WASHINGTON — President Trump signed an executive order late Friday giving federal agencies broad powers to unwind regulations created under the Affordable Care Act, including enforcement of the penalty for people who fail to carry the health insurance that the law requires of most Americans.
The executive order, signed in the Oval Office as one of the new president’s first actions, directs agencies to grant relief to every one of the constituencies affected by the sprawling 2010 health-care law: insurers, hospitals, doctors, pharmaceutical companies and states. While the order does not describe specific federal rules to be softened or lifted, it appears to give room for agencies to eliminate an array of taxes and requirements that exist under the law.
Though the new administration’s specific intentions are not yet clear, the order’s breadth and early timing carry symbolic value for a president who made repealing the ACA – his predecessor’s signature domestic achievement – a leading campaign promise.
The order’s language about easing economic and regulatory burdens also aligns with longstanding Republican orthodoxy that the government exerts too heavy a hand on the U.S. health-care system.
The order, several paragraphs long, does not identify which of the many federal rules that exist under the ACA the new administration intends to rewrite or eliminate. In general, federal rules cannot be undone with a penstroke but require a new rule-making process to replace or delete them.
But in giving agencies permission to “waive, defer, grant exemptions from or delay” ACA rules, the order appears to create room for the Department of Health and Human Services to narrow or gut a set of medical benefits that the ACA compels insurers to include in health plans that they sell to individuals and small businesses.
The order’s reference to relief from financial burdens could mean that the administration might try to ease taxes that the ACA imposes on various parts of the health-care industry – though it is unclear whether that would be possible, since the taxes are contained in the law itself.
The order does not mention Medicaid, but it says one of its goals is to “provide greater flexibility to States,” raising the question of whether the Trump HHS might try to loosen rules for states that have expanded the program for lower-income Americans, as the law allowed.
The order directs all federal agencies “to minimize the unwarranted economic and regulatory burdens” of the Affordable Care Act – the first step of Trump’s central campaign promise to repeal and replace former president Barack Obama’s health care plan.
Republican Sens. Susan Collins of Maine and Bill Cassidy of Louisiana are expected next week to introduce a replacement for the Affordable Care Act that would allow states to maintain what they have or choose other options to provide health insurance to their residents.
REGULATORY FREEZE
Also late Friday, Reince Priebus, Trump’s chief of staff, issued an executive memorandum ordering a freeze on regulations for all government agencies.
The memo could freeze several new Energy Department efficiency standards affecting portable air conditioners, swimming pool pumps, commercial boilers and uninterruptable power supplies, which were issued Dec. 28 but not yet published in the Federal Register. The regulations were part of the Obama administration’s broader effort to cut greenhouse gas emissions linked to climate change.
The move echoes a missive that then-White House Chief of Staff Rahm Emanuel sent the heads of every federal agency on Jan. 20, 2009, asking them to freeze any rules that had not yet been published in the Federal Register, and to consider a 60-day extension of the effective date of rules that had not yet gone into effect.
Trump’s health care order came at the end of what had otherwise been a largely ceremonial day. The White House did not immediately return requests for comment.
MORTGAGE FEE REDUCTION
Earlier Friday, in the Capitol, the new president took several more perfunctory executive actions shortly after he was sworn in at noon, the most notable being to overturn a recent mortgage-fee reduction – geared at helping first-time and low-income home buyers – that Obama announced last week and that called for the Federal Housing Administration to cut its annual borrowing fee by a quarter of a percentage point.
And just moments after Trump took the oath of office, he began implementing his general vision, transforming the official White House website with a new set of policy pledges that offered the broad contours of the Trump administration’s top priorities. They included fierce support for law enforcement and gun owners’ rights to defend themselves. There was also some notable absences, such as the omission of a policy page on climate change.
The issues page of Trump’s White House offered no new plans or policies but rather a rehash of many of his most prominent campaign promises – a signal to the nation that Trump, more pragmatic than ideological, plans to implement at least the key guideposts of his campaign vision.
The policies laid out on the website included plans to both withdraw from and renegotiate major trade deals, grow the nation’s military and increase cyber-security capabilities, build a wall at the nation’s southern border and deport undocumented immigrants who have committed violent crimes.
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