That's what I'm calling the mandate which allowed it to have a wider risk pool. I'm not really into going back and forth about this besides the point I've already made and since I'm busy, I'll let AI and copy/paste answer it for me, but he destabilized it and undermined it in many ways.
Although former President Donald Trump and Republican-controlled Congress failed to repeal and replace the Affordable Care Act (ACA) legislatively in 2017, the Trump administration took numerous actions to weaken it. These efforts included administrative changes, regulatory rollbacks, and legal challenges intended to undermine key ACA provisions and reduce enrollment.
Executive actions and regulatory changes
Expansion of non-ACA plans: The Trump administration expanded access to short-term, limited-duration insurance plans and association health plans. These plans offered cheaper alternatives but were not required to cover essential health benefits or protect people with pre-existing conditions, which siphoned healthier people out of the ACA's risk pool and destabilized the market.
Cuts to subsidies and enforcement: An early executive order from the Trump administration directed agencies to waive, delay, or grant exemptions from ACA provisions that imposed perceived "burdens". The administration also ended payments to insurers that helped reduce cost-sharing for low-income enrollees, though some state regulators intervened to prevent a market collapse.
Reduced enrollment outreach: The administration significantly cut funding for advertising, outreach, and "navigator" programs that helped people enroll in ACA coverage. This reduced awareness of deadlines and enrollment assistance, contributing to lower sign-ups.
Shorter enrollment periods: The open enrollment period on the federal HealthCare.gov marketplace was shortened from the standard 90 days to 45 days in 2017.
Relaxed state waiver requirements: The administration gave states more flexibility to alter their ACA requirements through waivers. Some states were encouraged to implement new rules that made it harder to enroll in Medicaid, such as work requirements and premiums for low-income individuals.
Congressional and judicial efforts
Removal of the individual mandate penalty: The 2017 Tax Cuts and Jobs Act eliminated the tax penalty for not having health insurance. This was seen as a key step in undermining the ACA, which was initially structured to have a broad risk pool of both healthy and sick individuals.
Support for legal challenges: The Trump administration backed a multi-state lawsuit, California v. Texas, that challenged the constitutionality of the entire ACA. In 2021, the Supreme Court ultimately dismissed the case, preserving the law.
Outcomes of these actions
While Trump's actions did not eliminate the ACA entirely, they did weaken some of its key pillars and reversed some of its coverage gains:
Rise in uninsured rates: The number of uninsured Americans began to increase under the Trump administration, reversing a trend of coverage gains under the ACA.
Higher premiums in some areas: The expansion of cheaper, non-compliant plans pulled healthier people out of the ACA marketplaces, causing premiums to rise for many who remained, particularly those without subsidies.
Uncertainty and destabilization: The ongoing attempts at repeal and the administrative sabotage created an environment of uncertainty that destabilized individual insurance markets in some states.
It was literally his first executive order:
On January 20, just hours after his swearing in ceremony, President Donald Trump issued his first executive order. The order directs his agencies to “waive, defer, or grant exemptions to any provision of the ACA [Affordable Care Act] to the maximum extent permitted by law.” Though the order does not contain specific or detailed instructions about which provisions of the law should be addressed, it is a strong statement against the law that remained highlighted throughout the presidential campaign. The executive order directs and authorizes agencies to roll back regulations, cease to enforce provisions, and otherwise nullify provisions set through the regulatory, rather than the legislative, process.
www.ancor.org