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Donald Trump may or may not be trying to destroy Obamacare, but his sheer incompetence is doing the job regardless. Noam Levey spoke to health insurance companies about their plans for 2018:

Health insurers across the country are making plans to dramatically raise Obamacare premiums or exit marketplaces amid growing exasperation with the Trump administration’s erratic management, inconsistent guidance and seeming lack of understanding of basic healthcare issues. ….Privately, many executives, including chief executives of major health plans, offered withering criticism of the Trump administration’s lack of leadership. “It’s hard to know who’s home,” said one chief executive. “We don’t know who is making decisions.” Another chief executive said: “There seems to be no coordination or coherent planning….It’s a mess.” A third official observed: “There is a sense that there are no hands on the wheel and they are just letting the bus careen down the road.” ….The uncertainty created by Trump comes as some Obamacare markets were beginning to stabilize, according to many industry and government officials. In several states, insurers and regulators noted that 2017 was shaping up to be a better year than the first several years of the marketplaces.

In addition, Trump’s team continues to haul out the threat of killing CSR subsidies. Trump has done it twice with Democrats, and Levey reports that a Trump appointee has also done it with insurers: “At one recent meeting, Seema Verma, whom Trump picked to oversee the federal Medicare and Medicaid programs, stunned insurance industry officials by suggesting a bargain: The administration would fund the CSRs if insurers supported the House Republican bill to repeal the Affordable Care Act. ‘It made no sense,’ said one official at the meeting.”

(The Trump administration denies Verma said this. But I assume they’re lying.)

Trump is both incompetent and a terrible negotiator—and that combination is wreaking havoc with the insurance market. If Trump really does kill the CSR subsidies and stops enforcing the individual mandate, insurance prices are going to go through the roof. Ironically, that wouldn’t affect the poor too much, since their premiums are capped at a percentage of income. But for middle-class buyers, especially those over 50, it would be a disaster as premiums skyrocket.

Republicans have been claiming forever that Obamacare is failing. That’s been flatly untrue: Obamacare has its issues, but has basically been running just fine—and the Congressional Budget Office projects that it will continue to to run just fine for years. Apparently this is too much for Republicans to bear, so now that they’re in power they’re going to force it to fail. The sheer callousness and venom this displays is breathtaking.