President Donald Trump Issues Executive Order Aimed at Affordable Care Act

The action is largely symbolic, but could lead to changes in the way the healthcare law is enforced
Breast Cancer News
January 25, 2017
Erin Rowley, Writer and Content Coordinator

As a candidate, Donald Trump promised to “repeal and replace” the Affordable Care Act, also known as Obamacare. On his first day in office, President Trump showed he intends to keep that promise. He used the first executive order of his presidency to tell federal agencies to ease up on certain aspects of the healthcare law. 

“The order is not likely to have any immediate impact on coverage,” says David Grande, MD, MPA, assistant professor of medicine at the Perelman School of Medicine and director of policy at the Leonard Davis Institute of Health Economics, at the University of Pennsylvania. 

It could matter much more for coverage next year, Dr. Grande says.  

What Is an Executive Order and What Does it Mean for You? 

Presidents use executive orders to give federal agencies directions about how to enforce laws. President Trump can’t just sign away the Affordable Care Act. He needs Congress to repeal the law. But by signing this executive order, he IS able to change how federal agencies understand and enforce the law. 

With this executive order, the president has told officials, in particular those at the Department of Health and Human Services, how he wants certain parts of the law to be enforced. He’s told them to do everything they legally can to limit restrictions and costs the Affordable Care Act places on states, individuals, families, health insurers and pharmaceutical companies, among others. 

This executive order doesn’t provide specifics about WHAT officials should do to limit restrictions and costs associated with the Affordable Care Act. It’s up to the federal agencies to decide how to carry out the president’s order. 

“Nobody really knows how the executive order will translate toward changes,” Dr. Grande says.  “It is a broad statement and has no legal meaning on its own, but rather is a general message and signal that the new administration intends to make changes.”

But experts say the order may signal changes that could make it more difficult in the future to sign up for Medicaid, the government health insurance program for people with limited resources. The order may also have an effect on the future on the Affordable Care Act’s individual mandate, which requires everyone to get health insurance. People who don’t must pay a tax penalty, unless they apply for and receive a hardship waiver. To get this waiver, people must show that buying health insurance would be too hard on them financially, or that they’re experiencing a crisis, such as homelessness or domestic abuse, that prevented them from getting insurance. This executive order may make a hardship waiver easier to get, which could lead to fewer younger, healthier people buying health insurance. To be profitable, insurers need healthier people who have fewer healthcare expenses to balance out less healthy people who have more healthcare expenses. Fewer healthier people could mean higher premiums in 2018 and beyond. 

This order will not take away insurance you already have for 2017 through the Affordable Care Act’s health insurance marketplaces. And it does not stop you from signing up for health insurance through those marketplaces if you haven’t already done so for 2017. (You have until the end of January.)

The order will not affect the part of the law that protects people with pre-existing conditions, including cancer, from discrimination. Congress must get involved in order for that to be eliminated. But President Trump has said he wants to keep that part of the law. 

Still, says Dr. Grande, “individuals with breast cancer obviously are uniquely impacted by and benefit from the ACA’s requirement that insurers cover people regardless of any pre-existing condition.  Some of what we hear coming from Washington could jeopardize these regulations that were put in place by the ACA.”

You can find more information about what could come next as Congress works to repeal the Affordable Care Act here.


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