What Lies Ahead For Obamacare In Donald Trump's Administration : Shots - Health News The president-elect has said he will ask lawmakers to repeal the Affordable Care Act. Or he can use regulations and the budget to dismantle the federal health law he calls "a disaster."

Trump Can Kill Obamacare With Or Without Help From Congress

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ROBERT SIEGEL, HOST:

Now that Donald Trump is headed to the White House, what happens to Obamacare? The president-elect has vowed to repeal and replace the 6-year-old health care law. Less clear is what would take its place.

Well, joining us now is NPR health policy correspondent Alison Kodjak to look ahead to health care under a Trump administration. And, Alison, first of all, can Donald Trump repeal the Affordable Care Act?

ALISON KODJAK, BYLINE: Well, with the support of the House and Senate which are remaining Republican, he could potentially just repeal the law as he has promised, but a straight repeal might encounter a Democratic filibuster - actually would likely encounter one. So he has some other ways that he could undermine the law or partly repeal it.

One is just changing the regulations that detail how the law is implemented to make them more compatible with his vision. Another is just not enforcing some of the policies, including the individual mandate.

And then lastly there is this court ruling that stands that takes away the subsidies - about half the subsidies - that people get under the law. It was a lawsuit filed by the House of Representatives a few years ago. And he could effectively just let that ruling stand rather than appeal it, which the Obama administration has done, and that would also destroy the Obamacare exchanges.

SIEGEL: Well, let's say that he does manage to either repeal or somehow kill Obamacare. What does he say he'll put in its place?

KODJAK: The proposals he's made during his campaign include replacing it with what's called health savings accounts, which are essentially tax-advantaged savings accounts to allow people to pay for their own health insurance, and to make health insurance premiums tax deductible, which he says will make everything more affordable.

In addition, he wants to allow insurance companies to sell insurance across state lines. That would make more competition and therefore, he says, lower premiums. Paul Ryan has also made a proposal. It's a little more detailed but has pretty much the same outlines. But above all, they would get rid of the mandate requiring people to buy health insurance.

SIEGEL: A lot of people have insurance because of the Affordable Care Act. What would happen to them? How does a President Trump move from one system to a post-Affordable Care Act system?

KODJAK: Yeah, well, that's a really good question, and it's left pretty unclear at this point. There are about 20 million people who have insurance directly because of the Affordable Care Act. About half of them have bought it through the exchanges, and about 10 million of them have it through Medicaid expansion. He hasn't really said what would happen with Medicaid if he were to repeal the law, whether states that have expanded Medicaid would have to reverse that expansion. So it's left unclear what will happen to those people.

In terms of what would happen to the people who have bought insurance through the exchanges, Mike Pence, his running mate and now vice president-elect, has said that they would phase out the subsidies over time to smooth the transition and allow people to find other ways to buy health insurance through these health savings accounts and other things. The only real comprehensive review of Donald Trump's proposals, however, says it will still leave millions of people uninsured.

SIEGEL: Alison Kodjak is NPR's health policy correspondent. Alison, thanks.

KODJAK: Thank you, Robert.

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