arrowFirst, we don’t know, because the election will decide a few things.  Mr. Trump proposes to dismantle the ACA but doesn’t say what will take its place (the Republicans have some ideas, but will he follow the party, and are their ideas fully worked out? (no would be the answer))
If Mrs. Clinton takes the seat, she can, will and should resume the conversations she was having when Mr. Clinton first arrived in office, which will include consideration of the “public (read – nuclear) option” which means replacement of the ACA with a government run system
for health care delivery.

The weird thing is that the government is denying that there are any medical “inflation” problems because the subsidies, which continue to be paid, offset these increases considerably.  So how long will the subsidies continue…especially in a Trump White House?

Meanwhile, the insurance companies have lost hundreds of millions of dollars and three of the largest – United, Humana and Aetna – have decided to drop out of most of the Exchanges in which they currently participate.  They are still very much in the game for group coverage, where they have long adapted to rules that affect how plans are delivered, but the individual plans continue to present a problem – a problem that everyone saw coming.  It’s a classic case – the carriers lowered their rates to be attractive, the government forced the issue by having negotiations with carriers that compelled them to be competitive, and then when older, sicker enrollees got on the plan, costs went up (no kidding).  And so here we are, facing the predicted “death spiral” which will only get worse as costs go up, those who need the coverage will continue while those that don’t won’t (and the cost of coverage remains considerably above the penalties imposed for failure to have coverage), more carriers will pull out (now some states only have one left, and what if they lose money?) which reduces competition, leading to even higher rate increases to go along with the deteriorating pool – and then either the ACA fails and the government abandons the issue…or the government doubles down and does it all.

A sampling:

Aetna pulls out of 11 of its 14 markets, and United out of 31 of its 34 markets
Enrollment in the ACA Exchanges are now said to be half of the original forecasts
Some states will now be down to one carrier of “choice”
Georgia regulators have approved double digit rate hikes for ACA plans
Connecticut increases supposed to be 25%
Florida should see increases of 19%
Nebraska increases will be an average of 35%
Thousands of West Virginians are unable to qualify for subsidies due to high incomes

And the list goes on (or the beat goes on, or something like that).