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Obamacare, You're Fired - December 2016 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 34 of 132

A s we look ahead to the uncertainty of an unlikely presiden- cy, there are more questions than answers about what the U.S. healthcare system might look like under Donald Trump's proposed policies. Is repeal and replace possible? About 21 million Americans are insured through the Affordable Care Act's (ACA) Medicaid expansion and insurance exchanges. Republican leadership, including Mr. Trump, have indicated they want to come up with a way to repeal Obamacare without leaving millions of their constituents without coverage. But President-elect Trump's reforms might turn out to be less drastic than he promised. The ACA, which became law in 2010, is complex legislation that's already entrenched in the nation's healthcare system. Its policies extend well past insurance exchanges to touch on payment reform, quality out- come reporting and patient-centered care. Republicans might soon discover they'll have to settle for remaking and renaming, not repeal- ing and replacing, Obamacare. Some of the ACA's insurance reforms — eliminating adverse selec- tion, underwriting people who couldn't otherwise afford insurance, encouraging healthy individuals to sign up to increase pools for high- risk patients — make sense, says anesthesiologist David Shapiro, MD, past president of the ASC Association. "If all that gets repealed, how do you replace it and what do you replace it with?" he asks. "Everybody wants the same thing, but differ on how to get there." The Republicans will likely use budget reconciliation to repeal ele- ments of the ACA that have substantial impact on the federal budget. That way forward has already been established. Last January, the D E C E M B E R 2 0 1 6 • O U T PA T I E N TS U R G E R Y. N E T • 3 5

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