Tracking the Trump administration’s steps to undermine the ACA

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at She welcomes questions and suggestions on health reform resources and tip sheets at Follow her on Facebook.

Photo: Ted Eytan via FlickrA 2017 rally in front of the White House in support of the ACA.

Can’t keep track of all the ways the Trump administration has weakened (many Democrats would say “sabotaged”) the Affordable Care Act?

Here are 14 (and counting) instances, according to a useful graphic from Haeyoun Park and Margot Sanger-Katz of the New York Times’ Upshot.

The most recent is the July 10 announcement slashing funding for ACA enrollment outreach workers, also known as navigators.

The first was at the very start of the Trump administration in January 2017, when officials took down consumer sign-up information from the ACA enrollment website.

The NYT’s feature is chronological, but it also can be useful to think about the measures as either enrollment-related or market-related.


  • Create Association Health Plans for small businesses that don’t have to comply with Obama coverage rules or patient protection. Also allowed short-term plans (sometimes called short duration plans) that don’t comply with the ACA rules.
  • Repeal the penalty for the individual mandate.
  • Make premium subsidies (slightly) less generous.


  • Suspension of the risk adjustment program that transfers dollars among insurers to help compensate those with disproportionately sick and expensive patients. (This does not involve tax dollars, just industry dollars)
  • Stop paying cost-sharing subsidies that help low-income people with out-of-pocket health expenses. (Many states did workarounds.)


  • Slashed navigator funding (in both 2017 and 2018) and cut advertising and promotion spending.
  • Stopped federal health official from participating in public events to promote enrollment, and instead created posted anti-ACA videos, tweets and other negative information.
  • Shut down for half of every Sunday during open enrollment.

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