As the initial shock of Donald Trump’s surprise victory in the presidential race wears off, his HHS transition team now has a leader and major professional associations are reaching out with policy priorities—which for some groups may include fighting the president-elect’s promise to repeal the Affordable Care Act (ACA).

Leading Trump’s HHS transition team will be a veteran of the agency, Andrew Bremberg. He served throughout the George W. Bush administration as special assistant to the executive secretary (2001-2005) and immediate office of the HHS Secretary (2005-2007) before finishing Bush’s term as chief of staff in the HHS’ Office of Public Health and Science.

Bremberg was a part of 2012 Republican candidate Mitt Romney’s transition team, which was working on a plan to overturn the ACA—at that time just two years old, with the insurance marketplace not yet open—by blocking subsidies for purchasing coverage.

More recently, he worked for Senate Republican Leader Mitch McConnell and served as a health policy advisor for Wisconsin Gov. Scott Walker’s short-lived presidential campaign.

According to the Wall Street Journal, Bremberg isn’t likely to back down from the Trump campaign’s promise to repeal the ACA.

“If the goal is repeal and replace Obamacare, my instincts are, ‘Well that’s not politically feasible.’ Andrew’s [are], ‘If that’s what we’re told to do, we’re going to find a way to do it,’” Tom Barker, former HHS General Counsel and member of the Romney transition team, told the Journal.  

Major medical associations are now reaching out to Bremberg and the transition team. Some, like the American Hospital Association, didn’t advocate for particular policies, but said it would work with the new administration to  work “on the nation’s health care challenges.”

The American College of Emergency Physicians (ACEP) offered a broader appeal for Trump to address healthcare issues like insurance gaps for emergency care and high deductibles, without specifying what reforms it would favor.

"Health insurance companies mislead patients by selling so-called 'affordable' policies that cover very little, until large deductibles are met—and then blame medical providers for charges," said ACEP President Rebecca Parker, MD.

For health IT groups, the effects of a Trump presidency remain a mystery.

“Cybersecurity threats are proliferating and becoming harder to detect. Additionally, we still confront a disjointed infrastructure that limits our ability to adequately exchange patient information,” said College of Healthcare Information Management Executives (CHIME) President and CEO Russell Branzel.

One of the stronger messages to the transition team on policy came from the Texas Hospital Association. THA President and CEO Ted Shaw said repealing the ACA without accounting for its reductions in the number of uninsured patients would be “problematic,” adding that cuts to Medicaid could “undermine innovations” and efficiencies achieved in recent years.

“For almost a decade, hospitals have adjusted in an age of reform as health care professionals strategized and adjusted to new priorities in quality and patient safety brought on by the ACA,” Shaw said. “While the law isn’t perfect, the opportunity now exists to engage consumers and political leaders on policies that go beyond whether you do or do not support Obamacare. Instead, we must fully invest ourselves in what it means to be healthy, what it means to provide health care, and how we want to pay for it."