Despite the repeated failure of Republicans in Congress to repeal and replace the Affordable Care Act, Trump has succeeded in raising health care premiums.

A number of insurers who provide coverage through the Obamacare marketplaces have requested double digit rate increases for the coming year, and the majority cite uncertainty about the actions of the Trump administrations as the reason for the requested increases, according to a new study released Thursday.

The study, from the Kaiser Family Foundation, looked at plans offered in 20 different states and in Washington D.C. The rates the study considers are requests and can be adjusted by regulators, but fewer insurers have even agreed to participate in the Obamacare exchanges in 2018.

According to the study, there were an average of 5.1 insurers per state in 2017, and an average of 4.6 insurers have said they intend to participate in the markets in 2018. Often, insurers don’t serve an entire state, so typically there are even fewer options for consumers.


The two main things the study cites as reasons for potential increases were uncertainty about enforcing the individual mandate and whether the Trump administration will continue to pay cost-sharing reductions (CSR).

“The vast majority of insurers included in this analysis cite uncertainty surrounding the individual mandate and/or cost sharing subsidies as a factor in their 2018 rates filings,” the study says. “Some insurers explicitly factor this uncertainty into their initial premium requests, while other companies say if they do not receive more clarity or if cost-sharing payments stop, they plan to either refile with higher premiums or withdraw from the market.”

The individual mandate brings down premiums by requiring healthier, younger people to buy coverage, who in turn subsidize individuals with higher health care costs, and CSRs are payments from the federal government to insurers to offset the costs of covering lower-income people. The payments are currently the subject of a lawsuit filed by House Republicans that was appealed by the Obama administration, and if Trump drops the appeal the payments will stop.

Additionally, there are ways Trump can avoid enforcing the individual mandate, and many attempts to repeal and replace Obamacare have included repealing the mandate.


Insurers who assume the individual mandate will not be enforced in 2018 proposed increases ranging from 1.2 percent to 20 percent, while those assuming CSR payments will not be made applied additional rate increases ranging from 2 percent to 23 percent, according to the study.

“Other insurers state that if they do not get clarity by the time rates must be finalized – which is August 16 for the federal marketplace – they may either increase their premiums further or withdraw from the market,” the study’s authors wrote.

Senator Mitch McConnell said I had "excessive expectations," but I don't think so. After 7 years of hearing Repeal & Replace, why not done? — Donald J. Trump (@realDonaldTrump) August 9, 2017

Trump himself has stoked the uncertainty, continuing to call for Senate Republicans to go back to the drawing board on how to repeal and replace the Affordable Care Act in recent days, despite Senate Majority Leader Mitch McConnell (R-KY) having said it’s “time to move on.”

“Senator Mitch McConnell said I had ‘excessive expectations,’ but I don’t think so. After 7 years of hearing Repeal & Replace, why not done?” Trump tweeted Wednesday.

Can you believe that Mitch McConnell, who has screamed Repeal & Replace for 7 years, couldn't get it done. Must Repeal & Replace ObamaCare! — Donald J. Trump (@realDonaldTrump) August 10, 2017

Mitch, get back to work and put Repeal & Replace, Tax Reform & Cuts and a great Infrastructure Bill on my desk for signing. You can do it! — Donald J. Trump (@realDonaldTrump) August 10, 2017

It’s worth noting that a relatively small number of people who receive care through the Obamacare exchanges will be affected by the proposed rate increases, as more than 80 percent of enrollees receive a tax credit that lowers their premiums.


About 6.7 million people buy coverage on the non-group market and do not receive subsidies. It’s this group that will bear the brunt of these proposed premium increases, should they go into effect.

For context, as Drew Altman of the Kaiser Family Foundation noted in Axios on Thursday, there are about 17.5 million people who purchase coverage through the non-group insurance market, 10.3 million of which are enrolled in ACA exchanges. 156 million people receive coverage through their employer, and 74 million are covered by Medicaid and the children’s health insurance program.