The incoming Trump administration and Congress have campaigned on promises to repeal the Affordable Care Act (ACA, a.k.a. "Obamacare"), which has helped over 20 million Americans gain health care coverage as well as ensuring those of us with preexisting conditions are not discriminated against by insurance companies.

What Comes Next?

Complete repeal of the ACA would be complicated and unpopular, not only among those who have gained or seen improvements in their health care coverage under it, but also among insurance companies, medical providers and hospital associations.

The president-elect has indicated since the election that he would like to keep some of the more popular components of the ACA, including prohibitions on discrimination against preexisting conditions (crucial for those of us living with HIV, HCV and other chronic conditions). However, he wants to repeal the individual mandate, which requires Americans to have health insurance or pay a tax penalty. Keeping the preexisting condition language without the individual mandate could make it very difficult for insurers to comply without drastically raising premiums, since it increases the likelihood that those purchasing health care already have serious health conditions.

It appears very likely that the ACA will be modified substantially, though it is difficult to know exactly how, how long it will take, and what it may be replaced with. Assuming, however, that Congress fully repeals the ACA with the president-elect's approval, the following would happen:

  • Millions will lose health coverage (as many as 20 million).
  • There will be no affordable options for the remaining 12 million uninsured people in the U.S.
  • Seniors could pay an average of $2,000 per year more for prescriptions.
  • Those with private insurance could face discrimination for preexisting conditions.
  • Millions will lose guaranteed free preventive services like recommended cancer screenings and vaccines.
  • Insurance companies will no longer be required to put premiums toward care rather than profits.
  • "Block grants" to states for Medicaid could mean fewer people covered and new limits for eligibility.
  • Women could face higher insurance premiums and lose the guarantee of preventive services, including birth control.

What Can We Do?

We will need to be very organized, stay very well-informed and advocate harder than ever over the coming months to prevent affordable health care access from being gutted. Here are a few suggestions for the present and immediate future:

  • Join the Federal AIDS Policy Partnership's HIV Health Care Access Working Group. HHCAWG has long advocated for access to affordable comprehensive coverage and care and treatment for people with HIV. In the coming year, the Working Group will be focused squarely on preserving key components of the ACA in collaboration with broader coalitions. Email to sign up.
  • Tell your or your client's story. In the press, congressional offices have said that they are not worried about repealing the ACA without a replacement plan because they have not heard from any constituents who have benefited from the program. Contact your senators and congresspeople and let them know how the ACA has helped you or your clients. Call the Capitol Switchboard at 202-224-3121 and ask to be connected to your senators' and representative's offices, or find their contact info here. On Twitter? Share your story using the hashtag #IfILoseCoverage. Sign FamiliesUSA's petition here.
  • Join broader health care advocacy coalitions. FamiliesUSA will be leading a large grassroots effort to fight for the ACA. We must unite far and wide with other advocates to demonstrate that a large and diverse group of constituents supports protecting access to non-discriminatory, affordable, comprehensive health coverage and health care services.
  • Enroll in insurance through the marketplace under the ACA now during the open enrollment period if you need an affordable option. The more who are enrolled, the more difficult it will be to dismantle.