President Donald Trump planned Thursday to move forward in changing U.S. health care by signing an executive order aimed at expanding low-cost insurance options, which critics say will leave some with skimpy coverage and hurt already-struggling insurance markets.

This step would signal a shift in the administration’s strategy, which relied on Congress to repeal the Affordable Care Act. Trump is now using the force of his executive rule-making authority to implement long-favored GOP policy alternatives.

“With Congress the way it is, I decided to take it upon myself,” Trump said in remarks at the White House earlier in the week. Senate Republicans failed within recent months to pass legislation to overhaul the ACA.

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