US President Donald Trump signs an executive order as Vice President Mike Pence looks on at the White House in Washington, DC on January 20, 2017.
President Donald Trump wasted no time in chipping away at the Patient Protection and Affordable Care Act (sometimes called “ACA” or “Obamacare”). Today, shortly after he was sworn in as the 45th President of the United States, President Trump signed an executive order giving the Department of Health and Human Services and “other executive departments and agencies” the authority and discretion to roll back certain aspects of the Affordable Care Act.
The order does not offer specifics. Rather, the order notes that the President intends to “seek the prompt repeal” of ACA. Pending the appeal, the order directs agency heads to “waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications.”
That language sure sounds latitude for the Internal Revenue Service (IRS) to not enforce the penalty, sometimes called a “shared responsibility payment,” and other ACA-related taxes. As currently implemented, ACA requires taxpayers to either have minimum essential health coverage, meet an exemption, or make a shared responsibility payment.
The order goes on to say “[t]o the extent that carrying out the directives in this order would require revision of regulations issued through notice-and-comment rule-making, the heads of agencies shall comply with the Administrative Procedure Act and other applicable statutes in considering or promulgating such regulatory revisions.” Additionally, the order notes that the order is to be “implemented consistent with applicable law and subject to the availability of appropriations.”
You can read the full text of the order here.
The broad language in the order could make picking and choosing which pieces of ACA to immediately dismantle difficult. Appropriations are funds which are designated for a specific purpose: approximately one-third of federal dollars are appropriations dollars. When it comes to ACA, there are a number of appropriations as part of the law which are used to fund a variety of funds and programs; some of these are designated in a single year, but others are multi-year. Taking out taxes and fees on a piecemeal basis could prove difficult.
At a press conference just before the start of tax season, IRS Commissioner John Koskinen indicated that, after meeting with the Trump transition team, he did not anticipate a problem with collecting the individual responsibility payment in 2017. Only a small number of taxpayers are responsible for making a payment. Koskinen told Congress that 80% of taxpayers indicated on their returns that they had qualifying coverage all year; in addition, nearly 13 million taxpayers, or about 9% of taxpayers, claimed one or more health care coverage exemptions. Those numbers were not expected to vary much when tax season begins on .
Whether the IRS would take additional steps following the order isn’t clear. An email to the IRS sent after hours seeking comment in response to the order was not immediately returned.
The promise to repeal ACA was a central theme of Trump’s candidacy, and he has made it clear that he hopes to abolish it as soon as possible. However, in recent days, many Republicans on the Hill have indicated that they are not comfortable moving forward without a suitable alternative in place. This order could be a shot across the bow to see how far the new Trump administration can push without Congressional action.
Last week, the Congressional Budget Office (CBO) issued a report on the estimated changes in health insurance coverage and premiums if ACA’s penalties and subsidies were repealed but the insurance market reforms remained. Their findings suggesting that doing so would increase both the number of people who are uninsured (32 million by 2026) and premium costs (which would nearly double by 2026). You can read the full report here (downloads as a pdf).
President Trump has indicated that any plan to replace ACA after a repeal would provide healthcare for “everybody.”