The GOP backup plan, according to President Trump, has always been to “let [Obamacare] be a disaster,” and blame Democrats for its failings while moving on to other elements of the Republican policy agenda. Ryan seemed to agree on Friday, although not in as cynical terms, saying during a press conference that “the worst is yet to come with Obamacare.” He warned of its imminent collapse via a “death spiral.” There is, as of yet, no evidence that such a death spiral exists.

But a combination of deliberate legislating and purposeful neglect on the part of Republicans might change that. Even now, several administrative departments and agencies, including the Department of Health and Human Services and the Centers for Medicare and Medicaid Services, are operating under a day-one executive order from Trump directing them to “minimize the unwarranted economic and regulatory burdens of the [Affordable Care] Act.” That order doesn’t need any congressional action to give officials wide latitude to reduce the number of people covered under the ACA and weaken the web of policies that hold the law together.

While Health and Human Services Secretary Tom Price and CMS Administrator Seema Verma still can’t step out of their regulatory and administrative roles as defined under the ACA, their roles are very broad. They can make decisions that achieve Trump’s goal of reducing spending and government involvement in health care. HHS and CMS can execute several possible policies that can slough low-income people from insurance coverage and weaken Obamacare overall. For one, the administration is pretty free to exempt large groups of people from the individual mandate via “hardship exemptions.” Or it could allow more insurers to provide coverage plans in the exchanges that don’t meet federal standards—essentially permitting some relaxation of the very “essential health benefits” provisions that tripped up the AHCA. Relaxing the individual mandate and the value of insurance that exchanges offer could result in the very death spirals that Ryan warns about. That’s because insurers will still be forced to cover sicker people with pre-existing conditions, even as healthy people leave markets by exemption or choose less comprehensive plans.

Within Medicaid, Verma has broad power to oversee the shape and form of state Medicaid programs. While she can’t make the kind of sweeping dictates mandating changes to the program that Congress can, via the Medicaid 1115 waivers she can approve state plans that deviate significantly from traditional Medicaid. One provision that seems certain to come up for review by Verma’s agency is a controversial work requirement that several states wish to implement. CMS has so far been unkind to work-requirement requests, which mandate that Medicaid enrollees must have a job to receive government benefits. But Verma’s former consulting firm helped craft some of those very requests, and she already signaled vague support for work requirements in a letter she and Price sent to governors. It noted that the agency intends to “approve meritorious innovations that build on the human dignity that comes with training, employment, and independence.”