<P> The CBO reported in August 2017 (prior to President Trump's decision) that ending the CSR payments might increase ACA premiums by 20 percentage points or more, with a resulting increase of nearly $200 billion in the budget deficit over a decade, as the premium tax credit subsidies would rise along with premium prices . CBO also estimated that initially up to one million fewer would have health insurance coverage, although more might have it in the long - run as the subsidies expand . CBO expected the exchanges to remain stable (i.e., no "death spiral" before or after Trump's action) as the premiums would increase and prices would stabilize at the higher (non-CSR) level . </P> <P> CBO estimated that of the 12 million with private insurance via the ACA exchanges in 2017, about 10 million receive premium tax credit subsidies and will be shielded from premium increases, as their after - subsidy premiums are limited as a percentage of income under the ACA . However, those 2 million who do not receive subsidies face the brunt of the 20% + premium increases, without subsidy assistance . This may adversely impact enrollment in 2018 and beyond . Another 13 million who are covered under the ACA's Medicaid expansion (in the 31 states that chose to expand coverage) should not be directly affected by Trump's action . </P> <P> President Trump's argument that the CSR payments were a "bailout" for insurance companies and therefore should be stopped, actually results in the government paying more to insurance companies ($200 B over a decade) due to increases in the premium tax credit subsidies . </P> <P> At various times during and after the ACA debate, Obama stated that "if you like your health care plan, you'll be able to keep your health care plan". However, in fall 2013 millions of Americans with individual policies received notices that their insurance plans were terminated, and several million more risked seeing their current plans cancelled . However, Poltifact cited various estimates that only about 2% of the total insured population (4 million out of 262 million) received such notices . Obama's previous unambiguous assurance that consumers' could keep their own plans became a focal point for critics, who challenged his truthfulness . On November 7, 2013, President Obama stated: "I am sorry that (people losing their plans) are finding themselves in this situation based on assurances they got from me ." Various bills were introduced in Congress to allow people to keep their plans . </P>

What is the patient protection and affordable care act