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Ending subsidy payments could help make part of the ACA better. Photo: Andrew Harnik/AP

President Trump's decision to quit paying a critical Affordable Care Act subsidy has given most of the country access to insurance with no monthly premiums — nudging it, however inelegantly, in the same direction Democrats have wanted to go (at least for the poorest enrollees).

The bottom line, from Democratic health care strategist Chris Jennings: "The R's are driving in reverse relative to their repeal dream."

How it works: When Trump decided to quit making payments to insurers for the ACA's cost-starring reduction (CSR) subsidies, insurers responded by raising their premiums for certain plans — mostly, the "benchmark" plans that are used to determine the size of the ACA's premium subsidies.

  • That, in turn, made those subsidies much more generous.
  • And now, in most counties in the U.S., the lowest-income enrollees will be able to find at least one plan for which their subsidy covers the entire premium.
  • "In a way, this was an incredibly complicated and convoluted way of increasing the premium subsidies available to consumers," said Larry Levitt of the Kaiser Family Foundation.
  • But people who don't receive subsidies could have to pay substantially more. And this backwards stumble into higher subsidy is still a net negative for insurers, who crave stability most of all.

What they're saying:

  • "The ACA was designed to protect low income consumers from situations like this-- as improbable as this one was," said Andy Slavitt, the former Centers for Medicare and Medicaid Services under President Obama. But "for people without subsidies, Trump's action disproportionately hurt those in the middle class."
  • Topher Spiro, of the Center for American Progress: "People can get better deals, but not unless they shop around—and there's mass confusion as a result of sabotage. So far, no insurers have pulled out, but continued uncertainty means there's a risk of insurers exiting for 2019—or not re-entering markets."

Reality check: The irony of all this is that Democrats — including Hillary Clinton — have consistently pushed for increased premium subsidies, albeit in a much more straightforward way. (And of course they also want the government to continue the payments Trump cut off.)

  • "We could spend that extra money we are shelling out today to pay for the excess premiums far more efficiently and get more people covered more affordably," Jennings said.
  • Congressional Republicans would never have agreed to create more "free" insurance plans on the government's dime. Their repeal-and-replace bills would have substantially reduced the law's premium subsidies. But many experts think higher subsides will help. "That's what it's going to take to make the ACA work," said Chris Condeluci, a former Republican aide on the Finance Committee.

Go deeper

37 mins ago - World

Special report: Trump's U.S.-China transformation

Illustration: Aïda Amer/Axios

President Trump began his term by launching the trade war with China he had promised on the campaign trail. By mid-2020, however, Trump was no longer the public face of China policy-making as he became increasingly consumed with domestic troubles, giving his top aides carte blanche to pursue a cascade of tough-on-China policies.

Why it matters: Trump alone did not reshape the China relationship. But his trade war shattered global norms, paving the way for administration officials to pursue policies that just a few years earlier would have been unthinkable.

McConnell: Trump "provoked" Capitol mob

Senate Majority Leader Mitch McConnell (R-Ky.) said on Tuesday that the pro-Trump mob that stormed the U.S. Capitol on Jan. 6 was "provoked by the president and other powerful people."

Why it matters: Trump was impeached by the House last week for "incitement of insurrection." McConnell has not said how he will vote in Trump's coming Senate impeachment trial, but sources told Axios' Mike Allen that the chances of him voting to convict are higher than 50%.

GOP leaders skip Trump sendoff in favor of church with Biden

House Speaker Nancy Pelosi (D-Calif.), Senate Majority Leader Mitch McConnell (R-Ky.), Senate Minority Leader Chuck Schumer (D-N.Y.) and House Minority Leader Kevin McCarthy (R-Calif.) in July. Photo by Erin Scott-Pool/Getty Images

Congressional leaders, including House GOP leader Kevin McCarthy and Senate Majority Leader Mitch McConnell, will skip President Trump's departure ceremony in Maryland tomorrow morning in favor of attending mass with incoming President Joe Biden ahead of his inauguration, congressional sources familiar with their plans tell Axios.

Why it matters: Their decision is a clear sign of unity before Biden takes the oath of office.