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How Trump Can Repeal Obamacare Step by Step

The future of President Obama’s signature health care law is in jeopardy.

After Donald Trump’s victory in the 2016 presidential election, dismantling Obamacare is expected to be one of the president-elect’s top priorities. Trump suggested he may be willing to keep portions of the health care system in place, but that doesn’t mean he won’t push for significant cuts.

Either way, this could bring about significant changes to the way you search for health insurance.

Trump’s plan to gut Obamacare will be boosted by the Republican majority in Congress. It remains to be seen how well the two sides will work together on Capitol Hill, but one thing they all agree on is their distaste for President Obama’s health care law.

Congress passed Obamacare in 2010 without a single Republican vote, and under Trump it may very well take apart the health care law without a single Democratic vote.

Step by step process to repealing Obamacare

How exactly will this all happen? For this, you'll probably need a refresher course in high school civics, but we'll try our best.

It’s important to remember that the president doesn't have the power to do whatever he wants with legislation. Trump will have to coordinate any repeal of Obamacare with Congress.

That task was simplified when Republicans, who also want to repeal Obamacare, maintained control of the Washington trifecta — White House, Senate and House of Representatives — for the first time in a decade.

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But it will still take time for the process to play out.

The new Congress comes to Washington the week of Jan. 3, and will have about two weeks to push through a bill to partially repeal Obamacare in time for Trump to sign a few weeks later on Inauguration Day.

Though Republicans control Congress, they do not have what’s known as a “super majority” in the Senate, which would give them enough votes to push through a full repeal of Obamacare. Senate rules require 60 votes to pass legislation, but Republicans will only have a slim majority in the upper chamber. There will be 52 Republicans and 48 Democrats, most of whom are certain to oppose any attempt to disband Obamacare.

That means Republicans will be forced to pursue a partial Obamacare repeal. There is an exception to the Senate’s 60 vote requirement for budgetary measures that specifically address spending.

These “reconciliation bills” only need a simple majority, or 51 votes, to pass. So Republicans believe they will have just enough votes to repeal the financial aspects of Obamacare.

That includes ending the subsidies that make health care affordable for low-income Americans, the employer mandate that requires large and mid-size companies to offer health insurance to their workers, the individual mandate that requires everyone who doesn’t have health insurance to pay a fine, the tax on high-quality health care plans and an expansion of Medicaid that covers millions of poor people.

But this partial Obamacare repeal would leave in place the requirement that insurers cover Americans with pre-existing conditions, and the provision that allows young adults under the age of 26-years-old to stay on their parents’ health care plans. Trump and Republican leaders have long suggested they support these provisions, so it may be a mute point.

Congress passed a similar reconciliation bill to repeal Obamacare last January, but it was vetoed by the president. With Trump taking the reins of the White House on Jan. 20, conservatives suggest this bill could serve as a starting point for Republicans, looking to quickly draft repeal legislation.

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The House does not have these same rules, and is expected to approve whichever Obamacare repeal bill the Senate passes.

Trump could pursue a complete overhaul of Obamacare, but that would take more time to push through Congress, and it is not clear whether Republicans would be able to muster enough Democratic support in Senate.

The question is how quickly Republicans will unite around a reconciliation bill and present it to Trump. The campaign shined the light on GOP in-fighting not only between Trump and congressional leaders, but also among Republican lawmakers from various wings of the party. This raises the possibility that Congress will not have an Obamacare repeal bill ready for President-elect Trump to sign on his Inauguration Day.

There’s little Trump could do on his own to dismantle Obamacare, though he may be able to cancel the health care subsidy payments for low-income Americans, which would discourage them from participating in the healthcare marketplace. Trump could also take steps to make life more difficult for insurers in an attempt to get them to drop out.

Obamacare repeal will take time

Let’s assume Republicans put aside their differences and rally together to present Trump with a bill to repeal Obamacare on his first day in office. What happens then?

Probably nothing, at least right away.

On the campaign trail, Vice President-elect Mike Pence suggested Republicans would give the public time to transition away from Obamacare. The reconciliation bill that Congress passed last year provided a two-year buffer before any of these Obamacare provisions were formally repealed. So if Republicans followed the same trajectory, that would protect Americans who rely on Obamacare until 2019.

And at the very least, anyone who has already enrolled for 2017 probably will not see their plans changed next year.

But repealing Obamacare is only the first step.

In the meantime, Trump will work with Congress to develop a new health care system to replace Obamacare.

Trump promised the process of switching Obamacare to a new system would be swift and painless, but critics doubt that. They say it could take years for Congress to pass a new health care system because Senate Democrats would need to support it. They’re concerned this could create a gap that millions of uninsured Americans would fall through.

In the end, a Trump victory is expected to be a major blow to Obamacare. Exactly how bad and when it will happen are the questions still up in the air.

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