“It’s not clear if the administration is going to be willing to work with Congress,” said Mark J. Mazur, an economist at the Brookings Institution who studies federal health care law.
“I think the Trump administration will probably be reluctant to negotiate a deal that would not include any kind of reinsurance or other cost sharing.”
Trump has threatened to withhold $1.4 trillion in federal funding from states that didn’t expand Medicaid coverage, according to a Wall Street Journal analysis.
The White House has been pressing Congress to extend federal subsidies to lower-income Americans who don’t qualify for the tax credits and is expected to make a similar pitch when Congress returns from recess in January.
In a letter to Republican senators, Trump has repeatedly stressed that “if you cannot provide a robust exchange plan to help Americans afford coverage, then you will be responsible for paying the consequences.”
In his budget proposal, the White House said that if Republicans fail to agree on a comprehensive plan to address rising health care costs, it will impose a “surge” on premiums for millions of people.
That would be a “major reversal” of President Barack Obama’s signature health care reform law, said Doug Holtz-Eakin, a Republican strategist.
“The White House will say this is the administration’s plan,” Holtz, a former aide to Obama, said in an interview.
“If you cannot pass this, the president is not going to negotiate with you.”
Trump has already said he is open to a deal with Congress that would include a federal subsidy to help people afford coverage but not a cost-sharing reduction that would eliminate the payments for people who choose not to enroll.
The White Health Policy Institute, a think tank, released a study this week that estimated that about one-third of the premium tax credits in the Senate GOP health care bill would disappear.
The bill would cut the tax credit for individuals making $50,000 or less to $3,400 and for families making $100,000 to $7,300.
But the nonpartisan Congressional Budget Office estimates that the Senate bill would save $8 billion in 2020.