President Trump signed an executive order (EO) on Sept. 24 outlining his America First Healthcare Plan, which addresses his Administration’s stance on surprise medical bills and preexisting conditions. The EO does not on its own create new substantive policies absent regulation or legislation and therefore is considered largely symbolic and a representation of Trump’s healthcare platform leading into the election. The major provisions of the EO are as follows:

• Affordable Care Act (ACA): The EO reiterates the Administration’s support for repealing the ACA, but retaining protections for individuals against insurance discrimination based on preexisting conditions. Whether the Administration has authority to require private health insurers to offer coverage to individuals with preexisting conditions, absent legislative authority such as in the ACA, is unclear. While supporting repeal of the ACA, the EO conveys support for giving “Americans seeking healthcare more choice, lower costs, and better care.”

• Surprise Billing: The EO pledges the Administration’s support for congressional action to protect individuals from surprise medical bills and sets a deadline of Jan. 1, 2021, for Congress to pass a legislative solution. If this timeline is not met, the EO calls on the Department of Health & Human Services (HHS) to “investigate regulatory action.” There have been no specifications provided as to what action HHS would take; Sec. Azar instead stated in a press meeting on the EO that he hopes stakeholder groups will work on a solution with Congress. While Congress has heavily debated surprise billing legislation, it has yet to pass any major legislation on this issue.