Early last year as an Obamacare repeal bill was flailing in the House, top Trump administration officials showed select House conservatives a secret road map of how they planned to gut the health law using executive authority.

The March 23 document, which had not been public until now, reveals that while the effort to scrap Obamacare often looked chaotic, top officials had actually developed an elaborate plan to undermine the law — regardless of whether Congress repealed it.


Top administration officials had always said they would eradicate the law through both legislative and executive actions, but never provided the public with anything close to the detailed blueprint shared with the members of the House Freedom Caucus, whose confidence — and votes — President Donald Trump was trying to win at the time. The blueprint, built off the executive order to minimize Obamacare’s “economic burden,” that Trump signed just hours after taking the oath of office, shows just how advanced the administration’s plans were to unwind the law — plans that would become far more important after the legislative efforts to repeal Obamacare failed.

Sen. Bob Casey (D-Pa.) obtained the one-page document from the Trump administration last month after blocking three of the administration’s health nominees to get it. Casey, who shared it with POLITICO, called it a list of options for “sabotage.”

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“The primary problem here is government officials, government agencies, were taking steps that would lead to fewer people having coverage and erecting barriers to people having coverage,” he said. “In addition to that, you have kind of a closed-door, back-room slimy deal here that should trouble anyone.”

The document lists 10 executive actions the Trump administration planned to take to “improve the individual and small group markets most harmed by Obamacare.”

Those include calling for stricter verification of people who try to sign up outside of the open enrollment period; cutting the sign-up period in half; and giving states authority to determine whether insurers had to cover the full range of benefits required by Obamacare and whether their networks of doctors were sufficient.

Those policies are among seven proposals in the plan that have since been implemented. Four of the ideas and a portion of a fifth had been publicly proposed but not yet finalized when the document was shared.

HHS on Thursday said it is committed to all legal actions to provide Americans “relief and access to affordable healthcare" and did not weigh in on whether the agency plans to implement the remaining policies.

“Under the Trump administration, HHS has been and remains committed to any and all actions, within the confines of the law, to provide relief and access to affordable healthcare for all Americans,” said HHS press secretary Caitlin Oakley.

Obamacare supporters opposed many of the changes after they were publicly released, arguing they would undermine consumer protections and make it harder for some people to obtain insurance coverage.

The document also said the administration would encourage states to build less robust exchanges than required by Obamacare and prevent health care providers from steering patients to Obamacare plans instead of to Medicaid — two policies that have not yet been enacted.

The document was a key part of a March 23 meeting in House Speaker Paul Ryan’s office among top Trump officials, including budget director Mick Mulvaney and then-HHS Secretary Tom Price, and several members of the conservative House Freedom Caucus. The House was about to vote for the first time on a bill to repeal Obamacare but conservatives were balking; they thought the bill didn’t go far enough to undo the health law.

Administration officials used the document to make the case that the legislation was just the first part of their repeal plan. Executive actions would be the second. But conservatives wouldn’t budge and the next day, Ryan pulled the bill. The House ultimately passed a repeal bill two months later, in May.

House Freedom Caucus Chairman Mark Meadows said it is routine for the administration to share its plans.

“It was shared — probably with a lot more emphasis — with the Freedom Caucus because there was a lot more concern with the inadequate nature of the original bill,” Meadows said Wednesday.

“I would say it’s not inappropriate,” Meadows added, pointing out that before Trump took office, the North Carolina Republican sent him a list of 300 regulations he’d like to see rolled back as “suggestions.”

Through the campaign and into 2017, the Trump administration and Republicans on Capitol Hill made no secret they intended to do all they could to repeal the health care law. Hours after he was sworn in, the president signed an executive order instructing his government to pursue Obamacare changes. But the order, as well as speeches and public comments by Trump and administration officials, often lacked many specifics.

Casey obtained the document last month after he placed a legislative hold on three HHS nominees — Robert Charrow for general counsel, Matthew Bassett for assistant secretary of legislation and Brett Giroir for assistant secretary for health. The holds effectively froze the nominations from being brought to the Senate floor for a confirmation vote.

Casey said he issued the holds after months of fruitless back-and-forth between his office and HHS in an attempt to obtain the document, which was first reported on in a March POLITICO story.

Barbara Pisaro Clark, HHS' acting assistant secretary for legislation, confirmed in a letter to Casey that the document was used in the March 23 meeting between Price and House lawmakers.

“We are not aware of any other Department of Health and Human Services materials being utilized during the meeting,” she wrote.

