You may have seen the picture of the new president rushing into his office to sign his first Executive Order. It was Friday, January 20, 2017, after the parades and before the inaugural balls. Chief of Staff Reince Priebus put the paper in front of him, and like a homebuyer whose eyes have glazed over from thirty pages of gobbledygook, President Trump quickly signed the document without a moment’s hesitation. Now if you or I were about to make history, and everything a president does, by definition, is historical, we might have looked at the document, maybe ever READ the document, prior to affixing our name to it.
Since we aren’t on our way to any formal dinners or balls, we have plenty of time to read the Executive Order. Please take a moment. It is only one page.
It is important to note that this was the first Executive Order. So what does it mean?
Option One – If the repeal, replace, demolition, or rebranding of Obamacare succeeds, this Executive Order will be hailed as the important first step President Trump made to keep his promise and to deliver a better program. That is a huge if.
Option Two – This Executive Order opens the door for major changes. Once a Secretary of Health and Human Services (HHS) has been confirmed by the Senate, he (Don’t judge me. All of the nominees are male.) will be able to determine what regulations are burdensome. Here’s a hint – All regulations are a burden to someone. The current nominee is Congressman Tom Price (R-GA). States looking to modify the cost of Medicaid by reducing benefits or access will find Mr. Price supportive. In fact, a quick read of his positions over the years will yield the impression that Mr. Price might happily remove any requirement that the poor and middle class have comprehensive insurance coverage.
And though all of the above might seem like enough of a motivation to sign this Executive Order, I still think that it isn’t enough to be #1. So allow me to offer another explanation.
The Patient Protection and Affordable Care Act (Obamacare) was structured in broad strokes with the details to be fleshed out in the form of regulations. This is not unusual. Major legislation like the Patriot Act are designed this way. The PPACA requires health plans to cover annual routine preventive care visits. These visits are covered at 100%. No deductible. No copays. It was HHS that determined that routine preventive care included a colonoscopy for those of us over 50. This has undoubtedly saved lives. It was also HHS that determined that preventive care included birth control pills, the IUD, and the morning after pill. That made the lives of countless Americans easier. And now that this Executive Order has been signed, it will be HHS that will decide birth control, the IUD, and the morning after pill are no longer part of preventive care.
This change could apply to both individuals and groups. The current court cases dealing with this will be dropped immediately. This will be seen as a victory for those employers who are opposed to these services. And to those who needed these benefits. Well, they aren’t the priority.