What Happens Next: Is a Trump Presidency Really the End for ACA?

Obamacare and the Affordable Care Act (ACA) are challenges you have been wrestling with for years. Now that Donald Trump has been elected president, was it all for naught? The short answer: No. While ACA as we know it is going away, change is likely to be slow and incremental rather than sudden and dramatic.

Even if his intent was full and utter repeal, making the ACA disappear will not be so simple. Obstacles include:

• Filibuster. The first set of challenges are the legislative barriers. According to Bill Hoagland, senior vice president of the Bipartisan Policy Center, while the Republicans control the House and Senate, there are fewer than 60 Republicans in the Senate which is the "critical number to overcome a filibuster."

• Unpopularity. President-elect Trump enters office with a low popularity rating as do the members of Congress with a November Gallup poll finding that only 11 percent of Americans approve of Congress.

• State insurance role. One of the proposed changes to health care insurance is to allow insurers to sell across state lines. Hoagland points out, however, that state policies could be a stumbling block—state insurance commissioners set rates and policies.

• Packed agenda. "Congress has a lot on its plate," notes Hoagland. As he discussed in his keynote presentation at G2's recent Lab Institute in Washington, D.C. the federal debt limit comes up in March—requiring Congressional attention—and Congress also will need to address Supreme Court, Cabinet and other appointments. That packed agenda could delay or slow down any legislative action with regard to health care.

There is an alternate route to make change more swift and easy for the new administration: the budget reconciliation act process, which Hoagland notes requires only a simple majority. He cautions that if that reconciliation path is used to repeal the ACA without any Democratic support it could cut a rough path forward for any policies approved in that process.

Another key question for laboratories and other providers is the potential impact on reimbursement reforms such as PAMA and MACRA and the shift to value-based health care delivery and payment models. "Republican and Democratic policy analysts [agree] that fee for service reimbursement system is part of the problem of cost escalation," says Hoagland. He does not foresee a change in that focus on shifting from fee for service to value based reimbursement. "It's hard to argue against paying for value."

Takeaway: Though change to ACA and health care systems may be coming, it may not come quickly or be as wholesale as promised or anticipated.