WASHINGTON, D.C. — With the clock ticking toward a year-end health care deadline, President Donald Trump has instructed Republicans not to extend enhanced Affordable Care Act subsidies, telling lawmakers they should “stop wasting time” and back a plan that sends money “directly to the people.” His stance has deepened a divide inside the GOP as millions of Americans brace for sharp premium increases.
What’s at Stake?
Roughly 22 million Americans could see their monthly health insurance costs jump — in some cases by thousands of dollars — when pandemic-era ACA subsidies end on December 31. Congress approved the temporary boost during COVID-19 to cap the cost of a benchmark plan at 8.5% of income, costing about $35 billion annually.
Rep. Jen Kiggans of Virginia, who represents a critical swing district, urged colleagues in a closed-door meeting to extend the subsidies for one year to avoid premium spikes.
“Doing nothing isn’t the answer,” she said, warning that families in her district could lose coverage.
But only 14 Republicans have backed her proposal, and party leaders showed little interest in reviving the current structure.
Trump Rejects an Extension
Trump has made his position clear: he will not support any plan that continues directing subsidy money to insurance companies.
“The only health care I will support is money going directly back to the people,” he wrote online, urging Congress to abandon ACA-based funding.
His message quickly became the party line. Sen. Rick Scott said plainly: “It’s going to end.”
GOP Pushes Alternatives
Republican leaders are now tasking members with designing replacement plans that shift funds into:
- Health Savings Accounts (HSAs)
- Flexible Spending Accounts (FSAs)
- Direct cash assistance
Lawmakers argue these options give patients control instead of insurers. Sen. Bill Cassidy said ACA rules allow insurers to spend up to 20% of subsidies on overhead and profit, while HSAs would route 100% of the benefit to individuals.
Conservatives insist a clean extension will not reach the House floor. Rep. Andy Harris warned it would “shut down business in the House completely.”
Others, like Rep. Rob Bresnahan of Pennsylvania, warned that letting the subsidies lapse without a backup plan would “rip the rug out” from families already struggling.
Democrats Say Time Has Run Out
Democrats and policy experts argue that insurers have already locked in rates for 2026, making a rapid transition to a new system impossible. They warn that ending the subsidies could push healthier Americans out of the marketplace and trigger a wave of premium hikes.
Jason Levitis of the Urban Institute said, “At this point, the only workable option is a straightforward extension.”
Tension Builds as Deadline Nears
Some Republicans hinted they may consider a rare discharge petition if leadership refuses to act. But even that wouldn’t guarantee support in the Senate, where 60 votes are needed.
Rep. Mike Lawler said the focus must be on speed:
“The objective is to get this done before the end of the year.”
For now, the GOP remains split between moderates who want a temporary fix and Trump-aligned members pushing to let the subsidies expire altogether — leaving millions uncertain about their health care costs in 2026.
