If Trump wants, he can unleash serious damage by undermining the individual markets in three ways. Insurers currently making decisions will closely scrutinize signs from the administration to gauge those markets’ long-term viability. His administration can weaken the individual mandate through various mechanisms, which would mean fewer younger and healthier people and higher premiums. It can pull back on all forms of outreach designed to get people to enroll on the marketplaces. Or it can stop paying “cost-sharing reductions” to insurance companies, which enable them to reduce out-of-pocket costs for lower-income enrollees, which may encourage insurers to flee the markets.
This could strand many of the 12 million people who have gotten coverage on the individual markets, according to Larry Levitt, a senior vice president at the Kaiser Family Foundation. They could be left with “no insurers in the marketplaces, no way to get tax credits, no way to get coverage at all,” Levitt tells me, adding that the insurer exodus could also prevent people who individually obtain coverage outside the exchanges from doing so: “You’re talking about small business owners, farmers, self-employed people, early retirees — who would have no way of getting health insurance.”
Trump is a childish, vindictive, bully. It wouldn’t be surprising at all if he tried to hurt the people who benefit from the ACA just because he can.