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The big picture on Trump's health care changes

HHS Secretary Alex Azar and President Trump
Health and Human Services secretary Alex Azar at his swearing-in ceremony last month with President Trump and Vice President Mike Pence. Photo: Chris Kleponis-Pool / Getty Images

This might be the best way to understand the Trump administration’s approach to the Affordable Care Act: the ACA’s exchanges, like health insurance itself, relied on healthy people subsidizing the cost of covering sick people — but they’re sliding deeper into something a lot more like a makeshift high-risk pool, in which healthy people are absent and the government simply pays to cover sick people.

Where it stands: The White House and congressional Republicans are not trying to change that reality. In some ways, they have accelerated it. At a minimum, they accept it.