Trump’s Health Plan Stalls as GOP Splits Over ACA Subsidies, Raising Risk of Steep Premium Hikes

President Donald Trump’s effort to advance a new health care plan has stalled amid sharp Republican divisions over whether to extend enhanced Affordable Care Act (ACA) subsidies, according to multiple people familiar with the matter. The internal dispute has slowed administration efforts to prevent a potentially dramatic rise in insurance premiums and casts doubt on whether a Trump-backed proposal will be ready for a Senate vote as soon as next week.

What went wrong

The White House had planned to unveil a framework that paired a temporary extension of the enhanced subsidies with conservative reforms intended to narrow their scope. That plan was scrapped after Republican lawmakers — many of whom were surprised by the approach — objected to its central elements. Officials reworking the proposal now say it is unlikely to be finalized this week, leaving Senate Republicans without a clear alternative to Democrats’ push for a straightforward extension before funding expires at year-end.

Why this matters

Roughly 22 million people rely on the enhanced tax credits approved during the Biden administration. Independent nonpartisan analysts project that if those credits lapse, premiums for many enrollees could more than double next year and an estimated 2 million more people could become uninsured, according to the Congressional Budget Office and KFF.

Political pressure and divisions

Trump has pressed aides to produce a plan, worried that voters will blame him for rising premiums if no viable alternative is offered. He has signaled opposition to a plain extension and called instead for federal support to be delivered directly to consumers rather than routed through insurers. That messaging — and an initial White House framework that modified rather than replaced the ACA subsidies — has surprised and split conservatives.

Moderate Republicans have privately urged swift action to blunt the expected 2026 premium spike, noting many enrollees live in conservative districts. Some GOP lawmakers are in quiet talks with rank-and-file Democrats seeking a bipartisan path forward, while others insist the subsidies should be allowed to expire.

Key elements of the original White House framework

The plan the White House drafted would have extended enhanced subsidies for two years but added new income limits and a required minimum monthly premium for enrollees. It proposed letting some federal aid flow into health savings accounts to encourage selection of lower-tier plans and creating routes for consumers to buy less comprehensive, lower-cost plans outside the ACA exchanges — moves that could weaken parts of the law and drew conservative ire.

Obstacles to a deal

Beyond internal GOP opposition, the administration faces competing demands that complicate bipartisan support: some members want Hyde-style protections restricting federal funds for abortion, while Democrats are unlikely to back measures that significantly undercut the ACA. With a Senate vote potentially imminent, the window for negotiation is narrowing.

What’s next

Administration officials continue to explore revised options that might attract both conservatives and moderates, including alternative mechanisms to preserve funding that could be more politically acceptable to skeptical members. Lawmakers face a tightening timeline, and many expect urgent talks to intensify as the year-end deadline approaches.

Reporters Sarah Ferris and Tami Luhby contributed to reporting.