The Affordable Care Act: Moving Forward in the Coming Years

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. 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 pre-existing 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-border insurance sales, Medicaid block grants to states, and a cap on non-economic damages. In this Viewpoint, we examine potential reforms of the ACA through the lens of empirical evidence to find whether they are likely to be effective, particularly in ensuring access to health insurance at a reasonable cost, and in a stable insurance market. We conclude that the public has a right to expect their representatives to find common ground and adopt evidence-based policies that expand coverage at a reasonable cost