Trump to issue preexisting conditions, surprise billing orders with little enforcement

President Donald Trump on Thursday will announce executive orders on the topics of protecting people with preexisting conditions and surprise billing that will have little practical consequence as he works to bolster his healthcare record.

Trump has faced criticism from Democrats for advocating that the entire Affordable Care Act be struck down in court, including the law’s protections for people with preexisting conditions. Trump timed the orders with a speech to outline his healthcare vision, which will highlight existing policy priorities and will not offer a plan to replace the Affordable Care Act.

A Supreme Court vacancy created by the late Justice Ruth Bader Ginsburg has cast new urgency on the possibility that the ACA will be struck down, as the Supreme Court will hear a case on the issue a week after Election Day.

HHS Secretary Alex Azar said the president would sign an executive order clarifying that it is the policy of the United States to protect people from insurance discrimination based on preexisting conditions. The protections are existing law under the ACA.

Azar said some individual market plans have high deductibles and are unaffordable and the order is intended to signal that Trump would preserve the protections if the ACA is struck down, though that action may have to go through Congress.

The second executive order would instruct HHS to work with Congress to achieve reform on surprise medical bills, as the agency has been doing for months. The order does not detail a strategy to resolve the standstill lawmakers have reached over how insurers should be required to pay for out-of-network care.

If no balance billing reform is acheived by Jan. 1, the order would ask HHS to “investigate regulatory actions” that could be taken on the issue.

Other health policy issues that Trump will address include lowering prescription drug prices, promoting hospital price transparency, making telehealth expansions permanent, and HSA expansions.

Democratic presidential nominee Joe Biden has proposed building on the ACA by offering a public insurance option on insurance exchanges and increasing subsidies and banning surprise billing.


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