The next Congress and administration is likely to take some steps to modify the ACA or allow states to escape some of its provisions. These won't be elegant steps, and some, like action on the Cadillac tax, are likely to be steps backward. It will most probably be a period of muddling along until the political planets align for a more coherent and structural reform at some point far in the future. Indeed, future historians are likely to look back on the period as yet another example of an expression allegedly offered by Winston Churchill: “You can always count on Americans to do the right thing—after they have tried everything else.”
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