Trump can do plenty on his own to unravel Obama health care law

WASHINGTON-President Donald Trump can do plenty on his own to unravel the Obama health care law, but some of those actions would create disruptions that undermine his administration's early promises. Other less sweeping steps could open the way for big changes, but might not get as much notice.
Suspending enforcement of tax penalties on people who remain uninsured would win Trump immediate cheers from the political right for taking down a widely unpopular requirement. But experts say it would destabilize insurance markets by allowing healthy people to opt out, raising costs for taxpayers and remaining consumers. It would also risk a protracted court battle.
Less visible but just as important, the administration appears to have wide latitude to let states experiment with Medicaid funds and other federal financing. That could provide a pathway for GOP-led states to try their ideas.
For now, the executive order that Trump signed Friday night has changed very little. Consumers can still sign up on HealthCare.gov. The IRS is enforcing fines on people who remain uninsured, as it reviews Trump's order. Insurers are providing medical benefits defined in the Affordable Care Act.
"The ACA is a big, complicated statute and the administration doesn't have a Senate-confirmed secretary and the high-level political staff you would need to push through these proposals," said Nicholas Bagley, a professor at the University of Michigan Law School. "Right now we are very much in a waiting game, but I would expect movement soon."
Bagley and a colleague have identified about 25 areas in which the Trump administration could act unilaterally, from a requirement that women employees of religious-affiliated nonprofits have access to free birth control, to fines on people remaining uninsured. The scope of the executive order will be an issue at Tuesday's Senate Finance Committee confirmation hearing for Trump's health secretary pick, Georgia congressman Tom Price.
Still, there are practical and political limits on the administration. As the executive order made clear, changes to regulations have to follow a legally established process, which can take time. And actions that disrupt the insurance markets could backfire politically, because Trump has promised to provide insurance for everybody and lower costs, while other Republicans offered assurances they won't "pull the rug out" from anyone currently covered.
Implementing changes would fall to three departments: Health and Human Services, Treasury, and Labor. Here's a look at a few of the options, as well as their likelihood and potential impact.
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INSURANCE MANDATE
The administration could decline to enforce the ACA's requirement that most people carry health insurance, or it could add new "hardship" exemptions. For example, GOP lawmakers have called for an exemption in communities where only one health insurer continues to offer coverage.
Likelihood: High.
Impact: It depends on how sweeping the administration's actions are. Declining to enforce the mandate is likely to trigger an exodus by insurers. Adding to the Obama administration's list of exemptions might be feasible.
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SUBSIDY LAWSUIT
A federal district judge has agreed with House Republicans that the Obama health law lacks specific legal authority to pay insurers billions to reduce consumers' deductibles and copayments. The case is on hold, but unresolved.
If the Trump administration agrees with the House and stops the payments, insurers would bail.
"It would destroy the individual insurance market and throw millions off their coverage, including many Trump voters," said Tim Jost, an emeritus professor at Washington and Lee University School of Law in Virginia.
Likelihood: A deal between the House and the administration could resolve the matter. Having won its legal argument, Congress could provide at least temporary spending authority.
Impact: High. However the issue is handled, it will be taken as a sign of Trump's intentions.
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BIRTH CONTROL COVERAGE
Under the health care law, women receive birth control at no additional cost as a preventive benefit. Houses of worship are exempt from the requirement, but women employees of church-affiliated nonprofits are covered. The new administration could rewrite the rules for nonprofits, or it could try to void the birth control requirement altogether.
Likelihood: An attempt to revise the rules for religious-affiliated nonprofits seems possible; a broader effort to void birth control coverage would be difficult.
Impact: Depends on the scope. Taking away a benefit for most women covered by workplace plans could provoke a backlash.
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STATE FLEXIBILITY
A little-known provision of the ACA allows states to seek a "Section 1332" waiver that gives them broad leeway to manage several streams of federal health care funding, provided they cover about as many people and don't add to the deficit. The Trump administration could rewrite the Obama administration's guidance for states, making it less restrictive.
"They can do a lot by adopting a different attitude," said economist Gail Wilensky, who ran Medicare for former President George H.W. Bush.
Likelihood: High. The Trump administration is also signaling flexibility on other red-state demands, such as work requirements for some low-income Medicaid recipients.
Impact: Uncertain. It would require major commitment and planning on the part of states.
White House press secretary: 'Our intention is never to lie'
By DAVID BAUDER, AP Television Writer
NEW YORK-White House press secretary Sean Spicer told a roomful of reporters that "our intention is never to lie to you," although sometimes the Trump administration may "disagree with the facts."
Spicer's first full press briefing was closely watched Monday following a weekend statement about President Donald Trump's inauguration audience that included incorrect assertions. After White House counselor Kellyanne Conway received wide social media attention for her explanation that Spicer had presented "alternative facts," Monday's briefing was televised live on CNN, Fox News Channel, MSNBC and, for a time, even ABC.
Meanwhile, ABC announced that anchor David Muir would interview Trump for a one-hour prime-time special to air at 10 p.m. EST Wednesday.
Spicer tried to defuse tension by opening with a self-deprecating joke about his lack of popularity, and his 78-minute session was wide-ranging and mostly substantive. He corrected one disputed statement from Saturday, defended another and expressed some frustration regarding how the new Trump administration feels about its news coverage.
Asked for a pledge not to lie, Spicer assented, saying, "I believe we have to be honest with the American people." He said he had received incorrect information about Inauguration day ridership on the Washington Metro system when he initially claimed the system was used more Friday than for Barack Obama's 2013 inauguration.
"There are times when you tweet something out or write a story and you publish a correction," he said. "That doesn't mean you were trying to deceive readers or the American people, does it? I think we should be afforded the same opportunity."
Spicer didn't back down from his claim that Trump's inauguration was the most-seen ever, clarifying that he was including people who watched online. The ceremony didn't have the highest TV ratings and aerial photographs indicate the live crowd wasn't as big as it was for Obama's first swearing-in, but there are no reliable crowd estimates or numbers indicating how many people across the world watched the ceremony online.
He expressed frustration about an erroneous report, later corrected, stating that a bust of Martin Luther King Jr. had been removed from a room in the White House following Trump's inauguration.
"Where was the apology to the president of the United States?" Spicer said. "Where was the apology to the millions of people who thought that it was racially insensitive?"
One reporter said Spicer had accepted an apology from the news outlet that made the mistake in a pool report.
Spicer would not say whether he was ordered by Trump or other staffers to make Saturday's statement, but explained some of the thinking that went into it. Like countless White House staffs before them, the Trump team is exasperated about "negative" and "demoralizing" coverage.
"When we're right, say we're right," he said. "When we're wrong, say we're wrong. But it's not always wrong and negative."
Spicer broke with the White House tradition of opening briefings with a question from The Associated Press. The AP was traditionally given the first question because it is a broad-based news cooperative that represents the largest swath of American newspapers, broadcasters and other kinds of news organizations.
Instead, Spicer initially called on a reporter from the New York Post, and he took questions from several news organizations that were rarely called on during the previous administration. He said four seats in the briefing room would be kept open for out-of-town reporters to participate via Skype.
The new press secretary-who took no questions Saturday-drew a laugh when he said he'd stay at the podium for as long as the reporters wanted him there, and he nearly did.
"I want to make sure we have a healthy relationship," he said.