The Health Cents blog surveyed its regular contributors for thoughts on the effects the election will have on American health care and on the future of the ACA.  Here is what several of them had to say.

Repeal the ACA? It's a lot harder than it sounds

By Robert I. Field

Now that Republicans are about to control the White House and both houses of Congress, their pledge to "repeal and replace" the ACA seems closer to fruition. It has been a rallying cry since the law was passed, and it sounds simple enough.

But repealing a law as complex as the ACA six and a half years after it was enacted is anything but simple. In fact, it would be virtually impossible. The ACA is intertwined into the fabric of our health care system.

When people think of the ACA, they often think only of the exchanges where people can purchase individual health insurance. Those marketplaces have made headlines recently for price hikes, insurance company losses, and reduced competition. But they are just one part of a much larger set of reforms.

To start, there is the Medicaid expansion. Thirty-two states have accepted federal funding to expand their programs. Seven million people have coverage because of it, and hundreds of hospitals rely on it to reduce their burden of uncompensated care. Repeal of that provision would leave those people with no access to health care and some hospital markets in chaos.

And 6 million young adults have been able to gain coverage by staying on their parents' policies.

Then there are reforms to Medicare, like closing the infamous doughnut hole in prescription coverage and paying hospitals for better performance. Repeal of those reforms would leave seniors with higher drug bills and force many hospitals to overhaul their finances.

The ACA also includes provisions for student loans and generic versions of specialty drugs. Repeal would make medical school less affordable for many promising students and disrupt the biotechnology market.

And repeal of the exchanges would leave millions of people with no health coverage and no way to get it.

The second half of the slogan, "replace", would have to be explained before repeal could be accomplished. House Speaker Paul Ryan has proposed elements of replacement plan for the exchanges, but it has major holes, and it neglects most of the other elements of the law.

And so far, Donald Trump has given few details of his health policy thinking, beyond endorsing the slogan.

So, even with Republicans in a position to make good on their promise, we still have to wait to find out what "repeal and replace" really means.

Election revealed distrust of institutions, but 22 million people still need coverage if the ACA is repealed

By Drew Harris

I believe the election outcome reveals a deep distrust of institutions. Whether it's politicians, government or pollsters, many voters have lost faith in collective efforts to solve societal issues. This is especially true when it comes to health.

In Pennsylvania, counties with significant health challenges, such as opioid addiction, chronic disease and access to affordable care, went 2 to 1 for Trump. These are places where Obamacare has significantly increased the number of people with real access to health care. Despite large subsidies that protect many people from recent rate increases, an expansion of Medicaid for the near poor, and rules that allow children to stay on their parent's policy until age 26, many Americans believe the program is a failure.

It's easy to find someone to blame for this loss of trust. There's the media who failed to communicate objective data about the program's success. The politicians who tried so hard to hobble the program and then lamented its failings. And even the voters themselves who don't appreciate how much they've gained. Ultimately, though, all perceptions of the ACA are filtered through a lens of distrust, a generally accepted attitude that government can never do anything right. Its easy to blow up something you don't value.

So while there's plenty of blame to go around, clearly ACA advocates and health policymakers failed to build a well of trust in this particular government program deep enough to weather its inevitable glitches.

If President Trump fulfills his campaign promise of an Obamacare repeal then in all likelihood 22 million currently insured people will lose their coverage. Only then will we know if newly uninsured people will demand a government they can trust to fix this. Said another way: you don't know what you have until it's gone.

Repealing the ACA would be disastrous

By Antoinette Kraus

Repealing the Affordable Care Act would have disastrous outcomes for over one million Pennsylvanians who depend on health insurance through the marketplace and Medicaid Expansion. While the ACA is not perfect repealing it is a reckless act jeopardizing the health and lives of millions of Americans.Repealing the ACA will send us back to a time when battling serious illnesses like cancer will mean that people have to worry as much about keeping their insurance  as they do about staying alive.

Open enrollment for 2017 will continue with the same deadlines in place for 2017. Consumers will maintain their coverage for this year. We expect that repeal and replace attempts will not happen overnight and our encouraging folks to continue to enroll in the marketplace.

Hospitals will work with all officials for access to affordable, high-quality care

By Andy Carter

While the 2016 election's long-term impact on hospitals and health care remains to be seen, Congress and the new administration are expected to explore options to replace the Affordable Care Act. Exactly what changes are pursued, when they may be voted, and exactly how they may impact hospitals and the patients they care for, remain uncertain.

As has always been, and will continue to be the case, The Hospital and Healthsystem Association of Pennsylvania looks forward to working with all elected and appointed officials in pursuit of a health policy agenda that delivers access to affordable, high-quality health care services to all Pennsylvanians.

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