What is the current thinking of the American public regarding the ACA?

In a survey published by US News and World Report in November 2016, at least 80% favored key principles of the ACA, including: expansion of Medicaid, inclusion of young adults on parental plans, coverage of preventive services, and financial assistance for individuals without employer-based plans. Nearly 70% do not favor denial of coverage due to preexisting conditions. However, only 35% believe that Americans should be mandated to have health insurance. On the day of his inauguration, President Trump signed an executive order stating that federal agencies can “waive, defer, grant exemptions from, or delay the implementation” of provisions deemed to impose fiscal burdens on states, companies, or individuals. This paves the way for undoing this individual health insurance mandate. However, a repeal of this mandate may mean that only individuals who are ill will seek health coverage, driving up the cost of insurance for everyone who seeks to purchase it and potentially driving away insurers who seek to attract healthy individuals to keep premiums low.

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Most Americans (75%) do not seem in favor of President Trump’s position for a “full repeal of Obamacare,” but a majority do want to see changes—with some favoring an expansion—in coverage (30%). In the words of President Obama, “If a repeal with a delay is enacted, the healthcare system will be standing on the edge of a cliff.…”

Experts on healthcare policy have raised concerns about the Trump healthcare agenda as represented by Tom Price, and legal experts believe that President Trump cannot completely reverse all of the provisions of the ACA. The Republican-controlled Congress cannot block a filibuster on certain aspects of the ACA but can draft a “reconciliation bill” that is immune from filibuster and can seriously affect portions of the law and block funding with budget cuts. Some Republican Congress members have voiced concerns about repealing coverage without a replacement plan, and the short timeline proposed to accomplish this. Thus far, President Trump has only directed Congress to repeal and replace “essentially simultaneously,” but a replacement plan has not been forthcoming from either the President or Congress.

Let us hope that President Trump’s desire to reform the ACA will retain its best components and improve on its shortcomings. As healthcare providers, we have an obligation to our patients—especially to those who are most vulnerable. A spokesperson for the Trump transition team told the New York Times that Price will “work to restore the patient-doctor relationship.” However, how can you have a patient–doctor relationship when the patient cannot afford to go to the doctor?

Judi Greif, RN, MS, APNC, is a family nurse practitioner and medical writer currently ­residing in East Brunswick, N.J.