Executive Order 13765:Prelude to ACA repeal

What the Executive Order Says

Executive Order (EO) 13765 is entitled "Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal" and was issued on January 20th, 2017.  This was the first EO signed by the current administration and it has 6 sections.

Section 1

This section defines the policy and frames the repeal of Obamacare as being motivated by individual freedom and States rights issues.

Section 2

This section directs the Secretary of Health and Human Services (HHS) and other agency heads to exercise all and any discretion defined in the PPACA so as to "waive, defer, grant exemptions from, or delay the implementation" of the PPACA.

Section 3

This section directs  the Secretary of HHS and other agency heads to exercise all and any discretion available to them in the PPACA to push decisions on implementation to the States.

Section 4

This section directs the Secretary of HHS and others to take actions, if possible to allow interstate commerce in the Health Care Insurance market.

Section 5

This section indicates that the usual rules for rulemaking apply.

Section 6

This section includes the usual legal fine print to assure the constitutionality of the EO.

My Commentary

It was to be expected that the administration would make repealing Obamacare a priority.  It was not expected that 11 months into the administration, we still have Obamacare in place and that there is discussion and debate amongst Republicans whether to include repeal of the individual mandate in the tax reform bill.
I think that there is a bit of a contradiction between sections 3 and 4.  If one considers that the efficiency and stability of insurance plans gets better as the pool of participants in the plan grows, then in reality, the larger the pool, the better it is for not only the participants, but also for health care providers.  To get bigger pools, then one really needs to consider groups on a national level.  However, as was discussed during some of the debates, each state is different and ultimately is their own unique marketplace and the health insurers would probably need to customize a plan for each state to take into consideration any State laws and regulations.  So these two priorities conflict.  If the States stipulate what they feel are the priorities of their citizens with respect to healthcare (exercising States' rights) then it largely makes interstate commerce impossible.
In thinking about the healthcare issue, recognizing that the whole country is not going to suddenly wake up one day and say "We should just adopt the Canadian system", one rule that might shift the thinking on how health insurance works and should work is what I would call the Healthcare neutrality rule.  Similar to Net Neutrality, it shouldn't matter if you are in or out of network, coverage, co-pays, etc. should be exactly the same.  This will give consumers more choices and defining which doctors can be used has always been a rallying cry against government run health care.  It would strongly promote transparency in pricing as well.