With the attempt to repeal and replace Obamacare in ruins in the Senate, President Donald Trump is mulling what actions he can take on his own to address the dysfunction that the Affordable Care Act has wrought on the American health care system. He is already thinking of incentivizing Congress to have another go by cutting off subsidies to insurance companies and for congressional health care plans.

Those initiatives would have the effect of accelerating the death spiral taking place in the Individual Health Insurance markets and imposing on members of Congress, their families, and staffs the pain of Obamacare other Americans are suffering.

Now, according to Reuters, Trump is contemplating an executive order that would reform how individual markets work by transforming them into group markets.

How the reform would work

The executive order President Trump is contemplating would be to allow groups to form health care associations. The way such an arrangement would work would be a group, say a professional association, to offer group health insurance. The associations would be able to negotiate better deals with insurance companies much like employers have been able to do. Instead of having to buy an individual health insurance policy with impossibly high premiums and deductibles, people who do not get insurance through an employer or the government can have options that they hitherto did not have.

The limits of executive authority

To be sure, the Affordable Car Act gives the executive branch broad discretion on how to shape health insurance policies. However, even if Donald Trump were to demonstrate the flagrant disregard for the Constitution that his predecessor harbored, his powers to fix Obamacare are somewhat limited.

On the other hand, the political effects of even limited executive actions cannot be overestimated. Trump could claim with some justification that he is acting while Congress is in gridlock. His popularity will be enhanced and, if the strategy works, Congress will be shamed into finally acting. Democrats, who accepted numerous usurpations of legislative power, will hardly be in the position to complain,

What comes out of Congress will not likely be called repeal and replace.

That phrase seems to be a stench in the nostrils of Democrats, even though millions are suffering from the Obamacare system they are so steadfastly defending. However, for any reform bill to work, it will have to constitute much the same thing. If the scenario plays itself out as expected, Trump will have snatched victory from the jaws of defeat. Such is the strange politics of health care reform in the United States.