Like many of you, my family relies on the health care insurance marketplace for our health insurance needs. The ACA has been a boon to me and my wife because we happen to have pre-existing conditions. Without the Affordable Care Act we would be uninsurable outside of a group plan.
Due to the recent election, the ACA is probably going to have some major changes in the next few years. Here's two reasons why we probably don't need to panic just yet.
1. Regulatory Timing
Insurance companies submit their finalized plans for the year to most states by April or May of the prior year. That means 2018 plans will be in process by May 2017. This leaves only a precious few months for the new Congress to get a fresh bill started and completed in both the House and the Senate. They're going to spend at least a month finalizing their rules and dickering about the filibuster which leaves even less time.
2. The Filibuster
In order to get rid of the preexisting condition clause the Senate has to either beat a filibuster or eliminate it entirely. The alternative is to pass a bill through the budget reconciliation process, which can only deal with monetary issues. If they pass the budget reconciliation version without eliminating the pre-existing condition clause the health care system in the US will experience a death spiral and the majority will get blamed. If, on the other hand, the new Senate eliminates the filibuster they're screwing their future selves. The Republicans will again be the minority party at some point in the future and the filibuster is one of the most powerful tools for the minority.
Of course, I very well could be wrong. Nobody really knows yet what the new president and the new congress have planned. It's best to have a backup plan, which for consultants and freelancers probably means getting friendly with some companies where you'd be comfortable working full time.