President Trump’s statement that his preferred replacement for the ACA would provide health “insurance for everybody” surprised those who have followed the contentious debate over the health care law since its passage in 2010. In recent years, though, Republicans have emphasized that gains in insurance coverage should not be the sole barometer by which health care reform is measured. Rather, the affordability of that coverage is the key to a better health care system with fewer uninsured Americans. For too long, Republicans have shied away from calling for “universal coverage” because they’ve equated it with the Democratic push for a government-run, single-payer health-care system. But that simply isn’t the case. Market-based reforms can both lower costs and lead to health insurance coverage for more Americans. Any market-based replacement to the ACA should: (1) Expand access to consumer-directed coverage arrangements such as health savings accounts coupled with high-deductible insurance plans; (2) Tailor government assistance to individual situations; (3) Give those with preexisting conditions access to mechanisms, such as properly funded high-risk pools, to help them both acquire and afford coverage; and (4) Allow for alternative pathways to private, tax-preferred coverage, by allowing health plans to be sold across state lines, as well as by giving unions, churches or other civic organizations the opportunity to offer coverage to members.

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