Source: Inside Health Policy
President Donald Trump vowed to fix health care with the Democrats as long as they first vote to end the federal government shutdown, which is racing to become the longest in history this week — though some movement on a shutdown plan might be taking shape as the Affordable Care Act marketplace open enrollment began over the weekend and the Senate Homeland Security and Governmental Affairs subcommittee on investigations is set to “assess Obamacare” on Thursday (Nov. 6).
Meanwhile, the Trump administration didn’t let the shutdown stop CMS from finalizing the 2026 physician fee schedule in time for the Nov. 1 deadline, but three other Medicare pay rules are still in limbo at the White House Office of Management and Budget.
Speaking of Nov. 1, ACA’s enrollment period also kicked off Saturday and without an extension of the APTCs, consumers can now see how the loss of the enhanced tax credits that will expire in December, as well as the estimated 26% increase in premium compared to 2025, affect their monthly contribution requirements. Stakeholders who spent months arguing that consumers would face massive sticker shock without the subsidies are now circulating news stories that illustrate why they were worried.
But the opening of healthcare.gov didn’t shake Trump, who on 60 Minutes on Sunday (Nov. 2) stuck to the GOP’s longtime message and said he thinks the Senate can get five more Democrats to open the government, after which he said he’d talk about fixing Obamacare. Trump again backed ending the filibuster to clear the logjam with a simple majority — but Senate Majority Leader John Thune (R-SD) has rejected that so-called nuclear option, saying he couldn’t get the votes.
On Monday, a bipartisan bill that would extend the subsidies for two years with changes that phase out the assistance for wealthier people and require the lowest income Americans to pay some amount of premium emerged in the House. Sen. Lisa Murkowski (R-AK) has also introduced a bill that would extend the subsidies as written for two years. Many consultants have been predicting for some time that a two-year extension is the most likely outcome, but whether it will be clean or with policy tweaks is unclear. Insurers and regulators hope for a clean extension because it’d be easier to implement but have also said they’ll work to do whatever is needed to ensure the credits are available.
The House remains out of session this week — as it’s been since passing its CR on Sept. 19 — but House Speaker Mike Johnson (R-LA) recently defended Republicans against mounting Democratic criticism that the GOP lacks an actual health care plan, pointing to years of health policy proposals from the Republican Study Committee (RSC) as evidence to the contrary.
