Most of the public conversations about health care these days revolve around what to do about the Affordable Care Act.

Hillary Clinton wants to build upon it, including the addition of a “public option” insurance program that will compete with private insurers. Supporters of Bernie Sanders want it to be ultimately scrapped and replaced with a single-payer system. Donald Trump says he will repeal it and replace it with “something much better.”

One health care activist says that one simple federal rule change could bring greater benefits to the middle classes than any change to Obamacare.

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