President Donald Trump can’t kill Obamacare, no matter how hard he tries.

His administration’s latest threat to the law, unveiled Wednesday, expands the availability of short-term health plans that critics deride as “junk” insurance. However, despite the administration’s unrelenting efforts to sideline Obamacare, more insurers are signing up to sell 2019 coverage, and premium increases will be the lowest in years.


“The rate shocks have kind of run their course,” said Chris Sloan, a director with consulting firm Avalere Health. “The administration has basically done everything it can around this market. … They kind of shot all their bullets.”

The Trump administration, in addition to boosting short-term plans, has expanded alternative coverage options for small businesses, halted payments to insurers for low-income customers and slashed Obamacare outreach. The markets’ resiliency to these efforts has turned out to be a surprise — if a welcome one — for Democrats on Capitol Hill, who are trying to convert Obamacare’s newfound popularity into electoral success in November.

“They’re going to keep launching attacks,” Sen. Chris Van Hollen (D-Md.), chair of the Democratic Senatorial Campaign Committee, said of the Trump administration. “They’re determined to take away coverage.”

POLITICO Pulse newsletter Get the latest on the health care fight, every weekday morning — in your inbox. Email Sign Up By signing up you agree to receive email newsletters or alerts from POLITICO. You can unsubscribe at any time. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Public support for Obamacare has skyrocketed since congressional Republicans made ill-fated repeal attempts last year. The Trump administration itself has struggled to land a clear knockout blow, despite advancing a series of policies designed to create new competition outside the Obamacare markets and siphon off healthier, low-cost enrollees.

“I think the law has proven to be more resilient than both its opponents and proponents had anticipated,” said Sen. Brian Schatz (D-Hawaii). “And that’s an economic observation as well as a political one.”

Trump administration health officials said the moves are designed to expand coverage options for people priced out of Obamacare coverage, particularly middle-income customers who aren’t eligible for federal insurance subsidies. Enrollment among unsubsidized customers in the individual market plummeted nearly 30 percent between 2015 and 2017 as premiums rose, according to an analysis by the Kaiser Family Foundation.

“There are individuals today who have been priced out of coverage because of the way that the Affordable Care Act has been implemented and the effects it has had on the market,” said Jim Parker, senior adviser for health reform at the Department of Health and Human Services.

Obamacare insurers criticized the expansion of short-term plans, which cover far less than Obamacare and typically refuse coverage for pre-existing medical conditions. They warned the move could destabilize the exchanges, driving up costs for the sicker population left behind. The health care industry broadly warned that the skinny plans will leave customers with big medical bills they weren’t expecting.

Still, there are no signs the Trump administration’s latest move would scare any insurers away from the Affordable Care Act markets. Obamacare enrollment among subsidized customers is actually up by 6 percent this year, demonstrating the strength of the health care law’s financial assistance.

“We don’t believe they will have a big impact on our ACA population,” Tami Hibbitts, vice president of individual markets at Michigan’s Priority Health, said of short-term plans. “We see more people who were going uncovered before perhaps picking up a short-term plan.”

More than a dozen states are seeing an increase in insurer competition in at least some counties. That includes the tech-focused startup Oscar Health, which is expanding into three new states while enlarging its footprint in three others. Another insurance startup, Bright Health, is entering Arizona and Tennessee for the first time. And two of the largest players in the exchanges — Centene and Molina Healthcare — are entering additional markets.

The boosted competition is a stark reversal from last year, when dozens of counties were at risk of not having a single insurer willing to sell Obamacare coverage.

There are promising signs across the country that Obamacare rate hikes for the 2019 enrollment season won’t approach the eye-popping increases of the past two years, though rates won’t be finalized until the fall. Enrollment reopens Nov. 1, days before the midterm elections.

For example, one year after Tennessee’s market seemed on the verge of collapse, BlueCross BlueShield of Tennessee plans to decrease rates by 10 percent and Cigna wants to lower rates by 5 percent. In Minnesota, all four of the state’s insurers are looking to lower premiums. And in several other states — including the key political battlegrounds of Indiana, Nevada, Michigan and Pennsylvania — proposed rate increases are 5 percent or less.

“The market is starting to stabilize,” said Nate Clark, CEO of Minnesota’s marketplace. “Insurers are figuring out how to make money.”

Those surprisingly positive signs may also complicate Democratic talking points ahead of November’s elections, given their eagerness to attack Republicans for “sabotaging” the marketplaces and driving up premiums. It’s a reversal of roles from the past eight years, when Republicans pilloried Obamacare on their way to winning total control of the federal government.

Democratic pollster Celinda Lake doesn’t believe the Obamacare markets’ surprising performance will neutralize the issue as a campaign cudgel, pointing out that Democrats enjoy a huge advantage — 16 points, according to a Pew Research Center poll — over Republicans on health care issues.

“Almost every candidate we have is running on health care,” Lake said. “It’s a lot simpler than it used to be. We just basically argue that you shouldn’t be taking away health care from people.”

While Democrats continue to savage Republicans for rate hikes, they are also highlighting what many see as an existential threat to Obamacare and a potential election-year gift: the Trump administration’s argument for tossing out popular protections for pre-existing conditions in a new anti-Obamacare lawsuit.

“That’s the No. 1: the protections for pre-existing conditions,” said Sen. Claire McCaskill (D-Mo.), whose opponent, Josh Hawley, is one of 19 state attorneys general backing the lawsuit. “They couldn’t prevail in Congress, so they’re taking the activist role and trying to use the courts to do what Congress refuses to do.”

The Obamacare markets’ resiliency is also complicating the GOP’s yearslong anti-Obamacare messaging.

HHS Secretary Alex Azar, in a Wednesday gathering with reporters, touted steps the agency has taken to stabilize the law, taking credit for Obamacare premiums that have so far come in lower than anticipated. Yet he also emphasized that HHS still views the law as fatally flawed.

“I don’t want to overpromise here,” Azar said. “The Affordable Care Act is sabotaging itself by its own structure.”

Republicans in Congress are still adapting to the more stable landscape, after years of warning that Obamacare was on the brink of failure.

Sen. Ron Johnson (R-Wis.), who last year lamented that “Obamacare continues to collapse” in his failed push for a replacement plan, told reporters this week that Obamacare is in fact a well-crafted handout for insurance companies.

“The system was never going to collapse,” he said. “Obamacare protected the insurance companies. They won either way, coming and going.”