Health care plan circulated by the White House runs into familiar GOP
divisions
[November 26, 2025]
By MARY CLARE JALONICK
WASHINGTON (AP) — A health care proposal circulated by the White House
in recent days is running into the reality of Republican divisions on
the issue — a familiar struggle for a party that has been trying to
scrap or overhaul the Affordable Care Act for the past 15 years.
The tentative proposal from President Donald Trump would extend expiring
ACA subsidies for two years while adjusting eligibility requirements for
recipients. The plan has so far been met with a stony silence on Capitol
Hill as Republicans debate among themselves whether to overhaul the law,
tweak it or simply let the subsidies expire.
It’s unclear now when the White House plan might be released, or if it
will be released at all.
The Republican indecision comes as the COVID-era tax credits are set to
expire Jan. 1, creating sharp premium increases for millions of
Americans. Democrats who shut down the government for six weeks over the
issue are demanding a straight extension with no changes, though some
indicated they could support a plan similar to the one circulated by the
White House.
But support may be harder to find in the GOP conference, where many
lawmakers say costs are still too high and have been eager to make
another run at repealing the ACA. The last effort in 2017 failed when
Republicans couldn’t decide on how to provide coverage to millions of
Americans who depend on government-run marketplaces for their health
care. It's a dilemma that persists for the party after record numbers
signed up for coverage this year.
Senate Majority Leader John Thune, R-S.D., promised a group of moderate
Democrats a vote on the ACA tax credits by mid-December in exchange for
their votes to end the government shutdown. But it’s unclear, so far,
whether that arrangement will lead to a solution.
Bipartisan compromise?
Health care has long been one of the most politically fraught topics on
Capitol Hill, so a bipartisan compromise seems unlikely. But the coming
price spikes have motivated some lawmakers to look for points of
agreement.
Republican Sen. Thom Tillis of North Carolina said last week that he
hopes the subsidies are extended.
“I’m sure some of my colleagues will be mad at me for saying this — if
we don’t address the subsidies issue in December, I don’t think it’s
going to get addressed next year,” Tillis said, adding that Democratic
campaigns will be “just churning up all the very sympathetic stories” if
it isn't fixed.
The draft White House proposal would put new income limits on the tax
credits — at 700 percent of the federal poverty level, according to two
people with knowledge of the proposal who requested anonymity to discuss
it. The White House would also require those on Obamacare, regardless of
the type of coverage, to pay some sort of premium for their plans. That
would effectively end zero-premium plans for those with lower incomes,
addressing a concern from Republicans who say the program has enabled
fraud.
Some Democrats have suggested they are open to those ideas as a part of
broader negotiations. “I’m glad the president is reportedly considering
a serious proposal,” said New Hampshire Sen. Jeanne Shaheen, one of the
Democrats who voted to end the shutdown.
Some Republicans have signaled support as well. Nebraska Rep. Mike
Flood, the chairman of the business-oriented Republican Main Street
Caucus, said in a statement that the group supports “President Trump’s
ongoing efforts to address the ACA tax credit cliff with an extension.”
Several bipartisan bills in the House would extend the ACA credits for
two years, with changes such as income limits for the enhanced credit.
“I think two years is really the sweet spot where everybody is OK,” said
Pennsylvania Rep. Brian Fitzpatrick, a co-chair of the bipartisan
Problem Solvers Caucus.
Premium spikes on Jan. 1
Still, House Speaker Mike Johnson, R-La., has declined to say whether he
will allow a vote on a health care bill. Many other members of his GOP
conference want to see the subsidies eliminated or the underlying law
overhauled. In addition, Thune and other Republicans have said they want
new language on abortion restrictions if they pass an extension — a
dealbreaker for Democrats.
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A podium is prepared before Democrats hold news conference on the
health care funding fight on the steps of the House before votes to
end the government shutdown, on Capitol Hill, Wednesday, Nov. 12,
2025, in Washington. (AP Photo/Mariam Zuhaib)
If Congress doesn’t act, the enhanced premium tax credits that have
helped many Americans pay for Affordable Care Act health insurance
plans will disappear. And premiums could more than double for
subsidized enrollees, according to an analysis by the health care
research nonprofit KFF.
Signups for next year’s insurance began on Nov. 1, meaning that many
Americans are already planning for the higher costs. Democrats who
forced the shutdown at the beginning of October had hoped to
negotiate an extension before open enrollment began.
“When people’s monthly payments spike next year, they will know it
was Republicans that made it happen,” Senate Democratic leader Chuck
Schumer said last week.
Republicans could go at it alone
As Democrats elevated the health care issue during the shutdown,
some Republicans saw an opportunity to renew their efforts to
overhaul the law. GOP lawmakers in the House and Senate have been
meeting to find consensus, though they haven't found it yet.
Among the GOP ideas are separate proposals from Florida Sen. Rick
Scott and Louisiana Sen. Bill Cassidy to use savings accounts to
either shop for insurance or defray out-of-pocket costs. Scott’s
legislation would create what he called “Trump Health Freedom
Accounts” and make some changes to the health care law, including by
allowing consumers to shop across state lines. Cassidy’s narrower
bill would create new savings accounts just to replace the enhanced
subsidies that are expiring.
The draft of the White House plan, meanwhile, would allow those in
lower-tier plans, such as the bronze-level or catastrophic plans, to
put money into health savings accounts.
Those proposals are unlikely to win over Democrats. Schumer said
last week that the savings accounts “will go nowhere in the Senate.”
Skeptical that the two parties will ever agree, some Republicans
have suggested that they try to pass a health care package using
budget maneuvers similar to Trump’s “ Big Beautiful Bill ” of tax
and spending cuts. If it worked, they could pass the legislation
with zero Democratic votes — a politically risky strategy that could
take months, well into the midterm election year.
It all depends on Trump
Some Republicans may be waiting for clear direction from Trump, who
has been sending mixed signals about what he wants.
For several weeks, Trump appeared to be backing the savings accounts
on social media, posting as recently as Nov. 18 that “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, WHO HAVE MADE $TRILLIONS, AND RIPPED OFF
AMERICA LONG ENOUGH.”
He added: “Congress, do not waste your time and energy on anything
else.”
Trump reiterated that message Tuesday evening.
“Don’t give the money to the insurance companies,” he told reporters
Tuesday evening. "You give the money to the people.”
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Associated Press writers Seung Min Kim, Joey Cappelletti, Kevin
Freking in Washington and Ali Swenson in New York contributed to
this report.
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