Day One: Kneecapping the Affordable Care Act

On his first full day in the White House, Donald Trump signed an executive order that effectively told all federal agencies to be lax on enforcing provisions of the Affordable Care Act, colloquially known as ObamaCare. That could lead to expanded waivers as tax time nears, reducing the number of people required to pay penalties for not buying insurance. It could mean the health department tipping off insurers that it won't object to lessening coverage provisions in their policies to reduce costs. By law, those waivers can be applied for only in certain periods during the year, and minimum coverage features are baked into the Act, but will agencies reading the order's vigorous instruction to act “to the maximum extent permitted by law” simply look the other way?

Perhaps it was only a gesture by Trump to prove to his following that he will deliver on his promise “to minimize the unwarranted economic and regulatory burdens”, as his order says, on the road to dismantling Obama's major achievement. But given language that is more than a suggestion, telling them to “waive, defer, grant ¬exemptions from or delay”, the agencies may think they had better take action or have to answer to Trump why they did not.

What if, while Republicans scramble to come up with a replacement to substitute for repeal (see related story), the Justice Department takes Trump's order to mean it should drop its defense against the House of Representatives suit against the government that says the subsidies are illegal? The health act provides subsidies to help people buy insurance, but the House never appropriated the money. The suit argues that funds meant for other purposes were misappropriated. The subsidies continue pending appeal, but if Justice drops its appeal, Obamacare's insurance market is sure to collapse.

This intemperate and unnecessary move by the President before any substitute has even been formulated could lead to serious erosion or even destruction of the healthcare act just when the new administration needs to assure the millions now benefiting from insurance that it is not going to be taken away. Instead, Mr. Trump seems to have a preference for chaos.