Obamacare has winners and losers. I'd argue a lot more losers than winners, but that's a matter of political perception.
Even among the winners, some win more than others. The majority of people who gained coverage because of Obamacare was due to Medicaid expansion. Fewer and fewer doctors and facilities accept Medicaid, but at least it's cheap. Other people got subsidized coverage through the exchanges. Deductibles are often so high that it's little better than catastrophic care insurance, but at least it's something. Probably the biggest winners were people with serious pre-existing health issues - Obamacare forced insurers to cover them and spread the cost across the entire pool rather than hiking premiums on the sick.
For everyone else - and that's a lot more people than the "winners" above - their health insurance got more expensive, some had their policies cancelled because they didn't meet minimum coverage requirements, provider networks shrank, taxes increased, and the national debt increased (the claim that Obamacare saves money is predicated on a massive lie - that Medicare reimbursement will be slashed in the out years. Now how likely do you think that is?)
So here are the broad strokes of what will likely replace Obamacare....
1. You'll be able to buy insurance from wherever you want, no matter the state, and for a broader range of coverage levels and deductibles. It's going to be more like shopping for car insurance.
2. You won't be required to buy insurance.
3. People who are already sick will be able to purchase insurance, and won't be able to be kicked off insurance, but their premiums will rise because their healthcare costs are higher. I expect we'll see the federal government bloc grant some money to the states to create "high risk pools" to help these individuals.
4. Current Obamacare subsidies will be sunset over a few years, and replaced with smaller refundable tax credits. The tax credits can be smaller than the current subsidies because the insurance will likely be cheaper (see item 1).
5. Medicaid funds will be bloc granted to the states, which should aid in efficiency and incentivizing creating ways to find cost savings. This is the best way to possibly reduce the cost of Medicaid.
6. Tax code will be revised to encourage HDHP/HSAs. This has several benefits. First, it puts more spending decisions directly in the hands of consumers, instead of an insurer middleman, which has distorted the market and contributed to such high healthcare costs. Second, we'll be able to spend the HSA money on premiums, helping to decouple insurance from employers. We're all better off if our insurance is more portable.
This is still going to be expensive but hopefully not as expensive as Obamacare and with a lot more winners than losers.
