The order included a directive to federal agencies to end rules forbidding employers from using health reimbursement arrangements (HRAs) to pay individual insurance premiums.

The order set out interim procedures in anticipation of repeal of the Patient Protection and Affordable Care Act (popularly known as the ACA, or Obamacare).

[13] On May 4, 2017, the United States House of Representatives voted to pass the American Health Care Act of 2017 (ACHA) by a narrow margin of 217–213, sending the bill to the Senate for deliberation.

[29] On September 13, 2017, Senators Graham, Cassidy, Heller, and Johnson released a draft amendment to the bill[30] that "repeals the structure and architecture of Obamacare and replaces it with a block grant given annually to states".

[34] Senator Rand Paul, who attended the signing, described the order as "the biggest free market reform of health care in a generation.

Section 1, title "Policy", lays out the policies supporting the provisions of the order, noting that the order directs that the government "facilitate the purchase of insurance across State lines" and prioritizes "association health plans (AHPs), short-term, limited-duration insurance (STLDI), and health reimbursement arrangements (HRAs)".

A separate decision on the same day commonly associated with the executive order resulted in no longer paying the cost sharing reduction (CSR) subsidies, which are payments to insurers to keep premiums down for low-income persons.

Other elements alleged to be part of the sabotage strategy include denying funding not mandated by law for cost sharing reduction (CSR) subsidies, significantly reducing funding for enrollment advertising and support efforts, asserting that the ACA exchanges are in a "death spiral" (contrary to CBO conclusions), and conducting negative advertising campaigns, among other measures.

[38] Journalist Sarah Kliff wrote that: "Trump announced last week he would stop making [CSR] payments.

[39] Journalist David Leonhardt wrote on October 15, 2017: "Last week, the administration took several steps to deprive people of health insurance.

He continued: "When [the executive order] takes full effect, it will most likely allow a variety of cheap insurance plans that don't cover many treatments.

[40] According to The Economist, Trump's plans "are likely to end up inflicting the most pain on self-employed, middle- to upper-income folk—in other words, on a Republican constituency".