New Healthcare Executive Order
Administration Health Care Executive Order, Health Affairs Blog, Katie Keith, September 2020
Trump believes he took action on Healthcare with an Executive Order protecting people with pre-existing conditions and also by eliminating surprise billing. He did not.
On September 24, 2020, D.J. Trump issued a health care executive order (EO) focusing on protecting people with preexisting conditions and eliminating surprise medical bills. The Executive Order itself will have little or no immediate effect on healthcare law. Instead of laying out a specific plan or action(s) to take, the EO is detailing the administration’s health policy priorities and general agency directives (such as “giving Americans more choice in healthcare”). The EO’s approach is consistent with the seven-item bulleted list released by the campaign in late August and reiterates the hopes of the constituency for affordable healthcare minus the detail.
The “release” of this Executive Order and its purpose is to distract and redirect attention away from the nomination of Amy Barrett to SCOTUS and blunting the criticism of President Trump for:
1) moving forward with his nomination so close to the death of Justice Ruth Bader Ginsburg ignoring the precedent established by McConnell on nominations close to an election; and trump’s
2) promising and not delivering a health care plan way ahead of the 2020 election.
It is a BS sleight – of – hand maneuver as an Executive order does not create law which is left to Congress and neither can it appropriate funds which is also left to Congress. It too ignores a precedent established by then Senator Jeff Sessions under the guidance of the GAO to block funding outside of already Congressional approved funding while Congressional Representatives Fred Upton and Jack Kingston inserted Section 217 in the CROMNIBUS bill to block the legal transfer of funds from other programs to the Risk Corridor Program. Effectively, both actions killed the Risk Corridor program which was a three year program of seeding insurance companies and Coops while they adjusted to their newly insured needs. The Risk Corridor Program is similar to Part D’s program to do such which is still in existence.
Health Affairs Katie Keith points out , the Executive Order attempts to blunt criticism of the President’s record which is no action on protecting people with preexisting conditions from insurance discrimination if trump and Republicans kill the ACA. As discussed here, protecting people with preexisting conditions is easier said than done. In California v. Texas, President Trump over the objection of his cabinet officials has asked the Supreme Court to invalidate the entire Affordable Care Act (ACA) which includes the ban on discrimination against people with preexisting conditions. The same as Republicans have nothing of substance to insure people, Trump has nothing in place either. This EO is an extension of the charade by trump to try and show he cares. I think I said it enough times.
An Executive Order can be used to direct federal agencies to draft new rules or give guidance consistent with the President’s legal authority. This is by no means instantaneous and can take up a significant amount of time. Proposed rules and actions responsive to the EO must be created and then solicit public comments and responses before finalizing the rules. This process takes months and sometimes years.
This is not trump’s first excursion into
writing having Executive Orders written on his behalf to impact healthcare. Prior EOs include the expansion of non-ACA plans, price and quality transparency, Medicare, kidney health, rural health, mental health, the pandemic, and prescription drug policy What is necessary is a federal program on healthcare to improve upon the ACA or re[lace it with something better such as single payor which will remove commercial interests from it.
Katie Keith at Health Affairs does exemplary coverage of the latest Republican attempt at providing healthcare coverage for Americans once a Republican dominated SCOTUS kills the ACA after the addition of another political appointee to the court.
The risk corridors were never intended as a marketing tool however. The experienced commercial insurers did not do a great job with their initial underwriting. It was not easy to understand where it would go when people deliberately excluded were now in the insurance pools while another group of probably very healthy people were suddenly obliged to buy insurance (not that they all did in reality). Still the coops were uniformly poorly underwritten. This is probably not a surprise as the selling point of the coops was to avoid all that expensive stuff that commercial insurers notoriously engaged in and just do the payment of claims. They appealed specifically to people thinking they would save a lot over commercial insurers and thus probably felt obliged to show very low prices. Risk corridors might have saved some coops for a year or two, but eventually their pricing needed to go up to levels that would make their customer base very unhappy. After the failures of most (or even all) the original coops, new coops were not established to provide coop insurance with sustainable underwriting.
Who the hell said it was a marketing tool to attract customers? The ACA Risk Corridor Program has precedence in that it is similar to the Part D Risk Corridor Tool with the exception of how they forecast losses and gains. This is ok for a Republican Part D program and not for the ACA. Where is your argument there?
Commercial healthcare insurance and CoOps both had issues entering the market and forced to insurance everyone who applied for insurance without raising their rates in a community rating scenario for those who had pre-existing conditions. CoOps avoid the Overhead commercial insurance were so willing to have and use to magnify medical care pricing. The 15 – 20% limit on Overhead works quite well when the price goes up for healthcare. If you lost greater than 3%, the Risk Corridor Program kick in to help with the losses. If you had profits of more than 3%, you were to kick in to the Risk Corridor Program. The CBO rated this program as a +$12 billion program.
Yes, they would adjust their rates over the existence of the program of three years (Part D Program still has Risk Corridor). Part D Risk Corridor program is an evergreen program.
You are wrong on the CoOps, they were cut off at the knees by Republicans in an attempt to sabotage the ACA.