AHCA meets BCRA; timeline, context, and future directions

Total healthcare spending in the USA surpassed $3.4 trillion dollars in 2016. This represents 19% of the country's gross domestic product.52 Observers largely agree that the current system needs repair. It remains to be seen the extent to which that repair will come through a modification of the traditional fee for service process53 54 that neurointerventional specialists know well or through alternative payment models.55 The ACA transformed healthcare, but by not delivering on the promises made when enacted in 2010, it has served as a rallying cry for Republicans in multiple election cycles. The events of November 2016 created a meaningful chance that the Republicans would fulfill their multi-year campaign promise. However, it seems that policy makers have learnt what physicians have known along, that healthcare financing is indeed complicated.For our current political leaders, it remains elusive to find the intersection of the goals of providing healthcare for all those in need and maintaining reasonable cost to those who are healthy. While the opportunity for Congressional action seems to have largely passed by this point, it remains at least conceivable that ACA repeal could still be achieved through further political and legislative maneuvering. Regardless, the ACA continues to face problems that require attention. Although unlikely in the current political climate, such challenges may best be addressed by politicians from both parties working together.