Donald Trump,Tom Price
President Donald Trump with Health and Human Services Secretary Tom Price, listens after addressing members of the media regarding the health care overhaul bill, Friday, March 24, 2017, in the Oval Office of the White House in Washington.
(Pablo Martinez Monsivais, Associated Press)
WASHINGTON - Even if in-fighting thwarts Republican efforts in Congress to repeal and replace the Affordable Care Act, Donald Trump's administration can act on its own to change parts of the law.
While Republicans still hope to pass legislation to dismantle Obamacare after failing in March, newly appointed Health and Human Services Secretary Tom Price plans to attack it administratively, regardless of what Congress does.
Price, a physician from Georgia, was a vocal critic of President Obama's signature health care reforms when he served in Congress. He's made it clear he'll use his new post to alter it significantly.
Price spokeswoman Alleigh Marre said the "flawed, failing" law can't be fixed through administrative action alone, but "Secretary Price and the HHS team will continue to pursue actions to mitigate the ACA's harmful effects and protect patients."
Marre wouldn't discuss specific ways her boss will alter Obamacare, whether he'll stop fighting lawsuits or limit the coverage required from insurance companies. But the Trump administration has already taken some preliminary steps, and health care experts cite others expected moves.
Take a look at how Obamacare could change, even without action by Congress.
1. No penalty for ignoring the insurance mandate
The day he was sworn in as President, Trump signed an executive order that instructed federal agencies to relax Obamacare's "unwarranted economic and regulatory burdens."
That's led to several changes already. For starters, the order altered how the Internal Revenue Service handles tax returns in which taxpayers don't state whether they have insurance coverage. Under the law, taxpayers face financial penalties for being uninsured. The IRS was supposed to reject returns this year if taxpayers didn't provide their coverage status, but that won't happen now.
Signs that there won't be penalties for failing to buy insurance run the risk of destabilizing the insurance market by encouraging healthier people to go without insurance, says Kaiser Family Foundation Senior Fellow Karen Pollitz.
Their absence from the market would make it harder for insurance companies to sell policies in 2018, said Pollitz, adding that the Congressional Budget Office estimated premiums would rise 15 to 20 percent in the first year if the mandate to buy insurance was dropped.
Trump signs first executive order as president
2. A chance for states to devise their own programs
Price cited Trump's executive order in encouraging states to apply for waivers from some of the law's restrictions if they can devise their own programs to provide residents with access to affordable, quality coverage choices.
"We are seeking to provide more flexibility and opportunities for innovation on the state level," he said in a March 13 letter to the nation's governors to solicit waiver applications under a provision of the Affordable Care Act called Section 1332.
3. Requiring premiums or jobs for Medicaid patients
Price sent the nation's governors a letter the next day that invited them to come up with new ways to meet Medicaid patients' needs. It said HHS would be open to states proposing work requirements for some Medicaid recipients, encouraging them to secure employer-provided insurance, and requiring them to pay small premiums, or other contributions "to encourage personal responsibility and ownership of their health and health care."
"States, as administrators of the program, are in the best position to assess the unique needs of their respective Medicaid-eligible populations and to drive reforms that result in better health outcomes," said the letter from Price and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma.
4. Redefining required benefits
Health insurance policies purchased under the Affordable Care Act have to cover ten categories of benefits, including prescription drugs, emergency services and preventive care, but it's up to the HHS secretary to determine the scope of what they must provide.
Some people believe the existing plan requirements are too comprehensive, and costs could be reduced if there were fewer of them, said Robert Wood Johnson Foundation health insurance expert Katherine Hempstead. Price is expected to alter what's allowed.
During a recent congressional hearing, Price wouldn't bite when Democratic members of Congress repeatedly urged him to specify what he'll require insurers to cover.
For example, when he was asked whether insurers should be required to cover pregnancy, maternity and newborn care, he replied: "What we believe is that it's important for every single American to be able to choose the kind coverage that they want, as opposed to have a government force them to buy what the government believes is best."
5. Bowing out of lawsuits
One way to gut the law would be to drop appeals of a lawsuit congressional Republicans filed to challenge the legality of Obamacare reimbursing insurers for the roughly $7 billion they spend each year to limit out-of-pocket expenses for low-income policy buyers.
The GOP lawsuit contends the payments are illegal because they don't go through the congressional appropriations process. Last year, a federal judge found in favor of the Republicans, but left the subsidies in place while the decision was appealed.
The case is on hold for now, with a status report due in May, shortly before insurers must file their proposed insurance plans for next year.
If the Trump administration drops its predecessor's appeal and insurers lose their reimbursement, many companies are expected to exit the Affordable Care Act market and leave customers without coverage.
Pollitz said roughly 60 percent of insurance policies purchased under the Affordable Care Act get the subsidies.
"Either Congress is going to appropriate the money, or the administration is going to appropriate the money or nobody is going to appropriate the money," added Hempstead. "They have to figure out what they're going to do."
When Price was asked at a recent congressional hearing whether the Trump administration would commit to continuing the cost-sharing efforts for low-income consumers, despite the lawsuit, he declined comment, explaining that he's now a party to the lawsuit because of his job.
He did pledge to uphold the law, saying: "So long as the law is on the books we at the department are obliged to uphold the law."