大象传媒

The battle over the replacement of Justice Ruth Bader Ginsburg has refocused American attention on the future of the Affordable Care Act. The Supreme Court is  that brought insurance coverage to .

Meanwhile, Trump recently released his 鈥�.鈥� In it, the president claims significant achievements. He also outlines broad principles of his vision for the future of health care in America.

Over the past three years, the Trump administration has taken a number of steps to dismantle pieces of the ACA. And his recently introduced executive order  and the .

The two factors leave me鈥攁  who 鈥攕keptical about the emergence of a  to the ACA that would expand insurance access should the Supreme Court invalidate the Obama administration鈥檚 signature achievement.

Trump鈥檚 Moves on Health Care

President Trump campaigned and entered office with the pledge to 鈥溾�� the ACA. In his own words, there would be a 鈥溾�� right after the election.

Since 2016, Congress has made little headway besides eliminating the ACA鈥檚 penalty for not carrying insurance. This is the basis for the  to be heard before the Supreme Court in November. The argument is that because Congress did away with the penalty, the individual mandate can no longer be constitutionally justified as a tax. As a result, the entire law should fall.

While Republicans have been unable to repeal the law, the Trump administration has taken a number of . In combination, these efforts have contributed to bringing the uninsured rate to . This leaves millions of Americans without coverage and exposed to medical bills should they fall ill.

A major target of the Trump administration has been reducing enrollment through the . Here, the administration  and drastically reduced funding for individuals who help consumers enroll in coverage as well as advertising. It also  to support low-income individuals with out-of-pocket costs, which also caused problems to insurers offering plans to those people.

The administration has also worked to expand alternative insurance plans such as so-called , and . While these plans have lower premiums, they do not carry the consumer protections of the ACA such as preexisting condition coverage. They also do not pay for prescription drugs or hospital stays. And unlike the ACA, they also require consumers to undergo a medical assessment before enrollment. Consumers may be charged higher premiums or rejected entirely based on their medical condition and age.

Regulations issued by the Trump administration have reduced access to reproductive care for women. The administration has also pushed states to implement  and  in Medicaid for fear of being denied permanent residency. As a result, .

Even on one of the president鈥檚 favorite topics, reducing the cost of prescription drugs, numerous initiatives regarding  for Medicare beneficiaries .

On one of the president鈥檚 other priorities, eliminating  for medical services that patients unexpectedly receive for care that they reasonably thought would be covered by their insurance, the administration鈥檚 actions have yet to have a meaningful effect.

An Executive Order Can鈥檛 Replace a Law

When it comes to Trump鈥檚 executive order, the topic that received the most public attention鈥攖he guarantee that 鈥淎mericans with preexisting conditions can obtain the insurance of their choice at affordable rates鈥濃�攃arries no legal weight nor clear explanation of how it would be achieved or funded.

More generally, , the  focuses primarily on past actions. It also spends just 491 words on laying out a set of objectives鈥攍ower costs, better care and more choice鈥攜et does not provide a mechanism or road map for how to implement them.

All this leads me to believe that if the ACA is overturned before the Supreme Court, the prospect of substantive replacement that seeks to expand care to more Americans is unlikely.

This article originally appeared in . It has been edited for 大象传媒 Magazine.