Since the day it was signed into law, Obamacare has been on the defense. And in a Trump administration, it could actually be left in tatters. Only the Republicans don’t exactly have a health care plan to enact in its place. Their strategy: repeal and delay. They want to repeal Obamacare as quickly as possible, while giving themselves a two to three year grace period to come up with an alternative plan. In order to expedite the vote, House Republicans are taking advantage of the budget process, which eliminates the Democrats ability to filibuster. So what does that mean for healthcare? The GOP plans are scarce on information, but there are two major issues with the Republican approach. Obamacare created the which requires everyone — healthy and sick — to buy insurance. Remember: healthy people balance out costs and keep premiums low. Republicans want to abolish the mandate. That means healthy people are less likely to buy coverage and sick people would get stuck with higher and higher premiums. Insurance companies have adjusted their plans to Obamacare, but without a replacement, they don’t know how to prepare for the future. This uncertainty would likely lead companies to pull out of Obamacare’s state-level marketplaces. With fewer companies in the marketplace, premiums will rise. And so begins the spiral: competition decreases, premiums rise, more healthy people leave, and on and on and on… until the whole system collapses. Repeal and delay isn’t final yet and there are some Republicans who don’t want it to be. But in the meantime, at least 20 million people’s access to healthcare hangs in the balance.