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President-elect Donald Trump focused on the Affordable Care Act (ACA) during his campaign, so what can we expect during his administration in regards to the US Healthcare?

Trump and the Republicans are likely going to implement measures that can impact all Americans, especially small cities, outer suburbs and rural counties. Together, with Representative Tom Price, Mr. Trump’s nominee for secretary of health and human services, congressional Republicans want to move quickly to change most of federal health insurance spending.

The Trump Administration will probably ask Congress not only to cut the taxes levied on businesses and the rich to finance Obamacare benefits for 20 to 30 million low and middle-income Americans, they also plan to slash federal commitments to Medicaid, giving states the autonomy to change their health care program for the poor and elderly.

Repealing Obama Care

In case the ACA, or Obamacare, is repealed, this would also hit a significant part of Americans. Taking Pennsylvania as example, there are around 468,000 low-income Pennsylvanians that had gained Medicaid coverage by August 2016, and another 439,000 who bought private coverage from the Obamacare marketplace. Out of those, more than three-fourths are getting tax credits averaging $251 per month, and it is probable they will not continue with private coverage if their tax benefit is cancelled.

On the other hand, there is the perspective that premiums for Americans have been rising, because payers do not receive sufficient federal funds to cover everyone in the United States. One explanation is that many Americans who could not buy healthcare have pre-conditions and morbidities that make them significantly more expensive than the average per capita spending in the United States. In summary, this could mean healthy Americans would be paying too much to cover less-healthy Americans.

However, healthcare is often sparse in nonurban areas and the providers that exist depend on federal insurance programs that help many patients pay for care. In case there are severe cutbacks in federal contributions to health insurance, providers such as Pennsylvania hospitals will lose vital sources of income, which may leave many lower-income and sick Pennsylvanians at risk of losing access to care.

Ending Obamacare means eliminating the taxes that subsidize healthcare for low and middle-income people. This may lead to the end of subsidized health insurance for millions of less privileged Americans living in non-urban central areas.

Moving Forward

According to a panel held by FiveThirtyEight, there has been a big division of Americans about whether the ACA should be repealed or not.

Most experts are focused on the first 100 days of Trump in the Presidency as an indicator of his intentions with the ACA. He may propose an orderly transition to a new system, or choose to undermine the ACA and build support for actual repeal and replace. In the case of the latter, there are a number of steps Trump could take to quickly and seriously undermine the law.

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