Many of the decisions that will affect consumers will fall to officials at the Treasury, Labor, and Health and Human Services Departments, after undergoing public comment periods. The order is intended to expand the use of health savings accounts, to allow more groups to band together for insurance to form "association health plans," and to lengthen the amount of time people can be on short-term health insurance plans.
Senior administration officials warned in a call Monday that any changes could take six months, meaning they wouldn't kick in until well after the open enrollment period for people to sign up for Obamacare coverage, which ends Dec. 15.
"Executive orders rarely have immediate legal effect. They're marching orders to agencies," tweeted Nicholas Bagley, an administrative law expert and professor at the University of Michigan Law School.
1/ Executive orders rarely have immediate legal effect. They're marching orders to agencies. This one is no different.— Nicholas Bagley (@nicholas_bagley) October 12, 2017
Still, Trump's move, politically and symbolically, allowed some to emerge more victorious than others.
Winner: Sen. Rand Paul
The Kentucky Republican opposed several bills that other Republicans supported to repeal and replace portions of Obamacare, partly leading to the failure of the most-recently considered healthcare legislation known as Graham-Cassidy. Even so, he worked with the Trump administration for months to make suggestions about executive actions that could be taken to allow people to buy cheaper health insurance plans with fewer Obamacare mandates. He stressed throughout the process that the changes would have little impact on government spending. Paul appeared beside Trump when he signed the order and made opening remarks. When Trump reached the lectern, he called Paul's support "a very positive thing."
"Sen. Paul was pleased to work hard to get this done and is very appreciative of the work President Trump did to make it happen — but the winners here are the millions of Americans who will have better, cheaper insurance and more power to negotiate with insurance companies," said Doug Stafford, chief strategist for Paul's political action committee.
Winner: President Trump
When the president signed his executive order, he framed his action as a direct response to Congress's inability to act on Obamacare. Trump for months has made it known that he is disappointed with congressional Republicans, who failed to send a bill to his desk that would have fulfilled the party's seven-year promise to repeal and replace portions of Obamacare. When he signed his executive order, he touted it as a positive way to fulfill his promises and said it was only the beginning of further actions.The move is already being used as promotion in election materials. In an email sent to supporters Thursday, Trump's re-election campaign declared that the president "takes the lead on healthcare" and that it was part of his "down payment on the party's pledge." Michael Glassner, executive director of Donald J. Trump for President Inc., said in a statement, "Despite their tremendous disappointment in Congress for failing to repeal and replace Obamacare, Americans are reminded today that they can rely on President Trump to do everything possible to fix this debacle by implementing free-market solutions through executive actions."
Although many Republicans support the executive order, muting perceptions that they are losers, the move could cast them as ineffective.
Loser: Sens. Lamar Alexander and Patty Murray
The leaders of the Senate Health, Education, Labor and Pensions Committee have been working together to try to come to a bipartisan agreement about how to stabilize the Obamacare exchanges. But committee Chairman Alexander and Murray, the top Democrat on the panel, haven't reached an agreement, and it's not clear whether other lawmakers or the White House will agree to pass the final product. Some Republicans have said they want more flexibility for states in exchange for the appropriation of funding for insurers, but more conservative members see it as as a "bailout." The executive order by Trump suggests a willingness to work against Obamacare, not to prop it up in the short term.
To be determined: Graham-Cassidy
Graham-Cassidy was the latest piece of legislation that aimed to overhaul Obamacare but failed to gain sufficient Republican support. It would have shifted Obamacare's funding to states and allowed them to create their own healthcare systems. Though Republicans have turned their attention to tax reform, the existence of Graham-Cassidy came up at the signing of the executive order, when Trump said he intended for Congress to revisit the proposal. One of the bill's sponsors, Sen. Bill Cassidy, R-La., praised Trump for his actions and said he was prepared to help with solutions on Obamacare. "Premiums are unaffordable for working families, preventing them from getting the coverage they need. With this order, the president is trying to create an opportunity for those folks to have insurance." White House chief of staff John Kelly said a new Obamacare repeal bill wouldn't be introduced until the spring, but having several months to sell the bill to constituents, hold hearings and make alterations could result in a different fate from the one the bill met last month.
However, the executive order could make Graham-Cassidy more difficult to pass, because one of the order's main goals is to allow people or groups to buy coverage across state lines. If the bill were to pass and several states were to keep Obamacare's framework, it could render many of the administrative decisions obsolete.
To be determined: Democrats
The executive order gives Democrats ammunition as they head into the 2018 elections. For months they have been blaming the Trump administration for the problems that the Obamacare exchanges face and called "sabotage" after the executive order was signed. It's not clear to what extent voters will agree with them. Because the implementation of the executive order will take a while, it's difficult to know if voters will view it as a positive or negative step. Further, it's not clear if the way some Democrats are speaking about their alternative of turning to single payer will win over voter support or whether voters would prefer the final product of Graham-Cassidy or even keeping Obamacare in place.
The exchanges will continue to face uncertainty in 2018. Critics of the executive order have warned that Obamacare's exchanges, which already face a disproportionate number of unhealthy and expensive customers, will become further depleted because healthier customers will choose the skimpier, cheaper plans. That means that heading into open enrollment in 2018, which is likely to be just before the election, insurers would continue to flee the exchanges and to raise premiums. Democrats will be working to convince the electorate that those issues are Trump's doing, but Republicans will remind voters that increases in premiums and insurer exits began to occur while former President Barack Obama was in office.