82 FR 48385 - Promoting Healthcare Choice and Competition Across the United States

Executive Office of the President

Federal Register Volume 82, Issue 199 (October 17, 2017)

[Federal Register Volume 82, Number 199 (Tuesday, October 17, 2017)]
[Presidential Documents]
[Pages 48385-48387]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2017-22677]




                        Presidential Documents 



Federal Register / Vol. 82 , No. 199 / Tuesday, October 17, 2017 / 
Presidential Documents

[[Page 48385]]


                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:

[[Page 48386]]

(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.

[[Page 48387]]

                    (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.

[FR Doc. 2017-22677
 Filed 10-16-17; 11:15 am]
Billing code 3295-F8-P