Within hours of taking the oath of office, President Trump signed an executive order that begins the dismantling of the Affordable Care Act (ACA), or Obamacare. (here) Supporters of the law contend that only Congress can amend or repeal the ACA. This belief overlooks the fact that the 2,700 page, strictly partisan law, states 1,300 times that the Secretary of the Health and Human Services Department (HHS) can change the ACA unilaterally. In other words, the architects of Obamacare gave the executive branch broad power to amend the ACA.

The executive order has six sections:

1. Seek prompt repeal of the ACA.
2. Give broad power to the Secretary of HHS and other agencies.
3. Provide greater flexibility to states.
4. Begin the process of selling health insurance across state lines.
5. Comply with the Administrative Procedure Act.
6. Standard disclaimers of an executive order.

Complete repeal of Obamacare will require Congressional action. Section 1, seeking prompt repeal, satisfies President Trump’s campaign promise to start the repeal process on Day One of his administration.

Sections 2 and 3 are really the important parts of the executive order. These allow and encourage the agencies under the executive branch of government to unwind as much of the ACA as possible. Some states, especially the red states, will take advantage of Section 3. States like Washington, on the other hand, will probably not move initially to dismantle any the ACA, especially the Medicaid expansion.

It will be interesting to see how Congress responds, especially Senate Democrats from states that Trump carried who are up for re-election in 2018, to the changes that occur under this executive order.