Trump draws line in sand on extending ACA credits

WASHINGTON — President Donald Trump on Tuesday gave his sharpest rebuke of congressional Democrats’ efforts to extend expiring Affordable Care Act enhanced tax credits, saying he would not support legislation to do so.

The announcement, made through a post on Truth Social, comes as Senate Republicans and the White House had promised to enter earnest negotiations with Democrats on health care as a condition of ending the government shutdown.

Trump has pushed for lawmakers to consider policies that would send money to individuals to subsidize health care costs rather than by lowering premiums paid to insurance companies participating in the 2010 health care law’s insurance marketplace.

“THE ONLY HEALTHCARE I WILL SUPPORT OR APPROVE IS SENDING THE MONEY DIRECTLY BACK TO THE PEOPLE, WITH NOTHING GOING TO THE BIG, FAT, RICH INSURANCE COMPANIES,” Trump said in the post. “Congress, do not waste your time and energy on anything else. This is the only way to have great Healthcare in America!!!”

Trump’s warning further complicates a split among lawmakers on a path to reducing health care costs before the end of the year. Democrats and some Republicans want the credits extended for at least one year.

House Majority Leader Steve Scalise told reporters after a GOP conference meeting on Tuesday that committee leaders are proposing ideas he said could lower premiums, including potential bills to expand health savings accounts and association health plans.

Scalise said the slate of bills include some that have already advanced through committees, but he didn’t name them. He expects to bring bills for a vote by the end of the year and dismissed the Senate’s planned mid-December vote to extend the ACA subsidies that Senate Majority Leader John Thune, R-S.D., promised Democrats.

“The Senate’s going in a different direction,” Scalise said. “We’re not here to bail out insurance companies. We’re here to give families lower premiums and better options.”

Thune on Tuesday said Trump’s remarks didn’t automatically rule out a bipartisan path on health care.

“I think a lot of it’s going to depend on where the negotiations go,” he said, adding that for a lot of Senate Republicans the key issue will be if Democrats are willing to accept applying Hyde amendment language, which restricts federal funding of abortions, in any legislative changes. “The question is, what’s the best way to do it, and can it be done in a way that is bipartisan.”

Senate Minority Leader Charles E. Schumer, D-N.Y., defended Democrats’ position that a tax credit extension is needed.

“Donald Trump’s unhinged ramblings shows he still has no idea how anything actually works,” Schumer said in a statement. “Americans want Congress to extend the ACA tax credits to keep health insurance premiums from skyrocketing on January 1.”

Last week, Democrats in the House filed a discharge petition to force a vote (H Res 780) on legislation that would extend the credits for three years.

Senate Republicans, meanwhile, are forming legislation to do what Trump called for. Louisiana GOP Sen. Bill Cassidy, who chairs the Health, Education, Labor and Pensions Committee, has floated sending the $26 billion that would be spent on the enhanced premium tax credits to health savings accounts. To access that funding, people would need to sign up for high-deductible bronze-level plans on the ACA exchanges.

The Senate Finance Committee, which has jurisdiction over the Affordable Care Act, is scheduled to hold a hearing Wednesday on how to lower health care costs.

GOP moderates

House Republicans appear divided about how to approach the expiring subsidies, with a small contingent of moderates feeling more urgency to act.

“The one thing that’s really wrong to do is to just let it lapse and do nothing significant,” said Rep. Jeff Van Drew, R-N.J., who supports efforts to extend the enhanced subsidies for one year. But House Republicans have not yet coalesced around a solution that would make a meaningful difference for people facing premium increases, he said.

“I spoke to the speaker a tiny bit about it on the floor and he says they really do have some good ideas, and they are going to put them together. I hope that they do.”

Rep. Don Bacon, R-Neb., said he is working with Rep. Tom Suozzi, D-N.Y., to modify a bipartisan bill introduced last week by Reps. Kevin Kiley, R-Calif., and Sam Liccardo, D-Calif., to extend the enhanced subsidies for two years with tweaks to eligibility and fraud protections.

Their hope, he said, is to align that bill more closely to the bipartisan framework that he, Suozzi, Jeff Hurd, R-Colo., and Josh Gottheimer, D-N.J., had released.

“We’re gonna have our bill this week. We’ll take it from there,” said Bacon, who wants the bill to tee up discussion for the committees of jurisdiction and appropriators to craft a compromise. “I’m not delusional enough to think my bill is gonna become law. This is about creating a spot for discussion.”

Bacon was more skeptical of the approach touted by Cassidy and Trump to fund HSAs for individuals who previously received the enhanced credits.

“I think it’s a longer-term plan that we could maybe do,” he said, but noted that it would not be feasible in the next month. “I do think we need a deeper discussion. We need in the interim to help lower the costs, and then we’ve got to have a better long-term plan.”

Kiley said that while ultimately the current Affordable Care Act system isn’t the system they want in the long term, lawmakers needed to be realistic about the time frame.

“We need to bend the cost curve to make health care more affordable for everyone, but we’re obviously not going to, you know, have those systematic reforms make a difference for folks within the next, you know, month and a half,” he said.

Kiley said he has not heard any pushback from leadership specific to his proposal but that there have been some “less than enthusiastic comments about the idea of an extension.”

He said he’s open to his joint proposal serving as a vehicle or being incorporated into something larger. “There’s enough interest on both sides that I think that doing nothing simply isn’t an option and would not reflect the will of the body in either the House or Senate,” he said.

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Aris Folley contributed to this report.

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