Promoting Healthcare Choice and Competition Across the United States

Executive Order 13813 of October 12, 2017

Promoting Healthcare Choice and Competition
Across the United States

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 affordable
prices for the American people. The Patient Protection
and Affordable 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 offering 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 often are able to obtain better terms on health
insurance for their employees than small employers because of their larger
pools of insurable individuals 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 affordable
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 affordable 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 affecting 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, while minimizing reporting burdens on affected 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 offer 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 thereafter, 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
    (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 affect:

(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 Office 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 officers, employees, or agents, or any
other person.

    (Presidential Sig.)

THE WHITE HOUSE,

    October 12, 2017.