President Trump signed an executive order Thursday that is intended to provide more options for people shopping for health insurance. The president invoked his power of the pen after repeated Republican efforts to repeal the Affordable Care Act, also known as Obamacare, have failed.
"The competition will be staggering," Trump said. "Insurance companies will be fighting to get every single person signed up. And you will be, hopefully, negotiating, negotiating, negotiating. And you will get such low prices for such great care."
The order directs the Labor Department to make it easier for groups of employers to band together for the purpose of offering insurance. In some cases, groups might purchase coverage across state lines — a move that Republicans have long advocated as a way to lower costs.
Trump described his action as a response to reduced insurance offerings and rising premiums in Obamacare's individual market.
Critics complain the president's move could make matters worse — offering a cheaper option for younger, healthier insurance customers but driving up prices for those who need coverage most.
Broader access to so-called association health plans, or AHPs, is an idea that has been promoted by Sen. Rand Paul, R-Ky.
"President Trump is doing what I believe is the biggest free-market reform of health care in a generation," Paul said during a signing ceremony in the White House Roosevelt Room. "This reform, if it works and goes as planned, will allow millions of people to get insurance across state lines at an inexpensive price."
State regulators and some insurance companies warn that association plans might cherry-pick the healthiest customers, offering discounted insurance to those who don't use a lot of medical care but driving up costs for others. Administration officials downplayed that concern, noting that association plans must offer coverage to any employee in a participating group.
The president's order also calls for expanding access to short-term insurance policies, which are not subject to some of Obamacare's coverage requirements. And it directs the Health and Human Services, Labor and Treasury departments to make it easier for employers to offer tax-free reimbursement to employees to help cover deductibles, copayments and other health care expenses.
All of the changes will be subject to a formal rule-making process, including a public comment period. Administration officials said any new insurance offerings would come in months, not weeks.
Trump said Thursday's order is not a substitute for congressional action, and he vowed to continue to press lawmakers to repeal the Affordable Care Act.
"Today is only the beginning," Trump said. "In the coming months, we plan to take new measures to provide our people with even more relief and more freedom."
Critics argue that the Trump administration has deliberately tried to sabotage the Obamacare exchanges. Trump has repeatedly threatened to withhold cost-sharing subsidies from insurance companies, and he has slashed spending on marketing efforts to bring more customers into the exchanges.
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