The U.S. healthcare industry remains at a crossroads. The healthcare reform legislation passed under President Barack Obama in 2010, officially called the Patient Protection and Affordable Care Act (ACA) but widely referred to in the United States as 'Obamacare' (initially as a pejorative, but, later, sincerely), resulted in significant changes in the U.S. healthcare system. These changes included a dramatic expansion in the number of insured patients, contributing to increased demand for services. Many of these newly insured are covered by the joint state-federal Medicaid programme, which generally covers low-income patients as an entitlement programme, and reimburses at the lowest rates in most markets. However, the ACA has created a number of challenges for the U.S. healthcare system as well, owing to both increased demand driven by newly insured patients and a view by many providers that the rates paid by many payors for healthcare services are inadequate.

Several years into the administration of Donald Trump as U.S. President, the future of the U.S. healthcare system remains uncertain. Trump, a Republican, campaigned on a promise to 'repeal and replace' the ACA legislation, and his administration has spearheaded a number of efforts to significantly weaken the programme as envisioned by President Obama, although his efforts to completely repeal the law have not been successful. Still, his efforts have had some impact, most significantly the tax reform legislation passed at the end of 2017 repealed the individual mandate, a cornerstone of the ACA. The Trump administration has also taken other actions to dismantle key components of the legislation, including introducing regulations to provide for short-term health insurance plans, allowing states to impose work requirements for Medicaid, and positioning the Justice Department to undermine the constitutionality of the provisions of the law related to pre-existing conditions.

Originally published in The Healthcare Law Review, Third Edition. 2019.