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What's Changing With Trump's Executive Order On Health Care


Congress has not been able to change the Affordable Care Act, so President Trump intends to try alone. He's expected to sign an order today that, the president says, will increase competition and lower consumer costs in the health insurance markets. Then again, you get what you pay for. And in some cases, prices may go down because people get less. How's all this work? Let's bring in NPR's Domenico Montanaro. Domenico, good morning.


INSKEEP: OK, so I'm reading this article that I recommend to people by NPR's Alison Kodjak that tries to explain what the deal is, but what's the deal? How are they going to lower costs and make things simpler for people?

MONTANARO: Yeah. I mean, part of this is - what they're trying to do is take these small businesses and be able to group them together into what's known as association health - association health plans, AHPs. And they want to be able to - the theory is that with a larger group you could have more power to negotiate prices and thereby lower your prices. Unfortunately, there's not a lot of evidence that that actually works and that the only way that that can work is if you take away some of these essential health benefits. The problem with the large, you know, employer theory on this a little bit is that people are already in big groups, given the individual markets in each state are already a big group.

INSKEEP: Oh, so I want to understand this. When you talk about essential health benefits, the Affordable Care Act, or Obamacare, required that all insurance plans had to cover some basic stuff. There's a list of things that each insurance plan must cover. And what we're saying here is that associations might get together - trade groups, trade associations, groups of small businesses, whatever - might get together and negotiate their own insurance plan that would just cover less, and so it'd be cheaper.

MONTANARO: Absolutely. And part of the problem with that is that you would then likely draw younger, healthier people who don't feel they need as much in health coverage. And what that would do is suck them out of the individual market and thereby raise prices for people who would actually need health insurance, people - not even people who are just - yes, they're older and sicker but people who may use health insurance just generally through the year. So that's a big piece of the pie here. And what a lot of Democrats and health care advocates worry about is that that would further reduce the individual marketplace and undercut Obamacare in an even more deleterious way instead of come up with fixes for the current system.

INSKEEP: I'm sorry. I was looking up deleterious. What were you saying there at the end? Anyway...

MONTANARO: (Laughter) It just means bad.

INSKEEP: (Laughter) It just means bad. OK, that's fine. But this is a large part of Republican rhetoric about health care, though, isn't it? You hear Republicans saying things like, I'm a man, why does my health insurance coverage have to include pregnancy protection, for example? I guess there's an answer to that because we are all supposed to be in a group and people kind of share the insurance costs, but they've argued there has to be a simpler, less regulated way to get cheaper insurance to some people.

MONTANARO: Sure. I mean, part of the problem with Obamacare, with the Affordable Care Act, currently is that it didn't attract as a magnet enough of these younger, healthier people to bring down the prices overall for people. So..

INSKEEP: Oh, younger, healthier people have just said I'll pay the tax penalty. I'm just not playing basically.

MONTANARO: Right. And, you know, you have Republicans also saying that they want to get rid of the mandate when it comes to, in other words, making people pay that tax penalty because if you have more people in that market, then you can reduce the price.

INSKEEP: So if the president takes this action, is that an admission that he's just not going to get anything larger through Congress to repeal and replace the Affordable Care Act?

MONTANARO: Not necessarily, but, I mean, it means that at this point he is not able to get anything through. So he's going to try to act on his own, which, ironically, is the exact thing that President Obama tried to do on something like DACA, for example, on the Deferred Action for Childhood Arrivals when it comes to immigration because Congress failed to act on immigration. So he decided to take a stopgap measure. What does that mean? It means that most likely this is not the end of the story for health insurance, even if President Trump goes and signs this today, which he is expected to do, because it will likely end up in the courts.

INSKEEP: A remarkable phenomenon not limited to Republicans by any means. People who are out of power are outraged by executive actions and other acts by the person in power. But as soon as the party shifts, the attitude shifts.

MONTANARO: Absolutely. And, you know, that's - there's no question that that's what both parties, you know, they try to do, you know, whether it's stop legislation or whether it's try to enact as much policy as they can through executive action or by - or through Congress, and that's what you're seeing playing out here.

INSKEEP: Domenico, thanks as always.

MONTANARO: You're welcome.

INSKEEP: NPR's Domenico Montanaro. Transcript provided by NPR, Copyright NPR.

Domenico Montanaro is NPR's senior political editor/correspondent. Based in Washington, D.C., his work appears on air and online delivering analysis of the political climate in Washington and campaigns. He also helps edit political coverage.
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