Among Donald Trump’s more pernicious and oft-repeated lies is that the Affordable Care Act (ACA) is imploding. It isn’t. But to the extent that problems are mounting, they are largely his doing. In March, the nonpartisan Congressional Budget Office (CBO) concluded that “in most areas,” Obamacare’s exchanges were stabilizing, and that most enrollees who received subsidies wouldn’t see their premiums increase significantly. Six months later, the CBO issued another report that, according to CNN, named “several policies the White House is pushing” that will lead “to rising premiums and decreased enrollment in individual insurance markets over the next year.”
In August, two months before Trump announced that he was discontinuing payments to insurers that limit out-of-pocket costs for low-income enrollees, a study by the Kaiser Family Foundation estimated that “uncertainty” about the possible move alone—along with doubts that the Trump regime would enforce the individual mandate—was causing insurers to request premium hikes for of up to 20 percent for 2018.
Trump seems to think he knows what he’s up to. He has said on multiple occasions that, as premiums spike and enrollment falls, congressional Democrats will be forced to come to him with hats in hand to negotiate some sort of replacement for Obama’s signature law. That’s a bad misreading of public opinion, which tends to hold the party in the White House responsible for virtually everything. Indeed, a Kaiser poll conducted in August found that 60 percent of respondents think Trump and Republicans would be “responsible for any problems with the ACA going forward,” compared with just 28 percent who said the same of Obama and Democrats.
It may be a political problem for Trump’s party, but a significant amount of real-world damage has been done. In January of 2014, when the Affordable Care Act’s Medicaid expansion kicked in, almost 18 percent of the population was uninsured, and in the 34 months that followed, that number fell to 10.9 percent, an all-time low. But in the year since Trump won the Electoral College vote on a promise to “repeal and replace” the law, the rate of uninsured has ticked back up to 12.3 percent. That trend doesn’t show any signs of slowing.
How exactly has Trump been sabotaging the ACA? Most prominently, he’s refused to pay a subsidy to insurers for reducing the out-of-pocket costs of their poorest enrollees. But in an interview with The Nation, Sam Berger, a senior policy adviser at the Center for American Progress who has been tracking these issues, says that it goes much further than that.