American Bridge Vice President Shripal Shah issued the following statement on Trump’s executive order further undermining the Affordable Care Act’s state insurance marketplaces as well as its protections for Americans with preexisting conditions: 

​”This is an outrageous, and potentially illegal, attack on Americans with preexisting conditions and the finances of middle class Americans. Trump’s actions will exacerbate the chaos in already-sabotaged marketplaces, force premiums to skyrocket, and open the doorway to large-scale health insurance fraud, all in the name of partisan politics. American families are paying attention, and they’ll know exactly who to blame when they’re hit with the consequences of Trump’s reckless behavior.”

​EXPERTS ON LEGALITY OF THE EXECUTIVE ORDER​

​American Enterprise Institute Resident Scholar Joseph Antos: “The E in ERISA is employee…They are going to have to stretch the definition of whether you’re an employee or not.” [Reuters, 10/12/2017]

Reuters: “U.S. President Donald Trump’s expected plan to let Americans buy insurance across state lines could violate federal law governing employee benefit plans and will almost certainly be challenged in court, several legal experts said….Several experts in healthcare and employment law said Trump’s plan could violate the U.S. Employee Retirement Income Security Act (ERISA), a federal law that governs large group plans that must be provided or maintained by employers or employee organizations.” [Reuters, 10/12/2017]

Politico: “‘How that doesn’t get challenged, how that isn’t such an expansive interpretation of ERISA that goes beyond the administration’s authority — someone’s absolutely going to’ bring a legal challenge, said an insurance industry official, who requested anonymity to discuss strategy. ‘This is chaos.’” [Politico, 10/12/2017]

Harvard Law School Professor Lawrence Tribe: “Trump’s abuse of presidential power to undermine laws passed by Congress rather than faithfully execute them” [Twitter, 10/11/2017]

Washington Post: “The prospect of letting individuals be part of these associations is the aspect of the executive order likely to draw legal complaints. The 1974 ERISA law, which permits large companies that insure themselves to do so with relatively little federal regulation, could be reinterpreted to apply to small businesses that band together, according to health policy experts familiar with the law. But ERISA does not apply to individuals buying coverage on their own.” [Washington Post, 10/12/2017]

Wall Street Journal: “Health analysts predicted that Thursday’s order could tempt critics to pursue legal challenges, opening a new front in the health-care battle.” [Wall Street Journal, 10/12/2017]

EXPERTS ON IMPACTS OF THE EXECUTIVE ORDER

​Associated Press: “But the president’s move is likely to encounter opposition from medical associations, consumer groups and perhaps even some insurers — the same coalition that so far has blocked congressional Republicans from repealing and replacing former President Barack Obama’s Affordable Care Act. Critics say the White House approach would raise costs for the sick, while the lower-premium coverage provided to healthy people would come with significant gaps.” [Associated Press, 10/12/2017]

Washington Post: “President Trump intends to sign an executive order this morning expanding association health plans. But 25 years ago, federal watchdogs concluded that such plans ripped off hundreds of thousands of Americans by refusing to pay their medical claims while violating state insurance laws and even criminal statutes.” [Washington Post, 10/12/2017]

Politico: “Importantly, they wouldn’t have to meet Obamacare’s benefit requirements or cover a minimum percentage of enrollees’ health care costs. Association health plans ‘could effectively cherry pick’ the most desirable participants, said Sabrina Corlette, an insurance expert at Georgetown University and a former Democratic congressional staffer. ‘Anybody who’s healthy and unsubsidized would quickly make the transition.’” [Politico, 10/12/2017]

Kaiser Family Foundation Senior Fellow Karen Pollitz: “Within a year, this would kill the market.” [Politico, 10/12/2017]

S&P Global Ratings Healthcare Analyst Deep Banerjee: “No one healthy is now going to sign up in the ACA risk pool, because they have this cheaper option…It just takes away the opportunity of this risk pool getting better.” [Politico, 10/12/2017]

Reuters: “Experts said the association health plans could attract young, healthy people and leave a sicker, more expensive patient pool in the individual insurance markets created under the healthcare law, driving up premiums and effectively eroding the law’s protection for those with pre-existing conditions.” [Reuters, 10/12/2017]

Veda Partners Policy Analyst Spencer Perlman: “It would essentially create a parallel regulatory structure within the individual and small group markets that is freed from the various consumer protections established…The end result could be a death spiral for ACA-compliant plans.” [Bloomberg, 10/12/2017]

Washington Post: “Critics, who include state insurance commissioners, most of the health-insurance industry and mainstream policy specialists, predict that a proliferation of such health plans will have damaging ripple effects: driving up costs for consumers with serious medical conditions and prompting more insurers to flee the law’s marketplaces. Part of Trump’s actions, they predict, will spark court challenges over their legality.” [Washington Post, 10/12/2017]

New York Times: “The influx of a set of plans exempt from the Affordable Care Act rules will essentially divide the market and make it increasingly unstable, said Rebecca Owen, a health research actuary with the Society of Actuaries. People who want or need broad coverage could find it increasingly difficult to obtain an affordable policy, experts say.” [New York Times, 10/12/2017]

Robert Wood Johnson Foundation Healthcare Expert Katherine Hempstead: “The easier you make it not to buy comprehensive coverage, the harder you make it to buy comprehensive coverage.” [New York Times, 10/12/2017]

Washington State Insurance Commissioner Mike Kriedler: “It would have a very negative impact on the markets…Our state is a poster child of what can go wrong. Association health plans often shun the bad risks and stay with the good risks.” [New York Times, 10/12/2017]

Center for American Progress Vice President for Health Policy Topher Spiro: “By siphoning off healthy individuals, these junk plans could cannibalize the insurance exchanges…For older, sicker people left behind in plans regulated under the Affordable Care Act, premiums could increase.” [New York Times, 10/12/2017]

Wall Street Journal: “But health-insurance experts say it could raise costs for sicker people by drawing healthier, younger consumers to these alternative plans, which could be less expensive and offer fewer benefits.” [Wall Street Journal, 10/12/2017]

Kaiser Family Foundation Vice President Larry Levitt: “If the order is as expansive as it sounds, association plans could create insurance products that would siphon off healthy people with lower premiums and skinnier benefits, leading more insurers to exit the ACA marketplace or raise premiums significantly.” [Associated Press, 10/12/2017]

Brookings Institute Center for Health Policy Fellow Matt Friedler:“Associations would siphon many healthier people out of the ACA-compliant market, driving up premiums…Higher premiums in the ACA-compliant market would result in big cost increases for many sicker enrollees — since they would not have the option of switching to the association market — and likely for the federal government as well.” [Bloomberg, 10/10/2017]

Kaiser Family Foundation Healthcare Marketplace Project Director Gary Claxton: “If the market’s already fragile right now, this is going to make it much more fragile…All of this would be the start of the end of the individual ACA market.” [Bloomberg, 10/10/2017]

Bloomberg: “An executive order from President Donald Trump to allow new health plans outside of Obamacare could further destabilize the law’s fragile markets, health-care experts say.” [Bloomberg, 10/10/2017]

Courthouse News: “Trump’s coming mandate could also lead to spikes in Obamacare premiums, and may spook large insurers to consider dropping out of the ACA altogether, a move that would starkly divide the insurance market while bringing the White House closer to its hard-fought goal: dismantling Obama’s health care law.” [Courthouse News, 10/10/2017]

Wall Street Journal: “One result, analysts said, could be that healthy people are drawn to the expanded, less-expensive plans, leaving sicker and higher-risk people in a dwindling pool that sees higher costs. Together, if executed in an expansive way, Mr. Trump’s changes could ‘cause a bifurcation of the market,’ said Cori Uccello, senior health fellow at the American Academy of Actuaries.” [Wall Street Journal, 10/9/2017]

Rhett Buttle, Former Department of Health and Human Services Director of Private Sector Engagement: “I agree that we need to find more options for small business, but AHPs are not the answer. They allow cherry picking that could undermine the traditional small group market…Additionally, they could lead to premium instability for small businesses and put some of their consumer protections at risk.” [Wall Street Journal, 10/9/2017]

Kaiser Family Foundation Vice President Larry Levitt: “Association plans exempt from the ACA can cherry pick healthy people and make coverage unaffordable for those with pre-existing conditions.” [Twitter, 10/10/2017]

• Kaiser Family Foundation Vice President Larry Levitt: “If loosely regulated association plans are allowed, insurers will leave the ACA marketplaces as soon as they can or hike premiums a lot.” [Twitter, 10/10/2017]
• Kaiser Family Foundation Vice President Larry Levitt: “Middle class people with pre-existing conditions ineligible for ACA subsidies could be especially vulnerable under the executive order.” [Twitter, 10/10/2017]

Former CMS Administrator Andy Slavitt: “10/ The EO allows “association health plans”– ability for plans to be offered with no pre-ex protections & turn ACA into a high risk pool. [Twitter, 10/5/17]

• Former CMS Administrator Andy Slavitt: “11/ In states that have done things like this, like TN, premiums have skyrocketed and competitors have left the market.” [Twitter, 10/5/17]