The health-care goals President Donald Trump mentioned in his address toa joint session of Congress Tuesday night werea high-water mark for policy specificity from this president. But that mark was a low bar.

The lack of detail was still glaring, and Trump either skirted the alligators lurking in the morass of Affordable Care Act repeal and replacement, or just poked them with a long stick. The process remains as chaotic as ever. That's a threat to health insurers who focus narrowly on government programs. It may also hurt those who don't.

Divergent

Some insurers have fared better than others since Trump's election, but a messy ACA fight could impact all of them

Source: Bloomberg

A draft of a possible Republican plan for ACA replacement, leaked last week, is splitting the GOP into factions.Some governors don't like the plan because it could leave too many people uncovered. More conservative membersof the party, meanwhile, find it too generous because it offers refundable tax credits, even if those areless generous than the ACA's.

TheGOP strategy, according to The Wall Street Journal,is to bet hardliners won't ultimately vote against a repeal -- a game of legislative chicken with more than 20 million ACA-insured lives at stake.

Untroubled By Trump's Speech

ACA Repeal Alligators

Trump didn't do much to resolve this stalemate with his address. Trump expressed support for tax credits, but still appears to differ with House leadership on other key points. Thefour biggest insurance-related goals outlined in the speech are vague and riddled with massive political and policy difficulties.

Shifting the Burden

A leaked draft bill suggests the GOP's ACA replacement would substantially favor the wealthy at the expense of older and poorer Americans

Source: Kaiser Family Foundation

The speech also avoided therather important question ofhow to pay for these efforts. A solution proposed by some in House leadershipis to cap the tax break people and employers get for employer-provided health insurance. This proposal was anathema to the GOP when it was made part of the ACA. Now it may be massively expanded under the GOP plan.

Such a cap would still be widely controversial. It could substantially shake up the employer-focused commercial insurance market. So would a repeal of the ACA's employer mandate and expansionoftax credits for individual coverage.

Meanwhile,insurers who participate in Medicaid still have to worry Trump will end up moving toward the House on capping grants and repealing the expansion.

Appetite For Disruption

Large parts of the health insurance market could be disrupted by a GOP effort to repeal and replace the ACA

Source: Bloomberg Intelligence

No one will be immune from the market disruption and policy chaos that has only just begun.

This column does not necessarily reflect the opinion of Bloomberg LP and its owners.

To contact the author of this story: Max Nisen in New York at mnisen@bloomberg.net

To contact the editor responsible for this story: Mark Gongloff at mgongloff1@bloomberg.net

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Trump Speech Leaves Health Care a Big Mess - Bloomberg