ACA/ Medicaid expansion on borrowed time - effects on FIRE

[moustachebar]

I believe ACA plans and Medicaid expansion are on borrowed time.

In conversations with relatives on non-employer non-ACA health insurance, prices on the private market for a small family are high enough to actually exceeds our family's total annual expenditure for housing, food, energy, clothing, car/ gas, and insurances combined.

As a low consumer of health care but with a pre-existing condition, I expect to be shunted to a high risk pool or unable to get private insurance at all.

It is possible this will not come to pass, but if it does it is like buying an SUV every year. A hair-on-fire emergency.

What are YOU thinking about as potential strategies or plans?

[jrhampt]

Well, this may not be a helpful strategy for everyone...but those who qualify for access to the VA including spouses should probably apply.  My spouse is a veteran, and my parents also have care through the VA.  Otherwise, idk.  Plan on hoarding money or think about medical tourism/moving somewhere else?

[spartana]

Well, this may not be a helpful strategy for everyone...but those who qualify for access to the VA including spouses should probably apply.  My spouse is a veteran, and my parents also have care through the VA.  Otherwise, idk.  Plan on hoarding money or think about medical tourism/moving somewhere else?

Usually that's for spouse's of veterans rated at 100% or permanently disable (and they can use a VA or Champus facility) so not always open to all spouse's. Plus there's a chance the VA will be privatised and eliminated under the new administration.

I use the VA myself for my healthcare now but agree that there are few options for others if the ACA is eliminated. High cost private plans or Employer sponsored programs will likely be the only option like it was before the ACA was enacted. It's gonna be tough especially if they can once again deny you coverage for pre-existing conditions. I'm getting all my medical stuff done at the VA this month and hope it'll still be available next year.

[jrhampt]

Well, this may not be a helpful strategy for everyone...but those who qualify for access to the VA including spouses should probably apply.  My spouse is a veteran, and my parents also have care through the VA.  Otherwise, idk.  Plan on hoarding money or think about medical tourism/moving somewhere else?

Usually that's for spouse's of veterans rated at 100% or permanently disable (and they can use a VA or Champus facility) so not always open to all spouse's. Plus there's a chance the VA will be privatised and eliminated under the new administration.

I use the VA myself for my healthcare now but agree that there are few options for others if the ACA is eliminated. High cost private plans or Employer sponsored programs will likely be the only option like it was before the ACA was enacted. It's gonna be tough especially if they can once again deny you coverage for pre-existing conditions. I'm getting all my medical stuff done at the VA this month and hope it'll still be available next year.

Ah yes, I forgot that the VA may be on the chopping block as well. 

[moustachebar]

I appreciate the responses. I'm not hearing a great/ widely available plan B out there so far. I hope you are able to maintain your VA coverage and it meets your needs.

If denied coverage, money ain't helping for very long no matter what you hoard, since the uninsured costs are so out of whack with the real costs/ what the insurers actually pay. I think this usually ends with nothing left and whatever Medicaid is willing to pay for.

Medical tourism is good for some things but not for keeping watch over pre-existing conditions. Impacts on school schedules or traveling without family support while ill or weak are both tough.

Where is the "somewhere else"? Are you considering states where something like ACA used to exist or has been proposed?

[obstinate]

In conversations with relatives on non-employer non-ACA health insurance, prices on the private market for a small family are high enough to actually exceeds our family's total annual expenditure for housing, food, energy, clothing, car/ gas, and insurances combined.

Why are they on a non-ACA plans? ACA plans have subsidies that bring the out of pocket costs down to a specified fraction of your income, unless you are rich.

[moustachebar]

Not my business/ don't know why they do that. Yes, that confirms the central issue if ACA were to be repealed.

It is as bad as it seems I guess. Overpay for care, fly around alone while ill, or move... somewhere.

[spartana]

I am curious what people (already FIREd or wanna-be FIRE) will do healthcare wise is there are big changes or elimination to the ACA, Medicare, Medicaid or the VA? I guess there's only so many options that will be available that most will probably continue working or going back to work for affordable healthcare until they are 65 (or maybe older if they increase the age for Medicare health covrage). Or just pay the full cost themselves for insurance.  Guess moving to another country or marrying someone with employer health insurance (wave hi to @Dicey lol) are options too.

[Rural]

I'm staying at work until I qualify for retiree heathcare through my employer. That's been my plan, and I stuck to it in fear of this happening over the last four years. Hope it works.


Husband has VA, but not 100% disabled, so I'm not eligible. Still hopeful on it; we'll see what they cut.

[seattlecyclone]

The ACA was modeled after a state-level program in Massachusetts. I'm hopeful that if the federal ACA is repealed my state would enact a decent replacement for it.

The longer a program like this exists, the more people come to rely on it, the harder it is to repeal...at least if you care about public opinion. I'd prefer to live in a country where that last bit could be taken as a given.

[bacchi]

As seattlecyclone suggests, other states may create their own "Romneycare."

What this means for my family: If our state doesn't create one, we'll move to where there is one. Or, if no state creates one, we'd move overseas. That's complicated because of our pets but it's better than going naked and potentially ending up bankrupt when we're 65.

There is, sadly, no great answer in America. We pay more and have the same or worse results.

[Captain FIRE]

Not to worry people more, but it actually takes quite a bit of effort to stand up a state healthcare exchange. That's not something that can happen overnight. I suspect it's harder to take down than Trump expects (widespread appeal these days) and if he does, other states may follow MA, but it'll take time to operationalize.

[moustachebar]

VA, retaining or going back to a job, domestic move, foreign move. Thank you all for a look into your plans.

I had wondered about moving to another state, and specifically MA since they had Romneycare. I know they had it briefly but I wonder whether states can actually pull off the exchanges, and especially subsidies, in times of recession. A mandate is one thing but without subsidy to pad profits I would expect insurers to flee particular markets.

Going abroad seems so extreme to me, but a better option than dying early for lack of funds, or leaving a bankrupt spouse.

What is frustrating is that as one posted above, the costs here are so much higher for the same or worse care. I have no problem with paying for services or insurance. Paying multiples of reasonable prices to extortionist cartels who have you between life and death seems so unreasonable.

I overheard a customer in a store recently telling a worker that she had just lost her husband. He was in the hospital for less than a week before he passed away, and there was nothing they could do to prolong his life. He was insured, but the hospital's bill to the insurer was over half a million dollars. Imagine an even slightly protracted illness and a spouse with nothing left but Social Security. Now imagine the same without Social Security. I know, probably preaching to the choir here.

Thanks again for sharing your thoughts.

[obstinate]

As seattlecyclone suggests, other states may create their own "Romneycare."

Well. They didn't last time, not even California. But we could hope they will this time? However, hope is not a strategy.

Our family has vastly oversaved so part of my strategy might simply be self-insuring. A full course of cancer treatment costs about $200,000 on average over a couple of years. We could absorb that cost by cutting back substantially on other stuff. I'm trying to estimate the likelihood that we get hit with a disease like that, and on what timeline, and how much would indeed be covered by insurance, etc.

What this means for my family: If our state doesn't create one, we'll move to where there is one. Or, if no state creates one, we'd move overseas. That's complicated because of our pets but it's better than going naked and potentially ending up bankrupt when we're 65.

Do you have citizenship in a country that has more healthcare subsidies than the US would? Because, if you don't, you may find it's a little harder to do this move after you're retired.

[seattlecyclone]

As seattlecyclone suggests, other states may create their own "Romneycare."

Well. They didn't last time, not even California. But we could hope they will this time? However, hope is not a strategy.

What "last time"? The ACA has not been repealed before. There has not yet been any need to create a state-level replacement for it.

[Paul der Krake]

Everyone needs to take a chill pill. Nobody has seriously run on repealing the ACA in quite a while.

[moustachebar]

Do you have citizenship in a country that has more healthcare subsidies than the US would? Because, if you don't, you may find it's a little harder to do this move after you're retired.

Yeah, or not even subsidy - but decent outcomes and non-extortionary pricing. I am not looking for foreign nationals to subsidize my care if I am not/ haven't been paying in.

But the interesting point is being able to immigrate when retired. Canada doesn't have a retirement visa. There are the countries with golden visas I guess, but those are its own financial commitment. Or nomad visas.

Everyone needs to take a chill pill. Nobody has seriously run on repealing the ACA in quite a while.

Appreciated. I see it as possible to probable but a significant disruption - more of one than a multiyear market mess, for me. So it is in my field of vision. Given focusing on circle of control, I want to know the outlines of that circle.

Short term I am looking at which jobs offer family health insurance and how I might start to prepare for them. That's within my circle of control to do, even if it isn't my fondest hope; we took this leap vowing to be flexible to make it work. But it occurred to me that others may have other backup plans I hadn't considered.

[jim555]

I have 5 years until Medicare so figure it takes two years for whatever changes are made to become effective.  That leaves me with 3 years to cover.  So I might go nomad for 3 years and come back, just pay full price, or do a permanent move since I have a British passport.  Isle of Man is looking interesting.

[sonofsven]

This is a well timed piece on countries that are trying to attract expats by offering retirement visas:

https://money.usnews.com/money/retirement/aging/articles/countries-that-offer-retirement-visas

Oregon has a new expanded Medicaid "Bridge" program offering free coverage up to 200%  of the FPL ($31,120 per year max income for individuals), although it's being funded by Federal money (basically using the ACA subsidy dollars) so it could all be cut by the "efficiency expert" that turned 44 billion dollars into 9.4 billion

[bacchi]

What this means for my family: If our state doesn't create one, we'll move to where there is one. Or, if no state creates one, we'd move overseas. That's complicated because of our pets but it's better than going naked and potentially ending up bankrupt when we're 65.

Do you have citizenship in a country that has more healthcare subsidies than the US would? Because, if you don't, you may find it's a little harder to do this move after you're retired.

World health insurance plans, ex-US, are very reasonably priced. No citizenship needed.

And, as someone mentioned, there are golden passports.

Everyone needs to take a chill pill. Nobody has seriously run on repealing the ACA in quite a while.

No one in this thread has mentioned making changes right now. I'm not packing as I type this reply.

Mike Johnson did recently state, though, that there would be "massive" reforms in healthcare.

"Health care reform’s going to be a big part of the agenda. When I say we’re going to have a very aggressive first 100 days agenda, we got a lot of things still on the table."
[...]
“No Obamacare?” an attendee asked Johnson, referring to the law Democrats passed in 2010, also known as the Affordable Care Act.

“No Obamacare,” Johnson responded, rolling his eyes.

[moustachebar]

Mike Johnson did recently state, though, that there would be "massive" reforms in healthcare.

"Health care reform’s going to be a big part of the agenda. When I say we’re going to have a very aggressive first 100 days agenda, we got a lot of things still on the table."
[...]
“No Obamacare?” an attendee asked Johnson, referring to the law Democrats passed in 2010, also known as the Affordable Care Act.

“No Obamacare,” Johnson responded, rolling his eyes.

I think "No Obamacare" in this context means "we're not dealing with Obamacare", not "there will be no Obamacare". Now, whether disabling components of it, or not including funding for it whenever they get to a budget process that isn't a CR, are considered dealing with it?

[obstinate]

As seattlecyclone suggests, other states may create their own "Romneycare."

Well. They didn't last time, not even California. But we could hope they will this time? However, hope is not a strategy.

What "last time"? The ACA has not been repealed before. There has not yet been any need to create a state-level replacement for it.

Before the ACA, there was a need. That's the last time I was referring to. During that time 1/50 states created a healthcare system that protected folks with preexisting conditions.

[spartana]

Everyone needs to take a chill pill. Nobody has seriously run on repealing the ACA in quite a while.

True but it was only enacted 14 years ago and wasn't up and fully running until 2014. So really only in full use for 10 years. That's a small time frame and only one GOP pres - Trump - during that time. 

I personally think they will leave it alone for now but may require assets testing as well as income. But over all I think it would be pretty easy and fast to dismantle it. Medicare, traditional Medicaid (for poor people who have no assets), and the VA will probably be left alone for now. Places like Calif will have some kind of healthcare in place like the state's current Medicaid that doesn't count assets or immigration status.

[mistymoney]

In conversations with relatives on non-employer non-ACA health insurance, prices on the private market for a small family are high enough to actually exceeds our family's total annual expenditure for housing, food, energy, clothing, car/ gas, and insurances combined.

Why are they on a non-ACA plans? ACA plans have subsidies that bring the out of pocket costs down to a specified fraction of your income, unless you are rich.

I know somewho who was funneled to medicaid but wanted private insurance, so paying full price.

[iris lily]

Everyone needs to take a chill pill. Nobody has seriously run on repealing the ACA in quite a while.

True but it was only enacted 14 years ago and wasn't up and fully running until 2014. So really only in full use for 10 years. That's a small time frame and only one GOP pres - Trump - during that time. 

I personally think they will leave it alone for now but may require assets testing as well as income. But over all I think it would be pretty easy and fast to dismantle it. Medicare, traditional Medicaid (for poor people who have no assets), and the VA will probably be left alone for now. Places like Calif will have some kind of healthcare in place like the state's current Medicaid that doesn't count assets or immigration status.

Shocker, income testing! (Nanny G isn’t set up to measure assets)

Maybe that’s what they SHOULD be doing.

[bacchi]

Everyone needs to take a chill pill. Nobody has seriously run on repealing the ACA in quite a while.

True but it was only enacted 14 years ago and wasn't up and fully running until 2014. So really only in full use for 10 years. That's a small time frame and only one GOP pres - Trump - during that time. 

I personally think they will leave it alone for now but may require assets testing as well as income. But over all I think it would be pretty easy and fast to dismantle it. Medicare, traditional Medicaid (for poor people who have no assets), and the VA will probably be left alone for now. Places like Calif will have some kind of healthcare in place like the state's current Medicaid that doesn't count assets or immigration status.

Shocker, income testing! (Nanny G isn’t set up to measure assets)

Maybe that’s what they SHOULD be doing.

The ACA does income testing. ??

[sonofsven]

Everyone needs to take a chill pill. Nobody has seriously run on repealing the ACA in quite a while.

True but it was only enacted 14 years ago and wasn't up and fully running until 2014. So really only in full use for 10 years. That's a small time frame and only one GOP pres - Trump - during that time. 

I personally think they will leave it alone for now but may require assets testing as well as income. But over all I think it would be pretty easy and fast to dismantle it. Medicare, traditional Medicaid (for poor people who have no assets), and the VA will probably be left alone for now. Places like Calif will have some kind of healthcare in place like the state's current Medicaid that doesn't count assets or immigration status.

Shocker, income testing! (Nanny G isn’t set up to measure assets)

Maybe that’s what they SHOULD be doing.

The ACA does income testing. ??

The cost of your ACA premium and subsidy (and deductible, and max oop, to a lesser extent) change based on your income (not your assets).
Is that not an income test?

[jim555]

Everyone needs to take a chill pill. Nobody has seriously run on repealing the ACA in quite a while.

True but it was only enacted 14 years ago and wasn't up and fully running until 2014. So really only in full use for 10 years. That's a small time frame and only one GOP pres - Trump - during that time. 

I personally think they will leave it alone for now but may require assets testing as well as income. But over all I think it would be pretty easy and fast to dismantle it. Medicare, traditional Medicaid (for poor people who have no assets), and the VA will probably be left alone for now. Places like Calif will have some kind of healthcare in place like the state's current Medicaid that doesn't count assets or immigration status.

Since they don't have 60 senate votes, assuming they keep the filibuster rule, they can only make changes around the edges Making a major change can't be done through reconciliation.  They might reduce the subsidy levels or Medicaid Federal matching rates, but a change like asset testing is a foundational change to the law that technically wouldn't be in order through reconciliation.  But since they seem to follow no rules or norms anything is possible.

The House is still up in the air, if the margin is super tight it will be hard govern for whoever controls it.

[spartana]

Everyone needs to take a chill pill. Nobody has seriously run on repealing the ACA in quite a while.

True but it was only enacted 14 years ago and wasn't up and fully running until 2014. So really only in full use for 10 years. That's a small time frame and only one GOP pres - Trump - during that time. 

I personally think they will leave it alone for now but may require assets testing as well as income. But over all I think it would be pretty easy and fast to dismantle it. Medicare, traditional Medicaid (for poor people who have no assets), and the VA will probably be left alone for now. Places like Calif will have some kind of healthcare in place like the state's current Medicaid that doesn't count assets or immigration status.

Since they don't have 60 senate votes, assuming they keep the filibuster rule, they can only make changes around the edges Making a major change can't be done through reconciliation.  They might reduce the subsidy levels or Medicaid Federal matching rates, but a change like asset testing is a foundational change to the law that technically wouldn't be in order through reconciliation.  But since they seem to follow no rules or norms anything is possible.

The House is still up in the air, if the margin is super tight it will be hard govern for whoever controls it.

Yeah I don't think it'll be a quick process (even if they do get a majority)  but the VA did asset testing (net worth) up until 2015 when they eliminated it. And they asked you to count EVERYTHING. Art work, jewelry, etc. Pretty much anything of value beyond your primary residence and vehicle. It was used to determine eligibility as well.as Co-Pays. So I can see them doing that again as well.as eliminating Medicaid for people between 18 and 65 (excluding some other categories like refugees and pregnant women)  regardless of your income or assets like before.

https://www.va.gov/healthbenefits/news/va_eliminates_net_worth_as_health_care_eligibility_factor.asp

"Effective 2015, VA eliminated the use of net worth as a determining factor for both health care programs and copayment responsibilities. This change makes VA health care benefits more accessible to lower-income Veterans"

"Instead of combining the sum of Veterans’ income with their assets to determine eligibility for medical care and copayment obligations, VA will now only consider a Veteran’s gross household income and deductible expenses from the previous year."

Of course if the ACA is eliminated assets or income won't matter l. But if, as you said, they nibbled around the edges I can see asset testing to be a thing in determining how much you'll pay for premiums.

[jim555]

Everyone needs to take a chill pill. Nobody has seriously run on repealing the ACA in quite a while.

True but it was only enacted 14 years ago and wasn't up and fully running until 2014. So really only in full use for 10 years. That's a small time frame and only one GOP pres - Trump - during that time. 

I personally think they will leave it alone for now but may require assets testing as well as income. But over all I think it would be pretty easy and fast to dismantle it. Medicare, traditional Medicaid (for poor people who have no assets), and the VA will probably be left alone for now. Places like Calif will have some kind of healthcare in place like the state's current Medicaid that doesn't count assets or immigration status.

Since they don't have 60 senate votes, assuming they keep the filibuster rule, they can only make changes around the edges Making a major change can't be done through reconciliation.  They might reduce the subsidy levels or Medicaid Federal matching rates, but a change like asset testing is a foundational change to the law that technically wouldn't be in order through reconciliation.  But since they seem to follow no rules or norms anything is possible.

The House is still up in the air, if the margin is super tight it will be hard govern for whoever controls it.

Yeah I don't think it'll be a quick process (even if they do get a majority)  but the VA did asset testing (net worth) up until 2015 when they eliminated it. And they asked you to count EVERYTHING. Art work, jewelry, etc. Pretty much anything of value beyond your primary residence and vehicle. It was used to determine eligibility as well.as Co-Pays. So I can see them doing that again as well.as eliminating Medicaid for people between 18 and 65 (excluding some other categories like refugees and pregnant women)  regardless of your income or assets like before.

https://www.va.gov/healthbenefits/news/va_eliminates_net_worth_as_health_care_eligibility_factor.asp

"Effective 2015, VA eliminated the use of net worth as a determining factor for both health care programs and copayment responsibilities. This change makes VA health care benefits more accessible to lower-income Veterans"

I think more likely they allow Medicaid work requirements if a state wants it.  They might reduce the Federal match from 90% to a lower number.  The work requirements are NOT part of the law and can be legally challenged, especially in light of the Supreme Court striking down the Chevron doctrine.  Chevron allowed agencies to make rules not in the law, that can now be challenged.

[spartana]

^^^yeah I can see that happening for sure. I know several.states have that. Calif doesn't do that but they have the ability to change it pretty fast. I think the work requirement is only for people under 60 so not an early retirement option. Max income level to qualify is pretty low (approx $1700/ month MAGI or less) so most people probably earn more in expensive Calif and wouldn't qualify.

[Paul der Krake]

Everyone needs to take a chill pill. Nobody has seriously run on repealing the ACA in quite a while.

No one in this thread has mentioned making changes right now. I'm not packing as I type this reply.

By my count, there are at least 4 separate threads all created in the last week where hypothetical ACA changes are being discussed:
https://forum.mrmoneymustache.com/ask-a-mustachian/aca-medicaid-expansion-on-borrowed-time-effects-on-fire/ (this one)
https://forum.mrmoneymustache.com/off-topic/how-long-until-the-aca-is-dismantled/
https://forum.mrmoneymustache.com/off-topic/elon-musk-and-donald-trumps-plan-for-fire-on-a-national-level/
https://forum.mrmoneymustache.com/off-topic/trump-2-0/

I'm sure there's more in the never-ending politics thread with hundreds of pages, but this is just from the last four days!

Breathe, people. Not only is it extremely unlikely that it will go away, everyone posting on an early retirement forum is like, top 1% of the general population in problem solving and personal agency. If that happens (it won't), we'll survey the landscape and come up with something.

[jim555]

^^^yeah I can see that happening for sure. I know several.states have that. Calif doesn't do that but they have the ability to change it pretty fast. I think the work requirement is only for people under 60 so not an early retirement option. Max income level to qualify is pretty low (approx $1700/ month MAGI or less) so most people probably earn more in expensive Calif and wouldn't qualify.

The under 60 thing is from SNAP.  CA is not going to request work requirements but plenty of red states with expansion would request it.

[obstinate]

I'm sure there's more in the never-ending politics thread with hundreds of pages, but this is just from the last four days!

Breathe, people. Not only is it extremely unlikely that it will go away, everyone posting on an early retirement forum is like, top 1% of the general population in problem solving and personal agency.

Most of the thread participants are having a sober discussion about how the landscape might change going forward and what should be done about it. I think that this is a reasonable thing to do at this juncture, and doesn't merit a "breathe!" admonition. Obviously threads about a change to the political landscape would be started after (gasp) the political landscape changes. Not everyone shares your estimate of how likely the ACA is to change.

[yachi]

I came here, and to some of the threads started in the off topic area out of concern for what the election might have on my FIRE status.  Health insurance was one of the last pieces of the puzzle to come into place leading up to my FIRE in 2021.  I felt like the ACA program surviving the first 4 years under Trump had set a good precedent to be able to rely on it for my needs.

"Project 2025", the document that may or may not set up a gameplan for doing things under Trump, lays out a number of proposed changes to the ACA.  I find the fact they have proposed changes to be an encouraging sign that they plan on keeping the program in place, even if one finds the changes distasteful.

A separate discussion could be had about the justice/tastefulness of the changes, but that would move into Off Topic for a discussion centering on the FIRE ramifications.

[Psychstache]

Everyone needs to take a chill pill. Nobody has seriously run on repealing the ACA in quite a while.

No one in this thread has mentioned making changes right now. I'm not packing as I type this reply.

By my count, there are at least 4 separate threads all created in the last week where hypothetical ACA changes are being discussed:
https://forum.mrmoneymustache.com/ask-a-mustachian/aca-medicaid-expansion-on-borrowed-time-effects-on-fire/ (this one)
https://forum.mrmoneymustache.com/off-topic/how-long-until-the-aca-is-dismantled/
https://forum.mrmoneymustache.com/off-topic/elon-musk-and-donald-trumps-plan-for-fire-on-a-national-level/
https://forum.mrmoneymustache.com/off-topic/trump-2-0/

I'm sure there's more in the never-ending politics thread with hundreds of pages, but this is just from the last four days!

Breathe, people. Not only is it extremely unlikely that it will go away, everyone posting on an early retirement forum is like, top 1% of the general population in problem solving and personal agency. If that happens (it won't), we'll survey the landscape and come up with something.

It wasn't that long ago that we had a poster here who went on and on for years like a legal scholar talking about how Roe v Wade was not in danger, stare decisis, settled law, etc. There is plenty of reason to speculate and hypothetically game plan out what the future could hold for the ACA that includes significant change and/or removal.

Pour one out for John Galt Incarnate!

[Financial.Velociraptor]

Post FIRE and pre-ACA, I had no true insurance plan because of pre-existing conditions.  No one would take me.  An insurance broker set me up with what is known as an "indemnity plan".  These plans have a monthly premium and pay out a fixed dollar amount for various claims.  I bought 5 units (the max) and that yielded up to $5,500/day for hospitalization for example.  I got a payment for filling prescriptions, I got a payment for routine PCP visits, I could get payments for essentially anything medical.  And if I went 'in-network' I got the insured rate instead of the uninsured rate for medical services.  It was more expensive than ACA, had no max out of pocket, and required shopping around and sometimes negotiation for services.  I used one of those free cards for prescriptions at first, then a 110/year Sams+ membership for their pharmacy discount.  It was cheaper than 'going naked' but more expensive than ACA by a lot.   

I will go back to that and draw down from the 15k or so I have in an HSA account if ACA is substantially impaired.  It is an inferior option.  Will consider the 'healthcare sharing plans' that were carved out as religious exemption to ACA mandate and are still around as well.  Can't imagine Trump and GOP will dare kill something that was promised/gifted to radically Pro-Life Evangelicals.  I think putting preachers in between people and their doctors is sort of lame but it might be better than the (no) alternative.

Would probably buy some one off policies like Cancer Policy to supplement this.

I have considered that Trump might make ACA better despite himself.  Maybe if he feels like he will get adulation for reforming ACA and changing the name to Trump-Care, there might be a scenario where red states will finally accept the money to expand Medicaid.  It would probably come with loss of patient rights (litigation reform), removal of reproductive care as a legal right - depending on your state, forbid 'gender affirming care', and maybe no longer cover routine vaccinations (RFK jr).  A net win for me as a 50-something male.  And something that could continue to be reformed when Trump is gone.   

[curious_george]

I think history might be a useful guide here, since Trump himself has no concrete ideas and simply operates off of general feelings about things.

Back in 2016, one of the things Trump ran on was the idea of repealing and replacing Obamacare. It was a pretty common talking point.

After Republicans gained control of both the house and Senate and Trump won the presidency, they finally unveiled and voted on their Obamacare replacement plan.

If you read through the text of their new plan, it was essentially an Obamacare lite plan. A lot of the same basic protections still existed, but the subsidies for healthcare premiums were reduced significantly and tapered off rapidly for middle / high income folks. IIRC I remember reading their new subsidy formulas and thinking "well, if I keep my income low enough, I will still be fine"

In addition try also tried to implement Medicaid work requirements in several states.

None of this really came to pass - except maybe some of the work requirements, but I think even those were struck down in the courts.

I suspect, since Trump did not even run on repealing the ACA this time, that mostly they will just make some changes around the edges. Try to reduce subsidies, remove women's healthcare, try and add work requirements, remove funding for advertising, make signing up harder, etc. 

Who knows how much of this will come to pass, but I think at this point even the Republicans realize there would be too much chaos in the healthcare markets if they outright repeal the ACA. So I personally don't see this occuring, but I also recognize that I might be eating those words this time next year.

No matter what, we will probably know within the next 2 years, and probably within the first year of Trump's presidency, what their general plans are for the aca. I imagine this is the sort of thing they would want to make any changes they are going to make while they have control over congress, so can't risk waiting too long.

I don't know anything about politics though, so I could be horribly wrong about everything.

ETA: In terms of backup plans, my backup plan would be to get a part time job somewhere for benefits, or ask my spouse to get a part time job somewhere for benefits.