The Democrats believe that a decent level of health care is a right, not a privilege, and that it must be guaranteed by the entire community, not the market. As a result, the key features of Obamacare are subsidies and community rating. Republicans, on the other hand, generally think that health care is a commodity like any other, that positive outcomes are driven primarily by personal responsibility, and that costs can be kept low by the operation of the market. You should not be surprised, therefore, to hear a lot of chatter about HSAs replacing Obamacare.
As I noted many times during Trump 1.0, the rosy Republican view of health care markets is not supported by the facts. The average consumer of health care services doesn’t know enough about the problems and products identified by physicians to bargain for them; wellness is driven as much by good genes and luck as by wise lifestyle choices; most hospitals are effectively monopolies; and drug patents are temporary monopolies by definition. In addition, relying on HSAs will benefit young and healthy people at the expense of older and sicker folks. The latter simply would have to go without the care they need if Trump’s concept of a plan becomes reality.
It won’t. The tiny GOP House majority is in no position to tackle fundamental health care reform in a way that will offend public opinion and threaten powerful vested interests. Any movement by the Republicans in that direction will only fail and cost them more votes.