The Affordable Care Act In 2017: Challenges For President-Elect Trump And Congress

Coauthored by Sara R. Collins

Affordable health insurance coverage and high-quality health care for everyone are essential components of a high-performing health system. The Affordable Care Act (ACA) has moved the nation affirmatively down this path since its passage in 2010, by insuring more than 20 million Americans and facilitating change in how we organize and pay for health care. These gains have reduced out-of-pocket health costs for many people, improved access to care, and led to better health. Commonwealth Fund surveys have consistently found that people who have gained coverage through the law's insurance expansions are satisfied with their health plans and their doctors.

At the same time, changes in how health care is delivered, brought about by the ACA as well as ongoing private-sector initiatives, have lowered hospital patient readmissions -- a good thing. These reforms have also helped reduce the rate of growth in national health care spending and coincided with historic improvements in quality of care.

We hope that the change in government leadership as a result of yesterday's election will not alter the nation's commitment to improving insurance coverage and health care. The recent challenges in the ACA marketplaces are not insurmountable. Policymakers at both the federal and state level have many options for improving the affordability of private health insurance, both in the marketplaces and in workplaces, as well as for promoting competition and consumer choice.

President-elect Trump has proposed repealing the ACA. Researchers at RAND have estimated that a repeal would erase all the coverage gains made over the past six years and increase consumers' insurance costs. A simple repeal would also end the significant care delivery system changes that the law brought to Medicare and the elimination of new sources of revenue, leading to a $33 billion increase in the federal deficit in 2018. The president-elect has said he believes that everyone should have health coverage. The replacement proposal on his campaign website, however, would not fully remedy the likely loss of insurance by millions of Americans. Any ACA replacement proposal should be measured by how well it ensures access to high-quality, affordable, and efficient care, especially for our most vulnerable populations.

The nation's gains in health care coverage and delivery system design over the last several years have made measurable differences in the lives of millions of Americans. There are many ways to achieve a high-performing health system. But it's critical that the nation remain committed to this goal.