The ACA Is Not Going Away

We are just over six months away from the 2016 election and –well—we certainly won’t pretend to know with any level of certainty what will happen.

That said, six months ago (or so), Clinton looked to be an absolute lock for the Democratic nomination with Vermont Senator Bernie Sanders a mere distraction at best. That has not borne out. And the GOP nod looked to be anybody’s to win: Dr. Ben Carson was leading in the polls, Donald Trump’s support was thought to be superficial at best (typical notion: “They’ll go to rallies to see the celebrity; they won’t show up at the polls.”) and Ted Cruz was well on his way to being an also-ran.

So: Don’t count anyone out yet—and that includes people who haven’t even been mentioned, especially on the Republican side. Uncertainty will reign until Election Day, not just at the presidential level, but also at the congressional level, as it remains to be seen what effect the eventual presidential nominees will have on House and Senate races.

Here’s one thing you can be pretty certain of, though: Core aspects of the ACA will remain in place regardless of the election results.

Note that I use the term “core aspects of the ACA,” as opposed to the ACA as a whole. That’s because no matter how much some Republican opponents of the ACA say they want to repeal it altogether, they will be hard-pressed to do so, even if the GOP somehow manages to both win the White House and solidify its grip on the House of Representatives and the Senate.

This is because even though the ACA itself may be (based upon poling data) still unpopular among a majority of Americans, a number of its provisions ARE politically popular, including but not limited to: 1) the prohibition on pre-existing condition exclusions, 2) the increase in the dependent age to 26 and 3) easier access to health insurance coverage in general. “Core aspects” of the ACA are, In other words, provisions having to do with more widespread health insurance coverage.

Hence, the phrase “Repeal and Replace,” which has become the new mantra of many staunch anti-ACA Republicans, given that the typical response to their old “Repeal It!” slogan was simply “And then what?”

The fact is that any real chance the ACA had of being repealed altogether diminished to virtually nothing the night President Obama was re-elected in 2012. Federal laws (including repeals of those laws) require a president’s signature, and there was no way that was going to happen on his watch, given that, after all, the ACA was (and is his signature policy achievement. Upon the president’s re-election, the ACA had four more years to become a part of the American health care landscape, and those roots now run fairly deep.

There is some good news for those anxious to see changes made to the ACA. Regardless of what happens in November, two things will be certainly true: The vast majority of Washington politicians who supported the ACA in 2010, including—and most importantly—President Obama, will no longer be in office after January of 2017. That means that there will be less pushback against changes to the ACA than there has been in recent years, for the simple reason that fewer people remain who have a personal stake in it.

What will those changes be? Well, that will depend upon the outcome in November, but here’s a 50,000-foot guide (as things stand right now, of course):

• Democratic Congress and Democratic president: Some changes where most obviously needed; mostly some tinkering.
• Republican Congress and Republican president: Substantial changes, but, again, core aspects of the ACA will remain in some form.
• Republican Congress and Democratic president: Few changes, and then only as part of negotiated legislation packages.
• Democratic Congress and Republican president (an extremely unlikely outcome): Ditto.
• Split Congress and Democratic president: Ditto.
• Split Congress and Republican president: Ditto.