Record Signup for Affordable Care Act Coverage

Even as President-Elect Donald Trump prepares to dismantle the Affordable Care Act (ACA), its sign-up sites had a record-breaking day, officials announced today.

After Tuesday’s election, the Democrats were repudiated, leaving a House and Senate stocked with Republicans ready to reverse many of the policies instituted over the previous eight years by the Obama administration. The ACA, best known as Obamacare (affectionately or pejoratively, depending on who’s saying it) will likely be a major Trump target.

Throughout the long and grueling 2016 campaign, while defeated candidate Hillary Clinton intimated that the ACA would be “strengthened,” Trump's mantra was “repeal and replace.”

On Nov. 9, the day after Trump's victory, more than 100,000 people signed up for care through the exchange, according to a tweet today from Health and Human Services Secretary Sylvia Burwell. Open enrollment began November 1st, and yesterday was the largest single-day signup in the bill’s history, perhaps due to the now-uncertain future of lower-cost health coverage.

Once in effect, the ACA entwined many tentacles deep into the healthcare economy so far in its young life, making it a controversial piece of legislation as much in concept as in practice. Such entrenchment may make an outright repeal of the entire bill a difficult process, and the Democrats, though a minority, will likely resist.

Some of the ACA's provisions have been popular with the public.

Insurers are prevented from denying coverage to those with pre-existing conditions, and young adults are able to remian on their parents' plans until age 26. About four million 19-to-25 year olds took advantage of that measure between 2010 and 2014, and the proportion of uninsured people in that age bracket fell sharply. Many preventive screenings are covered, spurring an increase in procedures such as colonoscopies. There is speculation that elements of these policies will survive or receive a second life in future legislation.

Others, like the mandated tax penalty for those who do not carry insurance, are a reason why the ACA has drawn so much ire. Many are saying they have no imaginable future in a potential replacement.

The policies proposed by Trump include health savings accounts (HSAs) that would be immune to taxation and transferrable upon death, in conjunction with the elimination of the estate tax. Restrictions against selling insurance over state lines would also be eliminated, according to a Trump campaign pledge, in order to stimulate competition and lower costs.

It remains to be seen what will become of the 20 million people who gained their insurance from the ACA. In an economy where most people receive their healthcare through their employers, the ACA aimed to fill in the gaps for those who didn’t. Rising premiums and general agreement that the ACA, as enacted, is too big, involved, and messy will perhaps be the last legacy of an act that faced fierce opposition from its very inception.

Whatever happens next will be crucial to its legacy. So far, stock prices have been one closely watched indicator. In the immediate aftermath of Trump’s victory, stocks of for-profit hospital companies fell. Many such companies have benefitted from more individuals having the opportunity to seek care.

Pharmaceutical companies saw the opposite trend, with noticeable gains. Despite Trump’s earlier comments that Medicare should have a say in drug prices by negotiating for discounts, the confidence boost may be based in pharma's relief that the Democrats were defeated. The party has been sharply critical of pharmaceutical prices and cost practices.

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