Jeff Lagasse

In fact, execs say automated systems are a requirement for survival in the rural healthcare market these days.

President Donald Trump on Thursday signed an executive order expanding access to "association health plans" Thursday, ostensibly to allow small business -- and perhaps individuals -- to purchase a type of health insurance that circumvents Affordable Care Act protections and state regulations. Republicans in the House and Senate have attempted numerous times to repeal and replace the ACA with a more conservative framework, and have been unsuccessful each time, falling just shy of the required number of votes.  Trump's executive order doesn't repeal the ACA -- the executive branch lacks the power to do so -- but it may effectively destabilize the ACA's insurance marketplaces by allowing some Americans to purchase bare-bones coverage at lower prices, removing younger, healthier people from the law's risk pools. According to the Washington Post, critics of the move include state insurance commissioners, policy specialists and most of the health insurance industry. The concern is that the order will drive up costs for those with serious medical conditions, and push insurers to jettison the ACA's marketplaces, a move some say will result in legal challenges. "Actions like these create extreme uncertainty that will undoubtedly saddle middle-class families with higher cost, less coverage and fewer protections," Ways and Means Committee ranking member Richard Neal, D-MA, said in a statement following the executive order. "The time for political gamesmanship on healthcare is over. I hope Republicans will join with Democrats to find bipartisan solutions to further strengthen our healthcare system to bring down costs, strengthen consumer protections and cover more Americans."  Part of the order instructs Cabinet departments to draft new federal rules for the association health plans, a type of insurance in which like business join together to negotiate health benefits. Under the order, such plans will be able to evade the ACA's benefits requirements, limits on yearly and lifetime costs for consumers, and the ban on charging more to people who have been sick. That may leave the sick and with rising rates. Currently, short-term insurance policies, geared primarily to young adults or the temporarily out-of-work, can last for no more than three months. The executive order stretches that to almost a year. The executive order comes weeks before the start of the fifth open enrollment season in the ACA marketplaces, on Nov. 1. Twitter: @JELagasse Email the writer: jeff.lagasse@himssmedia.com

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Despite recent controversies, the executive oversaw major growth at the marquee health system.

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