Donald Trump spent much of his first presidential campaign and first year in office blasting “Obamacare” and promising to “repeal and replace” it with the help of the Republican-controlled Congress that followed him after he defeated former Secretary of State Hillary Clinton in 2016.
But after the late Arizona Sen. John McCain doomed the Senate’s attempt to repeal the legislation with a now-iconic “thumbs down” during an overnight vote in August 2017, the president and his allies had to settle for the consolation prize of eliminating the tax penalty imposed on Americans who failed to obtain adequate health care under the terms of the 2010 law.
Although Trump often claimed that he would roll out his own plan during the last three years of his first term — often promising to release it “within two weeks” but failing to do so — health care largely ceased to be an animating issue for him or his supporters as Obamacare became increasingly popular with the American public.
Four years later and back in the White House, Trump still hasn’t delivered on the plan he promised to deliver during his first term, but in recent weeks he has tried to explain away the current Republican Party in the House of Representatives’ refusal to address the impending expiration of expanded Covid-era subsidies by recasting the tax credits as a giveaway to insurers that could be better spent as direct cash payments to Americans.
Federal subsidies for health insurers passed under the Biden-era Inflation Reduction Act of 2022 are currently pushing monthly or annual health insurance premiums through the Affordable Care Act’s public exchanges to manageable levels for millions of Americans. But they will soon expire, raising health care costs for 20 million Americans.
The battle over whether to continue these subsidies was one of the reasons for the government shutdown earlier this year. Now this is a point of attention as the calendar turns to 2026. Despite renewed pressure and the threat of rising costs, the Republican Party and Trump cannot get on the same page on their extension. Democrats, meanwhile, are sitting on the sidelines waiting – and hoping – that Republicans can come up with their plan before costs skyrocket.
At an event in the Oval Office on Monday, Trump responded to a question about what he would like the Republican Congress to do about the looming deadline by repeating a line he rolled out several weeks ago, bringing up the idea of direct payments again.
“I want all the money to go to the people and for the people to be able to buy their own health care. It will be incredible. They will do a great job. They will get much better health care at a much lower cost,” he said.
Privately, White House officials and people in the president’s circle with whom they have spoken The independent in recent months say Trump is caught between his innate desire to make deals that will please the people and his party’s partisan animus for former President Barack Obama’s signature legislative performance.
So far, he has let Congress take the lead in what has so far been a fruitless effort to find a legislative tool that will either extend the subsidies or provide an alternative acceptable enough to gain support from frontline Republicans in swing districts who support an extension that would prevent their constituents’ premiums from skyrocketing ahead of next year’s midterm elections.
Republicans elsewhere in Washington, however, are no closer than the president. On Capitol Hill, there are no signs of a unified Republican vision for the nation’s health care system, aside from opposition to Obamacare and support for the vaguest concepts, such as “innovation.”
In the Senate, Republicans are well aware that their party is confronted with the music. Following pleas from Senator Bill Cassidy, the chairman of the House Committee on Health, his caucus met with Democrats on Monday to discuss a path forward for the long-term reforms he and conservatives want to make to the Affordable Care Act, as well as the immediate danger posed by the loss of federal premium subsidies in January.
There are no signs yet that a plan is emerging that could surpass the Senate’s 60-vote filibuster threshold, but the meeting is a sign that the party is taking the severity of the looming premium spikes seriously. Cassidy indicated over the weekend that he would support a short-term compromise bill that would extend subsidies if Democrats were willing to discuss and vote for other reforms to the Obamacare program. His bill with Sen. Mike Crapo failed to pass the filibuster threshold after being called for a vote last week alongside a Democratic-backed plan to extend the subsidies for three years.
‘I would be willing to extend the premium tax credit in the short term for people with higher premiums, if they are willing to admit that we have to do something for the $6,000 out of pocket. [deductibles]Cassidy told CBS News on Sunday. “I think there’s a deal to be made here. We must push for that deal.”
However, liberal members of the Democratic caucus were skeptical that the talks would lead to the Republican Party making significant reforms. Democratic lawmakers and staffers who spoke The independent noted that Republicans are still working on a new amendment for restrictions on health savings accounts.
Sen. Ed Markey, a Massachusetts progressive facing a primary challenge from Rep. Seth Moulton, dismissed his Republican colleagues as not serious as a party and said the GOP simply couldn’t agree on a common platform.
“The last fifteen years are very predictive in terms of their inability to put together a comprehensive Republican health care substitute and are very predictive of where they are today,” Markey said.
“They haven’t shown up in 15 years. They don’t show up today, and there’s no way I can trust them to be anything other than the hypocritical crocodile shedding – the crocodile shedding party that they’ve had in health care, which really goes back to Social Security.”
His colleague, Senator Adam Schiff, added The independent: “They’ve never had more than drafts of a health care plan, and the reality is that it’s just not a priority for them.”
Speaker Mike Johnson’s caucus in the House of Representatives is a different story. The Republican chairman is convinced that the House will not vote on expanded subsidies at all, regardless of whether the Senate passes a compromise bill or not. However, the Senate has shown a willingness to ignore Johnson’s statements, recently refusing to amend a bill aimed at forcing the release of the Jeffrey Epstein files after the leader of the House of Representatives called on the chamber to do so.
Even more than in the Senate, however, Johnson faces the likelihood that a sudden end to federal subsidies (without a solution implemented) could wipe out his members in blue-red districts next fall.
Johnson was sharply criticized Tuesday by one of those frontline members, Rep. Mike Lawler.
“It’s crazy,” Lawler, a Republican from New York, told reporters about Johnson’s refusal to allow votes on possible compromises with Democrats. “I’m angry at the American people. This is absolute bulls***.”
Overall, a congressional Republican Party that has worked with the White House all year is now rudderless. And a president who won office through political infamy, in part by capitalizing on American anger over affordability, appears completely oblivious to the urgency his allies feel in the face of a financial crisis impacting millions of voters at the start of an election year.
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