That this year's election will have an unprecedented impact on, well, just about everything, is an understatement.  The [mostly] unexpected election of Donald J. Trump, combined with continued Republican control of both the House and Senate, will put much of what has been achieved by President Barack Obama on the chopping block, from the Affordable Care Act (Obamacare) to policies to address climate change, and so much more.  Elections matter.

What has struck me in the days since Mr. Trump became the President-elect is how many Washington, D.C. health care advocacy groups that supported the ACA, for instance, are responding by either hunkering down or by putting their fingers in the wind, trying to figure out how to get along. They don't want to make the new powers-to-be mad at them.  This is usually explained as being sure they "have a seat at the table" with the new administration.

This cynical, go-along-to get-along reaction is exactly what makes so many voters disgusted with Washington.

What's the alternative?  Well, if you are a hospital, physician, insurer, or consumer group that supported the Affordable Care Act on Tuesday morning, before the ballots were counted, you should still be supporting it today—even more so.  While you should to take into consideration the changed politics, it is unprincipled to abandon the 20 million uninsured who have coverage because of the ACA, and the tens of millions more who benefit from its protections, in the name of political expediency.

If you are a hospital, insurer or consumer group that supported the need to address climate change and its enormous consequences for human health, on Tuesday morning, before the ballots were counted, you should still be supporting such action today—even more so.  It would be unprincipled not to.

This should also be true of individual citizens—if you want to maintain the progress made by the ACA  in driving down the uninsured rate to unprecedented lows in every U.S. state, including many won by Mr. Trump, you should be ready, willing and able to speak up to lawmakers on why we need to keep it.  If you are concerned about climate change, then you need to be ready to urge your members of Congress to block any effort to roll back the commitments that have been made by our government to reduce carbon emissions.

This does not mean being unrealistic about the political realities.  As head of the advocacy arm of the American College of Physicians, a non-partisan organization representing internal medicine physicians, I have a responsibility to inform my elected physician leadership of the changed political realities affecting the ACA, climate change, prevention of violence from firearms, and so many other issues important to us.  On the ACA, for instance, I am telling them that President-elect Trump and the GOP Congress will try to deliver on their promise to repeal it, although they are likely to find that it is easier said than done.

While we will not bend in the wind and concede ACA repeal, we are willing to explore compromises that could be made with the GOP that would preserve much if not all of the coverage gains that have been achieved, even if that means significant changes in the ACA (including calling it something else) that incorporate conservative ideas on how to provide coverage with fewer federal mandates.

For sure, two days after an election is too early to assess how to respond to all the threats and opportunities created on the issues one cares about.

But there should be no uncertainty on the need to stand up on the issues that matter most, like not abandoning the 20 million Americans who depend on the ACA for coverage.  Elections matter, but so do one's values and principles.


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