Deregulating the individual insurance market would be part of former President Donald Trump's healthcare agenda in a second term, according to his running mate, Sen. JD Vance.
Details on the GOP nominee's healthcare plan have been sparse so far. At a debate on Sept. 10, Mr. Trump said he had "concepts of a plan" to replace the Affordable Care Act, adding that he "would only change it if we come up with something better and less expensive."
Speaking on NBC's Meet the Press Sept. 15, Mr. Vance offered some details on Mr. Trump's second-term healthcare priorities. The former president would focus on implementing "some deregulatory agendas" in the insurance market, the vice presidential nominee said.
One of these deregulations would be reintroducing risk pools in the individual market, a practice that existed before the ACA. A "one-size-fits-all" approach that puts all individuals in the same insurance risk pools "makes it harder for people to make the right choices for their families," Mr. Vance said.
"A young American doesn't have the same healthcare needs as a 65-year-old American," he said. "A 65-year-old American in good health has much different healthcare needs than a 65-year-old American with a chronic condition."
Splitting up risk pools in non-group markets is not a new proposal. The American Health Care Act of 2017, which would have repealed portions of the ACA, would have allowed states to apply for waivers to reintroduce high-risk pools. The bill, backed by then-President Trump, narrowly passed the House but failed in the Senate.
Under current law, ACA-compliant plans cannot charge individuals higher premiums based on their preexisting conditions, gender or other factors. Plans are permitted to vary premiums based on location, family size, tobacco use and age. Insurers cannot charge older adults more than three times what younger adults pay for the same plan. Splitting risk pools could lower premiums for younger enrollees with fewer health conditions.
"In theory, segregated high-risk pools could adequately protect people with preexisting conditions and keep their premiums affordable, but that would only be true if there's sufficient government funding for those pools," Larry Levitt, executive vice president for health policy at KFF, told The Hill.
Before the ACA market launched in 2014, most states maintained high-risk pools for people with preexisting conditions and offered some form of subsidy to offset costs, according to KFF. These premiums were typically 2.5 to 3 times higher than what lower-risk individuals paid.
Aside from high-risk pools, Mr. Vance did not elaborate on other details of Mr. Trump's deregulatory agenda in his Meet the Press appearance.
"We have to fix the problems of Obamacare," the vice presidential nominee said. "While on the other hand, making sure people continue to have good choices."
Mr. Trump's position on the Affordable Care Act has shifted throughout the campaign. In November, the former president said he intended to replace the law if elected. He later said he would not repeal the law but wanted to make the act "much better, stronger, and far less expensive."
A Trump campaign spokesperson told The New York Times in August the GOP nominee is "not running to terminate the Affordable Care Act."
In addition, the 2024 Republican Party platform does not mention the ACA. The party's healthcare priorities include increasing transparency, promoting choice and competition, and expanding access to new treatments and prescription drugs.
Healthcare reform has not been a central issue in Democratic nominee Kamala Harris' campaign either. Health insurance and the ACA have taken a back seat in this year's race, according to The New York Times. Neither candidate has focused on healthcare insurance reforms in speeches, ads or detailed plans on their websites.
Ms. Harris has said she is committed to maintaining and growing the ACA. During the Sept. 10 debate, she highlighted the provisions of the law requiring insurers to cover individuals with preexisting conditions.
"I don't have to tell the people watching tonight, you remember what that was like? Remember when an insurance company could deny if a child had asthma, if someone was a breast cancer survivor, if a grandparent had diabetes?" she said.
In the aftermath of multiple failed attempts to repeal the law, senior Senate Republicans have said political will to repeal the ACA has waned.
Future political debate over the law is likely to focus on subsidies, though neither presidential candidate is likely to make this topic a key part of their campaign, according to The Washington Post.
ACA enrollment hit a record high of 21 million in 2024, spurred in part by increased federal subsidies.