Trump hints at health care deal to end shutdown, but key hurdles remain

President Donald Trump’s pledge Monday that he is open to a health care compromise that could end the government shutdown has Democrats keen to make a deal — and conservatives eager to blow it up.

“I’d like to see a deal made for great health care,” Trump told reporters in the Oval Office on Monday, responding to questions about Affordable Care Act subsidies set to expire at the end of the year. He later wrote on his Truth Social platform that no deal would be possible until Democrats agree to end the shutdown, which Democrats say they will not do without an agreement on the subsidies.

Any plan to keep the health insurance subsidies from expiring faces significant hurdles, according to lawmakers, White House staff and outside advisers, some of whom spoke on the condition of anonymity to discuss private conversations. Democrats have insisted that Congress must continue the subsidies, which were expanded in 2021 during the coronavirus pandemic and cap the maximum percentage of household income that a person pays for coverage under the ACA, citing estimates that millions of Americans’ insurance premiums will double if the credits expire. GOP leaders have countered that the expanded subsidies are a covid-era relic, have focused on reported fraud within the program, and have called for new income caps to limit who can benefit from the subsidies.

Rep. Lauren Underwood (D-Ill.), an author of the legislation to make the ACA subsidies permanent, predicted that pressure would mount on Republicans as Americans receive notices of price hikes.

“They’ve lost major health care fights before because they were trying to take health care away from people,” Underwood said in an interview Tuesday, invoking the GOP’s past attempts to repeal the ACA. “It’s almost like déjà vu once again.”

Some anti-abortion groups have also insisted that the Hyde Amendment, a provision that prohibits federal funds from paying for abortions, must be attached to any new ACA legislation — a move that has previously scuttled health care deals with Democrats. Susan B. Anthony Pro-Life America, a leading anti-abortion organization, has warned that it would track lawmakers’ votes for “forced taxpayer funding of abortion through Obamacare.”

Republican lawmakers and White House aides on Monday acknowledged that they had considered theoretical compromises — such as an idea to “grandfather” in some ACA enrollees who receive the subsidies — but maintained that no deal with Democrats would be possible until the shutdown ends. GOP leaders also are targeting what are known as “zero-premium plans,” arguing that some insurance brokers have taken advantage of the expanded subsidies to wrongly enroll Americans in fully subsidized plans that represent a disproportionate share of fraud and abuse.

Conservatives further cautioned against interpreting Trump’s comments as willingness to build on the ACA, a program he has long criticized.

“The president didn’t say he wanted to permanently extend the COVID credits,” said Brittany Madni, executive vice president of the Economic Policy Innovation Center, a right-leaning policy organization that has been critical of the subsidies. “He said he was open to discussing Democrats’ ‘Failed Healthcare Policies’ that caused the underlying high costs of health care. And I think that’s totally reasonable because Obamacare itself is the problem.”

Democrats have countered with stories of how Americans depend on the subsidies to secure health care access, with some lawmakers saying that the situation is growing more alarming. Sen. Angus King, an independent from Maine who caucuses with Democrats, has been one of the three Democratic-aligned senators who has voted with Republicans to reopen the government for the past week, citing concerns about how the White House might use a shutdown to unilaterally shift federal funds.

But King said Monday night that he’s considering switching to voting against reopening the government because “so far, the Republicans aren’t being forthcoming with significant assurances about dealing with this ACA issue, which is really urgent.”

“The best they’ve been able to tell us so far is that they’re open to conversations about solving the ACA problem,” King said. “That doesn’t cut it.”

Some allies of the president, including his pollster Tony Fabrizio, have warned Trump about the political backlash of ending the program. Rep. Marjorie Taylor Greene (R-Ga.), a frequent supporter of Trump, also posted on social media that she opposes the Affordable Care Act but still wants to see a compromise.

“I’m absolutely disgusted that health insurance premiums will DOUBLE if the tax credits expire this year,” Greene wrote, noting that her adult children’s premiums would spike — a message that Senate Minority Leader Charles E. Schumer (D-N.Y.) read aloud on the Senate floor Tuesday morning, framing it as an endorsement.

Senate Majority Leader John Thune (R-S.D.) said Monday afternoon that the appetite for extending the ACA subsidies among Senate Republicans is “a mixed bag” but added that “there may be a path forward” after the shutdown, depending on what Trump will endorse.

“There are people out there with actually some pretty good ideas, but unfortunately, they’re not getting the chance to be heard while we’re stuck here,” he said.

Senate Appropriations Committee Chairwoman Susan Collins (R-Maine) told reporters Monday that she has circulated a tentative plan among several other senators to reopen at least parts of the government. While the plan is still preliminary, it would aim to set a deadline for a discussion on ACA subsidies and strike an agreement to advance some appropriations bills.

One option being discussed among Republicans would bar new ACA enrollees from obtaining the subsidies, with a five-year phasedown of the program; a second option would limit the subsidies only to people ages 60 to 64; and a third option would institute a sliding scale that reflects an ACA enrollee’s income, ensuring the end of zero-premium plans and more “skin in the game,” according to a senior congressional aide, who spoke on the condition of anonymity to detail private deliberations.

Sen. John Barrasso of Wyoming, the No. 2 Senate Republican, said Tuesday that it was too early to discuss Collins’s proposal or other specific ideas.

“Let’s open the government, and we can have lots of discussions and lots of negotiations,” Barrasso told reporters.

House Minority Leader Hakeem Jeffries (D-N.Y.) on Tuesday dismissed a proposal to extend the ACA subsidies for one year as a “nonstarter.”

Some Democrats rejected Trump’s suggestion Monday that the White House had “a negotiation going on right now with Democrats that could lead to very good things,” insisting that the president had not been speaking to any Democrats. Sen. Jeanne Shaheen of New Hampshire has been among the Democrats at the center of negotiations to try to find a deal on extending ACA subsidies. She said that the president’s remarks Monday were “helpful” but that she hadn’t personally spoken to him, adding that bipartisan discussions to find a route forward are “ongoing.”

“I think there’s a sincere effort to try to figure out how we address the current situation,” Shaheen said.

Schumer told reporters Monday evening — after the Senate had voted for the fifth time to reject two dueling partisan bills that would reopen the government — that his party was eager to return to the table.

“After five failed votes, it should be clear to Republicans that we cannot go forward unless they sit down and seriously negotiate with Democrats to address the health care prices,” Schumer said. “It’s that simple.”

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• Theodoric Meyer contributed.