Six Ways Trumpcare Will Differ from Obamacare

Published November 10, 2016

With control of the White House and both houses of Congress, Republicans may finally be in a position to follow through on their vow to repeal the Affordable Care Act (a.k.a. Obamacare). But how will President Donald Trump try to deliver on his pledge that “everybody’s going to be taken care of much better than they’re taken care of right now”?

These are the key elements of Trump’s healthcare policy, from his campaign website.

Repeal the individual mandate.

Republicans are united by the notion that no one should be forced to purchase health insurance (even though the original idea was promoted by conservatives as a way to enforce individual responsibility). Obamacare coupled the individual mandate with a requirement that insurers cover pre-existing conditions and charge the same amount for everyone regardless of health status. That way people couldn’t just wait to become sick before buying insurance. Trump wants to keep the pre-existing conditions requirement, which is popular among voters, but that may be tough without the mandate.

Allow the sale of health insurance across state lines.

This is a long-standing Republican idea, meant to increase competition among health plans. What’s untested is whether insurers will actively pursue this opportunity, since success in local markets depends on building up provider networks and investing in marketing.

Turn Medicaid into a block grant program.

States would be given more leeway to design and run their health insurance programs for the poor, which could allow them to innovate and adjust to local needs. Democrats have opposed block grant initiatives in the past, arguing that it is often a hidden way to cut funding.

Encourage importation of pharmaceuticals.

Brand name drugs can be a lot more expensive in the US than they are abroad. Drug “re-importation” including bus trips to Canada and ordering via mail order  was popular in the 1990s but faded once the Medicare Part D drug benefit was added and after Obamacare mandated drug coverage.

Make health insurance premiums deductible for individuals.

The aim of this policy would be to make insurance more affordable for people who buy policies on their own. The benefits would flow mainly to higher income people who are in higher tax brackets.

Expand the use of Health Savings Accounts (HSAs).

HSAs are often paired with high deductible health plans to help consumers pay for out-of-pocket expenses. Funds in the accounts grow tax free and are available for retirement expenses if they are not used for health plans.

With Republicans fully in charge of healthcare policy, Democrats will be in a position to critique GOP plans and hold their colleagues responsible for the inevitable shortcomings of what emerges. Whether Trumpcare will be more popular than Obamacare is anyone’s guess.