Trump Is Sabotaging Another Health-Care Deal

For months now, Washington, D.C., has waited on Donald Trump to broker a bipartisan deal to address the expiration of Obamacare subsidies that is producing skyrocketing premiums and out-of-pocket costs for the more than 20 million Americans who rely on these policies for their health insurance. He hasn’t been very helpful, even though the issue played a major role in triggering the longest government shutdown in history. Conservatives almost uniformly hate (or pretend to hate) Obamacare itself, so Republicans need cover from their president in order to accept a compromise that would extend the subsidies in exchange for some concessions on who receives them. Instead, Trump has fed partisan flames by launching his own attacks on Obamacare while demanding ancient right-wing health-care panaceas like increased health-savings accounts.

This week, Trump has an outstanding opportunity to promote a deal by saying something nice about the pending legislation that would extend subsidies for three years, which is very likely to pass the House with at least some Republican support. Instead, in a long, rambling speech to House Republicans on Tuesday, Trump quadrupled down on a conservative “solution” for rising health-care costs. But then, incredibly, he told his troops they needed to be “flexible” about the new abortion restrictions nearly all Republicans have long demanded with respect to Obamacare policies. So Trump won’t articulate or support an actual deal, but he’s suggesting that if some agreement emerges, it doesn’t need to include language beefing up restrictions on using Obamacare funds to indirectly subsidize abortion services.

As you can imagine, this Trump “curveball” did not go over well with Republicans, as the Washington Examiner explained:

Sen. James Lankford (R-OK), a healthcare negotiator with staunch anti-abortion views, offered a visceral response just minutes after Trump’s remarks made in Washington to House Republicans at the newly named Trump-Kennedy Center.

“I’m not flexible on the value of human life,” Lankford told the Washington Examiner. “I don’t believe some children are disposable and some children are valuable.”

Senate Majority Leader John Thune was more diplomatic about it, but he listed new abortion restrictions (or, as he put it, the “Hyde issue,” a reference to the Hyde Amendment that has long banned use of federal funds to directly pay for abortions) on Obamacare policies as a key demand he would insist on in any health-care deal.

Meanwhile, anti-abortion groups, which Trump enraged in 2024 by refusing to endorse a national abortion ban, are using this dispute to save face and reassert their iron grip on the GOP, as The Hill reports:

Susan B. Anthony Pro-Life America President Marjorie Dannenfelser said in a statement that Trump’s comment amounts to an “abandonment” of a “decades-long commitment.”

“For decades, opposition to taxpayer funding of abortion and support for the Hyde Amendment has been an unshakable bedrock principle and a minimum standard in the Republican Party,” Dannenfelser said. 

“If Republicans abandon Hyde, they are sure to lose this November,” she added.

This threat to take a dive in the midterms has to be chilling to Republicans who need the money and muscle of the anti-abortion lobby to win close races. So even as Trump refuses to lift a finger to make a bipartisan health-care deal possible, he’s poisoning Republican willingness to accept a deal, if one is somehow worked out without his help.

It’s unclear if this is intentional sabotage or just another example of the president’s erratic form of leadership. But it’s destructive in either event, and the Senate Republicans who have been working quietly with Democrats toward a health-care deal are livid, as Punchbowl News reports:

Behind the scenes, key Republicans are complaining that Trump, who’s been completely disconnected from the bipartisan Obamacare negotiations, is leaving them twisting in the wind.

“If [Trump] felt strongly enough to prod us in public, why doesn’t he send his advisers to come meet with us and work out a deal?” said a GOP senator involved in the bipartisan talks. “If the White House embraces a deal that’s squishy on Hyde, I have no doubt in the world that he can convince enough of us to vote for it.”

To many Republicans, the episode was further evidence that a deal simply can’t get done without intense involvement from the White House and, in some cases, Trump personally.

Where this all leads is anybody’s guess, but Trump’s “advice” is very likely to give a boost to those who don’t want a bipartisan health-care deal at all and would prefer a Republicans-only approach. There’s only one way that can happen: through a budget-reconciliation bill like last year’s One Big Beautiful Bill Act that can be enacted without a single Democratic vote. As it happens, there’s already substantial Republican support for doing just that, as Politico reported in December:

GOP factions have been divided for months about the prospect of a second reconciliation bill. Some see it as the party’s last, best chance to put wins on the board before Election Day …

Speaker Mike Johnson is publicly leaning into the possibility as he tries to appease hard-liners who wanted the House GOP to go much farther than it did this month in pushing a conservative health care overhaul.

Some rank-and-file conservatives in the House and Senate are privately discussing a potential centerpiece for a second reconciliation bill: using tariff revenues to send taxpayers cash to address rising health care costs after enhanced Obamacare subsidies expire Dec. 31, according to three people granted anonymity to describe the talks.

More cautious lawmakers likely remember the fiasco that ensued last time Trump and his party tried to pull off major health-care legislation via the reconciliation process: the failed 2017 effort to “repeal and replace” Obamacare. That happened despite a significantly larger GOP majority in the House than the one Mike Johnson has right now. But the bulk of congressional Republicans would rather risk a reprise of the disaster that contributed to big midterm losses in 2018 than to show any “flexibility” on abortion. It’s just who they are.