The first executive order that President Donald Trump signed gave federal agencies broad powers to change, delay or waive provisions of the Affordable Care Act. The order was short on specifics. At first, it seemed like a gimmick aimed at fulfilling Trump’s campaign pledge to start repealing Obamacare on his first day in office. But in its vagueness lies a major problem.
Trump has been all over the map on health care. He hates Obamacare but likes some of its provisions. He wants “something terrific” but won’t say what.
He promises “insurance for everybody” at “lower numbers, much lower deductibles.” He doesn’t want a single-payer plan, but something new under which everyone will be “beautifully covered.”
The real clue about his intentions is the very uncertainty of his order. The health insurance market does not like uncertainty. If insurers can’t make accurate predictions about who’s going to be covered and how sick they’ll be, they will bail out of Obamacare’s individual markets.
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If regulators ease the individual mandate requiring Americans to have health insurance or pay a big fine, or grant waivers to companies that say they can’t afford to cover their workers, fewer healthier people will be covered. Prices for those who need health insurance the most, older patients and those with chronic conditions, will become unaffordable. Merely by being vague, Trump’s order could tip the ACA into its much-feared “death spiral.”