President Donald Trump has been telling us all along that he believes his best course politically is to do what he can to ensure that Obamacare breaks. What you may not have noticed is that hes actually been executing that plan.

The Affordable Care Act has had its share of problems, some them serious like health insurance premiums that middle-class families cant afford, and swaths of the country with little to no competition among insurers.

Since the beginning of the year, the actions of Trump and his team have exacerbated those problems. And unless they start doing something different, much of what some consumers dont like about Obamacare is going to be even worse next year.

Premiums will be higher than they would have been. Fewer insurance companies will sell policies to people who buy their coverage directly or through an exchange like HealthCare.gov (as opposed to people who get health benefits at work or from a government program like Medicare or Medicaid).

We could see less progress in covering the uninsured, or possibly even some areas of the country could see increases in the uninsured rate with people being priced out, said Cynthia Cox, an associate director at the Henry J. Kaiser Family Foundation.

And this is only tangentially related to the push from Trump and the Republican-led Congress to repeal the Affordable Care Act and replace it with a new bill that would cover millions fewer Americans, weaken protections for people with pre-existing conditions and severely cut back on aid for low-income households.

When Trump became president, he took stewardship of the federal government and all the programs it runs. When it came to the Affordable Care Act a law the GOP has vowed to kill for over seven years Trump faced a choice: Manage it as best as he could while Congress debated what would come after it, or deliberately mismanage it. He has chosen the latter.

This all fits a pattern dating back to the ACAs enactment in 2010.

Republicans in 19 states have refused to expand Medicaid, leaving millions uninsured. GOP-led states put roadblocks in front of insurance enrollment counselors tasked with assisting people shopping for coverage. The Republican Congress cut funding for insurance companies that greatly contributed to their financial difficulties with the exchanges, and to the closure of many nonprofit co-op insurers created under the law. And Republicans have led or championed a slew of legal challenges to the law, including two cases that went to the Supreme Court and a cost-sharing lawsuit still causing uncertainty.

Rather than take steps to mitigate premium increases and insurers exiting the exchanges, Trump and the GOP have cheered them along . Rather than reassure insurance companies that the federal government will honor its agreements with them, Trump is going out of his way to make them believe it wont . Rather than consider the millions of people who rely on this coverage, Trump declares Obamacare dead and washes his hands of it.

Governors , state insurance regulators , insurance companies, health care providers and the business community are pleading with the Trump administration (and Congress) to provide some clarity about whats going to happen next year. They arent getting it. State insurance commissioners and companies are saying they dont even know who to talk to, and cant get straight answers from anyone in the administration.

Health insurance companies have already started hitting deadlines with state governments to state their intentions for next year about whether theyll participate in these markets and how much theyll charge .

More deadlines are looming in the coming weeks with state and federal regulators. Unless Trump changes course, its looking more and more likely that everyone will assume the worst, and either abandon the health insurance exchanges or jack up prices even more to protect themselves.