President Donald Trump's executive order Friday evening instructing federal agencies to go as far as they legally can to roll back the Affordable Care Act was not exactly surprising. He was expected to take some type of swift administrative action to signal his determination to repeal the law.
But the order—along with Trump senior adviser Kellyanne Conway's statement Sunday that Trump may stop enforcing the law's tax penalty against people who don't buy insurance—has rattled insurers and health policy experts.
They warn that effectively gutting the mandate—or even suggesting to consumers that they won't face any penalty for not buying coverage—could unravel the individual insurance market and prompt insurers not to offer plans in 2018. That could lead to 20 million Americans losing coverage next year.
The order “raises an open question about how some of the newcomers at the relevant agencies are going to interpret its fairly broad language,” said Ceci Connolly, CEO of the Alliance for Community Health Plans, which represents not-for-profit insurers. “Are you going to have individuals interpreting it so broadly and quickly that we'll have disruption before there's any chance to come up with a thoughtful replacement?”
It's possible that facilitating the ACA's collapse is Trump's goal. He tweeted earlier this month that Republicans should let Obamacare “fall of its own weight” and make “the Dems own the failed Obamacare disaster.” If he and the GOP can convince the public that the law unraveled on its own, that would make their job of repealing and replacing it politically easier.
Others speculate that Trump's purpose was to make a strong symbolic statement about his commitment to kill the law and buy time with his anti-Obamacare political base to come up with a plan to replace the law's coverage. While congressional Republicans passed a budget blueprint this month to wipe out most of the law, they and the administration are far from coming together around an alternative model.