Listen now (23 mins) | Listen Now With the election of Donald Trump Congressional Republicans are poised to repeal the Affordable Care Act (ACA) within the first 100 days of the 115th Congress via the budget reconciliation process. (At some future date they are pledging to draft ACA replacement language or legislation.) The expectation is repeal would have an effective date of 2018 or 2019, or after the mid-term Congressional elections. However, many if not most health policy experts agree the simple act of repeal would cause such instability state insurance marketplaces would collapse long before repeal would, legally, go into effect. Congressional Republican leadership is also promising to move major Medicare, via premium support and major Medicaid legislation, via block grants or per capita caps, though the upcoming Congress.