Conservatives who railed against Barack Obama's vast powers to build up the Affordable Care Act declared vindication Saturday with President Donald Trump’s executive order to tear it apart. 
 
 "For me, it’s a mix of irony and schadenfreude," says Josh Blackman, a law professor who's written two books that criticized the Obama administration's implementation of the law. "I’ve warned for years that, with a new president in the White House, the exact same powers could be used for different purposes. That’s what we’re seeing now, to a T." 
 
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 Trump's order, which encourages Health and Human Services, the IRS and other agencies to work toward dismantling the ACA, doesn't confer any new powers on the executive branch. But Trump explicitly instructs his agencies to use their existing powers to weaken the law “to the maximum extent permitted by law,” regardless of congressional action to repeal it. 
 
 That could be devastating to Obamacare because the Obama administration relied on its executive authority to set up the law. 
 
 "Its implementation depended critically — and depends critically — on rules and guidance that HHS and other agencies have put out," says Nicholas Bagley, a University of Michigan law professor who supports the ACA. "There are literally thousands of decisions that had to be made" by the administration — and "any decision that the Obama administration had the discretion to make, in principle, the Trump administration can revisit." 
 
 A big, complex law always requires a lot of the details to be filled in through regulation, but that was particularly true of Obamacare. The version that squeaked through the Senate in December 2009 wasn’t meant to be final; the bill’s authors’ expected to work with the House to smooth out language for a final version. 
 
 But when Republican Scott Brown won the Massachusetts Senate seat long held by Teddy Kennedy, the Senate Democrats lost their supermajority — and their chance to work out the kinks. That left a lot more for HHS and other federal agencies to fill in — which is now coming back to bite defenders of the law. 
 
 Many of the law's most controversial elements, like which Americans would be exempt from the mandate requiring most Americans to purchase insurance coverage, were administration decisions. Obama's HHS secretary was also empowered to flesh out the important details about the benefits that Obamacare insurance plans were required to cover, from mental health to maternity care. Even Healthcare.gov — the much-maligned website that turned into the linchpin of Obamacare enrollment efforts — was built out through executive authority. 
 
 The vast, and at times, legally questionable decisions undertaken by the Obama administration may also set precedent for the Trump administration to do the exact same thing. Both Blackman and Bagley agree the administration's 2013 decision to delay Obamacare's employer mandate was unlawful; House Republicans even sued, although their challenge was thrown out in court. Trump could now cite that delay as precedent for declining to enforce provisions that he dislikes. 
 
 The Trump administration could also issue a slew of waivers to exempt Americans from the ACA's individual mandate — although the Obama administration already broadened those exemptions in 2013, after the political outcry from Americans whose plans were canceled because they didn’t meet Obamacare criteria. 
 
 The "'like it, keep it' fiasco" set a precedent for Trump too, says Bagley. 
 
 At the time, the administration said it would give hardship waivers to Americans who had difficulties paying for coverage under the ACA. But "if you define the hardship as that, then every American is facing higher premiums because of the ACA, one way or another," says Blackman. “Obamacare is itself the hardship.” 
 
 House Republicans also sued and won an initial ruling over the Obama administration's payments to subsidize health care costs such as co-pays and deductibles for Obamacare enrollees under a certain income level. A federal court agreed the funds were illegally appropriated; the Obama administration appealed that decision. But Trump could discontinue the appeal, and hold that over Democrats in negotiations to replace the law: If he chooses to discontinue those payments, health insurers — which would be on the hook for those payments even if the government funding dried up — would probably flee the markets or jack up prices next year. Millions of ACA customers would likely see their premiums spike and their plans become unaffordable. 
 
 "If Trump were to stop the cost-sharing payments, he could send the individual insurance markets into an immediate tailspin," says Bagley. "It would be an extraordinary hit." 
 
 The Trump administration could also act quickly and issue less-dramatic guidance that maintains pieces of Obamacare but allows tweaks to make them more conservative. 
 
 The executive order issued by Trump just hours after his inauguration calls for giving states more power to shape health programs, and several Republican-led states have wanted to expand Medicaid but only if they could impose new restrictions, like requiring able-bodied beneficiaries to show that they were working or seeking employment, or to pay small premiums. The Obama administration had opposed these provisions, warning they would shift new costs onto the low-income Americans the program was meant to help. 
 
 “This is potentially quite significant to the extent that governors want to innovate their Medicaid programs,” says Lanhee Chen, former policy director for Mitt Romney’s 2012 presidential campaign. “But, ultimately, how far the action reaches will depend on whether President Trump is willing to use executive authority to gut Obamacare in the same way that Barack Obama used it to implement the law.” 
 
 Other elements of the law require more complex rule-making processes that would likely stretch a year or more. For instance, the Trump administration could revisit the 10 essential benefits now required to be covered through Obamacare health plans. Some conservatives want Trump to allow insurers to sell a mix of plans with less comprehensive coverage — but that would require a series of proposals and comment periods. 
 
 Paring back those benefits would make the ACA’s plans much less expensive. But it also would gut some of the protections conferred by Obamacare, like the mental health benefits that are currently covered in all plans. 
 
 "The Trump administration has to strike a delicate balance here," Bagley says. "If they don’t want to pull the rug out from under people, they have to be very cautious." 
 
 But the executive order makes "real policy commitments to providing regulatory relief — and those goals are in tension with each other,” he says. 

 The Trump administration may stop enforcing the Obamacare requirement that most Americans carry health insurance even before Congress repeals the law, Kellyanne Conway, a top adviser to the new president, said in interviews broadcast on Sunday. 
 
 Such a move would take the teeth out of former President Barack Obama’s health-care law and could destabilize insurance markets, analysts say. It was not clear from Conway’s remarks whether President Donald Trump would try to use his executive authority to make the change, which would be much faster than writing new regulations or waiting on lawmakers. 
 
 "What President Trump is doing is, he wants to get rid of that Obamacare penalty almost immediately, because that is something that is really strangling a lot of Americans, to have to pay a penalty for not buying government-run health insurance," Conway, whose title is counselor to the president, said Sunday on ABC News’s "This Week" 
 
 When host George Stephanopoulos asked her if Trump would "stop enforcing that mandate," Conway responded: "He may." 
 
 Coverage Gains 
 
 Trump campaigned on a pledge to repeal and replace the Affordable Care Act, a law he dubbed a “disaster.” The Obama administration estimated that it has led to about 20 million people who didn’t previously have health insurance gaining coverage, and the Congressional Budget Office said in a report last week that repealing the law without enacting an alternative policy would cause 32 million people to lose their insurance. 
 
 "We want to make very clear to everyone that those who are relying upon coverage will not lose it," Conway told Stephanopoulos. 
 
 On Friday, his first day in office, Trump signed an executive order declaring that his administration will seek “prompt repeal” of the law. The order also commanded federal agencies to try to waive or delay requirements of Obamacare that impose economic or regulatory burdens on states, families, the health-care industry and others. 
 
 That may have been a reference to the so-called individual mandate that requires Americans to carry insurance. Conway, in an interview broadcast Sunday on NBC News’s “Sunday Today With Willie Geist,” appeared to indicate that the law’s requirement that most employers offer coverage to their full-time workers would also end. 
 
 “We’re doing away with this Obamacare penalty,” she said in the NBC interview, which was conducted Thursday. “This tax has been so -- such a burden on many Americans. And it’s also been a burden on many small business owners, many of whom complained to us that that Obamacare penalty, along with so many other draconian regulations, are just a stranglehold.” 
 
 Limits of Orders 
 
 Presidents can’t use executive orders to end laws unilaterally, so it’s unlikely that Trump’s order would entirely end the Obamacare mandates, according to Timothy Jost, a professor with expertise in health law at Washington and Lee University School of Law and a contributor to Bloomberg View. But the administration could give more flexibility for people to avoid the requirement by saying it poses a hardship. 
 
 Undoing the ACA’s requirement that all people have coverage could destabilize the market. That’s because healthier people might choose not to buy health plans, leaving only sick people covered. If the administration doesn’t enforce the mandate, that could be enough to push some insurers from the market, according to California Insurance Commissioner Dave Jones. 
 
 “This executive order is likely to destabilize health insurance markets across the United States,” he said Saturday in a statement. 
 
 New York Governor Andrew Cuomo provided an early indication of how some states may push back on Trump’s pledge to undo the health law. On Saturday, he proposed rules requiring New York’s health insurers to cover birth control and medically necessary abortions, even if the President Barack Obama’s health-care overhaul is repealed. 
 
 Repeal and Replace 
 
 Ultimately, it’ll be up to Congress to repeal the health law and pass a replacement policy. Republican lawmakers have taken initial steps to begin repealing Obamacare using the congressional budget process, though they haven’t provided details on which pieces of the law will end or what they’ll enact instead. 
 
 Trump has said his administration will lay out its replacement plan once his nominee for Health and Human Services Secretary, Representative Tom Price of Georgia, is confirmed. Price faces a hearing on Tuesday before the Senate Finance Committee, which will then vote on whether to put his nomination before the full Senate. 
 
 Republicans have faced questions about whether their health policy will result in Americans losing insurance coverage, particularly those who buy plans with subsidies in the new markets created by Obamacare, and those who are covered in the law’s expansion of Medicaid. Conway joined Trump in saying that people will keep their plans, though she qualified her remarks. 
 
 “President Trump has said that people will not go without coverage. And he means that,” she said in the NBC interview. She later said that “there will be ways for people to access affordable, quality health insurance if they’d like to get it.” 
 
 Taking Ownership 
 
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 Conway mentioned two features of Trump’s Obamacare replacement. She said Medicaid funds will be provided to states in the form of block grants. And she said the plan will include health-savings accounts, which are a way for people to put aside money to pay for health expenses with tax advantages. They’re typically linked to high-deductible health plans, and are already available under the Affordable Care Act. 
 
 Conway said those accounts would lead to individuals taking more ownership over their health-care choices. 
 
 “Very few people take the car to the car wash before they return it to the rental station,” she said. “You don’t have ownership of it. And this way you do. It’s a great analogy, actually, so that people can understand what it means to have a health savings account.” 

 President Trump's executive order on Obamacare Friday reaffirmed his commitment to dismantle the health reform law. But it could have little tangible impact on the law... at least initially. 
 
 The order directed the Health and Human Services secretary and the heads of other agencies to minimize the financial burden of Obamacare on Americans, states, insurers, health care providers and others to the maximum extent permitted by law. 
 
 Therein lies one of the main hurdles to quickly taking down the Affordable Care Act. Much of Obamacare is controlled by law or by a hefty slew of regulations that an executive order can't undo with the stroke of a pen. 
 
 What the Trump administration can do is tinker with the guidance that enables agencies, states, insurers and others to actually implement Obamacare. Also, the Health secretary can be more liberal with his use of waivers in order to loosen some provisions or allow states to tailor their implementation of certain aspects of the law, particularly Medicaid expansion. 
 
 Related: Trump issues executive order to start rolling back Obamacare 
 
 "It's a mix of symbolic arm waving (lacking more specific and targeted details) and directional guidance to empower Trump administration officials to lean against more regulation on the margin," said Tom Miller, resident fellow at the American Enterprise Institute, which has long opposed Obamacare. "What remains unclear is how far they can go before they bump up against clearer statutory requirements and existing final regulations." 
 
 Here are some examples of what the executive order could do: 
 
 Loosening guidance: The Health secretary -- Trump's pick Tom Price has yet to be confirmed -- could revise the guidance they've issued to carry out the Affordable Care Act's regulations. 
 
 Even more so than many other laws, Obamacare has largely been implemented through regulation and the Obama administration continued to make adjustments for years, delaying some provisions such as the mandate that employers provide affordable policies, tightening the rules on who can still sign up for coverage after open enrollment ends and revising the risk formula that governs how insurers are compensated if they have a large share of sicker and costly enrollees. 
 
 Related: Why it's so hard to replace Obamacare 
 
 Trump appears to be taking aim at the individual mandate, which requires that nearly all Americans get insurance or face a penalty. 
 
 "What President Trump is doing is, he wants to get rid of that Obamacare penalty almost immediately, because that is something that is really strangling a lot of Americans to have to pay a penalty for not buying," Kellyanne Conway, Trump's senior adviser, said on ABC News "This Week" on Sunday. 
 
 His administration might loosen the criteria for qualifying for a hardship exemption, which would allow more people to remain uninsured without paying a penalty. 
 
 However, experts said he cannot simply waive the mandate or penalty or broaden the exemption so much that it essentially nullifies it without facing lawsuits. Also, weakening the mandate too much could prompt healthy people to stop buying coverage, which could prompt insurers to pull out. 
 
 Under the order, officials could also opt not to impose penalties for certain infractions of Obamacare provisions. For example, some companies, particularly small businesses, used to provide workers with money to buy their own individual health insurance. Under Obamacare, those employers can be slapped with a penalty of $100 per day, per person. Trump could suggest to his new IRS commissioner that enforcing the rule is counterproductive and a waste of resources, especially when Congress plans to replace Obamacare. 
 
 Granting more waivers: Trump's executive order also directed agencies to provide greater flexibility to states to run their own health care programs. 
 
 The Obama administration already granted states waivers allowing them to tailor the way they administer Medicaid expansion. For instance, it allowed some to charge premiums and co-pays. Under Trump, more will likely be allowed to require participants to work -- a request Obama officials never granted. (States will still have to apply for these waivers and the Centers for Medicare and Medicaid Services must review them, a process that could take months.) 
 
 Yet, another major obstacle to delivering swift blows to Obamacare is Trump and Congressional Republicans' repeated promises not to leave millions of Americans without insurance. 
 
 Related: How Trump could use his executive power on Obamacare 
 
 "For the 20 million who rely upon the Affordable Care Act in some form, they will not be without coverage during this transition time," Conway said on Face the Nation Sunday. 
 
 That vow limits the extent to which Trump can upend the law's provisions. Changing them too much or injecting too much uncertainty into the market could prompt health insurers to flee next year, which might leave some Americans without options and others forced to pay higher premiums. These are the very problems with the current law that Republicans criticize so they will be wary to take actions that exacerbate them. 
 
 The main lobbying organization for health insurers said only that it has been meeting with policymakers to offer its recommendations. 
 
 "There is no question the individual health care market has been challenged from the start. The president said he would take swift action, and he has," America's Health Insurance Plans wrote in a statement. "We look forward to working with the administration as well as members of Congress to ensure health care works to lower costs for all Americans." 
 
 While insurers are bound by contract to provide coverage in 2017, nothing requires them to continue next year. The carriers are in the final stages of determining their participation and rates for 2018, which they will file with state regulators this spring. They will be watching the administration's moves to make sure it doesn't do anything that leaves them with a pool of sicker and costlier consumers. 
 
 Related: Even as they repeal Obamacare, Republicans still have to fund it 
 
 "The short of it is that the Trump administration, by trying to bring relief to some consumers, could just as easily further undermine the already shaky Obamacare risk pool," Robert Laszewski, an Obamacare opponent who runs Health Policy and Strategy Associates wrote in a blog post Sunday morning. 
 
 The real work of undoing Obamacare, however, will likely proceed along a two-track system -- through changing regulations at agencies and passing new laws in Congress. Both of those will take more time, especially considering Price has yet to be confirmed and Republican lawmakers remain divided on how to repeal and replace President Obama's landmark health reform law. 
 
 Related: Why GOP governors like Medicaid under Obamacare. Hint: $ 
 
 The Trump administration can make changes to Obamacare's regulations. But this requires an agency to publish the proposed changes, allow the public to comment and then write a final rule, a process which can take up to two years. 
 
 Meanwhile, Republicans in Congress are already on the path to repealing major provisions of Obamacare, though they have yet to decide how and when to come up with a replacement plan. Even after they pass a law changing Obamacare, it could take two or three years for the agencies to pass new regulations and then insurers to come up with new policies to offer consumers. 

 Joshua Roberts/Reuters 
 
 There’s a growing sense among Republican leaders in Congress that they need to be cautious about repealing and replacing Obamacare in order to avoid causing unintended havoc in the health insurance market. Tennessee's Lamar Alexander, who heads the key Senate Committee on Health, Education, Labor, and Pensions, has argued, for instance, that lawmakers should only do away with the Affordable Care Act once there is a new set of “concrete, practicable reforms in place” to supplant it. 
 
 
 
 Donald Trump, though? Our new president isn't so into caution. Right now, he appears to be debating a move that could dynamite the foundations of the whole individual market. 
 
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 This story began to unfold Friday evening, when Trump issued an executive order instructing agencies to roll back bits of Obamacare wherever possible. It told regulators to “waive, defer, grant exemptions from, or delay” provisions of the legislation to the “maximum extent permitted by law.” Practically speaking, it didn't do a lot; the document merely made it formal administration policy to enforce the rules using a light touch. But some industry experts worried that, by signaling his intentions to dismantle the Affordable Care Act administratively, Trump had tossed a “bomb” of uncertainty into the already-wobbly individual insurance market that could frighten away carriers. 
 
 Turns out, they were right to be concerned. On Sunday, presidential adviser Kellyanne Conway said that Trump might stop forcing Americans to either buy insurance or pay a tax penalty, as required under Obamacare's individual mandate. Per Bloomberg: 
 
 
 
 "What President Trump is doing is, he wants to get rid of that Obamacare penalty almost immediately, because that is something that is really strangling a lot of Americans, to have to pay a penalty for not buying government-run health insurance," Conway, whose title is counselor to the president, said Sunday on ABC News’s "This Week" 
 
 When host George Stephanopoulos asked her if Trump would "stop enforcing that mandate," Conway responded: "He may." 
 
 It is hard to overstate how destructive this decision could be. The individual mandate is Obamacare's keystone—that's why conservatives challenged its constitutionality all the way to the Supreme Court when they were trying to kill health reform via judicial fiat. The rule is designed to make enough healthy Americans buy coverage so that carriers can still make a profit while paying claims on the older, sicker, more expensive patients they're required to insure under the legislation. It's not clear exactly how effective the mandate has been up to this point, but without it, Obamacare's markets would likely fall into complete disarray. A recent Congressional Budget Office report suggested that killing the rule without undoing the ACA's other regulations would leave millions uninsured, send premiums rocketing an additional 20 to 25 percent, and cause insurers to flee the market. 
 
 It is unclear how far Trump could curtail the individual mandate without Congress' help. But regulators can already grant exemptions to it in cases where paying for insurance would cause someone significant hardship. The rule is designed to be flexible, so the new administration could choose to give out relief more generously. Over time, it could also water down the rule by rewriting it. 
 
 But the technical issues of how Trump might try to undermine the mandate may be less important than the basic yes-or-no question of whether he intends to kill it. If the answer is yes, then we might see a mass exodus of insurers from the market hoping to get out before things truly get ugly. 

 President Trump took little time to begin targeting ObamaCare. 
 
 On Friday, hours after being sworn in, he signed an executive order that directs federal agencies to ease the "regulatory burden" of the law. 
 
 The order, though, came with few specifics, and all eyes are on the practical effects going forward. 
 
 And there could be more actions to come, with Kellyanne Conway, a top Trump adviser, saying the administration could stop enforcing the ObamaCare mandate that Americans get health insurance. 
 
 Republicans also have set their sights on ObamaCare's essential health benefits, which set standards for the healthcare services insurance plans must cover. 
 
 The Trump administration has some leeway to loosen those rules, which Republicans say would lead to cheaper, less comprehensive plans becoming available. 
 
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 The administration could also cancel ObamaCare payments known as cost-sharing reductions, which reimburse insurers for giving discounted deductibles to low-income enrollees. House Republicans argue the payments are being made unconstitutionally without an appropriation, but immediately canceling them would likely cause chaos in the market as insurers dropped out or hiked their premiums. 
 
 Meanwhile, Congress is vowing to plow ahead on repealing ObamaCare. Next Friday, Jan. 27, is the deadline set by the recently adopted budget for committees to produce their sections of the ObamaCare repeal bill. However, lawmakers have emphasized that there is no penalty for missing that deadline, and it seems likely that Congress will not make it. 
 
 Lawmakers still need to work out the details of the repeal bill and deal with concerns among many lawmakers about the need to have a replacement ready at the same time. 
 
 President Trump has also said that he wants repeal and replace to happen "simultaneously," though it will be a tall task to get a replacement bill ready anytime soon. 
 
 Rep. Tom Price (R-Ga.), the nominee for Secretary of Health and Human Services, will have his second confirmation hearing on Tuesday, this time before the Senate Finance Committee, which will actually vote on his nomination. 
 
 Democrats have been grilling Price over his trades of medical company stocks while a member of Congress, but Republicans have been defending him and there is no sign that he will not be confirmed. 
 
 At his first hearing, Price did not get into the details of any ObamaCare replacement plan, but spoke only in broad terms about wanting everyone to have "access" to coverage. 
 
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– President Trump's first executive order, issued Friday, went after ObamaCare, though the practical implications remain unclear. Trump instructed federal agencies to "waive, defer, grant ­exemptions from or delay" any aspects of the law that would "impose a financial burden." Some coverage of what that might mean: Perhaps the biggest issue at play is the fate of the individual mandate, which requires people to buy insurance, reports BuzzFeed. If agencies provide widespread exemptions, it could roil insurance markets. Indeed, Trump adviser Kellyanne Conway said Sunday that the White House may try to stop enforcement of the provision even before Congress acts, reports Bloomberg. If Trump kills or weakens the mandate, "it's hard to overstate how destructive this decision would be" to the law, per an analysis at Slate. It calls the mandate the "keystone" of the Affordable Care Act, but adds that it's not clear how far Trump can go on the matter without Congress. CNN provides examples of what Trump's executive order can do, including giving states more leeway on how they run their programs. One vulnerability of ObamaCare is that an unusually large portion of it is in place as the result of executive action rather than Congress, explains Politico. That's a result of Democrats losing their supermajority in the Senate with the election of Scott Brown in 2010. For now, Trump's action is the equivalent of tossing a "bomb" into the "already shaky" insurance market, a consultant tells the Washington Post. Congress, meanwhile, will continue working on repeal-and-replace legislation, but it's a safe bet that a Jan. 27 deadline for committees to present their particular sections of a new bill will be missed. The Hill takes a look at what's next on Capitol Hill.