President Trump is intent on repealing Obamacare. If there were any doubts to the contrary, one of his first official actions in office was to sign an executive order to “minimize the unwarranted economic and regulatory burdens of the [Affordable Care] Act.” That order grants the Secretary of Health and Human Services, the Centers for Medicare and Medicaid, the Department of the Treasury, and the IRS all authority available under the current law of the ACA to roll back the pieces that make it work.
What could such an order actually accomplish? At first glance, the executive order might look like a symbolic gesture, since the secretary cannot do anything outside of the bounds of the law. But the incoming Secretary of Health and Human Services—presumably nominee Tom Price—has some broad powers granted by the Act itself and sometimes exercised by the Obama administration that could have significant effects on the law, and eventually destabilize health care enough to require a repeal and replacement.
The part of Trump’s executive order that directs the secretary to “waive, defer, grant exemptions from, or delay the implementation” of pieces of the law is probably the most worrisome component for supporters of Obamacare. The irony of that component is that it rests on precedent set by the Obama administration, which used executive and regulatory power liberally to make the law work in the face of Republican opposition. The most likely actions under the new executive order expand or reverse Obama-era decisions.