Donald Trump has said in no uncertain terms that he’s willing to let health care coverage under the Affordable Care Act “implode” — and his actions in delaying subsidies to insurers on behalf of those most in need of health care are actively helping that intention.

That’s the conclusion of a report from the Congressional Budget Office/Joint Committee on Taxation on the impact of Trump’s refusal to say if the federal government will pay the Affordable Care Act’s subsidies in 2018.

Alternet reports that the action (well, inaction) by the administration will result in an increase of 15 percent in premiums for the 12 million people who bought non-group health plans through the ACA’s exchanges. Eight million of those people received subsidies with which to buy coverage.

And while the CBO/JCT report says the number of individuals seeking Obamacare coverage and receiving subsidies is slated to grow by 1 million in 2018, if the administration holds to its strategy of withholding subsidies, the resulting higher premiums, if implemented, would reverse that.

“In 2018, the agencies project, the average benchmark premium will be roughly 15 percent higher than it was in 2017, largely because of short-term market uncertainty—in particular, insurers’ uncertainty about whether federal funding for certain subsidies that are currently available will continue to be provided—and an increase in the percentage of the population living in areas with only one insurer in the marketplace,” the CBO/JCT says in the report.

The agencies also write, “That increase in enrollment in 2018 is limited by projected premium increases due to near-term market uncertainty and by announced reductions in federal advertising, outreach, the enrollment period, and other enrollment efforts, which push enrollment down,” referring to other efforts by the White House to sabotage ACA coverage.

Trump’s tightening the purse strings on the subsidies is just one aspect of Republican efforts to repeal the ACA and replace it with an as-yet-undetermined substitute that would slash Medicaid, but despite the GOP’s heretofore-unsuccessful efforts to do so, market chaos has resulted in higher costs. If they were to succeed, analysts have said that 32 million people could lose health insurance over the next 10 years.

The congressional report also says that the ACA insurance markets had stabilized by this year and were allowing private insurers to profit, unlike earlier years during which people who had lacked coverage signed up and began to receive care for long-untreated conditions. “In other words,” the Alternet report says, “without GOP intervention, there would be no increase in 2018’s premiums.”

“Data about insurers’ profitability in the first quarter in 2017 are consistent with the market’s being stable,” CBO/JCT writes. “Insurers’ profitability, as measured by the share of premiums that goes toward their administrative costs and profits rather than paying for claims, has increased in 2017 to move closer to pre-ACA levels. That evidence suggests that the premium increases in 2017 were a sufficient adjustment by insurers to account for the underlying health risk of the nongroup population.”

Instant Insights /

CBO says Trump delay on ACA subsidies will boost premiums 15 percent

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