Kentucky Sen. Rand Paul had a prime spot at the White House on Thursday when President Donald Trump wielded his rule-making power to launch an end run that might get him closer to his goal of repealing and replacing “Obamacare.”
Paul was one of the three votes that recently helped sink Republicans’ latest effort to repeal and replace the Affordable Care Act.
“President Trump is doing what I think is the biggest free market reform of health care in a generation,” Paul said at the executive order signing in the White House.
Trump made light of the conflict between the two of them during the GOP presidential primary debates. He gave Paul a pen used to sign the executive order.
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“When you get Rand Paul on your side, it has to be positive,” Trump said. “I’ll tell you that.”
Opponents of the policy say it could drive up costs for people in the individual health care market, because healthier people would sign up for the cheaper insurance in health care associations, leaving a sicker pool of people in the individual market
“I don’t know how anybody could be opposed to it,” Paul said. “People will leave the individual market though, and I think that’s a good thing.
“We think it has the possibility of allowing millions of people who don’t have insurance to get some,” Paul said. There are currently around 28 million uninsured people in the country.
Whether Trump’s executive order will be the play that breaks through on the GOP goal of repealing Obamacare isn’t clear.
Experts say consumers aren’t likely to see major changes any time soon, although the White House is promising lower costs and more options.
Some experts warned that hard-won protections for older adults and people in poor health could be undermined by the skinny lower-premium plans that Trump ordered federal agencies to facilitate. Others say the president’s plans will have a modest impact, and might even help.
People on different sides of the polarized health care debate did agree that it will take months for the government bureaucracy to turn Trump’s broad-brush goals into actual policies that affect millions of people who buy their own health insurance policies.
“Today is only the beginning,” Trump said at the Oval Office signing ceremony. He promised new measures in coming months, adding, “We’re going to also pressure Congress very strongly to finish the repeal and replace of ‘Obamacare’ once and for all.”
Democrats denounced Trump’s order as more “sabotage” while Republicans called it “bold action” to help consumers. A major small business group praised the president, while doctors, insurers and state regulators said they have concerns and are waiting to see details.
“We want to make sure that all the consumer protections are there and included,” said Michael Munger, president of the American Academy of Family Physicians.
One of the main ideas from the administration involves easing the way for groups of employers to sponsor coverage that can be marketed across the land. That reflects Trump’s longstanding belief that competition across state lines will lead to lower premiums.
Those “association health plans” could be shielded from some state and federal insurance requirements. Responding to concerns, the White House said participating employers could not exclude any workers from the plan, or charge more to those in poor health. Self-employed people might be able to join.
Paul has previously pushed for the expansion of association health plans.
Other elements of the White House plan include:
▪ Easing current restrictions on short-term policies that last less than a year — an option for people making a life transition, from recent college graduates to early retirees. Those policies are not subject to current federal and state rules that require standard benefits and other consumer protections.
▪ Allowing employers to set aside pre-tax dollars so workers can use the money to buy an individual health policy.
“This could be much ado about nothing, or a very big deal, depending on how the regulations get written,” said Larry Levitt of the nonpartisan Kaiser Family Foundation. “The intent of the executive order is clear, to deregulate the insurance market under the ACA.”
Levitt said association health plans and short-term health insurance policies could be designed to lure healthier people away from the state insurance markets created by the Obama health law. They’d offer lower premiums to those willing to accept fewer benefits. That would drive up costs for consumers in the already-shaky “Obamacare” markets, making them less attractive for insurers and raising subsidy expenses for the government.
But economist Douglas Holtz-Eakin, president of the center-right American Action Forum, said it looks like the impact will be on market niches, not the broad landscape of health insurance.
“This just isn’t a revolution to insurance markets,” he said. “It’s a policy change. What we’ve got isn’t working, so we might as well try something else.”
On Capitol Hill, House Democratic Leader Nancy Pelosi called Trump’s move “cynical.”
“The American people overwhelmingly rejected Trumpcare, but President Trump is still spitefully trying to sabotage their health care, drive up their costs and gut their coverage,” Pelosi said in a statement.
About 17 million people buying individual health insurance policies are the main focus of Trump’s order. Nearly 9 million of those consumers receive tax credits under the Obama law and are protected from higher premiums.
But those who get no subsidies are exposed to the full brunt of cost increases that could reach well into the double digits in many states next year. Many in this latter group are solid middle-class, including self-employed business people and early retirees.
Cutting their premiums has been a longstanding political promise for Republicans, but experts see no immediate impact.