In all likelihood, Trump’s election victory will spell the end for the Affordable Care Act, President Obama’s most prominent achievement. With Republicans in control of Congress and with Trump in the White House, the sweeping healthcare legislation will almost certainly be dismantled. But, with its demise will come a great deal of uncertainty. Despite the fact that the majority of Americans in post-election polls opposed a complete dismantling of the law, it stands little chance of surviving Trump, who has repeatedly promised to repeal and replace. Only one in three voters favored complete repeal and replacement of the ACA.

Therein lies some of the uncertainty. President-elect Trump has been short on specifics when it comes to what is to replace the ACA. He has offered up some typical conservative talking points, all of which are vague in nature. “Open up the healthcare market.” This is generic statement, and when pressed, those who offer this up as a solution offer little in details, as has Trump. “Allow companies to sell policies across state lines.” The effectiveness of this proposal is dubious, at best. As with the telecommunications market, we have seen the consolidation of monopolies, and thus people’s ability to choose from a wide variety of options has dwindled to choosing between three or four multinational conglomerates. There is no evidence to support the claim that this will increase options, lower the cost of healthcare, or improve it.

It is important for Trump and members of Congress to recognize that there are aspects of the ACA that are both popular and necessary for any industrialized nation. The ACA made huge strides in providing health insurance to people who did not previously have access to it. The majority of those people were children and the working poor. Most of America’s poorest citizens were already covered by Medicare. But, the ACA expanded the reach to include a great number of working class citizens who did not previously qualify for Medicare. The ACA also forced insurance companies to offer coverage to those with pre-existing conditions, most of which are life-long struggles and extremely debilitating conditions. Before the ACA, such people were forced into bankruptcy because of their lack of insurance coverage and inability to pay million dollar healthcare bills.

It is also important for Trump and members of Congress to recognize that there are aspects of the ACA that have not been successful. Obama promised that healthcare expenses would decrease, and for the vast majority of Americans, they have increased. The idea of penalizing those who do not purchase health insurance is constitutionally questionable, and future members of the Supreme Court may overturn the individual mandate.

The ACA did nothing to control the cost of individual healthcare services, or lower the cost of age old procedures that do not require innovation or new technology, yet have fallen victim to an inexplicable rise in rates. The ACA set about to ensure quality of healthcare regardless of income, but in the end, it became unaffordable for too many middle-class Americans, while maintaining the highest of quality care standards for the wealthy. The ACA also failed to prevent the price gauging tendencies of the pharmaceutical industry. They, too, have been increasing rates for medicines that have not required any changes in decades.

In general, the ACA did nothing to bring America’s archaic healthcare system in line with all other modern nations of the world who have been guaranteeing healthcare services for their citizens for decades. The fact that it made improvements, yet still failed so miserably is a testament to how far behind the rest of the world our healthcare system was in Obama’s first term. Sadly, it still is. But, before you take the liberty of placing the blame on Obama, I feel I should remind everyone that the ACA was modeled after the suggested legislation of Congressional Republicans in the 1990’s, that the individual mandate originated with the conservative think tank, the Heritage Foundation, and an early version of the ACA was put into practice on a statewide level by a Republican governor in Massachusetts.

So, it seems that neither Republicans nor Democrats have any idea how to slow the financial tidal wave that is the American healthcare system. I also think it is obvious that the previously suggested “free market principles” do not mesh well with the necessities of healthcare. Market principles are based on what consumers are willing to pay for a good or a service. Should healthcare be based on what a patient is willing to pay for their life, or rather, if they can afford to in the first place?

James Bliss ia Jamestown native who studied philosophy at Florida State University.