In the popular book and movie series about a dystopian society pitting the “Haves” vs. the “Have-Nots.” We see a clash play out between the urban elite ruling-class under siege by an uprising of the subjugated rural lower-class.

Over the course of the 2016 Presidential election, and now into the beginnings of the Trump administration we are watching eerie parallels of reality imitating fiction.

Our country has divided into Blue States of Urban-Intellectual Elites vs. Red States of Rural-Disenfranchised Workers.

The Red States spoke out with a voice crying for change, and selected a change agent as the 45^th President that promises to upend many fundamental underpinnings of our country that have been taken for granted for decades.  High on the list of what will be upended is our health care system. If the Affordable Care Act (Obamacare) is to be repealed on day one as promised, what can we expect to happen?

Will coverage for as many people as possible be ditched for a new priority of making sure that those who can afford the best care can get what they are able to pay for?

Will Medicaid continue to cover the elderly, poor and children or will those decisions be left up to the states as they are given the “power” to figure out how to make due with less funding?

Will Medicare become privatized and be turned into a financial windfall for the big insurance companies selected to manage what is now the most cost-effective payor of healthcare in the Unites States?

Let the Games Begin

As has been the case for most of what Candidate Trump promised during the election; President-Elect Trump’s actual intent is hard to pin down. But one thing is certain, the Trump administration and the Republican controlled Congress have Obamacare in their crosshairs.

Expect repeal action to commence as soon as on the first day of the incoming administration. It will prove to be a chaotic and controversial process. It will also be a stark reality check for the “Red State” voters in many ways as campaign promises turn out to be antithetical to their best interests.

Medicaid could be turned over to the states to run with less funds through block grants.

The perceived win will be the freedom to “incentivize” participants to “manage” their care through higher co-pays, premiums and more stringent requirements to qualify such as employment for non-disabled applicants.

Medicare could be privatized by turning it into a subsidized voucher system for participants to use to buy private health insurance coverage. Ironically, this will have a disproportionate impact on the voter demographic that supported Trump whether they realize it yet or not.

The Affordable Care Act will likely be replaced by a program of re-privatization that attempts to incentivize people to maintain coverage through tax incentives towards premium payments for health insurance coverage. Mandates will be eliminated while pre-existing coverage prohibitions will be maintained. How to overcome the negative impact of adverse selection driving up costs when only those most in need elect for coverage, while the young and healthy self-insure is anybody’s guess.

To the Victor go the Spoils

In the first week after the election over a million new registrants signed up for coverage under the ACA hoping to get in under the wire. But the White House, Congress, and a majority of state capitols are under Republican control (and so is the Supreme Court for that matter) at a time when the party is at its most conservative and nationalistic in our country’s history. 73 million Americans are covered by Medicaid, 44 million are covered by Medicare, and 20 million gained coverage under Obamacare. All of these people and more will be impacted by what is to come. It has been said that a nation’s health care system is a reflection of its core values—and what constitutes our “core values” today is very much in question and in flux.

In our real world version of the Healthcare Hunger Games, who will be the winners—the people who need coverage or corporate interests such as insurance companies, hospitals and doctors? Well, let the games begin because we are about to find out.

Chris Orestis is the CEO of Life Care Funding and a 20-year veteran of both the insurance and long-term care industries.  A former Washington DC lobbyist, he is a nationally known senior care advocate and author of the Amazon best-selling books “Help on the Way” and “A Survival Guide to Aging,” a legislative expert, featured speaker, columnist and contributor to a number of insurance and long term care industry publications.