The Affordable Care Act is on the chopping block, likely to be one of the first casualties when President-elect Donald Trump takes office next month.

“We will repeal the disaster known as ‘Obamacare’ and create new health care — all sorts of reforms that work for you and your family,” Trump promised in Florida last week.

Before that happens, President Obama and his aides want to put a marker down on what they see as the law’s accomplishments over the last six years.

“When I came into office, 44 million people were uninsured,” Obama told reporters during his pre-Christmas news conference at the White House. “Today, we’ve covered more than 20 million of them. For the first time in our history, more than 90 percent of Americans are insured.”

So far, more than 6.4 million people have signed up for insurance coverage in 2017 through the federal exchange. Enrollments are on track to exceed last year’s total, with many coming from states like Florida, Texas, and North Carolina that were carried by Trump.

While expanded insurance coverage is the yardstick most often cited, defenders argue the Affordable Care Act has also helped limit rising health care costs and put more emphasis on the quality of care, not just how much is done.

“While multiple factors are likely playing a role, payment reforms introduced in the [Affordable Care Act] have made substantial, quantifiable contributions to slowing the growth of health care costs in both Medicare and private insurance,” White House economists wrote in a report this month.

The report cites estimates from the Congressional Budget Office that Obamacare has shaved 1.3 percentage points off the annual growth in per-person Medicare spending.

For people who get health coverage through their employer, the slowdown has been even sharper, the report says. The cost of family coverage has grown just over 3 percent per year since the Affordable Care Act was passed in 2010. That’s a 45 percent reduction from the pace of the previous six years. While many workplace insurance plans now include higher deductibles and co-pays, workers’ out-of-pocket costs are still growing more slowly than they were before Obamacare, White House economists say.

The law also encourages payment reforms that reward doctors and hospitals for high-quality care, not simply performing a lot of tests and procedures. More than 30 percent of Medicare payments are now based on these “alternative payment models,” along with about 10 percent of payments for workers covered by private insurance.

To be sure, the Affordable Care Act remains deeply controversial. Americans who dislike the law slightly outnumber those who approve of it. That’s partly a reflection of the law’s partisan history. It was passed without a single Republican vote.

Implementation has also been rocky — especially the disastrous debut of the government’s insurance exchange website in 2013. Nineteen states — most with Republican leadership — declined to take advantage of the Affordable Care Act’s Medicaid expansion.

What’s more, after losing money in past years, many insurance companies have stopped offering policies on the government-run exchanges. According to the Kaiser Family Foundation, about 20 percent of people shopping for coverage on the exchanges this year have just one insurance company to choose from. With less competition, premiums on the exchanges have risen sharply: about 25 percent on average.

Despite these drawbacks, supporters say the Affordable Care Act has been a net-plus, both for individual customers who can no longer be denied access to health insurance and for the federal government which has steadily reduced its forecast of long-term health-care costs.

At the same time, the law has not proven to be the drag on job growth that many Republicans warned of.

“Since I signed Obamacare into law, our businesses have added more than 15 million new jobs,” Obama noted.

The president can point to a number of other positive indicators as he prepares to leave office, including long-awaited wage gains in the last year and a modest decrease in income inequality, stemming, in part, from higher taxes on the wealthy.

The president and his team are trying to document those gains, mindful that the next occupant of the White House wants to reverse much of what Obama has put in place.

“What the president-elect is going to be doing is going to be very different than what I was doing, and I think people will be able to compare and contrast and make judgments about what worked for the American people,” Obama said during his year-end news conference. “I hope that, building off the progress we’ve made, that what the president-elect is proposing works. What I can say with confidence is that what we’ve done works.”

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“This year there’s been one big home run and a lot of scratch singles.” That’s how Red Sox fan and editor-in-chief of the New England Journal of Medicine, Dr. Jeffrey Drazen, sums up the year-that-was in public health.

Zika was the home run of 2016. It got lots of attention. It created a lot of drama. And it had a significant public health impact this year, says Drazen, who is a professor at the Harvard T.H. Chan School of Public Health. The Zika outbreak prompted travel warnings throughout the hemisphere and sparked frantic efforts to develop a vaccine.

And then there are the “scratch singles.” In baseball a “scratch single” is when a hitter barely hits the ball — “scratches” it — but still manages to get to first base. Drazen is talking about the non-glamorous work in public health that wins games over the long haul.

With ongoing efforts to combat mosquitoes and get people to sleep under bed nets, deaths from malaria continue to decline in Africa — down from more than 800,000 a year in 2000 to roughly 400,000 last year.

New HIV infections and fatalities have stabilized globally, although that still means that the virus spread to about 2 million more people in 2016 and killed another million. This flat-lining on HIV/AIDS is seen by some as a worrisome indication that progress against the epidemic has stalled. The more optimistic voices in the HIV world, however, point out that given the rapidly expanding population in Africa, where the bulk of new infections occur, the fact that numbers aren’t rising illustrates a heroic effort to keep this epidemic from getting far worse through prevention, education and HIV treatment programs.

Middle Eastern Respiratory Syndrome or MERS refuses to die but appears to be slouching toward extinction. MERS has primarily been a Saudi Arabia problem thus far. Since the virus was first discovered in 2012, 1482 of the 1841 cases reported to the World Health Organization have been in Saudi Arabia. One significant exception came in 2015, when a MERS outbreak in Korea caused panic in Seoul, temporarily shutting down schools, hospitals and factories. The outbreak in Korea was sparked by a businessman who’d recently returned from the Middle East. And although transmission of the virus continues at only a low level in Saudi Arabia, there’s no reason that a traveler couldn’t trigger another outbreak like the Korean one somewhere else in the world.

But in baseball terms, MERS in 2016 was the slugger at the bottom of the batting order, still getting up to the plate, still a threat but not causing much concern.

On the good news front, there have been lots of little advances — promising stars emerging from the ranks of the minor leagues. “There’s a new herpes vaccine for shingles that’s 90 percent effective,” Drazen says enthusiastically about a Glaxo Smith Kline vaccine that just wrapped up clinical trials. The GSK vaccine is far more effective than the roughly 50 percent offered by the only commercial shingles vaccine currently on the market.

“And guinea worm, we are almost close to eradicating that,” Drazen adds. Guinea worm is a nasty tropical parasite that’s spread by contaminated water. The worms pop out of people’s legs like long, burning strands of spaghetti. The Carter Center, which has been one of the lead agencies in the effort to stamp out guinea worm, says there were fewer than two dozen cases in the first 10 months of 2016.

Rob Henry, a senior public health adviser with USAID’s Neglected Tropical Disease (NTD) program, shares Drazen’s outlook: “I think 2016 was an excellent year,” he says.

“This year, for example, Guatemala was declared free of onchocerciasis — river blindness. That’s a big one.”

River blindness is a parasitic infection, spread by black flies, that causes excruciating itching and in severe cases blindness. The declaration that Guatemala is now free of the disease means that river blindness has been eliminated from everywhere in the Americas except one remote area in the Amazon along the border between Brazil and Venezuela.

River blindness is one of the seven neglected tropical diseases that USAID’s NTD program focuses on. Lymphatic filariasis is another. Also known as elephantiasis, it can cause horrific swelling of the legs and scrotum.

“Cambodia this year got acknowledgement from WHO as having eliminated lymphatic filariasis as a public health problem,” Henry says. “That’s a big moment for Cambodia.”

Henry says eliminating diseases like elephantiasis can’t compete in the headlines with the fight against fatal conditions. But he too is a big believer in the power of small hits: “It’s one thing to say you’re out there saving lives but it’s another thing to talk about how do you improve lives. How do you improve things to enable people to be able to make a living for themselves, for kids to be able to go to school, for people to be able to take care of their farms.”

Mass de-worming programs supported by USAID can break the transmission cycle of the parasite that causes lymphatic filariasis. And Henry notes that significant progress is being made against this disease not just in Cambodia but across the tropics.

“In Africa, Togo is just about ready to be able to declare the elimination of lymphatic filariasis,” he says. In the year 2000 in some parts of Togo up to 22 percent of residents were infected with the parasites that cause the debilitating swelling.

The other disease eradication effort that is tantalizingly close to victory but can never quite hit it out of the park is the campaign to end polio. And 2016 was a complicated year for the virus. On the one hand only 34 cases had been detected in 2016 as of this week. Unfortunately four of them were in Nigeria, which had previously been declared “polio-free” along with the rest of the African continent.

The new cases in Africa were found in areas recently liberated from Boko Haram. The insurgents barred health workers, destroyed health clinics and made routine immunization campaigns impossible.

Jeff Drazen says polio eradication is no longer a medical problem.

“We have the medical capacity to do this but it’s become a political problem,” he says. “It’s not as much a medical challenge as it is a political challenge.”

Or as the great baseball player Yogi Berra once said, “It ain’t over ’til it’s over.”

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Chelsea Arnold was getting into debt over tiny pieces of plastic: diabetic test strips. When Arnold was first diagnosed with diabetes she needed to test her blood sugar 10 times a day. She went to Wal-Mart and found that one box, which contained only a five-day supply of test strips, was $80. Arnold called her parents and told them she didn’t know what to do. She didn’t have the money.

Arnold then did what a lot of people do when they need help: She searched on Google. She typed in the words “cheap test strips,” and Craigslist came up. She bought eight boxes for less than $100. At Wal-Mart, she would have paid $640. Arnold said, “it was like having a life sentence and then realizing that there’s a cure.”

With this Google search, Arnold stumbled into an underground economy for diabetic supplies. It’s a market that offers a lower-cost option for test strips, though it is hard for customers to know where the boxes come from. Some boxes may be repackaged and unsafe to use, and some boxes are sold by diabetics who are desperate for cash. But many of them come from people who have health insurance and have accumulated extra test strips.

Trey falls into this category. (He asked us not to use his last name, because he fears retribution from his insurance company, even though he feels he hasn’t broken any laws.) He moved from one type of blood sugar monitoring system to another type of monitoring system and ended up with 20 extra test strip boxes.

At that point, Trey began researching. He said, “Obviously No. 1: Is it legal to be able to sell test strips?” Trey realized that it is legal, with a caveat. “It’s kind of a gray market as long as you don’t get them from Medicare and Medicaid,” he said. Trey then found a local buyer on Craigslist.

It starts to look a little seedy here. He put the 20 boxes in a brown paper lunch bag. “When I went to sell the test strips we met in a McDonald’s parking lot,” Trey said. “I came out with the bag full of test strips, and he had his wallet full of money and it was like we were doing a geriatric drug deal in the McDonald’s parking lot to get rid of some test trips.”

Trey made $300 off the geriatric drug deal. He jokingly calls the cash he made “blood money.” He used his “blood money” to buy Christmas presents for his kids.

As far as we can tell, his test strips went on to the next stop: a gray market middleman, something like a wholesaler, someone like Christa Kral. Along with her cousin, Kral purchases diabetic test strips from people like Trey. Their website is called sellusdiabeticteststrips.com.

To advertise, Kral used to post fliers near the train station in her town. Now her ads are online. She thinks the company’s unusual tagline has also brought in customers: “Two moms will buy your test strips.”

Kral operates her business out of her dining room. She has a cardboard box with about 20 boxes of test strips inside. She might pay $50 a box. It depends on the brand, the condition of the box, and the expiration date for the test strips.

Then she sells them at a markup to the next part of this chain: retailers. Arnold, the woman who bought test strips off Craigslist because they were too expensive at Wal-Mart, is now a retailer. That time when she couldn’t afford her test strips and keep her blood sugar in check — it scared her, and it made her decide to change her career path.

Arnold had been planning to go to medical school. But “that’s what really made me think I shouldn’t be a doctor and that I should go and help people try to afford the test strips,” she said.

Arnold started a website, glucomart.com. It’s a place where people can buy affordable test strips. She turned her garage into a kind of pharmacy. Her floor is epoxied, and she has pharmacy shelves.

Arnold realizes that if manufacturers or insurance companies lowered the price of test strips, she could be put out of business. She’s actually OK with that, because, she said, “the business exists to help people afford the test strips they need.”

Arnold would be happy to go back to her original plan and trade in her pharmacy shelves for a doctor’s coat.

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