By Kristen Rasmussen

President Donald Trump late last week made good on a threat to simply stop making insurer subsidies under the Affordable Care Act. He also directed the Labor, Treasury, and Health and Human Services Departments to allow small businesses and individuals to obtain non-ACA-compliant health care plans.

An executive order, signed by Trump on Thursday, seeks to expand small businesses' and even individuals' ability to buy health insurance through nationwide association health plans. Health insurance is regulated by the states. Those changes to the law will require notice and comments and could take effect by the 2019 benefit year.

Later Thursday, the Trump administration announced that it would immediately stop making cost-sharing reduction payments (CSRs), which were designed to offset the cost of discounts that insurers were required to give eligible lower-income Americans under the ACA, also known as Obamacare.

Then, on Friday, New York Attorney General Eric Schneiderman announced a lawsuit filed by 19 attorneys general, including California AG Xavier Becerra,  to defend those health care subsidies. The group of AGs in August won a motion to intervene in a 2014 lawsuit filed by House Republicans challenging the legality of insurer subsidies.

According to the New York Times, two top U.S. senators reached a bipartisan deal Tuesday to fund the subsidies to health insurers that Trump said he would cut last week.

While the changes begin to make their way through the federal courts and regulatory agencies, American Lawyer Media reached out to health care lawyers nationally for their observations about the Trump administration's latest attempt at health care reform. Here's a snapshot of what some of them had to say.

Carrie Byrnes of Michael Best & Friedrich: How impactful the order will be will depend largely on how the secretaries take action in response to it. All that is called for under the order is “consideration” of changes by the impacted secretaries. Whether and how they determine that they can effectuate changes under the current law (without any legislative action) remains to be seen. Any responsive rule-making we receive in the wake of this order will take many months to work through the notice and comment period. The scope of any rule-making issued (even in proposed form) will likely also impact when Congress revives its repeal-and-replace efforts. The enhanced focus on federal tax reform may continue if the rule-making is impactful from a Republican perspective. It seems unlikely that the order will be sufficient in and of itself to avoid further efforts by the Republicans in Congress to restrict spending and repeal the individual and employer mandates, but the order may facilitate a delay in that regard.

Claire Cowart Haltom of Baker, Donelson, Bearman, Caldwell & Berkowitz: The Trump administration's decision to end Obamacare cost-sharing subsidies is viewed by many as a political move to force congressional Democrats to engage in the repeal-and-replace conversation. With premiums for 2018 spiking 20 percent, and more than $7 billion in subsidies abruptly withdrawn, it is individual purchasers and insurers outside of Washington who will suffer the most from this abrupt political maneuver. If last week's political move doesn't advance the conversation in Congress, we should expect additional executive orders to further dismantle Obamacare. President Trump has found the Obamacare destabilization levers and he's showing us he's not afraid to pull them.

D. Brian Hufford of  Zuckerman Spaeder: After failing to “repeal and replace” Obamacare, President Trump elected to sabotage the Affordable Care Act so he could blame Democrats if it collapsed. In doing so, he ignored the adverse impact on millions of Americans. His first executive order allowing the formation of health care plans which will not have to comply with the ACA's “essential benefits” requirement means that many young and healthy people will be self-directed to limited, low-cost plans that leave them dramatically underinsured, while older and sicker people (with pre-existing conditions) will be forced into high-cost policies that could price them out of the market. His second executive order withholding promised payments to insurance companies to give them incentives to reduce out-of-pocket costs for low-income insureds will lead to skyrocketing premiums, while many insurers may elect to leave the market entirely. It is time for elected officials to make decisions based on policy, not politics.

Mark Rust of Barnes & Thornburg: The permission to market less-expensive, ACA non-compliant health plans will be very effective in reducing insurance policy prices for healthy people looking for alternatives to expensive public-market plans. Those who object to what the policies do and do not cover proceed from the belief that only ACA-defined benefits—not free-market preferences—can define what a “good” policy is. Time will tell which proves to be true in the public mind. In the short term, however, it will have the effect in 2019 (too late for 2018) of driving exchange prices up, as sick people stay and healthier people have the opportunity to leave. The only solution to this chaos will require a congressional rethinking of how to create a proper insurance pool that includes people with pre-existing conditions.

Contact reporter Kristen Rasmussen at [email protected].