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Sabotage Watch: Tracking Efforts to Undermine the ACA

Following the failed Republican attempt to repeal the Affordable Care Act (ACA), President Trump said that, politically, the best thing to do would be to let the ACA “explode.” This timeline tracks Administration actions that would sabotage the ACA by destabilizing private insurance markets or reversing the law’s historic gains in health coverage.

January 20th, 2017
Trump issues anti-ACA executive order

Shortly after President Trump’s inauguration, he issues an executive order directing federal agencies to use their administrative powers begin dismantling the Affordable Care Act “to the maximum extent permitted by law.” The order instructs agencies, for example, to do what they can to grant exemptions or delay implementation of ACA provisions that impose a tax, fee, or other costs and to encourage development of a “free and open market” in health care services among states, while Congress works to pass repeal legislation.

January 26th, 2017

The Administration announces that it will stop planned ads for the final week of open enrollment for marketplace health coverage.

January 31st, 2017

After running ahead of 2016 enrollment totals through mid-January, final 2017 plan selections come in slightly below 2016.

February 14th, 2017
IRS scraps its plan to tighten reporting for the individual mandate

Building on the confusion created by the President’s January 20th executive order, the Administration announces a new step to undermine stability in the marketplace by preventing the IRS from using new tools to enforce the individual responsibility provision of the ACA – a crucial part of keeping a healthier pool and keeping premiums affordable. While having coverage is still the law – and the IRS will continue enforcing the provision in the same way it did the previous two years – the announcement creates added uncertainty that could damage the marketplaces going forward.

February 15th, 2017

Administration’s first health care rule is billed as market stabilization, but would discourage enrollment and undermine market stability by making plans less affordable.

March 28, 2017

After House Republicans fail to advance a bill repealing the Affordable Care Act, Administration officials and congressional Republican leaders continue to discuss bringing that or a similar bill to the floor.

Ongoing talk about the possibility of legislative action only fans insurers’ uncertainty and could cause them to increase premiums or pull back their participation in states’ individual markets in 2018 — even if the House Republican bill never becomes law.

April 12, 2017
Trump threatens to withhold ACA cost-sharing reduction payments to insurers

President Trump threatens to withhold ACA cost-sharing reduction payments to insurers. His comments could on their own cause insurers to balk at offering marketplace plans or to raise their premiums. If he actually followed through, the fallout would be even worse.

Trump’s remarks heighten uncertainty for insurers at the very moment they’re making premium and participation decisions for next year. The cost-sharing reduction payments, which reduce deductibles and other cost-sharing charges for low-income people enrolled in silver-level marketplace plans, have been the subject of a lawsuit by House Republicans since 2014.   If the federal government stopped these payments, the average premium for a silver plan would have to rise 19 percent to compensate, the Kaiser Family Foundation estimates. Equally important, a decision to stop the payments – or even prolonged uncertainty around these payments – could convince insurers that the Administration will keep taking actions that sabotage the individual market and lead them to stop offering plans altogether.

The President suggested that withholding the payments would force Democrats to negotiate with him on health care legislation, after House Republicans failed to advance their health care bill in March. That amounts to holding millions of people’s health care hostage in an attempt to push through legislation that would take away health coverage from millions more people.

April 13, 2017

The Trump Administration finalizes its rule for the individual health insurance market that will raise consumers' deductibles and other out-of-pocket costs, reduce premium tax credits that help millions of people buy insurance, and make it harder for people to enroll in coverage. While the Administration claims the changes are needed to stabilize the insurance market, many of them will reduce market stability by shrinking enrollment and making the pool of people with coverage sicker, on average. What's more, the changes do nothing to address the latest threats roiling insurance markets: comments from President Trump that he may withhold cost-sharing reduction payments and ongoing efforts by Republicans to repeal the ACA.