Trump’s ACA order: What does it do? Who’s in support?

On the first day of his presidency, Donald Trump signed an executive order suggesting federal agencies offer as many exemptions as possible to the Affordable Care Act (ACA)’s individual mandate.

Opening with a statement asserting the administration will “seek the prompt repeal” of the ACA, the order directs the HHS Secretary and all other federal agencies to exercise “all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden.”

It also directs agencies under the executive branch to “provide greater flexibility to states and cooperate with them in implementing healthcare programs” and “encourage the development of a free and open market in interstate commerce for the offering of healthcare services and health insurance.”

The order isn’t a repeal—only Congress can do that—and doesn’t outline a clear direction for agencies. But it does have some symbolic weight, reiterating Trump’s desire to eliminate the law with the support of Republicans in Congress.

“In the coming weeks, we will repeal Obamacare and begin rebuilding our broken healthcare system and cleaning up the mess left behind by the previous administration,” said House Energy and Commerce Committee Chairman Greg Walden, R-Oregon.

There are reasons for the healthcare industry to be nervous about the order’s impact. Kellyanne Conway, a counselor to President Trump, said in numerous talk show appearance on Jan. 22 that the administration may use the order to stop enforcing mandates for individuals to buy or employers to provide health insurance. Advocates of the ACA have warned that could lead to many enrollees canceling their health plans and cause the individual market to “unravel.”

“The law is not a burden to the 22 million Americans who would not have health insurance without it. It is not a burden to women who have access to free contraceptive coverage. It is not a burden to millions with employer coverage who no longer have lifetime limits on their coverage,” said Topher Spiro, vice president of health policy at the liberal Center for American Progress.

Republican Sen. Susan Collins of Maine gave more muted criticism, calling the order “very confusing.”

Though health insurers seemingly have the most to lose thanks to Trump’s order, the industry’s largest trade group, America’ Health Insurance Plans (AHIP), appeared to be on board with the changes and the repeal of the ACA.

“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,” the group said in a statement.