By Sy Mukherjee
September 29, 2017

Department of Health and Human Services (HHS) Secretary Tom Price resigned Friday following a scandal over expensive, private chartered flights that he rang up on the taxpayer dime—to the tune of more than $1 million—during his tenure. But Price’s brief legacy will have long-lasting consequences for Obamacare, the health law he sought to gut as both a former seven-term Republican Georgia Congressman and Trump administration Cabinet leader during the past eight months.

Price’s resignation may not be much of a surprise, considering the cascading reports from Politico journalists Dan Diamond and Rachana Pradhan finding that he used private and military jets to make cross-country trips that included visits with family and friends. President Donald Trump reportedly became infuriated with the reports and announced earlier in the day that he would make a decision on Price’s future Friday evening, even after Price pledged to pay back $52,000 to the government with a personal check. Trump has accepted Price’s resignation.

But although the bad publicity and accusations of hypocrisy likely drove Price’s departure–he has long been a self-proclaimed small government, fiscal conservative–Price and Trump were eye-to-eye on one of the GOP’s most persistent political goals: Dismantling Obamacare. And Price’s HHS took major steps to unilaterally hobble the health law over the past eight months while the Republican-controlled Congress has continually failed to pass Obamacare repeal legislation.

MORE: Tom Price Left Out Two Key Words in His Private Jet Apology: ‘I’m Sorry’

Immediately after coming into office in January, the Trump White House and HHS rolled back several Obamacare rules, such as postponing certain mandates on employer coverage and scaling back the open enrollment period for signing up for insurance under the law.

Some experts argued that those changes—as well as a last-minute decision to entirely pull federal Healthcare.gov advertising funding in the critical, final three-week stretch of 2016 Obamacare open enrollment—likely drove down the number of young people signing up for Obamacare plans. Fewer young (and presumably more healthy) enrollees means higher premiums for everyone in the markets.

Trump himself has also continuously threatened to cut off key insurance company subsidies meant to lower out-of-pocket medical costs for poor Americans. Multiple health insurers have specifically singled out the uncertainty from these threats as a reason for exiting Obamacare markets.

But perhaps the largest effect Price has had on Obamacare stems from the persistent political war he has waged against the program, since the department he oversees is directly responsible for implementing it. Price’s disdain for the Affordable Care Act has never been a secret. However, with a heavily-shortened 2018 Obamacare open enrollment season slated to begin November 1, HHS has taken steps to actively discourage signups—a move that some say is unprecedented for an administrative agency. For instance, HHS is reportedly ditching enrollment events in the dozens of states that manage their own individual health insurance marketplaces (rather than directly through the federal exchange).

And Price used his social media accounts to send out a string of political videos and memes criticizing Obamacare, potentially undermining the program under his official purview, Congressional Democrats have argued.

The persistent chaos and open antagonism to Obamacare has convinced many major insurance companies that it’s not a business worth investing in, at least for now.

But that dynamic may change with Price’s departure and the recent failure of yet another Obamacare repeal effort, the so-called Graham Cassidy bill. A bipartisan duo of Senators who lead a critical Senate health committee are reportedly close to hashing out a deal to stabilize Obamacare markets. But, as Price proved during his time as HHS Secretary, unilateral administrative decisions by his replacement will also have a big part to play in the health law’s success or demise.

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