What Will Happen To The ACA Under A Trump Presidency?

Recently, Harvard professor of Public Health John E. McDonough wrote an article for the Scientific American that takes a hard look at what we can expect from the Affordable Care Act now that Donald Trump will be the next president. Given that the Republican Party has been one of the most outspoken and vocal opponents of the ACA legislation (also known as “Obamacare”), it’s safe to say that some significant changes are on the horizon. So, what can we expect to be different about our health care system in the near future? Let’s take a look.

Repeal, Replace, or Revise?

Exactly what will happen to the Affordable Care Act (ACA) is hard to predict — Donald Trump’s exact position on the legislation seems to be fluid, to say the least. However, it’s a reasonable assumption that the ACA will look much different moving forward. How exactly the GOP goes about altering the ACA seems to be the pressing question at the moment: will they seek to repeal, replace, or revise the ACA as it currently stands?

To repeal the ACA entirely seems unfeasible, according to Professor McDonough. That would require more votes than the Republicans have in Congress, despite their majority control. However, there is a loophole that allows the repeal of budget-related items within the legislation — and these repeals would not even be subject to filibuster.

In that case, what we may be looking at is more of a revision than a total repeal. What Trump and his party surrogates mostly dislike about the ACA are those very same budget-related issues, anyway. The expansion of low-income subsidies to cover the poorest Americans will undoubtedly be looked at as an area where funds may be removed or re-allocated.

What Items Might Remain?

Since the ACA probably won’t be completely deleted from the legislative books, it’s looking to be a good bet that many items will still remain from the existing legislation. In particular, Trump has recently signaled that he is in favor of certain aspects of the law. One of the things that the public has grown accustomed to (and likes) about the ACA is the provision regarding pre-existing conditions. Prior to the ACA, insurers could deny coverage to people with potentially very expensive pre-existing conditions. This created a financial nightmare for many families to go along with the medical one they were experiencing, and the ACA eliminated this problem.

Based on Trump’s comments and the fact that the pre-existing condition provision does not fall under a budgetary item that the GOP can attack, it’s very possible that this item will remain. Regardless, the likelihood that any substantial changes will take a while to see effect is very high. Blocks from congressional Democrats and the natural slow speed of the legislative process are probably going to mean that, much like any policy change, this will be a marathon rather than a sprint.