Dismantling the ACA without help from Congress.

Members of Congress usually escape the humid summer heat and head home for the August recess. But this year, Senate Majority Leader Mitch McConnell is keeping them in Washington, DC, for 2 more weeks in what is expected to be an unsuccessful attempt to pass the Better Care Reconciliation Act, repealing and re placing the Patient Protection and Affordable Care Act (ACA), former President Barack Obama’s signature health-care law. As this went to press, the Senate’s 48 Democrats remain solidly against a repeal, and Republicans are struggling to craft repeal legislation that would satisfy both the conservative and moderate branches of their slim majority. If the Senate does approve some form of repeal legislation, it would have to be reconciled with the House of Representatives’ bill after working out any differences. But President Donald Trump is not patiently waiting for the Republicancontrolled Congress to keep their party’s 7-year promise to scrap the law. “I’ve been saying for a very long time”, he said, “let Obamacare fail and then everybody is going to have to come together and fix it”. And he is confident of the outcome: “Eventually, we’re going to get something done and it’s gonna be very good”, the President said. Meanwhile, support for the ACA, also known as Obamacare, hit an all-time high last month, 51%, the Kaiser Family Foundation reported in its latest poll. The percentage of Americans without health insurance has dropped to a record low of 10·9% in the fourth quarter of 2016, compared with 18% in 2013, just before the ACA took effect, according to the Gallup-Healthways Well-Being Index. Waive, defer, and delay While the congressional saga continues, the ACA remains in effect and the Trump administration is at the helm, in charge of a programme the President promised during his campaign to eliminate. Trump officials have an essential role in implementing the law and improving it, as well as unique opportunities to fulfil their prophecy that it will fail.