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Frustrated over setbacks in Congress, President Donald Trump wielded his rule-making power Thursday to launch an end run that might get him closer to his goal of repealing and replacing "Obamacare."

Whether Trump's executive order will be the play that breaks through isn't clear.

Experts say consumers aren't likely to see major changes any time soon, although the White House is promising lower costs and more options.

Some experts warned that hard-won protections for older adults and people in poor health could be undermined by the skinny lower-premium plans that Trump ordered federal agencies to facilitate.

Others say the president's plans will have a modest impact, and might even help some consumers who don't now benefit from financial assistance under the Obama-era law.

People on different sides of the polarized health care debate did agree that it will take months for the government bureaucracy to turn Trump's broad-brush goals into actual policies that affect millions of people who buy their own health insurance policies.

"Today is only the beginning," Trump said at the Oval Office signing ceremony. He promised new measures in coming months, adding, "we're going to also pressure Congress very strongly to finish the repeal and replace of 'Obamacare' once and for all."

Democrats denounced Trump's order as more "sabotage" while Republicans called it "bold action" to help consumers. 

DFL U.S. Sen. Al Franken says the president's latest executive order demonstrates Trump wants to do anything he can to undermine the Affordable Care Act and does not care about Americans' health.

"This is very cynical," Franken said. "This is a guy who has put no energy whatsoever into understanding how health care works. This will mean higher premiums for people in the individual market. It's completely counterproductive."

A major small business group praised the president, while doctors, insurers, and state regulators said they have concerns and are waiting to details.

"We want to make sure that all the consumer protections are there and included," said Michael Munger, president of the American Academy of Family Physicians.

The Minnesota Chamber of Commerce says some 7,000 employers in the state with 50 or fewer employees have dropped out of the small group market over the last few years because of cost. Bentley Graves, the chamber's director of health care policy, said the order appears to be welcome news because it could create more options for businesses.

"We're always looking for greater flexibility for employers — particularly small employers and additional options for small employers and this looks to be, on-the-face of it, something that may increase those options," he said.

One of the main ideas from the administration involves easing the way for groups of employers to sponsor coverage that can be marketed across the land. That reflects Trump's longstanding belief that competition across state lines will lead to lower premiums.

Those "association health plans" could be shielded from some state and federal insurance requirements. Responding to concerns, the White House said participating employers could not exclude any workers from the plan, or charge more to those in poor health. Self-employed people might be able to join.
Other elements of the White House plan include:

• Easing current restrictions on short-term policies that last less than a year — an option for people making a life transition, from recent college graduates to early retirees. Those policies are not subject to current federal and state rules that require standard benefits and other consumer protections.

• Allowing employers to set aside pre-tax dollars so workers can use the money to buy an individual health policy.

"This could be much ado about nothing, or a very big deal, depending on how the regulations get written," said Larry Levitt of the nonpartisan Kaiser Family Foundation. "The intent of the executive order is clear, to deregulate the insurance market ... it's unclear how far the administration will ultimately go."

Levitt said association health plans and short-term health insurance policies could be designed to lure healthier people away from the state insurance markets created by the Obama health law. They'd offer lower premiums to those willing to accept fewer benefits. That would drive up costs for consumers in the already-shaky "Obamacare" markets, making them less attractive for insurers and raising subsidy expenses for the government.

But economist Douglas Holtz-Eakin, president of the center-right American Action Forum, said it looks like the impact will be on market niches, not the broad landscape of health insurance.

"This just isn't a revolution to insurance markets," he said. "It's a policy change. What we've got isn't working, so we might as well try something else."

On Capitol Hill, House Democratic Leader Nancy Pelosi called Trump's move "cynical."

"The American people overwhelmingly rejected Trumpcare, but President Trump is still spitefully trying to sabotage their health care, drive up their costs and gut their coverage," Pelosi said in a statement.

But Sen. Rand Paul, R-Ky., called Trump's action "one of the most significant free market health care reforms in a generation" that would "reduce government interference and provide more affordable health care options to everyday Americans."

Paul attended the White House ceremony and was honored by Trump with a pen used to sign the executive order. 
Paul was among the handful of GOP senators whose opposition scuttled the most recent effort to repeal Obama's law. Congressional Republicans have moved on from health care, and are now focusing on tax cuts.

About 17 million people buying individual health insurance policies are the main focus of Trump's order. Nearly 9 million of those consumers receive tax credits under the Obama law and are protected from higher premiums.

But those who get no subsidies are exposed to the full brunt of cost increases that could reach well into the double digits in many states next year. Many in this latter group are solid middle-class, including self-employed business people and early retirees.

Cutting their premiums has been a longstanding political promise for Republicans, but experts see no immediate impact.

MPR News reporter Mark Zdechlik contributed to this story.

Correction (Oct. 13, 2017): Bentley Graves' name was misspelled in an earlier version of this article. The story has been updated. 

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Experts say consumers aren't likely to see major changes any time soon, although the White House is promising lower costs and more options.


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