Obamacare: Trump touts death blow, but Florida sign-ups hit 1.7M

President Donald Trump said removing the penalty for lacking health insurance essentially repeals Obamacare, but sign-ups for 2018 remain close to the same in half the time — and they hit an unexpected 1.7 million in Florida.

Hearing that we matched last year’s total of 1.7 million Floridians is amazing,” said Jodi Ray, project  director for the enrollment-promotion group Covering Florida, on Friday.

Ray said it “proves not just how hard everyone worked to help as many consumers as feasibly possible, but just how great the need is and the personal desire to have health care coverage is to Floridians and Americans across the country.”

And it’s not quite over in the state with the most enrollees  in the federal marketplace. Florida residents can still sign up through Dec. 31, because of an extension related to Hurricane Irma.

The Trump administration cut the enrollment window in half to six weeks and reduced the advertising budget 90 percent. The president said this week he believes the health law is more or less nullified because the tax bill that just became law removes the penalty for not having insurance, which starts at $695.

“When the individual mandate is being repealed, that means Obamacare is repealed,” Trump said Wednesday.

“We didn’t want to bring it up,” Trump said. “I told people specifically be quiet with the fake news media because I don’t want them talking too much about it. Because I didn’t know how people would – but now that it’s approved, I can say the individual mandate on health care, where you had to pay not to have insurance, okay, think of that one. You pay not to have insurance. The individual mandate has been repealed.”

It’s possible that will still have a significant future effect on the Affordable Care Act marketplace. Congressional number-crunchers projected that if fewer healthy people sign up, it could raise premiums for remaining buyers about 10 percent.

Then again, the vast majority of Obamacare’s remaining customers are receiving government subsidies to reduce the cost of insurance — so their out-of-pocket costs change very little despite headline premium increases. Monthly premiums remain under $100 for most in Florida.

So for many, it’s still a better deal than they can find if they are not already covered by an employer’s plan or a government plan like Medicare. The people not getting a good deal are those making too much income to qualify for subsidies.

Nationally, sign-ups stand at about 8.8 million, not far from last  year’s 9.2 million.

Seema Verma, head of the Centers for Medicare and Medicaid Services, said that just proves the Trump administration administered the law more efficiently.

“This year CMS took a more cost effective outreach approach, spending just over $1 per enrollee on outreach and education for Exchange coverage compared to nearly $11 per enrollee last year,” Verma tweeted.

Please, supporters of the Affordable Care Act said. The enrollment numbers came in spite of the administration’s best efforts to kill it, they said.

“There is no reasonable justification for the administration cutting in half the time families had to enroll in coverage and slashing outreach to families,” said Frederick Isasi, executive director of  pro-ACA group Families USA.

Despite that, he said, and despite “slashing funding to provide in-person enrollment assistance, redirecting outreach money, shutting down HealthCare.gov on Sundays, and reducing the advertising budget by a startling 90 percent – families from across the nation overcame the hurdles put in their way and signed up for coverage at an unprecedented pace.”

In fact, his group says consumers set a new record for weekly enrollment Dec. 10 to December 15, when 4.1 million people selected health insurance plans on HealthCare.gov. Previous high: 4 million signing up during the week of Dec. 13 to Dec. 19, 2015.

2018 ACA Marketplace Enrollment
Florida 1.73 million
U.S 8.8 million
Source: Centers for Medicare and Medicaid through Dec. 15; excludes states with their own exchanges like California and New York.

Aetna-CVS: Is health’s biggest deal good for consumers?

Analysts are calling it the biggest health insurance deal of all time, but the debate is only beginning about the consumer impact of a $69 billion merger announced by insurer Aetna and pharmacy giant CVS.

Nobody disputes it is a heavyweight combination of national companies with large Florida footprints.

The pharmacy chain, which has 10,000 U.S. locations including 12 in West Palm Beach alone, would join forces with one of the nation’s biggest insurers, particularly strong in employer health plans.

It will make health care “easier to use and less expensive for consumers,” CVS Health President and CEO Larry J. Merlo said. Company officials painted the picture of a one-stop source for primary medical care, testing for conditions like high blood pressure and diabetes, and getting prescriptions filled, all under one roof.

Skeptics were not sure all the rosy talk was likely to translate to lower premiums or drug costs for customers.

“Looks to us like this corporate merger is more about higher profits for shareholders than lower prices for patients,” said Ben Wakana, executive director of the advocacy group Patients For Affordable Drugs.

A selling point for some mergers is creating greater efficiency, sometimes through job reductions, though it is not clear how much that would apply to two companies that have historically performed different roles in the health marketplace. CVS alone has more than 20,500 employees in Florida.

“We have no announcement about any job consolidations,” CVS spokesman Mike DeAngelis said Monday.

Competing health insurers have tried to make themselves more accessible in brick-and-mortar locations, such as Florida Blue’s customer help centers in locations including Boynton Beach. But those storefronts aim to help with insurance, not provide health products or services on the spot.

The best-case scenario for consumers: It costs less for Aetna to cover many of its customers at retail locations in the same corporate family, and the savings get passed along to customers, said Eric Wilson, a health insurance broker based near Chicago.

“This could bring the costs down for everybody,” Wilson said.

But that remains to be seen, he said. Another possible outcome is simply “one player getting a bigger piece of a market that’s exploding,” while consumer savings remain elusive as drug prices and other expenses continue to rise.

Some observers see the advertised Aetna-CVS consumer benefits as “nebulous,” not obviously much different than what consumers can already get in a wide range of places. The deal is really “driven by the desire to fend off scary new competitors in the healthcare industry, such as Amazon and Wal-Mart,” asserted Los Angeles Times columnist Michael Hiltzik.

Amazon has been securing permission to distribute prescription drugs in a dozen states, with Florida not yet among them, according to published reports.

CVS’s Merlo didn’t mention the potential competition in a statement Sunday, but said, “This combination brings together the expertise of two great companies to remake the consumer health care experience.”

CVS says it pharmacy locations will include “space for wellness, clinical and pharmacy services, vision, hearing, nutrition, beauty, and medical equipment, in addition to the products and services our customers currently enjoy.”

The stores will serve as a “community-based health hub dedicated to connecting the pathways needed to improve health and answering patients’ questions about their health conditions, as well as prescription drugs and health coverage,” the companies said in a joint release.

Aetna’s ill-fated merger with insurer Humana ran into government challenges on the grounds it could reduce consumer choices. This plan would still need shareholder and regulatory approvals, though it is not clear if it would face the same antitrust scrutiny as the union of two big insurers.

A key question could arise on drug prices: whether more control of the drug supply chain — the middlemen between the manufacturer and consumer — adds up to good news for consumers or just more control of profits for the combined concern.

“This is the next step in our journey, positioning the combined company to dramatically further empower consumers,” said Mark T. Bertolini, Aetna chairman and CEO.



Tax cuts: Killing Obamacare penalty could cost some Floridians $1,392

A U.S. Senate plan to cut taxes would remove the $695 or more penalty for not buying health insurance, but not everyone gets a break — if you’re 60 in Florida, it could raise your premiums a projected $1,392 in 2019, a new analysis says.

(Getty Images)

It’s no small matter in a state that once again leads the nation with more than 500,000 residents signed up so far for plans on healthcare.gov. Enrollment for 2018 ends Dec. 15.

A benchmark health plan would cost $656 more for a Floridian who is 40 and $538 more at age 27 for those buying coverage in the Obamacare marketplace,  according to the New York-based Commonwealth Fund. The 99-year-old foundation that says it aims to promote health care access for seniors, low-income people and others.

The reasoning: An estimated 13 million people nationally won’t buy health insurance without the penalty, the Congressional Budget Office says, and that affects what others pay.

Whether it’s because people don’t want it, are healthy and hope they don’t need it, or can’t afford it, having no penalty removes an incentive to buy health insurance.

A Kaiser Family Foundation analysis released this month found that 54 percent or 5.9 million of the 10.7 million people who are uninsured and eligible to purchase an Affordable Care Act marketplace plan in 2018 could pay less in premiums for health insurance than they would owe as a tax penalty.

But if folks bail on health insurance, their actions don’t just happen in a vacuum — they affect others, the argument goes.

“Since many of those expected to drop coverage in the individual market would be healthy, insurers would increase premiums to cover costs for a pool of less-healthy enrollees,” Commonwealth figures.

Not everyone thinks the impact of removing the penalty would be so severe. Rating service Standard & Poor’s, for example, predicts 3 million to 5 million fewer people will buy health insurance over a decade.

Others focus on the benefits of removing the penalty. Dumping it would free up $338 billion in the federal budget over 10 years, because fewer people would need government spending such as financial aid to lower premiums, CBO projected. That liberates more money for tax cuts, while also removing something that has long bothered small-government advocates  — it amounts to government coercion to buy a product, health insurance.

U.S. Sen. Lisa Murkowski, R-Alaska, has been a notable GOP holdout on previous Affordable Care Act overhaul efforts that she thought went too far. She signaled support for the idea last week.

“Repealing the individual mandate simply restores to people the freedom to choose,” Murkowski said. Nothing else about the health law would change, she said.

If a  tax bill killing the penalty can pass both the House and Senate, “that’s great,” White House budget director Mick Mulvaney said Nov. 19. “If it becomes an impediment to getting the best tax bill we can, then we are OK with taking it out.”

It’s a dicey political calculation that rests largely on voter perceptions: Is it welcome relief from overreaching government? Or is it pushing millions out of health coverage (and making others pay more) to deliver tax cuts that largely benefit upper-income folks? Health care was a leading issue in exit polls among Virginia voters who turned out strongly for Democrats this month.

Enrollment in Obamacare plans is running about 46 percent ahead of last year, though that’s partly because of a shorter sign-up period and it’s too soon to know how final numbers will look.

“Despite uncertainty in the market, we’re thrilled that Florida once again leads the nation in getting covered,” said Epilepsy Foundation of Florida CEO Karen Basha Egozi, whose group helps coordinate sign-up assistance.

Total enrollment has been projected to drop after the Trump administration cut budgets for advertising and in-person assistance and reduced the sign-up period by six weeks.

Estimated Florida premium hikes
Additional premium costs on benchmark Affordable Care Act marketplace policies in 2019 under a Senate tax plan to repeal the penalty for not carrying health insurance
Age 27 $538
Age 40 $656
Age 60 $1,392
Source: The Commonwealth Fund

Palm Beach ACO doctors top nation in Medicare savings

A doctor group based in Palm Beach County leads the country in saving taxpayers money while meeting goals for keeping Medicare patients happy and healthy.

(Getty Images)

Palm Beach Accountable Care Organization based in Palm Springs saved taxpayers $62 million and was allowed to keep $30 million of that for 2016 because it earned high scores for patient health and satisfaction, according to federal officials. The group ranked No. 2 nationally in shared savings a year ago.

“We’re keeping our patients healthier and out of the hospital,” said board chairman Richard Weisberg. “The savings are good and we’re proud of those. Keeping patients healthy is most important.”

The group of 275 primary-care doctors and 175 specialists serves 69,000 Medicare patients from St. Lucie County to Miami-Dade County.

Others in the region stood out as well. Ranking No. 10 in the nation for shared savings was Orange Accountable Care of South Florida, based in Miami Lakes and serving patients in counties including Palm Beach. It saved Medicare $28.6 million and earned $13 million.

It’s no simple task. Out of more than 400 Medicare “accountable care” organizations nationwide, about one in three shared savings with the federal agency. Program savings amounted to $652 million, according to a spokesman for the Centers for Medicare and Medicaid Services.

The program represents one of several efforts in recent years to make federal spending more efficient while rewarding providers who get high marks for patient care.

Not everyone is a fan of the concept. West Palm Beach attorney Ted Babbitt casts a skeptical eye toward assurances patient needs will always come first.

“Any time there is financial incentive to reduce care I am concerned for both patient care and physician liability,” Babbitt said.

But ACO officials argue the program provides incentives to offer more attention, not less, at the primary-care level. That can mean seeing patients on short notice, at unusual hours or several times in a week — if it helps patients control a chronic condition such as diabetes and avoid a more costly trip to the hospital.

For example, ACO doctors might pay special attention to factors such as the body weight of a patient at risk of congestive heart failure, said Palm Beach ACO board member Daniel Boss.

“I have a nurse who’s calling frequently, to make sure the weight’s not going up,” Boss said.

If signs point to a potential problem, “we can intervene,” he said. That can mean bringing the patient to the office for diuretics to help the body pass fluids more quickly, he said.

Under the traditional fee-for-service system, doctors have been paid by how many services they performed, not by the health outcome of the patient, ACO supporters say. If patients went to the emergency room, primary-care doctors had no particular financial reason to be concerned if the hospital repeated expensive tests they had already done.

To share savings, ACOs must get high scores measuring patient health and satisfaction. If patients don’t think they are being treated well, they can choose other doctors at any time. The spending is measured against what Medicare spent on the patients in the past.

Early versions of the program have split savings roughly in half between Medicare and ACOs, though a shift to newer models increases rewards but also puts ACOs at risk of paying the government if they fail to achieve their goals.

Accountable Care Options in Boynton Beach, serving 11,500 patients, said it achieved gross savings of $10.2 million in 2016 and was allowed to keep 75 percent of that, said CEO Rich Lucibella. That ranked No. 3 in the nation for its particular “track,” or version of the program, he said.

One challenge is how to account for unexpected events like storms, which can disrupt normal care, he said.

“What about Hurricane Irma?” Lucibella said. “They’re benchmarking us against years without a major hurricane.”

Getting the rules right can matter a lot to the program’s future. A federal spokesman noted  agency officials have asked for feedback on a variety of initiatives, including ACOs, that are designed to promote efficiency while giving consumers more information and options.

“CMS supports efforts to shift from a fee-for-service system that reimburses only on volume and towards a value-based payment system that rewards improving outcomes,” the spokesman said.




Stop balance billing by ambulances, state board says

The message to legislators from a state health advisory board is simple: Stop ambulance services from billing consumers for whatever is left over after insurance pays, a practice known as “balance billing.”

That can leave consumers with surprise bills of hundreds of thousands of dollars after they call 911, The Palm Beach Post has reported.

Consumers in an emergency “are not able to make an informed decision or negotiate at arm’s length about the cost of the transport,” wrote Carol Ostapchuk, executive director of the Florida Health Insurance Advisory Board, in a letter to state insurance commissioner David Altmaier.

The letter, dated Oct. 20, summarizes the board’s findings. It was released Tuesday by the Florida Office of Insurance Regulation.

Altmaier “generally supports a prohibition on balance billing because the practice can bring harm to consumers,” a spokeswoman said.

As chairman of the advisory board, the commissioner did not vote on the matter, she said.

The advisory board, whose function is to advise state officials on matters of public policy, recommended lawmakers adopt rules similar to those in a bill that passed a year ago to limit what providers can bill consumers in certain situations where they have no realistic choice of providers. Example: An out-of-network anesthesiologist at an in-network hospital.

The law limits consumer bills to the equivalent of “in-network” charges, though it excluded emergency medical transportation. A state working group has been meeting over the last year on ambulances and is expected to issue a “white paper” by December.

Most public and private ambulance services choose not to join insurer networks, because they say reimbursement is often too low. If they are effectively forced to join networks, representatives warned, it could mean higher taxes or cuts to service.

“If you don’t have balance billing, then you’re asking the taxpayers of Stuart to pick up the difference,” Stuart Fire Rescue Chief David Dyal told a state working group last month.

Ambulance officials say insufficient payment by insurers or rising deductibles in  health plans are often to blame, but insurers argue there has to be some incentive for ambulances to negotiate contracts, rather than bill consumers for whatever amount they choose.

As Post has reported since 2012, consumers like Penny Farrow of Boynton Beach feel frustrated they pay for insurance and taxes for county or city ambulance services, yet still get charged for amounts they don’t understand after they call 911.  She found found a $600 bill for a short ground ambulance trip “outrageous.”







Surprise ambulance bills: Watch for white paper by year’s end

Consumers concerned about ambulance charges of hundreds or thousands of dollars after they call 911 can expect a report by the end of the year from a state group that met for a fourth and final time Tuesday.

The contents of the “white paper” could set the stage for what state legislators attempt to do, or not do, in their spring 2018 session.

A big issue: Whether the work of the Emergency Medical Transportation Working Group hosted by Florida insurance consumer advocate Sha’Ron James amounts to a strong case for a ban on “balance billing.” That means public or private ambulance providers, most of whom decline to join insurer networks, could be prohibited from charging consumers more than the equivalent of “in-network” costs.

Ambulance providers warned it could mean higher taxes or reduced services.

“If you don’t have balance billing, then you’re asking the taxpayers of Stuart to pick up the difference,” said Stuart Fire Rescue Chief David Dyal.

There’s only so much “blood in the turnip” of taxpayer support, he said.

In many cases, ambulance providers say, consumers are paying more because their health plans increasingly make them responsible for higher deductibles.

But groups representing insurers argue there has to be some incentive for ambulance providers to negotiate rates — particularly with air transport, where charges can run into tens of thousands of dollars — or consumers will increasingly get hit with big bills they do not expect.

Fearing such charges becomes a public-safety issue if consumers hesitate to call 911 when they really need fast help.

“If God forbid we were in an emergency in the future, I would think twice about calling an ambulance,” Bonny Fishman of Boynton Beach said in February about charges of more than $800 for her husband’s ground ambulance ride.

“There are points where stakeholders are clearly apart,” James said Tuesday, but “we’re all here to work for the best interests of patients or consumers or policyholders.”



Stunned by an ambulance bill? Watch this meeting

If you’ve ever been surprised by a bill for hundreds or thousands of dollars for ambulance service, you can follow the fourth and final meeting Tuesday of a group that aims to help state legislators decide what to do about it in coming months.

Bonny and Ed Fishman said they were surprised by an ambulance charge of more than $800. (Damon Higgins / The Palm Beach Post)

The Florida Channel will be streaming live the 9 a.m. Oct. 31 meeting in Tallahassee of the Emergency Medical Transportation Working Group, hosted by Florida insurance consumer advocate Sha’Ron James.

“I was shocked,” Edward Fishman, 64, of Boytnon Beach told the Palm Beach Post in February about ambulance charges of more than $800. “What is this? We pay taxes for fire and rescue. Why is there a charge? How do they determine how much they charge?”

While grateful for emergency help, many consumers feel frustrated that they pay taxes for county or city ambulances plus insurance premiums, only to get hit with additional charges they were not expecting after they call 911.

Such charges have been rising. They can range from several hundred dollars to more than $1,000 for ground ambulances. In the case of air ambulances, charges can quickly run into the tens of thousands of dollars, a devastating threat to a family’s finances.

Median air ambulance charges doubled in four years to $30,000 per transport, a Government Accountability Office report in July found.

Under Florida law, ambulance providers can, in effect, charge consumers virtually any amount they choose after the insurance payment has come in. This is an emergency situation where patients can’t shop around, consumers say.  It raises a public safety issue if families, facing panicky situations where the severity of an injury or medical condition may be unclear, hesitate to call 911 out of fear they could receive charges they cannot afford.

“If God forbid we were in an emergency in the future, I would think twice about calling an ambulance,” Bonny Fishman, 62, said in February.

One possible legislative solution: End “balance billing.” That means ambulance services cannot charge consumers whatever amount they say is left over after they have collected payment from insurers. Under this concept, consumer charges could be capped at the equivalent of “in-network” services. In essence, ambulance providers would have to work out payments with insurers, and hold consumers harmless.

Public and private ambulance providers generally refuse to join insurer networks, and many argue taxes could rise or private providers could go out of business if they are forced to do so.

Perhaps the first thought for patients should be “did they survive to complain about the bill in the first place?” said Mac Kemp, deputy chief of clinical affairs for Leon County Emergency Medical Services, representing the Florida Association of Counties.

After heavy lobbying, ambulances were left out of a bill that passed two years ago to cap other kinds of consumer charges in medical situations where consumers cannot realistically choose other providers, such as an out-of-network anesthesiologist at an in-network hospital.

“Over the past year, I have had the opportunity to hear from a variety of stakeholders regarding ground and air emergency medical transportation services in Florida,” James said. “I look forward to moving the discussion forward by making policy recommendations that will ultimately protect consumers from suffering financially after recovering from an emergency medical event.”

The working group’s effort is coming to a close, but legislators are just starting their work for the 2018 session — so it matters that they hear from people who care about this issue. Tell your state legislator. Tell Post reporter Charles Elmore at (561) 820-4811 or celmore@pbpost.com.

Or you can share your story online with James’s office here:






Florida CFO asks Congress to block health tax

Florida Chief Financial Officer Jimmy Patronis sent a letter to Florida’s congressional delegation Monday urging them put  a hit on a federal Health Insurance Tax, or HIT.

Florida CFO Jimmy Patronis

Last year, Congress delayed implementation of the Affordable Care Act tax but without additional action it will become effective Jan. 1, CFO Jimmy Patronis said. Insurance companies are expected to raise rates to cover the costs.

“Congress has delayed the 2017 HIT implementation, lowering policyholders’ premiums by three percent, and saving the health care system an estimated $13.9 billion,” Patronis wrote. “However, a delay is but a temporary reprieve. Without immediate Congressional action, the tax will go into effect January 1, 2018, with a $22 billion first-year fiscal impact. With a 10-year projected impact of $267 billion, Florida simply cannot afford inaction.”

Florida faces a $1.7 billion overall increase in 2018 health care premiums, the CFO wrote. Workers in a state health plan can expect a $188 annual increase for individual coverage, and families can expect to pay an additional $518 in 2018, he said.

Who wants the tax? Insurers and business groups have repeatedly advocated for delaying it. The progressive Century Foundation has argued for keeping it to pay for Obamacare, saying delay provides little bang for the buck in lowering insurance premiums.

But in the strange-bedfellows world of Washington, GOP Congressional leaders may find it quietly useful to make the budget math look better for other tax cuts, Bloomberg noted earlier this year.

Trump administration ends subsidies to lower consumer health costs

The Trump administration announced at 11:23 p.m. Thursday it will stop paying billions of dollars to hold down health costs for consumers, a move that has helped drive up premium increases on government exchange plans an average of 45 percent in Florida for 2018.

President Donald Trump (Getty Images)

Florida insurers had already priced into 2018 rate increases the possibility the administration would end “cost sharing” payments of $7 billion or more annually, following threats from President Donald Trump to end what he called “bailouts” for insurers.

About 93 percent of Florida’s more than 1 million Affordable  Care Act marketplace customers will see little change in what they pay each month, though those making too much income to qualify for subsidies get no protection from rate hikes.

U.S. Health and Human Services Acting Secretary Eric Hargan and Centers for Medicare & Medicaid Services Administrator Seema Verma released a statement announcing that cost-sharing reduction payments will be discontinued immediately based on a legal opinion from the U.S. Attorney General’s Office.

“It has been clear for many years that Obamacare is bad policy,” the statement said. “It is also bad law. The Obama Administration unfortunately went ahead and made CSR payments to insurance companies after requesting — but never ultimately receiving — an appropriation from Congress as required by law.”

The statement continued, “In 2014, the House of Representatives was forced to sue the previous Administration to stop this unconstitutional executive action. In 2016, a federal court ruled that the Administration had circumvented the appropriations process, and was unlawfully using unappropriated money to fund reimbursements due to insurers.”

After a  legal review,  the statement said, “we believe that the last Administration overstepped the legal boundaries drawn by our Constitution.  Congress has not appropriated money for CSRs, and we will discontinue these payments immediately.”

It’s now up to Congress to decide whether to continue the payments.

In May, New York Attorney General Eric T. Schneiderman and California Attorney General Xavier Becerra, leading a coalition of 18 states, moved to intervene in the House v. Price court case to defend the subsidies. The DC Circuit granted their intervention in August.

“Again and again, President Trump has threatened to cut off these subsidies to undermine our healthcare system and force Congress to the negotiating table,” Schneiderman said in a statement. “That’s unacceptable.”

Schneiderman said he will not allow consumers to be used “as political pawns in his dangerous, partisan campaign to eviscerate the Affordable Care Act at any cost.”

The coalition of states, which does not include Florida, stands “ready to sue if President Trump cuts (subsidies) off,” he said in a statement at 10:20 p.m. Thursday.

Trump order ignites debate: New health choices or destabilizing move?

President Donald Trump today touted an executive order aimed at making it easier for millions to gain access to cheaper health policies, but Florida Democrats called it “sabotage” and a national consumer group blasted it as a move to promote “junk insurance” and destabilize markets.

Trump said “we are moving toward lower costs and more options in the health care market, and taking crucial steps toward saving the American people from the nightmare of Obamacare.”

The executive order bypasses Congress and represents an attempt to guide health policy from the White House.

“While this executive order claims to help improve consumers’ access to affordable care, it would have the exact opposite effect,” said Betsy Imholz, special projects director for Consumers Union. “Allowing insurers to sell substandard association health plans that aren’t required to cover basic services and benefits will further fragment and destabilize the insurance markets as a whole. This action splits the market into two, pitting the healthy against those with preexisting conditions and life-threatening illnesses — but ultimately both groups lose in this new scheme.”

As the Palm Beach Post reported, selling policies across state lines faces certain practical limitations — insurance companies have increasingly narrow networks of health providers set up within each state. That often means plans in one state are not necessarily convenient or attractive to consumers in another.

The order instructs federal agencies to begin making rules to broaden options for small businesses and their employees to join associations that provide health coverage across state lines. Another part calls for rules allowing certain “short-term” health plans to stay in effect longer, and be renewable. A key question in both cases: Whether this lets the plans make an end run around key Obamacare regulations.

The process could take months.

Sen. Rand Paul, R-Ky., said at the White House Thursday, “Today’s a big day. President Trump is doing today what I believe is the biggest free-market reform of health care in a generation.”

It will allow “millions of people to get insurance across state lines at an inexpensive price,” Paul said.

Trump signaled his intentions late last month.

“We believe states are going to have a far bigger issue than insurance companies when it comes to this concept of selling across state lines, as each individual state has its own insurance commission that has a job to protect its own consumers,” Gordon F. Bailey III, vice president of public affairs and community engagement for Jacksonville-based Florida Blue, the state’s largest health insurer, said Sept. 28 in West Palm Beach.

Insurers will do their best to live with whatever the rules are, he said.

“Allowing health plans to offer innovative products and increasing lower cost options for businesses and individuals is not a bad thing,” Audrey S. Brown, president of the Florida Association of Health Plans, said Thursday.

Florida’s Department of Financial Services “will continue to look deeper at the concept of inter-state insurance sales — and its possible impacts on Florida’s policyholders — as the specifics of President Trump’s plan come to light,” said spokeswoman Ashley Carr said then. “Florida has fashioned itself a leader in implementing insurance consumer protections, and we’d look to see that those protections remain in place.”

On Thursday, Consumers Union’s Imholz said, “Expanding the sale of these association health plans means the growth of junk insurance — coverage that may seem affordable to consumers but actually covers very little, potentially leaving them on the hook for huge out-of-pocket costs.”

She continued, “This is yet another action that undermines the good bipartisan efforts in the Senate to actually strengthen and stabilize the health insurance markets. Consumers deserve better. Every public health stakeholder group — from insurers, to providers, hospitals, patient and public interest groups — has warned that this type of action would hurt the markets and consumers. It’s time for regulators to listen and let the Senate finish their work.”

Trump’s move was applauded by Obamacare critics, including Americans for Limited Government president Rick Manning.

“President Trump has wisely asked the Department of Labor to examine the law and body of regulation to determine whether new regulations can be put into effect allowing for the sale of association health plans across state lines,” Manning said. “The vast majority of Obamacare was written by federal bureaucrats interpreting the law via the regulatory process. President Trump’s direction to the Department of Labor will now use that same process, created by Congress, to inject competition into the health care markets. The great news is that this competition promises to allow more Americans more choices at an affordable cost, truly providing affordable health care options, unlike Obamacare.”

A statement from Florida’s Democratic Party said, “Donald Trump’s executive order will continue his sabotage of health insurance markets across the country. Trump has already caused premiums to increase for millions by deliberately creating instability, limiting funding for advertising and cutting the ACA’s open enrollment period.”