 After the Trump Administration took office in 2017, there was an effort by it and the Republican Congress to repeal and replace the ACA. The House, with a significant Republican majority, narrowly passed the American Health Care Act of 2017. The Senate version of it failed to receive a majority of votes, and the efforts to repeal the ACA and replace it later with a plan to be worked out also failed to pass. Because President Trump has continued to threaten the ACA and the Republican leadership in both houses put replacing the ACA high on their list of goals, arguably the victory of the ACA and its goal of reducing significantly the number of uninsured is not secure as of the summer of 2017. (We return in Section 2 to discuss further the Republican model of universal access, resting as it does on the “choice” to be uninsured.) 