Quora Question: How Fast Can Obamacare be Dismantled?

President Barack Obama signs the Affordable Care Act, dubbed Obamacare, during a ceremony in the East Room of the White House in Washington, March 23, 2010. Reuters

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Answer from Dan Munro, author of "Casino Healthcare:"

How quickly can Donald Trump scrap Obamacare? Not in its entirety, but he could begin to dismantle big chunks of it very quickly, at his own discretion, starting quite literally on Friday, January 20 (his inauguration). Here's how:

Most people are unaware of the federal subsidies called Cost Sharing Reductions (CSR) that the Obama administration has been paying to commercial insurance. These subsidies are what enable the insurance companies to offer silver plans at a "preferred/affordable" rate.

These federal subsidies were being made—some claim illegally—from a fund that wasn't appropriated by Congress for this purpose, thereby overstepping the powers of the executive branch. In fact, there's pending litigation by Congress against the administration for making these payments (House vs. Burwell). The Obama administration has been defending against this litigation (while continuing to make the payments) ever since the lawsuit was filed (July of 2014).

Trump could simply stop defending against the litigation and stop the payments. No legislation required. In fact, he could argue that the payments are, in fact, illegal (House vs. Burwell) and shift the burden to the Democrats to challenge him—legally. The point here is that the payments would effectively stop immediately until all legal actions were decided. As we've already seen with House vs. Burwell, that could easily take at least 2 years—and it could be all 4 years of his first term if it tracks to the Supreme Court (very possible).

Assuming he stops these payments (say on the day of his inauguration or shortly thereafter) the premium rates for silver plans would increase substantially—and more commercial insurers would exit Obamacare altogether as unprofitable—which Obamacare has already been for most commercial insurers. The top three commercial payers have lost hundreds of millions of dollars on Obamacare—and that's what prompted many to exit the exchange even before the election.

Stopping the CSR payments is another way to simply choke off the supply of affordable healthcare coverage under Obamacare. Again, no legislation or "repeal" needed. The question remains—will Trump do this? This is entirely unknown at this point—but it is well within his legal powers as president to do this—without even engaging congress. Trump could also signal a decision to do this before the inauguration—or not. We'll just have to see. But the point is, a key aspect of government subsidized health coverage—Silver Plans on the Health Insurance Marketplace (Obamacare) is already at significant risk.

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