Considering the majority in the house and senate, day 1 the ACA is going to get repealed - millions will lose their health coverage, and my employer's profitability is going to tank as a result as an increase of patients coming into the ER can't pay their medical bills and we end up sending them to collections before eventually writing it off.

It is highly telling that pharma stocks are strongly up following the Trump victory.

Investors believe that drug prices and healthcare costs will reap increasing profits to shareholders in the next four years.

Republicans already had a majority in the house and senate, and have tried to repeal the ACA many times. They still don't have a supermajority in the senate, though, so I expect Democrats will continue to filibuster any attempts to repeal.

They passed a reconciliation bill[1], which needed only a simple majority in both houses and is filibuster-proof. The only thing that stopped that bill from going through was a Presidential veto. The ACA is going to be repealed.

1. https://www.congress.gov/bill/114th-congress/house-bill/3762

This scares me.

Before the ACA, no one would sell me health insurance. Several years ago, I had my gallbladder out. So whenever I'd try to buy health insurance, "pre-existing condition" would kick in, even though I'm perfectly healthy.

So, I'm scared now, to once again be a self-employed adult without access to medical care. At least I'm in pretty good health. I know a few people who rely on their health care who, if they end up getting kicked off of their insurance plans, may not live very long. That's scary to think about, too.

I'm in a similar boat. I'm a cancer survivor, in my early thirties, and run a technology business. Without government intervention, I can not buy health insurance.

Even if you want to remove the compassion for it, eliminating the ability obtain medical insurance is terrible for the economy. I waited for years to separate from my last employer until I was confident that I could obtain health insurance. There are a ton of risks when starting a new company and the last thing you want to think about is whether or not you can pay medical bills if something were to happen again.

Rather than working on my business, I now need to setup a meeting with the state's high-risk insurance pool to figure out whether they're finally going to eliminate the program and then compare that with the paltry list of plans left on ACA as well as what a broker can find me. To be clear, ACA has massive issues. That said, it meant that I could buy insurance, even if it wasn't the perfect insurance that I wanted.

What would you say to thousands of people with decent health whose premiums and deductibles have gone up and who are forced to keep paying it to avoid the penalty?

While it seems fair to subsidize the costs of your particular problem, does it also seem fair to ask of them to subsidize the costs associated with obesity and palliative care of the old?

These people do not have software developer salaries either. The income cut-off for being offered some sort of a discount on the plans is rather low, so it really eats into the budgets of their families.

Prior to ACA, people who were old or obese could still buy insurance. Prior to ACA, people like me who were cancer survivors could not, in any way shape or form, buy health insurance outside of government programs. If you are asking whether or not I believe it to be fair that premiums have gone up because in order to cover the uninsurable, absolutely.

And, to be clear, even now health insurance is not cheap for me. I did better in my business than I ever did before and I still budget for and spend 9% of my gross income on healthcare, which is split between premiums and my out of pocket max.

ACA is absolutely, positively not a perfect law. However, ACA has allowed me to start a business. ACA has given me the possibility of starting a family. I am not alone. If the cost of that is the requirement that I muster enough compassion to cover the costs associated with subsidizing the obese and old, then that is absolutely worth it.

I think it is fair to ask healthy people to subsidize health care for unhealthy people.

I think the best means of structuring society's relationship to medical care is to make it available to everyone within that society, spreading the costs across all parts of society.

That, to me, is the most sensible approach, even when some people pay more than they use, or some people use more than they pay for.

Pooled costs and guaranteed access to shared resources is one of the things that society is/does. Medical care doesn't seem different from roads, schools, police, the FCC, whatever.

Whether the ACA does a good job spreading the costs around or getting people access to medical care, that's a separate discussion. But whether it should at all, not a question for me. It should.

I feel for you. Working in the medical industry I feel the ACA is one of the most important (if not what many of us would have wanted) steps towards providing care to everyone we have taken, the fact that it's going to end up vanishing is going to have a huge impact - one that unfortunately is likely to only be felt years from when it happens.

Without the Medicaid expansion, they likely won't be able to afford any private insurance as well. The ultimate outcome is going to be uninsured people flooding the ER, who by law has to stabilize them. But maintenance drugs will be out of reach of many.

It's the loss of access to maintenance drugs that's going to shorten the lives of some folks I know.

God help us if any of us get cancer.

Aaaand, just learned that a buddy of mine was diagnosed with liver cancer.

Shit.

Repeal and replace. I'm sure Trump's solution will not leave you in the cold. It would be wreckless to repeal without ensuring people like you keep your insurance.

Would you trust your health or your life to "repeal and replace"?

Because that is what has been asked of me and some folks I know.

Serious question. Are you in a position where your access to health care rests on "repeal and replace" working out?

Replace with what, exactly?

A few years ago I read an article in the online version of some magazine -- Fortune, maybe -- that was attempting to rebut the argument that the GOP opposed the ACA but had never offered a coherent counterproposal. The author listed maybe a dozen plans that had been put forth by various Republican legislators.

I commented on the piece that a dozen plans is no plan. The GOP needed, I argued, to settle on a single plan to go to the voters with and say, "Here, this is what we should do instead of the ACA." Nothing like that has ever happened.

Well, now they'll have their chance to repeal the ACA with or without a replacement in hand. I won't be surprised at all if they don't replace it with anything, and we'll be back to where we were. -- Which will really put a damper on people over 45 or so quitting their jobs to do startups.

> I'm sure Trump's solution will not leave you in the cold.

I hope you're right, but I don't know how you can possibly be sure.

The current insurance market is not a permanent thing. If you look at the ACA marketplace, the list of plans changes year by year and that's the same thing that happens on the private market. In that context, what does keep your insurance even mean? Yes, I highly doubt we'll get dropped from our insurance plans in the middle of the year, but those of us on the independent market almost always have to buy a new plan every year. As such, the question of whether or not we can obtain a new plan is extremely important.

They also had a president that would veto any attempt to do so, only time will tell at this point - but the outlook is grim in my opinion.

millions lost their health coverage when premiums and deductibles skyrocketed

At present, there are millions more people with health insurance in the USA than before Romneycare became the law of the land. Especially in the states that implemented the Medicaid expansion provisions.

The Medicaid expansion is a particular sore spot if the ACA gets repealed, a majority of our physicians are in California where Medi-Cal has had gobs of funding and covered an expanded population well before the ACA was implemented - but for those in states that did rely on the expansion funding I expect our collection rates are going to plummet as Medicaid patients continue to make up a large majority of those that utilize emergency department and urgent care facilities.

There's going to be a lot of people losing Medicaid if this happens that will become self-pay (aka, no money) patients. Not a good time to be in the billing industry.

They didn't necessarily lose their coverage, they just ended up with much worse coverage with much higher deductibles.

Those of us who have stuck with our pre-Obamacare plans are paying dearly for the privilege. That's OK, I understand that Obamacare was supposed to fail from day one, in order to pave the way for single-payer coverage.

But it's becoming increasingly apparent that we're going to get the first part without the second.

Maybe he will more or less admit that alot of it was just theatrics, and he will go on to be a sane[ish] human being and normal[ish] POTUS

One hopes. But people did vote for whom he appeared to be. Even if it was an act, that is, to me, a scary thought.

The world is a scary place. Did you not know that? Bullies, liars, and cheaters win. That's the unfortunate truth.

You don't think the checks and balances built into congress and the supreme court basically force him to be a normalish POTUS?

The checks and balances are a republican controlled congress (House and Senate). And a supreme court where republicans will be able to select a majority of the members. The only check and balance left is via a Democratic filibuster.

And maybe I'll get a pony.

And even if that somehow happens, those scenes from his rallies are not going away. The videos of people cheering racist rhetoric, cheering the idea of an entire religion being banned from the country, the idea of not giving a shit that someone confessed to sexual assault, is not going away. If anything, it's going to flourish.

This is what I fear the most. The rise of alt-right rhetoric making it's way into the mainstream. I guess the pendulum had to swing away from talk of global unity and progress and towards isolationism at some point - I just hope it swings back the other way before it's too late.

You do realize when you're talking about "global unity" that almost the whole rest of the world is more racist and sexist than the US, right? I come from a Muslim country. Replace "Muslims" with "Jews" and the worst things said at a Trump rally would be socially acceptable where I am from.

That's a shame, though I doubt you could objectively quantify and compare the sort of racism and sexism here with that of another given nation except at a surface level.

You don't even need an objective measure. It's so deeply ingrained people don't even think about it. For example, Americans will refer to someone from another country by their nationality. "He's Canadian" or "he's German." In Bangladesh, everyone not from Bangladesh is "bideshi"--"foreigner."

And if you're "bideshi" you'll never be "Bangladeshi." A white person can live in Bangladesh their whole life and never be "from there." But at least they generally respect white people. Hang around an immigrant community somewhere like Toronto and get folks talking about black people or Jewish people. Ask a girl's parents about how they would feel about her marrying a black person. You won't get a more negative reaction anywhere in Alabama.

As to the issue of sexism--I don't think it even needs saying.

There are lots of ways to objectively quantify racism and sexism. Just off the top of my head:

- Are women/minorities legally allowed to vote?

- Do women/minorities vote at the same rates as majority men?

- Are women/minorities represented in office at the same rates as majority men?

- Are there any legal restrictions against women/minorities that don't apply to majority men like the right drive, the right to own property, rules around dress or appearance?

- Are women/minorities paid as well for their work as majority men?

- Is abortion legal?

- Do women/minorities have equal access to education as majority men?

- Is interracial marriage legal? How common is it?

- How integrated is housing? Do people of different races tend to live near each other?

I'm sure this list isn't exhaustive. As I said, just a start off the top of my head.

Act as an unfiltered pass-through for the house most likely.

The same he always does: Blaming things on others. This is what worries me the most: Trump won't get anything done but blame it, yet again, on some minority. And, yet again, chances are people will believe him.