With President Trump and the Republicans in Congress, it is difficult to know where the ignorance ends and the lying begins. They have openly put killing Obamacare at the center of their national agenda with Trump routinely going on tirades about how horrible it is.

While tens of millions of people still get Medicaid or subsidized insurance through the exchanges, they have largely succeeded in making individual coverage unaffordable to people with health conditions. This means that people with heart conditions, cancer survivors or others with a serious illness are unlikely to be able to afford insurance unless their income is low enough to qualify for a subsidy.

This seems to have been exactly the goal of Trump and the Republicans. The whole point of Obamacare was to make it so people with health issues can afford insurance.

The basic logic is pretty simple. Insurers are happy to insure people in good health. While anyone's health can deteriorate unexpectedly, most people in good health will stay in good health in any given year.

This means that they have handed the insurance company money for nothing. The insurer is obligated to pay most of their bills, but since they have few or no bills, the insurance company got to pocket the money.

If insurers only insure healthy people, then premiums can remain reasonably low and insurers can still make a profit. But it is a different story where the people who need insurance most are unable to afford it.

The point of the insurance mandate in the Affordable Care Act was to create a single pool where both people in good health and people with health conditions would pay the same premium. This makes insurance affordable for people in bad health, but raises the price for people in good health.

Trump and the Republicans came up with the brilliant idea of making it so that people can buy "temporary" plans outside of the exchanges that don't meet the rules required of plans in the exchanges. These temporary plans, which can be in effect for as long as three years, are not required to cover many of the conditions required for plans in the insurance exchanges.

More importantly, they are allowed to discriminate based on preexisting conditions. This means that they can tell people with heart disease, cancer survivors, multiple sclerosis and other health conditions to go away. Healthier people will be able to save money with these plans – the great Trump-Republican victory – but less healthy people are out of luck.

We are now finding out how out of luck these people are. Insurers in Maryland are requesting rate increases averaging 36 percent for 2019. Insurance companies in Washington State are requesting 19 percent rate hikes. Patients got somewhat good news in Florida where rates are only projected to rise by 5 percent in 2019, but that is after a 45 percent rate hike in 2018.

According to calculations by the AARP, the Trump changes will push the cost of an exchange plan for an older pre-Medicare age worker to more than $15,000 in several states. In the most costly states the premium will exceed $20,000 a year.

And this is only for the middling silver plans that are designed to cover 70 percent of health care costs. More comprehensive insurance would cost even more.

While more moderate-income households can still get subsidies under Obamacare that will make insurance more affordable, middle-income couples will be out of luck thanks to the "reforms" put in place by Trump and the Republicans. For example, a couple earning $65,000 a year could easily find themselves paying more than half of their after-tax income for insurance premiums. And, they could still find themselves liable for thousands of dollars in health care expenses.

Apparently Trump and the Republicans are very proud of the high health care costs that they have imposed on millions of people. We should all hope that they put these high costs at the center of their 2018 election platform.

Meanwhile, the Democrats should get serious about putting forward concrete proposals that will again get people covered. Lowering the Medicare age to 55 or 60 is a very good place to start. Also, allowing everyone to buy into a Medicare-type public plan will be another big step forward.

That would be a great issue for the election. One party that has worked aggressively to make health insurance unaffordable for the people who need it most and another party that is trying to ensure that everyone has access to health care.

- Dean Baker is a Senior Economist at the Center for Economic and Policy Research (CEPR) in Washington, DC. He is the author of Getting Back to Full Employment: A Better Bargain for Working People, among other books [http://deanbaker.net/

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Published in Truthout, September 3, 2018