On January 20 Donald Trump will be sworn in as the 45th president of the United States. How exactly he and the Republican-controlled Congress will reshape U.S. policy and institutions is unclear, but their approach to health care reform will have profound impacts on the health and well-being of the American people and on the U.S. economy. Trump’s stated goal is to repeal and replace the Affordable Care Act (Obamacare), but the details of his plan are still unknown. We can ill afford a prolonged period of paralysis and debate. The Trump administration must move quickly to apply what’s been learned so far to a new program that addresses the cost, quality, and accessibility of health care.