Friday, January 20, 2017

The Executive Order on Obamacare (January 20, 2017) (Full Text)

On his first day in office, President Trump issued an Executive Order asking the branches of government to do the maximum possible, within the law, to take actions to minimize "the economic and regulatory burdens of the ACA."   The order requires compliance with the Administrative Procedures Act, which generally means that implementation created by agency rulemaking and regulations needs to be rescinded by another round of rulemaking.

The order applies to "all agencies and authorities" and is targeted to those parts of the act that impose economic burdens on states or individuals, providers, payers, or medical manufacturers.

Health order:  Coverage at New York Times, here.  At WSJ, here.  CNN, here.   Forbes, here.  For a rapid post by the prolific Timothy Jost at Health Affairs, here.   NBC highlights "five provisions that could change right away" (here) while The Hill advises that "Hill waits for word from Trump" on what to do next (here).  For discussion by policy expert Nicholas Bagley, here.  For an assessment of the executive order as "very confusing," Vox, here.

General Regulatory Freeze: The White House also issued a freeze on the issuance of any regulations except those required by emergencies (here; at Politico, here.)

Full text after the break.


By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows:

Section 1
It is the policy of my Administration to seek the prompt repeal of the Patient Protection and Affordable Care Act (Public Law 111-148), as amended (the "Act"). In the meantime, pending such repeal, it is imperative for the executive branch to ensure that the law is being efficiently implemented, take all actions consistent with law to minimize the unwarranted economic and regulatory burdens of the Act, and prepare to afford the States more flexibility and control to create a more free and open healthcare market.

Sec. 2
To the maximum extent permitted by law, the Secretary of Health and Human Services (Secretary) and the heads of all other executive departments and agencies (agencies) with authorities and responsibilities under the Act shall exercise all authority and discretion available to them 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.

Sec. 3
To the maximum extent permitted by law, the Secretary and the heads of all other executive departments and agencies with authorities and responsibilities under the Act, shall exercise all authority and discretion available to them to provide greater flexibility to States and cooperate with them in implementing healthcare programs.

Sec. 4
To the maximum extent permitted by law, the head of each department or agency with responsibilities relating to healthcare or health insurance shall encourage the development of a free and open market in interstate commerce for the offering of healthcare services and health insurance, with the goal of achieving and preserving maximum options for patients and consumers.

Sec. 5
To the extent that carrying out the directives in this order would require revision of regulations issued through notice-and-comment rulemaking, the heads of agencies shall comply with the Administrative Procedure Act and other applicable statutes in considering or promulgating such regulatory revisions.

Sec. 6
(a) Nothing in this order shall be construed to impair or otherwise affect:

(i) the authority granted by law to an executive department or agency, or the head thereof; or
(ii) the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.

(b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.

(c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.

January 20, 2017.

As of 1 am Eastern time, 1/21, the E.O. was not yet posted at