Trump healthcare would reduce premiums, and coverage, study says

Presumptive Republican presidential nominee Donald Trump's health care plan would significantly lower premiums purchased directly by consumers but would cause 18 million people to lose their insurance, according to a nonpartisan think tank's study. 

Although the plan wouldn't affect people who have insurance from their employers and those on Medicare, millions of poor Americans who gained coverage under the Medicaid expansion of President Obama's Affordable Care Act would lose their coverage, according to the study released Thursday from the Center for Health and Economy.

Under Mr. Trump's plan, taxpayers would save money, since the federal government would no longer subsidize Americans' insurance, the researchers found.

The study was unable to determine the impact of Trump's idea to allow insurers to sell across state lines for competition, which it said could lead to anywhere between 1 million and 7 million people getting individual policies.

The business of health insurance is mostly regional, relying on in-state or in-system providers, and opening markets beyond borders could take time, the researchers say. Out-of-state providers would likely have to charge more than local competition, and would likely struggle to build physician networks to compete, the study found.

"The biggest wild card is (Trump's) approach to allowing people to buy across state lines," Douglas Holtz-Eakin, a Republican economist who is a board member of the center, told the Associated Press. The center includes both conservative and liberal analysts.

Trump is calling for the repeal of Obama's Affordable Care Act, according to his official campaign policy. Trump has called for the repeal of the individual mandate, which would no longer require those who do not want to to purchase health insurance.

He has presented a handful of different of health care ideas during the campaign, as The New York Times reported in April. Originally, he said he liked the Obama administration's "mandate," before criticism from conservatives caused him to reevaluate his position.

Trump has said he would encourage individual purchases of health care by allowing those who make those purchases to take tax deductions for their premium payments, the Times reported. For those who do not make enough income to pay enough in taxes that such a deduction would have an impact, Trump has said he would retain Medicaid as a block grant to state governments. However, critics say that this plan will not cover the loss of insurance that the repeal of the Affordable Care Act would cause.

"If you repeal the Affordable Care Act, you've got to have a serious way to expand coverage to replace what you have taken away," Gail Wilensky, the administrator of Medicare and Medicaid under President George H.W. Bush from 1990 to 1992, told the Times. "There's nothing I see in Trump's plan that would do anything more than cover a couple million people."

The Trump campaign believes Obama's health care law needs immediate repeal and the free market can help improve health care.  

"As it appears Obamacare is certain to collapse of its own weight, the damage done by the Democrats and President Obama, and abetted by the Supreme Court, will be difficult to repair unless the next President and a Republican congress lead the effort to bring much-needed free market reforms to the healthcare industry," the campaign's official policy position says. 

Many analysts don't believe that the campaign's particular assemblage of free market ideas is exactly the ticket, however.

Robert Laszewski, a former insurance executive and critic of the Obama administration's Affordable Care Act, told the Times Trump's health care proposals were "a jumbled hodgepodge of old Republican ideas, randomly selected, that don't fit together."

This report contains information from the Associated Press.