Republicans in Congress and the White House keep trying to destroy America’s health care safety nets and are exposing tens of millions of Americans to real peril.

That is the takeaway after another chaotic week in the nation’s capital, where, as the Pew Center on the States summarized in its Stateline Daily report, “So Far, All GOP Health Proposals Would Mean More Decisions, Less Money for States.”

But the specifics are much more draconian, and in some cases, namely where the White House is using executive branch authority, the damage is mounting.

On Friday, the Trump administration issued a rule to gut the birth control requirements in the Affordable Care Act, or Obamacare, which could mean hundreds of thousands of women would no longer have access to contraception free of charge.

On Thursday, the House passed a budget resolution setting spending goals for the federal fiscal year that began October 1, by proposing the age when one becomes eligible for Medicare be raised from the current 65 to 67.

Also on Thursday, the Washington Post reported the Trump administration was posed to deny a request by Iowa, a Republican-run state, to reorganize its insurance marketplace selling policies under the Affordable Care Act. Saying no to Republican states is part of its campaign to destroy the law—even if Congress couldn’t repeal it.

“The White House also has yet to commit to funding the cost-sharing reductions that help about 7 million lower-income Americans afford out-of-pocket expenses on their ACA health plans,” the Post report said. “Trump has regularly threatened to block them and, according to an administration official who was not authorized to speak publicly, officials are considering action to end the payments in November.”

The Obamacare wrecking ball doesn’t stop there. The Trump administration, through the Department of Health and Human Services, has slashed grants to states to help people sign up for Obamacare’s annual open enrollment, which is set to begin November 1.

Meanwhile, Congress has not reauthorized the Children’s Health Insurance Program for 2018, a federal-state program that covers low-income, uninsured children who live in families whose income is too high for Medicaid, the state-run anti-poverty program. CHIP covers nearly 9 million kids and 370,000 pregnant women across the country.

Obviously, health advocates are not sitting still for this.

“On a party line vote, the House just passed a budget that cuts Medicare by nearly $500 billion and Medicaid by up to $1.5 trillion, along with raising the Medicare eligibility age to 67,” said Alex Lawson, executive director of Social Security Works, which advocates for expanding that bedrock retirement program’s benefits. “Yet again, the Republican Party has betrayed the American people to give their Wall Street donors massive tax handouts.”

On another front, former top Obama administration health policy officials have launched a campaign to get people signed up for Obamacare in its open enrollment period, from November 1 through December 15, at GetAmericaCovered.com and #GetUSCovered.

“Starting on November 1, people can sign up for health care at HealthCare.gov but unlike previous years, the current administration has made clear they’re not going to provide people with the information they need to sign up for health coverage, so others must fill in the gaps,” the founding statement on Medium.com said. “The facts people need to know — and that the administration isn’t talking about — is that they must take action to sign up for coverage by December 15 for 2018 coverage and that because of financial help most people can find a plan for $50 to $100 per month.”

But the other fact that people need to know is that Trump’s intentional chaos and the House GOP’s continuing war on healthcare safety nets are causing insurers to raise their rates for 2018, the calendar year. Needless to say, in a system dominated by private insurers, the companies are making sure their profits hold and are passing costs along to the public.

The impact is unfolding differently on the Obamacare exchanges and for businesses that buy group policies for their employees.

“Several states have announced rates for health insurance premiums on the Obamacare exchanges for 2018. Topping the list is Georgia, with rates that are 57 percent higher than last year, while Florida said some premiums will be 45 percent higher,” Marketplace, the nationwide public radio program, reported Thursday. “Insurers are raising premiums in the face of repeated threats from President Trump to stop funding so-called cost-sharing reductions, payments to insurers that cover out-of-pocket costs for some low-income consumers. Trump previously referred to these payments as “bailouts” for insurance companies and threatened to stop making the payments so as to “let Obamacare implode.”

For businesses buying policies apart from the Affordable Care Act, which is where most Americans get their coverage, the next year’s premium increases are expected to rise at least 5 percent at large companies, the National Business Group on Health told the Los Angeles Times. “A separate survey by the Kaiser Family Foundation and the Health Research & Educational Trust found that premiums for employer plans rose 3 percent this year, to an average $18,764. That cost is usually divided between employers and workers.”

But the bottom line is Trump’s chaos is roiling the nation’s healthcare systems, with the most harm unfolding for people who rely on government safety nets or benefits that are required under federal law—and it looks like this is going to get worse.

“This has been the most unstable and challenged health insurance market in my tenure as a public servant,” Dave Jones, California health insurance commissioner, told the Times. “The degree of uncertainty and instability that the Trump administration has injected into the market this year cannot be overstated.”

Steven Rosenfeld covers national political issues for AlterNet, including America’s democracy and voting rights. He is the author of several books on elections and the co-author of Who Controls Our Schools: How Billionaire-Sponsored Privatization Is Destroying Democracy and the Charter School Industry (AlterNet eBook, 2016).

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