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November 21, 2012

The Power to Block the Affordable Care Act: What Are the Limits?

JAMA. 2012;308(19):1975-1976. doi:10.1001/jama.2012.51175

Health care reform remains precarious in the United States, with intense political disagreement about the Affordable Care Act (ACA). Former Governor Romney vows to “repeal and replace” President Obama's signature domestic achievement.1 Although repeal would face potentially insurmountable political barriers,2 a Republican president could selectively enforce the ACA, effectively blocking full implementation. The president has wide discretion in implementing legislation, so understanding the scope of executive powers is important—not only for the ACA but also for a broad range of social welfare legislation.