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Trump executive order hints at limiting healthcare consolidation, promotes price transparency — what does this mean for ASCs?

On Oct. 12, President Donald Trump released an executive order with further instructions to dismantle the ACA. The bulk of his executive order focused on health insurance, but he also addressed his administration's plans to limit consolidation and promote competition in healthcare markets.

 Here are five quick notes:

1. Section 1 (C) states: "My administration will also continue to focus on promoting competition in healthcare markets and limiting excessive consolidation throughout the healthcare system." Consolidation had been a chief concern for ASCs as increased regulation, low reimbursements and technology costs, among other factors, have made it more difficult for independent centers to survive.

2. The Trump administration, per the executive order, announced plans to "lower barriers to entry, limit excessive consolidation and prevent abuses of market power" as a way to improve competition in the future. However, the executive order did not give specifics as to how this would occur.

3. Healthcare information transparency was also addressed in the executive order, promoting transparent data on healthcare prices and outcomes without placing undue reporting burden on payers, providers and plans. Select ASCs across the country have begun quality and price transparency initiatives, posting outcomes benchmarks and global pricing online. It does take considerable upfront work to gather data and develop an appropriate price, especially for global or bundled payments.

4. In relation to health insurance, the executive order noted premium increases recorded since 2013 and highlighted policies that led to consolidation and limited competition among health insurance companies. President Trump's administration will champion association health plans; short-term, limited duration insurance; and health reimbursement arrangements. These moves aim to achieve several goals, including making it less costly for small businesses, such as many ASCs, to provide health insurance.

5. Shortly after the executive order was signed, HHS announced it would discontinue cost sharing reduction payments to insurance companies initiated by the ACA, believing they were unlawful because they weren't appropriated by Congress.

"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," HHS Acting Secretary Eric Hargan and CMS Administrator Seema Verma said in a statement. "After a thorough legal review by HHS, Treasury, OMB and an opinion from the Attorney General, we believe that the last Administration overstepped the legal boundaries drawn by our Constitution. Congress has not appropriated money for CRS, and we will discontinue these payments immediately."

This move will affect health insurance companies, especially those serving low-income individuals in the ACA marketplace. The AMA released a statement opposed to ending the subsidies, noting both Republicans and Democrats in Congress have expressed concern about eliminating CRS funding.

"This most recent action by the Administration creates still more uncertainty in the ACA marketplace just as the abbreviated open enrollment period is about to begin, further undermining the law and threatening access to meaningful health insurance coverage for millions of Americans," said AMA President David Barbe, MD, in a statement. "Our patients will ultimately pay the price. We urge Congress to accelerate its efforts to reinstate these payments before further damage is done."

If you have thoughts or a reaction to how President Trump's executive order or the HHS statement will affect ASCs, contact Laura Dyrda at to share your insight and expertise with the Becker's readership.

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