Maxim Jacobs explains for Washington Examiner readers how the president-elect could act without Congress to fix some of Obamacare’s problems.

… [W]hile Donald Trump ran on a platform of “repealing and replacing Obamacare”, it might be wise to start with some small changes to the Affordable Care Act (ACA) that could still have large benefits.

I would begin by amending its “essential health benefits” provision which mandates the minimum of what plans in the health care exchanges cover. Besides covering obvious items such as emergency services and hospitalization, the ACA also requires coverage for pregnancy, maternity and newborn care, breastfeeding (including breast pumps), mental health, substance abuse disorders, pediatric services and birth control. This coverage must be bought even if a patient is single, menopausal and/or has no family history of mental health issues. It’s the equivalent of making a law that bundles auto insurance with boat insurance and mandates all car drivers purchase both. …

… The Trump administration can also combat the cost of pharmaceuticals by eliminating regulations that are currently hampering efforts to move to value-based contracts between pharmaceutical companies and payers. In these innovative arrangements, the pharmaceutical manufacturer would rebate part or all of the price of a product purchased for patients who don’t achieve a certain outcome (such as a pre-specified LDL or HbA1c level). In other words, they only end up making money if the drug actually works. Besides the potential cost savings, another potential benefit would be that pharmaceutical companies would no longer be incentivized to develop and market drugs for broad indications like depression when they know it only works in a small percentage of the population. …

… Finally, the Trump administration can amend policies that protect expensive biotechnology drugs from generic competition even if there is no patent protection. This includes the 12-year biologic drug exclusivity period, seven-year orphan drug protection, and the difficult and expensive biosimilar pathway to drug approval (which often requires head to head trials).