cal care; or (4) some combination of those options. In other words, individuals would
decide how their healthcare dollars are spent, and healthcare providers and insurers would cater to them, not the government. Trump has suggested — but may
be reconsidering — giving Obamacare subsidies, which currently go to health insurers, directly to the roughly 22 mil- lion Obamacare enrollees who receive subsidies. Supporters say recipients would be better consumers, saving the system money. But there’s a problem: That’s taxpay-
er money, rather than an employer’s or individual’s own money. Handing out billions of taxpayer dollars would cre- ate an incentive for individuals and employers to drop their current cover- age and enroll in Obamacare. Moreover, given the concern about widespread waste and fraud in Medi- care, Medicaid, welfare programs, and even Obamacare, why make Obam- acare a bigger attraction for fraudsters? Better to give people affordable
health insurance options instead of using taxpayer dollars to make insur- ance appear “affordable.” Health insurance deregulation —
For large HSAs to work well, individu- als will need access to a wide range of health insurance options: comprehen- sive coverage, high-deductible plans, short-term plans, limited-benefit plans, sharing plans, and others. However, Obamacare largely out-
lawed most types of health insurance. Remember, President Barack Obama’s “If you like your health plan, you can keep your health plan” won him Politi- fact’s 2013 “Lie of the Year.” Republicans failed to repeal Obam-
acare in 2017, but they may not need to. They just need to repeal Obamacare’s insurance restrictions, allowing insur- ers once again to underwrite policies in the individual health insurance market. Democrats will complain that healthcare and health insurance are too complicated to allow people to decide how to spend their healthcare dollars.
But a system where patients control
the money would force insurers to cre- ate policies that consumers want and doctors and hospitals to create package prices for medical services that patients can understand — just as cosmetic sur- geons do now, since their services are usually paid for out-of-pocket. Obamacare becomes a high-risk
pool — Obamacare requires insurers selling to individuals — there are some- what different rules for the 160 mil- lion people with employer coverage — to accept anyone regardless of their medical condition.
In other words, Obamacare would
likely become the national safety net for uninsured people with a major medical condition who are looking for coverage. Prior to the passage of Obamacare,
some 35 states had high-risk pools, but those shut down. Obamacare would essentially become a federal high-risk pool.
Direct access to prescription
drugs — Most patients buy their pre- scriptions from local pharmacies, which get their supply from mid- dlemen known as pharmacy benefit managers. PBMs negotiate discounts from
drug makers and are supposed to pass those discounts on to pharmacies and patients. But there are growing con- cerns that PBMs are keeping most of those discounts and rebates. One way to bypass that middleman
is for individuals to buy their drugs directly from the manufacturers. Trump’s proposed TrumpRX
One way to bypass that middleman is for individuals to buy their drugs directly from the manufacturers.
That requirement, known as “guar-
anteed issue,” is driving up Obamacare premiums. That’s because people can remain uninsured until they have a major medical condition and then sign up during the open enrollment period. As Obamacare premiums explode,
younger and healthier people will drop out, which is why Democrats are so determined to keep the enhanced subsi- dies — to mask the premium increases. If health insurers are allowed to underwrite individual policies again, millions of people will have better, more affordable options than Obam- acare. And those who are refused coverage or charged a much higher premium can go to Obamacare with its original subsidies.
option, which is scheduled to go live in early 2026, could make that hap- pen. Several drugmakers are prom- ising steep discounts on TrumpRX on some of their most expensive and most popular products, like weight- loss drugs. This is a new delivery system, so
startup hiccups will likely need to be worked out. And competition from other companies is forming. But it’s opening a door to a new consumer- friendly drug delivery system that would be very appealing to value-con- scious consumers paying with their HSA funds.
Empowering patients, rather than
insurers or the government, has been the missing ingredient in creating a competitive, innovative, and afford- able healthcare market. If Republi- cans want healthcare providers and insurers to compete on quality and price, these four reforms would go a long way toward reaching that goal.
Merrill Matthews is a health policy analyst and co-author of On the Edge: America Faces the Entitlements Cliff.
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