President-elect Donald Trump's promise to repeal the Affordable Care Act raises a host of questions for health-insurance companies and consumers.

The uncertainty has left health-policy wonks dissecting Republican replacement plans and trying to parse Trump's statements about the elements of the law he'd like to keep in place.

Oscar Health, a start-up insurance company that has been valued at $2.7 billion, grappled with the uncertainty last week. In a blog post, its founders acknowledged the unknowns: “Though the precise nature of these changes has not yet been determined, we believe it is important to set forth Oscar's observations on the health care landscape.”

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A co-author of that blog post happens to be Joshua Kushner — the brother of Ivanka Trump's husband, Jared Kushner. The brothers are business partners in an online real estate investment site. Oscar is named after the Kushners' great-grandfather. And Jared Kushner, the New York Times has reported, is in discussions about taking a formal role in the Trump administration, which could test a federal anti-nepotism law.

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The Trump family's many business ties have already raised questions about possible conflicts of interest that are without precedent in American presidential history. Trump's plan for his children to run his companies has been criticized over concerns of potential conflicts.

It's even harder to know what to make of the fact that Trump has a relative whose company's fortunes will depend, in part, on what comes next in health care. Before the election, Esquire reported that Joshua Kushner, who also founded the venture firm Thrive Capital, was a lifelong Democrat and was unlikely to vote for Trump. A spokesman for Kushner declined to make any comments about his relationship with the incoming administration.

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What is clear is that this is yet another relationship that Trump may have to carefully navigate as president, particularly since repealing the Affordable Care Act and replacing it is a major priority. Oscar started out selling insurance to individuals, and in the blog post, Kushner and company co-founder Mario Schlosser said that the company “undoubtedly” benefited from President Obama's signature health-care law, although they also note it has many shortcomings.

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“It’s not unusual for the relatives of either the president or his family or other senior administration officials and cabinet secretaries to have business interests,” said Trevor Potter, president of the Campaign Legal Center and a former chairman of the Federal Election Commission. “There are conflict-of-interest rules in place to ensure that those individuals do not take advantage of those relationships in an improper way. ... Normally, once an administration is up and running, the White House counsel and the ethics people would make sure that any contacts were carefully thought through and screened, so as not to present the appearance of improper access or influence.”

Even the appearance of a conflict is something against which presidents must guard. In 1988, as a candidate for president, George H.W. Bush wrote to his son George W. Bush warning that friends might be calling him with favors, asking to be connected to people within the federal government.

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“My plea is this: please do not contact any federal agency or department on anything. A call from a 'Bush' will get returned, but there is a great likelihood that it will be leaked; maybe deliberately misrepresented,” Bush wrote.

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A question to the Trump administration about the possible conflict of interest was not immediately answered.

Oscar, in the meantime, is airing its views on the future of health care. Schlosser and Kushner emphasize in their post that the company is not solely dependent on the Affordable Care Act's marketplaces, which they call “a gateway” into the broader business of selling consumer-friendly insurance. The company is expanding next year into the business of selling insurance to employers.

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“We can’t speculate on what the election outcome means for the health care industry. Fundamentally, we hope and expect that the new administration will keep the spirit of consumer choice and competition alive in the marketplace, which is a world where we have done pioneering work — and, are ultimately both prepared and motivated to participate,” Oscar spokeswoman Anne Espiritu wrote in an email.

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Some have questioned how Trump can support one popular provision of the law — a prohibition on denying insurance coverage to people with preexisting conditions — without an unpopular provision — a mandate that individuals carry insurance. But Oscar's co-founders say they see a way forward.

“An individual market that bars lifetime limits and denial of preexisting condition coverage can be made to work through a smart combination of continuous coverage provisions and tax credits,” Kushner and Schlosser wrote. “The battle to improve American health care was never intended to be a speedy endeavor, and will remain critical despite policy changes. We’re in this for the long haul.”

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