Although the Affordable Care Act (ACA) has been under attack since the election of the current president, it remains in effect through 2019, and the mid-term elections of 2018 are likely to at least temporarily blunt the efforts to repeal and replace the law.

The Henry Kaiser Family Foundation has provided excellent resources about the future of the ACA.  Key findings describing anticipated priorities for the new Congress related to the future of the ACA are provided, as well as discussion focused on where Medicaid expansion is headed.  Some of those findings are provided below.

  1. The Kaiser Family Foundation conducted polling following the November midterm elections that revealed most Americans want to see Democrats and Republicans in Congress working together, and a majority expect Congress to oversee the Trump administration’s actions related to health care policies. However, the polling results also showed that very few (6%) respondents believe that will happen.
  2. Before the midterm election, 34 states had already adopted Medicaid expansion, a key component of the ACA, in order to increase coverage of adults considered to be at low income levels. After the election, 3 more states adopted Medicaid expansion.
  3. A narrow majority of citizens living in states without ACA-funded Medicaid expansion have favorable opinions of the provision and would like to see their states expand their programs.

While just over half of those polled believe that a top priority of the newly Democratic House of Representatives will be to provide oversight of the Trump administration’s actions on health care, education, and the environment, a smaller percentage (36%) believe that examining the current administration for corruption should be a top priority.

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An interesting indicator about where we are headed with the ACA can be gleaned from the outcomes of voting on Medicaid expansion in 4 states. Idaho voters passed an initiative supporting the implementation of Medicaid expansion. Montana already has implemented Medicaid expansion, although voters rejected an initiative that would have provided further support for Medicaid and Medicaid expansion. Voters in Nebraska passed their pro-expansion initiative, while those in Utah supported a proposition that would expand Medicaid coverage and limit cuts to future coverage of Medicaid and the federal Children’s Health Insurance Program.  

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Finally, 3 important governor races may also provide insight into where the ACA and Medicaid expansion are headed; newly elected governors in Wisconsin, Maine, and Kansas support Medicaid expansion..

While this information may indicate stabilization of the ACA and signal the potential addition of new states to the 37 currently part of the ACA’s Medicaid expansion effort to increase coverage for Americans at low income levels, it’s clear that survival of the ACA isn’t a sure bet. The 2020 presidential, congressional, and gubernatorial races will likely affect the future of the ACA. Although it appears that the recent shift in Congress has provided significant support, only time will tell if the ACA will be a permanent pillar of our health care system.