President Donald Trump could begin undoing the Affordable Care Act almost immediately through the use of executive orders that would weaken the law, and through other methods.
But some in the GOP are getting skittish about the prospect of taking insurance away from up to 30 million people, and a few senators have said they will not support repeal without a replacement plan in place.
Trump and other GOP leaders have given conflicting messages about repealing the ACA. Trump has praised efforts to move quickly to repeal and has made broad promises about a replacement with “insurance for everybody” that more cautious Republicans are not willing to fully stand behind.
But Vice President Mike Pence said early this month that the incoming administration is “working on a strategy, in concert with the leadership of the House and the Senate, for both a legislative and executive action agenda to ensure that an orderly and smooth transition to a market-based healthcare reform system is achieved.”
Trump administration officials have not yet specified what executive actions the new president may take with the ACA, but he could direct federal agencies on different ways to carry out the law.
He could broaden hardship exemptions to the individual mandate or direct that penalties not be imposed for certain violations of the law. He could also extend an administrative fix to the law and allow more plans with skimpy coverage that would otherwise not qualify.
Trump could also stop defending lawsuits like the House Republicans' case that cost-sharing subsidies to insurers are being improperly paid or the challenge to the mandate requiring employers and insurers to provide free contraception services.
Another option would be for the administration to approve more state Medicaid expansion waivers. President Barack Obama's administration had refused some of the waivers with more conservative provisions such as work requirements.
These actions could, however, have a major destabilizing effect on the marketplace exchanges and the industry is likely to push back on big changes. The American Medical Association, the American Hospital Association and other groups have said there should be no repeal until a replacement plan is put forward.