re: 18 States Sue to Challenge Loss of Subsidies

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I disagree.

Trump is putting this on Congress. He is saying "you have not authorized the funding needed to provide the subsidies to insurance companies--basically the profit guarantees to insurance companies--you want to give".

People will see ACA for what it is---a huge subsidy to insurance companies and providers.

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Lets clear this up.

The law states this:

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(3) Methods for reducing cost-sharing

(A) In general

An issuer of a qualified health plan making reductions under this subsection shall notify the Secretary of such reductions and the Secretary shall make periodic and timely payments to the issuer equal to the value of the reductions.

(B) Capitated payments

The Secretary may establish a capitated payment system to carry out the payment of cost-sharing reductions under this section. Any such system shall take into account the value of the reductions and make appropriate risk adjustments to such payments.

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LINK

The cost-sharing subsidies are administered and paid by insurers, who are after-the-fact reimbursed by the government. What Trump is doing is saying "I will not pay this bill." But since the law still requires insurers to pay and administer these cost sharing subsidies, they will have to continue to do so. Republicans have argued they had to appropriate the funding to pay this bill first, which they refused to do. So they sued the Obama administration for paying the bills. The first ruling sided with the Republicans but has been appealed and is still ongoing.

What Trump's decision does is force insurers to find ways to make up for that non-payment. Their solution has largely been to offset those costs by over-correcting with premium increases. So the net cost to the government is actually greater than if Trump just paid the cost-sharing subsidies.

The subsidies to insurers are not going away, to the contrary, they are now going to get bigger.

What is happening, is if you do not have subsidies(since all of the subsidies increase with the increased costs of premiums and out-of-pocket expenses) you are facing much higher premiums to make up for the loss of the reimbursements for the cost sharing administration. You feel the full brunt of the increases. So this is going to harm the middle income people without subsidies but stuck on the individual market the hardest.