NTF Issue Paper: president50.doc. 10-17.

Obama Care is an unnecessary government intrusion into the American healthcare system. Premiums in the Obama Care exchanges may rise by double-digit rates for 2018, affecting about 7% of Americans who languish in the individual Obama Care marketplaces rather than enrolled in employer-based coverage, Medicare, or Medicaid, and an additional 9% of Americans still uninsured, this level of non-participation a sign Obama Care is failing to deliver affordable insurance. The Trump health care reform executive order focuses on promoting competition in markets and limiting excessive consolidation and abuses of market power. Nebraskans will enjoy improved access to and quality of information needed to make informed health care decisions about prices and providers and minimize onerous reporting requirements for plans, insurers, and consumers. His order will give people more competition, choices, and lower premiums. Trump acted only because Congress appears unable to reform health care. This order is only the first of many executive actions Trump will announce on health care in future months. Business groups, including the National Federation of Independent Business, hailed the order, saying it will provide more options for consumers and result in lower costs for workers and employers. Trump signed the order in the White House Roosevelt Room surrounded by Vice President Mike Pence and members of his Cabinet and Congress. The President says he still wants Congress to repeal and replace the Obama health care law.

Not only have premiums skyrocketed lately, but fewer insurers are offering plans, reducing competition even in many urban markets. Now, consumers will enjoy more affordable options. Consumers can choose coverage options costing half of what Obama Care cheapest bronze plans cost. Premiums in the individual market more than doubled since 2013 because of Obama Care regulatory mandates. Trump plans will allow individuals to exempt themselves from several of these mandates. Nebraskans can purchase insurance policies from group insurance across state lines to best suit their interests. The order will help millions of uninsured people who have no access to employer plans but find Obama Care beyond reach because of its skyrocketing premiums and scant availability or choice. Obama Care exchanges have no competition in 33% of U.S. counties. Trump plans will boost competition and thus lower premium costs. Some mandated coverage will disappear. Cheaper options will relieve the 8 million now paying the Obama Care tax penalty for not having insurance and 11 million uninsured who avoided the penalty by pleading poverty. Healthier and younger people will obtain insurance for less than the cost of plans in the Obama Care exchanges.

Only 33% of workers at small businesses now receive health insurance through their employers, compared to about 50% of such workers in 2010 prior to Obama Care. Large employers can obtain better advantages on health insurance for their employees because of their larger pools of insurable people across which they can spread risk and administrative costs. Trump expanded this option to small businesses by permitting them to group into self-insurance or buy large group health insurance. Such expansion will allow small businessmen to avoid many Obama Care expensive requirements. Employers in the same field of business or in the same associations anywhere in the country can join together to offer health care coverage to their employees. Expansion will offer more affordable health insurance options to hourly wage earners, farmers, and employees of small businesses. These health plans are free from state benefit mandates and several benefit mandates imposed by Obama Care, such as essential benefits. Association plans lie exempt from many such regulations, like the requirement to cover a slate of medical conditions known as “essential health benefits.” The plans do not have to adhere to all Obama Care provisions, such as the requirement to provide comprehensive benefits that cover prescription drugs, mental health, pregnancy, and drug abuse. Trump relief also allows association plans to deny coverage to groups or set rates based on the medical history of those in the group, so plans with younger, healthier members could offer lower premiums. Employers participating in these plans could not exclude employees. Because these plans will not have the same minimum coverage requirements as Obama Care, premium costs will drop.

These plans, implemented by cabinet officers, are exempt from Obama Care burdensome and expensive insurance mandates and regs. Short term insurance policies will cover longer periods and ease renewal. Obama Care limited these plans to 90 days and prevented renewal, fearing that such plans, which do not meet Obama Care benefit requirements, would attract consumers away from Obama Care exchange coverage. Those who have short term plans now not considered insured and fall subject to the Obama Care tax penalty. This option will especially attract people on Obama Care who do not receive a tax credit or only a small one to help pay the cost of insurance. Such plans will assist people who are between jobs, missed the enrollment deadline, or have few other insurance options. These revised policies will become free from Obama Care mandates. However, Congress probably must pass legislation to fully implement the free market approach totally free of Obama regulations.

The requirements to adopt a Health Savings Account (HSA) now appear complicated and time-consuming. Prior to Obama Care, employers used HSAs to reimburse workers for a wide array of expenses, including premiums. Obama barred the use of HSAs to buy policies on the individual market. Health care experts expect HSAs thanks to Trump to allow payment of premiums for individual market policies. They will expand and become more flexible to provide many employees with more options to finance their health care. Non-group coverage can utilize HSAs only. This option allows employers to deposit pre-tax dollars for employees to use for their health expenses, to buy their choice of insurance in the free market.

Within 6 months and every 2 years thereafter, 3 cabinet departments and the Federal Trade Commission must submit reports on increased health care industry consolidation and how it raises health care costs, with suggested actions to halt and reverse this trend. These same departments must announce these regulatory alterations within 60-120 days.

Trump halted the $7 billion (2017) Obama subsidy funding of payments to health insurers that reduced deductibles and copayments for the poor. This subsidization promulgated by Obama without lawful appropriation by Congress brought a stinging rebuke from a federal judge, who labeled this action unconstitutional. Trump declared that the Department of Health and Human Services determined there is no appropriation for subsidy payments to insurers under the Obama Care law. “We will discontinue these payments immediately,” said acting HHS Secretary Eric Hargan and Medicare administrator Seema Verma. The payments have long caused dispute. The Republican-controlled House of Representatives sued the Obama Administration in 2014, arguing the payments were illegal because appropriated by the executive branch instead of Congress, which never authorized them. The government cannot legally continue to pay the cost-sharing subsidies, because it lacks a formal authorization by Congress. Officials said a legal opinion from the Justice Department supports that conclusion. The nonpartisan Congressional Budget Office found that though the move would cause some pain short term for Obama exchanges, lower income folks soon would have suitable alternatives. People with pre-existing conditions will still receive subsidies, not from healthy insurance buyers but from the U.S. Treasury. Because of Obama Care, individual subsidizers now have suffered premiums that more than doubled since 2014 and probably will rise another 25-35% this winter. These sufferers, however, soon will shed this burden.

The law requires that such orders allow public comments on the proposals. Trump pledges that the process will provide opportunity for much participation. Insurance companies already have finalized most of their offerings for 2018, so these changes post-comment will not enter actual insurance plans until 2019.

Each month, a middle class couple pays a $950 premium for the lowest level Obama Care plan, debating going without coverage and paying a fine for violating federal law. It feels like forced government extortion, forcing them to pay an exorbitant premium for a policy they dislike to cover a huge variety of health services they neither want nor need. Also, continue to pay from savings monthly health care costs, because the plan deductible is $14,100. As small business owners, they cheered the Trump executive order, knowing that it would not cheapen the cost of their health insurance immediately. They cheer elimination of excessive coverage requirements and the ability to join a larger risk pool with other businesses.

President Trump is doing everything possible to fix the debacle of Obama Care by implementing free market solutions through executive actions. White House lawyers believe this entire Trump action litigation-proof from leftist legal groups. Winners are Nebraskans who will enjoy better quality, cheaper insurance and more leverage to negotiate with insurance companies. This order will pressure Congress very strongly to finish the repeal and replacement of Obama Care and give Nebraskans Obama Care Relief. Lobby your representative and 2 senators today to privately and publicly support this Trump initiative.

Research, documentation, and analysis for this issue paper done by Nebraska Taxpayers for Freedom. This material copyrighted by Nebraska Taxpayers for Freedom, with express prior permission granted for its use by other groups in the NE Conservative Coalition Network. 10-17 C.

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