The Waiting Room | Trump's Health Care Plan Gets Aborted after GOP Backlash

Greetings, Lincoln Square readers! I hope you had a peaceful Thanksgiving holiday.

When we left off two weeks ago, the federal government had been re-opened after Senate Democrats managed to get Republicans to agree to a) stop starving 42 million Americans to death (including 14 million children) and b) give them a vote on actually extending the enhanced ACA tax credits which are still scheduled to expire less than four weeks from today.

Republicans started scrambling to slap together something, anything they could come up with to deal with the looming disaster, including…

• GOP Sen. Bill Cassidy’s “HSAs for All!” proposal

• GOP Sen. Rick Scott’s “Put all your Money in a Trump Account!” insanity

• And, amazingly, the legitimately reasonable “HOPE Act” from a bipartisan group of House members.

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This all culminated in last week’s big news that Trump himself was finally going to roll out his own proposed “alternative” plan, which was purported to include a couple of semi-reasonable provisions:

• Two year extension of enhanced tax credits

• Bringing the Subsidy Cliff back at 700% FPL instead of 400% FPL

… along with a whole bunch of completely UNACCEPTABLE poison pills, such as killing Silver Loading, trapping people in Bronze plans, opening the floodgates on junk plans and codifying discrimination against transgender individuals, among others.

However, all of this proved to be Much Ado About Nothing, because literally a few hours after the story about the upcoming proposal broke … the White House reversed itself in response to an immediate backlash by House Republicans.

… all of which leaves things pretty much right back where they were in the first place.

In fact, according to a new Politico story, after the Trump proposal fell apart, it sounds like Congressional Republicans may have just decided to sort of do … nothing at all.

So, where does that leave things for, y’know, all ~24 million or so actual ACA enrollees?

There’s now less than two weeks left before the deadline to enroll for coverage starting January 1 in most states.

While you still have until mid-January to enroll for coverage starting in February in every state except Idaho, at this point I’d advise anyone who’s been holding off to enroll because they’re waiting for a last-minute deal on the enhanced tax credits to go ahead and enroll … with the assumption that they won’t be in place for 2026.

Some key points to remember on this issue:

• While the ACA exchanges are able to handle much higher capacity than they used to, I still worry about the prospect of, say, 10 million people attempting to enroll via HealthCare.Gov at the same time on the evening of the 15th (or similar loads on the 21 state-based ACA exchange servers).

• Related to the above: I don’t know what the status is of the HC.gov support staff these days. I haven’t heard anything specific about DOGE gutting call center staffing, but they might have.

• If there is some sort of last-minute extension after the 15th, keep in mind that in every state except Idaho, you’ll have until at least Jan. 15 to switch plans (for coverage starting Feb. 1) if necessary.

This would be far from ideal for most for logistical reasons (not to mention your deductible would reset again), but it’s at least something.

• If Congress does end up extending the enhanced subsidies after Jan. 1, it could be done so retroactively to the beginning of the year. In fact, this is actually how the enhanced tax credits were handled in the first place: They were originally part of the American Rescue Plan Act (ARPA), which was signed into law by President Biden in March 2021, with the extra financial help made retroactive to Jan. 1st, 2021.

I would once again STRONGLY urge you to read my UPDATED ACA Enrollment Guide for all of the deadlines (which vary from state to state) as well as a ton of other important information about Open Enrollment.

I also want to once again stress that there are over a dozen states where you can likely get a GOLD plan for LESS THAN Silver…or a BRONZE plan for dirt cheap:

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One more thing:

• I’ve posted many times about how devastating the enhanced tax credit expiration will be for millions of enrollees.

• I’ve also posted several times about how some states have taken action to mitigate the damage.

Yesterday, I posted about a case study which perfectly illustrates the most extreme examples of both of these … for the exact same household.

In Murphysboro, Illinois, a one dollar income change could mean the difference between an older couple getting a GOLD PPO plan for less than $11/month…or having to pay over $3,700/month for a BRONZE plan with a $17,200 deductible.

The larger point of this example is to underscore how vitally important it is NOT to passively allow yourself to be automatically re-enrolled.

SHOP AROUND. SHOP AROUND. SHOP AROUND.

Good luck to us all and I’ll see you again in two weeks … which will be after the initial enrollment deadline in most states (and the final one in Idaho).

Charles Gaba Healthcare policy & data analysis, advocacy & snark along with whatever other musings come to mind.