The decision to end the payments, worth an estimated $7 billion this year, marks President Donald Trump's most aggressive move yet to dismantle Obamacare. | Brendan Smialowski/AFP/Getty Images Trump will scrap critical Obamacare subsidies Cutting off the payments to insurers, which could happen almost immediately, is likely to provide another jolt to Obamacare markets. 
 
 President Donald Trump plans to cut off subsidy payments to insurers selling Obamacare coverage in his most aggressive move yet to undermine his predecessor's health care law. 
 
 The subsidies, which are worth an estimated $7 billion this year and are paid out in monthly installments, may stop almost immediately, since Congress hasn’t appropriated funding for the program. 
 
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 The decision — which leaked out only hours after Trump signed an executive order calling for new regulations to encourage cheap, loosely regulated health plans — delivered a double whammy to Obamacare after months of failed GOP efforts to repeal the law. With open enrollment for the 2018 plan year set to launch in two weeks, the moves seem aimed at dismantling the law through executive actions. 
 
 Press secretary Sarah Huckabee Sanders confirmed the decision in a statement emailed to reporters Thursday night. 
 
 “Based on guidance from the Department of Justice, the Department of Health and Human Services has concluded that there is no appropriation for cost-sharing reduction payments to insurance companies under Obamacare,” she said. “In light of this analysis, the Government cannot lawfully make the cost-sharing reduction payments. … The bailout of insurance companies through these unlawful payments is yet another example of how the previous administration abused taxpayer dollars and skirted the law to prop up a broken system.” 
 
 Trump's move to scrap the subsidy payments, which was first reported by POLITICO, is likely to jolt already fragile Obamacare markets — although the impact might be less severe than it would have been a few months back. 
 
 “Certainly problematic markets are going to become more unstable," said Greg Scott, who oversees Deloitte’s health plans consulting practice. 
 
 Adding to the uncertainty, Trump on Friday morning appeared to express hope that his decision to cut off the subsidies would help him cut a legislative deal, possibly with Democrats. "The Democrats ObamaCare is imploding. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!" Trump tweeted. 
 
 The president has made overtures in the past to Democrats on health care, tweeting last Saturday that he had talked with Senate Minority Leader Chuck Schumer about potential negotiations. But Schumer separately said Trump had suggested another Obamacare repeal-and-replace effort, which the New York Democrat said was a nonstarter. 
 
 On Thursday night, Schumer (D-N.Y.) and House Minority Leader Nancy Pelosi (D-Calif.) issued a joint statement calling Trump's latest move "sabotage." 
 
 “It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America," they said in a joint statement. "Make no mistake about it, Trump will try to blame the Affordable Care Act, but this will fall on his back and he will pay the price for it." 
 
 But many insurers had priced next year's plans higher than they otherwise would have, fearing this outcome after months of threats from the White House. Others have already fled the Obamacare markets, which are set to begin open enrollment in Nov. 1 for the 2018 plan year. 
 
 “What it adds up to me is a gross dereliction of duty,” John Baackes, CEO of L.A. Care Health plan, said of the decision. “The Affordable Care Act is still the law of the land and the cost-reduction subsidies are part of that. … Even if there’s a lawsuit about it, it should still be honored until the last appeal is exhausted. I thought they took oaths to uphold the law of the land. They’re just flaunting it now.” 
 
 Trump has threatened for months to cut off the payments, deriding them as a “bailout” for insurers. California, the country’s most successful Obamacare marketplace, added a 12.5 percent surcharge this week on silver plans as a hedge against the possibility the subsidies would be pulled. By loading them on silver plans, taxpayers will pick up the cost. 
 
 While Republican lawmakers complained the subsidies were never properly appropriated by Congress, many were wary of ending them suddenly. 
 
 Failed Obamacare repeal packages considered by the House and Senate included near-term funding for the program, which had been paid out through the executive branch each month. 
 
 Attorney General Jeff Sessions said Friday on Fox News that the subsidies were not on solid legal ground to begin with because Congress did not appropriate them. He said it's up to Congress to step in. 
 
 "It's time for Congress to fix this bill. That's what needs to happen. Congress has got to get together," Sessions said. "Republicans and the Democrats, they've got to come on board and they've got to develop a plan that will actually work. It can not continue in this fashion. It's in a death spiral it seems to me." 
 
 In the near term, the announcement is expected to put more pressure on a bipartisan effort in the Senate's health committee to preserve the subsidies to shore up Obamacare marketplaces. 
 
 “While I’m sure initial reactions will be negative, this might be the spark Congress needs to act on this issue," said an insurance lobbyist who declined to be named. "There was no pressure before … That might actually be the silver lining.” 
 
 As the White House reached out to lawmakers to inform them of its decision Thursday night, even some Republican lawmakers expressed consternation. 
 
 "Cutting health care subsidies will mean more uninsured in my district," tweeted Rep. Ileana Ros-Lehtinen, a Florida Republican late Thursday. "@potus promised more access, affordable coverage. This does opposite." 
 
 New York Attorney General Eric Schneiderman, who led a group of Democratic attorneys general to defend the subsidies in court this past spring, said they would sue to stop the administration from acting. 
 
 "I will not allow President Trump to once again use New York families as political pawns in his dangerous, partisan campaign to eviscerate the Affordable Care Act at any cost," he said in a prepared statement. 
 
 Some insurers are also likely to sue the Trump administration over the failure to make payments that they believe they’re entitled to under the Affordable Care Act. 
 
 Insurers will have the option to try to adjust their rates or pull out of the markets immediately when the subsidy payments end. That's because the contracts insurance companies signed to offer Obamacare plans have an "out" if the payments stop. 
 
 But it’s far from certain whether insurers would try to leave markets. They would have to go through an extensive back-and-forth with state regulators on changes, a process that could be lengthy and could vary by state. 
 
 Trump has argued that Democrats will take the blame if the markets implode, but polling strongly suggests the public will point the finger at Republicans for Obamacare problems under Trump's watch. 
 
 Dan Diamond, Jennifer Haberkorn, Renuka Rayasam and Victoria Colliver contributed to this report. ||||| Breaking News Emails Get breaking news alerts and special reports. The news and stories that matter, delivered weekday mornings. 
 
 / Updated By Benjy Sarlin 
 
 WASHINGTON — Health care premiums will spike, insurers will exit the market, and deficits will increase if President Donald Trump follows through on his threats to cut off government payments to insurance companies, according to a new Congressional Budget Office report. 
 
 The cost of a “silver” insurance plan under Obamacare would be 20 percent higher in 2018 and 25 percent higher by 2020 compared to current law, according to the report. About five percent of the population would not be able to buy insurance through Obamacare at all next year, the CBO predicted, because companies would withdraw plans in response to the “substantial uncertainty” created by the move. The markets would stabilize in future years, however, as insurers adjusted to the new policy. 
 
 Trump has said for months he is considering cutting off the cost-sharing reduction payments, which reimburse insurers for lowering out-of-pocket costs for customers, in order to increase pressure on lawmakers to repeal and replace Obamacare. The CBO analysis was requested by House Democratic leaders. 
 
 While the president has decried the payments as a “bailout” for insurers, the CBO projected that ending them would cost the government $194 billion more over the next decade. This is because Obamacare’s subsidies are pegged to the cost of a silver plan in an area, meaning people who are eligible for federal help would be insulated from the premium hike. In fact, the CBO predicted the change would slightly increase the number of people with insurance, since some customers buying cheaper bronze plans would benefit from the higher subsidies. 
 
 The payments are the subject of an ongoing lawsuit by House Republican, who argue the law did not explicitly authorize the Obama administration to make the payments. Trump could decide to drop the White House’s defense of the law, although he’d face a challenge from a coalition of Democratic state attorneys general who have sought to uphold the payments. 
 
 Insurers have warned for months that cutting off the cost-sharing reduction payments would prompt them to raise premiums or stop offering plans entirely on Obamacare’s state exchanges. In some states, companies have submitted two preliminary rates for their 2018 plans — one in which the CSR payments continue, and a higher one if they’re cut off. Insurers must make a final decision on whether to participate in the 2018 markets next month. 
 
 Obamacare’s exchanges are still fragile: Many insurers raised premiums and pulled out of some markets last year after finding the customers who signed up tended to be sicker and more expensive than they hoped. That left large numbers of people with fewer choices than they would like, including about one-fifth of customers who have only one insurer on the individual market in their area, according to the Kaiser Family Foundation. 
 
 But reports this year suggest insurance profits are up and markets are stabilizing. The biggest threat at the moment appears to be uncertainty over the law’s future -- not just over the cost-sharing payments, but whether Congress will pass a broader replacement, and whether the White House will try to make the law’s various elements work or “let Obamacare fail,” as Trump has threatened. 
 
 Republicans in Washington are wary of Trump’s threats to cut off CSR payments. Some Senate and House Republicans have even proposed joining with Democrats to fund them if they can’t reach a deal on repealing and replacing Obamacare. ||||| Sen. John McCain John Sidney McCainFive Takeaways from West Virginia's Senate debate Trump's Russia ambassador Jon Huntsman reveals cancer diagnosis Scarborough rips Graham for saying he’ll introduce legislation to end birthright citizenship: He’s ‘degrading’ himself for Trump MORE’s (R-Ariz.) announcement that he will oppose the latest GOP ObamaCare repeal bill has left both parties wondering about the health care law’s future. 
 
 Some Republicans are still pushing for repeal, given the tiny chance that they could still scrounge up enough votes before Sept. 30, the deadline for using budgetary rules that prevent a filibuster on the measure. 
 
 Vice President Pence said Friday that he and President Trump are “undeterred” in their effort to repeal the law, while Democrats say that they are on guard and will keep up the pressure. 
 
 But it seems more likely that the debate could be moving into a new stage. 
 
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 Democrats are pushing for bipartisan talks in the Senate Health Committee, which Republicans shut down earlier this week. 
 
 McCain cited those talks in opposing the new bill, and Trump has given more nods toward working with Democrats in recent weeks. The president also wants to turn to tax reform, which is taking up an increasing amount of his workload. 
 
 A key issue in the bipartisan talks would be addressing payments known as cost-sharing reductions that help insurers provide coverage to low- and middle-income people. 
 
 Trump has threatened to cancel those payments in an effort to make ObamaCare “implode.” And he still could. 
 
 The bipartisan Senate talks were aimed at providing congressional approval for those funds to cement their legality and prevent Trump from canceling them. Insurers say that step would be critical in giving them certainty and preventing premium increases. 
 
 Sen. Lamar Alexander Andrew (Lamar) Lamar AlexanderOvernight Health Care — Presented by Purdue Pharma — Judge urges insurers to drop challenge over non-ObamaCare plans | Azar vows to push ahead with drug pricing proposal | No increase for ObamaCare outreach budget Dems blast Trump rule changes on ObamaCare Overnight Health Care — Presented by the Coalition for Affordable Prescription Drugs — Senate blocks Dem measure on short-term health plans | Trump signs bill banning drug price 'gag clauses' | DOJ approves Aetna-CVS merger | Juul ramps up lobbying MORE (R-Tenn.), chairman of the Health Committee and the lead Republican negotiator, has not yet commented after McCain’s announcement. 
 
 It is highly unlikely that an end to the ObamaCare repeal effort would usher in an era of bipartisanship on health care. 
 
 House conservatives and liberal Democrats in the House and Senate have very different ideas on how to move forward on health care, something underlined by a CNN debate scheduled for Monday. Its participants include Sen. Bernie Sanders Bernard (Bernie) SandersFive Takeaways from West Virginia's Senate debate Election Countdown: 5 days to midterms | Steve King faces his toughest test | Oprah stumps for Abrams in Georgia | Trump stokes controversy with immigration ad | Dems keep focus on health care | Polls show West Virginia, Indiana Senate races tightening Former Maryland Governor predicts gubernatorial race will narrow MORE (I-Vt.), whose single-payer system is gaining steam with Democrats, and the authors of the latest GOP ObamaCare repeal bill, Sens. Bill Cassidy William (Bill) Morgan CassidyDyslexia is more common than society realizes. Here’s what we can do to help children struggling in the shadows. Congress must protect eye care patients from frightful prescriptions Trump signs bills banning drug pricing 'gag clauses' MORE (La.) and Lindsey Graham Lindsey Olin GrahamThe birthright citizenship debate explained GOP Senate candidates dodge on Trump's plan to end birthright citizenship Kobach: 'Misimpression' that 14th Amendment guarantees birthright citizenship MORE (S.C.). 
 
 Without any bipartisan action or a final long-shot repeal attempt, ObamaCare, which has extended coverage to roughly 20 million people, will remain on the books. 
 
 Despite worries that there would be counties next year without any insurance options, insurers have stepped in to fill every area. Standard & Poors found in July that ObamaCare markets are “stabilizing.” 
 
 Democrats believe there are plenty of risks to the law, however, as long as Trump is in the White House. 
 
 They accuse the president of threatening to “sabotage” the law — both with his threats on the insurer payments and a 90 percent cut to funds used to advertise and enroll people in the insurance exchanges. 
 
 Within hours of McCain’s statement on Friday, Democrats were pointing to an announcement that the administration would be taking healthcare.gov offline from 12 a.m. to 12 p.m. every Sunday during the enrollment period. 
 
 “More sabotage of our health care system,” Matt House, a spokesman for Senate Democratic Leader Chuck Schumer Charles (Chuck) Ellis SchumerMcSally accuses Arizona media of 'protecting' Dem opponent Sinema Scarborough tears into GOP candidates promising protections for pre-existing conditions: ‘They’re all lying’ Manchin wrestles with progressive backlash in West Virginia MORE (N.Y.), wrote on Twitter. 
 
 A spokesman for the Centers for Medicare and Medicaid Services said the downtime is part of regularly scheduled “maintenance outages” that happen every year. “This year is no different,” the spokesman said. 
 
 Frederick Isasi, executive director of Families USA, a leading pro-ObamaCare group, said that repeal is still a “very, very real threat for millions and millions of Americans.” 
 
 But beyond that threat, he warned: “It's a real concern that the administration is trying to sabotage the ability of Americans to get high-quality affordable coverage.” 
 
 He warned that if enrollment efforts fall off, fewer healthy people will be enrolled in ObamaCare, which will harm the long-term sustainability of the exchanges. 
 
 McCain’s opposition is a major blow to the seven-year effort to repeal the law. 
 
 It almost certainly dooms the current legislation, given opposition to the bill from Sen. Rand Paul Randal (Rand) Howard PaulOvernight Defense: Trump says 15,000 troops could deploy to border | Mattis insists deployment is not 'stunt' | Pompeo calls for Yemen peace talks in November GOP senators press Trump to halt nuclear energy talks with Saudi Arabia Tester fights for survival at home MORE (R-Ky.), and Sen. Susan Collins Susan Margaret CollinsFlake: Trump 'can't' and 'shouldn't' nix birthright citizenship Judiciary's GOP chairman says ending birthright citizenship would require rewriting Constitution Avoid temptation to seek partisan advantage from pipe bomb arrest MORE (R-Maine) said in a statement that she is leaning against it. Collins is seen as a long-shot to vote for repeal, and Republicans can only afford two defections. 
 
 It’s also possible there are other GOP senators who do not want to back the bill. 
 
 It’s of course still possible Republicans could make another effort at repeal either before or after Sept. 30. 
 
 Sen. Orrin Hatch Orrin Grant HatchOn The Money: Dow, S&P; turn negative for 2018 | Maxine Waters among Dems targeted by bomb threats | Senate Finance chair says new Trump tax cuts 'unlikely' this year Senate Finance chair: Trump's new tax cut 'highly unlikely' this year Romney on suspicious packages: 'Hate acts follow hate speech' MORE (R-Utah) has even floated the idea of pairing ObamaCare repeal with tax reform under a new budget resolution that would again allow Republicans to avoid a Democratic filibuster. 
 
 Yet such a plan would put tax reform at risk, something that seems unlikely at this stage. 
 
 Rep. Mark Meadows (R-N.C.), chairman of the conservative House Freedom Caucus, sounded a note of disappointment but did not criticize McCain after his announcement. 
 
 “Certainly today's news is not a positive sign for people yearning for lower insurance premiums but to criticize Senator McCain would be to allow my disappointment to manifest itself in a manner that won't produce a different outcome,” Meadows said. “Amendments and a floor vote should still be allowed.” 
 
 Scott Wong contributed.
– In a move that analysts say could be a devastating blow to ObamaCare, President Trump is ending one of the health care bill's crucial subsidies. White House press secretary Sarah Huckabee Sanders confirmed Thursday night that the federal government will stop "cost-sharing reduction" payments to health insurers, which help millions of people afford insurance they get through ObamaCare's exchanges, Politico reports. Sanders called the payments a "bailout of insurance companies" and "another example of how the previous administration abused taxpayer dollars and skirted the law to prop up a broken system." Related coverage: The impact: The Washington Post likens the decision to "throwing a bomb into the marketplaces" created by ObamaCare. Insurers have said this is the strongest step Trump could take to undermine the law, because rising costs would force them to bail without the promise of getting reimbursed. The alternative could be to remain, but to raise premiums to levels most couldn't afford. The New York Times also calls the subsidies "essential" to the Affordable Care Act. Trump's possible offer: "The Democrats ObamaCare is imploding," the president tweeted Friday morning. "Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!" The last part might be the most telling. The Wall Street Journal reports that Trump has told at least one lawmaker that he's open to preserving the payments if a bipartisan deal is struck on health care. All eyes on this: Trump is referring to a deal being negotiated by GOP Sen. Lamar Alexander and Democratic Sen. Patty Murray. Under the broad strokes, the subsidies would be continued, a win for Democrats, but states would get more flexibility to avoid ObamaCare rules, a win for Republicans, per the Journal. Big deadline: Open enrollment for the ObamaCare exchanges begins in less than three weeks, raising pressure for a quick resolution. Background: A federal court declared the subsidies illegal last year, though the decision is being appealed. The subsidies add up to around $7 billion this year, a figure expected to steadily rise in coming years. The attorneys general of California and New York vowed Thursday night that they would challenge the latest move in court, while Nancy Pelosi and Chuck Schumer called it "a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America." Second move: Earlier Thursday, Trump signed an executive order that's expected to undermine ObamaCare in a different way.