Trump's not-so-quick fix to undo Obamacare

  • World
  • Friday, 13 Oct 2017

U.S. Senator Rand Paul (R-KY) applauds as U.S. President Donald Trump signs an executive order to make it easier for Americans to buy bare-bones health insurance plans and circumvent Obamacare rules at the White House in Washington, U.S., October 12, 2017. REUTERS/Kevin Lamarque

NEW YORK (Reuters) - President Donald Trump on Thursday prescribed a quick fix to undo Obamacare through executive order after Republicans in the U.S. Congress failed to repeal and replace the healthcare law as promised, but industry experts said there are many steps involved that will slow it down.

Trump's plan rests on one main pillar, the creation of associations in which multiple employers can band together to buy health plans under the same law that large employers do. That law rests outside of many of the mandates of the 2010 Affordable Care Act, dubbed Obamacare.

Here are some questions and answers about these plans.


Potentially, small business employees and maybe even more people would be able to buy such plans. The executive order envisions that associations will form to offer these new health plans for small businesses that want to join together. It is not clear from the order whether freelance workers or other individuals interested in buying health insurance outside of Obamacare would be able to access these association plans through other routes. That may be decided in the federal rule-making process, which takes months.


There currently are some associations that have united to buy health insurance, but the order imagines the creation of many new associations around the country. By allowing small businesses to join forces to create a larger pool of employees when buying insurance, these associations can decrease the risk of having a higher proportion of members with costly illnesses that can drive up coverage costs for small employers.

It is not clear who would create these groups, but there are some employer trade groups, like the National Restaurant Association, that have advocated this year to allow restaurants to band together to buy healthcare.


Groups first need to create an association, register it with the U.S. Labor Department, design the benefit plans, sign up medical providers or hire a third-party company that establishes networks of doctors, and then advertise and sell those plans to employees, insurance experts said.

Signing up providers such as doctors and hospitals could be challenging, especially across state lines, said Dave Dillon, a fellow and actuary at the Society of Actuaries. Doctors and hospitals charge higher prices when they are uncertain about how many patients they might have, even when they are dealing with known entities like the large health insurers.

In addition, Americans next month are due to start buying their plans for next year during open enrolment, whether that is through an employer or on their own.

That means 2018 would be off the table for the executive order's provisions.


"To get ready for 2019, you would have to be fairly up and running by the spring or early summer, and you would have to have things in place for the employers who would want to sell coverage for a 1/1 date," Dillon said, referring to Jan. 1, 2019.

By the time April rolls around, health insurers like Aetna Inc and UnitedHealth Group Inc and benefit design brokers like Aon PLC and Mercer, part of Marsh & McLennan Cos., are shopping around plans for 2019 with the goal to sign contracts by the summer. That gives them time to create the advertisements and documents that go to employees in time for sign-up.

The 2019 plans would go on sale in November 2018.


Legal challenges from Democratic state attorneys general who have fought some of Trump's initiatives could further delay associations from forming, or employers from deciding to move employees from current small group plans or to offer a plan to employees currently being served by the individual market.

(Reporting by Caroline Humer; Editing by Will Dunham)

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