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President Trump said the executive order he signed today is just the beginning of the administration's effort to reshape the health care system, and it's clear where that effort is leading: toward a broader market for insurance plans that are less generous and less expensive.

The bottom line: The substance of Trump's executive order is about what we expected, and many of the details will still have to be worked out through regulations. Broadly, though, it would expand access to more loosely regulated insurance options with low premiums, and some experts say those changes could undermine the Affordable Care Act's insurance markets.

What's next: There are still plenty of big outstanding questions about how each of these policies would work, which federal agencies will have to fill in through regulations. (The executive order itself is just a set of marching orders to those agencies.) That's a long process, and insurance companies have already finalized their most of their offerings for 2018, so these changes won't be reflected in actual insurance plans until 2019.

The details: Trump's executive order does three big things:

  • Expand access to association health plans, in which a group of small employers can band together to buy insurance as a collective.
  • Expand access to short-term health plans. These policies don't cover much and don't cost much; today, you can only keep one for three months. Trump will extend that time limit to a year.
  • Expand the use of health reimbursement accounts, which allow employers to set aside tax-free money to help cover their employees' health care costs. Workers will likely be able to tap that money to pay the premiums for a plan in the individual market.

The reviews: Conservatives are thrilled. Sen. Rand Paul, a champion of association health plans, was at the White House for the signing.

But many independent policy analysts are less enthusiastic. They worry that these changes will divert healthy people into cheaper policies outside the ACA's exchanges, leaving those markets with a sicker and more expensive customer base, which would cause premiums to rise.

Go deeper

Updated 3 hours ago - Energy & Environment

Thousands without power as "hazardous" winter storm lashes East Coast

Satellite imagery of the Northeastern U.S. taken by NOAA on Jan. 17. Photo: NOAA

A major winter storm lashed much of the East Coast Sunday and Monday, causing widespread power outages and disrupting travel over the holiday weekend.

The latest: Authorities in North Carolina confirmed that two people died in a car crash and that they responded 600 vehicle accidents during the storm on Sunday, per the Washington Post.

Texas abortion law remains in effect after appeals court ruling

Pro- and anti-abortion protesters outside the Supreme Court as arguments begin about the Texas abortion law on Capitol Hill in November. Photo: Jabin Botsford/The Washington Post via Getty Images

A U.S. appeals court transferred a challenge to Texas' law banning most abortions after about six weeks of pregnancy to the state supreme court in a 2-1 vote on Monday evening.

Why it matters: The 5th U.S. Circuit Court of Appeals' decision means the country's most restrictive abortion law can remain in place for the time being.

5 hours ago - World

At least 2 dead after Tonga volcano eruption and tsunami

A satellite image of the explosive eruption of the Hunga Tonga-Hunga Ha'apai volcano on Saturday. Photo: UNICEF/NOAA

At least two people are confirmed to have died in Tonga following the undersea volcanic eruption that sent tsunami waves toward the island nation and across the Pacific over the weekend, officials said Monday.

The big picture: Officials reported major damage along the western coast of the main island of Tongatapu, where the capital, Nuku'alofa, was covered in ash and dust, including on the runway of the airport. A New Zealand Ministry of Foreign Affairs spokesperson told Axios over the phone that two people had been confirmed to have died in the disaster.

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