President Donald Trump hasn’t officially unveiled his new health care plan. But plenty in his party already oppose it.
The White House on Monday delayed its proposal for averting a spike in Affordable Care Act premiums amid harsh blowback from an array of Republican allies and lawmakers, two people familiar with the matter told CNN.
The planned rollout had sparked immediate consternation on Capitol Hill, where many Republicans said they only learned about it after details leaked to the press. The proposal drew heavy criticism from conservatives who panned the proposal for including an extension of key enhanced ACA subsidies that are due to expire at the end of the year.
“What this means is the Republicans will be expanding Obamacare,” said Michael Cannon, the director of health policy studies at the libertarian Cato Institute. “It’s really disheartening.”
The swift backlash to the administration’s framework casts fresh doubt on the GOP’s ability to coalesce behind a plan for addressing health care costs, despite Trump’s repeated vow to deliver a better alternative to the ACA.
And it underscores the long odds that Congress faces in striking a bipartisan compromise that can head off a looming increase in consumer health costs. Senate Republicans agreed to hold a mid-December vote on the fate of the enhanced ACA subsidies as part of a government funding deal. But by the time senators return from their Thanksgiving recess, that deadline will be just days away.
More than 22 million Americans benefit from the enhanced ACA subsidies, many of whom would face hefty premium increases if those tax credits are allowed to run out at the end of the year. That threat has thrust the issue to the fore for both Democrats and Republicans, ahead of midterm elections that the two parties believe will be driven by voters’ deepening concerns over the cost of living.
“The White House understands they have to do something on this, as bad as Obamacare is,” said one adviser to the White House. “This feeds into the whole affordability issue.”
The tentative package developed by the administration in recent weeks sought to balance a temporary extension of the ACA subsidies with a range of conservative reforms, according to details circulated among aides and allies in recent days.
It envisioned continuing the enhanced subsidies for two years, but with new guardrails aimed at limiting their scope — including a new income cap and a requirement that all enrollees make a minimum monthly premium payment.
The proposal also aimed to incentivize enrollees to choose lower-tier ACA plans by allowing them to redirect some federal aid into a health savings account, fulfilling Trump’s demand that more money be given directly to individuals rather than routed through insurance companies.
The framework floated a range of other conservative priorities, such as expanding the availability of plans outside the ACA exchanges and imposing new restrictions on the use of federal funds for gender-affirming care or health care for undocumented immigrants.
Yet those initial details immediately fell flat with much of the Republican conference on Capitol Hill on Monday, blindsiding rank-and-file lawmakers who had no idea the administration had developed its own proposal and irritating others over its support for a key element of the ACA.
Multiple Republicans told CNN that they first found out about the framework from their social media feeds. In the House, where Obamacare remains a toxic political tagline, it was viewed with heavy skepticism, with many key details unanswered. There is little expectation that anything with two more years of subsidies — even with a stricter income cap and other reforms — could pass muster with House Republicans. Indeed, various other health care cost plans being developed by House lawmakers do not include any extension of the subsidies.
Some conservatives also saw the framework as an abrupt U-turn from the principles the White House had telegraphed just days earlier, when Trump suggested that any funding go directly to Americans buying coverage.
“Not very Trumpian,” one former senior administration official said of the plan.
A White House official disputed that the administration had finalized its health plan, cautioning that “until President Trump makes an announcement himself, any reporting about the Administration’s healthcare positions is mere speculation.” The official also noted that the White House had never officially scheduled any announcement, though the people familiar with the matter said aides had briefed some key lawmakers ahead of time on their plans for an imminent rollout.
On Monday, White House press secretary Karoline Leavitt declined to offer a new timeline, saying only that Trump is “very focused on unveiling a health care proposal that will fix the system and bring down costs for consumers.”
“Sometimes you report things and then President Trump comes out with an announcement, and those things are not always true, what you hear from sources inside the building. So I’ll let the president speak for himself,” she told reporters outside the White House.
Still, the messy episode offered a stark preview of the difficulty that the White House faces in assembling a proposal that can win over a majority of Republicans — much less garner the Democratic supported needed to pass it into law before the end of the year.
The framework earned tepid praise from just a few deal-minded Democrats, including Sens. Jeanne Shaheen and Maggie Hassan of New Hampshire and Jacky Rosen of Nevada, all of whom broke ranks earlier this month to help end a record-long government shutdown.
“If the reports are true and the President is considering coming to the table in good faith, I believe we can find a path forward that can earn broad bipartisan support in Congress,” Shaheen said in a statement.
But on the whole, congressional Democrats overwhelmingly rejected the proposal in favor of sticking to their long-running demand for a straightforward extension of the ACA subsidies.
“Instead of working in good faith with Democrats to lower the cost of Americans’ health care, Republicans have chosen to retreat to the comfort of their longstanding ideological crusades,” said Sen. Ron Wyden of Oregon, the top Democrat on the Senate Finance Committee.
Within Trump’s orbit, some allies pointed to the immediate divisions within the Republican Party as evidence of the steep challenge of putting together a successful health plan — and the dangers of even trying.
Even before Monday, two people close to the administration’s policy process had cast serious doubt on officials’ ability to come up with a package that could prove popular with both Republican lawmakers and voters, privately questioning how Trump might succeed now where he and others have failed for the last decade.
Cannon, who in conversations with Republicans has advocated expanding access to short-term health plans outside of the ACA, said it’s no longer worth trying to overhaul the ACA itself because “Obamacare sort of trapped us in this situation where anything that a Republican proposes, Democrats scream that they’re undermining Obamacare.”
But Trump has remained personally fixated on striking the sweeping health care deal that’s eluded him for years. And with voters increasingly anxious about affordability and skeptical of the administration’s agenda, advisers said there’s little choice left but to give it another shot.
“The president understands this,” the adviser to the White House said. “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.”
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