President Donald Trump responds to a question at the end of a meeting. Photo: Susan Walsh / AP

The Affordable Care Act used a carrot-and-stick approach to get healthy people to sign up for coverage. The stick is the individual mandate and the penalty for going uninsured; the carrot is a system of subsidies to help people afford their premiums. Under Republicans' watch, the stick is getting a lot weaker while the carrot is looking more and more delicious.

What's happening: We're ending up in a place where the poorest consumers can get even cheaper coverage than the ACA intended, especially if they choose less comprehensive care, while wealthier consumers increasingly don't have much incentive to get covered at all. Those trends will only grow more pronounced if Republicans successfully repeal the individual mandate in their tax bill, leaving the law with only its carrot, and no stick.

  • Compare that to what the law was initially designed to do — move a lot of people into the same system, in which even the people who didn't get a subsidy would benefit from a competitive marketplace to shop for coverage.

How it works:

  • President Trump's decision to cut off the ACA's cost-sharing payments has caused premiums — and premium subsidies — to soar. The poorest consumers, who are eligible for the biggest subsidies, have more access to cheaper plans than ever before.
  • The people who don't get subsidies are on the hook for bigger premium increases. At least 20% of the unsubsidized population are exempt from the individual mandate because their premiums are too expensive, according to data released yesterday by the Robert Wood Johnson Foundation.
  • Together, that means subsidies are going further for the people who get them, and those who don't are increasingly off the hook for the individual mandate.
  • We've also seen a moderate shift away from middle-of-the-road "silver" plans, toward both the cheaper "bronze" and more generous "gold" options.

The bottom line: All of this has compressed the ACA's benefits.

Go deeper

Wall Street is no longer betting on Trump

Illustration: Sarah Grillo/Axios

Betting markets have turned decisively toward an expected victory for Joe Biden in November — and asset managers at major investment banks are preparing for not only a Biden win, but potentially a Democratic sweep of the Senate and House too.

Why it matters: Wall Street had its chips on a Trump win until recently — even in the midst of the coronavirus-induced recession and Biden's rise in the polls.

With new security law, China outlaws global activism

Illustration: Eniola Odetunde/Axios

The draconian security law that Beijing forced upon Hong Kong last week contains an article making it illegal for anyone in the world to promote democratic reform for Hong Kong.

Why it matters: China has long sought to crush organized dissent abroad through quiet threats and coercion. Now it has codified that practice into law — potentially forcing people and companies around the world to choose between speaking freely and ever stepping foot in Hong Kong again.

44 mins ago - Health

Axios-Ipsos poll: There is no new normal

Data: Axios/Ipsos poll; Chart: Andrew Witherspoon/Axios

The longer the coronavirus pandemic lasts, the farther we're moving apart, according to our analysis of nearly four months of data from the Axios-Ipsos Coronavirus Index.

Why it matters: Ever since life in the U.S. as we knew it came to a screeching halt, we've been trying to get our heads around what a "new normal" will look like. But so far, the politicization of the virus — and our socioeconomic differences — are working against any notion of national unity in impact or response.