November 20, 2025 • 8 mins
Health Reporter for The Hill, Nathaniel Weixel, explains the GOP's plan for alternative ACA subsidies and Trump's push for direct payments.
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Speaker 1 (00:00):
Just go to the hotline and bring in health reporter
for The Hill, Nathaniel Wexel. You can check out all
of his working a whole lot more at The Hill
dot com, and you can follow him on acts at
Nate Wexel. Nathaniel, thanks so much for taking a few
minutes to come on the show, and I wanted to
have you on to get an update on where things
stand with this GOP plan to address healthcare. What's the
(00:23):
latest from both lawmakers on Capitol Hill and the White House.
Speaker 2 (00:29):
Yeah, so where we are is that these Enhanced s
Affordable Care Act subsidues expire at the end of the year.
The government was shut down for weeks because Democrats demanded
an extension that didn't happen. Republicans still haven't really decided
(00:51):
if they want to extend the subsidies or if they
want to go their own way and do something completely different.
They're still debating at there are some plans in the
Senate and in the House. In the Senate, at least
you've get Senator Bill Cassidy, who has a plan to
(01:11):
give everybody on a bronze plan both savings accounts. You've
got President Trump who says I'm not going to sign
a law that extends these subsidies. I just want direct
pass to people. So Republicans are still just kind of
trying to figure out where to go.
Speaker 1 (01:32):
One of the big problems here is that, like you said,
time is running out, and it's hard to see how
trying to change things at this point would lead to
a meaningful impact on the costs that those people who
are on Obamacare are facing for twenty twenty six, right right.
Speaker 2 (01:56):
I mean open enrollment is underway and if somebody wants
coverage that starts January first, that deadline is in about
four weeks, so there's really not a lot of time.
That's sort of what Democrats is been saying. You know,
their points is, we've been calling for this for months
and months and months. It's not over a year. You know,
(02:18):
these subjecdies are going to expire. We got to do
something about it. And they're sort of saying Republicans haven't
printed and now their argument is the only course of
actionists to just do a simple one year extension of
these any sort of broader health care discussion things go
on at the same time. So long as these subsidies
(02:38):
get extended and then we can sort of come back
to the table and look get healthcare in general. But yeah,
time is running out in the clock is sticking.
Speaker 1 (02:46):
We're joined by health reporter for The Hill, Nathaniel Wexel.
We know what President Trump has said about extending the
Obamacare subsidies, even for just a year, But what is
the consensus if there is one among especially Senate Republicans
who really seem to be kind of taking the lead
on this, Is there an appetite for that as they
(03:08):
work on broader reforms.
Speaker 2 (03:12):
That's hard to say. There's a divide. Some definitely seem
interested in making sure there is a bipartisan effort at
least to extend these subsidies. And again, anything is going
to have to be bipartisan because it's subject to that
sixty goot thresholds in the Senate to in the filibuster.
(03:34):
But there's a lot of different sticking points. There's the
real dislike of Obamacare and people who don't want to
prop up what they say is a failing law. There's
issues around what Republicans say is abortion and that they
want to make sure there's more anti abortion language and
restrictions on plans that cover abortion. Democrats aren't going to
(03:58):
go for that, so there's a lot of sticking points.
No one's really hear exactly what the pass forward is
right now. There's sort of differents happening among different groups
who want different things. And again, four weeks or so
left before the Juny first opening moment deadline.
Speaker 1 (04:17):
Let's put the subsidies aside for a second. I want
to focus on these two different ideas, one floated by Trump,
one being floated by Senator Taciity. Let's start with President Trump.
He wants to send cash to people, and then I
guess they they do what they want with it in
the healthcare realm, but wouldn't most people And the point
(04:41):
of that would be, so we're not just sending the
money directly to insurance companies, but wouldn't most people be
using that money to pay for insurance. So it's just
you know, a roundabout way of the insurance companies getting
that money anyway.
Speaker 2 (04:56):
Yes, uh, it's not really clear what Trump plan is,
but yes, generally direct cats giving people money to buy
health incurrence is sort of how the exchanges work. I
imagine he wants something different, but you know, in the
in the Trump way, it's not really clear what it
(05:19):
is that he wants. Different senators have different interpretations of
what it is, and no one has total buy in
from either their colleagues or the administration. If you go
to Senator Cassidy again, his plan not the official Republican position.
He doesn't have legislative language. But what he wants to
(05:40):
do is give a health savings account to people on
Obamacare Bronze plans, and these are our high deductible health plans,
so the premiums are lower than some of the other
the Silver plans, which is what the subsidies are based
off of, but the deductibles are are quite high. So
(06:01):
his plan is to give people assays those can be
used to optset some of the costs of the deductible
and some of the costs of fair But his legend
his idea isn't fully fleshed out, so we don't know
how much money in the hsas would be given, if
(06:24):
it would be income based, or if he'd used the
full amounts that's currently going to the subsidies. So we
don't really know a lot of details on that, but
it is one of the more detailed proposals that we've
seen so.
Speaker 1 (06:36):
Far, the hssays would be directly tied to people who
are purchasing health insurance, because one concern was you set
up HSA's health savings accounts for people and if they
don't have to purchase insurance, then you start getting a
bunch of healthy people who take themselves out of the
(06:58):
overall pool, and it raises costs for everybody who is
purchasing insurance.
Speaker 2 (07:05):
Right, And that's sort of part of the concern with
the direct past proposal is that it would leave people
would remove them as you said, people would remove themselves
in the marketplace, and they'd use this money to sort
of pay for whatever care they need, and then everyone
else who is actually purposing insurance is going to face
(07:25):
higher costs because they are going to be the more
sick of people who need the care. So yeah, from
what we've seen so far is this would be directly
tied to people who purchase these insurance plans. But again
details haven't fully been fleshed out yet. I imagine if
he gets more buy in, this is something that would
be more thought out, but again, just a couple of
(07:49):
weeks less all right.
Speaker 1 (07:50):
Health reporter for The Hill, Nathaniel Wexel You can find
all of this reporting, including on this at the Hill
dot com, and you can follow him on ex for
more at nay Wexel. Nathaniel really appreciate time and insight.
Thanks so much.
Speaker 2 (08:04):
Thank you.
Just go to the hotline and bring in health reporter
for The Hill, Nathaniel Wexel. You can check out all
of his working a whole lot more at The Hill
dot com, and you can follow him on acts at
Nate Wexel. Nathaniel, thanks so much for taking a few
minutes to come on the show, and I wanted to
have you on to get an update on where things
stand with this GOP plan to address healthcare. What's the
(00:23):
latest from both lawmakers on Capitol Hill and the White House.
Speaker 2 (00:29):
Yeah, so where we are is that these Enhanced s
Affordable Care Act subsidues expire at the end of the year.
The government was shut down for weeks because Democrats demanded
an extension that didn't happen. Republicans still haven't really decided
(00:51):
if they want to extend the subsidies or if they
want to go their own way and do something completely different.
They're still debating at there are some plans in the
Senate and in the House. In the Senate, at least
you've get Senator Bill Cassidy, who has a plan to
(01:11):
give everybody on a bronze plan both savings accounts. You've
got President Trump who says I'm not going to sign
a law that extends these subsidies. I just want direct
pass to people. So Republicans are still just kind of
trying to figure out where to go.
Speaker 1 (01:32):
One of the big problems here is that, like you said,
time is running out, and it's hard to see how
trying to change things at this point would lead to
a meaningful impact on the costs that those people who
are on Obamacare are facing for twenty twenty six, right right.
Speaker 2 (01:56):
I mean open enrollment is underway and if somebody wants
coverage that starts January first, that deadline is in about
four weeks, so there's really not a lot of time.
That's sort of what Democrats is been saying. You know,
their points is, we've been calling for this for months
and months and months. It's not over a year. You know,
(02:18):
these subjecdies are going to expire. We got to do
something about it. And they're sort of saying Republicans haven't
printed and now their argument is the only course of
actionists to just do a simple one year extension of
these any sort of broader health care discussion things go
on at the same time. So long as these subsidies
(02:38):
get extended and then we can sort of come back
to the table and look get healthcare in general. But yeah,
time is running out in the clock is sticking.
Speaker 1 (02:46):
We're joined by health reporter for The Hill, Nathaniel Wexel.
We know what President Trump has said about extending the
Obamacare subsidies, even for just a year, But what is
the consensus if there is one among especially Senate Republicans
who really seem to be kind of taking the lead
on this, Is there an appetite for that as they
(03:08):
work on broader reforms.
Speaker 2 (03:12):
That's hard to say. There's a divide. Some definitely seem
interested in making sure there is a bipartisan effort at
least to extend these subsidies. And again, anything is going
to have to be bipartisan because it's subject to that
sixty goot thresholds in the Senate to in the filibuster.
(03:34):
But there's a lot of different sticking points. There's the
real dislike of Obamacare and people who don't want to
prop up what they say is a failing law. There's
issues around what Republicans say is abortion and that they
want to make sure there's more anti abortion language and
restrictions on plans that cover abortion. Democrats aren't going to
(03:58):
go for that, so there's a lot of sticking points.
No one's really hear exactly what the pass forward is
right now. There's sort of differents happening among different groups
who want different things. And again, four weeks or so
left before the Juny first opening moment deadline.
Speaker 1 (04:17):
Let's put the subsidies aside for a second. I want
to focus on these two different ideas, one floated by Trump,
one being floated by Senator Taciity. Let's start with President Trump.
He wants to send cash to people, and then I
guess they they do what they want with it in
the healthcare realm, but wouldn't most people And the point
(04:41):
of that would be, so we're not just sending the
money directly to insurance companies, but wouldn't most people be
using that money to pay for insurance. So it's just
you know, a roundabout way of the insurance companies getting
that money anyway.
Speaker 2 (04:56):
Yes, uh, it's not really clear what Trump plan is,
but yes, generally direct cats giving people money to buy
health incurrence is sort of how the exchanges work. I
imagine he wants something different, but you know, in the
in the Trump way, it's not really clear what it
(05:19):
is that he wants. Different senators have different interpretations of
what it is, and no one has total buy in
from either their colleagues or the administration. If you go
to Senator Cassidy again, his plan not the official Republican position.
He doesn't have legislative language. But what he wants to
(05:40):
do is give a health savings account to people on
Obamacare Bronze plans, and these are our high deductible health plans,
so the premiums are lower than some of the other
the Silver plans, which is what the subsidies are based
off of, but the deductibles are are quite high. So
(06:01):
his plan is to give people assays those can be
used to optset some of the costs of the deductible
and some of the costs of fair But his legend
his idea isn't fully fleshed out, so we don't know
how much money in the hsas would be given, if
(06:24):
it would be income based, or if he'd used the
full amounts that's currently going to the subsidies. So we
don't really know a lot of details on that, but
it is one of the more detailed proposals that we've
seen so.
Speaker 1 (06:36):
Far, the hssays would be directly tied to people who
are purchasing health insurance, because one concern was you set
up HSA's health savings accounts for people and if they
don't have to purchase insurance, then you start getting a
bunch of healthy people who take themselves out of the
(06:58):
overall pool, and it raises costs for everybody who is
purchasing insurance.
Speaker 2 (07:05):
Right, And that's sort of part of the concern with
the direct past proposal is that it would leave people
would remove them as you said, people would remove themselves
in the marketplace, and they'd use this money to sort
of pay for whatever care they need, and then everyone
else who is actually purposing insurance is going to face
(07:25):
higher costs because they are going to be the more
sick of people who need the care. So yeah, from
what we've seen so far is this would be directly
tied to people who purchase these insurance plans. But again
details haven't fully been fleshed out yet. I imagine if
he gets more buy in, this is something that would
be more thought out, but again, just a couple of
(07:49):
weeks less all right.
Speaker 1 (07:50):
Health reporter for The Hill, Nathaniel Wexel You can find
all of this reporting, including on this at the Hill
dot com, and you can follow him on ex for
more at nay Wexel. Nathaniel really appreciate time and insight.
Thanks so much.
Speaker 2 (08:04):
Thank you.
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