WASHINGTON (AP) — Frustrated over setbacks in Congress, President Donald Trump wielded his rule-making power Thursday to launch an end run that might get him closer to his goal of repealing and replacing "Obamacare."
Whether Trump's executive order will be the play that breaks through isn't clear.
Experts said consumers aren't likely to see major changes any time soon, although the White House is promising lower costs and more options.
Some experts warned hard-won protections for older adults and people in poor health could be undermined by the skinny lower-premium plans that Trump ordered federal agencies to facilitate.
Others said the president's plans will have a modest impact, and might even help some consumers who don't now benefit from financial assistance under the Obama-era law.
People on different sides of the polarized health care debate did agree it will take months for the government bureaucracy to turn Trump's broad-brush goals into actual policies that affect millions of people who buy their own health insurance policies.
"Today is only the beginning," Trump said at the Oval Office signing ceremony. He promised new measures in coming months, adding, "we're going to also pressure Congress very strongly to finish the repeal and replace of 'Obamacare' once and for all."
Democrats denounced Trump's order as more "sabotage" while Republicans called it "bold action" to help consumers.
A major small business group praised the president, while doctors, insurers, and state regulators said they have concerns and are waiting to details.
"We want to make sure that all the consumer protections are there and included," said Michael Munger, president of the American Academy of Family Physicians.
One of the main ideas from the administration involves easing the way for groups of employers to sponsor coverage that can be marketed across the land. That reflects Trump's longstanding belief that competition across state lines will lead to lower premiums.
Those "association health plans" could be shielded from some state and federal insurance requirements.
Responding to concerns, the White House said participating employers could not exclude any workers from the plan, or charge more to those in poor health.
Self-employed people might be able to join.
Other elements of the White House plan include:
Easing current restrictions on short-term policies that last less than a year — an option for people making a life transition, from recent college graduates to early retirees. Those policies are not subject to current federal and state rules that require standard benefits and other consumer protections.
Allowing employers to set aside pre-tax dollars so workers can use the money to buy an individual health policy.
"This could be much ado about nothing, or a very big deal, depending on how the regulations get written," Larry Levitt of the nonpartisan Kaiser Family Foundation said. "The intent of the executive order is clear, to deregulate the insurance market it's unclear how far the administration will ultimately go."
Levitt said association health plans and short-term health insurance policies could be designed to lure healthier people away from the state insurance markets created by the Obama health law. They'd offer lower premiums to those willing to accept fewer benefits. That would drive up costs for consumers in the already-shaky "Obamacare" markets, making them less attractive for insurers and raising subsidy expenses for the government.
But economist Douglas Holtz-Eakin, president of the center-right American Action Forum, said it looks like the impact will be on market niches, not the broad landscape of health insurance.
"This just isn't a revolution to insurance markets," he said.
"It's a policy change. What we've got isn't working, so we might as well try something else."