​https://newsatjama.jama.com/2017/11/20/jama-forum-the-health-care-law-that-continues-to-escape-death/

The Affordable Care Act has survived more assassination attempts than Fidel Castro — and it’s still kicking. The Kaiser Family Foundation’s Larry Levitt has a piece in the JAMA Forum laying out the argument that the ACA “continues to escape death.”

• Levitt’s piece is mostly focused on the Senate’s repeal-and-replace efforts and the Trump administration’s implementation decisions — cutting off payments for cost-sharing subsidies and dramatically scaling back enrollment outreach.
• “If these efforts were intended to make the marketplace implode, they may, in fact, be backfiring,” Levitt says, citing the weird abundance of plans with $0 monthly premiums and enrollment totals that are beating some experts’ expectations.

This is just the latest chapter. The ACA has been a fixture of public debate since 2009, and it has never veered far from death’s door. In that time, it has survived:

• Any number of make-or-break moments during the legislative debate
• Two potentially disastrous Supreme Court challenges
• The Republican waves of 2010 and 2014, and the countless repeal votes that followed
• A slew of self-inflicted wounds, from provisions that proved unworkable to the hot mess that was the HealthCare.gov launch.

Between the lines: The ACA has definitely taken some hits — it’s not as strong its drafters might have hoped on the day it passed. But congressional Republicans’ failure to repeal it, and President Trump backing into a massive increase in its subsidies, are just the latest signs of the law’s surprising durability.

Until Congress repeals the individual mandate, anyway…