N.H. officials split on Trump’s health care executive order

  • FILE - In this photo taken Wednesday June 29, 2016 Executive Councilor Chris Sununu listens during the Council meeting Concord, N.H. Sununu is seeking the Republican nomination for governor. New Hampshire has struggled to attract and retain young people, a trend that's likely to continue without major policy changes. While the gubernatorial candidates propose solutions to the problem in bits and pieces, few have a full scale of ideas to address New Hampshire's demographic challenges.(AP Photo/Jim Cole/FILE) Jim Cole

Monitor staff
Friday, October 13, 2017

Some sounded an optimistic note in the Granite State while others warned of dire consequences for consumers after President Donald Trump on Thursday issued a sweeping executive order targeting the Affordable Care Act.

The order aims to make it easier for individuals and businesses to buy cheaper health care plans that offer less coverage with fewer government protections. The president and his allies say the move will spur needed competition and give consumers more options.

“The time has come to take action to IMPROVE access, INCREASE choices, and LOWER COSTS for HEALTHCARE!” the president wrote on Twitter.

But critics, including organizations representing insurance regulators and hospitals, have argued that a parallel system of cheaper, skimpier plans could draw younger, healthier individuals out of the ACA’s exchanges, leaving the sickest behind in increasingly destabilized and unaffordable markets.

The most impactful part of the order tasks federal agencies with rewriting rules around “association health plans,” a type of health care plan purchased by small businesses who pool together to purchase coverage for employees. The ACA required that these plans cover certain essential health benefits, and many fear precisely those requirements will be jettisoned when details emerge around the order’s implementation.

The order still needs to go through the federal government’s rulemaking process, which will take months, and experts said they expect little impact until at least 2019. And for Lucy Hodder, the Director of Health Law and Policy Programs at the University of New Hampshire’s School of Law, that’s part of the problem.

“It just doesn’t answer the questions we need answered to allow for people to make reasonable choices on Nov. 1,” she said, referring to when enrollment begins for ACA plans.

Trump has for months remained coy about whether he’ll fund cost-sharing reductions, a key ACA subsidy, despite the open enrollment period start day looming. He’s also cut the enrollment period in half and slashed most of the funding for advertising. That’s created major uncertainty in insurance markets and contributed to soaring premiums in the individual market, in New Hampshire and across the country.

“It’s not helpful to put that out as something to explore as you’re undermining the competitive marketplace that has been created,” she said. “We need to stabilize what we have now.”

Hodder added that it’s worth looking into AHPs as the country mulls health care reform. But she said they have been tried before – and not always successfully.

“The problem is it’s hard to form health plan coalitions among small business and individuals – it’s hard to fund the plan, it’s hard to ensure that they don’t kick out the high utilizers, or skimp on coverage benefits,” she said.

Roger Sevigny, the state’s insurance commissioner, echoed Hodder and pressed the president for immediate action to calm insurance markets.

“I ask the Administration to take action to stabilize individual markets across the country, which have been affected this year by uncertainty at the federal level,” he wrote in a statement.

As for the order itself, Sevigny said his staff would be watching the rulemaking process closely.

“My staff and I will continue to focus on resolving concerns about consumer protections, solvency requirements, and market stability. We expect to provide feedback to the U.S. Department of Labor during its rule-making process to help address these concerns,” he wrote.

Republican Gov. Chris Sununu said he welcomed the order’s “potential benefits” but would be watching the process as federal agencies flesh out details.

“To the extent that President Trump’s executive order will roll back the inherent flaws of Obamacare and address Congress’ failure to act on health care reform, we welcome its potential benefits,” Sununu said in a statement. “When structured properly, AHP’s can provide options and flexibilities for individuals; something I have been very supportive of. I stand ready to work with the Trump Administration to ensure that the rule making process produces results that will benefit New Hampshire consumers, including the preservation of protections for individuals with pre-existing conditions.”

State Senate Majority Leader Jeb Bradley, who chairs a study commission looking to lower premiums on New Hampshire’s individual market, hailed AHPs as a useful way to inject competition into the markets.

“To me, I’d like to try it,” the Wolfeboro Republican said of the low-cost plans. “We ought to be trying some of these measures that would drive down the cost of health insurance.”

And he brushed off concerns raised by insurance regulators.

“The commissioners don’t like it because they start losing regulatory control over what’s in the plan,” Bradley said.

New Hampshire’s all-Democratic congressional delegation, on the other hand, was quick to condemn Trump’s order as a naked attempt to further undermine ACA.

“Americans have been very clear over the past months that they don’t want to return to the days of discrimination against people with pre-existing conditions and bare-bones junk insurance that’s not there when you need it – but that’s exactly what this executive order would do,” Rep. Carol Shea-Porter, who represents the first district, said in a statement.

Sen. Jeanne Shaheen, who has introduced legislation to permanently fund and extend eligibility for cost-sharing reductions, urged the president to work on a bipartisan solution.

“The President must abandon these political efforts to destabilize the ACA, and finally prioritize working with Congress to address and fix this manufactured crisis,” she said in a statement.

In a series of tweets, Sen. Maggie Hassan said the move would divide the market, provide poor coverage, and hike prices for the most vulnerable.

“By signing this order, President Trump is further sabotaging the insurance market and putting Americans’ health care at risk. Shameful,” Hassan wrote.

And Rep. Annie Kuster, who represents the state’s second congressional district, wrote in a statement that the order was a return to “the failed repeal and replace mantra.”

Other elements of the White House proposal 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.


(The Associated Press contributed to this report. Lola Duffort can be reached at 369-3321 or lduffort@cmonitor.com.)