Health care politics “We Democrats are going to be relentless in making sure the American people exactly understand who is to blame for the rates,” says Senate Minority Leader Chuck Schumer. (Photo: Shutterstock)

What’s next for the Affordable Care Act? It’s hard to say.

Although Republicans repeatedly failed last year to fully repeal the landmark health legislation, they have implemented changes aimed at weakening the law. Most notably, the tax overhaul approved in December repealed the individual mandate and the Trump administration stopped making cost-sharing reduction payments to insurers to provide discounted health plans to low-income customers.

Six months later, the cuts to CSR payments have not affected the premiums that low-income customers pay for health plans. Those who were already eligible for premium tax credits have not seen the price they pay for plans rise; instead the federal government is simply paying a larger share of the premium.

While health advocates warn that many customers who are signing up for health plans might end up paying big in terms of deductibles and co-pays as a result of the CSR cuts, those customers have not yet been scared away from the ACA marketplace, as many ACA supporters worried may happen.

That may not last long. The first 2019 rate requests are in, projecting double-digit increases in premiums. It’s the latest weapon in Democrats’ growing finger-pointing arsenal. It’s Republicans who have to answer for rising premiums, they say, It’s the GOP, after all, who sought to torpedo the system.

“We Democrats are going to be relentless in making sure the American people exactly understand who is to blame for the rates,” said Senate Minority Leader Chuck Schumer, D-N.Y., at a recent press conference. “Republicans control the House, the Senate, the presidency. The rates go up, especially after all their actions, it’s on their back and they know it.”

Republicans, however, argue their changes remove undue burden and restrictions from the American people, and the aftermath is just a reflection of a poorly designed system.

“We’re seeing more the true costs of a terribly flawed Obamacare health system that’s still in place, and so I continue to urge the Senate Republicans to unite and find a way to repeal Obamacare and really replace it with more affordable, patient-centered health care,” House Ways and Means Committee Chairman Kevin Brady said.

Long-term issues will continue to plague the Obamacare exchange. In particular, the Trump administration’s actions could continue to erode at enrollment and deter healthy individuals and those who are not eligible for subsidies to sign up for plans. That could undermine the risk pool, driving up premiums even more.

In a recent letter to supporters, Sen. Lamar Alexander, R-Tenn., the chairman of the Senate Committee on Health, Education, Labor and Pensions, blamed Democrats for giving up on attempts to stabilize the ACA marketplace. As a result, he said, he is asking the Trump administration to do whatever it can on its own.

Alexander said he is exploring “other administrative actions they can take to give states more flexibility to help lower health insurance premiums, especially for the 9 million working Americans in the individual market who do not receive a federal subsidy.”