The Trump administration finalized plans Tuesday to let small companies and the self-employed band together and buy health insurance outside of Obamacare’s strict rules, moving to offer coverage to people priced out of the market by the 2010 health care law.

Critically, people will be able to band together across state lines — a key goal for President Trump, who said the moves will bring down costs for millions of Americans starting in September.

“You’re going to save a fortune,” Mr. Trump said at the National Federation of Independent Business’ 75th anniversary celebration.

The U.S. Chamber of Commerce said the change “will give employers the relief and flexibility they need to cover more employees at a lower cost with more choices for quality care.”

The Congressional Budget Office estimates that 4 million people, including 400,000 who otherwise would go without insurance, are expected to join association health care plans by 2023.

Introducing association health plans, or AHPs, has long been a goal for congressional Republicans. They say the plans offer a way for people to take advantage of the group insurance market, even if they are self-employed or work for a business too small to provide insurance.

Labor Secretary Alexander Acosta said the plans will “level the playing field” by giving small businesses bargaining power and the ability to spread risk among a huge swath of customers.

“As the cost of insurance for small businesses has been increasing, the percentage of small business offering health coverage has been dropping substantially,” Mr. Acosta said. “This expansion will offer millions of Americans more affordable health care options.”

It’s also the first major change the administration has made to Obamacare’s framework since Congress repealed the individual mandate in the tax cut bill last year.

Top Republicans cheered the move as a pathway to escape soaring Obamacare premiums.

Democrats said the administration was opening the door to “junk plans” that siphon healthier customers from Obamacare’s web-based exchanges, weakening the law.

The plans must abide by the same protections for sicker or older Americans as those that apply to large companies, yet they wouldn’t have to cover the full range of benefits mandated by the 2010 Affordable Care Act, so provisions such as mental health or maternity care might be missing.

Those hefty coverage rules have been blamed for hiking prices of health care plans across the board, forcing customers to pay for services they don’t want.

Obamacare’s defenders said consumers might not understand what kind of coverage they are getting and that sicker consumers who rely on robust coverage will face higher premiums because insurers will expect those who remain in the exchanges to file expensive claims.

“Association health plans are not the solution to any problem Americans have. They won’t make drugs more affordable, they won’t help Americans get health care they need, and for every person who pays a slightly lower premium upfront, more goes to insurance companies and less of that goes to their care,” said Andy Slavitt, who oversaw Obamacare in the previous administration. “When they finally do get sick, they find out at exactly the wrong time and coverage is more expensive or unavailable. For everyone else, costs rise when you split up the risk pool.”

The rule will be phased in starting Sept. 1, though its effectiveness depends in part on buy-ins from insurers, who are used to operating within local networks instead of selling their products across state lines.

America’s Health Insurance Plans, the main trade group for insurers, said it was wary of anything that could disrupt the existing markets under Obamacare.

“We remain concerned that broadly expanding the use of AHPs may lead to higher premiums for consumers who depend on the individual or small group market for their coverage,” the trade group said. “Ultimately, the rule could result in fewer insured Americans and may put consumers at greater risk of fraudulent actors entering this market.”

Mr. Trump’s push to expand AHPs is the first of two major moves to offer cheaper alternatives to individuals and small businesses that say robust coverage under Obamacare is too pricey.

The administration is finalizing a second plan that allows people to hold skimpy “short-term” plans for a full year instead of limiting them to three months.

Democrats say they are part of a broader Republican effort to chip away at Obamacare.

“Finalizing this rule is simply the latest act of sabotage of our health care system by the Trump administration and a back door to expanding junk insurance plans, which benefit the insurance industry but hurt the average American,” said Senate Minority Leader Charles E. Schumer, New York Democrat.

Republicans said premiums were already soaring under Obamacare and the law needed fixes to make it more responsive to customers’ needs.

“We are putting more power back into the hands of the American people to choose the health insurance plan that best meets their needs at a price they can afford,” said Sen. Rand Paul, a Kentucky Republican who championed association plans during the repeal debate last year.

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