Trump’s order is intended to create less regulated, less expensive alternatives to Obamacare. It is not an attempt to unwind the law so much as to work around it, providing options that do not exist under the current scheme, which has resulted in steady and significant increases in health insurance premiums and limited health insurance choices in many parts of the country. The order is less a direct attack on Obamacare and more of an attempt to escape its failings.
Yet the reaction from defenders of Obamacare has been to accuse the president of undermining the health law. By creating a parallel insurance scheme, with less expensive plans that offer less robust coverage, they warn, it will lure healthy people away from Obamacare’s insurance markets, and in the process will cause the insurance pool to become smaller and sicker, which inevitably means more expensive. It will exacerbate Obamacare’s problems.
On the policy merits, this criticism is not wrong. Obamacare’s government-created marketplaces were expensive and unstable before Trump took office, thanks in large part to the effect of its rules governing how insurers must cover preexisting conditions. But Trump’s order won’t ease that instability, and may well exacerbate it.
This would be true, however, of practically any effort to create more insurance options outside of its regulatory scheme. The law effectively requires total buy in, from market participants and from political overseers, in order to function. The result is situation in which the only way to avoid undermining the law is to prop it up. Obamacare is built to allow no alternative and no escape.