Trump EO on ACA: what we know so far

Late Friday, President Trump issued an executive order on the Affordable Care Act (aka ACA or Obamacare). While the full effects of the order are not yet known, it generally does the following:

• Restates his Administration’s policy to seek prompt repeal of the ACA
• Pending a repeal, the order directs department heads to 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 imposes a “fiscal burden” on states 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.” This is to be done “to the maximum extent permitted by law.”
• Sets forth a number of other directives, related to increasing state flexibility and encouraging “a free and open market” for healthcare services and insurance. Based on comments made by Trump aides on Sunday news programs, the “flexibility” language is being interpreted by some news media as signaling a proposal to block-grant Medicaid funding to the states, but note that such a proposal has not yet been made formally by the new administration
• Requires that heads of agencies follow the Administrative Procedure Act in any rulemaking required in order to carry out the order

This executive order is both very broad and somewhat vague. The requirement to follow the Administrative Procedures Act should mean that the normal regulatory process is supposed to be followed in making changes to regulations and guidance previously issued to states, which suggests that proposed changes will be undertaken in an orderly manner with time for public comment. Further, given that the proposed HHS Secretary, Tom Price, has yet to be confirmed, and that a number of other positions directed to act by the order are not yet filled either, the timing with which any such proposed action will be put forth is as yet unclear. But, this does signal strongly that President Trump intends to uphold his campaign promise on ACA, although notably, the order does not mention a replacement for the coverage provided under the ACA, just its repeal.

A link to the full order and two analyses you may find useful in case you get questions locally are in the ACA resource section of the CWDA website: http://www.cwda.org/post/aca-resources-federal-administration-transition.