Donald Trump’s proposal for healthcare reform would lower premiums for insurance policies purchased directly by consumers, but leave as many as 18 million without coverage, a new independent study suggests.
The analysis from the nonpartisan Center for Health and Economy evaluates the healthcare concepts found on the Republican presidential candidate’s website, including allowing insurers to sell policies across state lines and rolling back Medicaid expansion under the Affordable Care Act.
The analysis assumes that a President Trump and a Republican Congress would be able to completely repeal the ACA, replacing it with Trump’s policies.
Overall, the group – which includes both liberal and conservative researchers – concluded that Trump’s plan would have little effect on people who receive group health insurance through their employers and those enrolled in Medicare.
For those low-income adults covered by Medicaid, however, coverage loss is likely. The new individual policies would also cover much less than what’s sold now, the report said.
Without the ACA’s minimum benefit requirements, financial protections to insurers and limitations on charging higher premiums to older adults, coverage would become more expensive. Researchers suggest insurers would respond by offering these “skinnier,” low-cost plans to attract healthy young adults to offset the risk pool.
That would lead to an average premium decrease of more than 20%, the report said.
But there is some uncertainty on whether individuals would buy health coverage with no federal mandate. The requirement for insurers to extend coverage to people with health problems would also disappear, along with HealthCare.gov’s individual online insurance market, tax credits for premiums and subsidies for out-of-pocket costs. Instead, individuals and families would be able to deduct their premiums from taxes.
This would save most taxpayers money, but lower income individuals and older, sicker people may have less access to care. In fact, the group suggests that by 2026, there would be 13 million more uninsured people than currently projected under the ACA, most of whom would have pre-existing health conditions.
Researchers are also less certain about the benefits of one of Trump’s main talking points: selling policies nationally to promote competition.
Though a popular Republican talking point, the Center for Health and Economy suggests that in 10 years’ time, the change could lead to as many as 7 million people getting individual policies, or as few as 1 million.
The wide degree of uncertainty there has to do with the fact that health insurance is largely a local and regional business, with costs veering wildly around the country. A Texas company selling policies in New York City would have to charge higher premiums, for example, and out-of-state insurers may struggle to identify networks of quality doctors and healthcare providers – two things that could make it difficult to attract customers.
“The biggest wild card is [Trump]’s approach to allowing people to buy across state lines,” concluded Douglas Holtz-Eaken, a Republican economist and board member with the center.
All told, one health expert who reviewed the study but was not involved in the research says he feels the coverage losses could even go beyond 18 million people.
“You are going to get a lot thinner coverage both in terms of higher deductibles and fewer benefits,” John Holahan of the Urban Institute told the Associated Press. “The policy is bad for people with high risk, and good for people with low risk.”
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