Repeal in doubt, what Trump alone can do on 'Obamacare'

With prospects in doubt for repealing "Obamacare," some Republicans say the Trump administration can rewrite regulations and take other actions to undo much of the health care law on its own.

Some of those moves could disrupt life for millions of people, many in states that the new president carried. And then there's the risk of court challenges. Remember the White House travel ban?

"In a world where Obamacare is not going to be repealed and replaced, do you work to try to make it succeed, or do you take steps to undermine it in order to continue blaming President Obama and the Democrats for the dysfunction of the health care system?" asked Nicholas Bagley, a University of Michigan law professor who's analyzed the administration's leeway to make changes. "Right now we don't know the answer, and we are getting conflicting signals from the administration."

The nonpartisan Congressional Budget Office recently concluded that insurance markets would probably be stable "in most areas" under the Obama-era Affordable Care Act, or ACA. But President Donald Trump has said "it's imploding, and soon will explode."

GOP congressional leaders, who had to pull their repeal bill, describe a multi-pronged attack on "Obamacare" that includes administration action. Democrats warn of "sabotage." Enduring political turmoil is seen as contributing to insurers' worries about returning to the health law's markets next year.

Here's a look at the pros and cons of some actions Trump could order:

STOP COST-SHARING SUBSIDIES

In addition to subsidized insurance premiums, the ACA provides financial assistance for deductibles and copayments to consumers with modest incomes. House Republicans have challenged the constitutionality of aid payments, estimated at $7 billion this year.

A U.S. district judge in Washington agreed, finding that the law does not explicitly authorize such expenditures. The case is on hold by mutual consent of the House and the Trump administration. Insurers, who are legally obligated to provide assistance to qualifying customers, continue to be reimbursed by the government. That could end unless the legal issue is resolved.

Pro: For opponents of the ACA, stopping the cost-sharing payments would be the boldest step they could take short of outright repeal.

Con: Insurers would bail out or jack up premiums to make up for the loss of government payments. A market "death spiral" could begin in short order. "There's a tension here for the White House between avoiding a crisis in the insurance markets and facilitating the collapse of a program they bitterly oppose," said Larry Levitt of the nonpartisan Kaiser Family Foundation.

Officials won't comment on pending litigation, but there doesn't appear to be any policy change in the new administration.



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