On Thursday, President Donald Trump made steps toward dismantling the Affordable Care Act, signing an executive order that he says will bring affordable health insurance to millions more people. The ACA, Obamacare, was the signature piece of legislation signed by Barack Obama that propelled Trump’s presidential campaign in addition to immigration issues.

Here is an excerpt of Trump's remarks:

"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."

Trump’s order seeks to develop policies to increase competition in the healthcare field, while also lowering prices and improving levels of care. Trump signed the order in the Roosevelt Room of the White House. He said that it will "millions of Americans with Obamacare relief," adding that it will "cost the United States government virtually nothing and people will have great great health care. And when I say people, I mean by the millions and millions."

These measures, Trump said, "should have been done a long time ago, and could have been done a long time ago."

The president has directed the Labor Department to find out how small businesses and individuals may join together to buy health insurance through nationwide association health plans. The Labor Department may give employers in the same industries more flexibility to offer group coverage across state lines, while providing them with a broader range of policies at lower rates.

The executive order will allow consumers to buy short-term policies that need not comply with Obamacare's protections for those with pre-existing conditions. It seeks to allow employers to give workers money to buy their own coverage through health reimbursement arrangements. The changes may take at least six months to take effect, according to CNN.

"Having failed to repeal the ACA in Congress, the president is using a wrecking ball to singlehandedly rip apart and sabotage our healthcare system," tweeted Senate Minority Leader Chuck Schumer (D-NY) in response to the announcement. Republican replacements for Obamacare have have floundered after critics determined that the number of Americans without medical insurance would increase by more than 20 million.

"This is a case where doing something is worse than doing nothing," said Dr. Ezekiel Emanuel, who was one of the drafters of Obamacare, said on CNN. "It's not going to solve the problem at all and remember, it affects a very small number of people." Emanuel is the brother of Chicago mayor Rahm Emanuel. "It won't do anything for a lot of the people on the exchange who are not members of franchises or trade associations," Emanuel said. "So this is more show than actual reality in terms of making health care affordable for Americans."

In an op-ed published at Breitbart News, Sen. Rand Paul (R-KY) -- a physician -- described Trump's plan:

"How will it work? Well, nationwide associations like the National Restaurant Association will be allowed to form groups across state lines and, with the leverage of size, demand Big Insurance bring down their outrageous premiums.

"Many of the 28 million people left behind by Obamacare who still don’t have insurance work low-wage jobs in our fast food restaurants. The President’s decision today will allow workers from two million restaurants to come together to form a buying group and through sheer size get cheaper and better insurance.

"Millions of people will be eligible for the same group insurance that big corporations offer. In fact, Health Associations may grow to be larger than the largest of our corporations. Currently, about half of private insurance is cross-state, self-insured ERISA plans, and most employees love them. The President’s action today will allow the millions of people in the individual market an escape route to group insurance.

"Association Health Plans will be among the biggest free-market reforms of health care in a generation, and it will do more to counter the impact of Obamacare than most of the repeal bills did, because it will actually go after regulations that the legislation didn’t touch due to Senate rules."

Below is the statement from the White House:

“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 www.healthcare.gov 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.




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Martin Barillas is a former US diplomat and the editor of Spero News.

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