Presidential Executive Order 13765 (Donald Trump, 2017)

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Executive Order 13765: Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal is a presidential executive order issued by President Donald Trump (R) in January 2017 that confirmed the intention of the Trump administration to repeal the Affordable Care Act (ACA). Pending repeal, the order gave broad authority to the head of the Department of Health and Human Services (HHS) and the heads of other federal agencies to grant waivers, deferrals, or exemptions in an effort to delay provisions of the ACA that could result in what the administration described as fiscal or regulatory burdens on individuals, providers, or government entities.[1]

Background

See also: Donald Trump presidential campaign, 2016/Healthcare

During the 2016 presidential election, then-candidate Donald Trump (R) campaigned on a pledge to begin repealing the Affordable Care Act (ACA) on his first day in office. "Obamacare has to be replaced," he stated in a speech on November 1, 2016. "And we will do it and we will do it very, very quickly. It is a catastrophe.”[2][3]

Trump took action on his campaign promise shortly after his inauguration on January 20, 2017. That same day, he issued E.O. 13765, titled "Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal," the first executive order of his presidency. Reince Priebus, Trump's chief of staff at the time, described E.O. 13765 as "an executive order minimizing the economic burden of the Patient Protection and Affordable Care Act pending repeal." The order confirmed the Trump administration's intention to repeal the ACA and gave broad authority to the head of the U.S. Department of Health and Human Services (HHS) and the heads of other federal agencies to grant waivers, deferrals, or exemptions in an effort to delay provisions of the ACA that could result in what the administration described as fiscal or regulatory burdens on individuals, providers, or government entities.[1][4]

Impact

For up-to-date information on federal agency actions pursuant to E.O. 13765, see Federal policy on healthcare, 2017-2020.

Congress had yet to repeal the ACA as of May 2018. Federal agencies, however, had announced the following regulatory actions pursuant to E.O. 13765 that impacted provisions of the ACA as of May 2018:

  • April 13, 2017: The Centers for Medicare and Medicaid Services (CMS) finalized a rule changing some of the regulations for plans sold on the ACA's health insurance exchanges. According to CMS, the rule was intended to help "stabilize the individual and small group markets and affirm the traditional role of State regulators." Click here for more information.[5]
  • May 17, 2017: CMS issued guidance to allow insurers and insurance brokers to enroll individuals in ACA-compliant health plans without using the federal platform Healthcare.gov. The action was intended to reduce what it deemed the regulatory burden on insurers and brokers who facilitate ACA health plan enrollment, and to stabilize the ACA risk pool by expanding enrollment, according to the guidance document. Click here for more information.[6]
  • August 31, 2017: HHS announced it would cut funding for ACA advertising and enrollment outreach from $100 million to $10 million. The department also announced that exchange navigators—outside employees and organizations who assist individuals with enrolling in ACA health plans—would see their funding tied to their performance going forward. Click here for more information.[7][8]
  • October 6, 2017: The Trump administration published rules stating that any employer or insurer could stop following the contraception mandate that was part of the ACA if they had moral or religious objections to providing birth control to employees. The rule took effect immediately. Click here for more information.[9][10][11]
  • October 13, 2017: The Trump administration submitted a filing to the United States Court of Appeals for the District of Columbia Circuit stating that HHS would cease the cost sharing reimbursements immediately. Click here for more information.[12][13]
  • December 22, 2017: President Donald Trump signed HR 1—the Tax Cuts and Jobs Act—into law. The law, among other things, eliminated the ACA's individual mandate beginning in 2019. Click here for more information.[14]
  • February 20, 2018: HHS, the U.S. Department of Labor, and the U.S. Department of the Treasury issued a proposed rule “to expand the availability of short-term, limited-duration health insurance by allowing consumers to buy plans providing coverage for any period of less than 12 months, rather than the current maximum period of less than three months,” according to a press release from HHS. Click here for more information.[15]

Provisions

Purpose

The order confirmed the Trump administration's intention to repeal the ACA:

“ It is the policy of my Administration to seek the prompt repeal of the Patient Protection and Affordable Care Act (Public Law 111-148), as amended (the “Act”). In the meantime, pending such repeal, it is imperative for the executive branch to ensure that the law is being efficiently implemented, take all actions consistent with law to minimize the unwarranted economic and regulatory burdens of the Act, and prepare to afford the States more flexibility and control to create a more free and open healthcare market.[1][16] ”

Waivers and exemptions

The order directed the heads of HHS and other federal agencies to issue waivers, deferrals, or exemptions in a effort to minimize what the administration considered to be fiscal and regulatory burdens associated with provisions of the ACA:

“ To the maximum extent permitted by law, the Secretary of Health and Human Services (Secretary) and the heads of all other executive departments and agencies (agencies) with authorities and responsibilities under the Act shall 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 would impose a fiscal burden on any State 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.[1][16] ”

Flexibility for states

The order encouraged the heads of HHS and other federal agencies to allow flexibility for states in healthcare programs:

“ To the maximum extent permitted by law, the Secretary and the heads of all other executive departments and agencies with authorities and responsibilities under the Act, shall exercise all authority and discretion available to them to provide greater flexibility to States and cooperate with them in implementing healthcare programs.[1][16] ”

Other provisions

The order directed agency heads to implement regulatory changes through the Administrative Procedure Act's rulemaking process. The order also encouraged the development of "a free and open market in interstate commerce for the offering of healthcare services and health insurance, with the goal of achieving and preserving maximum options for patients and consumers."[1]

See also

External links

Footnotes

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Federal Register, "Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal," January 24, 2017
  2. ↑ CNBC, "Donald Trump blasts Obamacare — with a lot of help from running mate Mike Pence," November 1, 2016
  3. ↑ Forbes, "Day One: Trump Issues Executive Order Granting Modest Relief From Obamacare," January 20, 2017
  4. ↑ NPR, "Trump Signs Executive Order To 'Ease The Burdens Of Obamacare,'" January 20, 2017
  5. ↑ Centers for Medicare and Medicaid Services, "Patient Protection and Affordable Care Act; Market Stabilization," April 13, 2017
  6. ↑ Centers for Medicare and Medicaid Services, "Health Insurance Exchange Guidance," May 17, 2017
  7. ↑ The Hill, "Trump to slash ObamaCare outreach funding," August 31, 2017
  8. ↑ Fox News, "Trump administration slashes budget for ObamaCare ads," August 31, 2017
  9. ↑ The Hill, "Trump officials roll back birth-control mandate," October 6, 2017
  10. ↑ FederalRegister.gov, "Religious Exemptions and Accommodations for Coverage of Certain Preventive Services Under the Affordable Care Act," October 6, 2017
  11. ↑ FederalRegister.gov, "Moral Exemptions and Accommodations for Coverage of Certain Preventive Services Under the Affordable Care Act," October 6, 2017
  12. ↑ Politico, "White House to continue Obamacare payments, removing shutdown threat," April 26, 2017
  13. ↑ The Washington Post, "White House’s decision to stop ACA cost-sharing subsidies triggers strong opposition," October 13, 2017
  14. ↑ The Wall Street Journal, "Trump Signs Sweeping Tax Overhaul Into Law," December 22, 2017
  15. ↑ HHS.gov, "Trump Administration works to give relief to Americans facing high premiums, fewer choices," February 20, 2018
  16. ↑ 16.0 16.1 16.2 Note: This text is quoted verbatim from the original source. Any inconsistencies are attributable to the original source.
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