What Donald Trump would do with the US healthcare system

Universal coverage

The Affordable Care Act, passed by Democrats in 2010, aims for universal coverage but stops short of creating a centralized system covering every American. Instead, it provides subsidies to buy private insurance and it expands Medicaid, a government program that covers people with low incomes.

Trump would replace the reform law with new policies—“We’re going to have something better,” he said in February1—but he has said very little about what that system would be. “If somebody has no money and they’re lying in the middle of the street and they’re dying, I’m going to take care of that person.”

Don Berwick, who implemented the Affordable Care Act as the head of the US government's Center for Medicare and Medicaid Services (CMS), says he is not sure what that statement means. He thinks it might mean that Trump believes every American has a right to healthcare. But he says it’s also possible that Trump is simply supporting “the kind of episodic care that emergency rooms already offered” before reform, without providing any preventive care.

Jeff Anderson, a senior fellow …