Donald Trump’s triumph in the 2016 presidential election marks the beginning of an uncertain and tumultuous chapter in U.S. health policy. In the election’s aftermath, the immediate question is this: Can Republicans make good on their pledge to repeal Obamacare? The Affordable Care Act (ACA) has persisted largely thanks to President Barack Obama’s protection. With Trump in the White House and Republicans maintaining House and Senate majorities, that protection is gone.
Obamacare’s vulnerability reflects not only the 2016 election results, but also its shallow political roots. The ACA has achieved much, including a large reduction in the uninsured population. Still, it lacks strong public support and an organized beneficiary lobby, has encountered significant problems in its implementation, and has been enveloped by an environment of hyperpartisanship.1If the ACA were more popular and covered a more politically sympathetic or influential population, if its insurance exchanges were operating more successfully and had higher enrollment, and if Democrats and Republicans were not so ideologically polarized and locked in a power struggle, then an incoming GOP administration would probably be talking about reforming rather than dismantling Obamacare.
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