or very likely” they will have to limit the territory their program will serve, according to the survey.
This could primarily impact consumers living in rural areas.
Some 55 percent of statewide navigator programs and 72 percent of regional programs expect to limit services to rural residents this year, KFF found. “ (H)

“New Jersey will lose more than 60 percent of the federal funding it expected to receive this year to help enroll vulnerable citizens in health insurance plans, a new report found, a change advocates fear will make it harder to reach those most in need of affordable care.
Officials at the federal Centers for Medicare and Medicaid Services announced more than $26 million in funding cuts in September that will impact the Affordable Care Act navigator programs in all but three states (Delaware, Kansas, and West Virginia); more than a dozen states lost at least half their funding.
New Jersey saw support drop to nearly $721,000 from the roughly $1.9 million received last year, according to a detailed analysis of these cuts released Wednesday by the nonprofit Kaiser Family Foundation. The money is distributed among five nonprofit programs that will see between 10 percent and 86 percent less funding this fall than they had to work with in 2016, the foundation determined.” (I)

What scares the members of Congress who for decades have collected hefty donations from the insurance and health-care industries and then used their positions of public trust to sustain and protect profiteering by those industries?
The threat of a single-payer “Medicare for All” health-care system.
By replacing the bureaucratic profiteers with an efficient system that would guarantee care for every American—and fair compensation for doctors and nurses—single payer would not merely make health care more accessible and more affordable. It would also make politics more honest and responsive to the will of the people.
House Speaker Paul Ryan has, through the campaign committees and political action committees that he guides, collected millions of dollars from Wall Street interests, insurance interests, pharmaceutical interests, private hospital and nursing home interests, and “health products” interests over the course of a political career that has seen him go to the mat, again and again, in defense of Wall Street interests, insurance interests, pharmaceutical interests, private hospital and nursing home interests, and “health products” interests.
So is it any surprise that Ryan keeps trying to “repeal and replace” the Affordable Care Act with measures that benefit his crony-capitalist campaign funders?
Single payer is a bad idea for senators whose political survival is based on banking checks from health-care profiteers. But it is a very good idea for America.” (J)

(A) Trump signs executive order to scale back Obamacare insurance rules, Amy Goldstein, http://www.chicagotribune.com/news/nationworld/politics/ct-trump-health-care-executive-order-20171012-story.html
(B) Trump’s health care order: What’s in it?, By Brittany De Lea, http://www.foxbusiness.com/politics/2017/10/12/trumps-health-care-order-whats-in-it.html
(C) Foiled in Congress, Trump Moves on His Own to Undermine Obamacare, By ROBERT PEAR and REED ABELSON, https://www.nytimes.com/2017/10/11/us/politics/trump-obamacare-executive-order.html?_r=0
(D) Trump begins Obamacare dismantling with executive order, by Tami Luhby and Kevin Liptak, http://www.cnn.com/2017/10/12/politics/trump-obamacare-executive-order/index.html
(E) How Narrow Networks Doom Trump’s Plan For Insurance Sales Across State Lines, by Bruce Japsen, https://www.forbes.com/sites/brucejapsen/2017/10/08/how-narrow-networks-doom-trumps-insurance-sales-across-state-lines/#5b1ce52335f9
(F) Mulvaney on Trump’s Message to GOP: ‘Keep Your Promises’, by KAILANI KOENIG, https://www.nbcnews.com/politics/congress/mulvaney-pres-trump-s-message-gop-keep-your-promises-n808821
(G) Sen. Ron Johnson suggests compromise on health care, By Eli Watkins, http://www.cnn.com/2017/10/08/politics/ron-johnson-healthcare-cnntv/index.html
(H) ObamaCare enrollment groups likely to decrease services after Trump funding cuts, BY JESSIE HELLMANN, http://thehill.com/policy/healthcare/354879-obamacare-enrollment-groups-likely-to-decrease-services-after-trump-funding
(I) NJ LOSES FEDERAL FUNDING TO EXPAND ACA ENROLLMENT, by LILO H. STAINTON, http://www.njspotlight.com/stories/17/10/11/nj-loses-federal-funding-to-expand-aca-enrollment/
(J) Why Do Republicans (and Some Democrats) Vilify Single Payer?, by John Nichols, https://www.thenation.com/article/why-do-republicans-and-some-democrats-vilify-single-payer/