Congress returns to Washington on Monday and immediately launches a fast-paced sprint to address the expiration of Affordable Care Act subsidies and stop health insurance premiums from rising for millions of Americans.
But lawmakers in both parties say everything hinges on one thing: whether President Donald Trump decides what he actually wants.
Over the Thanksgiving recess, the situation only grew more unclear. Early on, Trump seemed close to supporting a temporary extension of ACA subsidies with new eligibility limits. But after sharp criticism from inside the GOP, he backed away.
In his only recent public comments, Trump added even more uncertainty — saying he doesn’t want to extend the subsidies but recognizes he might need to. This back-and-forth has lawmakers scrambling to figure out where he will ultimately land and how to secure his support in a policy fight that could shape the outcome of next year’s midterm elections.
Rep. Brian Fitzpatrick (R-Pa.) said the stakes are simple:
“The president has to sign whatever we pass, or it’s just a meaningless exercise.”
Fitzpatrick is preparing a bipartisan proposal that largely mirrors the leaked White House draft plan.
Time Is Running Out
The Senate is preparing to hold a vote as soon as December 9. No one is sure what the bill will contain, but Senate Majority Leader John Thune promised Democrats a vote as part of the deal that ended the 43-day government shutdown.
“Time is not our friend,” Fitzpatrick warned.
Centrists on both sides are trying to build a bipartisan package that extends the subsidies (important to Democrats) while adding new income limits and safeguards (important to Republicans). The Republican Main Street Caucus has signaled support for this direction.
GOP Divisions Complicate the Path
Other Republicans want a far more sweeping overhaul of Obamacare. Sens. Bill Cassidy and Rick Scott have pitched Trump on plans centered on individual health spending accounts — one branded as “Trump Health Freedom Accounts.”
Trump’s shifting stance has left Congress guessing. For weeks, many Republicans believed he opposed extending the credits — until the leaked framework revealed the opposite. Most lawmakers learned about it from news reports, sparking backlash and forcing the White House to halt the rollout.
One House Republican said privately that the administration should have consulted GOP leaders directly before the leak, adding: “Trump cannot please everyone with any health plan.”
Major Political Obstacles Ahead
Winning votes in both chambers — and Trump’s signature — won’t be easy.
A major sticking point: the leaked framework did not include new abortion restrictions, which many Republicans demand and many Democrats will never accept.
Sen. Mike Rounds (R-S.D.) said firmly:
“We’re not going to allow taxpayer dollars to fund abortion.”
Some Republicans will also refuse to support anything connected to Obamacare, no matter the details.
In the background, several GOP lawmakers and committee chairs are drafting additional health care proposals — though it’s uncertain whether the party will ever unify behind one plan.
A Backup Plan: Forced Vote
House GOP centrists are preparing a discharge petition to force a vote on extending the subsidies if leadership cannot move a bill. But they want to give the Senate time to try for a bipartisan agreement first.
Some lawmakers believe the real deadline is January 30, when the next government funding bill is due — even though ACA subsidies would already be expired by then.
Democrats Face Their Own Divisions
Democrats were initially encouraged that Trump was considering an extension — even with eligibility limits. But their optimism faded when Republicans revolted.
Senate Democrats, who control which proposal comes to the floor under the shutdown deal, have not united behind any plan. They are set to discuss their strategy at a Tuesday caucus lunch.
Some Democrats, including Sen. Jeanne Shaheen and Rep. Tom Suozzi, are working closely with bipartisan negotiators like Fitzpatrick and Sen. Lisa Murkowski.
Others, like Sen. Bernie Sanders, want Democrats to go bold with a sweeping health care expansion — even if it cannot pass — to energize voters.
Ultimately, Everything Comes Down to Trump
As Sen. Chris Murphy (D-Conn.) put it:
“You can negotiate in good faith with Republicans, but none of it matters until Donald Trump weighs in.”
Democrats believe Republicans know voters will punish them if they fail to prevent health care price spikes — but fear some in the GOP would rather risk electoral damage than support anything connected to the ACA.