6. create a cross border system for insurance.

The major obstacle for the House GOP will be  meet is cost.  Trumpcare will cost more than Obamacare.  The insurance lobby will insist that the high risk pool offers enough money to meet their costs as well as create a profit incentive.  This will create an issue for the  fiscal conservatives in the House.

Obviously the GOP is not going to propose a single payer system.  There are several reasons for this. In addition to party ideology,   two reasons come to mind.  One is the underlying issue of the cost of health care  in the US.  Unless a single payer system somehow addressed the inflation issue, the GOP would get the blame just as Obama has.  The problem, is that most of that inflation comes from the providers, not the insurance companies.  Obamacare, as it is now, does provide some gentle pressure on the providers to restrain the rate of health care inflation but no insurance system, even single payer, can change what providers bill unless the government imposes price controls.   The second reason is that single payer faces a huge bureaucratic challenge  because we have so many different provider systems.  The idea of nationalizing the entire system, insurance plus providers, is likely beyond the athletic prowess of the American government.   We will need to wait until some state or states make such an effort.

The next issue will be what sort of policies will the companies offer if Trumpcare covers  high risk for all as well as ordinary healthcare for about 40% of “poor” Americans .  I suppose the insurance companies might compete on the range of providers they cover?