Donald Trump's plan to replace Affordable Care Act results in 18 million fewer insured, study says

Donald Trump's healthcare plan would repeal the Affordable Care Act, remove barriers for the sale of insurance across state lines; and allow consumers to deduct premiums from their taxable income.

A new Center for Health and Economy study looked at the effects of the plan the presumptive Republican nominee has posted on his website as the "proposal."

The proposal would remove allow consumers in the Individual market to purchase out-of-state insurance. Implementation would be hindered by regulatory conflicts between the state where the policyholder resides and the state where they are buying their insurance, the study by the nonpartisan research organization said.

Networks would also need to be developed in states where the "exported" plan would be sold.

Also, jurisdictional issues regarding legal disputes between in-state residents and out-of-state insurers would likely need to be addressed by Congress and the federal courts, the study said.

While the proposal repeals the Affordable Care Act, Trump's plan does not always replace it with comparable provisions, leading to 18 million fewer insured individuals in 2017, according to the study. By 2026, this number is expected to be 13 million fewer than under the current law.

The proposal would decrease the total premium cost of private health insurance, with the largest effect on silver, gold, and catastrophic plans, the study said.

The ACA mandates that health insurance plans cover essential health benefits including maternity care, mental health services, and other services that might not otherwise be included in a health insurance plan.

Without the essential health benefit requirement, Trump's plan would allow health insurers to remove costlier benefits in exchange for less expensive premiums.

In addition, offering higher deductibles would allow insurance companies to offer less generous and lower premium plans for those with low expected medical costs.

In general, as premiums go down, more people are insured through the individual market due to consumers opting to forgo employer sponsored insurance coverage for a cheaper plan.

The study estimates that the proposal would lead to a slight decrease in enrollment in employer sponsored insurance.

A proposal to repeal the out-of-pocket maximum would allow insurance companies to offer catastrophic coverage plans with much higher deductibles.

The net effect of these provisions is to decrease the average insurance premiums in all categories between 24 and 37 percent relative to current law by 2026. The largest effects are in bronze and catastrophic plans for single coverage, and silver and bronze plans for family coverage, the study said.

By 2026, the study projects that medical productivity would increase by 2 percent; provider access would increase by 11 percent; and the federal deficit would be reduced by $583 billion.

However, the cost of healthcare varies across different regions in ways unrelated to the insurance market, the study said.

Under current law, health insurance plans are only able to alter prices based on three factors: geographic location, age and tobacco use, and are explicitly prohibited from taking into account any information on expected medical expenses.