“Real change begins with immediately repealing and replacing the disaster known as Obamacare,” Donald Trump said during one of his final campaign rallies of the 2016 race. “We’re going to repeal it. We’re going to have a really great plan that’s going to cost much less and be much better.” While Trump has kept few of his campaign promises, this one is coming half-true—if not necessarily the way Republicans had planned. Congress failed to repeal the Affordable Care Act, but Trump has attacked the law in subtler, nonetheless devastating ways. For many Americans, Obamacare has effectively ceased to exist.

“Across the country, the details vary but the story is the same. The Trump administration has been rolling back sections of the Obama-era health law piece by piece,” The Wall Street Journal reported on Wednesday. “The result is that the country is increasingly returning to a pre-ACA landscape, where the coverage you get, especially for people without employer-provided insurance, is largely determined by where you live.”

As for a “really great plan that’s going to cost much less,” Trump has been less successful. Last month, he rolled out a rule allowing small businesses to band together to provide cheaper health care to employees—without all of Obamacare’s coverage protections. But on Thursday, Politico reported that the National Federation of Independent Business, a business group that has advocated for so-called association health plans for two decades, won’t be creating such a plan because Trump’s rule is unworkable. Other trade groups are reportedly tepid, too.

In short, the health care system in America, after modest improvements under Obama, is becoming a chaotic mess under Trump—and his political opponents are poised to capitalize on it.

On Thursday morning, 70 Democrats in the House of Representatives launched a Medicare for All caucus. The roll includes a few expected names—Representative Keith Ellison of Minnesota—but also more recent converts to the cause, proving the policy no longer belongs to the fringe. In 2017, 122 House Democrats co-sponsored Representative John Conyers’s Medicare for All bill before he resigned amid a sexual harassment scandal. As Trump’s attacks on the ACA increase, so has Democratic support for a sweeping alternative.