The Affordable Care Act is still in effect, and the 2019 open enrollment period just ended for most Americans. The recent ruling by a Texas judge declaring the act invalid doesn’t change that.

But the Trump administration and Republicans are still undermining the health law.

People who earn too much to qualify for financial assistance for policies purchased through the A.C.A.’s health insurance exchanges or directly from insurers — five million now enrolled, including three to four million enrolled off-exchange — will pay for that sabotage in higher premiums. (Another nearly five million are uninsured and priced out of the market.) In the graphic below, I estimate how much more these unsubsidized enrollees will have to lay out in 2019 than they would have if not for the Trump administration’s actions.

Its sabotage efforts in 2018 included cutting off subsidy reimbursement payments for low-income enrollees (the cost of which insurers pass along to unsubsidized consumers), slashing the marketing budget by 90 percent and gouging the outreach-assistance budget by 40 percent. Next year will have those plus the repeal of the individual mandate and the expansion of non-Obamacare-compliant policies that don’t include the law’s patient protections.

These moves siphon off healthy enrollees, damaging the A.C.A. “risk pool,” so that its customers tend to be sicker and more expensive to carriers. In setting their premiums, many insurers specifically point to these actions as reasons for rate increases.