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With Signature, Trump Tries to Chip Away at Obamacare

President’s bold promises not reflected in heavily bureaucratic order

President Donald Trump signed an executive order Thursday that could mean major changes for former President Barack Obama’s signature 2010 health care law. Also pictured, Vice President Mike Pence; Kentucky Sen. Rand Paul, sixth from left; North Carolina Rep. Virginia Foxx, third from left; Labor Secretary Alexander Acosta, left. (Alex Wong/Getty Images)
President Donald Trump signed an executive order Thursday that could mean major changes for former President Barack Obama’s signature 2010 health care law. Also pictured, Vice President Mike Pence; Kentucky Sen. Rand Paul, sixth from left; North Carolina Rep. Virginia Foxx, third from left; Labor Secretary Alexander Acosta, left. (Alex Wong/Getty Images)

President Donald Trump continued chipping away at his predecessor’s legacy when he signed an executive order Thursday that spells major changes for President Barack Obama’s 2010 health care law. But the order merely directs agencies to craft new rules that one senior official would only say could “possibly” help millions of Americans despite Trump’s bold promises.

Trump called the order a “historic announcement” and promised it would come at zero cost to federal coffers. During a signing ceremony at the White House, he also promised it would bring more affordable coverage to “millions,” and said plans would be available “all across state lines” with competition among providers that he promised will be “staggering.”

“Once and for all, we will have great health care in our country,” he said of the order and his expectation that Republican lawmakers will eventually pass a bill repealing and replacing the 2010 law.

The order, however, does not contain language that would make those things happen quickly — or even at all.

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It directs three federal agencies to craft rules aimed at making more individuals eligible for insurance plans that White House and administration officials hope will lower costs for “tens of millions” of Americans, Andrew Bremberg, director of the president’s Domestic Policy Council, told reporters Thursday.

One major thrust of the order is to help individuals cluster together to buy insurance via so-called association plans. It also terminates Obama-era regulations on “short-term medical insurance,” which the previous administration deemed insufficient to the 2010 law’s goals.

Bremberg and other administration officials who briefed reporters on the call a couple of hours before Trump signed the order said the president still expects Congress to pass legislation addressing Obama’s controversial health care law. The president said the same during a Wednesday visit to Harrisburg, Pennsylvania.

More to come

But, in a sign of how intent Trump and his team remain on taking apart as much of the Obama legacy they can without Congress’ help, officials told reporters to expect additional executive actions targeting the health care law in the coming months.

The health care order is merely the latest in a string of moves Trump has taken to erode much of what Obama put in place.

From health care to climate policy to an expected decertifying of the Iran nuclear deal on Friday, Trump has busily targeted parts of the 44th president’s legacy that he has the legal authority to take down on his own. And he’s getting an assist from the GOP-controlled Congress on nixing a slew of Obama-era regulation.

But whether the health order will be as effective as, for instance, rolling back those regulations or withdrawing from the Paris climate accord won’t be known for several months — and perhaps longer.

That’s because the document mostly provides guidance to three federal departments — Health and Human Services, Labor and Treasury — to consider or begin the often-cumbersome process of crafting new rules that might drastically change the 2010 law. Even Bremberg’s rhetoric earlier Thursday was tepid: “We expect these policy changes could potentially benefit tens of millions of Americans over time.”

Sen. Rand Paul, who worked on the order with White House officials, dubbed it the “biggest free-market” change to the health care system in many years.

Speaking at the White House moments before Trump signed the mandate, the Kentucky Republican lauded the order as providing help to “28 million people who were left behind by Obamcare,” arguing it is tailored for those who still lack insurance coverage or cannot afford it. 

At first glance, it is more bureaucratic than bold. Notably, Trump’s rhetoric in recent days about the order described a much more muscular document.

“A big percentage of people will be able to get health care, and they’ll be able to go across state lines,” Trump said Tuesday, referring to the order. “They’ll be able to buy from many, many competitors. … And it will not cost our country anything.”

But whether that is the case, administration officials made clear Thursday morning, will depend on what the final rules from the three agencies look like.

No choice?

In recent days, the president and his top aides have made clear they decided he had no choice but to sign the order since the Republican-controlled Congress failed to pass a bill that would at least partially repeal and replace the 2010 law.

Asked if Trump is alienating himself by attacking GOP lawmakers, White House Press Secretary Sarah Huckabee Sanders said Tuesday that Congress has alienated itself by “not getting the job done.”

“Time and time against, Congress has made promises and failed to deliver,” she said, pointing to a failed health care overhaul effort as the prime example.

Trump began the work week with a tweet chiding Congress for not being able to “get its act together on HealthCare.” He said he planned to sign the order to “give great HealthCare to many people — FAST.”

Democrats have acknowledged that the health care law is flawed and must be revised, but they are skeptical of Trump’s order.

Washington Sen. Patty Murray, ranking member on the Health, Education, Labor and Pensions Committee, slammed the order in a statement. 

“The policies President Trump is announcing today are the latest and worst in his yearlong effort to create Trumpcare by sabotage,” Murray said. “They will force patients across the country to pay more for their care, lose quality coverage options, and find themselves with surprise medical bills when they can least afford it.”

The Democratic National Committee was even more harsh in its own statement.

“Trump has already done extensive damage and caused premiums to increase for millions by creating uncertainty, limiting funding for advertising and cutting the ACA’s open enrollment period,” the DNC said, referring to the 2010 law by its abbreviation.

The order would “create a loophole that would allow insurers to sell stripped-down insurance plans that do not cover essential health benefits or a minimal percentage of a person’s medical bills,” the DNC said, adding that it would “could cause young, healthy people to leave individual insurance markets, creating a death spiral that could cause premiums to increase and insurers to leave markets.”

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