Benjamin D. Sommers, M.D., a physician and healthcare economist, in a  New England Journal of Medicine piece headlined “Health Care Reform’s Unfinished Work — Remaining Barriers to Coverage and Access,” concludes:

“{T}he ACA is succeeding in expanding coverage and access, with promising indications for population health. But challenges remain; the fundamental political question is how — and whether — they’ll be addressed. Though some members of both political parties favor replacing the ACA entirely, that seems unlikely to happen. Liberals who believe a single-payer system is the easiest method of eliminating cracks in our patchwork coverage approach must face the political realities that derailed a single-payer effort in liberal Vermont and have made it so challenging to implement even a centrist national health care reform law. Many conservatives still advocate ‘repeal and replace,’ but the almost-certain backlash against taking coverage away from more than 15 million Americans makes it hard to imagine this rhetoric becoming reality….”

“What’s likely, then, is healthcare reform version 1.1, rather than version 2.0. We’ll probably see substantial debate over refining the ACA rather than replacing it, much as occurred after the enactment of Medicaid and Medicare in 1965. Perspectives on how to do so will vary; some policymakers will argue that the law isn’t generous enough, while others will insist that it’s already too costly and intrusive. Ultimately, there are likely to be only incremental changes….”