Presidential Documents

Federal Register / Vol. 82, No. 199 / Tuesday, October 17, 2017 / Presidential Documents 48385 

Executive Order 13813 of October 12, 2017 

Promoting Healthcare Choice and Competition Across the 

United States 

By the authority vested in me as President by the Constitution and the 

laws of the United States of America, it is hereby ordered as follows: 

Section 1. Policy. (a) It shall be the policy of the executive branch, to 

the extent consistent with law, to facilitate the purchase of insurance across 

State lines and the development and operation of a healthcare system that 

provides high-quality care at affordable prices for the American people. 

The Patient Protection and Affordable Care Act (PPACA), however, has 

severely limited the choice of healthcare options available to many Americans 

and has produced large premium increases in many State individual markets 

for health insurance. The average exchange premium in the 39 States that 

are using www.healthcare.gov in 2017 is more than double the average 

overall individual market premium recorded in 2013. The PPACA has also 

largely failed to provide meaningful choice or competition between insurers, 

resulting in one-third of America’s counties having only one insurer offering 

coverage on their applicable government-run exchange in 2017. 

(b) Among the myriad areas where current regulations limit choice and 

competition, my Administration will prioritize three areas for improvement 

in the near term: association health plans (AHPs), short-term, limited-duration 

insurance (STLDI), and health reimbursement arrangements (HRAs). 

(i) Large employers often are able to obtain better terms on health insurance 

for their employees than small employers because of their larger pools 

of insurable individuals across which they can spread risk and administrative costs. Expanding access to AHPs can help small businesses overcome 

this competitive disadvantage by allowing them to group together to selfinsure or purchase large group health insurance. Expanding access to 

AHPs will also allow more small businesses to avoid many of the PPACA’s 

costly requirements. Expanding access to AHPs would provide more affordable health insurance options to many Americans, including hourly wage 

earners, farmers, and the employees of small businesses and entrepreneurs 

that fuel economic growth. 

(ii) STLDI is exempt from the onerous and expensive insurance mandates 

and regulations included in title I of the PPACA. This can make it an 

appealing and affordable alternative to government-run exchanges for many 

people without coverage available to them through their workplaces. The 

previous administration took steps to restrict access to this market by 

reducing the allowable coverage period from less than 12 months to less 

than 3 months and by preventing any extensions selected by the policyholder beyond 3 months of total coverage. 

(iii) HRAs are tax-advantaged, account-based arrangements that employers 

can establish for employees to give employees more flexibility and choices 

regarding their healthcare. Expanding the flexibility and use of HRAs 

would provide many Americans, including employees who work at small 

businesses, with more options for financing their healthcare. 

(c) My Administration will also continue to focus on promoting competition in healthcare markets and limiting excessive consolidation throughout 

the healthcare system. To the extent consistent with law, government rules 

and guidelines affecting the United States healthcare system should: 


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48386 Federal Register / Vol. 82, No. 199 / Tuesday, October 17, 2017 / Presidential Documents 

(i) expand the availability of and access to alternatives to expensive, 

mandate-laden PPACA insurance, including AHPs, STLDI, and HRAs; 

(ii) re-inject competition into healthcare markets by lowering barriers to 

entry, limiting excessive consolidation, and preventing abuses of market 

power; and 

(iii) improve access to and the quality of information that Americans 

need to make informed healthcare decisions, including data about 

healthcare prices and outcomes, while minimizing reporting burdens on 

affected plans, providers, or payers. 

Sec. 2. Expanded Access to Association Health Plans. Within 60 days of 

the date of this order, the Secretary of Labor shall consider proposing regulations or revising guidance, consistent with law, to expand access to health 

coverage by allowing more employers to form AHPs. To the extent permitted 

by law and supported by sound policy, the Secretary should consider expanding the conditions that satisfy the commonality-of-interest requirements under 

current Department of Labor advisory opinions interpreting the definition 

of an ‘‘employer’’ under section 3(5) of the Employee Retirement Income 

Security Act of 1974. The Secretary of Labor should also consider ways 

to promote AHP formation on the basis of common geography or industry. 

Sec. 3. Expanded Availability of Short-Term, Limited-Duration Insurance. 

Within 60 days of the date of this order, the Secretaries of the Treasury, 

Labor, and Health and Human Services shall consider proposing regulations 

or revising guidance, consistent with law, to expand the availability of 

STLDI. To the extent permitted by law and supported by sound policy, 

the Secretaries should consider allowing such insurance to cover longer 

periods and be renewed by the consumer. 

Sec. 4. Expanded Availability and Permitted Use of Health Reimbursement 

Arrangements. Within 120 days of the date of this order, the Secretaries 

of the Treasury, Labor, and Health and Human Services shall consider 

proposing regulations or revising guidance, to the extent permitted by law 

and supported by sound policy, to increase the usability of HRAs, to expand 

employers’ ability to offer HRAs to their employees, and to allow HRAs 

to be used in conjunction with nongroup coverage. 

Sec. 5. Public Comment. The Secretaries shall consider and evaluate public 

comments on any regulations proposed under sections 2 through 4 of this 

order. 

Sec. 6. Reports. Within 180 days of the date of this order, and every 2 

years thereafter, the Secretary of Health and Human Services, in consultation 

with the Secretaries of the Treasury and Labor and the Federal Trade Commission, shall provide a report to the President that: 

(a) details the extent to which existing State and Federal laws, regulations, 

guidance, requirements, and policies fail to conform to the policies set 

forth in section 1 of this order; and 

(b) identifies actions that States or the Federal Government could take 

in furtherance of the policies set forth in section 1 of this order. 

Sec. 7. General Provisions. (a) Nothing in this order shall be construed 

to impair or otherwise affect: 

(i) the authority granted by law to an executive department or agency, 

or the head thereof; or 

(ii) the functions of the Director of the Office of Management and Budget 

relating to budgetary, administrative, or legislative proposals. 

(b) This order shall be implemented consistent with applicable law and 

subject to the availability of appropriations. 


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(c) This order is not intended to, and does not, create any right or benefit, 

substantive or procedural, enforceable at law or in equity by any party 

against the United States, its departments, agencies, or entities, its officers, 

employees, or agents, or any other person. 

THE WHITE HOUSE, 

October 12, 2017. 

[FR Doc. 2017–22677 

Filed 10–16–17; 11:15 am] 

Billing code 3295–F8–P 


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