One of the common plot devices of horror films is to have a climactic event where a threatening evil is defeated. The triumphant characters breathe a sigh of relief, begin putting their lives together and then, BANG! The supposedly vanquished terror unexpectedly raises its ugly head again in a final effort to overcome the forces of good.

Was the Republican American Health Care Act (AHCA) evil? No. A poorly conceived piece of legislation hastily put together? Yes. A gift to the insurance industry? Yes. A threat to the health care coverage for over 20 million Americans? Yes.

But through the efforts of multiple groups who vigorously opposed the AHCA, coupled with Republican infighting, the bill was withdrawn rather than face an ignominious defeat. And now everyone who worked so hard to oppose it breathes a sigh of relief that the Affordable Care Act (ACA) is saved and they may be tempted to just go back to other activities. Especially when President Trump and Speaker Ryan say they are done with health care legislation for the foreseeable future and are now focused on tax reform.

However, Congress can still pass small pieces of legislation that can seriously harm the ACA.

For example, Republicans have suggested that funding for the Center for Medicare and Medicaid Innovation (CMMI) be eliminated. The CMMI (created under the ACA) is tasked with testing whether various innovations in health care delivery and payment can result in cost savings without adversely impacting health outcomes. Last September the Congressional Budget Office reported that the CMMI’s innovations would reduce health care spending by the federal government by $34 billion over the next 10 years. An efficient federal center producing that much savings does not match with the Republican slogan that private is better. If Republicans want to abolish the ACA, then getting rid of the CMMI is a good way to make the ACA less efficient and more expensive.

But it doesn’t take legislation to weaken the ACA. President Trump’s January executive order requires that executive departments utilize all discretion allowed by law (ACA) to avoid burdening individuals with the penalty for not purchasing health care insurance. While it is not clear how that order would be implemented (individuals still would have to apply for a waiver), removing the penalty could do severe damage to the cost effectiveness of the ACA.

In order for any health care insurance plan to function optimally (either before or under the ACA), it is dependent on a wide pool of individuals participating so that the risk of the few who develop catastrophic health care needs can be distributed over the much larger population of those with minimal needs.

To allow people to not get some type of coverage means that insurers have to concentrate their costs on the smaller pool of individuals who do have insurance. When someone without insurance needs health care, the cost of that unreimbursed care is passed on to all who have insurance. Just as it is fair to require drivers to have auto insurance, it is fair to all of us to require individuals to have some type of health insurance.

However, the biggest threat to the ACA would be for both political parties and the president to refuse to sit down with each other to discuss how to fix real problems in the ACA, such as the limited number of insurance plans available in some regions and the continuing rise in health care premiums. With modification of the ACA these problems can be solved. But our Republican and Democratic elected officials in Congress, as well as our Dealmaker-in-Chief, need to be pushed by their constituents to actually talk with each other. If they do not address these issues, then the ACA may eventually implode. And that would be a really frightening ending to the ACA health care saga.

Dr. Stephen Soltys is a retired professor emeritus who still teaches at SIU School of Medicine on a volunteer basis.