The Affordable Care Act survived a year of Donald Trump and a Republican Congress.
But it’s wounded.
The Republicans failed to repeal the ACA but they inflicted heavy damage by the start of 2018. Uncertainty about the law’s future, combined with the cessation of the Cost-Sharing Reduction Subsidies, had prompted major insurers to flee many state markets for 2018, and there are many counties without a lot of competition – and 2019 could look worse. In addition, the repeal of the individual mandate penalty effective in 2019, and new rules that will allow the sale of skimpier health plans that don’t comply with ACA regulations are likely to further segment the market, with healthier people peeling off and older and sicker people staying in the ACA exchanges.