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).