Intended for healthcare professionals

News US Election 2016

Obamacare and abortion under threat, but soda tax and marijuana laws are passed in some states

BMJ 2016; 355 doi: (Published 16 November 2016) Cite this as: BMJ 2016;355:i6138
  1. Michael McCarthy
  1. Seattle

It’s not just Obamacare that is likely to change as a result of last week’s election. Michael McCarthy rounds up the policy winners and losers

The sweep by Republicans in the US elections that secured the presidency and both houses of Congress gave them a free hand to overturn President Barack Obama’s signature legislative accomplishment, the Affordable Care Act.1

During the campaign Donald Trump said that, if elected, he would call a special session of Congress to “repeal and replace” the 2010 health reform law, often called Obamacare, which Trump has described as “a catastrophe.” In an interview since being becoming president elect Trump said that he wanted to retain at least two popular provisions of the law: that prohibiting insurers from denying coverage to people with pre-existing conditions, and the provision allowing parents to keep their children on their insurance policies until age 26.

In his first post-election press conference as outgoing president, Obama predicted that Republicans would find it harder to repeal his health reform law than they thought. The law has provided coverage to 20 million people who were previously without insurance, mandated popular consumer protections for uninsured people, and saved the Treasury “hundreds of billions of dollars” by slowing the growth of healthcare spending, he said. “Now suddenly you are in charge and you are going to repeal it. OK, well, what happens to those 20 million people who have health insurance?” Obama asked.


Before he was elected president Trump said that he would nominate “pro-life” justices to the Supreme Court who would overturn the court’s landmark 1972 Roe v Wade decision that established a woman’s right to an abortion in the US.2 Trump also promised to repeal provisions in the Affordable Care Act that require insurers to provide free contraceptive services. Ilyse Hogue, president of NARAL Pro-Choice America (formerly National Association for the Repeal of Abortion Laws), described Trump’s policies as “a clear and present danger to women.” She said that her organization would oppose any attempts by the Trump administration to limit access to abortion and contraception. Women’s health groups are urging their clients to make sure to get health insurance coverage through the Affordable Care Act while it is still available and to avail themselves of cost free contraceptive services.


On 8 November voters in California, Nevada, Maine, and Massachusetts also agreed to the legalization of the recreational use of marijuana, joining Colorado, Oregon, Alaska, and Washington.3 The ballot victories mean that around a fifth of US residents can now legally use marijuana recreationally.

Arkansas, Florida, and North Dakota voted to legalize the medical use of marijuana, while in Montana voters passed a measure that would loosen restrictions on doctors prescribing the drug. They join many other states that have legalized medical marijuana since California was the first state to pass such legislation in 1996.

Soda tax

In California the cities of Albany, Oakland, and San Francisco followed the lead of neighboring Berkeley by introducing a 1 cent per ounce tax on sugar sweetened beverages. Voters in Boulder, Colorado, agreed to a 2 cent per ounce tax.

In 2014, Berkeley became the first US city to impose a “soda tax” that, one study showed, was followed by a 21% decline in the consumption of sugar sweetened drinks in the city’s poorer neighborhoods.4

Lethal drugs for terminally ill patients

Colorado voters passed a law that would let doctors prescribe lethal doses of drugs to terminally ill patients who were expected to die within six months, joining California, Montana, Oregon, Vermont, and Washington, which have similar legislation.

Death penalty

Voters in Nebraska chose to reinstate the death penalty, a year after it was repealed.5



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