The Trump administration is so concerned that the Affordable Care Act is failing that it wants the program to fail even more.

On Monday the Department of Health and Human Services released a report on insurance coverage trends for people who obtain coverage on their own rather than through employers. Although the report provided a broad overview of enrollment trends, as previous agency reports have, this brief focused much more heavily on one group: people who buy private plans without the help of federal tax credits that the Affordable Care Act has made available.

Mostly, these are people who make more than four times the poverty line , or roughly $49,000 a year for an individual or $100,000 a year for a family of four, because thats the income cutoff for the tax credits. They get their insurance through a variety of sources in some cases through HealthCare.gov or one of the state-run exchanges like Covered California and in other cases through brokers, privately run websites or directly from insurers.

Average monthly enrollment among people in this group fell by 20 percent from 2016 to 2017, HHS found . That works out to about 1.3 million fewer people buying unsubsidized private coverage. The governments findings are broadly similar to the results of a study that researchers at the Henry J. Kaiser Family Foundation , using data from the consulting firm Mark Farrah Associates , unveiled last week.

This trend toward declining coverage among unsubsidized buyers is worrisome. Its consistent with a broader story that close observers of the health care system have understood for some time namely, that the impact of the Affordable Care Act varies a lot depending on where you live and, especially, how much money you make.

A central question in health care policy right now is what to do for those people who are really struggling.

How Obamacare Works And Doesnt Work

The basic idea behind the Affordable Care Acts regulation of private coverage was to upgrade the policies available to people who buy policies on their own, to take care of people who couldnt get or afford decent coverage before. That meant prohibiting insurers from charging higher premiums or denying coverage to people with existing conditions. It also meant requiring that all policies limit out-of-pocket expenses and include 10 essential benefits , including mental health and maternity care.

These changes, though popular, have necessarily made insurance more expensive, because they mean insurers must pay medical bills they were once able to avoid. By design, the new federal tax credits offset that effect, in much the same way that people with job-based health benefits get an indirect tax subsidy through their employers.