Despite not officially unveiling his new health care plan, President Donald Trump is already facing significant opposition from within his own party. On Monday, the White House postponed its proposal aimed at preventing a surge in Affordable Care Act (ACA) premiums, following intense backlash from various Republican allies and lawmakers, according to sources familiar with the situation and reported by CNN.
The planned announcement generated immediate concern on Capitol Hill, where many Republicans claimed they were unaware of the proposal until details leaked to the media. The initiative drew strong criticism from conservative factions, particularly for its inclusion of an extension of crucial enhanced ACA subsidies set to expire at the end of the year. Michael Cannon, director of health policy studies at the libertarian Cato Institute, expressed dismay, stating, “What this means is the Republicans will be expanding Obamacare. It’s really disheartening.”
This swift backlash raises questions about the GOP’s ability to unite behind a cohesive plan to address health care costs, despite Trump’s repeated assurances of a better alternative to the ACA. It also highlights the challenges Congress faces in reaching a bipartisan agreement that can prevent an impending rise in consumer health expenses.
Senate Republicans have agreed to conduct a mid-December vote regarding the future of the enhanced ACA subsidies as part of a government funding agreement. However, with the Thanksgiving recess approaching, the deadline for this vote is rapidly approaching. More than 22 million Americans currently benefit from these enhanced ACA subsidies, and many would experience significant premium hikes if these tax credits expire at the year’s end. This looming crisis has brought the issue to the forefront for both Democrats and Republicans, particularly with midterm elections approaching, which are expected to be influenced by voters’ growing concerns about the cost of living.
A White House adviser noted, “The White House understands they have to do something on this, as bad as Obamacare is. This feeds into the whole affordability issue.”
The tentative package developed by the administration in recent weeks aimed to balance a temporary extension of the ACA subsidies with a series of conservative reforms. According to circulated details, the plan proposed continuing the enhanced subsidies for two years but included new limitations, such as a new income cap and a requirement for all enrollees to make a minimum monthly premium payment. Furthermore, the proposal sought to encourage enrollees to select lower-tier ACA plans by allowing them to redirect some federal aid into a health savings account, aligning with Trump’s preference for providing more direct financial assistance to individuals rather than through insurers.
Additionally, the framework included various conservative priorities, such as enhancing the availability of plans outside the ACA exchanges and instituting restrictions on the use of federal funds for gender-affirming care and health care for undocumented immigrants.
However, these initial details did not resonate well with many Republican lawmakers, who felt blindsided by the administration’s proposal, learning about it through social media rather than official channels. In the House, where the term "Obamacare" remains politically contentious, skepticism abounded regarding the proposal, which left many key questions unanswered. There is little expectation that a plan offering two more years of subsidies, even with stricter income caps, will gain traction among House Republicans, as many alternative health care proposals currently under consideration do not include an extension of these subsidies.
Some conservatives perceived the framework as a significant departure from the principles previously articulated by the White House, particularly following Trump’s suggestion that any funding be directed to Americans purchasing coverage. A former senior administration official remarked, “Not very Trumpian,” regarding the plan.
A White House official contended that the administration had not finalized any health care plan, suggesting that any reports on the administration’s health care positions are speculative until Trump makes an official announcement. White House press secretary Karoline Leavitt also refrained from providing a timeline, stating that Trump is “very focused on unveiling a health care proposal that will fix the system and bring down costs for consumers.”
Nevertheless, this tumultuous episode underscores the substantial obstacles the White House faces in crafting a proposal that can garner the support of a majority of Republicans, let alone the Democratic backing necessary for legislative passage before the year concludes. A few deal-minded Democrats, including Senators Jeanne Shaheen, Maggie Hassan, and Jacky Rosen, have offered cautious praise for the framework, hinting at the possibility of bipartisan cooperation. However, the overall response from congressional Democrats has been overwhelmingly negative, favoring a straightforward extension of the ACA subsidies instead.
Within Trump’s circle, some allies have pointed to the evident divisions within the Republican Party as indicative of the formidable challenge in crafting a successful health care plan. Before Monday’s events, doubts were already surfacing about whether the administration could develop a package that would appeal to both Republican lawmakers and voters. Cannon noted that the ongoing debate over health care has become increasingly complicated, suggesting that attempting to overhaul the ACA may no longer be worthwhile.
Despite the challenges, Trump remains determined to achieve a comprehensive health care deal that has eluded him for years. With voter anxiety over affordability and skepticism towards the administration’s agenda on the rise, advisers emphasize the necessity of pursuing a new plan. “If we can come up with something that actually gives people more choices and makes health care more affordable, that’ll be a powerful message headed into the midterms,” the adviser remarked.