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The Trump administration has been touting the fact that Affordable Care Act coverage is on track for relatively modest premium increases next year in much of the country. But a new paper published in Health Affairs offers a reminder that Trump has not been a friend to the ACA’s exchanges.

Expand chart
Data: Kaiser Family Foundation; Map: Lazaro Gamio / Axios

By the numbers: In 2016, 93% of the country lived in a county where they'd have at least three insurers to choose from, if they wanted to buy coverage through the exchanges. This year, that's down to 60% of the population.

Unsurprisingly, the places where insurers backed out tended to be rural, impoverished and unhealthy.

"It is unclear" whether this trend "represented a long-run equilibrium or more transient factors such as the fluid policy environment and insurer 'panic' over early losses," the paper says.

The bottom line: Premiums also skyrocketed in this period — the average premium for a middle-of-the-road policy rose by about 37% from 2017 to 2018. And insurers have said plainly that policy changes from the administration and congressional Republicans made them skittish.

Go deeper

Dan Primack, author of Pro Rata
14 mins ago - Politics & Policy

Democrats' billionaires tax explained

Illustration: Aïda Amer/Axios

There is now legislative language behind the push to tax American billionaires on unrealized capital gains, as Sen. Ron Wyden last night released his 107-page plan.

Why it matters: This would be a sea change in U.S. tax policy, which has only applied to realized gains (otherwise known as income).

1 hour ago - World

Scoop: Blinken protests Israel settlements approval in "tense" phone call

Benny Gantz (L) and Tony Blinken. Photo: Jacquelyn Martin/Pool/AFP via Getty

Secretary of State Tony Blinken protested the decision to approve 3,000 new housing units in Israeli settlements in the occupied West Bank during a tense phone call on Tuesday with Israeli Defense Minister Benny Gantz, three Israeli officials tell me.

Why it matters: This is the first time new construction in the settlements has been approved since President Biden assumed office, and the Biden administration had been privately pressing the Israeli government not to proceed.

The startup that wants to disrupt big internet providers

Illustration: Maura Losch/Axios

A new startup backed by funding from AOL founder Steve Case and Laurene Powell Jobs wants to break up broadband monopolies across the country.

Why it matters: Internet access has been crucial during the pandemic, but it's not ubiquitous, and it can be both slow and unaffordable in swaths of the country.