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What executive actions did Trump take to undermine the ACA between 2017 and 2019?
Executive summary
President Trump used a mix of executive orders, agency rule changes, funding cuts and legal positions between 2017 and 2019 that critics say “sabotaged” the Affordable Care Act (ACA) — including a January 20, 2017 executive order directing agencies to undermine the law “to the maximum extent permitted by law,” cuts to outreach and navigator funding, ending cost‑sharing reduction (CSR) payments, and policies expanding short‑term plans and association health plans that skirt ACA standards [1] [2] [3]. Advocates and several policy trackers tie those actions to higher premiums, insurer exits and reduced enrollment; competing analysts dispute the size of the effect [4] [5] [6].
1. “First‑Day” command: an executive order to weaken the ACA
On January 20, 2017, President Trump signed an executive order instructing federal agencies to “take all actions consistent with law to minimize the economic and regulatory burdens of the ACA” and to “exercise all authority and discretion available” to limit the law’s implementation — language that opponents immediately characterized as a directive to undermine the law “to the maximum extent permitted by law” [2] [1]. That order set the administration’s public posture and provided administrative cover for ensuing regulatory and enforcement choices [2].
2. Pulling money and people from outreach: shorter enrollment and fewer navigators
Days after the inauguration, the Centers for Medicare & Medicaid Services (CMS) sharply reduced outreach and advertising for the 2017 open‑enrollment window and subsequently cut Navigator program funding nearly 90 percent, moves that critics say reduced enrollment and discouraged consumers from using exchanges [1] [7]. Democracy Forward’s later lawsuit and advocacy groups cite the cuts and shortened enrollment periods as central to claims that the administration intentionally impeded access to marketplace coverage [8] [7].
3. Stopping CSR payments and the resulting market disruption
The administration halted cost‑sharing reduction (CSR) payments to insurers — payments Congress had previously authorized to lower out‑of‑pocket costs for low‑income enrollees — which insurers responded to by “silver‑loading” premiums and shifting costs, contributing to premium instability and insurer rate increases in 2017–2018, according to policy trackers [9] [2]. Observers linked those moves to higher premiums for many enrollees and to insurers’ warnings in rate filings that uncertainty raised costs [4] [2].
4. Regulatory changes to broaden non‑ACA plans (short‑term and association plans)
The administration issued rules expanding the availability of short‑term limited‑duration plans and loosening standards for association health plans, products critics label “junk” insurance because they exempt providers from core ACA protections; these alternatives attracted healthier enrollees and risked raising premiums in ACA markets by skimming favorable risk [3] [10]. Brookings and other analysts highlight these expansions as deliberate policy levers that weakened the comprehensiveness of coverage options under the ACA [6] [3].
5. Legal strategy: backing challenges to the ACA and arguing to strike key protections
Beyond agency action, the Justice Department in Trump’s administration adopted legal positions arguing the ACA’s individual mandate becoming unenforceable after tax‑law changes rendered the penalty zero — a stance that led DOJ to ask courts to invalidate key insurance protections (guaranteed issue and community rating) in litigation such as Texas v. United States [9]. Advocates say this legal posture was a parallel track to administrative changes designed to destabilize the law [9] [3].
6. Quantifying the impact: disputed but observable market effects
Multiple policy groups assert that the combination of these actions raised premiums and reduced enrollment: the Center on Budget and Policy Priorities, Center for American Progress and others estimated measurable increases in premiums and market instability tied to Trump policies, and some sources cite millions of people losing coverage or being underinsured during the period [2] [3] [9]. At the same time, the American Enterprise Institute and other analysts argue the net effects are overstated and point to market stabilization by 2019 — a disagreement about magnitude that underscores the contested interpretation of cause and effect [5] [4].
7. Litigation and counter‑responses: cities, states and courts push back
Cities, states and advocacy groups sued to stop what they called “sabotage,” alleging constitutional and statutory violations and seeking restoration of outreach funding and enrollment protections; some courts ruled against specific Trump regulations as unlawful and struck down portions of administrative changes [8] [11]. Meanwhile, states also enacted laws to buttress ACA protections, reflecting an ongoing federal–state policy clash [12] [11].
8. Context and limits of the record
The sources agree Trump pursued an administrative and legal strategy to weaken ACA functioning, but they differ on how much those actions alone explain enrollment and premium trends: some trace clear causal lines from policy moves [2] [3], while others emphasize market resilience and alternate explanations [5] [4]. Available sources do not quantify every causal link definitively; where they dispute effects, I have cited both perspectives so readers can weigh contested interpretations [5] [6].