Trump moves fast to strike at Obamacare

President Donald Trump, in his first day in office, issued an executive order to cripple the administration of the Affordable Care Act.

trumppositionThe order (1) forbids administrators to issue any new order or regulation that imposes new costs on states and (2) authorizes administrators to suspend any order or regulation that imposes undue costs on individuals or states.

The limitations are that the change has to be permitted by law and that there have to be advance note and public comment on the changes if the law requires it.

That may sound relatively harmless, but the ACA is so complicated that it is hard to make it work and easy to make it cease functioning—like removing a couple of bolts from a highly complex machine.

Here are some of the things reporters said could happen under Trump’s executive order:

  • Delay indefinitely enforcement of all the individual and state mandates to buy or provide health insurance.
  • Expand hardship exemptions under the individual requirement to buy health insurance so that they cover virtually everybody.
  • Extend the option of state governments to approve health insurance plans that don’t meet all the requirements of the ACA, including refusal to refuse insurance to people with pre-existing conditions.

Another thing the Trump administration could do is to stop defending a lawsuit by the House of Representatives challenging the legality of a program to reimburse insurers for providing subsidies for low-income patients.   The program was authorized by law, but no money was ever specifically appropriated for it.   The U.S. District Court agreed the program is illegal; the case is now on appeal to the U.S. Court of Appeals.

I underestimated Donald Trump.   I wrongly thought he would be ineffective because he isn’t interested in understanding the details of policy.

I should have remembered Ronald Reagan, who was not only successful, but transformative, because he knew his own mind and had loyal followers to implement his philosophy.


President Trump’s Day One Executive Order Can Severely Damage Obamacare by Seth Chandler for Forbes.

Executive actions Trump could take to change the ACA by Nicholas Bagley and Adrianna McIntyre for The Incidental Economist. [Added 1/24/2017]

What Does Trump’s Executive Order Against Obamacare Actually Do? by Margaret Sanger-Katz for The New York Times.

House GOP Wins Obamacare Lawsuit by Jennifer Haberkorn for POLITICO.

The Republican Health-Care Debate: a Guide for Perplexed Americans by Yuval Levin for National Review.

This is how American health care kills people by Ryan Cooper for The Week.   This is about a middle-class man who is insured under the Affordable Care Act, and yet is in imminent danger of death because he doesn’t have enough money to pay for live-saving medical treatment.

Donald Trump is right that the United States needs something better than the ACA.   I don’t think that simply repealing the ACA is an answer, but I think that would be better than leaving the ACA in place and crippling its administration.

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