When he takes office early next year, President-elect Donald Trump will have a rare opportunity to remake America's healthcare system for the better.
To do so, he'll need to follow through on some of the best policy ideas from his first term while taking additional steps to bring more choice, competition, and common sense to our health sector.
He can start by resuming his earlier efforts to expand access to short-term health plans.
They can be an affordable alternative to exchange coverage because they're exempt from Obamacare's costly mandates, including its requirement that every policy cover ten essential health benefits.
According to a 2019 analysis by the Manhattan Institute's Chris Pope, short-term plans can provide coverage that is on-par with that of exchange plans, sometimes at nearly half the price.
Trump issued rules during his first term that allowed short-term plans to last for up to 364 days and that permitted insurers to renew them for up to three years.
The Biden administration promptly scrapped those rules and set a maximum term of three months, with an option for a one-month renewal.
Some states --- including California, New York, and New Jersey — have banned short-term plans altogether.
It's time to go back to the future — and restore the Trump-era rules governing the plans. Doing so would offer consumers more choice and affordability in health coverage.
Trump would also do well to liberalize rules governing association health plans.
AHPs allow self-employed people and small businesses to pool their resources and sponsor large-group coverage.
The entities within an AHP have more leverage to request better deals from insurers together than they would on their own.
Large groups are also exempt from many costly federal and state regulations, including those imposed by Obamacare.
Trump took steps to try to expand the availability and use of AHPs in a 2018 rule. But the courts blocked Trump's effort in 2019.
The Biden administration formally rescinded Trump's 2018 rule earlier this year.
That was a mistake — one which Trump has the power to begin correcting on his first day in office.
Trump should also crack down on fraud that has grown rampant on Obamacare's exchanges. As the Paragon Health Institute's Brian Blase pointed out in a recent analysis, there is significant evidence that roughly five million exchange enrollees have misrepresented their income in order to qualify for zero-premium coverage on the exchanges.
That coverage may appear free to enrollees. But it's not free to taxpayers, who are covering the premiums.
By Blase's estimates, this widespread deception cost the government $20 billion this year.
In other words, Trump could save taxpayers billions of dollars simply by enforcing rules already on the books.
By the same token, Trump and congressional Republicans should allow Obamacare's enhanced premium subsidies to expire, as they are set to do at the end of next year.
They amount to taxpayer transfers to big insurers.
Making them permanent would cost some $383 billion over the next decade.
Rather than obscuring the cost of coverage with public money, Trump should deregulate the insurance market so that competition can make health insurance more affordable.
Championing work requirements in Medicaid is yet another way for Trump to make our health sector fairer, more sensible, and less wasteful.
Years of Democratic reforms have succeeded in pushing millions of able-bodied, working-age Americans onto Medicaid's rolls — ballooning the program's costs in the process.
According to the Foundation for Government Accountability, the number of Medicaid enrollees who fit this description has jumped by 27 million since 2000.
Total enrollment in Medicaid and the related Children's Health Insurance Program is roughly 80 million. Total spending on the program was more than $800 billion in 2022.
In many cases, Medicaid encourages people not to work, since any increase in their income could disqualify them from the program.
Work requirements can counteract those perverse incentives — and hopefully nudge more people toward gainful employment and private health insurance, whether through their employer or on the individual market.
Trump's second term promises a return to health policy that promotes choice, competition, and affordability while discouraging Americans from embracing fraud and government dependence.
Now he has four more years to finish the work he started last time around.
Sally C. Pipes is president, CEO, and the Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is "False Premise, False Promise: The Disastrous Reality of Medicare for All," (Encounter Books 2020). Follow her on Twitter @sallypipes. Read Sally Pipes' Reports — More Here.