“The political implications go only as far as people understand that they are a direct consequence of the administration’s actions,” said Rep. Raul Ruiz (D-Calif.), a medical doctor who sits on a key committee that oversees health care. “If they realize that, then they will be very, very upset with them.”

In particular, Democrats blame Republicans for eliminating the mandate penalty for failing to obtain health insurance, which was designed to be a cudgel to compel people who might otherwise go uninsured to buy coverage. They also point to the Trump administration’s efforts to make it easier to buy skinnier, cheaper plans that don’t meet the Affordable Care Act’s coverage requirements and patient protections as an exacerbating factor.

“Once they fractured the mandate, that changed the insurance pool,” said Rep. Richard Neal (D-Mass.), the ranking member on the Ways and Means Committee. “Insurance is based upon shared risk, meaning fewer people contributing, the premiums escalate.”