Congressional Republicans are huddling at a closed-door retreat this week to craft a replacement for the Affordable Care Act, but it’s President Trump who’s calling the shots.

On Friday, hours after taking office, he issued his first executive order. No surprise, it targeted ObamaCare, instructing federal agencies to do everything possible while the ACA is still on the books to lighten the law’s “economic burden.”

Expect relief soon if you’re one of the 10 million getting clobbered by penalties — averaging $995 per adult and $500 per child — for refusing to buy a pricy ObamaCare plan. The executive order is also likely to result in insurers in most states — though not New York — offering more affordable plans.

Beyond these changes, Trump’s wide-ranging order could provide relief within months to doctors, employers and many others suffocating under ObamaCare’s 20,000 pages of regulations. It also puts Congress on a faster timetable to repeal and replace the law.

Fairness demands immediately halting the penalties for those who don’t buy insurance. The ACA promised choice and affordability and delivered neither. In nearly a third of the nation’s counties, only one insurer is offering ACA coverage — no choice at all. And premiums have doubled since 2013.

ObamaCare already allows the Health and Human Services secretary to grant “hardship” exemptions from the penalty. As soon as Trump’s HHS secretary is confirmed, he should automatically exempt anyone who applies.

Beyond penalty relief, Friday’s order will give the feds some leeway to reduce the bells and whistles now included in every plan. That means you might be able to choose between paying top dollar for a plan that includes breast pumps and contraceptives without a copay, like the Obama administration required, or buying a streamlined plan for less.

Sorry, though, no choices for New Yorkers. On Friday, Gov. Cuomo signaled that Albany pols, not consumers, are in charge here. Cuomo announced that every insurance plan must cover “free” contraception and abortion, without a copay, so that New York women “will have cost-free access to reproductive health care.” Free? Do you also believe in the Tooth Fairy? Insurance buyers will be forced to pay for these items, whether they want them or not.

Meanwhile, ACA defenders are making alarming predictions that Trump’s executive order will cause the insurance market to collapse. Unless the healthy are coerced with penalties into signing up, they warn, only the sick will enroll, causing insurers to see huge losses ahead and flee the market.

Let’s face facts: Coercion is needed because ObamaCare is a rip-off. The law forces the healthy to pay the same premiums as people with pre-existing illnesses. The sickest 5 percent of the population consumes 50 percent of the nation’s health care. Their costs are 10 times the average. The healthy pay premiums but never meet their sky-high deductibles. Instead, their premiums foot the bills for the very sick. A scam.

As for a market collapse, it can be averted by separately funding insurance for the sick with taxpayer dollars.

That will spread the cost broadly, relieving buyers stuck in the individual market from bearing the whole burden.

Both Trump and many GOP lawmakers seem inclined to do this. Funding risk pools or reinsurance programs in each state could well result from the budget bill passed this month. The sooner the better. It’ll lower premiums for everyone else and stabilize the market.

Meanwhile, ObamaCare’s defenders talk nonstop about the 20 million who gained coverage under the law, but never acknowledge the 200 million who have been hurt by the law: the silent majority. They include millions paying penalties, part-timers who’ve had their hours slashed to evade the employer mandate, seniors hurt by Medicare cuts, doctors forced to close their practices and 155 million with on-the-job coverage whose deductibles have soared.

This silent majority was ignored. Now Trump has signed an executive order to help them.



Betsy McCaughey is a senior fellow at the London Center for Policy Research.