There's a laundry list of things President-elect Donald Trump could do on his own to modify the Affordable Care Act, even if Congress gets hung up on exactly how to repeal and replace it.
While the Affordable Care Act is a lengthy piece of legislation, the Obama administration issued many more pages of regulations and guidance explaining exactly how it should be implemented. The new administration, under the direction of Trump, could amend or get rid of those directives as soon as it's in place next year, and thus significantly alter the law without having to wait for Congress.
Additionally, the Department of Justice is involved in several ongoing disputes involving the healthcare law and some of the payments it lays out for insurers. A Trump administration could direct it to act in ways more favorable to Republican interests.
Here are five ways Trump could use his executive authority to weaken or change Obamacare:
1. Trump could direct Justice to stop fighting a lawsuit from House Republicans, who argue the Obama administration illegally paid cost-sharing subsidies to insurers without first getting an appropriation from Congress.
Last May, federal judge Rosemary Collyer ruled for the House but the administration has appealed the ruling. Trump could both rescind that appeal and halt the flow of subsidies to insurers, which could in turn weaken the marketplaces.
2. He could prohibit Justice from settling another lawsuit, this one from insurers seeking risk corridor payments to help cover the costs from their sickest patients. The Obama administration had hinted it might settle the lawsuits as a way of getting the payments to the insurers.
That infuriated Republicans, who say the payments amount to an illegal bailout of insurers since Congress has passed legislation requiring the risk corridor program to be budget neutral. That measure meant many insurers were compensated at levels far below what they had requested.
3. Trump could propose rules creating more exemptions from the individual mandate to buy coverage, further weakening the tool that was supposed to ensure everyone has a way to pay for the healthcare they'll inevitably need to use at some point.
4. He could halt outreach and enrollment assistance funds for the Obamacare marketplaces, which would likely hurt signups near the end of open enrollment season.
5. Finally, Trump could revise what's known as the "HHS mandate," a guidance document from the Obama administration requiring employers to include all FDA-approved contraception in their insurance plans.
To the joy of social conservatives who oppose the mandate, the Supreme Court has required the administration to allow more businesses to opt out. But conservatives are still unhappy that the administration hasn't completely exempted any employer with a religious objection to birth control.