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. Congress also suspended several taxes that are supposed to pay for the legislation, opening it to yet more political attacks on fiscal grounds. For millions of people with subsidies, the ACA will continue to be attractive – it won’t “implode” as critics have predicted. But fixing it, restoring it to its authors’ original vision, would require effort and compromise – which is not at all likely given that one party has spent the last eight years intent on the law’s destruction.