As President Obama’s time in office wanes, the exiting president offers his perspective in the New England Journal of Medicine on the potential repeal of his administration’s Affordable Care Act. The ACA currently stands as a significant part of the president’s legacy, a landmark bill that transformed the healthcare industry in the United States, for better or worse. President Obama recognizes that “health care policy often shifts when the country’s leadership changes. That was true when I took office, and it will likely be true with President-elect Donald Trump.” The President explains his pride in how the current system offers high-quality care to millions of previously uninsured Americans. Indeed, a larger portion of Americans have health insurance now than ever before. However, Obama recognizes that work remains to be done to improve the Affordable Care Act. He notes a lack of choice exists in some health insurance markets, premiums remain unaffordable for some families, and high prescription-drug costs. His administration’s ideas for overcoming these issues have been documented in articles and budget proposals, but “persistent partisan resistance to the ACA has made small as well as significant improvements extremely difficult.”

The incoming administration’s seems geared on repealing first and replacing later (potentially 2-3 years later), a course of action that President Obama deems irresponsible and “could potentially bleed the health care system that all of us depend on… the health care system will be standing on the edge of a cliff… insurance companies may not want to participate in the Health Insurance Marketplace in 2018 or may significantly increase prices in the next year or two, partly to try to avoid the blame for any change that is unpopular.” Obama lists more potential snowball effects of a full or partial repeal, including the risk of losing coverage for preexisting conditions, an aspect of the ACA that President-elect Trump wishes to maintain. The president exclaims that he will applaud legislation that improves Americans’ care, but improvements need to be identified explained by the new administration before action is taken.

Evidence-based practice is expected within our modern health care system. Health care reform, too, should be evidence-based and driven by what is best for the patient. President Obama concludes by urging policymakers to consider what is best for the patient, in this case the entire population of our country, and abide by the physician’s oath of “first, do no harm.”

What will a full repeal mean for the life science industry which provides so many life changing and lifesaving solutions to patients in clinical care? The impact remains to be seen. Stay tuned!