James Capretta of the American Enterprise Institute outlines the current state of health reform. According to Capretta, one of the political challenges in health policy is how the coalitions for repealing and replacing the Affordable Care Act is so fluid. Many members of Congress want to vote on a "repeal" bill, but fewer want to vote on a "replace" bill. Multiple approaches and strategies have thus been evolving, including a "repeal and delay" strategy, and others. With the new administration, policy proposals that have momentum include a new high-risk pool system to allow insurers to participate in the exchanges in 2018; HSA liberalizations to encourage personal saving; replacement tax credits for the premium tax credits available through the ACA; and reforming Medicaid onto a per-capita cap basis. Regulatory changes such as tightening the enrollment period and widening the age bands are also relatively popular. Politically, however, there are many uncertainties and open questions that must be resolved.

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