Trump Is Launching a Stealth Attack on Obamacare
The administration’s new solution to affordability sounds great—until you get sick.
THE TRUMP ADMINISTRATION ANNOUNCED last week that it is winding up to deal yet another blow to the Affordable Care Act. But don’t feel bad if you haven’t heard about it.
The warning was tucked deep in the Federal Register, which is where agencies post notices of new regulations they hope to put in place. It was part of what’s called the “Marketplace Integrity and Affordability Final Rule,” which the federal government issues every year to guide operations of the Affordable Care Act.
The annual rule, hundreds of pages long, is a chance to tinker with the program—and not simply for the sake of adapting to the ever-changing health care economy. Administrations have traditionally used the rule to pursue their agendas, which under Barack Obama and Joe Biden meant finding ways to maximize the Affordable Care Act’s reach.
Donald Trump has a very different agenda and his administration’s proposed rule, which would affect how the Affordable Care Act works in 2027, reflects that. It would roll back requirements on what insurers must cover, while encouraging a shift into plans that have lower premiums—but only because they also have much higher out-of-pocket costs.
Philosophically, the changes are of a piece with what Republicans have been trying to do ever since the Affordable Care Act became law in 2010. The administration’s own accounting suggests the net effect would be between 1.2 and 2 million fewer people enrolling in Affordable Care Act plans. It’s not the same kind of impact as, say, repealing the law outright, which is what Republicans tried to do in 2017. But it’s still a lot of people.
The proposal is not a fait accompli. The administration has to allow public comment for a few weeks, during which time it could decide to modify or delay provisions, especially if insurers ask for more time to make what could be substantial adjustments. Any changes the administration eventually puts in place could also face a legal challenge, as happened last year when a lawsuit blocked a similar Trump administration proposal.
And that is to say nothing of the possible political pressure the administration could confront. The proposal is landing less than a year after Trump and his Republican allies cut more than $1 trillion out of federal health programs, including the Affordable Care Act—and just weeks after they allowed for the expiration of extra financial assistance Democrats had put in place to help people buying coverage through the marketplaces.
All of that is making health care more expensive, especially for people buying Affordable Care Act insurance at HealthCare.gov or one of the marketplaces that states run. And there are plenty of signs the higher prices are rattling people. Already enrollment is down by more than a million, and the higher cost of health care is