On his first day in office, President Trump signed Executive Order 13765, titled "Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal." The order directed all federal agencies to exercise existing statutory authorities to reduce what the administration characterized as the economic and regulatory burden imposed by the ACA. Rather than pursuing legislative repeal immediately, the executive order provided agencies with broad discretion to waive, defer, or delay ACA provisions wherever law permitted. The Department of Health and Human Services, the Internal Revenue Service, and the Department of Labor subsequently used this authority to delay enforcement of the individual mandate penalty, expand short-term health plans that operate outside ACA regulations, and broaden association health plans that bypass ACA consumer protections.
The direct effects rippled across the insurance market and affected millions of Americans. Individuals who previously faced penalties for lacking coverage experienced relief, while simultaneously the pool of people paying into comprehensive insurance plans shrank, destabilizing the individual market in many states. The expansion of short-term and association plans created an alternative market of stripped-down policies without ACA requirements like coverage of pre-existing conditions, essential health benefits, or preventive care. Workers and self-employed individuals migrated toward these cheaper but less comprehensive options, fragmenting the insurance landscape.
This order established a template for regulatory dismantling that accelerated over subsequent Trump administrations. The approach of directing agencies to minimize enforcement and maximize discretionary waivers appeared in later healthcare actions, from the Title X program's shift away from birth control access to vaccine recommendation overhauls at the CDC. The philosophical consistency remained: using administrative mechanisms to deprioritize health protections deemed economically burdensome rather than legislatively repealing them outright. The order's framing of healthcare regulations as mere economic "burdens" rather than consumer safeguards reflected a governing approach that prioritized deregulation as an economic objective independent of health outcomes.
Executive Order 13765: Minimizing Economic Burden of the Affordable Care Act
🏥 Healthcare · First Term (2017–2021) · 🤖 AI-categorized
On January 20, 2017, President Trump signed Executive Order 13765, directing federal agencies to exercise all existing powers to reduce the economic and regulatory burden of the Affordable Care Act (ACA). The order instructed agencies to waive, defer, or delay ACA provisions and requirements where permitted by law. Confirmed direct impacts included delays in enforcement of the individual mandate penalty, expanded availability of short-term health plans outside ACA regulations, and expansion of association health plans, resulting in millions of Americans becoming eligible for health coverage plans not subject to ACA requirements.