REVEALED: Trump's 10-step plan to dismantle Obamacare

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Presidents Donald Trump and Barack Obama

• An early Trump administration plan to dismantle Obamacare via executive action was released Wednesday.
• The list was designed to show conservative members of the Republican conference how the Trump administration would take apart the healthcare law outside of congressional action.
• The list includes seven provisions that have already been enacted - like shorter open-enrollment periods - and a few that have not, like "skinny" Obamacare exchanges.

Republicans have so far failed to repeal and replace the Affordable Care Act in Congress, but President Donald Trump's administration appears to be in the process of enacting an early plan to undermine the law on its own.

Politico's Jennifer Haberkorn reported that former Health and Human Services Secretary Tom Price attended a meeting with lawmakers last year, bringing with him a one-page document that listed 10 steps the Trump administration planned to take to dismantle the law.

The steps do not need congressional approval and were designed to help reshape the seminal healthcare law without input from Congress.

HHS has already implemented many of the seven of the 10 proposed changes listed, such as cutting the open-enrollment period for federal Obamacare exchanges in half during Trump's first year in office.

According to Politico, the 10-step list represented an attempt to win over conservatives during the repeal and replace fight. Some members, such as the House Freedom Caucus, insisted on a full-repeal strategy rather than the bill Republican leaders pushed.

The list provided a way to show reluctant members that the bill, which was called the American Health Care Act, was not the only measure for dismantling Obamacare that the Trump administration was pursuing.

Many advocates for Obamacare and health policy experts said that the changes on the list could undermine some of the protections afforded by Obamacare, destabilize the exchanges, and cause an increase in the number of uninsured.

The document was obtained by Democratic Sen. Bob Casey via a request to HHS. Casey originally heard about the document from media reports last March.

Here's a rundown of the 10 steps on the document:

1. Restrict special enrollment periods: Require stricter identification requirements for people signing up for Obamacare plans outside of open enrollment. (Enacted)
2. Back pay of premiums during grace periods: Allow insurers to collect prior unpaid premiums when a person reenrolls with an insurer after dropping their coverage.
3. Shorten open enrollment: Decrease the length of the open enrollment period. The enrollment window for the federally run Healthcare.gov exchanges was trimmed to six weeks in 2017 from 12. (Enacted)
4. Network adequacy oversight: Instead of federal oversight to ensure all Obamacare providers had sufficient networks of doctors and providers, HHS wanted to give that oversight power to the states. (Enacted)
5. Roll back Essential Health Benefits: EHBs are 10 baseline types of care that must be covered by any Obamacare plan for it to qualify for sale. HHS wanted to give the oversight authority to determine what qualified as satisfying the EHB requirements to the states. (Enacted)
6. Speed up the Section 1332 wavier approval process: These waivers allow states to modify Obamacare exchanges or bypass some regulations if they can show the changes will improve costs and coverage in their state. HHS wanted to make this process faster and less rigorous. (Enacted)
7. Regulate steering of patients from Medicaid to ACA plans: HHS wanted to crack down on insurance brokers and providers telling patients to sign up for plans through the exchanges instead of through Medicaid or Medicare.
8. "Permit lower cost direct enrollment pathways for issuers, brokers, and states": While this is vague, it appears to be designed to loosen restrictions on methods that non-federal groups could enroll people in plans. (Enacted)
9. Loosen rules on benefit design: Allow insurers more options on how to structure pricing for certain health benefits. (Enacted)
10. "Encourage states to build 'skinny' exchanges": While vague, this appears to be a possible rule to allow states to enlist more private sector assistance in setting up Obamacare exchanges with less robust offerings.