The article examines the strategy of the administration of D. Trump and the Republican Party regarding the system of affordable medical insurance, which has become a key initiative and pride of B. Obama and the Democrats. Official assessments of the status of this program and the impact of the Republican administration initiatives on the US health system are given. The goal announced by the republican president - to abolish an expensive federal health care program – was not achieved because of opposition from some of the republican legislators. Failing to solve this problem legally, the administration of D. Trump embarked on the path of its smooth dismantling, using the mechanisms of the executive power.