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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

Updated 12 mins ago - Politics & Policy

Omicron dashboard

Illustration: Brendan Lynch/Axios

  1. Health: Pfizer and Moderna boosters overwhelmingly prevent Omicron hospitalizations, CDC finds — Omicron pushes COVID deaths toward 2,000 per day — The pandemic-proof health care giant.
  2. Vaccines: The case for Operation Warp Speed 2.0 — Starbucks drops worker vaccine or test requirement after SCOTUS ruling — Kids' COVID vaccination rates are particularly low in rural America.
  3. Politics: Biden concedes U.S. should have done more testing — Arizona says it "will not be intimidated" by Biden on anti-mask school policies — Federal judge blocks Biden's vaccine mandate for federal workers.
  4. World: American Airlines flight to London forced to turn around over mask dispute — WHO: COVID health emergency could end this year — Greece imposes vaccine mandate for people 60 and older — Austria approves COVID vaccine mandate for adults.
  5. Variant tracker

Arizona governor sues Biden administration over COVID funds tied to mandates

A teacher prepares a hallway barrier to help students maintain social distancing at John B. Wright Elementary School in Tucson, Arizona, on Aug. 14, 2020. Photo: Cheney Orr/Bloomberg via Getty Images

Arizona Gov. Doug Ducey (R) filed a lawsuit Friday against the Biden administration for ordering the state to stop allocating federal COVID relief funds to schools that don't comply with public health recommendations such as masking, the Arizona Republic reports.

Why it matters: The Treasury Department said last week that the state would have to pay back the money if Ducey does not redesignate the $173 million programs to ensure they don't "undermine efforts to stop the spread of COVID-19."

Federal judge blocks Biden's vaccine mandate for federal workers

President Biden speaking from Eisenhower Executive Office Building on Jan. 21. Photo: Yuri Gripas/Abaca/Bloomberg via Getty Images

A federal judge in Texas blocked the Biden administration from enforcing its coronavirus vaccine mandate for federal workers on Friday, citing the outcome of last week's Supreme Court ruling that nullified the administration's vaccine-or-test requirement for large employers.

Why it matters: It's a blow to President Biden's efforts to increase the U.S.' vaccination rates, though much of the federal workforce has already been vaccinated against the virus.