Healthcare executives and clinical leaders predict “no clear winners, only losers” when asked to assess President Donald Trump’s impact on their industry in a survey conducted by the New England Journal of Medicine.

More than 1,000 members of the NEJM Catalyst Insights Council completed the survey, which was conducted after Trump took office but before the failure of the American Health Care Act (AHCA), the most serious attempt in the new administration to replace the Affordable Care Act (ACA).

That doesn’t mean respondents were confident about the ACA sticking around, which was one of several key findings in the survey:

1. Most think ACA will be repealed

Some 62 percent of respondents predict the ACA will be repealed within the next year, combining those who believe it will be fully eliminated and replaced (27 percent) and those who think it will be repealed but with a replacement delayed indefinitely (35 percent). Just 28 percent of respondents feel the ACA will be left “substantially intact.”

Some individual commenters expect even greater change, with one predicting the ACA will transform into a single-payer system “driven by consumer pressure.” Several hope political partisanship can be removed from the repeal-and-replace discussion.

“The ACA had some great concepts but when the two parties used it to divide instead of working together to improve the plan, it suffered,” remarked one executive from a small physician organization in the mid-Atlantic.

One executive from a large, for-profit hospital physician organization in the Northeast has a bolder prediction: “Trump will be impeached and we can get on with the hard work of healthcare transformation. Otherwise, there is no hope.”

2. Insurance coverage won’t be improved

Despite Trump’s initial promises of “insurance for everybody,” those surveyed have expectations more in line with what the Congressional Budget Office forecast with the AHCA: 69 percent predict insurance premiums will rise, 70 percent predict coverage benefits to decline and 74 percent expect more people will be uninsured.

Overall, respondents were most pessimistic about how things will change for everyone involved in the delivery system. Nearly three-quarters (73 percent) feel patients would be negatively impacted by Trump’s changes to the healthcare landscape, followed by 63 percent saying clinicians would be negatively affected and 62 percent predicting providers will be worse off.

3. Murky future for value-based care

One area lacking consensus from respondents is what future awaits value-based care policies in the age of Trump. Some 36 percent think the trend away from fee-for-service will stay the same, but equal numbers of respondents (11 percent each) believe the trend will increase or decrease significantly.

“I would hope the positive effects of the (Center for Medicare & Medicaid Innovation) are recognized and that serious attention is given to value-based care, as it is the only viable idea in healthcare for decades that has the potential to actually reduce national healthcare costs while improving health outcomes,” said one respondent.

4. Consolidation trend will continue

The Trump administration was expected to be more lenient on healthcare mergers. Respondents to the survey agree, with 65 percent predicting increased consolidation among providers and 58 percent expecting the same among insurance companies.

5. Funding will be cut

The survey was conducted before Trump’s proposed budget, which would reduce funding to HHS by $15.1 billion, was released, but respondents wouldn’t have been surprised, judging by the survey results.

The majority expected funding for CMMI (69 percent), the Office of the National Coordinator for Health IT (61 percent), and CMS as a whole (61 percent) to be slashed under Trump. Two-thirds (67 percent) expected funding for medical research would be reduced, another prediction which came true when the proposed budget called for $5.8 billion in cuts to the National Institutes of Health (NIH).