After multiple congressional efforts to repeal/replace/modify the Affordable Care Act (ACA) have failed due to partisan and inter-party disagreements, President Trump issued an Executive Order and then announced an end to Cost Sharing Subsidies (CSS) to force change.

The order, titled “Promoting Healthcare Choice and Competition Across the United States,” directs regulatory agencies to focus on three areas with the goal of facilitating the purchase of insurance across state lines and providing high-quality care at affordable prices.

• Expand Access to Association Health Plans: The goal is to allow small employers to pool their risk together in an effort to have access to more affordable health insurance options. The Secretary of Labor has 60 days to propose regulations.

• Expand Availability of Short-Term Limited-Duration Insurance: The prior administration limited these plans to a 90-day duration. The Secretaries of Treasury, Labor, and Health and Human Services (HHS) are charged with proposing regulations within 60 days to allow these plans for longer periods of times and to be renewable.

• Expand Availability and Permitted Use of Health Reimbursement Arrangements (HRAs): Within 120 days of the order, the Secretaries of Treasury, Labor, and HHS shall consider proposing regulations or revising guidance to expand employers’ ability to offer HRAs to their employees and to allow HRAs to be used with non-group coverage (i.e. individual policies).

The agencies will be required to write proposed regulations and then allow for public comment. It will be a challenging — if not impossible — task to get this done on time for the January 1, 2018, plan year…especially the Association Health Plan goal due to both federal and state laws and regulations which must be navigated.

The more immediate and possibly impactful announcement made by the Trump administration Thursday, October 12, is the decision to eliminate the Cost Sharing Reduction Subsidies. The administration’s announcement calls for an immediate halt to these subsidies. A federal court has already determined these subsidies to be illegal. These subsidies are used to reduce or eliminate deductibles and other health plan out-of-pocket expenses — making them attractive and more affordable for low income individuals. The immediate cutoff delivers another severe blow to the already fragile individual Marketplace.

All of these changes will put pressure on Congress to attempt some type of healthcare reform and will also surely trigger multiple legal challenges. Early claims say that these cheaper policies provide fewer benefits and eliminate the consumer protections provided under the ACA.

Stay tuned as we prepare for an exciting race toward January 1, 2018.