The Affordable Care Act is not dead yet. Even if Republicans have a reconciliation bill repealing portions of the ACA ready for President Trump to sign on January 20, it seems likely that they will delay the effective date of the legislation for several months or perhaps several years so as to leave themselves time to produce a replacement. Presumably President Trump will want to see results sooner than that. What can he do to dismantle the ACA on Day 1?

I imagine that lawyers on the Trump transition team have been puzzling over this question for the last month. I am not a health law expert, and President-elect Trump hasn’t asked me for my thoughts on the matter. But if he did, I’d tell him: The ACA isn’t so easy to undo through the exercise of executive power.

For purposes of this post, I’ll focus on five moves that others have suggestedTrump might make in the early days of his presidency: (1) dropping the Obama administration’s appeal to the D.C. Circuit in House v. Burwell; (2) halting reinsurance payments to insurers; (3) blocking any settlement of the risk corridor lawsuits; (4) granting waivers to states under section 1332; and (5) changing the definition of “essential health benefits” through regulatory action. In brief: (1), (2), and (3) are all within the President’s power, but they won’t accomplish much. Option (4) would run aground on the shoals of judicial review, if not before then. And (5) might be possible legally, but it would be disastrous politically.

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