For Republicans, Trump’s Hands-Off Approach to Health Care Is a Problem

The prospect of soaring health care costs could exacerbate Americans’ feelings about affordability, an issue that President Trump has tried to downplay. But Democrats plan to keep the issue front and center.

When Senator Chuck Schumer, Democrat of New York, met with President Trump in the Oval Office in September, the president made a sweeping statement about the need for a complete rewrite of the Affordable Care Act, the cornerstone of U.S. health care policy.

“I need a whole new A.C.A.,” Mr. Trump said, Mr. Schumer recently told reporters.

Yet three months later, no such plan from the White House has materialized. Health care reform talks between Mr. Trump and congressional Democrats never occurred. And health care costs are set to rise dramatically for roughly 20 million Americans as extra subsidies for Obamacare plans lapse.

Mr. Trump was asked by a reporter on Friday what he would say to Americans whose premiums were set to rise.

“You make it sound so bad,” the president said, adding that “Obamacare is horrible health insurance.”

Mr. Trump’s hands-off approach to health care reform comes as he tries repeatedly to downplay Americans’ concerns about the cost of living. And in the process, he has created a political problem for his own party: If health care costs spike, voters are likely to blame the G.O.P., the party in power, political analysts say.

“In a midterm environment, the president’s party is always getting blamed,” said Kyle D. Kondik, an elections expert at the University of Virginia’s Center for Politics. “There’s both an actual problem for millions of Americans that is on the horizon and also, this is a political problem for Republicans. What is the president as the leader of his party doing to ameliorate that political problem for his party? The answer seems like not that much.”

Should health care negotiations stretch into the middle of next year, that will increase the chances that the midterm elections will be fought on political terrain more favorable to the Democrats, instead of on issues that the White House would prefer, such as crime or immigration, Mr. Kondik said.

Aware of the political importance of the issue, Karoline Leavitt, the White House press secretary, said on Thursday that Mr. Trump would make an announcement on the topic “very soon.”

Later on Thursday Mr. Trump suggested he may soon enter negotiations with congressional Democrats.

“I think we’re going to start working together on health care. I really predict that,” he said at a White House event with lawmakers.

For more than a decade, Mr. Trump has pledged to release a health care reform plan. In 2019, he told ABC News that he had a “concept of the plan” that would be released within two months. In 2024, he made a similar pledge.

But health care policy is particularly challenging, and there is still significant disagreement among Republicans about the best approach.

Last month, Mr. Trump suggested he would support an extension of the enhanced subsidies tied to the Affordable Care Act that are set to expire at the end of the year. But word of Mr. Trump’s deliberations caused considerable pushback on Capitol Hill — from the right and the left — and underscored how difficult it would be to get any health care policy passed in a deeply divided Congress.

There has been little progress on anything resembling a deal on Capitol Hill, and Mr. Trump has largely faded from public view on the issue.

On Thursday, Senate Democrats put forward a plan to stave off a large increase in health care costs for millions of Americans by extending the current subsidy structure. Republicans promptly blocked it.

For their turn, Senate Republicans proposed a plan they say would reform the U.S. health care system by replacing the enhanced subsidies with an expansion of tax-advantaged health savings accounts and direct payments of up to $1,500 to people who buy the most basic health insurance plans. But Democrats blocked it.

A bipartisan group of lawmakers have proposed what they are billing as a compromise plan to scale back and extend the subsidies for two years. But like the other proposals, it does not have the votes.

And on Friday, House Republicans unveiled yet another plan — a narrow health care bill that would make several changes aimed at holding down costs but allow expanded Affordable Care Act subsidies to expire as scheduled at the end of the month.

The situation leaves lawmakers looking to the White House for direction. While Mr. Trump has spoken in generalities about endorsing a plan that sounds similar to the Senate G.O.P. plan, the White House has not put forward a proposal.

“Instead of spending this week working on this, or last week, he’s going off saying, ‘Affordability is a hoax,’” said Senator Amy Klobuchar, Democrat of Minnesota. “This is not a president that’s coming to try to find any kind of a compromise or work with us on this, and the American people see right through it.”

Speaking at the same Capitol Hill news conference as Ms. Klobuchar, Mr. Schumer said: “Republicans now own America’s health care crisis.”

The topic of affordability is a sore spot for Mr. Trump, who promised to bring down costs upon his election to a second term, but has struggled to do so.

The White House and swing-district Republicans are aware of the political potency of the issue. Democrats rallied around an affordability message during successful elections this year in Virginia and New Jersey.

“I have 40,000 people in my district who rely on this health care, and doing nothing to prevent a spike in their premiums is wrong,” Representative Jen Kiggans, a Republican who represents a battleground district in Virginia, said at a recent news conference on Capitol Hill.

Ms. Leavitt on Thursday said the administration was also focused on bringing down the cost of prescription drugs. She argued that Democrats were to blame for the state of the economy, and that Mr. Trump’s policies were improving conditions.

“It goes back to the issue of affordability,” she said. “Democrats are now pretending they want a solution to this issue, but they created the problem. The president and Republicans are currently coming up with creative solutions and ideas to lower health care costs for the American people, and you’ll continue to hear more from them on that.”

She said Mr. Trump was open to talks with Mr. Schumer on the issue, though no such conversations were underway with just weeks left before the enhanced assistance expires.

“If Chuck Schumer actually wanted to lower health care costs, I’m sure the president would welcome him and his entire Democrat caucus to a legitimate coordination on the president’s policies of bringing down drug prices,” Ms. Leavitt said.

Chris Cameron contributed reporting.

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