Since Trump’s electoral college victory became apparent early Wednesday morning and especially since Secretary Clinton’s concession speech, many bioethicists–and many more American residents–have been wondering what a Trump Presidency means for the Affordable Care Act, AKA “Obamacare.” While the ACA is a far cry from the single payer health care that provides a basic tier to most residents of Canada and the UK, or the co-op system that works fairly well in Germany, or the tightly government-regulated private insurance and health care market in Japan, the ACA did dramatically increase insurance coverage for Americans by subsidizing-and-mandating individual health insurance as well as expanding Medicaid in most states. It also allowed persons with pre-existing conditions, who had previously been either ineligible for coverage by private insurance or had been charged impossibly high monthly premiums, to get access. In addition, the law reduced the co-pay for contraceptives to zero.

In a first for a sitting US President, Barack Obama published a defense of the ACA in the Journal of the American Medical Association earlier this year. Despite publishing multiple critical responses in the same issue, JAMA was criticized for giving Obama this platform while critiques of the ACA from outside the journal proliferated.

U.S. President Barack Obama meets with President-elect Donald Trump in the Oval Office of the White House on Thursday in their first public step toward a transition of power November 10, 2016 in Washington, DC. Photo by Olivier Douliery/ABACA

The ACA’s flaws and successes have been roundly debated.  The law itself was attacked by President-elect Trump many times in his campaign. Indeed, Mr. Trump’s plan for his first 100 days in office–a traditional plan for a president-elect to release to the public–includes initiating the repeal of the ACA.

Repeal and Replace Obamacare Act. Fully repeals Obamacare and replaces it with Health Savings Accounts, the ability to purchase health insurance across state lines, and lets states manage Medicaid funds. Reforms will also include cutting the red tape at the FDA: there are over 4,000 drugs awaiting approval, and we especially want to speed the approval of life-saving medications.

No wonder, now, that there is such concern over what his electoral victory means for this law on which many Americans now depend, but which has done little to stall the skyrocketing premium increases we have consistently seen for decades, as well as for drug safety and monitoring. In just this past day, Trump has seemed to moderate his plan for the ACA, further confusing the matter.

I would normally make a normative recommendation in a blog entry after careful analysis. But the fact of the matter is that no one, perhaps not even President-elect Trump, knows what concrete action will in fact be taken regarding the ACA.  I have, however, compiled for readers a partial list of some useful considerations by others for your perusal:

• A sense of whiplash about the affordable care act (Trump says he may keep parts of Obama Health Care Act) [Nov 11, 2016]
• Trump hedges on health care, points to ‘amending’ ACA [Nov 11, 2016]
• Day One and Beyond: What Trump’s Election Means for the ACA [Nov 9, 2016]
• Trump Posts Preliminary Plan to Repeal ACA [Nov 11, 2016]
• Obamacare’s Future In Critical Condition After Trump’s Victory [Nov 9, 2016]
• Trump Outlines Health Plan, From Obamacare Repeal to Abortion [Nov 10, 2016; includes video with CC as well as text]
• Donald Trump Just Said He’ll  Consider Keeping Some Major Parts of Obamacare [Nov 11, 2016]

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Time will tell.  What it will tell? That’s anybody’s guess at this point.

EDIT: I posted a link to this on Twitter, and Daniel Goldberg (@prof_goldberg) shared this opinion by legal scholar Lindsay Wiley, which I am sharing with you.