To all those voters who put Donald Trump in office thinking he didn't really mean it when he said he'd end Obamacare, he meant it. He wants to get rid of your health insurance. Among his first actions in office was signing an executive order giving "instructions for the federal government to dismantle the Affordable Care Act to the maximum extent permitted by law.'" That doesn’t repeal the law—he can’t do that unilaterally. But here’s what it does:
The executive order is a powerful political statement about the health care law, one that directs agencies to "waive, defer, grant exemptions from, or delay" any taxes or penalties they possibly can. The order doesn’t give Trump any new powers, but does suggest that he wants to move quickly on dismantling major parts of the the health overhaul.
"This order doesn't in and of itself do anything tangible," says Larry Levitt, vice president at the Kaiser Family Foundation. "But, it directs federal agencies to start taking steps to use their administrative authority to unwind the ACA in all sorts of ways. This is a signal that the Trump administration is not waiting for Congress to start making big changes."
It's the clearest statement so far of Trump's specific priorities on the health care law. In recent weeks, Trump has said he wants to improve health coverage for all Americans, but he's been vague about what that means. This document suggests he may take aim at a piece of the law long-loathed by Republicans, the individual mandate.
Here's the part of the order that looks like the mandate: "any provision...that would impose a fiscal burden on any State, or a cost, fee, tax, penalty, or regulatory burden on an individual." That doesn't mean that the individual mandate to buy insurance ends now, it means he's essentially directing the government to start the process of undoing it.
Tim Jost, a law professor at Washington and Lee College, and supporter of the law explained to Vox's Sarah Kliff that Trump can't repeal the law unilaterally, so the phrase "to the maximum extent permitted by law" is included in the directives. "What he is saying here is that our general policy is going to be to deregulate," Jost explains. "He's saying, 'I do not want more regulations, we should grant waivers where we can, and give more authority to the states.'" But he also included this: "To the extent that carrying out the directives in this order would require revision of regulations issued through notice-and-comment rulemaking, the heads of agencies shall comply with the Administrative Procedure Act." That means he will follow the established Administrative Procedure Act, an 80-year old law that governs the rulemaking process: "issuing draft rules, accepting comments, sometimes holding public hearings, and ultimately issuing a final rule that takes all the feedback into effect."
"I think he’s been advised that he can't repeal the Affordable Care Act through executive action, and now we see where this goes," Jost says. He really means to do it. So what this means right now is that Trump is trying to weaken the law, and particularly the individual mandate. And that, says David Anderson, a Duke University health policy analyst, could "make the [market] sicker and on average more expensive. It made lead to carriers reconsidering their participation for the 2018 plan year."
For 2017, however, Obamacare is open and still taking enrollments through January.