The story of the Affordable Care Act is far from over, according to Indivisible Princeton’s health care panel.

Last Friday Republicans in Washington withdrew legislation for their proposed new health care bill, and Democrats celebrated victory in staving off seven years of Republican efforts to repeal and replace the Affordable Care Act (ACA). President Trump, however, announced, “The best thing politically is to let Obamacare explode.”

On Monday night before a gathering of about 50 at the Unitarian Universalist Congregation Church on Cherry Hill Road, four experts on health care and government policy discussed what’s still at risk and how the Trump Administration, the state of New Jersey and others will continue to influence who gets care in our communities. The grassroots bipartisan organization and the lead speakers also addressed strategies for advocacy in Trenton and Washington to protect and stabilize the ACA.

Panelists included Larry Epstein, Atlantic Medical Group administrator and CEO for Pulmonary and Allergy Associates in Summit; Tara Oakman, senior program director at the Robert Wood Johnson Foundation; Christine Grant, former New Jersey Commissioner of Health and Senior Services; and Julie Pantelick, practicing physician in Trenton and faculty member in the Department of Internal Medicine at St. Francis Medical Center.

Mr. Epstein led off the presentations with an explanation of “how we got to where we are today,” a condensed history of the country’s healthcare delivery system, from 1901 with the reorganization of the American Medical Association (AMA) up through the start of Medicare and Medicaid in 1965, introduction of HMOs in the 1970s, rising health care costs and American medicine in a crisis mode through most of the past decades up to the ACA of 2010.

Ms. Oakman then posed the question “How is the ACA doing?” as she reviewed the key elements of the ACA, “what it achieved and where challenges remain.” She pointed out that despite considerable political resistance, access to health insurance has risen significantly over the past seven years, though 28 million Americans remain uninsured.

Ms. Oakman went on to explore ways to reduce the uninsured rate and to improve the health of the marketplace. She concluded that many factors in Washington or in state governments could discourage participation in the ACA and undermine the program.

Focusing on the ACA and the expansion of Medicaid in New Jersey, Ms. Grant then described a number of risks to the stability of the ACA and of medical care in the state, including a dwindling pool of interested insurers, high debt levels among young people, structural lower employment, uninsured, undocumented residents, and federal regulatory changes.

Urging continued education and advocacy to enhance the stability of the ACA, Ms. Grant proposed continuing political involvement at all levels to ensure tax-subsidized healthcare locally and nationally.

Ms. Pantelick’s remarks, including the moving story of a patient who “would probably have died in the ICU if he hadn’t had insurance,” delineated how the ACA had changed the lives and helped many of the most complicated cases of the underserved in New Jersey. She went on to propose a range of political, societal and cultural reforms needed in the U.S. “Do we want to be a healthy country?” she asked. “Are we really serious about reforming health care?”

Concluding with an outline of strategies for defending the ACA on the federal and state levels, Indivisible Princeton representative Kathy Taylor went on to entertain a range of comments and questions from the audience.

There was significant interest in pursuing further discussion of a single-payer healthcare system and the possibility of Medicare for all in New Jersey, but that topic was left for a later date. The goal of Monday’s session, Ms. Taylor stated, was not to come up with alternative health plans but to focus on “preventing damage to the ACA from the current administration, resisting the Trump agenda in a bipartisan way.”