The Uncertain Future of the ACA

Public Health faculty weigh-in on key health issues after the election of Donald Trump—looking at the Affordable Care Act and the potential impacts of its repeal on health disparities, Medicaid, Medicare, and people living with HIV:

Vincent Mor, PhD

Florence Pirce Grant University Professor, Professor of Health Services, Policy and Practice

What might the new Congress change in the Affordable Care Act?

There are several provisions of the ACA related to Medicare that the Republican Congress is likely to change. First and foremost, they are unlikely to renew the Patient Oriented Outcomes Research Institute which is a separate entity which funds demonstration programs and health services research.  Funding for this derives from the Medicare Trust fund and, while not really substantial, research funded could be viewed as asking questions that the Republicans are not likely to want to answer. READ MORE

Amal Trivedi, MD, MPH

Associate Professor of Health Services, Policy and Practice, Associate Professor of Medicine
Will there be more health inequities if the ACA is repealed? 

In a 1966 speech to the Medical Committee for Human Rights, Dr. Martin Luther King said: “of all the forms of inequality, injustice in health is the most shocking and inhumane.”  The Affordable Care Act, though imperfect, made important progress in addressing the inequalities of which Dr. King spoke. It bent the US health care system towards justice. Dismantling the ACA without replacing it would jeopardize this progress.  READ MORE

Anya Rader Wallack, PhD

Program Manager, Center for Evidence Synthesis in Health
And what happens to Medicaid? 

The ACA changed Medicaid in important ways. Fundamentally, the law allowed states to expand Medicaid eligibility to anyone with an income below 138 percent of the federal poverty level.  Previously, many states had lower eligibility thresholds, and some categories of people (like childless adults) were rarely eligible. The federal government picked up the vast majority of the cost associated with the eligibility expansion, and 32 states have opted to implement it.  Additionally, the marketing and outreach efforts associated with the new health insurance exchanges brought millions of Americans into Medicaid who had previously been eligible for, but not enrolled in, the program.  The combined effect of the expanded eligibility and the increased outreach, increased Medicaid and Children’s Health Insurance Program (CHIP) enrollment by almost 17 million people nationally. That includes approximately 96,000 Rhode Islanders.   READ MORE

Ira B. Wilson, MD

Professor and Chair of Health Services, Policy and Practice, Professor of Medicine
How might repeal of the ACA affect people living with HIV?

There is much discussion of how President-elect Trump will change our health care system, and more specifically if he will attempt to repeal all or parts of the ACA. How many people living with HIV could be affected will depend upon the details of these changes. But both the ability to purchase health insurance through state and federal exchanges, and the expansion of Medicaid, have had important positive effects on access to needed care for people living with HIV. Losing these sources of coverage, and the care they facilitate, would cause serious hardship for many people living with HIV. It would also place their sexual partners at higher risk of HIV acquisition.  READ MORE



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