Donald Trump's ACA executive order 'more than symbolic,' former Bush adviser says

Marc Samuels, CEO of the consulting firm ADVI and a former healthcare policy adviser under President George H.W. Bush, says President Donald Trump's executive order reaffirms his commitment to repeal and replace the Affordable Care Act.

With his swift executive order concerning the Affordable Care Act, President Donald Trump sent a clear message about his healthcare policy intentions, according to one expert.

The order, which Trump signed within hours of being elected the 45th president, instructs federal agencies to “waive, defer, grant exemptions from or delay” any Affordable Care Act provisions that “burden” consumers, providers, insurers or other industry stakeholders.

Though the executive branch has limited power to dismantle the ACA, the order was “more than symbolic,” said Marc Samuels, CEO of the consulting firm ADVI and a former healthcare policy adviser under President George H.W. Bush.

“It showed a commitment to those that voted for him, Congress and those who disagree with him that he was serious about keeping a campaign promise and reaffirming his commitment to repeal and replace the ACA,” he said.

Implications for insurers

Some have expressed concern that the executive order will add to instability in the individual marketplaces by creating more uncertainty for health insurance companies. Indeed, even before Trump officially took office, industry groups warned about the need to provide a stable transition between the ACA and whatever comes next.

Yet Samuels said that it is too soon to tell if the Trump administration’s healthcare policy plans will result in an insurer exodus from the exchanges. The real determining factor will be a full legislative ACA replacement bill approved by Republican leadership.

“On the positive side, they now have a clearer picture of who won the election, what that person wants to do, and from there can begin to develop their own strategic priorities,” he said.

Congressional vs. executive action

As she introduced an ACA replacement plan on Monday alongside Sen. Bill Cassidy, R-La., Sen. Susan Collins, R-Maine, made it clear that while some improvements to the law can be made through regulations from the Trump administration, “that by no means takes away the need for comprehensive legislation.”

“I think the executive order is really confusing and we don’t yet know what the impact of that will be,” she said.

For Samuels’ part, he doesn’t believe Trump’s move was meant as a “signal that anybody should necessarily move out ahead of Congress.”

That said, the order can pave the way for the administration’s “beachhead teams”—or temporary federal agency appointees who set the stage for the president’s agenda while his nominees await Senate confirmation—to work on ways to alter the ACA or peel back its provisions.

One likely target would be easing the employer or individual mandate, according to Samuels.

Trump’s administration could also give states more flexibility to reshape their Medicaid programs, as Seema Verma, Trump’s pick to lead Centers for Medicare & Medicaid Services, did in Indiana. Or it could try to revise the contraceptive coverage rules for religious nonprofits that have objected to the mandate.

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Whatever moves Trump’s administration makes on healthcare, Samuels said it’s nothing new for presidents to make liberal use of executive orders to push their agenda. What may be unique are the ideas Trump proposes.

“I’m not even sure you can say all of the executive orders that President Trump will do will be pro-Republican,” he said. “I think they’ll be pro-competition, pro-market, pro ‘USA.’”