a Department of Health Law , Policy & Management, Boston University.
b Department of Health Systems and Policy , School of Public Health, Rutgers, the State University of New Jersey.
J Aging Soc Policy. 2018 May-Jun;30(3-4):282-299. doi: 10.1080/08959420.2018.1462684. Epub 2018 May 10.
The ACA has survived multiple existential threats in the legislative and judicial branches, including dozens of congressional attempts at repeal and two major Supreme Court cases. Even as it seems that the ACA is here to stay, what the law accomplishes is far from settled. The Trump administration is using executive powers to weaken the law, in many cases using the same powers that President Obama used to strengthen the effects of the reform. States have responded by seeking flexibility to pursue reforms, such as work requirements, that could not pass Congress and that were not allowed by the Obama administration. There is no indication that the ACA is imploding as President Trump has predicted and seems to desire, although these changes have a real and substantial impact on the lives of many Americans, including the near-elderly in unique ways.
ACA 在立法和司法部门中多次经受住了生存威胁，包括数十次国会试图废除该法案和两次最高法院重大案件。即使 ACA 似乎已经站稳脚跟，但该法律的实际效果还远未确定。特朗普政府正在利用行政权力削弱该法律，在许多情况下，政府使用的是奥巴马总统用来加强改革效果的相同权力。各州已经通过寻求灵活性来进行改革作为回应，例如工作要求，这些改革无法通过国会通过，也不被奥巴马政府所允许。尽管这些变化对许多美国人的生活产生了真实而重大的影响，包括以独特的方式影响到接近老年的人群，但没有迹象表明 ACA 会像特朗普总统所预测并似乎期望的那样崩溃。
