Healthcare Policy

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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. Policy. (a) It shall be the policy of the executive branch, to the extent consistent with law,

to facilitate the purchase of insurance across State lines and the development and operation of a

healthcare system that provides high-quality care at a�ordable prices for the American people. The

Patient Protection and A�ordable Care Act (PPACA), however, has severely limited the choice of

healthcare options available to many Americans and has produced large premium increases in

many State individual markets for health insurance. The average exchange premium in the 39 States

that are using www.healthcare.gov in 2017 is more than double the average overall individual

market premium recorded in 2013. The PPACA has also largely failed to provide meaningful choice

or competition between insurers, resulting in one-third of America’s counties having only one

insurer o�ering coverage on their applicable government-run exchange in 2017.

(b) Among the myriad areas where current regulations limit choice and competition, my

Administration will prioritize three areas for improvement in the near term: association health

plans (AHPs), short-term, limited-duration insurance (STLDI), and health reimbursement

arrangements (HRAs).

(i) Large employers o�en are able to obtain better terms on health insurance for their

employees than small employers because of their larger pools of insurable individuals

EXECUTIVE ORDERS

Presidential Executive Order Promoting Healthcare Choice and Competition Across the United States

HEALTHCARE

Issued on: October 12, 2017

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across which they can spread risk and administrative costs. Expanding access to AHPs can

help small businesses overcome this competitive disadvantage by allowing them to group

together to self-insure or purchase large group health insurance. Expanding access to AHPs

will also allow more small businesses to avoid many of the PPACA’s costly requirements.

Expanding access to AHPs would provide more a�ordable health insurance options to

many Americans, including hourly wage earners, farmers, and the employees of small

businesses and entrepreneurs that fuel economic growth.

(ii) STLDI is exempt from the onerous and expensive insurance mandates and regulations

included in title I of the PPACA. This can make it an appealing and a�ordable alternative to

government-run exchanges for many people without coverage available to them through

their workplaces. The previous administration took steps to restrict access to this market

by reducing the allowable coverage period from less than 12 months to less than 3 months

and by preventing any extensions selected by the policyholder beyond 3 months of total

coverage.

(iii) HRAs are tax-advantaged, account-based arrangements that employers can establish

for employees to give employees more flexibility and choices regarding their healthcare.

Expanding the flexibility and use of HRAs would provide many Americans, including

employees who work at small businesses, with more options for financing their

healthcare.

(c) My Administration will also continue to focus on promoting competition in healthcare

markets and limiting excessive consolidation throughout the healthcare system. To the extent

consistent with law, government rules and guidelines a�ecting the United States healthcare

system should:

(i) expand the availability of and access to alternatives to expensive, mandate-laden

PPACA insurance, including AHPs, STLDI, and HRAs;

(ii) re-inject competition into healthcare markets by lowering barriers to entry, limiting

excessive consolidation, and preventing abuses of market power; and

(iii) improve access to and the quality of information that Americans need to make

informed healthcare decisions, including data about healthcare prices and outcomes,

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while minimizing reporting burdens on a�ected plans, providers, or payers.

Sec. 2. Expanded Access to Association Health Plans. Within 60 days of the date of this order, the

Secretary of Labor shall consider proposing regulations or revising guidance, consistent with law, to

expand access to health coverage by allowing more employers to form AHPs. To the extent

permitted by law and supported by sound policy, the Secretary should consider expanding the

conditions that satisfy the commonality-of-interest requirements under current Department of

Labor advisory opinions interpreting the definition of an “employer” under section 3(5) of the

Employee Retirement Income Security Act of 1974. The Secretary of Labor should also consider

ways to promote AHP formation on the basis of common geography or industry.

Sec. 3. Expanded Availability of Short-Term, Limited-Duration Insurance. Within 60 days of the date

of this order, the Secretaries of the Treasury, Labor, and Health and Human Services shall consider

proposing regulations or revising guidance, consistent with law, to expand the availability of STLDI.

To the extent permitted by law and supported by sound policy, the Secretaries should consider

allowing such insurance to cover longer periods and be renewed by the consumer.

Sec. 4. Expanded Availability and Permitted Use of Health Reimbursement Arrangements. Within

120 days of the date of this order, the Secretaries of the Treasury, Labor, and Health and Human

Services shall consider proposing regulations or revising guidance, to the extent permitted by law

and supported by sound policy, to increase the usability of HRAs, to expand employers’ ability to

o�er HRAs to their employees, and to allow HRAs to be used in conjunction with nongroup

coverage.

Sec. 5. Public Comment. The Secretaries shall consider and evaluate public comments on any

regulations proposed under sections 2 through 4 of this order.

Sec. 6. Reports. Within 180 days of the date of this order, and every 2 years therea�er, the Secretary

of Health and Human Services, in consultation with the Secretaries of the Treasury and Labor and

the Federal Trade Commission, shall provide a report to the President that:

(a) details the extent to which existing State and Federal laws, regulations, guidance,

requirements, and policies fail to conform to the policies set forth in section 1 of this order; and

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(b) identifies actions that States or the Federal Government could take in furtherance of the

policies set forth in section 1 of this order.

Sec. 7. General Provisions. (a) Nothing in this order shall be construed to impair or otherwise a�ect:

(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 O�ice 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 o�icers, employees, or agents, or any other person.

DONALD J. TRUMP

THE WHITE HOUSE,

October 12, 2017.