NOTE: I communicated with Gaba regarding the Arkansas data and have made a correction to this post. See below.

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Charles Gaba, the health insurance data guru who has consistently made accurate predictions about enrollment numbers and premium changes, has a massive new post up today about the various forms of sabotage the Trump administration has tried against the Affordable Care Act.

While GOP legislative efforts mostly failed (with the exception of the repeal of the individual mandate, which doesn’t kick in until 2019 but has likely already impacted enrollment), Trump did manage to cause some trouble for the millions of non-group private plans that must be compliant with the law. These are individual or family plans for people who buy insurance themselves because they don’t have a plan through a job or a big public program like Medicare. Through a series of regulatory schemes, threats, efforts to spook carriers, withholding promised reimbursement payments, interference with outreach and marketing, and other shenanigans, Gaba demonstrates that Trump was able to bump premium increases this year for those plans higher than they otherwise would have been.


Many Americans are entirely shielded from those increases because they are eligible for ACA subsidies. However, those who make more than 400 percent of the federal poverty level (that’s $48,500 for an individual) aren’t eligible for subsidies, and they’re the ones who end up bearing the entire cost of what Gaba calls the “Trump tax.”

It’s not clear what the policy rationale for Trump’s sabotage was, other than that he doesn’t like Obamacare and wanted to create worse outcomes. Trump was happy to harm middle-class Americans simply out of pique.


Gaba estimated that the effects of the sabotage impacts almost 6.8 million Americans to the tune of $6.5 billion. In Arkansas, the Trump bump hit more than 90,000 people*, Gaba estimates, increasing their premiums by $47 per month more than they would otherwise be, or $564 over the course of the year. Make American great again.

I’m probably one of the only people on the planet interested in the deep weeds that Gaba gets in to in his analysis (there are plenty of caveats and these are estimates about a complex system), but you can see his detailed explanation here.

* CORRECTION: Gaba originally estimated more than 300,000 Arkansans would be impacted, but that appears to be an error based upon the inclusion of more than 200,000 private option enrollees, who are on the private plans in question but have their premiums paid for by Medicaid. Under the state’s unique form of Medicaid expansion, the Medicaid program purchases private plans for eligible beneficiaries; the “Trump tax” would marginally increase the costs that the federal government and the state has to play for those plans, but wouldn’t impact those beneficiaries.