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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 15 mins ago - Politics & Policy

No motive yet determined in Indianapolis FedEx shooting

Crime scene investigators walk through the FedEx parking lot in Indianapolis the day after a mass shooting left nine dead, including the gunman, who took his own life. Photo: Jeff Dean/AFP via Getty Images.

Police have not yet uncovered the motive for Thursday's mass shooting at an Indianapolis FedEx facility, where a gunman left at least eight people dead and multiple others wounded.

The latest: Police Chief Randal Taylor said Friday that the warehouse employed a "significant" number of Sikhs, AP reports, and the Sikh Coalition confirmed that members of its community were among those who were injured and killed.

The legacy of Bernie Madoff

Bernie Madoff, architect of the largest Ponzi scheme in American history, died on Wednesday in federal prison, 11 years into his 150-year sentence.

Axios Re:Cap digs into Madoff’s crimes, what they revealed about America's financial system and what changed after the scheme came crashing down with Diana B. Henriques, author of the The Wizard of Lies: Bernie Madoff and the Death of Trust.

Updated 2 hours ago - World

Russia to expel 10 U.S diplomats, ban top Biden officials in response to sanctions

Photo: Alexei Druzhinin\TASS via Getty Images

Russia will expel 10 U.S. diplomats and add eight current and former U.S. officials to its no-entry list in retaliation for sanctions that the Biden administration leveled at Moscow on Friday, Russian foreign minister Sergey Lavrov said Friday.

Why it matters: The measures come after the U.S. said it would expel 10 Russian intelligence officers operating under diplomatic cover, as part of a broad package of sanctions retaliating against the SolarWinds hack of federal agencies and Russia's interference in the 2020 election.

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