Now, under the new rule, plans that last for 364 days out of 365 can qualify as “short term.” As relatively healthy people who like the low price tag leave the exchanges to buy short-term coverage, the pool of people left on the exchanges will be relatively sicker. Prices will surge by an average of 18 percent in most states, according to researchers at the Urban Institute.

Already, unscrupulous brokers are using high-pressure tactics to sell short-term plans over the phone. Internet searches for “Obamacare plans” or “ACA enroll” will usually direct people to brokers selling short-term plans, not comprehensive coverage. Many of those people will be in for a rude shock when they get sick and discover how little their insurance actually covers.

There’s more. Earlier this year, a low-profile rule change reduced the subsidies for people who buy health insurance through the exchanges. President Trump’s own health officials recommended against the change because it “would cause coverage losses, further premium increases, and market disruption.” But the White House approved the cut anyway, and 70,000 people are expected to lose coverage as a result.

Insurance for the poor

At the same time, the Trump administration is laboring to tear health care from the poor. In its most galling move, it has been allowing states to add work requirements to Medicaid. To date, 18 states (most Republican controlled) have sought to impose work requirements, though Kentucky is likely to drop the request after Gov. Matt Bevin’s apparent loss last week.

Work requirements poll well: If you’re getting benefits on the government’s dime, shouldn’t you be expected to pull your own weight? But they are a policy nightmare. Fully 60 percent of those who are subject to work requirements already work. Of those who don’t, the overwhelming majority are in school, disabled or caring for dependents. There just aren’t that many people on Medicaid who can work but have chosen not to.

That’s why work requirements can’t stimulate much new employment. Every Medicaid beneficiary who’s subject to the requirements, however, has to jump through the bureaucratic hoops of attesting to their work status. Desperately poor people who lack the bandwidth or the wherewithal to comply will lose health coverage because they can’t manage the paperwork.

Experience in Arkansas bears the point out. More than 18,000 people, or nearly one in four Medicaid beneficiaries subject to work requirements, lost coverage in the first seven months of the program. A careful study in the New England Journal of Medicine found that “lack of awareness and confusion about the reporting requirements were common.” Employment rates didn’t budge.