Chipping Away at the ACA

(Oct. 13, 2017) Ed. note: The Trump Administration argues that the Affordable Care Act (Obamacare) is a "disaster" and a "nightmare," pointing to skyrocketing premiums and limited choices.  In addition to its high-profile efforts working with Congress to repeal the ACA the administration has taken many actions to dismantle the law, starting with the very first executive order Trump signed on Jan. 20, 2017, "Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal."  Supporters of the ACA have watched these actions with alarm, and particular concern has been raised about the stability of individual health insurance marketplaces.  (The Center on Budget and Policy Priorities has a useful page titled "Sabotage Watch: Tracking Efforts to Undermine the ACA").  On Oct. 12, 2017 the adminstration took two actions seen as undermining the ACA.

- Trump signed an executive order expanding access to association health plans;
- The administration announced that cost-sharing reductions payments would be discontinued.

The White House
October 12, 2017


“The time has come to give Americans the freedom to purchase health insurance across state lines, which will create a truly competitive national marketplace that will bring costs way down and provide far better care.” – President Donald J. Trump
EXPANDING ACCESS TO MORE AFFORDABLE OPTIONS: President Donald J. Trump is taking action to increase the healthcare choices for millions of Americans, potentially allowing some employers to join together across State lines to offer coverage.
·         President Trump signed an Executive Order to reform the United States healthcare system to take the first steps to expand choices and alternatives to Obamacare plans and increase competition to bring down costs for consumers.
·         The order directs the Secretary of Labor to consider expanding access to Association Health Plans (AHPs), which could potentially allow American employers to form groups across State lines.
o   A broader interpretation of the Employee Retirement Income Security Act (ERISA) could potentially allow employers in the same line of business anywhere in the country to join together to offer healthcare coverage to their employees.
§  It could potentially allow employers to form AHPs through existing organizations, or create new ones for the express purpose of offering group insurance.
o   By potentially making it easier for employers to band together, workers could have access to a broader range of insurance options at lower rates in the large group market.
o   Employers participating in an AHP cannot exclude any employee from joining the plan and cannot develop premiums based on health conditions.
·         The order directs the Departments of the Treasury, Labor, and Health and Human Services to consider expanding coverage through low cost short-term limited duration insurance (STLDI).
o   STLDI is not subject to costly Obamacare mandates and rules. One study found that on average STLDI costs one-third the price of the cheapest Obamacare plans.
o   Despite its low cost, STLDI typically features broad provider networks and high coverage limits.
o   The main groups who benefit from STLDI are people between jobs, people in counties with only a single insurer offering exchange plans, people with limited coverage networks, and people who missed the open enrollment period but still want insurance.
·         The order directs the Departments of the Treasury, Labor, and Health and Human Services to consider changes to Health Reimbursement Arrangements (HRAs) so employers can make better use of them for their employees.
o   HRAs are employer-funded accounts that reimburse employees for healthcare expenses, including deductibles and copayments.
o   The IRS does not count funds contributed to an HRA as taxable income.
o   Expanded HRAs could potentially give American workers greater flexibility and control over how to finance their healthcare needs.
OBAMACARE IS FAILING: The status quo is not delivering quality healthcare options for the American people, who are facing higher premiums and fewer options.
·         The percentage of workers at small firms receiving coverage through their employer has declined from nearly half in 2010 to about one-third in 2017.
·         In 2018, more than 1,500 counties (nearly 50 percent of all counties) are projected to have only one option on their individual insurance exchanges, according to the Centers for Medicare and Medicaid Services.
o   This means 2.6 million Americans, or nearly 30 percent of exchange participants, will be left without a choice of insurers.
·         From 2013 to 2017, average premiums for individual health insurance plans have doubled, increasing by $2,928 according to the Department of Health and Human Services.
o   During this period, every State using saw individual insurance premiums increase.
·         Americans are departing the Obamacare exchanges and millions are choosing to pay the law’s penalty instead.
o   500,000 fewer Americans enrolled in an Obamacare plan in 2017 compared to the prior year.
o   Current exchange enrollment is 60% below what the Congressional Budget Office expected when the law took effect.
o   6.7 million Americans chose to pay the Obamacare penalty in 2015 rather than purchase insurance on the exchanges. 37% of penalized households made less than $25,000, and 79% of penalized households made less than $50,000.

Remarks by Vice President Pence and President Trump at Signing of Executive Order Promoting Healthcare Choice and Competition

Roosevelt Room

11:32 A.M. EDT

THE VICE PRESIDENT: Well, good morning. Secretary Acosta, Senator Paul, Secretary Mnuchin, Director Mulvaney, Administrator McMahon, and Senator Paul, thank you for those thoughtful remarks. And to Congressman Greg Walden and Congresswoman Virginia Foxx, other distinguished members of Congress, and job creators, it's an honor to share this moment with you today -- a moment where President Trump will take a critical step to lower the cost of health insurance for working Americans.

Since day one of our administration, President Trump has made it a top priority to rescue the American people from the disastrous failure of Obamacare.

Every day Obamacare survives is another day the American people struggle. And all the job creators gathered here today at the White House have witnessed the failures of Obamacare firsthand. Premiums have more than doubled since Obamacare went into effect, and next year premiums are set to increase even more.

costs have been skyrocketing, choices are plummeting. Next year, nearly half of America's counties will have only one choice of health insurance provider, which means they essentially have no choice at all.

As the President and I have traveled the country, we've heard stories from small-business owners like those gathered here today, from working families who are struggling under the weight of Obamacare. Today, President Trump will take decisive action to provide the American people with flexibility and freedom from the burdens of Obamacare and expand the number of affordable healthcare options for working Americans.

And, Mr. President, I can say, I speak for everyone here and for millions of Americans when I say how grateful we are for your determination to repeal and replace Obamacare and your commitment demonstrated today by this action to provide the American people with more choices for more affordable healthcare in the 21st century.

with that, ladies and gentlemen, it's my privilege to introduce the President of the United States of America. (Applause.)

11:34 A.M. EDT

THE PRESIDENT: Thank you. Thank you very much to Vice President Pence for that wonderful introduction and for the great job you do. And I want thank Secretary Acosta, Secretary Mnuchin, Acting Secretary Hargan, and Administrator McMahon for joining us today. We're all gathered together for something, I believe, that's going to be very, very powerful for our nation and very good for a lot of people.

But before I begin, I have a important update. Yesterday, the United States government, working with the government of Pakistan, secured the release of Caitlan Coleman, Joshua Boyle, and their three children from captivity from the Haqqani Network, a terrorist organization with ties to the Taliban. The Pakistani government's cooperation is a sign that it is honoring America's wish that it do more to provide security in the region.

And I want to thank the Pakistani government. We want to thank Pakistan. They worked very hard on this, and I believe they're starting to respect the United States again. It's very important. I think right now a lot of countries are starting to respect the United States of America once again.

We hope to see this type of cooperation and teamwork in helping secure the release of remaining hostages and in our future joint counterterrorism operations.

So with that, I want to begin by saying it's my pleasure to welcome so many great small business and association leaders to the White House as we prepare to make this truly historic announcement. And that's exactly what it is.

We've been hearing about the disaster of Obamacare for so long -- in my case, many years, most of it outside in civilian life. And for a long period of time since I've started running and since I became President of the United States, I just keep hearing "repeal and replace, repeal and replace." Well, we're starting that process, and we're starting it in a very positive manner.

And I can say, when you get Rand Paul on your side, it has to be positive, that I can tell you. (Laughter.) Boy. (Applause.) I was just saying as he's getting up and saying all these wonderful things about what we're going to be announcing, I said, boy, that's pretty unusual. I'm very impressed. (Laughter.)

But seven years ago, congressional Democrats broke the American healthcare system by forcing the Obamacare nightmare onto the American people. And it has been a nightmare. You look at what's happening with the premiums and the increases of 100 percent and 120 percent, and even in one case, Alaska, over 200 percent. And now, every congressional Democrat has blocked the effort to save Americans from Obamacare, along with a very small, frankly, handful of Republicans -- three. And we're going to take care of that also because I believe we have the votes to do block grants at a little bit later time, and we'll be able to do that.

Premiums have gone skyrocketing. But today, one-third of all the counties in America have only a single insurer selling coverage on an exchange, and next year it looks like nearly half of all counties in our country -- think of that -- all of the counties, one half will have only one insurer. And many will have none. Many will have absolutely created roadblocks for people to have any form of the insurance we're talking about.

is why, in a few moments, I will sign an executive order taking the first steps to providing millions of Americans with Obamacare relief.

It directs the Department of Health and Human Services, the Treasury, and the Department of Labor to take action to increase competition, increase choice, and increase access to lower-priced, high-quality healthcare options. And they will have so many options. This will cost the United States government virtually nothing, and people will have great, great healthcare. And when I say people, I mean by the millions and millions.

we aim to allow more small businesses to form associations to buy affordable and competitive health insurance. This would open up additional options for employers to purchase the health plans their workers want.

I'm also directing Secretary Acosta to consider ways to expand these associations and these healthcare plans all across state lines. This will create tremendous competition and transformative -- in so many ways -- change aimed at creating more and lower prices for millions of Americans.

But the competition will be staggering. Insurance companies will be fighting to get every single person signed up, and you will be hopefully negotiating, negotiating, negotiating, and you'll get such low prices for such great care. Should have been done a long time ago, and it could have been done a long time ago.

This will allow thousands of small business employers to have the same purchasing power as large employers to get more affordable and generous insurance options for their workers. Rich and Leslie Baudry -- where are they? Where are they? How are you? Nice to see you. Come on, get up here. Come on. How are you? Nice to see you, Leslie.

They're here today from Louisiana -- a great state. I just left. They had a little hurricane damage, a little, sort of -- they got hit, Lake Charles. But we took good care of it, right?

MS. BAUDRY: Absolutely.

THE PRESIDENT: We took good care of it. They're great people.

They're small business owners, and they know personally the benefits of association health plans, one of which used to provide health insurance for their employees.

But after Obamacare, they were unable to afford their association plan. So they had a great thing, their employees were happy, and then it ended like so many more. I mean, this is something I hear. Greg, you know exactly what I'm talking about. Greg has been so incredible on this subject. And people had plans that worked, and then all of a sudden they were just totally cut off. And it happened to your company also.

Rich and Leslie have said that they would love, once again, to use an association health plan, and there are millions of Americans who want more affordable options just like them. And now, with this executive order, Americans will likely soon have those options. We will be very happy to provide them to you, and you will be very happy, Rich. I think you're going to be extremely pleased. If you're not, you can tell them right now, okay? (Laughter.)

MS. BAUDRY: Thank you so much.

THE PRESIDENT: Thank you, Leslie. Appreciate it. Great to see you. Thank you very much.

In addition, my administration will explore how we can expand something called short-term limited duration insurance. These health insurance policies are not subject to any very expansive and expensive Obamacare coverage mandates and rules. The cost of the Obamacare has been so outrageous it is absolutely destroying everything in its wake.

They were so attractive that, just last year, the previous administration crippled the market in an effort to keep people from fleeing the failing Obamacare plans. In fact, they prevented these plans from lasting more than three months. They will take action to fix that and to make these affordable, flexible plans much more widely available. So we're going to have a very widely available plan that's going to cost much less. And from the standpoint of the United States government, we will be very happy, won't we, Virginia?

REPRESENTATIVE FOXX: We will, Mr. President.

THE PRESIDENT: So they'll get better and it will cost us nothing. That's not too bad, right? (Laughter.) We need some more answers like that.

Finally, today's executive order instructs Secretaries Acosta, Mnuchin, and Hargan to explore how they can allow more businesses to use tax-free health reimbursement arrangements or HRAs to compensate their employees for their healthcare expenses. Currently, only about one-third of small business employees receive coverage at work, forcing millions of workers to enroll in the exchanges or remain uninsured and to pay the individual mandate penalty. Not good. Not good. That is one of the most unpopular things I've ever seen in government, I can tell you.

This order takes first steps to make it easier for businesses to help their workers afford high-quality and more flexible healthcare through reimbursement accounts. With these actions, we are moving toward lower costs and more options in the healthcare market and taking crucial steps towards saving the American people from the nightmare of Obamacare.

Today is only the beginning. In the coming months, we plan to take new measures to provide our people with even more relief and more freedom. And, by the way, on another subject, that will include massive tax cuts. We are going to get massive tax cuts, and I believe even Senator Rand Paul, and I know Virginia, Greg, I think you're with us. But the whole country is looking for these massive tax cuts, and we will get them.

And we're going to also pressure Congress very strongly to finish the repeal and the replace of Obamacare once and for all. We will have great healthcare in our country.

you all very much. Appreciate it. Thank you. Thank you very much. (Applause.)

THE VICE PRESIDENT: Mr. President, you need to sign it.

THE PRESIDENT: Oh. (Laughter.) I'm only signing it because it costs nothing. (Laughter.)

Well, this is promoting healthcare choice and competition all across the United States. This is going to be something that millions and millions of people will be signing up for, and they're going to be very happy. This will be great healthcare.

So congratulations to everybody. (Applause.)

(The executive order is signed.)


 11:46 A.M. EDT

American Bridge 21st Century

Statement: Trumpcare Executive Order Undermines Americans' Access to Healthcare and Risks Legal Challenges

American Bridge Vice President Shripal Shah issued the following statement on Trump's executive order further undermining the Affordable Care Act's state insurance marketplaces as well as its protections for Americans with preexisting conditions:

​ "This is an outrageous, and potentially illegal, attack on Americans with preexisting conditions and the finances of middle class Americans. Trump's actions will exacerbate the chaos in already-sabotaged marketplaces, force premiums to skyrocket, and open the doorway to large-scale health insurance fraud, all in the name of partisan politics. American families are paying attention, and they'll know exactly who to blame when they're hit with the consequences of Trump's reckless behavior." 


​ American Enterprise Institute Resident Scholar Joseph Antos: “The E in ERISA is employee...They are going to have to stretch the definition of whether you’re an employee or not.” [Reuters, 10/12/2017]

Reuters: “U.S. President Donald Trump’s expected plan to let Americans buy insurance across state lines could violate federal law governing employee benefit plans and will almost certainly be challenged in court, several legal experts said….Several experts in healthcare and employment law said Trump’s plan could violate the U.S. Employee Retirement Income Security Act (ERISA), a federal law that governs large group plans that must be provided or maintained by employers or employee organizations.” [Reuters, 10/12/2017]

Politico: “‘How that doesn't get challenged, how that isn't such an expansive interpretation of ERISA that goes beyond the administration's authority — someone's absolutely going to’ bring a legal challenge, said an insurance industry official, who requested anonymity to discuss strategy. ‘This is chaos.’” [Politico, 10/12/2017]

Harvard Law School Professor Lawrence Tribe: “Trump’s abuse of presidential power to undermine laws passed by Congress rather than faithfully execute them” [Twitter, 10/11/2017]

Washington Post: “The prospect of letting individuals be part of these associations is the aspect of the executive order likely to draw legal complaints. The 1974 ERISA law, which permits large companies that insure themselves to do so with relatively little federal regulation, could be reinterpreted to apply to small businesses that band together, according to health policy experts familiar with the law. But ERISA does not apply to individuals buying coverage on their own.” [Washington Post, 10/12/2017]

Wall Street Journal: “Health analysts predicted that Thursday’s order could tempt critics to pursue legal challenges, opening a new front in the health-care battle.” [Wall Street Journal, 10/12/2017]


​ Associated Press: “But the president's move is likely to encounter opposition from medical associations, consumer groups and perhaps even some insurers — the same coalition that so far has blocked congressional Republicans from repealing and replacing former President Barack Obama's Affordable Care Act. Critics say the White House approach would raise costs for the sick, while the lower-premium coverage provided to healthy people would come with significant gaps.” [Associated Press, 10/12/2017]

Washington Post: “President Trump intends to sign an executive order this morning expanding association health plans. But 25 years ago, federal watchdogs concluded that such plans ripped off hundreds of thousands of Americans by refusing to pay their medical claims while violating state insurance laws and even criminal statutes.” [Washington Post, 10/12/2017]

Politico: “Importantly, they wouldn't have to meet Obamacare's benefit requirements or cover a minimum percentage of enrollees' health care costs. Association health plans ‘could effectively cherry pick’ the most desirable participants, said Sabrina Corlette, an insurance expert at Georgetown University and a former Democratic congressional staffer. ‘Anybody who's healthy and unsubsidized would quickly make the transition.’” [Politico, 10/12/2017]

Kaiser Family Foundation Senior Fellow Karen Pollitz: “Within a year, this would kill the market.” [Politico, 10/12/2017]

S&P Global Ratings Healthcare Analyst Deep Banerjee: "No one healthy is now going to sign up in the ACA risk pool, because they have this cheaper option...It just takes away the opportunity of this risk pool getting better." [Politico, 10/12/2017]

Reuters: “Experts said the association health plans could attract young, healthy people and leave a sicker, more expensive patient pool in the individual insurance markets created under the healthcare law, driving up premiums and effectively eroding the law's protection for those with pre-existing conditions.” [Reuters, 10/12/2017]

Veda Partners Policy Analyst Spencer Perlman: "It would essentially create a parallel regulatory structure within the individual and small group markets that is freed from the various consumer protections established...The end result could be a death spiral for ACA-compliant plans.” [Bloomberg, 10/12/2017]

Washington Post: “Critics, who include state insurance commissioners, most of the health-insurance industry and mainstream policy specialists, predict that a proliferation of such health plans will have damaging ripple effects: driving up costs for consumers with serious medical conditions and prompting more insurers to flee the law’s marketplaces. Part of Trump’s actions, they predict, will spark court challenges over their legality.” [Washington Post, 10/12/2017]

New York Times: “The influx of a set of plans exempt from the Affordable Care Act rules will essentially divide the market and make it increasingly unstable, said Rebecca Owen, a health research actuary with the Society of Actuaries. People who want or need broad coverage could find it increasingly difficult to obtain an affordable policy, experts say.” [New York Times, 10/12/2017]

Robert Wood Johnson Foundation Healthcare Expert Katherine Hempstead: “The easier you make it not to buy comprehensive coverage, the harder you make it to buy comprehensive coverage.” [New York Times, 10/12/2017]

Washington State Insurance Commissioner Mike Kriedler: “It would have a very negative impact on the markets...Our state is a poster child of what can go wrong. Association health plans often shun the bad risks and stay with the good risks.” [New York Times, 10/12/2017]

Center for American Progress Vice President for Health Policy Topher Spiro: “By siphoning off healthy individuals, these junk plans could cannibalize the insurance exchanges...For older, sicker people left behind in plans regulated under the Affordable Care Act, premiums could increase.” [New York Times, 10/12/2017]

Wall Street Journal: “But health-insurance experts say it could raise costs for sicker people by drawing healthier, younger consumers to these alternative plans, which could be less expensive and offer fewer benefits.” [Wall Street Journal, 10/12/2017]

Kaiser Family Foundation Vice President Larry Levitt: “If the order is as expansive as it sounds, association plans could create insurance products that would siphon off healthy people with lower premiums and skinnier benefits, leading more insurers to exit the ACA marketplace or raise premiums significantly.” [Associated Press, 10/12/2017]

Brookings Institute Center for Health Policy Fellow Matt Friedler:“Associations would siphon many healthier people out of the ACA-compliant market, driving up premiums...Higher premiums in the ACA-compliant market would result in big cost increases for many sicker enrollees -- since they would not have the option of switching to the association market -- and likely for the federal government as well.” [Bloomberg, 10/10/2017]

Kaiser Family Foundation Healthcare Marketplace Project Director Gary Claxton: “If the market’s already fragile right now, this is going to make it much more fragile...All of this would be the start of the end of the individual ACA market.” [Bloomberg, 10/10/2017]

Bloomberg: “An executive order from President Donald Trump to allow new health plans outside of Obamacare could further destabilize the law’s fragile markets, health-care experts say.” [Bloomberg, 10/10/2017]

Courthouse News: “Trump’s coming mandate could also lead to spikes in Obamacare premiums, and may spook large insurers to consider dropping out of the ACA altogether, a move that would starkly divide the insurance market while bringing the White House closer to its hard-fought goal: dismantling Obama’s health care law.” [Courthouse News, 10/10/2017]

Wall Street Journal: “One result, analysts said, could be that healthy people are drawn to the expanded, less-expensive plans, leaving sicker and higher-risk people in a dwindling pool that sees higher costs. Together, if executed in an expansive way, Mr. Trump’s changes could ‘cause a bifurcation of the market,’ said Cori Uccello, senior health fellow at the American Academy of Actuaries.” [Wall Street Journal, 10/9/2017]

Rhett Buttle, Former Department of Health and Human Services Director of Private Sector Engagement: “I agree that we need to find more options for small business, but AHPs are not the answer. They allow cherry picking that could undermine the traditional small group market...Additionally, they could lead to premium instability for small businesses and put some of their consumer protections at risk.” [Wall Street Journal, 10/9/2017]

Kaiser Family Foundation Vice President Larry Levitt: “Association plans exempt from the ACA can cherry pick healthy people and make coverage unaffordable for those with pre-existing conditions.” [Twitter, 10/10/2017]
  • Kaiser Family Foundation Vice President Larry Levitt: “If loosely regulated association plans are allowed, insurers will leave the ACA marketplaces as soon as they can or hike premiums a lot.” [Twitter, 10/10/2017]
  • Kaiser Family Foundation Vice President Larry Levitt: “Middle class people with pre-existing conditions ineligible for ACA subsidies could be especially vulnerable under the executive order.” [Twitter, 10/10/2017]
Former CMS Administrator Andy Slavitt: “10/ The EO allows "association health plans"-- ability for plans to be offered with no pre-ex protections & turn ACA into a high risk pool. [Twitter, 10/5/17]
  • Former CMS Administrator Andy Slavitt: “11/ In states that have done things like this, like TN, premiums have skyrocketed and competitors have left the market.” [Twitter, 10/5/17]

Democratic National Committee

Tom Perez on Trump’s Executive Order to Sabotage Americans’ Health Care

In response to President Trump signing an executive order that would continue his sabotage of health insurance markets across the country, DNC Chair Tom Perez released the following statement:
“Donald Trump is signing away Americans’ right to quality, affordable health care. This loophole will undermine protections for people with pre-existing conditions and raise premiums for those who need affordable health care the most. Instead of letting Americans suffer from Trump’s recklessness, Republicans should put an end to their party’s efforts to sabotage our health care system.
“Democrats believe health care is a right, not a privilege – and so do the American people. It’s time for Republicans to join us as we work to build on the progress of the Affordable Care Act and improve our health care system for all Americans.”

U.S. Department of Health and Human Services
October 12, 2017

Trump Administration Takes Action to Abide by the Law and Constitution, Discontinue CSR Payments

U.S. Health and Human Services Acting Secretary Eric Hargan and Centers for Medicare & Medicaid Services Administrator Seema Verma released the following statement announcing that cost-sharing reductions payments will be discontinued immediately based on a legal opinion from the Attorney General:

“It has been clear for many years that Obamacare is bad policy.  It is also bad law. The Obama Administration unfortunately went ahead and made CSR payments to insurance companies after requesting - but never ultimately receiving - an appropriation from Congress as required by law.  In 2014, the House of Representatives was forced to sue the previous Administration to stop this unconstitutional executive action. In 2016, a federal court ruled that the Administration had circumvented the appropriations process, and was unlawfully using unappropriated money to fund reimbursements due to insurers.  After a thorough legal review by HHS, Treasury, OMB, and an opinion from the Attorney General, we believe that the last Administration overstepped the legal boundaries drawn by our Constitution.  Congress has not appropriated money for CSRs, and we will discontinue these payments immediately.”

Memo [PDF]

American Medical Association
For immediate release: Oct 13, 2017

AMA Statement on CSR Payments

Statement attributed to:
David O. Barbe, M.D., President, American Medical Association

“The AMA is deeply discouraged by the Administration’s decision last night to end the cost sharing reduction (CSR) payments to insurers, which are used to reduce deductibles and co-payments for low-income enrollees in the marketplace plans created under the Affordable Care Act (ACA). Republicans and Democrats alike have expressed concern about the affordability of health care coverage under the ACA, and bipartisan efforts have been underway in Congress to provide the specific authorization and funding for CSR payments to address the legal issues involved. This most recent action by the Administration creates still more uncertainty in the ACA marketplace just as the abbreviated open enrollment period is about to begin, further undermining the law and threatening access to meaningful health insurance coverage for millions of Americans.  Our patients will ultimately pay the price. We urge Congress to accelerate its efforts to reinstate these payments before further damage is done.”

# # #

Media Contact:
Jack Deutsch

America's Health Insurance Plans
October 13, 2017

Health Plans Issue Joint Statement Regarding Funding for Cost-Sharing Reduction Benefits for Millions of Americans

Washington, D.C. – America’s Health Insurance Plans (AHIP) and Blue Cross Blue Shield Association (BCBSA) together issued the following statement in response to the Administration’s decision to end funding for cost-sharing reduction (CSR) benefits for nearly 6 million Americans:

“Millions of hard-working Americans with modest incomes depend on cost-sharing reduction (CSR) benefits to get access to medical care. These benefits help real people every day, and if they are ended, there will be real consequences. These payments are not a bailout – they are passed from the federal government through health plans to medical providers to help lower costs for patients who see a doctor to treat their cancer or fill a prescription for a life-saving medication.

“We need constructive solutions that increase consumer choice, lower consumer costs, and stabilize local markets. Terminating this critical program will do just the opposite. This action will make it harder for patients to access the care they need. Costs will go up and choices will be restricted.

“We are committed to pursue every possible path to ensure that all Americans who depend on these benefits can continue to get the care they need when they need it.”

Democratic National Committee
October 13, 2017

DNC Chair Tom Perez on Trump Refusing To Make CSR Payments

In response to President Trump's decision to refuse to pay cost-sharing reduction payments, DNC Chair Tom Perez released the following statement:
“Donald Trump is gambling with American lives. By ending cost-sharing reduction subsidies, Trump will cause millions of Americans to face skyrocketing premiums, and a million people will lose their insurance entirely in the next year. Trump and Republicans in Congress will bear sole responsibility for the devastation they inflict on hardworking families.
“The American people believe health care is a right, not a privilege. But with this decision, Trump is betraying their trust and intentionally sending our health care system into chaos. It's time for Republicans to put an end to Trump's recklessness and start working with Democrats to protect and expand health care for all Americans."

Ed. note: recall this from Jan. 20, 2017

Executive Order Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal

- - - - - - -

By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows:

Section 1.  It is the policy of my Administration to seek the prompt repeal of the Patient Protection and Affordable Care Act (Public Law 111-148), as amended (the "Act").  In the meantime, pending such repeal, it is imperative for the executive branch to ensure that the law is being efficiently implemented, take all actions consistent with law to minimize the unwarranted economic and regulatory burdens of the Act, and prepare to afford the States more flexibility and control to create a more free and open healthcare market.

Sec. 2.  To the maximum extent permitted by law, the Secretary of Health and Human Services (Secretary) and the heads of all other executive departments and agencies (agencies) with authorities and responsibilities under the Act shall exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications.

Sec. 3.  To the maximum extent permitted by law, the Secretary and the heads of all other executive departments and agencies with authorities and responsibilities under the Act, shall exercise all authority and discretion available to them to provide greater flexibility to States and cooperate with them in implementing healthcare programs.

Sec. 4.  To the maximum extent permitted by law, the head of each department or agency with responsibilities relating to healthcare or health insurance shall encourage the development of a free and open market in interstate commerce for the offering of healthcare services and health insurance, with the goal of achieving and preserving maximum options for patients and consumers.

Sec. 5.  To the extent that carrying out the directives in this order would require revision of regulations issued through notice-and-comment rulemaking, the heads of agencies shall comply with the Administrative Procedure Act and other applicable statutes in considering or promulgating such regulatory revisions.

Sec. 6.  (a)  Nothing in this order shall be construed to impair or otherwise affect:
(i)   the authority granted by law to an executive department or agency, or the head thereof; or
(ii)  the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.
(b)  This order shall be implemented consistent with applicable law and subject to the availability of appropriations.
(c)  This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.

    January 20, 2017.