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With President-elect Donald Trump, an uncertain future for the health care of tens of millions

, by Emily Land

Since being signed into law in 2010, the Affordable Care Act, or “Obamacare” has brought affordable health insurance to nearly 20 million people—including people with pre-existing health conditions like HIV and others who might not otherwise have been able to sign up for coverage. In six years, the percentage of uninsured adults has fallen from 20% to 15% in our country. And for very low-income people, the rate of uninsured people has dropped even more dramatically—from 28% to 17%. In 2015, the rate of uninsured people in the U.S. was the lowest it had been in decades.

President-elect Donald Trump

President-elect Donald Trump

But the future of the Affordable Care Act may be in peril with the recent election of Donald Trump and a Republican-dominated Congress. Trump has made dismantling the ACA a cornerstone of his campaign—and has been quoted as saying things such as, “I would end Obamacare and replace it with something terrific, for far less money for the country for the people,” and “We are going to repeal Obamacare. We are going to replace Obamacare with something so much better.”

What’s in store for the ACA—and especially for people with chronic conditions who rely on the health insurance coverage provided by ACA?

It’s not immediately clear, especially since Trump has been vague about his plans for affordable health care coverage. Although, some articles have already surfaced in the Washington Post, on NPR, and in other sources to speculate on what might happen.

“We must take Trump at his word, and he has repeatedly said his first act would be to repeal the ACA – even calling Congress into special session, if necessary,” said Ron Pollack, executive director of the health care consumer advocacy group Families USA.

“This will have tragic consequences for tens of millions of people. Studies show that repealing the ACA will force 20 million people into the ranks of the uninsured. Approximately 130 million people with pre-existing conditions will be in danger as insurance companies are once again allowed to discriminate against the sick. We will see a return to annual and lifetime insurance caps that can leave people with severe illnesses or accidents in a ‘no-insurance zone’ where they will either go without care or go bankrupt.”

At least one expert has asserted that repealing the ACA, in its entirety, “will not happen.” Although, explained Timothy Jost, JD, emeritus professor at the Washington and Lee University School of Law, there may be many ways Trump could undermine the ACA’s continued implementation through the budget reconciliation process, preventing enforcement of existing protocols, or loosening ACA implementation requirements at the state level. (Read the full article, with a more in-depth explanation here.)

At least in the immediate future, people should not worry about their health insurance coverage if they purchase a plan through their state’s health insurance exchange. “Health policy experts don’t expect Republicans to immediately kick millions of people off their insurance policies. Instead, they predict lawmakers may repeal parts of the law and allow for some transition period for consumers while a replacement plan is put together,” said Chat Terhune in a California Healthline article.

Two California legislative leaders, California Senate President pro Tempore Kevin de Leon, and California Assembly Speaker Anthony Rendon released a statement to assuage fears brought about by the recent election. Although the leaders do not specifically name the ACA, it seems likely that the lawmakers have this in mind as they describe how they will use their political influence to protect programs, laws, and services that benefit Californians.

“California has long set an example for other states to follow. And California will defend its people and our progress. We are not going to allow one election to reverse generations of progress at the height of our historic diversity, scientific advancement, economic output, and sense of global responsibility…We will maximize the time during the presidential transition to defend our accomplishments using every tool at our disposal,” the statement read.

Covered California, the state exchange for California, recently released an alert to reassure partners that open enrollment will continue through January 31, 2017. “We understand that there may be a lot of chatter in the  media about the election, but here are three things you need to know,” the alert said. “Your coverage will remain intact for 2017 and the foreseeable future; your financial assistance are protected under the law; and, the rates for 2017 will not change.”

“It is too soon to anticipate potential changes to the ACA,” said Colleen Chawla, deputy director of heath and director of Policy and Planning at San Francisco Department of Public Health. “However, as the Health Department, we are absolutely thinking about the impact of the election on health and health care services in San Francisco. As we plan for the future, we will continue to keep the needs of our city’s most vulnerable residents at the top of mind.”

Read more about the future of the Affordable Care Act:

California Faces Major Reversal If Trump, Congress Scrap Health Law, by Chad Terhune on California Healthline.

Day One And Beyond: What Trump’s Election Means For The ACA, by Timothy Jost on Health Affairs Blog.

Obamacare’s future in critical condition after Trump’s victory, by Amy Goldstein on The Washington Post.

Trump Can Kill Obamacare With Or Without Help From Congress, by Alison Kodjak on NPR.


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