Donald Trump's executive order on the ACA sparks fears of insurance market instability

Donald Trump
President Donald Trump has been firm in his commitment to quickly repeal and replace the Affordable Care Act.

Not long after being sworn in as the next president, Donald Trump issued an executive order that urged his administration to push for a quick Affordable Care Act repeal, leaving some worried it will spur further instability in the individual marketplaces.  

The executive order, which Trump issued Friday, instructs federal agencies to “waive, defer, grant exemptions from or delay” any Affordable Care Act provisions that impose a “burden” to consumers, providers, health insurers or even drug- and device-makers.

It also told the agencies to use their authority to “provide greater flexibility to states” to design their own healthcare programs, and encourage a “free and open market in interstate commerce for the offering of healthcare services and health insurance.”

The order does, however, acknowledge the executive branch’s limitations to alter the healthcare law, noting that any revised regulations require “notice-and-comment” rulemaking.

Still, Trump’s move has the effect of lobbing a “bomb” into the already-struggling marketplaces, signaling there will not be an orderly transition away from the ACA, Robert Laszewski, president of the consulting firm Health Policy and Strategy Associates and a longtime critic of the ACA, told The Washington Post.

The Alliance of Community Health Plans is also skeptical of the way ACA repeal efforts are progressing. “Now is the time to improve the market, not throw it into chaos,” President and CEO Ceci Connolly said in an emailed statement. “Our nonprofit, community-based plans look forward to working with policymakers to ensure a smooth path forward.”

“There is no question the individual healthcare market has been challenged from the start,” America’s Health Insurance Plans Spokeswoman Kristine Grow said in an emailed statement. But she added that the trade group is optimistic about what comes after the ACA, saying: “we have been meeting with policymakers to offer our recommendations for a better marketplace, and we have found them to be highly engaged and focused on finding real solutions.”

RELATED: AHIP: How to keep individual markets stable in Trump era

Leerink Partners analyst Ana Gupte, meanwhile, sees the executive order as having “little to no impact on the stability of the individual or exchange markets,” according to a research note emailed to FierceHealthPayer. Health insurers have spent little time lobbying about the fate of the marketplaces, she pointed out, and have focused instead on topics like the repeal of the health insurance tax.

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