That prospect captures the core challenge facing the GOP. Deregulating insurance to allow the sale of less comprehensive plans than the ACA requires would likely produce lower initial premiums both for younger and healthier and older and sicker consumers. That would also save the federal government money because it could provide smaller tax credits for the uninsured to buy those less expensive plans.
Those with fewer health needs may find that system acceptable, which is why Tanner argues, “the people who have very little health-care costs will be winners.” But inevitably those skimpier plans would cover fewer services and demand more out of pocket costs from those with greater health needs—if they can buy coverage at all. “They are going to have less comprehensive coverage,” said Tanner flatly.
That might prove a very unpleasant surprise for Obamacare recipients whose principal complaint has been that the coverage already costs them too much not only in premiums, but also co-payments and deductibles. “What people really want out of the health-care system is to pay less for health care,” said Leavitt. “And it’s not at all clear that the replacement plans on the table now would have that result.” That’s especially true for older people with typically greater medical expenses. Since seniors are protected by Medicare, the most vulnerable group in a system with less risk sharing may be older adults aged 45-64. And today, over two-thirds of people in that age group are white, compared to only about 55 percent of younger adults aged 20-34, according to calculations provided by the Brookings Institution demographer William Frey. In November, Trump won just over three-fifths of all whites aged 45-64, and together with white seniors, they provided nearly three-fifths of all of his votes, according to exit polls. In particular, Trump carried a remarkable 71 percent of 45-64 year-old whites without a college degree—his best showing among those blue-collar whites in any age group.
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