In the face of congressional inaction, the Trump administration has set out to reform Obamacare by executive order. The reforms stretch the boundaries of what many thought was possible without an act of Congress. Although some changes are still in the comment period (before the rules become formalized), the Trump reforms in some ways are more radical than Obamacare itself.

Personal and portable health insurance. The United States has a long history of encouraging health insurance at the place of work. Premiums paid by employers avoid federal and state income taxes as well as the Social Security (FICA) payroll tax. By contrast, unless they get Obamacare subsidies, most Americans receive no tax relief if they buy health insurance on their own.

Unfortunately, group insurance is not portable. When people leave their job, many must turn to individually purchased health insurance instead. This is the primary source of the “pre-existing condition” problem. Before Obamacare, insurers in the individual market could and did deny coverage to people with expensive health conditions, although Wharton health economist Mark Pauly finds that the instances of this were rare.