On November 8, 2016, the future of the Patient Protection and Affordable Care Act (ACA) became more uncertain. Republicans in Congress have been working to repeal the ACA since it was passed in 2010, and now, with control of both houses of Congress and the White House, they may finally get the chance to do so. President-elect Trump has stated that the Trump Administration will work with Congress to repeal the ACA and replace it with a “patient-centered healthcare system” that includes Health Savings Accounts (HSAs), the return of high-risk pools and the “modernization” of Medicare. Trump announced this week the nomination of Georgia Congressman Tom Price, a physician and long-time critic of the ACA, as Secretary of the Department of Health and Human Services. Additionally, Speaker Paul Ryan has set forth his “A Better Way” healthcare reform plan that would repeal and replace the ACA. Ryan’s plan includes substantial reform to Medicaid through per capita allotment financing and block grants; the creation of a “Medicare Exchange” in which private plans would compete with traditional fee-for-service Medicare; and Medicare “premium support” payments that would be paid by Medicare directly to the private plan or the fee-for-service program to subsidize its cost.