Donald Trump’s health care plan is in limbo after pushback from Republicans who were caught off guard by the president’s forthcoming proposal — questioning, in particular, whether it would include additional abortion restrictions.
Trump had been expected to unveil a new policy framework Monday afternoon, said two people familiar with the plan and granted anonymity to describe deliberations around it. That framework was expected to center around a two-year extension of Affordable Care Act subsidies with income caps and other new limits backed by conservatives.
But while White House press secretary Karoline Leavitt said Monday that Trump remained focused on “unveiling a health care proposal,” she declined to get into specifics about subsidy extensions or a timeline for the rollout: “I’ll let the president speak for himself."
A White House official separately noted Trump’s daily schedule never listed plans for a Monday rollout.
The uncertainty around the timing of the announcement comes as Hill Republicans remain sharply divided over whether to extend the enhanced tax credits to prevent premiums from skyrocketing next year or to let them expire at the end of the year and coalesce around an alternative approach to keep health care costs down.
One House Republican granted anonymity to speak freely said in an interview Monday they needed to see “what structural changes” Trump might float, adding that GOP lawmakers should demand “reforms … in exchange for extending the subsidies.”
According to three additional people granted anonymity to share details of the plan ahead of its release, Trump was preparing to place new income caps on individuals receiving the subsidies and require minimum premium payments for Obamacare enrollees. He also was expected to propose an option for enrollees to receive part of their tax credit in a tax-advantaged savings account if they downgrade to a lower-premium health plan.
These policy changes align with what many conservatives have been seeking. But it wasn’t clear Monday whether the plan would also include expanded restrictions under the so-called Hyde amendment, which bans federal funds from being used for abortions.
One of the people who described the tentative plan and two other people granted anonymity to disclose private discussions said congressional Republicans still didn’t know how Trump’s proposal would deal with that thorny issue.
The ACA has always barred federal subsidies from paying for abortions but left it up to states to determine whether health insurance plans in the individual market could cover abortion using other funding.
Marjorie Dannenfelser, the president of SBA Pro-Life America, reiterated in a statement Monday her anti-abortion group will penalize any lawmaker who votes for a subsidies extension without additional abortion guardrails that ban coverage nationwide.
“We oppose any health care plan that fails to include this safeguard,” she said. “Our position is consistent and will not change.”
Trump’s plan to extend the ACA credits — even with changes sought by conservatives — also blindsided some Hill Republicans who have dug in against any bipartisan deal to extend the credits.
"I know that we've got different ideas in our conference," House Majority Whip Tom Emmer (R-Minn.) said in a Monday morning interview on Fox Business Network. "I think you're going to hear more from the White House.”
House GOP leadership last week gave a presentation to the House Republican Conference slamming the subsidies for perpetuating what they dubbed the “Unaffordable Care Act,” a moniker Emmer repeated Monday.
Not all Republicans reacted negatively to the news of a forthcoming health policy announcement from Trump. Rep. Tim Burchett in an interview Monday credited the president with having “some guts” to get lawmakers “to the table.” Trump’s forthcoming framework, Burchett added, “starts the negotiating.”
“I don’t like the subsidies,” the Tennessee Republican continued, “but everybody griping about it doesn’t have a plan, so get some guts, put up a plan … or get the heck out of the way.”
Burchett also said the White House will now roll out the plan Tuesday, underscoring confusion and mixed messaging around the forthcoming presentation.
Leavitt left open a broad array of possibilities for the final White House plan Monday, including that it might not ultimately include a subsidy extension. Asked specifically if that provision would be included, she told reporters, "As you all know, sometimes you report things and then President Trump comes out with an announcement and those things are not always true."
Some Democrats expressed cautious optimism upon learning that Trump was preparing to embrace an extension of the ACA credits.
Sen. Jeanne Shaheen (D-N.H.), who has been heavily involved in the bipartisan negotiations on health care, said in a statement Monday that she has had “constructive conversations” with Republicans about extending the enhanced tax credits.
“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.
She added that anything Trump puts out on the issue could signal “a serious proposal to begin negotiations.”
Democrats, including Shaheen, have been discussing what their strategy should be ahead of a floor vote in mid-December on a proposal to extend the subsidies, which was promised to Democrats by Senate Majority Leader John Thune in exchange for their votes to end the government shutdown. Democrats will get to decide what proposal they want a vote on, though Republicans are expected to offer their own alternative unless there is a bipartisan deal.
One provision that had been included in Trump’s tentative plan — pegging the eligibility cap for the subsidies at 700 percent of the federal poverty line — is among the ideas being mulled by Shaheen and her colleagues.
But other Democrats slammed the proposal outright, further casting doubt on how Trump’s opening salvo would land on Capitol Hill.
In a statement Monday afternoon, the three top House Democrats on committees with jurisdiction over health care — Reps. Richard Neal of Massachusetts, Frank Pallone of New Jersey and Bobby Scott of Virginia — panned the White House’s forthcoming proposal, calling it the “greatest hits of Republican health care ideas the people have rejected for years.”
They continued, “At this point, anything short of a clean extension is unworkable and won’t avoid the price hikes people are now facing.”
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