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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

Biden administration seeks to allow separated migrant families to reunite in U.S.

Secretary of the Department of Homeland Security Alejandro Mayorkas announced Monday that the Biden administration will explore "lawful pathways" to allow migrant families separated under the Trump administration to reunite in the U.S.

Why it matters: Biden has pledged to reunite the hundreds of families still separated as a result of the Trump administration's "zero tolerance" policy, and signed an executive order last month creating a family separation task force chaired by Mayorkas.

CDC director warns "now is not the time" to lift COVID restrictions

CDC director Rochelle Walensky warned states on Monday that "now is not the time" to lift public health restrictions, as the recent dramatic declines in coronavirus cases and deaths "appear to be stalling."

Why it matters: While the average of 70,000 new infections and 2,000 daily deaths is nowhere near the extremely high levels recorded at the start of 2021, the figures are still a poor baseline to "stop a potential fourth surge" — especially with the threat posed by more contagious new variants, Walensky warned.

Sen. Elizabeth Warren introduces "ultra-millionaire" wealth tax bill

Photo: Greg Nash-Pool/Getty Images

Sen. Elizabeth Warren (D-Mass.) on Monday introduced a bill in the Senate that would impose a new tax on the assets of America's wealthiest individuals.

Why it matters: The plan, which Warren introduced along with Reps. Pramila Jayapal (D-Wash.) and Brendan Boyle (D-Pa.) is similar to a proposal that was the centerpiece of Warren's campaign for the presidency in 2020.