It’s quite simple, create enough adverse selection that a death spiral is created…it’s already started as 2027 is looking at large premium increases again.
The ACA included barring insurers from denying coverage or hiking premiums for people with pre-existing conditions, elimination of annual and lifetime coverage maximums and making it compulsory for all health plans to offer dependent coverage allowing young adults to stay on their parent’s plan until they reach age 26.
Those provisions, while benefiting individuals, drive higher premiums to cover the high risk.
Now, initiated in part by eliminating the higher COVID era subsidies, premiums paid by individuals are rising sharply.
Higher premiums encourage healthier individuals unlikely to use expensive healthcare to drop coverage. The result is the enrolled population is more likely to use health care thereby driving higher premiums to cover those costs and the trend compounds each year driving higher premiums for individuals and higher subsidy payments by government under the original rules because of higher premiums.
The subsidy is the gap between the benchmark premium and your required contribution. That required contribution is set on a sliding scale tied to income, so the subsidy itself changes as premiums change.
Nobody gets richer from these higher premiums, insurance companies still must meet legal requirements for spending those premiums on policyholders.
QUINNSCOMMENTARY 
Yes, please read the report.
https://aspe.hhs.gov/reports/aca-exchange-enrollment-2026
While you can quibble with their characterization of enrollment in public exchange coverage as “… improper, phantom and fraudulent enrollment peaked at 5.6 million people in 2025″… clearly, some people were not entitled to the coverage due to waste fraud and abuse.
Again, the goal should be to take actions that lessen the number enrolled in taxpayer subsidized Medicaid and exchange coverage.
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Waste, fraud and abuse is a propaganda phrase to excuse cutting programs. Some is real, of course, but not to extent implied. Trump even says SS can be solvent if the fraud is eliminated. Best i can find is it comprises 1-2% of federal spend and most not by beneficiaries of the programs.
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The goal should be to REDUCE the number enrolled in Medicaid and taxpayer-subsidized exchange coverage …. still almost double the number in 2020 pre-COVID.
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Just a total misrepresentation!
Here are the marketplace open enrollment data since the start:
2014 8.0MM
2015 11.7MM
2016 12.7
2017 12.2
2018 11.7
2019 11.4
2020 11.4
2021 12.0
2022 14.5
2023 16.3
2024 21.4
2025 24.3
2026 23.1MM
The COVID subsidies that lapsed on 12/31/25, similar to the original Health Reform legislation, were adopted by Democrats, when there was a Democratic House, Senate and Presidency – with no, REPEAT NO Republican votes.
So, the decision to add COVID subsidies, which were never necessary (as COVID was already in our rear view mirror for the 2022, 2023, 2024, 2025 subsidies signed into law by President Biden in 2021 legislation, and the decision to stop COVID subsidies were only the result of Democratic actions.
Trump had NOTHING to do with it.
And, as you can see, in 2026, we still have almost twice as many people in the marketplace coverage options as we did prior to COVID!
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I think you miss the point. It’s that eliminating the extra subsidies naturally makes coverage less desirable for those who need it less and that those who need and use most keep it thus leading to adverse selection which as you know will drive up premiums.
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I’m confident you miss the point.
Trump had nothing to do with the original Health Reform (and the specific subsidies for exchange coverage), nor did any Republican vote for PPACA. That was President Obama and Democrats.
Trump had nothing to do with extending and increasing the subsidies for exchange coverage for years 2022, 2023, 2024, and 2025. Those subsidies were never needed as we had the vaccine and COVID was all but in the rear view mirror. And again, no Republican voted for that legislation, either, legislation that was signed into law by President Biden.
Just as important, 2026 enrollment is still almost double that in place prior to COVID.
Is your goal to have MORE THAN TWICE as many people on taxpayer subsidized exchange health care coverage as would be the situation under the original PPACA legislation? Sure sounds like it. Shouldn’t our goal be to REDUCE the number of Americans who need taxpayer subsidized coverage?
Bottom line, the majority of the extra dollop of subsidies went to people who could afford to buy exchange coverage – supposedly subsidized by working individuals with their own employer-sponsored health care coverage … working people where half had a median income of lesss than $70,000.
In fact, the idiot asses Obama and Biden, in large part due to Health Reform and the added dollop of subsidies, have added $29+ Trillion to our national debt since 3/23/10 – deficit spending which sent the bill to generations of Americans too young to vote and generations yet unborn.
I don’t have grandchildren, so, none of my descendants will be called upon to pick up the bill from Health Reform’s deficit spending. However, I will never understand why anyone who does have grandchildren would put this millstone of debt around their necks.
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Ok, never thought differently, but what has that to do with what is happening now?
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According to federal data released by the Department of Health and Human Services (HHS) and analysed by healthcare researchers like KFF, monthly effectuated enrollment fell from a high of over 22 million in 2025 down to approximately 19.2 million in February 2026—a drop of nearly 3 million people (roughly 12% to 13%).
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