Congress waits on Trump as December health push starts

Congress reconvenes on Monday to tackle the looming expiration of Affordable Care Act (ACA) subsidies, aiming to prevent insurance premium hikes for millions of Americans. Lawmakers from both parties acknowledge that progress depends on a single question: can President Donald Trump clarify his stance?

Since leaving Washington 10 days ago, Trumps position has become increasingly unclear. Early in the holiday break, he appeared ready to unveil a framework to temporarily extend Obamacare subsidies with revised eligibility rules. However, after facing sharp criticism from within the GOP, he withdrew the proposal. In his only public comment last week, Trump expressed reluctance to extend the subsidies, though he conceded it might be necessary.

The uncertainty has left congressional factions scrambling to anticipate Trumps decision and secure his support for a contentious policy battle with significant implications for next years midterms. The president has got to sign whatever we do, otherwise its a legislative exercise, said Rep. Brian Fitzpatrick (R-Pa.), who is working on a bipartisan proposal largely reflecting the leaked White House framework.

Time is running short. The Senate is scheduled to vote on a health care measure as early as December 9, fulfilling a promise Majority Leader John Thune made to Democrats to end the 43-day government shutdown. The question is, how quickly can something come together? Thune said before Thanksgiving. Fitzpatrick added, Time is not our friend.

Centrist lawmakers are pushing for bipartisan support for a subsidy extension, which Democrats favor, combined with new income restrictions and safeguards demanded by Republicans. The proposal has tentative backing from the Republican Main Street Caucus, chaired by Rep. Mike Flood (Neb.), who endorsed the leaked framework. Meanwhile, some GOP members are pursuing a more radical approach to Obamacare, with Sens. Bill Cassidy (La.) and Rick Scott (Fla.) promoting individual spending account plans, with Scott branding his idea as Trump Health Freedom Accounts.

Most Republicans learned about the tentative White House framework from media reports rather than direct communication. This prompted criticism within the party, with one anonymous House GOP member noting that consultation with congressional leaders would have been wiser. Trump cannot please everyone, the lawmaker said, adding that the initial acceptance of a modified extension was viewed positively by most.

Securing approval for a subsidy extension requires navigating political complexities. The framework did not address new abortion restrictions, a red line for many Republicans and a deal-breaker for Democrats. Were not going to allow public funds to be used for funding abortion, Sen. Mike Rounds (R-S.D.) said before Thanksgiving. Additionally, a subset of Republicans is firmly opposed to any ACA-related extension.

Other GOP factions, including key committee chairs, are exploring alternative health care proposals, but it remains uncertain whether a unified party approach will emerge or if a bill will pass this year. As a contingency, House GOP centrists are preparing a discharge petition to force a floor vote, while allowing time for potential bipartisan Senate negotiations. Some lawmakers view the January 30 government funding deadline as the real cutoff for a deal, even though subsidies would expire earlier. Senate Finance Chair Mike Crapo (R-Idaho) emphasized efforts to pursue bipartisan solutions rather than partisan reconciliation measures.

Democrats were initially encouraged by Trumps reported willingness to extend subsidies, despite eligibility restrictions. However, GOP pushback tempered optimism. Senate Democrats will decide which proposal to vote on as part of their agreement with Thune, but internal divisions remain. Some Democrats, like Sen. Jeanne Shaheen (N.H.) and Rep. Tom Suozzi (N.Y.), are engaging with Republicans to explore bipartisan options, while others, including independent Sen. Bernie Sanders (Vt.), prefer a broad health care plan that would not gain GOP support but could energize their base before midterms.

The overarching challenge is Trumps influence over any GOP-backed health plan. You can have good-faith negotiations with Republicans, but it just doesnt matter until Donald Trump weighs in, said Sen. Chris Murphy (D-Conn.). Lawmakers worry that Republican opposition to the ACA and Obama-era policies may outweigh electoral considerations.

Author: Sophia Brooks