Trump signs first executive order on Affordable Care Act

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President Trump signs his first executive order in the Oval Office, which will direct agencies 
to ease the regulatory burdens associated with the Affordable Care Act, as Vice Presiden
Pence swears in retired Gen. James Mattis and retired Gen. John F. Kelly. (Reuters)
President Trump signed an executive order late Friday giving federal
 agencies broad powers to unwind regulations created under the 
Affordable Care Act, which might include enforcement of the penalty
 for people who fail to carry the health insurance that the law requires
 of most Americans.
The executive order, signed in the Oval Office as one of the new
 president’s first actions, directs agencies to grant relief to all
 constituencies affected by the sprawling 2010 health-care law: 
consumers, insurers, hospitals, doctors, pharmaceutical companies, 
states and others. It does not describe specific federal rules to be 
softened or lifted, but it appears to give room for agencies to eliminate 
an array of ACA taxes and requirements.
However, some of these are embedded in the law, so it is unclear what
 latitude the executive branch will have.
Though the new administration’s specific intentions are not yet clear, 
the order’s breadth and early timing carry symbolic value for a president
 who made repealing the ACA — his predecessor’s signature domestic 
achievement — a leading campaign promise.
Additionally, the order’s language about easing economic and regulatory
 burdens aligns with long-standing Republican orthodoxy that the 
government exerts too heavy a hand on the U.S. health-care system.
As Republicans in Congress gear up to repeal the Affordable Care Act, two Pennsylvanians 
reflect on their different experiences under Obamacare. (Alice Li/The Washington Post)
“Potentially the biggest effect of this order could be widespread waivers
 from the individual mandate, which would likely create chaos in the 
individual insurance market,” said Larry Levitt, senior vice president 
at the Kaiser Family Foundation. In addition, he said, the order 
suggests that insurers may have new flexibility on the benefits they 
must provide.
“This doesn’t grant any new powers to federal agencies, but it sends a 
clear signal that they should use whatever authority they have to scale 
back regulations and penalties. The Trump administration is looking 
to unwind the ACA, not necessarily waiting for Congress,” Levitt said.
The order, several paragraphs long, does not identify which of the
 many federal rules that exist under the ACA the new administration
 intends to rewrite or eliminate. In general, federal rules cannot be
 undone with a pen stroke but require a new ­rulemaking process to 
replace or delete them.
But in giving agencies permission to “waive, defer, grant ­exemptions
 from or delay” ACA rules, the order appears to create room for the 
Department of Health and Human Services to narrow or gut a set of 
medical benefits that the ACA compels insurers to include in health
 plans that they sell to individuals and small businesses.
The order does not mention Medicaid, but it says one of its goals is
 to “provide greater flexibility to States,” raising the question of
 whether the Trump HHS might try to loosen rules for states that have 
expanded the program for lower-income Americans, as the law allows.
The order directs all federal agencies “to minimize the unwarranted
 economic and regulatory burdens” of the ACA — the first step of 
Trump’s central campaign promise to repeal and replace former 
president Barack Obama’s health-care plan.
Trump’s action drew swift protests from ACA proponents who
 have coalesced to try to preserve the law. “While President Trump 
may have promised a smooth transition” from the current law to a
 replacement, said Leslie Dach, director of the fledging Protect Our
 Care Coalition, “the executive order does the opposite, threatening 
disruption for health providers and patients.”
Also late Friday, Reince Priebus, Trump’s chief of staff, issued an executive
 memorandum ordering a freeze on regulations for all government 
The memo could freeze several new Energy Department efficiency
 standards, such as those affecting portable air conditioners, 
commercial boilers and uninterruptable power supplies, which were
 issued Dec. 28 but not yet published in the Federal Register. The 
regulations were part of the Obama administration’s broader effort to 
cut greenhouse-gas emissions linked to climate change.
The move echoes a missive that then-White House Chief of Staff Rahm 
Emanuel sent the heads of every federal agency on Jan. 20, 2009, 
asking them to freeze any rules that had not yet been published in
 the Federal Register, and to consider a 60-day extension of the 
effective date of rules that had not yet gone into effect.
Also Friday, Trump signed the official paperwork installing Defense 
Secretary James Mattis and Homeland Security Secretary John F. Kelly,
 two of his Cabinet picks the Senate voted to confirm earlier in the day.
Trump’s health-care order came at the end of what had otherwise 
been a largely ceremonial day. The White House did not immediately
 return requests for comment. 
During his campaign and afterward, Trump pledged that fundamental 
changes to the health-care system would be a first priority. In a speech
 outside Philadelphia six days before the November election, Trump 
vowed to abolish the ACA before he was sworn in. “Have to do it,” he
 said. “I will ask Congress to convene a special session so we can repeal
 and replace.”
Last week, both chambers of Congress approved a budget resolution 
that was the first legislative step toward repealing the 2010 law, which
 was the centerpiece of the Obama administration’s health policies. But 
health care was not among a half-dozen issue areas listed on the new website that debuted shortly after noon on Friday.
Earlier Friday, in the Capitol, the new president took several more
 perfunctory executive actions shortly after he was sworn in at noon, 
the most notable being to overturn a recent mortgage-fee ­reduction — 
geared at helping first-time and low-income home buyers — that Obama
 announced last week and that called for the Federal Housing 
Administration to cut its annual borrowing fee by a quarter of a
 percentage point.
Trump also signed a waiver for Mattis to lead the Defense Department,
 despite his having been retired from military service for only three years.
 Without the waiver, federal law would have prohibited Mattis from 
serving as defense secretary until he had been retired from the military
 for at least seven years.
And just moments after Trump took the oath of office, he began
 implementing his general vision, transforming the official White House 
website with a new set of policy pledges that offered the broad contours
 of the Trump administration’s top priorities. They included fierce 
support for law enforcement and gun owners’ rights to defend 
themselves. There were also some notable absences, such as the
 omission of a policy page on climate change.
The issues page of Trump’s White House offered no new plans or 
policies but rather a rehash of many of his most prominent campaign
 promises — a signal to the nation that Trump, more pragmatic 
than ideological, plans to implement at least the key guideposts of
 his campaign vision.
The policies laid out on the website included plans to both withdraw
 from and renegotiate major trade deals, grow the nation’s military
 and increase cybersecurity capabilities, build a wall at the nation’s
 southern border and deport undocumented immigrants who have
 committed violent crimes.
“Our job is not to make life more comfortable for the rioter, the looter, 
or the violent disrupter,” read the law-and-order section, which calls 
for “more law enforcement” and “more effective policing.” “Our job is
 to make life more comfortable for parents who want their kids to be 
able to walk the streets safely. Or the senior citizen waiting for a bus.
 Or the young child walking home from school.”
The climate change Web page that existed under Obama was not 
replaced on the Trump site, with scant mention of climate change 
under the new president’s energy plan. Also gone or not immediately
 replaced were Web pages the previous administration had devoted to 
the rights of lesbian, gay, bisexual and transgender individuals; 
people with disabilities; and civil rights more generally.
Trump’s entire campaign was largely a repudiation of Obama, and a
 new Republican administration is unlikely to have the same set of
 issues and priorities as an outgoing Democratic one. But the missing
 issue pages were particularly alarming to Democrats and activists, 
especially after a vitriolic campaign in which Trump drew criticism 
for seeming to mock a disabled reporter and being insensitive to the
 needs and rights of minority communities.
On energy, Trump vowed to eliminate “harmful and unnecessary 
policies” such as the Climate Action Plan and the Waters of the
 United States rule. The first represents a variety of efforts Obama
 had pursued to reduce U.S. ­greenhouse-gas emissions while the 
second is a rule issued by the Environmental Protection Agency to
 protect not only the largest waterways but also smaller tributaries 
that others believe should fall under the jurisdiction of states rather
 than the federal government.
The initial Trump website also did not devote a separate section to 
immigration, another central tenet of his candidacy, though it 
mentioned immigration under the law enforcement section. Despite
 rumors within the immigration advocacy community that one of
 Trump’s initial executive actions could be to revoke Obama’s
 protections for “dreamers” — undocumented immigrants brought 
to the country as young children — his website so far focused only on 
big-picture enforcement and security goals.
“He is dedicated to enforcing our border laws, ending sanctuary cities, 
and stemming the tide of lawlessness associated with illegal
 immigration,” read part of the immigration section.
The new administration’s language echoed Trump’s tough rhetoric
 on the campaign trail, including his promises to strengthen
the law enforcement community, crack down on what he views as a
 broad range of trade violations and potentially forge alliances with 
countries long considered dangerous rivals, such as Russia.
“Finally, in pursuing a foreign policy based on American interests,
 we will embrace diplomacy,” read part of Trump’s policy vision. “The
 world must know that we do not go abroad in search of enemies, that
 we are always happy when old enemies become friends, and when old 
friends become allies.”
Melania Trump, the first lady, also received a biographical overhaul.
 Her web page featured a black and white glamour shot of her, and
 touted her jewelry line and modeling career, describing the many
 high fashion photographers with whom she has worked and the 
glossy magazines for which she has posed (Vogue and the Sports
 Illustrated swimsuit edition, among others).
The first lady’s biography also correctly stated that she began 
college at the University of Ljubljana in Slovenia, her home country,
 but never graduated — a fact that was misstated during the campaign.
Only at the very end of her page did Melania offer a glimpse of the
 sort of first lady she might be: “Mrs. Trump cares deeply about issues
 impacting women and children,” read the biography, “and she has 
focused her platform as First Lady on the problem of cyber bullying
 among our youth.”
Juliet Eilperin, Chris Mooney and Steven Mufson contributed to 
this report.