Moving Forward in the Coming Years

Lawrence O. Gostin, JD1; David A. Hyman, JD, MD1; Peter D. Jacobson, JD, MPH2

President Barack Obama signed the Affordable Care Act (ACA) in 2010 with no Republican support. The ACA has been politically divisive ever since, with the House repeatedly voting for repeal. Earlier this year, Congress successfully passed a repeal, with the Senate using a legislative process called “reconciliation,” which requires only a simple majority for certain tax and spending bills to pass. However, Congress failed to override a presidential veto.

President-elect Donald Trump pledged to “repeal and replace” the ACA but would keep the most popular features: (1) guaranteed issue—health plans must enroll applicants regardless of preexisting conditions; and (2) dependent coverage—health plans must keep dependent children on their parents’ plan until age 26. Although his reform package has not been announced, it will likely include health savings accounts (HSAs), cross-state insurance sales, Medicaid block grants to states, and a cap on noneconomic damages.

JAMA