Trump and the ACA

Well, we're all a bit shocked by the Trump victory in the presidential election, I think it's safe to say. In the health, insurance, and HR world, this development is especially dramatic. One of Trump's main campaign promises was repealing and replacing the ACA/Obamacare, and there's no reason to think he won't keep his word, and quickly. And it's hard to think of a single policy change that would affect more people and industries.

I've been accused of being an ACA cheerleader many times, and I'm mostly guilty as charged. After writing about health care for nearly two decades, I had talked to too many providers and patients who firmly believed the old system wasn't working and needed reform. And the ACA was an honest, reasonable attempt to make health care more accessible and affordable. Now, like a lot people in the industry, I would've preferred to give the new system more time to iron out the bugs and fix the problems that had sprung up. But it's clear the ACA did have problems. I continued to hear from patients/consumers who couldn't afford the new plans. We all know that compliance was a problem for some businesses and that small businesses hadn't yet really seen a lot of the promised improvements.

So, it's not like the ACA was a perfect solution running on all cylinders. My concern is, will the Trump Administration and its Republican allies be able to come up with a "replace" solution that works better than what we have now with the ACA? Right now, based on what I've heard, I'm doubtful. The ray of hope that I see is that Donald Trump, whatever you think of him, *has* been pretty consistent about saying he thinks everyone should have health insurance. At one time he even talked up single-payer. It's very unlikely we'll hear him go back to that solution now, but as far a basic value, this seems to matter to him. The solutions he has suggested in the campaign, to my thinking, are short on details and not likely to really address the problems. But Trump won the presidency, so we'll see what the Republicans can come up with. If they kick millions off of insurance without a good replacement plan; if they don't address rising health care costs (including premium costs, which routinely went up even before Obamacare), if they don't recognize the economic burden of having tens of millions without coverage, you can bet the people will speak again.

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