Trump Poised to Sign Order Opening New Paths to Health Insurance

Stymied in his efforts to repeal the Affordable Care Act, President Trump is poised to issue an order that could ease some federal rules governing health insurance and make it easier for people to band together and buy coverage on their own, administration officials said Saturday.

One official said the directive could move the president a step closer to one of his longstanding goals: allowing consumers to buy health insurance across state lines. Conservatives say that interstate sales could expand options for consumers, increase competition in the insurance market and perhaps lower costs.

The order, which the administration officials said was likely to be announced in the coming week, would instruct three cabinet departments to take actions to help individuals and small businesses join together to buy insurance through arrangements known as association health plans. Such plans could be sponsored by trade and professional groups and community organizations.

While the order could exempt association health plans from some federal and state rules that Republicans say drive up costs, the president could not unilaterally change the laws that regulate insurance, such as the Affordable Care Act of 2010 and the Employee Retirement Income Security Act of 1974, the foundation for employee health benefits. But, officials said, he can direct federal agencies to reinterpret key provisions of those laws and to revise rules issued under them.

The plan for the presidential order was first reported by The Wall Street Journal.

Some insurers, including Blue Cross and Blue Shield plans, oppose association health plans, saying they would skim off healthier consumers and leave traditional insurers with sicker, more expensive customers.

The National Association of Insurance Commissioners, representing state regulators, has long opposed association health plans, saying they are bad for consumers because they can operate outside some state consumer-protection laws. In addition, the state regulators said this year in a letter to Congress, proposals to allow such purchasing groups “could actually increase the cost of insurance for many small businesses whose employees are not members of an association health plan.”

But Mr. Trump has presented such plans as a potential solution for millions of Americans. He stated his intentions on Sept. 27 as he left the White House for a trip to Indiana.

“I am considering an executive order on associations, and that will take care of a tremendous number of people with regard to health care,” Mr. Trump said then. “I’ll probably be signing a very major executive order where people can go out, cross state lines, do lots of things, and buy their own health care. And that will be probably signed next week. It’s being finished now. It’s going to cover a lot of territory and a lot of people — millions of people.”

Senator Rand Paul, Republican of Kentucky, said he had been working with the Trump administration to clear the way for association health plans, which he said would allow more people to obtain good coverage at a lower cost.

“The health care debate is not over,” Mr. Paul said. “Conservatives are still fighting for free-market reforms to the health care system. I am excited to be working with President Trump on this initiative.”

“Association plans would let plumbers, carpenters, welders or any type of small business band together to get group health insurance,” Mr. Paul said recently, describing his vision. “Literally any group — your church, the National Rifle Association, the American Civil Liberties Union — any group of people who choose to do so could offer cheaper, better health insurance.