Local reaction to President Trump's executive order regarding health care ranged from forcefully opposed to wait-and-see.

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The executive order signed by President Donald Trump Thursday that could lead to changes in health insurance was greeted with strong condemnation by Washington state’s insurance commissioner.

“The executive order President Trump issued today proposes misguided and simplistic solutions to fix a complex problem — the growing costs of health care,” Commissioner Mike Kreidler said in a statement.

The executive order is the second insurance-related move the Trump administration has made since the latest attempt by Republicans in Congress to repeal and replace the Affordable Care Act, also known as Obamacare, failed late last month. Last week, the U.S. Department of Health and Human Services rolled back a federal requirement issued under the ACA that employers must include birth-control coverage in their health-insurance plans.

Some experts said Thursday’s executive order would chip away at the ACA by easing rules that allow small businesses and individuals to get insurance through health associations, which could bypass regulations and mandates set by states and the ACA. Other experts said Trump’s proposals appear to be modest and would have limited impact.

U.S. Sen. Patty Murray, D-Wash., who has been working with Sen. Lamar Alexander, R-Tenn., to stabilize the ACA, blasted the president’s actions. “The president has made a lot of promises to families about their health care, and if he truly wants to keep them, he’ll stop trying to create Trumpcare by sabotage, accept that repeal is off the table, and support Congress in getting our work done for patients and families,” she said.

But Kris Johnson, president and CEO of the Association of Washington Businesses, said health associations have been a successful part of Washington’s health-care landscape for two decades. The AWB’s health association includes about 2,500 small and medium-sized businesses that purchase insurance through the group.

“This really is about providing small businesses with the opportunity to provide coverage to their employees,” he said.

Meg Jones, executive director for the Association of Washington Healthcare Plans, said her organization and the state’s insurance companies have yet to digest the executive order but said the goal should be a stable market.

“We continue to be committed to working with regulators to ensure the market is stable and there is affordable access to care for families in Washington,” Jones said.

According to The Washington Post, a senior administration official said before the signing that the order will require agencies to write new rules and solicit public comment, which means that any changes or new insurance options won’t be available for coverage that starts next year. Open enrollment under the Affordable Care Act begins Nov. 1.

The majority of Americans get their health insurance through work. In Washington state, 180,000 get their insurance through the Washington Health Benefit Exchange and 151,000 on the individual market. Health associations provide coverage for an estimated 300,000 to 350,000 people.

Repealing the ACA and allowing the purchase of health insurance across state lines was a key campaign promise of Trump’s. The president says that allowing health associations to provide cheaper insurance and sell it across state lines would make the market more competitive and coverage more affordable.

When asked in an interview if insurers in Washington state are clamoring to sell plans across state lines, which might be one of the outcomes of the executive order, Kreidler replied, “Absolutely not. Absolutely not.”

Insurance companies have long been able to sell insurance in multiple states. To do so, though, they need to meet each state’s requirements and create a network of providers — factors that are both daunting and expensive.

State insurance commissioners from both political parties, as well as insurers, have said younger, healthier people might be drawn to association plans that can skirt government mandates and are cheaper but provide fewer benefits and protections. But that would leave older and sicker consumers paying more in the individual market and state insurance exchanges.

“Association health plans are just one more way to segment the insurance market and pull the good risk out at the expense of people unlucky enough to get sick. Too often, people get priced out of coverage,” Kreidler said.

Washington state Attorney General Bob Ferguson filed a federal lawsuit on Monday in an attempt to block the Trump administration’s rule allowing employers and insurers to opt out of covering contraceptives. His office is keeping an eye on this latest action.

“My legal team is reviewing the executive order. I will use the legal tools available to me to defend the Affordable Care Act and protect Washingtonians’ access to quality, affordable care,” he said.