Given President Trump's selection of Sen. Tom Price for HHS Secretary, one should expect the replacement plan to be similar to the Emp[o]wering Patients First Act.
He's probably right, and that scares the hell out of me, for a very simple reason: individual health insurance without a mandate cannot possibly work. Yes, you will be able to buy something that looks like an insurance policy. The insurance companies will happily take your money as long as you are healthy. But the instant you get sick they will drop you like a hot rock. An individual health policy without a government mandate is necessarily a scam. No free market mechanisms can possibly change this. If you have cancer, no one is going to insure you if they don't have to.
Health insurance only has value if an insurance company has some reason to keep you on board after you get sick. In the case of group plans, that reason is that they can't drop you individually. The only way they can drop you is to drop the whole group. The reason employer-based insurance works even in the absence of government mandates is that employers do two things: they aggregate people into groups that are large enough that you can use statistics to manage the risk. And they filter out the sickest and most expensive people. If you're over 65, or if you already have cancer, you're less likely to be applying for a job than if you're in your 20s and healthy. But if you are by yourself, in the absence of a government mandate like the one provided by the ACA, they can drop you individually. And they surely will. What makes it a scam is that most people don't get sick, and so most people will think they have insurance (or at least access to insurance) even though in reality they don't.
In California, it doesn't take much to make a group: you only need two people. So my wife and I started a company, and for the last ten years that has qualified us for group insurance. But with the advent of the ACA, California changed the rules. You still only need two people, but now they can't be related to each other. So I'm now on an ACA individual plan. If the ACA is repealed I, and about 20 millions other Americans, will be totally hosed. The only way I can get back on a group rate is to shutter my company and go back to work as an employee, or get divorced. It is no small irony that I will be faced with this choice because of the party that ostensibly wants to support entrepreneurship and family values.
This is what happens when you deny reality. You can choose to ignore the laws of physics and the laws of economics, but they will not ignore you. Sooner or later, if the Republicans are not stopped somehow, sea levels will rise and people will die.
And this is by design. Read the text of Donald Trump's executive order:
To the maximum extent permitted by law, the Secretary of Health and Human Services (Secretary) and the heads of all other executive departments and agencies (agencies) with authorities and responsibilities under the Act shall exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications. [Emphasis added]
Note the complete absence of any mention of impact on the overall sustainability of the system, or the actual health and well-being of patients. Trump's quality metric is purely financial. Fiscal burdens are bad, and so they need to be eliminated, period, end of story. There are no other considerations. If a few more people die, who cares.