As House and Senate lawmakers try to find a cure for rising healthcare costs ahead of the December 31 expiration of more generous Affordable Care Act subsidies, President Trump on Tuesday said he won’t support extending those tax credits.
“THE ONLY HEALTHCARE I WILL SUPPORT OR APPROVE IS SENDING THE MONEY DIRECTLY BACK TO THE PEOPLE, WITH NOTHING GOING TO THE BIG, FAT, RICH INSURANCE COMPANIES, WHO HAVE MADE $TRILLIONS, AND RIPPED OFF AMERICA LONG ENOUGH,” Trump wrote on his social media platform.
Trump again touted a vague plan to allow Americans to “negotiate and buy” their own insurance. “Congress, do not waste your time and energy on anything else,” he wrote. “This is the only way to have great Healthcare in America!!! GET IT DONE, NOW.”
Trump’s comments come as House Republicans are launching into discussions about how they want to address healthcare costs, with party leaders reportedly slamming the expiring tax credits in an initial conference-wide conversation that reportedly took place on Tuesday.
A recent poll found that 74% of Americans want the subsidies renewed, but Republicans are divided, with moderates willing to extend the subsidies, perhaps with tighter income caps or other restrictions, and conservatives dead set against them and more interested in a broader healthcare overhaul — one that could potentially send Obamacare into a death spiral.
“Conservatives in the House Freedom Caucus and Republican Study Committee, for instance, have excoriated the enhanced premium tax credits as hand-outs for insurance companies,” Politico’s Benjamin Guggenheim noted. “At the same time, leadership and the committee chairs also have to reckon with a vocal group of GOP moderates who see an extension of the Obamacare subsidies as central to their political survival in next year’s midterms.”
Finding broad agreement within the conference may be difficult — and doing so quickly enough to prevent some 24 million Americans from facing a huge spike in premium costs could be even more challenging.
Senate Republicans are further ahead in laying out policy proposals, such as a plan from Sen. Bill Cassidy to directly fund individual health savings accounts, though it’s not yet clear whether they can coalesce around a specific plan with the support of the White House — or whether they can avoid the political pitfalls and intraparty differences that bedeviled them for years as they sought to “repeal and replace” the Affordable Care Act.
It's also not clear whether any GOP plan that adhered to Trump’s outline could get enough Democratic votes to pass the Senate this year or whether Republicans will ultimately look to pass another party-line budget reconciliation bill containing their policies. Also unclear: whether proposed GOP changes would actually result in improved affordability or avoid massive coverage losses.
Larry Levitt, the executive vice president at health policy research organization KFF, warned that Trump’s direct payment proposal carries risks. “This sounds like an effort to let people bypass the ACA,” Levitt wrote on X. “Healthy people could buy cheaper insurance that doesn't cover pre-existing conditions, sending the ACA into a premium death spiral.” Levitt added that he did not believe that Cassidy’s plan, which would require people to keep a bronze-level Obamacare plan to be eligible for the federal HSA money, would cause the same death spiral, though the loss of ACA subsidies might make it harder for people to buy plans with affordable deductibles.
Senate Democratic Leader Chuck Schumer dismissed Trump’s post, arguing that it showed Trump does not understand the healthcare issue. “Donald Trump’s unhinged ramblings shows he still has no idea how anything actually works,” Schumer said in a statement. “His ‘plan’ makes no sense. Sending people a few thousand dollars while doing nothing to lower healthcare costs is a scheme to help the ultra-wealthy at the expense of working people with cancer or pre-existing conditions.”