Tracking Trump’s Sabotage of the ACA

Call your members of Congress today to tell them to STOP Trump’s sabotaging of the ACA: House – 202.225.3121 Senate – 202.224.3121

Congressional Republicans have been trying to sabotage the Affordable Care Act (ACA) since it was first enacted. Under the Trump administration, these efforts have accelerated as the president and congressional Republicans seek to discredit the law. President Donald Trump has been clear about his goal, saying, “[T]he best thing we can do politically speaking is let Obamacare explode.”

From canceling billions of dollars in payments that help lower people’s deductibles and copays to repealing the individual mandate, Trump and Congress have repeatedly taken steps to undermine the law.

This sabotage has real consequences. While the ACA marketplace was poised for a successful 2018, efforts by President Trump and congressional leaders to sow uncertainty and hurt the markets have driven up premiums and caused insurers to leave the marketplace. To help people understand who is undermining the individual insurance market and how they are doing it, the Center for American Progress Action Fund is tracking these sabotage efforts and their effects.

Sabotage is carried out through two principal means: policy changes that hurt the ACA marketplace and threats by policymakers to inflict further damage to the market in order to scare away insurers and drive up prices.

We will be updating this page periodically to account for new developments in these sabotage efforts. This page was last updated on August 1, 2018.

• On January 20, 2017, President Trump issued an executive order that directs agencies to take all legal steps to undermine the ACA, including by weakening enforcement of the individual mandate.
  • As a result of the order, on February 14, the IRS canceled a new policy that would improve enforcement of the individual mandate. In October, the IRS announced that it will reinstate the new policy for the upcoming year.
• On January 26, 2017, the Trump administration canceled millions of dollars’ worth of outreach efforts to inform people of the availability of ACA health plans during a crucial moment of the enrollment period for 2017 coverage. The former chief marketing officer for HealthCare.gov estimated that this reduced enrollment by almost 500,000 people.
• On February 23, 2017, the Trump administration extended by another year an exemption from ACA requirements for certain health insurance plans. This policy change will keep healthier, less expensive enrollees out of the ACA marketplace, increasing prices for everyone else.
• On April 18, 2017, the U.S. Department of Health and Human Services (HHS) issued a so-called Market Stabilization rule. HHS acknowledged that “there is some uncertainty regarding the net effect on enrollment, premiums, and total premium tax credit payments” and that the effect of the rule on enrollment and premiums could be negative; HHS is certain, however, that the rule will transfer money from consumers to insurance companies. The rule will have many negative consequences, including:
  • Lowering premium tax credits for enrollees, resulting in an increase in the amount they will pay for care
  • Cutting the enrollment period in half, which will likely decrease enrollment
  • Expanding the number of people subject to burdensome paperwork when they seek coverage after a qualifying event such as losing a job or having a child, which will decrease the number of healthy people who sign up for health coverage and raise costs for everyone
• On May 4, 2017, the House majority passed the American Health Care Act, which would result in 23 million people losing coverage and destabilize the individual health insurance market in states that contain one-sixth of the U.S. population.
• On May 5, 2017, House leaders refused to clarify in the annual spending bill that they will fully fund CSR payments, allowing President Trump to continue to threaten to cancel the payments and thereby exacerbating uncertainty for insurers.
• On May 22, 2017, the Trump administration asked the D.C. Court of Appeals for a three-month extension in House v. Price, a lawsuit brought by House Republicans during the previous administration to try to end CSR payments, which will extend uncertainty for insurers beyond the August rate filing date, guaranteeing massive premium increases in the absence of congressional action.
• On May 23, 2017, President Trump proposed in his budget to reduce funding for HealthCare.gov by 21 percent, which would decrease enrollment and make insurance more expensive.
• On July 13, 2017, HHS announced that it would stop providing premium tax credits to individuals for paperwork errors without addressing concerns about providing them proper notice; this would cause people’s costs to increase and therefore decrease marketplace enrollment.
• On July 20, 2017, it was reported that HHS had been using funding that was provided to encourage enrollment in the ACA marketplace to instead wage a public relations campaign to undermine the law.
• On July 20, 2017, it was reported that HHS had canceled contracts to provide in-person enrollment assistance in 18 cities, including enrollment fairs and sign-ups in public libraries.
• On August 10, 2017, it was reported that HHS is not coordinating enrollment efforts with the Latino Affordable Care Act Coalition, a group of local and national organizations that have worked with the administration in every previous enrollment period, helping to ensure Latinos have the necessary information to sign up for health insurance.
• On August 14, 2017, it was reported that HHS is not coordinating enrollment efforts with a range of partner groups that have assisted in such efforts in previous years, including youth organizations, medical organizations, churches, private companies, and women’s groups.
• On August 24, 2017, it was reported that some states had not yet been contacted by administration officials regarding open enrollment, a sharp break from past practice.
• On August 31, 2017, HHS announced that it would be cutting funding for advertising to encourage enrollment in the ACA marketplace by 90 percent or $90 million. It also announced that it would be cutting funding for people who help individuals enroll in coverage by more than $25 million.
• On September 22, 2017, Minnesota was informed by HHS that its state innovation waiver to create a reinsurance program to reduce premiums was approved, but that funding for its basic health program, which provides health care to low-income Minnesotans, would be cut by hundreds of millions of dollars as a result. This was contrary to previous statements from HHS that the waiver would not result in a funding cut to the basic health program.
• On September 22, 2017, HHS announced that it will shut down HealthCare.gov, the primary means for people to sign up for health insurance, for 12 hours every Sunday but one during the open enrollment period. This is the equivalent of shutting the site down for 2.5 days and a significant increase in downtime from previous years. HHS will also shut down the website overnight on the first day of open enrollment.
• On September 26, 2017, HHS delayed the deadline for issuers to inform consumers about plan renewals and 2018 rates, which is necessary to help them make informed enrollment decisions for the upcoming year.
• On September 27, 2017, it was reported that HHS regional representatives would no longer be attending pre-enrollment events to help outside groups prepare for open enrollment and understand changes from the previous year’s enrollment period.
• On September 29, 2017, Oklahoma was forced to withdraw a state innovation waiver to create a reinsurance program that would have reduced premiums by more than 30 percent. HHS did not approve the waiver in time for it to be enacted, despite having approved a similar waiver for Alaska earlier in the year.
• On October 12, 2017, Trump issued an executive order that directed agencies to take steps that would increase premiums for small businesses and middle-class Americans purchasing insurance in the individual marketplace. Specifically, the order directs:
  • The U.S. Department of Labor to seek to allow small businesses with particularly healthy employees to band together and leave the small group insurance market through so-called association health plans, driving up premiums for small businesses with less-healthy workers.
  • The departments of the Treasury, Labor, and Health and Human Services to seek to expand access to short-term, limited duration plans. These plans can discriminate against people with pre-existing conditions; charge women more than men; have annual and lifetime limits; exclude coverage for services such as prescription drugs and maternity care; and charge older Americans significantly more than others. By diverting healthy people into these plans, premiums for the middle class in the individual insurance market would increase drastically.
  • The departments of the Treasury, Labor, and Health and Human Services to seek to allow employers to use health reimbursement accounts to move their less healthy employees into the individual insurance market, increasing premium costs in that market.
• On October 12, 2017, Trump canceled cost-sharing reduction payments, which help reduce deductibles and copays for low-income Americans. The nonpartisan Congressional Budget Office estimates that canceling these payments will increase premiums by 20 percent in 2018 and 25 percent in 2020, result in 1 million more uninsured people in 2018, and increase the federal deficit by almost $200 billion over the next decade.
• On October 20, 2017, it was reported that the Trump administration would automatically re-enroll people into health care plans after the open enrollment period ended, leaving them no opportunity to choose a different plan. Previously, automatic re-enrollment would occur during the open enrollment period, so people could choose another plan if they did not like the one into which they were automatically re-enrolled.
• On December 22, 2017, Trump signed into law a tax bill that repeals the individual mandate penalty. Repealing this provision will result in an estimated 13 million fewer people with health coverage in 2025 and a 10 percent increase in premiums nationwide.
• On February 5, 2018, HHS announced that it would provide funding to states seeking to, among other things, reduce the comprehensiveness of health coverage, so that insurance plans could cover fewer services for consumers. The funding would help states determine how to reduce the scope of benefits that plans have to provide.
• On April 9, 2018, HHS issued the 2019 ACA marketplace rule, which takes a number of steps to undermine the individual health insurance marketplace, including:
  • Reducing protections for people with pre-existing conditions by setting lower standards for the benefits all plans must cover
  • Increasing the cost of health coverage, such as by letting insurers increase premiums up to 15 percent without justification and by making it easier for states to lower consumer rebates when insurers fail to spend their premium dollars on actual care
  • Making it harder for people to obtain coverage by reducing consumer access to enrollment assistance and by increasing the burden of verifying eligibility for low-income enrollees
• On April 9, 2018, HHS extended by another year an exemption from ACA requirements for certain health insurance plans. This policy change will keep healthier, less expensive enrollees out of the ACA marketplace, increasing prices for everyone else.
• On April 9, 2018, HHS significantly expanded the circumstances in which people are exempted from the requirements of the individual mandate.
• On June 7, 2018, in a lawsuit brought by the state of Texas, the U.S. Department of Justice broke with long-standing policy to announce that it will refuse to defend key provisions of the ACA that protect consumers with pre-existing medical conditions. The Justice Department also argued that the law’s individual mandate, which was upheld by the U.S. Supreme Court in 2012, has become unconstitutional. The Justice Department’s legal argument has been widely denounced, including by conservative lawyers who oppose the ACA. Three career attorneys at the Justice Department who had been working on the case informed the court that they were withdrawing and would not be signing on to the argument.
• On June 19, 2018, the Trump administration finalized a rule to expand access to “association health plans.” These plans would allow self-employed individuals and small businesses to band together in order to purchase health insurance off the ACA marketplace. As a result, these cheaper plans could bypass the ACA’s requirement to cover essential health benefits and would ultimately draw an estimated 3.2 million people away from the individual and small group markets. This rule threatens health care access for individuals with pre-existing conditions and works to raise premiums and to further destabilize the individual market.
• On July 10, 2018, the Trump administration announced steep funding cuts for programs that provide in-person assistance to individuals looking to enroll in health insurance coverage. Grant funding for health care navigators will be cut by 40 percent—from $36.8 million in 2018 to just $10 million in 2019. In addition, the administration is encouraging navigators to steer people toward President Trump’s junk plans, which provide limited benefits and few consumer protections.
• On July 10, 2018, the Sunlight Foundation reported that the Trump administration removed nearly every reference to the ACA—including 14 webpages—from the Medicaid website. The webpages contained information about the health care law, including eligibility requirements and how it interacts with Medicaid and the Children’s Health Insurance Program (CHIP). Approximately one month after the removal of this content, a section on the ACA was added back to Medicaid.gov’s “Program History” page.
• On August 1, 2018, the Trump administration finalized new rules expanding access to short-term plans. These plans do not have to cover essential health benefits such as maternity care and prescription drugs; can charge women and older Americans more; and can discriminate against individuals with pre-existing conditions. The new rules allows these junk plans to extend to 12 months—departing from the original limit of three months—with the option to renew for up to three years. They will drive up premiums and cost taxpayers billions of dollars.

• February 23, 2018: Trump told the Conservative Political Action Conference: “I think we may be better off the way we’re doing it, piece by piece by piece, ObamaCare is just being wiped out. … The individual mandate essentially wipes it out, so I think we may be better off….”
• December 20, 2017: Trump claimed: “When the individual mandate is being repealed, that means Obamacare is being repealed. We have essentially repealed Obamacare, and we will come up with something much better.”
• October 16, 2017: Trump said: “Obamacare is finished. It’s dead. It’s gone.” He went on to say: “You shouldn’t even mention it. It’s gone. There is no such thing as Obamacare anymore. It is a, and I said this years ago, it’s a concept that couldn’t have worked.”
• October 14, 2017: Steve Bannon, former White House chief strategist, said: “Then you had Obamacare. Not gonna make the CSR [cost-sharing reduction] payments, gonna blow that thing up, gonna blow those [insurance] exchanges up, right?”
• October 13, 2017: Trump said: “You saw what we did yesterday with respect to health care. … We’re taking a little different route than we had hoped, because getting Congress — they forgot what their pledges were. So we’re going a little different route. But you know what? In the end, it’s going to be just as effective, and maybe it’ll even be better.”
• October 13, 2017: Vice President Mike Pence said: “President Trump and I will not rest, we will not relent, until we end the Obamacare nightmare once and for all.”
• October 13, 2017: Trump tweeted: “ObamaCare is causing such grief and tragedy for so many. It is being dismantled but in the meantime, premiums & deductibles are way up!”
• October 13, 2017: Trump tweeted: “The Democrats ObamaCare is imploding. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!”
• July 31, 2017: Trump tweeted: “If ObamaCare is hurting people, & it is, why shouldn’t it hurt the insurance companies & why should Congress not be paying what public pays?”
• July 30, 2017: Office of Management and Budget Director Mick Mulvaney said: “I think his attitude is this, and his attitude is pretty simple. What he’s saying is, look, if Obamacare is hurting people—and it is—then why shouldn’t it hurt insurance companies and more importantly perhaps for this discussion, members of Congress?”
• July 29, 2017: Trump tweeted: “If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!”
• July 19, 2017: At a lunch with Senate Republicans, Trump said: “But being fine with Obamacare isn’t an option for another reason. Because it’s gone. It’s failed. Not going to be around. We pay hundreds of millions of dollars a month in subsidy that the courts don’t even want us to pay. And when those payments stop, it stops immediately. It doesn’t take two years, three years, one year. It stops immediately.”
• July 18, 2017: Trump tweeted: “As I have always said, let ObamaCare fail and then come together and do a great healthcare plan. Stay tuned!”
• July 18, 2017: Then-Deputy Press Secretary Sarah Huckabee Sanders said: “The only thing that’s dead is Obamacare.”
• June 26, 2017: Trump tweeted: “Republican Senators are working very hard to get there, with no help from Democrats. Not easy! Perhaps just let OCare crash & burn.”
• June 21, 2017: White House launched website claiming: “President Donald J. Trump promised to repeal and replace this [Obamacare] disaster, and that is exactly what he is working with Congress to achieve.”
• June 7, 2017: Trump says that “Obamacare is in a total death spiral. The problems will only get worse if Congress fails to act.”
• May 22, 2017: Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma reportedly threatened to withhold payments unless insurers agreed to support the ACA repeal bill.
• May 19, 2017: Trump reportedly wanted to end CSR payments, telling an aide, “Why the hell would we [continue payments]?”
• May 11, 2017: In an interview with The Economist, Trump said, “You know when people say, ‘Oh, Obamacare is so wonderful,’ there is no Obamacare, it’s dead. Plus we’re subsidising it and we don’t have to subsidise it. You know if I ever stop wanting to pay the subsidies, which I will.”
• April 30, 2017: Trump tweeted, “You can’t compare anything to ObamaCare because ObamaCare is dead. Dems want billions to go to Insurance Companies to bail out donors.”
• April 23, 2017: Trump tweeted, “ObamaCare is in serious trouble. … it dies far sooner than anyone would have thought.”
• April 21, 2017: Office of Management and Budget Director Mick Mulvaney said that the administration will use CSRs as a bargaining chip to get funding for President Trump’s border wall.
• April 18, 2017: CMS Administrator Verma refused to tell insurers that CSR payments will be made.
• April 12, 2017: Trump threatened to withhold CSR payments to force Democrats to negotiate with him to replace the ACA.
• April 4, 2017: In an interview with The New York Times, Trump said, “[T]he easiest thing for me to do would be to not do health care. … If I don’t do that, other things happen. And I think it’s time that we have—because, look—what’s going to happen is Obamacare is not sustainable. It’s over. It will be anywhere from six months to a year. It’s over. It’s over.”
• April 4, 2017: During a congressional hearing, HHS Secretary Tom Price did not commit to funding outreach and enrollment efforts that would help ensure a large and healthy risk pool for 2018.
• March 24, 2017: Trump said, “[T]he best thing we can do politically speaking is let Obamacare explode.”
• March 20, 2017: HHS launched a new website to provide “relief” from the ACA.
• March 9, 2017: House Speaker Paul Ryan (R-WI), in discussing the ACA repeal bill, falsely claimed that the ACA markets are in a “death spiral.”
• January 12, 2017: Speaker Ryan falsely claimed that the ACA markets are in a “death spiral.”