During the election campaign, Donald Trump promised to abolish Obamacare and replace it with better health reform that would not leave anyone behind. In order to understand what is implied by that promise, consider Figure I, which highlights three groups of people:
- About 11 million people are getting insurance in the exchanges and many of them are unhappy. In the words of former president Bill Clinton, many are “paying twice as much for half the coverage” they were previously enjoying.
- Another 11 million or so people are getting individual insurance outside the exchanges. These people have all the same problems as people in the exchanges. But, they receive no federal tax break for the purchase of insurance, even though a federal mandate requires them to buy it.
- In addition, about 29 million people are uninsured and that number is unlikely to change very much going forward. Polls show that the most important reason why so many people are uninsured is cost.
One way to think about Donald Trump’s campaign promise is to see that he wants to make health insurance less expensive and better for the first two groups without leaving the third group permanently uninsured. And he wants to do it with money that is already in the system. In other words, without raising taxes.
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