TY - JOUR T1 - The flywheel: the Affordable Care Act is picking up momentum JF - British Journal of General Practice JO - Br J Gen Pract SP - 250 LP - 251 DO - 10.3399/bjgp19X702545 VL - 69 IS - 682 AU - John Frey Y1 - 2019/05/01 UR - http://bjgp.org/content/69/682/250.abstract N2 - Elections always have consequences. The midterm elections in the US were not solely a referendum on the xenophobic, misogynistic, and hateful rhetoric of President Trump and the inability of his flimflam appointees to dismantle most of the progressive reforms of the Obama administration. The election results, somewhat surprisingly, were also driven by the increasing value Americans are putting on the Affordable Care Act (still, unfortunately, referred to as Obamacare) and the reliance that 20 million Americans have developed on it for securing affordable insurance.The cry of ‘Repeal Obamacare’ has changed over time to ‘Fix Obamacare’ and the door has been opened to serious discussion about methods to achieve universal coverage, advocated in the US since before the First World War but defeated repeatedly. The two relatively easy-to-understand government-funded or subsidised insurance programmes — Medicaid for individuals on low incomes and families, and Medicare for everyone over the age of 65 years, are being used by Democrats as examples of how expansion of either or both of those programmes might move the country towards the goal of universal coverage. For the first time, a majority (56%) of Americans want the government to ensure healthcare coverage.1 And no one is pounding the table decrying ‘socialised medicine’!During the most divisive, … ER -