NEJM December 6, 2018
David K. Jones, Ph.D., Christina Pagel, Ph.D., and Christopher F. Koller, M.P.P.M., M.A.R.

The future of U.S. health care reform is muddier now than at any point in the past two decades. Health care was one of the most important issues for voters in the 2018 election, but there is little reason to believe that substantive national action is likely any time soon. The Trump administration is taking aggressive steps to undermine the Affordable Care Act (ACA) but is limited in what it can do on health policy absent legislation from Congress. States are poised to fill this vacuum. The risk of replicating the hyperpartisanship that has stalled Congress in recent years is real — 37 state governments will be controlled entirely by one party in 2019, and only Minnesota’s legislature will have...