Executive Order 13813

Last updated
Executive Order 13813 [1] [2] [3]
Executive Order Promoting Healthcare Choice and Competition
Seal of the President of the United States.svg
Type Executive order
Executive Order number13813
Signed by Donald Trump on October 12, 2017 (2017-10-12)
Federal Register details
Federal Register document number 2017-22677
Publication dateOctober 17, 2017 (2017-10-17)
Document citation82-48385
Summary
  • Allows insurance companies to sell low-cost short-term plans with lesser coverage;
  • Enables small business to collectively purchase association health plans;
  • Expands health savings accounts
President Trump signing the Executive Order, October 12, 2017. Photo of the Day October 13, 2017 (26150669029).jpg
President Trump signing the Executive Order, October 12, 2017.

The Executive Order Promoting Healthcare Choice and Competition, also known as the Trumpcare Executive Order, or Trumpcare, [4] [5] is an Executive Order signed by Donald Trump on October 12, 2017, which directs federal agencies to modify how the Patient Protection and Affordable Care Act of the Obama Administration is implemented. The order included a directive to federal agencies to end rules forbidding employers from using health reimbursement arrangements (HRAs) to pay individual insurance premiums. [6]

Contents

In a separate announcement made shortly after the order was signed, Trump announced that he would end subsidies to health insurance companies that sell to low-income consumers through the state health insurance marketplaces. [7] [8]

Some sources have described the effect of these executive actions as replacing Obamacare with a new healthcare regime; several days after signing the order, Donald Trump himself stated in a press conference that reporters should no longer refer to "Obamacare" because "it's gone, there is no such thing as Obamacare anymore". [9]

Executive Order 13813 was formally revoked by President Joe Biden on January 28, 2021. [10]

History

Legislative efforts to repeal the Affordable Care Act

The first executive order signed by U.S. President Donald Trump, executed just hours after he was sworn into office on January 20, 2017, was Executive Order 13765, titled Executive Order Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal. The order set out interim procedures in anticipation of repeal of the Patient Protection and Affordable Care Act (popularly known as the ACA, or Obamacare). [11] The order came on Trump's campaign pledges to repeal the Patient Protection and Affordable Care Act, [12] which Trump stated would take a long time, with a replacement possibly not being ready until 2018. [13]

On May 4, 2017, the United States House of Representatives voted to pass the American Health Care Act of 2017 (ACHA) by a narrow margin of 217–213, sending the bill to the Senate for deliberation. [14] [15] [16] [17] [18] It would repeal the parts of the Affordable Care Act within the scope of the federal budget, including provisions contained within the Internal Revenue Code such as the "individual mandates" (in IRC § 205), employer mandates (in IRC § 206) and various taxes (IRC § 201 et. seq.), and also modifications to the federal Medicaid program (in Sections 111-116 and 121). [19]

The nonpartisan Congressional Budget Office projected that the AHCA would increase the number of uninsured people by 23 million over 10 years, but would decrease the federal budget deficit by $119 billion over the same period (about 1%), mainly by cutting Medicaid coverage for lower income Americans. Both the House AHCA bill and Senate BCRA bill would cut taxes largely for wealthy Americans. Insurance premiums were projected to decrease for younger, healthier, and wealthier people, while older and poorer people would likely see their premiums increase. [20]

Senate Republicans initially approached the AHCA with an unprecedented level of secrecy; a group of 13 Republican senators drafted the Senate's substitute version in private, raising bipartisan concerns about a lack of transparency [21] [22] [23] and about the all-male composition of the committee. [24] [25] [26] On June 22, 2017, Republicans released the first discussion draft for an amendment to the bill. [27] On July 25, 2017, although no amendment proposal had yet garnered majority support, Senate Republicans voted to advance the bill to the floor and begin formal consideration of amendments.

On July 28, 2017, the bill was returned to the calendar [28] after the Senate rejected several amendments, including S.Amdt. 667, the "Skinny Repeal" package offered by Sen. Mitch McConnell, which failed on a 49–51 vote. Sens. John McCain, Susan Collins, and Lisa Murkowski were the only Republicans to vote against the measure. [29] On September 13, 2017, Senators Graham, Cassidy, Heller, and Johnson released a draft amendment to the bill [30] that "repeals the structure and architecture of Obamacare and replaces it with a block grant given annually to states". [31] However, it was not voted upon due to lack of support. The deadline for Congressional Republicans to end the ACA as part of the Congressional budget reconciliation process (which would enable Senate Republicans to pass new legislation with 51 votes, rather than 60) then expired on September 30, 2017. [32]

Execution of the Executive Order

Following the failure of Congress to repeal the ACA through legislation, Trump issued the new order. Both supporters and critics asserted that the provisions of the order were intended to redefine the American health care market and effectively replace Obamacare with a new health care regime. [4] [33] [ dubious ] Trump briefly forgot to sign the order before leaving the signing ceremony, but was ushered back to the table by Vice President Mike Pence to complete this step. [34] Senator Rand Paul, who attended the signing, described the order as "the biggest free market reform of health care in a generation." [33]

Provisions

The order reverses a number of aspects of Obamacare upon which that regime had relied.

Section 1, title "Policy", lays out the policies supporting the provisions of the order, noting that the order directs that the government "facilitate the purchase of insurance across State lines" and prioritizes "association health plans (AHPs), short-term, limited-duration insurance (STLDI), and health reimbursement arrangements (HRAs)". Whereas Obamacare had prohibited insurance companies from selling low-cost short-term health insurance plans "that can circumvent some of the mandates created under Obamacare", [4] such as requiring coverage for persons with preexisting conditions, and requiring coverage for various medical services. The order reversed this prohibition, and also directs the Departments of Health and Human Services, Labor, and Treasury to ease access to "association health plans", which also need not provide the coverage that had been mandated by Obamacare, and expands health savings accounts. [4]

Section 2, titled "Expanded Access to Association Health Plans", directs the Secretary of Labor to take steps to "expand access to health coverage by allowing more employers to form AHPs".

Section 3, titled "Expanded Availability of Short-Term, Limited‑Duration Insurance", directs the Secretaries of the Treasury, Labor, and Health and Human Services to take steps to "expand the availability of STLDI".

Section 4, titled "Expanded Availability and Permitted Use of Health Reimbursement Arrangements", directs the Secretaries of the Treasury, Labor, and Health and Human Services to take steps 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".

Impact

A separate decision on the same day commonly associated with the executive order resulted in no longer paying the cost sharing reduction (CSR) subsidies, which are payments to insurers to keep premiums down for low-income persons. The Congressional Budget Office reported in August 2017 that not making the CSR payments could increase health insurance premiums on the ACA exchanges by as much as 20% and add nearly $200 billion to the budget deficit over a decade. The deficit increase is because the premium tax credit subsidy (the largest Affordable Care Act subsidy) increases to offset increases in health insurance premium amounts, far outweighing savings from not paying the smaller CSR subsidy. [35]

Reception

Critical response

Critics described the Executive Order as another part of an ongoing strategy to sabotage the ACA by enabling insurance companies to circumvent ACA mandates and sell insurance that does not cover mandated conditions, and excludes individuals with pre-existing conditions. Other elements alleged to be part of the sabotage strategy include denying funding not mandated by law for cost sharing reduction (CSR) subsidies, significantly reducing funding for enrollment advertising and support efforts, asserting that the ACA exchanges are in a "death spiral" (contrary to CBO conclusions), and conducting negative advertising campaigns, among other measures. [36] [37]

For example, President Trump tweeted on October 13, 2017, that: "The Democrats ObamaCare is imploding. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!". Journalist Ezra Klein wrote that: "Trump has long held the view that if he can inflict sufficient damage to the Affordable Care Act, Democrats will have no choice but to cut a deal — on Trump's terms — to save it". [38]

Journalist Sarah Kliff wrote that: "Trump announced last week he would stop making [CSR] payments. But let's be clear: That decision will cause the federal government to spend billions more subsidizing insurance companies, not less." That is because the savings from reducing CSR payments is less than increases in the insurance premium tax credits, which rise along with sizable (20%+) premium increases for 2018 caused by Trump's threats to the CSR payments during 2017. Kliff used the CBO estimate of $194 billion in higher budget deficits from stopping CSR payments as an estimate of the net impact over a decade. [39]

Journalist David Leonhardt wrote on October 15, 2017: "Last week, the administration took several steps to deprive people of health insurance. In doing so, it has both a short-term goal (have the federal government do less to help vulnerable citizens) and a long-term goal (sabotage Obamacare, so that Congress can more easily repeal the law)". He continued: "When [the executive order] takes full effect, it will most likely allow a variety of cheap insurance plans that don't cover many treatments. These plans will siphon healthy families from the normal markets, raising prices on the sick. It will work nicely for healthy families, until it doesn't. If they get sick and want insurance that pays for their treatments, they will be out of luck". [40]

According to The Economist , Trump's plans "are likely to end up inflicting the most pain on self-employed, middle- to upper-income folk—in other words, on a Republican constituency". [41]

Murray—Alexander Individual Market Stabilization Bill

Senator Lamar Alexander and Senator Patty Murray reached a compromise to amend the Affordable Care Act to fund cost-sharing reductions. [42] President Trump had stopped paying the cost sharing subsidies and the Congressional Budget Office estimated his action would cost $200 billion, cause insurance sold on the exchange to cost 20% more and cause one million people to lose insurance. [43] The plan will also provide more flexibility for state waivers, allow a new "Copper Plan" or catastrophic coverage for all, allow interstate insurance compacts, and redirect consumer fees to states for outreach.

Although Trump initially expressed support for the compromise, he later reversed course by tweeting a dismissive tweet about it. [44]

See also

Related Research Articles

<span class="mw-page-title-main">Pat Tiberi</span> American politician

Patrick Joseph Tiberi is an American lobbyist and politician who served as the U.S. representative for Ohio's 12th congressional district from 2001 to 2018. His district included communities north and east of Columbus. He is a member of the Republican Party, and previously served in the Ohio House of Representatives from 1993 to 2000. He briefly served as Chair of the new Republican Main Street Congressional Caucus from September 7, 2017.

Families USA is a nonprofit, nonpartisan consumer health advocacy and policy organization.

<span class="mw-page-title-main">Health insurance coverage in the United States</span> Overview of the coverage of health insurances in the United States

In the United States, health insurance coverage is provided by several public and private sources. During 2019, the U.S. population overall was approximately 330 million, with 59 million people 65 years of age and over covered by the federal Medicare program. The 273 million non-institutionalized persons under age 65 either obtained their coverage from employer-based or non-employer based sources, or were uninsured. During the year 2019, 89% of the non-institutionalized population had health insurance coverage. Separately, approximately 12 million military personnel received coverage through the Veteran's Administration and Military Health System.

In the United States, health insurance marketplaces, also called health exchanges, are organizations in each state through which people can purchase health insurance. People can purchase health insurance that complies with the Patient Protection and Affordable Care Act at ACA health exchanges, where they can choose from a range of government-regulated and standardized health care plans offered by the insurers participating in the exchange.

A health insurance mandate is either an employer or individual mandate to obtain private health insurance instead of a national health insurance plan.

<span class="mw-page-title-main">Affordable Care Act</span> U.S. federal statute also known as Obamacare

The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act (PPACA) and colloquially known as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the enactment of Medicare and Medicaid in 1965.

The Affordable Care Act (ACA) is divided into 10 titles and contains provisions that became effective immediately, 90 days after enactment, and six months after enactment, as well as provisions phased in through to 2020. Below are some of the key provisions of the ACA. For simplicity, the amendments in the Health Care and Education Reconciliation Act of 2010 are integrated into this timeline.

King v. Burwell, 576 U.S. 473 (2015), was a 6–3 decision by the Supreme Court of the United States interpreting provisions of the Patient Protection and Affordable Care Act (ACA). The Court's decision upheld, as consistent with the statute, the outlay of premium tax credits to qualifying persons in all states, both those with exchanges established directly by a state, and those otherwise established by the Department of Health and Human Services.

United States House of Representatives v. Azar, et al. was a lawsuit in which the United States House of Representatives sued departments and officials within the executive branch, asserting that President Barack Obama acted illegally in his implementation of the Patient Protection and Affordable Care Act. The lawsuit was touted by House Speaker John Boehner, and asserted that President Obama exceeded his constitutional authority in delaying the implementation of the employer mandate of the Affordable Care Act and also addressed "Republican opposition to an estimated $175 billion in payments to insurance companies over the next 10 years as part of a cost-sharing program under the healthcare law."

<span class="mw-page-title-main">Rod Blum</span> American politician (born 1955)

Rodney Leland Blum is an American businessman and politician who served as the U.S. representative for Iowa's 1st congressional district from 2015 to 2019. A member of the Republican Party, he was first elected in 2014 and won a second term in the 2016 elections.

The following is a list of efforts to repeal the Affordable Care Act, which had been enacted by the 111th United States Congress on March 23, 2010.

<span class="mw-page-title-main">2017 Affordable Care Act replacement proposals</span>

The following is a list of plans which were considered to replace the Affordable Care Act during the Donald Trump administration. The plans were considered after the Republican Party gained a federal government trifecta in 2016. "Repeal and replace" has been a Republican slogan since March 2010 when the ACA was signed into law and had been adopted by former President Donald Trump.

<span class="mw-page-title-main">Executive Order 13765</span> Executive order signed by U.S. President Donald Trump

Executive Order 13765 is the first executive order signed by former U.S. President Donald Trump on January 20, 2017, which set out interim procedures in anticipation of repeal of the Affordable Care Act (Obamacare).

<span class="mw-page-title-main">American Health Care Act of 2017</span> Proposed U.S. law

The American Health Care Act of 2017 was a bill in the 115th United States Congress. The bill, which was passed by the United States House of Representatives but not by the United States Senate, would have partially repealed the Affordable Care Act (ACA).

The "Jimmy Kimmel test" is a political litmus test used in political discourse in the United States during 2017 efforts to repeal the Affordable Care Act. First proposed by United States Senator Bill Cassidy, the test was used throughout 2017 to frame political debate over health care reform, and Cassidy's use of it in September 2017 prompted comedian and late-night talk show host Jimmy Kimmel to publicly attack a Senate health care bill co-sponsored by Cassidy. The resulting public debate contributed to the failure of the Senate bill.

<span class="mw-page-title-main">Graham–Cassidy health care amendment</span>

Graham–Cassidy or Graham–Cassidy–Heller–Johnson is the common name for Senate Amendment 1030 to the American Health Care Act of 2017. S.Amdt. 1030 was introduced on September 13, 2017, sponsored by Lindsey Graham (R-SC), with Bill Cassidy (R-LA) as a co-sponsor, after whom the amendment is named. The other three co-sponsors are Dean Heller (R-NV), Ron Johnson (R-WI), and Roy Blunt (R-MO). The amendment would repeal the Affordable Care Act (ACA), also known as Obamacare. It would also return control of the Medicaid program to the states and cap the program's funding. The amendment would also redistribute federal money differently to different states, with some states that expanded Medicaid under the ACA losing federal money to states that did not.

<span class="mw-page-title-main">Bipartisan Health Care Stabilization Act of 2017</span>

The Bipartisan Health Care Stabilization Act of 2017 was a 2017 proposed compromise reached by senator and HELP Committee chairman Lamar Alexander and senator and HELP Committee ranking member Patty Murray to amend the Affordable Care Act to fund cost-sharing reductions subsidies. The plan will also provide more flexibility for state waivers, allow a new "Copper Plan" or catastrophic coverage for those under 30, allow interstate insurance compacts, and redirect consumer fees to states for outreach. President Trump had stopped paying the cost sharing subsidies and the Congressional Budget Office estimated his action would cost $200 billion, cause insurance sold on the exchange to cost 20% more and cause one million people to lose insurance.

The cost sharing reductions (CSR) subsidy is the smaller of two subsidies paid under the Patient Protection and Affordable Care Act (ACA) as part of the healthcare system in the United States. The subsidies were paid from 2013 to 2017 to insurance companies on behalf of eligible enrollees in the ACA to reduce co-payments and deductibles. They were discontinued by President Donald Trump in October 2017. The nature of the subsidy as discretionary spending versus mandatory was challenged in court by the Republican-controlled House of Representatives in 2014, although payments continued when the ruling in favor of the GOP was appealed by the Obama administration. The non-partisan Congressional Budget Office (CBO) estimated that ending the payments would increase insurance premiums on the ACA exchanges by around 20 percentage points, resulting in increases in the premium tax credit subsidies, thereby adding nearly $200 billion to the budget deficits over the following decade. Critics argued the decision was part of a wider strategy to "sabotage" the ACA.

The Patient Protection and Affordable Care Act, often shortened to the Affordable Care Act (ACA) or nicknamed Obamacare, is a United States federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the passage of Medicare and Medicaid in 1965. Once the law was signed, provisions began taking effect, in a process that continued for years. Some provisions never took effect, while others were deferred for various periods.

California v. Texas, 593 U.S. ___ (2021), was a United States Supreme Court case that dealt with the constitutionality of the 2010 Affordable Care Act (ACA), colloquially known as Obamacare. It was the third such challenge to the ACA seen by the Supreme Court since its enactment. The case in California followed after the enactment of the Tax Cuts and Jobs Act of 2017 and the change to the tax penalty amount for Americans without required insurance that reduced the "individual mandate" to zero, effective for months after December 31, 2018. The District Court of the Northern District of Texas concluded that this individual mandate was a critical provision of the ACA and that, with a penalty amount equal to zero, some or all of the ACA was potentially unconstitutional as an improper use of Congress's taxation powers.

References

  1. "EXECUTIVE ORDER 13813" (PDF). Amazon S3 . United States: Amazon.com. October 12, 2017. Retrieved October 17, 2017.
  2. Office of the Press Secretary (October 12, 2017). "Presidential Executive Order Promoting Healthcare Choice and Competition Across the United States". whitehouse.gov . Washington, D.C. Retrieved October 17, 2017 via National Archives.
  3. "Promoting Healthcare Choice and Competition Across the United States". Federal Register . Washington, D.C.: National Archives and Records Administration. October 12, 2017. Archived from the original on October 18, 2017. Retrieved October 17, 2017. Alt URL.
  4. 1 2 3 4 Klein, Philip; King, Robert; Leonard, Kimberly (October 9, 2017). "Daily on Healthcare: Trumpcare is coming to an association health plan near you". The Washington Examiner . Washington, D.C.: Clarity Media Group. Archived from the original on October 9, 2017. Retrieved October 12, 2017.
  5. Gleckman, Howard (October 13, 2017). "Middle Income 50-Somethings Will Be Big Losers In Trumpcare". Forbes . New York City . Retrieved October 13, 2017.
  6. Luhby, Tami (October 13, 2017). "What's in Trump's health care executive order?". CNN . Atlanta: Turner Broadcasting System . Retrieved October 14, 2017.
  7. Liptak, Kevin (October 12, 2017). "Trump will end health care cost-sharing subsidies". CNN . Atlanta: Turner Broadcasting System . Retrieved October 12, 2017.
  8. Robert Pear, Maggie Haberman and Reed Abelson (October 12, 2017). "Trump to Scrap Critical Health Care Subsidies, Hitting Obamacare Again". New York Times. Retrieved October 14, 2017.
  9. "Trump: No such thing as Obamacare anymore". CNN . Atlanta: Turner Broadcasting System. October 16, 2017. Retrieved October 18, 2017.
  10. "Executive Order on Strengthening Medicaid and the Affordable Care Act". January 28, 2021. Retrieved January 28, 2021.
  11. Knox, Olivier (January 20, 2017). "Trump signs first executive order, targeting Obamacare with few specifics". Yahoo! News . Sunnyvale, California: Yahoo! . Retrieved October 13, 2017.
  12. Davis, Julie Hirschfeld; Pear, Robert (January 20, 2017). "Trump Issues Executive Order Scaling Back Parts of Obamacare". The New York Times . New York City . Retrieved January 23, 2017.
  13. Leonard, Kimberly (February 6, 2017). "Trump Appears to Push Back Obamacare Replacement". U.S. News & World Report . Washington, D.C.: U.S. News & World Report, L.P. Retrieved October 13, 2017.
  14. Kaplan, Thomas; Pear, Robert (May 4, 2017). "House Passes Measure to Repeal and Replace the Affordable Care Act". The New York Times . New York City. Archived from the original on May 4, 2017. Retrieved October 12, 2017.
  15. Sanger-Katz, Margot (May 4, 2017). "Who Wins and Who Loses in the Latest G.O.P. Health Care Bill". The New York Times . New York City. Archived from the original on May 4, 2017. Retrieved October 12, 2017.
  16. Clerk of the United States House of Representatives (May 4, 2017). "Final Vote Results for Roll Call 256". United States House of Representatives . Washington, D.C.: United States Congress. Archived from the original on May 4, 2017.
  17. Lee, MJ (May 4, 2017). "House Republicans pass bill to repeal and replace Obamacare". CNN . Atlanta: Turner Broadcasting System. Archived from the original on May 5, 2017. Retrieved May 4, 2017.
  18. Associated Press. "Republican health care bill: What's in it?". Fox News . New York City: Fox Entertainment Group. Archived from the original on May 4, 2017. Retrieved October 12, 2017.
  19. Clerk of the United States House of Representatives (May 4, 2017). "All Bill Information (Except Text) for H.R.1628 – American Health Care Act of 2017". United States House of Representatives . Washington, D.C.: United States Congress. Archived from the original on April 19, 2017. Retrieved October 12, 2017.
  20. Kurtzleben, Danielle (May 24, 2017). "GOP Health Plan Would Leave 23 Million More Uninsured, Budget Office Says". NPR . Washington, D.C.: National Public Radio, Inc. Archived from the original on June 21, 2017. Retrieved October 13, 2017.
  21. Kaplan, Thomas; Pear, Robert (June 15, 2017). "Secrecy Surrounding Senate Health Bill Raises Alarms in Both Parties". The New York Times . New York City. Archived from the original on June 18, 2017.
  22. Bump, Philip (June 13, 2017). "The remarkable steps Republicans are taking to obscure what's in their health-care bill". The Washington Post . Washington, D.C.: Nash Holdings LLC. Archived from the original on June 20, 2017. Retrieved October 13, 2017.
  23. Sarlin, Benjy; Caldwell, Leigh Ann (June 15, 2017). "The Senate's Health Care Bill Remains Shrouded in Secrecy". NBC News . New York City: NBC. Archived from the original on June 19, 2017.
  24. Kasana, Mehreen (May 7, 2017). "The 13 Senators Working on the Health Care Bill Are All Men". Bustle . New York City: Bustle Digital Group. Retrieved October 13, 2017.
  25. Pear, Robert (May 8, 2017). "13 Men, and No Women, Are Writing New G.O.P. Health Bill in Senate". The New York Times . New York City . Retrieved October 13, 2017.
  26. Cohen, Michael A. (June 7, 2017). "Why are 13 men — behind closed doors — writing the health care bill?". The Boston Globe . Boston: Boston Globe Media Partners, LLC. Retrieved October 13, 2017.
  27. Black, Diane (June 22, 2017). "H.R. 1628, Better Care Reconciliation Act of 2017, discussion draft ERN17282" (PDF). Senate Budget Committee . Washington, D.C.: United States Senate . Retrieved October 13, 2017.
  28. "Congressional Record p. S4415" (PDF). United States Senate . Washington, D.C.: United States Congress. July 27, 2017. Retrieved October 13, 2017.
  29. Black, Diane (July 28, 2017). "On the Amendment S.Amdt. 667". United States Senate . Washington, D.C.: United States Congress . Retrieved October 13, 2017.
  30. Graham, Lindsey (September 13, 2017). "Amendment in the nature of a substitute to H.R. 1628, discussion draft LYN17709". United States Senate . Washington, D.C.: United States Congress . Retrieved October 13, 2017.
  31. Graham, Lindsey (September 13, 2017). "Press Release: Graham-Cassidy-Heller-Johnson Background and Endorsements". United States Senate . Washington, D.C.: United States Congress . Retrieved October 13, 2017.
  32. King, Robert (September 1, 2017). "Deadline for fast track Obamacare repeal bill expires Sept. 30". Washington Examiner .
  33. 1 2 Schallhorn, Kaitlyn; Gomez, Serafin (October 12, 2017). "Trump clears way for ObamaCare 'alternatives' in new executive order, goes around stalled Congress". Fox News . New York City: Fox Entertainment Group . Retrieved October 12, 2017.
  34. Wilts, Alexandra (October 12, 2017). "Donald Trump almost forgets to sign executive order before reminder from Mike Pence". The Independent . London: Independent Print Limited. Retrieved October 12, 2017.
  35. "The Effects of Terminating Payments for Cost-Sharing Reduction". Congressional Budget Office . Washington, D.C.: United States Government. August 15, 2017. Archived from the original on October 16, 2017. Retrieved October 17, 2017.{{cite news}}: CS1 maint: bot: original URL status unknown (link)
  36. Scott, Dylan (October 12, 2017). "Trump will pull Obamacare subsidies in another attack on health law". Vox . United States: Vox Media . Retrieved October 13, 2017.
  37. Editorial Board (October 12, 2017). "Congress Shouldn't Let Mr. Trump Kill Obamacare on His Own". The New York Times . New York City . Retrieved October 13, 2017.
  38. Klein, Ezra (October 16, 2017). "On Obamacare, Donald Trump is sabotaging himself". Vox . United States: Vox Media . Retrieved October 16, 2017.
  39. Kliff, Sarah (October 18, 2017). "Trump's stance on insurance "bailouts" is completely incoherent". Vox.
  40. Leonhardt, David (October 15, 2017). "How to Fight the New Trumpcare". The New York Times . New York City . Retrieved October 15, 2017.
  41. H.C. (October 13, 2017). "Donald Trump's health-care orders will hurt middle-class, self-employed Americans". The Economist . Westminster, London. ISSN   0013-0613 . Retrieved October 13, 2017.
  42. Kaplan, Thomas; Pear, Robert (October 17, 2017). "2 Senators Strike Deal on Health Subsidies That Trump Cut Off". The New York Times . New York City . Retrieved October 18, 2017.
  43. Kliff, Sarah (August 15, 2017). "CBO says Trump's Obamacare sabotage would cost $194 billion, drive up premiums 20%". Vox . United States: Vox Media . Retrieved October 17, 2017.
  44. Kaplan, Thomas; Pear, Tobert (October 18, 2017). "Trump Pulls Back From Senate Deal to Fund Health Subsidies". The New York Times . New York City . Retrieved October 18, 2017.

Further reading