President-elect Donald Trump is in a strong position to destroy the Affordable Care Act himself when he takes office in two months.
While the complexities of creating a law to repeal and replace Obamacare appear to be causing headaches among Congressional Republicans, if Trump’s first priority is truly to kill the existing system, he can largely do it by simply agreeing to stop the payments the Department of Health and Human Services is currently making to insurers as part of the ACA.
Those payments are currently threatened by a lawsuit, House of Representatives v. Burwell, launched by Congressional Republicans last year.
They alleged that the Obama administration’s practice of paying insurers to offer lower-price health care plans on the ACA marketplace is illegal because it was never expressly authorized by the health bill that the Democratic Congress approved in 2010.
Even in the absence of a bill repealing the ACA, which will likely take months to craft, a move by the next president to stop the payments would likely devastate the private insurance exchange and force even more participating insurers to pull out of the system.
Insurers have protested, alleging in a brief filed in response to the lawsuit that the suspension of payments would cause premiums for ACA customers to skyrocket.
The consequences of a collapse of the ACA exchange have been brought into sharp relief in the days since the election, as hundreds of thousands of consumers have rushed to purchase health plans through healthcare.gov.
While Republicans have said that they want to do whatever necessary to ensure that those who currently depend on marketplace plans will have a period of time to transition into different coverage, what that coverage will look like remains a mystery.
Some conservatives would be content replacing the subsidized coverage with a tax credit that people can use to buy health care, while others fear that that won’t be good enough for those who have grown accustomed to the coverage they have enjoyed for more than three years now.