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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

32 mins ago - Health

WHO: AstraZeneca vaccine must be evaluated on "more than a press release"

A medical syringe and vial with fake coronavirus vaccine in front of the World Health Organization (WHO) logo. Photo Illustration: Pavlo Gonchar/SOPA Images/LightRocket via Getty Images

Top scientists at the World Health Organization on Friday called for more detailed information on a coronavirus vaccine developed by AstraZeneca and the University of Oxford.

Why it matters: Oxford and AstraZeneca have said the vaccine was 90% effective in people who got a half dose followed by a full dose, and 62% effective in people who got two full doses. AstraZeneca has since acknowledged that the smaller dose received by some participants was the result of an error by a contractor, per the New York Times.

Court rejects Trump campaign's appeal in Pennsylvania case

Photo: Sarah Silbiger for The Washington Post via Getty Images

A federal appeals court on Friday unanimously rejected the Trump campaign's emergency appeal seeking to file a new lawsuit against Pennsylvania's election results, writing in a blistering ruling that the campaign's "claims have no merit."

Why it matters: It's another devastating blow to President Trump's sinking efforts to overturn the results of the election. Pennsylvania, which President-elect Joe Biden won by more than 80,000 votes, certified its results last week and is expected to award 20 electoral votes to Biden on Dec. 12.

Dave Lawler, author of World
3 hours ago - World

Belarus dictator Lukashenko says he'll leave post after new constitution

Photo: Valery Sharifulin\TASS via Getty

Longtime Belarusian President Aleksandr Lukashenko has said he will step down after a new constitution comes into force, according to Belarusian state media.

Why it matters: Lukashenko has faced three months of protests following a rigged election in August. He has promised to reform the constitution to reduce the near-absolute powers of the president, but has insisted that his strong hand is needed to see that process through.

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