By Tim Callender, Esq.

On Friday January 20th, President Donald Trump signed his first executive order, directing agencies to give more leeway to the states in the way that states implement (“carry out”) the Affordable Care Act.  It appears that this executive order is primarily a precursor of things to come and is an attempt to set general expectations as to healthcare policy under the Trump Administration.  At its core, the order provides a sweeping mandate, directed at the heads of agencies that administer the ACA, to find ways to ease the financial burden of the ACA.  Specifically, the order does mention the Department of Health and Human Services, soon to be headed up by Representative Tom Price.  As all of us in the industry know, HHS might be the federal agency most impacted by the ACA.  HHS’s actions, or inactions, under this order will likely guide the IRS and the DOL, the other two federal agencies primarily guiding the day-to-day execution of the ACA.


Many pundits have already spoken up, concerned, or pleased, that this marks the end of the individual marketplace (aka The Exchanges).  Truth be told, whether a support of the ACA and its marketplaces, or not, it seems that all would agree the marketplaces have seen significant troubles and the sustainability of the model has been in question for some time.  Is this the piece that truly spells the end of the ACA marketplaces?  Perhaps it is.

But, as in all things coming from Washington D.C., we will have to wait to see the true, logistical impact of this broad, executive order.

In addition, GOP Senators Bill Cassidy (R-LA) and Susan Collins (R-ME) recently released one Republican-led proposal that may be introduced as a replacement to the ACA.  Among the highlights of the plan are measures allowing states to continue with the ACA, should they “like it” – whatever that means.  Additionally, the proposal appears to urge pricing transparency on medical procedures, while also allowing for the existing subsidies and tax credits provided in the 2010 law to remain intact.  This proposal seems to be a mid-ground departure from many other GOP plans, in that it seems to allow for many aspects of the ACA to remain in place.

The most interesting aspect of the Cassidy-Collins proposal is an item that would appear to push all uninsured residents into a federally subsidized catastrophic plan, through auto-enrollment.  Good idea or bad idea – I don’t know.  But, it feels like an interesting departure from the typical, market-driven, free-choice arguments that conservative lawmakers usually provide when discussing healthcare.  Then again, perhaps the focus on a catastrophic plan narrows the concern that this “forced” auto-enrollment would be replacing market-driven free-choice in that a catastrophic plan would not cover many of the day-to-day health needs that a plan member might want, thus pushing him or her to explore additional, private options for their routine coverage.  Perhaps the genius of this “forced” catastrophic move is that it takes a good deal of the risk off of the primary insurer thus causing those costs to decline?

It all remains to be seen.  Stay tuned as we watch, digest, and continue to comment on the upcoming changes affecting our industry.