WASHINGTON -- President Donald Trump's move late Thursday to cut off critical federal payments to health insurers sent shock waves through the health care system Friday, threatening widespread disruption to markets nationwide and igniting new legal and political battles over the Affordable Care Act.
Caught in the middle are millions of Americans likely to see their insurance premiums shoot higher as the administration intensifies its effort to dismantle the 2010 health care law, often called Obamacare.
Insurers have said that markets in some parts of the country could collapse, leaving many consumers who don't get insurance on the job with no choices for health plans. And state insurance regulators predicted premiums in the individual market nationally would rise by 12 percent to 15 percent next year because of the cutoff.
"These kinds of decisions have real-life consequences," warned Stacey E. Stewart, president of the March of Dimes. "It is not fair for our leaders to play games with people's health and their health care."
The move to cut off the money, known as cost-sharing reduction payments, came after months of indecision by the administration on the issue.
It marked a sharp shift by Trump to a hard-line approach on health care after a brief period in which the administration had sent mixed signals on whether it might cooperate with bipartisan efforts in Congress to strengthen the Obamacare markets, rather than upend them.
The money at issue is roughly $7 billion in annual payments that the federal government makes to insurers to reimburse them for reducing deductibles and copayments for low-income consumers, something the law requires health plans to do.
Trump's decision to end those payments paralleled a similar shift this week to embrace a more hard-line position on immigration, with the president demanding that Congress restrict legal immigration and build a wall along the Southern border in exchange for White House support for legalizing the status of the so-called Dreamers, young people who came to the U.S. illegally as children.
In both cases, Trump took more conservative positions supported by many of his core voters.
But both steps also threatened to blow up bipartisan talks in Congress and to severely disrupt the lives of ordinary Americans -- some 700,000 Dreamers and millions of health plan consumers -- as a way of putting pressure on lawmakers.