Democrats and independents in voting against it. Actions to hinder implementation Under both PPACA (current law) and the AHCA, CBO reported that the health exchange marketplaces would remain stable. However, Republican politicians took a variety of steps to undermine it, creating uncertainty that adversely impacted enrollment and insurer participation while increasing premiums. Concern of the exchanges became another argument for reforms. Past and ongoing Republican attempts to weaken the law have included: Lawsuits such as King v. Burwell and House v. Price. President Trump ended the payment of cost-sharing reduction subsidies to insurers on October 12, 2017. CBO estimated in September 2017 that discontinuing the payments would add an average of 15–20 percentage points to health insurance costs on the exchanges in 2018 while increasing the budget deficit nearly $200 billion over a decade. In response, insurers sued the government for reimbursement. Various cases are under appeal as of 2019. Several insurers and actuarial groups estimated this resulted in a 20 percentage point or more increase in premiums for the 2018 plan year. In other words, premium increases expected to be 10% or less in 2018 became 28–40% instead. The insurers would need to make up the $7 billion they had previously received in CSRs by raising premiums. Since most premiums are subsidized, the federal government would cover most of the increases. CBO also estimated that initially up to one million fewer would have health insurance coverage, although rising subsidies might eventually offset this. The 85% of enrollees who received subsidies would be unaffected. CBO expected the exchanges to remain stable (i.e., no "death spiral" before or after Trump's action) as the premiums would increase and prices would stabilize at the higher (non-CSR) level. The 2015 appropriations bill had a rider that ended the payment of risk corridor funds. This was repeated in later years. This resulted in the bankruptcy of many co-ops. This action was attributed to Senator Rubio. The cutoff generated some 50 lawsuits. The Supreme Court granted certiorari in 2019. Trump weakened the individual mandate with his first executive order, which limited enforcement of the tax. For example, tax returns without indications of health insurance ("silent returns") will still be processed, overriding Obama's instructions to reject them. Trump reduced funding for advertising for exchange enrollment by up to 90%, with other reductions to support resources used to answer questions and help people sign-up for coverage. CBO said that the reductions would reduce PPACA enrollment. Trump reduced the enrollment period for 2018 by half, to 45 days. Trump made public statements that the exchanges were unstable or in a death spiral. Implementation In 2010 small business tax credits took effect. Then Pre-Existing Condition Insurance Plan (PCIP) took effect to offer insurance to those who had been denied coverage by private insurance companies because of a pre-existing condition. By 2011, insurers had stopped marketing child-only policies in 17 states, as they sought to escape this requirement. In National Federation of Independent Business v. Sebelius the Supreme Court allowed states to opt out of the Medicaid expansion. In 2013, the Internal Revenue Service ruled that the cost of covering only the individual employee would be considered in determining whether the cost of coverage exceeded 9.5% of income. Family plans would not be considered even if the cost was above the 9.5% income threshold. In July 2 Obama delayed the employer mandate until 2015. The launch for both the state and federal exchanges was a disaster due to management and technical failings. HealthCare.gov, the website that offers insurance through the exchanges operated by the federal government, crashed on opening and suffered